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Biomedical subjects

F H Fu

Publications and source records attributed to F H Fu.

At least 55 records · Page 3Linked to original sources
PubMed1999

Peroneal tendon subluxation in athletes: new exam technique, case reports, and review.

Traumatic peroneal tendon subluxation is an uncommon cause of ankle pain. As a result, the diagnosis is often delayed. A new technique of examining the patient in the prone position, allowing for easier visualization of the subluxation or dislocation, is described. Three illustrative cases, including a rare case of midsubstance rupture of the peroneal retinaculum are presented along with a review the literature. An acute repair in athletes and in those patients who do not want to risk the chance of a 40-50% failure rate after 4-6 wk of casting is currently recommended. Surgical repair can be facilitated using Mitek suture anchors for acute, symptomatic chronic, and subacute injuries. Deepening of the groove is performed only in those patients that have no sulcus or a convexity of the groove.

Adolescent↗
PubMed1999

An analytical approach to determine the in situ forces in the glenohumeral ligaments.

The purpose of this study was to use an analytical approach to determine the forces in the glenohumeral ligaments during joint motion. Predictions from the analytical approach were validated by comparing them to experimental data. Using a geometric model, the lengths of the four glenohumeral ligaments were determined during anterior-posterior loading simulations and forward flexion-extension. The corresponding force in each structure was subsequently calculated based on length data via load-elongation curves obtained experimentally. During the anterior loading simulation at 0 deg of abduction, the superior glenohumeral ligament carried up to 71 N at the maximally translated position. At 90 deg of abduction, the anterior band of the inferior glenohumeral ligament had the highest force of 45 N during anterior loading. These results correlated well with those found in previous experimental studies. We believe that this validated analytical approach can be used to predict the forces in the glenohumeral ligaments during more complex joint motion as well as assist surgeons during shoulder repair procedures.

Aged↗
PubMed1999

Transfer of lacZ marker gene to the meniscus.

BACKGROUND: Lesions in the avascular two-thirds of the meniscus do not heal well and are of concern clinically. Various growth factors promote the synthesis of matrix by meniscal cells and thus have the potential to augment healing. However, their clinical application is severely hindered by problems with delivery. An attractive approach to overcoming such problems is to transfer genes that encode the growth factors in question to the site of the injury. As a prelude to this, we evaluated methods for delivering genes to the meniscus. METHODS: Gene transfer was evaluated in vitro and in vivo with a lacZ marker gene, which expresses the enzyme beta-galactosidase. Two types of vectors were tested: an adenovirus and a retrovirus. Monolayers of lapine, canine, and human meniscal cells, as well as intact lapine and human menisci, were used for the in vitro studies. Lesions were created in the menisci of rabbits and dogs for the in vivo studies. Gene transfer to the sites of the experimental meniscal lesions in vivo was accomplished in two ways. In the lapine model, a suspension of adenovirus carrying the lacZ marker gene was mixed with whole blood and the clot was inserted into the lesion. In the canine model, retrovirally transduced allogenic meniscal cells carrying the lacZ marker gene were embedded in collagen gels and transferred to the defects. The animals were killed at various time-points, and gene expression was evaluated by histological examination of sections stained with 5-bromo-4-chloro-indolyl-beta-D-galactose (X-gal), from which a blue chromagen is released in the presence of beta-galactosidase. RESULTS: Monolayer cultures of lapine, canine, and human meniscal cells were susceptible to genetic transduction by both adenoviral and retroviral vectors. In vitro gene transfer to intact human and lapine menisci proved possible both by direct, adenoviral, delivery and indirect, retroviral, delivery. Gene expression persisted for at least twenty weeks under in vitro conditions. With regard to the in vivo studies, gene expression persisted within the clot and in some of the adjacent meniscal cells for at least three weeks in the lapine defect model. In the canine defect model, gene expression persisted within the transplanted, transduced meniscal cells for at least six weeks. CONCLUSIONS: It is possible to transfer genes to sites of meniscal damage and to express them locally within the lesion for several weeks.

Animals↗
PubMed1999

Posterior cruciate ligament injuries of the knee joint.

Posterior cruciate ligament (PCL) injuries have a reported incidence of between 3 and 37%, depending on the clinical setting. The most common mechanism of injury in motor vehicle accidents is a dashboard injury or direct force to the proximal anterior tibia. Sports related injuries result from hyperflexion of the knee with the foot typically plantarflexed. The latter mechanism is the most common cause of isolated PCL injuries, while in the trauma population as many as 95% of patients with knee injuries have combined ligamentous damage. Improved knowledge at an anatomical, biomechanical and clinical level has provided the orthopaedist with a more defined treatment algorithm. Isolated, partial PCL injuries (grades I and II) can best be treated nonoperatively while complete injuries (grade III) may require operative treatment based on clinical symptoms. All combined ligamentous injuries usually respond best with surgical management.

Athletic Injuries↗
PubMed1999

Comparison of two abdominal training devices with an abdominal crunch using strength and EMG measurements.

BACKGROUND: The purpose of this study was to compare the training effects of the Ab-Flex (F), Ab-Roller (R) and standard crunch (C) on EMG production, isometric maximum voluntary contraction (MVC), and isokinetic average peak torque at 30 degrees/sec (ISO) of the abdominal muscles. It was hypothesized that the training devices would have similar value in a strength training program. METHODS EXPERIMENTAL DESIGN: this was a prospective study involving 18 training sessions of progressively increasing repetitions. SETTING: Neuromuscular Research Laboratory, University of Pittsburgh. SUBJECTS: thirty-two subjects volunteered for this study, but only 26 completed the training. Each subject participated in recreational activity, but had not performed any abdominal training prior to starting this study. Each subject was randomly assigned to either the control group or one of the treatment groups. INTERVENTIONS: there were three interventions: two training devices (Ab-Flex and Ab-Roller) and the standard crunch, considered a control group. MEASURES: the pretest consisted of skin fold measurements (%), EMG activity (V) during the three interventions, and peak torque (Nm) plus EMG during the MVC and ISO tasks. The 18 training sessions over three weeks consisted of three sets of exercise with increasing repetitions from 10 to 20, by 2, every three sessions. The difference in pretest/posttest scores were compared using a One-way ANOVA on the mean differences (Mdiff) for each of: MVC, ISO (peak torque), and EMG for upper rectus (UR), lower rectus (LR), internal oblique (IO), and external oblique (EO). A T-Test was used to detect significance for the body fat measures. RESULTS: Mean differences (Mdiff) were normally distributed about zero for both MVC and ISO (MVC = -0.55, ISO = 4.57). The analysis by group showed no difference (p = 0.596) on the reported means (Nm) -3.16 (C), 5.84 (F) and -4.83 (R). The change associated to the treatment during MVC was only 4% (eta = 0.04). For the ISO the Mdiff (Nm) were 1.39 (C), 13.66 (F) and -2.06 (R) which were not significant (p = 0.127). The Ab-Flex was the only group to have a 95% confidence interval above zero, increasing by an average of 16.5%. There were no significant differences for the EMG activity for Mdiff or between group scores. CONCLUSIONS: No significant differences were found with this study. These results would suggest that using these devices does not add significantly to overall abdominal strength development, or reduction of body fat. A suggestion could be made that certain devices influence muscles differently.

Abdominal Muscles↗
PubMed1999

Effects of muscular fatigue on knee joint laxity and neuromuscular characteristics of male and female athletes.

OBJECTIVE: To elucidate the effects of muscular fatigue on knee joint laxity and the neuromuscular characteristics of male and female athletes. We were particularly interested in determining whether such effects would be more pronounced in female athletes than in males participating in the same sport. DESIGN AND SETTING: Subjects were assessed on 4 dependent variables during a rested and an isokinetically induced muscular fatigue state. We ensured that posttesting measurements were obtained in the fatigued state by testing only 2 dependent variables after each exercise bout. SUBJECTS: We recruited male (n = 17) and female (n = 17) subjects from a population of healthy collegiate basketball and soccer players. MEASUREMENTS: MEASURED DEPENDENT VARIABLES WERE AS FOLLOWS: anterior tibial translation, kinesthesia determined by assessing the threshold to detection of passive motion moving into knee flexion and extension; lower extremity balance ability quantified through a stability index value; and the electromyography-measured muscle activity of 6 knee-stabilizing muscles. RESULTS: In response to muscular fatigue, subjects demonstrated an overall decrease in the ability to detect joint motion moving into the direction of extension, an increase in the onset of contraction time for the medial hamstring and lateral gastrocnemius muscles, and an increase in the first contraction area of the vastus medialis and vastus lateralis muscles. Additionally, the increase in area of the vastus lateralis was greater for the males compared with the females. CONCLUSIONS: Our results suggest that both male and female athletes exhibit decrements in proprioceptive ability and alterations in muscular activity subsequent to muscular fatigue.

Journal Article↗
PubMed1999

Muscle preactivity of anterior cruciate ligament-deficient and -reconstructed females during functional activities.

OBJECTIVE: Underlying the ability of the hamstrings to decrease tibial anterior shear is the time of firing in comparison with the quadriceps. This timing may be aided by neural programming during a planned or expected activity. It is theorized that individuals who have better programming ability will suffer fewer anterior cruciate ligament (ACL) injuries due to joint protection through muscular stabilization. A component of this dynamic restraint is the development of muscular tension before the knee is loaded. The objective of our study was to compare the muscular activity before footstrike in ACL-deficient (ACL-D), ACL-reconstructed (ACL-R), and control (C) females during functional activities. DESIGN AND SETTING: Active females were divided into groups based on their ACL status. The study was conducted in a neuromuscular research laboratory. SUBJECTS: Twenty-four female subjects (ACL-D = 6, ACL-R = 12, C = 6). MEASUREMENTS: Integrated electromyographic (IEMG) activity from the thigh (vastus medialis obliquus [VMO], vastus lateralis [VL], medial hamstring, and lateral hamstring) and leg (medial gastrocnemius and lateral gastrocnemius [LG]) and footswitch signals were recorded during downhill walking (15 degrees at 0.92 m/s), running (2.08 m/s), hopping, and landing from a step (20.3 cm). IEMG activity was normalized to the mean amplitude of the sample and analyzed for area and mean amplitude for 150 milliseconds before heelstrike. Side-to-side differences were determined by t tests, and separate one-way analyses of variance (ANOVA) were used to detect differences among the 3 groups for each muscle of each activity. RESULTS: IEMG area side-to-side differences for the ACL-D group appeared in the LG (involved [I] = 36.4 +/- 19.7, uninvolved [U] = 60.1 +/- 23.6) during landing, in the VMO (I = 11.4 +/- 3.8, U = 7.2 +/- 3.1) and VL (I = 13.3 +/- 2.7, U = 8.9 +/- 1.9) during running, and in the VMO (I = 9.2 +/- 4.2, U = 19.5 +/- 7.3) during downhill walking. IEMG mean amplitude side-to-side differences for the ACL-D group appeared in the LG (I = 79.7 +/- 30.3, U = 122.3 +/- 34.9) during downhill walking and in the VMO (I = 78.6 +/- 23.2, U = 45.8 +/- 18.9) during the run; IEMG mean amplitude side-to-side differences for the ACL-R group appeared in the LG (I = 74.7 +/- 40.0, U = 52.8 +/- 14.3) during the hop. The ACL-D group had higher IEMG means than control in the VL (ACL-D = 12.9 +/- 5.8, C = 7.1 +/- 3.9), but lower in the VMO (ACL-D = 9.2 +/- 4.2, C = 15.7 +/- 3.6). CONCLUSIONS: The side-to-side differences of the ACL-D and ACL-R groups, as well as the group differences between ACL-D and control, suggest that different muscle activation strategies are used by females when performing different dynamic activities. Therefore, muscle unit differentiation may be the cause of our results. These changes appear to be reversed through surgery or the associated postoperative rehabilitation.

Journal Article↗
PubMed1999

Reactive muscle firing of anterior cruciate ligament-injured females during functional activities.

OBJECTIVE: The high incidence of noncontact anterior cruciate ligament (ACL) injuries in females has attracted research to investigate the capacity of muscles to reflexively protect the knee joint from capsuloligamentous injury. Numerous reflex pathways link mechanoreceptors in the ACL with contractile fibers in the quadriceps and hamstring muscles. Loads placed on the ACL modify reactive muscle activity through the feed-back process of neuromuscular control and are critical for dynamic muscular stabilization. Noncontact ACL injuries may be the result of aberrations in reactive muscle firing patterns. Therefore, compensatory muscle activation strategies must be employed if functional stability is to be restored after injury or surgical reconstruction. The purpose of our study was to compare the amplitude of reactive muscle activity in females with ACL-deficient (ACLD), ACL-reconstructed (ACLR), and control knees during functional activities. DESIGN AND SETTING: Female volunteer subjects were stratified into groups based on the status of their ACLs. Each subject performed 4 functional activities, bilaterally, during a single test session. SUBJECTS: Twenty-four female subjects participated in this study (ACLD = 6, ACLR = 12, control = 6). MEASUREMENTS: Integrated electromyographic (IEMG) data were collected with surface electrodes from the vastus medialis, vastus lateralis, medial hamstring, and lateral hamstring during downhill walking (15 degrees , 0.92 m/s), level running (2.08 m/s), and hopping and landing from a jump (20.3 cm). IEMG was normalized to the mean amplitude of 3 to 6 consecutive test repetitions. The mean area and peak IEMG of a 250-millisecond period after ground contact was used to represent reactive muscle activity. Side-to-side differences were determined using dependent t tests, and group differences were determined using a one-way analysis of variance. RESULTS: During running, the ACLD group demonstrated significantly greater area and peak IEMG activity in the medial hamstring in comparison with the ACLR group and greater peak activity in the lateral hamstring when compared with the control group. The ACLD group also demonstrated greater peak activity in the vastus medialis and a smaller area of IEMG activity in the lateral hamstring than the control group during running. During landing, the ACLD group demonstrated significantly less area of IEMG activity in the vastus lateralis when compared with the control group. No significant differences were identified between the ACLR and control groups, nor were side-to side differences revealed. CONCLUSIONS: Our results suggest that adaptations occur in the reactive muscle activity of ACLD females during functional activities. Strategies to minimize the anterior tibial translation in response to joint loading included increased hamstring activity and quadriceps inhibition. The reactive muscle activity exhibited in ACLD subjects is presumably an attempt to regain functional stability through the dynamic restraint mechanism. The absence of side-to-side differences suggests that these adaptations occur bilaterally after ACL injury.

Journal Article↗
PubMed1998

Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction.

The purpose of this project was to determine if guidelines established by the International Knee Documentation Committee (IKDC) could distinguish differences in outcome, as indicated by the patients' subjective rating of knee function following ACL reconstruction, and to determine if all subgroups included in the IKDC rating system contribute to the prediction of the overall final IKDC rating. A total of 133 patients undergoing ACL reconstruction were evaluated according to IKDC guidelines 1-5 years postoperatively. Each subject was rated in each of four subgroups on the IKDC scale: patient subjective assessment, symptoms, range of motion (ROM), and laxity. The worst rating for the subgroups defined the overall final rating. The outcome from the patient's perspective was determined by asking them to rate the function of their knee on a scale from 0 to 100 with 100 being the level of function before injury. Average length of follow-up was 3.2 years (range 1.1-6.3 years). ANOVA indicated that the patients' subjective rating of knee function on a scale from 0 to 100 differed according to the overall final IKDC rating (F = 16.1, P < 0.001). The average subjective rating of knee function for those with a normal IKDC rating was 95.2, nearly normal was 91.2, abnormal was 84.9, and severely abnormal was 75.4. The average subjective rating of knee function for those who were severely abnormal was significantly different from those rated normal, nearly normal, and abnormal, and the average subjective rating for those who were abnormal was significantly different from those who were normal or nearly normal. There was no significant difference in average subjective rating between those who were rated as normal or nearly normal. Regression analysis indicated that all four subgroups contributed significantly to the prediction of the final IKDC rating (r2 = 0.70), but the majority of the variance (62%) was accounted for by symptoms and laxity. These results appear to indicate that the IKDC guidelines are useful for describing the outcome following ACL reconstruction. Further testing of the IKDC guidelines is necessary to determine if they are capable of detecting a change in the patients over time following treatment and/or surgery of the knee.

Adolescent↗
PubMed1998

Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction?

Radiographic enlargement of bone tunnels following anterior cruciate ligament (ACL) reconstruction has been recently introduced in the literature; however, the etiology and clinical relevance of this phenomenon remain unclear. While early reports suggested that bone tunnel enlargement is mainly the result of an immune response to allograft tissue, more recent studies imply that other biological as well as mechanical factors play a more important role. Biological factors associated with tunnel enlargement include foreign-body immune response (against allografts), non-specific inflammatory response (as in osteolysis around total joint implants), cell necrosis due to toxic products in the tunnel (ethylene oxide, metal), and heat necrosis as a response to drilling (natural course). Mechanical factors contributing to tunnel enlargement include stress deprivation of bone within the tunnel wall, graft-tunnel motion, improper tunnel placement, and aggressive rehabilitation. Graft-tunnel motion refers to longitudinal and transverse motion of the graft within the bone tunnel and can occur with various graft types and fixation techniques. Aggressive rehabilitation programmes may contribute to tunnel enlargement as the graft-bone interface is subjected to early stress before biological incorporation is complete. Further basic research is required to verify the effect of the various proposed factors on the etiology of bone tunnel enlargement. We recommend that routine follow-up examinations after ACL reconstruction should include the measurement of bone tunnel size in order to contribute to a better understanding of the incidence, time course, and clinical relevance of this phenomenon. Improved and more anatomical surgical fixation techniques may be useful for the prevention of bone tunnel enlargement.

Adolescent↗
PubMed1998

Identification of types II, IX and X collagens at the insertion site of the bovine achilles tendon.

Achilles tendinous collagen fibrils insert into the calcaneus by first passing through a zone that is defined histologically as fibrocartilaginous. This zone consists of four regions: tendon proper, non-mineralized and mineralized fibrocartilage and bone. The function of this zone has not yet been clearly defined. To gain more insight into the role of this fibrocartilaginous zone, collagens present in the zone of the Achilles tendon-calcaneus interface were isolated and characterized. Types II, IX and X collagens were identified in the pepsin digests of the tissue harvested from the bovine Achilles tendon-calcaneus interface. Western blotting using specific antisera to types II, IX and X collagens confirmed the identity of these collagens. Immunofluorescence localization placed type X collagen predominantly in the mineralized zone of the tendon-calcaneus junction, while type IX collagen was distributed throughout the the insertion site. The presence of the cartilage-specific collagens at the Achilles tendon-calcaneus-interface suggests that this zone is cartilaginous in nature. The presence of type X collagen at this junction is not clear, but our present findings go along with the previous report which showed that type X collagen is present in the mineralized zone of the medial collateral ligament femoral insertion site. These data suggest that type X collagen may be a resident of mineralized fibrocartilaginous zones of tendon or ligament-bone junctions and may participate in anchoring ligament or tendon to bone.

Achilles Tendon↗
PubMed1998

Benchmarking the perioperative process: II. Introducing anesthesia clinical pathways to improve processes and outcomes and to reduce nursing labor intensity in ambulatory orthopedic surgery.

STUDY OBJECTIVES: (1) To introduce anesthesia clinical pathways as a management tool to improve the quality of care; (2) to use the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as a template for data collection and analysis; and (3) to determine the effects of anesthesia clinical pathways on surgical processes, outcomes, and costs in common ambulatory orthopedic surgery. DESIGN: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995-1996 and 1996-1997. Patient data from AY 1995-1996, during which no intraoperative anesthesia clinical pathways existed, served as historical controls. Data from AY 1996-1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. Regional anesthesia options were routinely offered to patients in the clinical pathway. SETTING: Ambulatory surgery center in a teaching hospital. MEASUREMENTS AND MAIN RESULTS: The records of 503 ASA physical status I and II patients were reviewed. 1996-1997 patients underwent clinical pathway anesthesia care in which the intraoperative and postoperative anesthesia process was standardized with respect to symptom management, drugs, and equipment used. 1995-1996 patients did not have a standardized intraoperative and postoperative anesthetic course with respect to the management of common symptoms or to specific drugs and supplies used. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by the use of the anesthesia clinical pathway, were measured. Clinical pathway anesthesia care of ACLR in 1996-1997, which actively incorporated regional anesthesia options, reduced pharmacy and materials cost variability; slightly increased turnover time; improved intraoperative anesthesia and surgical efficiency, recovery times, and unexpected admission rates; and decreased the number of required nursing interventions for common postoperative symptoms. CONCLUSIONS: Clinical pathway patient management systems in anesthesia care are likely to produce useful outcome data of current practice patterns when compared with historical controls. This management tool may be useful in simultaneously containing costs and improving process efficiency and patient outcomes.

Adult↗
PubMed1998

Benchmarking the perioperative process: III. Effects of regional anesthesia clinical pathway techniques on process efficiency and recovery profiles in ambulatory orthopedic surgery.

STUDY OBJECTIVES: (1) To incorporate regional anesthesia options for common outpatient orthopedic surgery into clinical pathways; (2) to use the clinical pathway format and the Procedural Times Glossary published by the Association of Anesthesia Clinical Directors (AACD) as management tools to measure postoperative same-day surgery processes and discharge outcomes; and (3) to determine the effects of general, regional, and combined general-regional anesthesia on these processes and outcomes. DESIGN: Hospital database and patient chart review of consecutive patients undergoing anterior cruciate ligament reconstruction (ACLR) during academic years (AY) 1995-1996 and 1996-1997. Patient data from AY 1995-1996, during which no intraoperative anesthesia clinical pathway existed, served as historical controls. Data from AY 1996-1997, during which intraoperative anesthesia clinical pathways were used, served as the treatment group. SETTING: Ambulatory surgery center in a teaching hospital. MEASUREMENTS AND MAIN RESULTS: The records of 503 ASA physical status I and II patients were reviewed. 1996-1997 patients selected general anesthesia (+/- femoral nerve block) or epidural anesthesia, after which the remainder of the perioperative anesthesia process was standardized with respect to the drugs and equipment used. 1995-1996 patients did not necessarily have a choice in anesthesia technique and did not have a standardized perioperative anesthetic course with respect to specific drugs and supplies. Intervals described in the AACD Procedural Times Glossary, anesthesia drug and supply costs, and patient outcome variables (postoperative nursing interventions required and unexpected admissions), as influenced by anesthesia technique used, were measured. Combined general-regional anesthesia care for ACLR in 1996-1997, when compared with general anesthesia alone, led to increased pharmacy and materials costs and increased turnover time. However, patients with the combined technique showed improved recovery profiles and lower unexpected admission rates, and they required fewer nursing interventions for common postoperative symptoms. Patients receiving epidural anesthesia showed discharge outcomes similar to those patients receiving general anesthesia with femoral nerve block. Postanesthesia care unit bypass (fast-tracking) was more likely in clinical pathway regional anesthesia patients, when compared with the clinical pathway general anesthesia used. CONCLUSIONS: Clinical pathway regional anesthesia care for outpatient orthopedics may have a significant role in simultaneously containing costs and improving both process efficiency and patient outcomes.

Adult↗
PubMed1998

A dynamic analysis of glenohumeral motion after simulated capsulolabral injury. A cadaver model.

We used a dynamic shoulder-testing apparatus and nine fresh-frozen, entire upper extremities from cadavera to evaluate the effects of varying degrees of capsulolabral injury on the kinematics of the glenohumeral joint during abduction in the scapular plane and external rotation. Joint kinematics were recorded with use of a six-degrees-of-freedom magnetic tracking device before and after the creation of each capsulolabral lesion in a progressive manner. Dislocation did not occur after simulation of a large Bankart lesion or even after sectioning of the anterior aspect of the joint capsule. However, division of the entire joint capsule (that is, both the anterior aspect and the posterior aspect) resulted in a significant increase (p < 0.05) in posterior translation during abduction in the scapular plane, and two of the nine shoulders dislocated posteriorly. External rotation of the abducted extremity produced no increase in anterior or posterior translation.

Aged↗
PubMed1998

Development of a patient-reported measure of function of the knee.

The purpose of the present study was to demonstrate the reliability, validity, and responsiveness of the Activities of Daily Living Scale of the Knee Outcome Survey, a patient-reported measure of functional limitations imposed by pathological disorders and impairments of the knee during activities of daily living. The study comprised 397 patients; 213 were male, 156 were female, and the gender was not recorded for the remaining twenty-eight. The mean age of the patients was 33.3 years (range, twelve to seventy-six years). The patients were referred to physical therapy because of a wide variety of disorders of the knee, including ligamentous and meniscal injuries, patellofemoral pain, and osteoarthrosis. The Activities of Daily Living Scale was administered four times during an eight-week period: at the time of the initial evaluation and after one, four, and eight weeks of therapy. Concurrent measures of function included the Lysholm Knee Scale and several global measures of function. The subjects also provided an assessment of the change in function, with responses ranging from greatly worse to greatly better, at one, four, and eight weeks. The Activities of Daily Living Scale was administered to an additional sample of fifty-two patients (thirty-two male and twenty female patients with a mean age of 31.6 years [range, fourteen to sixty-six years]) before and after treatment within a single day to establish test-retest reliability. Factor analysis revealed two dominant factors: one that reflected a combination of symptoms and functional limitations and the other, only symptoms. The internal consistency of the Activities of Daily Living Scale was substantially higher than that of the Lysholm Knee Scale (coefficient alpha, 0.92 to 0.93 compared with 0.60 to 0.73), resulting in a smaller standard error of measurement for the former scale. Validity was demonstrated by moderately strong correlations with concurrent measures of function, including the Lysholm Knee Scale (r = 0.78 to 0.86) and the global assessment of function as measured on a scale ranging from 0 to 100 points (r = 0.66 to 0.75). Analysis of variance with repeated measures revealed significant improvements in the score on the Activities of Daily Living Scale during the eight weeks of physical therapy (F2,236 = 108.13; p < 0.0001); post hoc testing indicated that the change in the score at eight weeks was significantly greater than the change at four weeks and that the change at four weeks was significantly greater than that at one week (p < 0.0001 for both). As had been hypothesized, the patients in whom the knee had somewhat improved had a significantly smaller change in the score, both at four weeks (F1,189 = 33.50; p < 0.001) and at eight weeks (F1,156 = 22.48; p < 0.001), compared with those in whom the knee had greatly improved. The test-retest reliability coefficient (intraclass correlation coefficient[2,1]) was 0.97. These results suggest that the Activities of Daily Living Scale is a reliable, valid, and responsive instrument for the assessment of functional limitations that result from a wide variety of pathological disorders and impairments of the knee.

Activities of Daily Living↗
PubMed1998

Gene therapy in sports medicine.

Sports injuries frequently involve tissues that have limited healing capabilities. In order to improve the healing process and thus prevent the serious consequences of injury, it is necessary to understand the molecular and cellular biology of healing. Several growth factors and other cytokines have been identified as important mediators of a successful healing process. Such molecules have promise as novel agents for the treatment of sporting injuries, but there is presently no clinically useful way to deliver them. Gene transfer may be used to serve this purpose. In this role, gene therapy functions as a type of local biological drug delivery system. Recent studies have shown the feasibility of transferring marker genes to synovium, chondrocytes, meniscal fibrochondrocytes, tenocytes and ligamental fibroblasts, prompting optimism about the eventual success of this approach.

Animals↗
PubMed1998

Cryo/Cuff use after arthroscopic surgery: effect on knee joint temperature.

Any modality that alters joint homeostasis could have a potential negative effect on cartilage. During arthroscopic knee surgery, the temperature in the knee joint decreases significantly. The use of cryotherapy after this surgical procedure could maintain or increase these temperature variations. This prospective, randomized study evaluated the change in intra-articular knee temperature with the use of the Cryo/Cuff (Aircast Inc, Summit, New Jersey) in 30 patients after arthroscopic knee surgery. In 15 patients, a Cryo/Cuff with an automatic pump was applied immediately after surgery (group 1), and in the remaining 15 patients, only a wound dressing was applied (group 2). The mean intra-articular temperature at the beginning of the procedure was 34.8+/-1 degrees C for both groups. At the end of surgery, the temperature was 26.8+/-2.2 degrees C for group 1 and 27.5+/-2.2 degrees C for group 2. One hour after the end of the procedure, the mean temperature was 34+/-1.6 degrees for group 1 and 34.8+/-1.7 degrees C for group 2. These differences were not statistically significant. These results demonstrated that the use of the Cryo/Cuff does not alter temperature recovery in the knee, thereby excluding potential damage to the articular cartilage.

Adult↗