Biomedical subjects
Publications and source records attributed to E E Berg.
The peroneus brevis tendon is frequently used in lateral ankle ligament reconstruction for chronic instability. Intraoperative tendon rupture at the exit of the interosseous transfibular tunnel occurred in two cases. A technique is described to salvage this situation. At 2-year follow-up, both cases had successful restoration of ankle joint stability.
Two pediatric tibial eminence fractures were arthroscopically reduced and fixed with cannulated screws. At 2-year follow-up, anterior tibial translatory laxity was normal and the pivot shift test was negative. In one case, the screw transgressed the proximal tibial physis; however, neither case showed evidence of proximal tibial growth arrest.
A patellar bone-tendon-bone tibial inlay reconstruction of the posterior cruciate ligament using a popliteal arthrotomy was designed to minimize graft-tunnel wall abrasion. Arthroscopic techniques are used for femoral graft fixation. In a small series, the procedure decreased the quadriceps active drawer in 70 degrees of flexion by an average of 4 mm and improved patellofemoral symptoms.
Allograft or synthetic meniscal replacement has the potential to delay the arthritic sequelae of the meniscectomized knee. Meniscal implants must, however, be side and size specific. A cadaveric study was performed in which medial and lateral menisci were painted with a radiopaque tantalum powder-cyanoacrylic mixture. Radiographs of this preparation demonstrated reproducible relationships between each meniscus and established bony landmarks. When corrected for magnification, meniscal size could be derived from plain films. Meniscal width equaled the distance (coronal) from the peak of the tibial eminence to the periphery of the tibial metaphysis on anteroposterior films. Meniscal length was measured from lateral radiographs. Medial meniscal length was 80%, and lateral meniscal length was 70% of the measured sagittal length of the tibial plateau. Measurement error averaged 7.8% by these parameters.
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A case is described in which a coronal plane fracture of the lateral femoral condyle propagated through the femoral tunnel 2 months after endoscopic anterior cruciate ligament reconstruction.
Heterotopic ossification is a well-recognized complication of musculoskeletal trauma and elective orthopaedic surgery. A series of 10 cases of arthroscopic subacromial decompressions developed postoperative heterotopic bone. In eight, the ectopic bone caused recurrent shoulder impingement. These are the first reported cases in which heterotopic ossification compromised the results of an arthroscopic procedure. It is recommended that the patient at risk (e.g., with active spondolytic arthropathy or a profile of hypertrophic pulmonary osteoarthropathy--obesity, diabetes with a history of chronic pulmonary disease) be considered for heterotopic ossification prophylaxis.
Comminuted cortical fracture fragments have not been reported to cause technical problems with intramedullary rod fixation of long bone fractures. Two such cases are reported here. In one case an interposed free cortical fracture fragment caused loss of fracture alignment. In the other case the fragment propagated fracture comminution in an unusual "splitting wedge" manner.
Recurrent medial ankle instability is an uncommon clinical entity. A case that resulted from a distal fibular physeal arrest is described. Symptoms resolved after a one-stage fibular lengthening.
Two cases are described in which displaced sternal fractures were associated with thoracic spine fractures of minimal, initial displacement. Nonoperative, expectant treatment led to significant kyphotic deformity. It is postulated that the sternum and ribs represent a fourth column of structural thoracic spine support. An overriding, displaced sternal fracture is a marker for a severe flexion-distraction unstable thoracic spine injury with a propensity for deformity.
Multisuture arthroscopic repair of two comminuted tibial eminence anterior cruciate ligament avulsion fractures in adult patients is reported. Lack of rigid fixation and a tentative rehabilitation program resulted in arthrofibrosis and limited knee motion.
An unexpected degree of joint contamination was detected during arthroscopic debridement of three intraarticular, low-velocity gunshot wounds to the knee. When bullet wounds traverse a joint, it is recommended that clothing be inspected for fabric defects and that arthroscopy be considered for the surgical debridement.
In some human autopsy specimens, a bony prominence located anterior to the tibial eminences represents the confluent insertion of the anterior horn medial meniscus and the medial fibers of the anterior cruciate ligament (ACL). The prominence has been called "Parsons' knob" by anatomists and the "tuberculum intercondylare tertium" by radiologists. This article reviews the anatomy and provides the first magnetic resonance image study and perhaps the first roentgenographic depiction of this landmark in the English-speaking orthopedic literature. This structure, if noted preoperatively, can be helpful in identifying the appropriate site of tibial tunnel placement for ACL reconstructive operations performed under arthroscopic or fluoroscopic guidance.
Thirty patients who had arthroscopically assisted autogenous patellar tendon anterior cruciate ligament reconstructions were retrospectively reviewed to determine the blood loss associated with this procedure. On average, a 1.5 U blood loss (9-point hematocrit decrease) occurred with this procedure. The amount of blood lost was not affected by use of an intraoperative tourniquet. Blood loss was minimally increased by extra-articular iliotibial band surgery and was unrelated to surgical timing, in the acute versus chronic phase of the injury.
Anterior tibial tunnel placement contributed to the failure of two previous anterior cruciate ligament reconstructions. An allograft patellar bone-tendon-bone nonunion within the tibial tunnel caused dysfunctional ligament laxity. This is the first report of this type of reconstructive cruciate ligament failure.
An unclosed central one-third patellar tendon anterior cruciate ligament donor site was evaluated in a 22-year-old man. The repair was reevaluated eight months later by histologic analysis and magnetic resonance imaging. The donor defect healed intrinsically with hypertrophic tendinous tissue. This case suggests that sutured patellar tendon donor site closure may be unnecessary.