Biomedical subjects
J Gillquist
Publications and source records attributed to J Gillquist.
Surgical or conservative treatment of the acutely torn anterior cruciate ligament. A randomized study with short-term follow-up observations.
In a prospective study, 90 consecutive patients with total midstructural tears of the anterior cruciate ligament (ACL) were assigned at random to surgical (Group I) or conservative (Group II) treatment. Within 18.2 months of operation, 95% of the patients in Group I and 11% of those in Group II had a stable knee. The mean knee function score in Group I was 89 points, and 75% achieved more than 84 points (good or excellent). In Group II the mean score was 85; only 53% achieved more than 84 points (p less than .05). Group II patients showed greater mean quadriceps strength than those in Group I. The ability to perform a one-leg jump and to run a figure eight was similar in both groups. Early primary suture of the acutely torn ACL usually resulted in a stable knee, whereas conservatively treated patients showed knee instability. At the 18-month interval, however, the patients' functional performance seemed to be comparable in the two groups.
Functional anatomy of the anterior cruciate ligament and a rationale for reconstruction.
In thirty-three normal cadaver knees from adults (mean age, twenty-nine years), the average length of the anterior cruciate ligament was 31 +/- 3 millimeters and the angle between the ligament and the long axis of the femur was 28 +/- 4 degrees with the knee at 90 degrees of flexion. We could find no macroscopic or microscopic evidence of discrete subdivisions of the anterior cruciate ligament. We studied the functional importance of the positions of the attachments of the anterior cruciate ligament. The distance between the central points of the normal attachment areas on the tibia and on the femur was found to be isometric during flexion and extension. The so-called over-the-top position on the femur was the least favorable of the positions that we tested, since it resulted in an average elongation of the ligament of ten millimeters with the knee in full extension as compared with full flexion. On the basis of the results in the present study, we suggest some basic principles for a standardized replacement operation for a deficient anterior cruciate ligament.
Duration of stretching effect on range of motion in lower extremities.
The duration of the effect of contract-relax stretching on range of motion (ROM) in the lower extremities was measured on eight male volunteers. The stretching procedure was performed as one isometric contraction, followed by relaxation and then a passive extension of the muscle being stretched. The treated muscle groups were the adductors, hamstrings, rectus femoris, iliopsoas, gastrocnemius, and soleus. The total stretching time was 15min. Six ROMs were tested 0, 30, 60, and 90min after the stretching procedure. There was a significant increase in hip abduction (+17% +/- 3), knee flexion (+4% +/- 1), hip flexion (+4% +/- 2), ankle dorsiflexion with knee flexed (+18% +/- 7), and ankle dorsiflexion with knee straight (+16% +/- 5). The increase remained for 90min for all ROMs except for ankle dorsiflexion with the knee straight.
[Suture of peripheral meniscus rupture--a prospective study].
Explore the source record for details and available documents.
Muscle strength and flexibility in different positions of soccer players.
One-hundred eighty soccer players were tested for muscle strength in knee extension and knee flexion and for flexibility in the lower extremity. The strength measurements were done with a Cybex II isokinetic device (Lumex, Bay Shore, New York). The range of motion (ROM) was measured according to a method described by Ekstrand et al. (1982). The players were divided into groups according to their player position: goalkeepers, defenders, midfielders, and forwards. The results showed a significantly higher knee extensor torque in goalkeepers and defenders than in forwards (P less than 0.05). The knee flexion/knee extension ratio (H/Q ratio) was significantly higher for forwards compared to goalkeepers (P less than 0.001) and defenders (P less than 0.01). The goalkeepers were significantly more flexible than the other players in hip flexion (P less than 0.001), knee flexion (P less than 0.01), and ankle dorsiflexion (P less than 0.001).
A comparison between arthroscopic meniscectomy and modified open meniscectomy. A prospective randomised study with emphasis on postoperative rehabilitation.
Arthroscopy is now well established as a method of diagnosing meniscal lesions, and its advantages have been pointed out in several reports. Arthroscopic surgery, however, is difficult to master, so that for meniscectomy open methods remain commoner. By taking advantage of the new instruments and equipment developed for arthroscopic operations, a modified technique of open meniscectomy, designed to improve the postoperative course, has been developed. In a prospective randomised study, the results after this modified open meniscectomy were comparable with those obtained after arthroscopic operation and were significantly better than those after conventional meniscectomy. The best results of all, however, were those after partial arthroscopic meniscectomy.
Knee function after arthroscopic meniscectomy. A prospective study.
In a prospective study, operation under arthroscopy was done in 100 consecutive patients (11 women and 89 men) with a lesion of one meniscus. Meniscectomy was done in 86 patients with medial meniscus tears and in 14 with lateral tears. After 2 weeks, 85 patients were back at work.
Two-year follow-up of conservative treatment of knee ligament injuries.
Sixteen patients with old knee ligament injuries and symptoms of instability or pain were treated with a 3-month thigh muscle strength training program. Nine patients had a tear of the anterior and six patients a tear of the posterior cruciate ligament. One patient had a tear of both cruciates. Knee function was determined with a knee scoring scale, and thigh muscle strength with a Cybex-II dynamometer before training, after 1 and 3 months of training, and at a late follow-up after 2 years. Ten patients who increased their quadriceps strength by more than 15 per cent increased their score over 30 per cent. Three patients who showed a minor increase in strength did not increase their score significantly. Three patients did not increase their strength at all. All of these admitted a reluctance to train. Four patients, all with anterior cruciate ligament tears, were operated on after the 3-month training period. All four patients increased their strength. Two of them increased their functional score also, but they strove for a very high activity level and were therefore operated on. The other two patients had no symptomatic relief and were therefore also operated on. Improvements in muscle strength and knee function were unchanged at the 2-year follow up. Before planning a knee ligament reconstruction, a period of strength training is recommended.
Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up.
Thirty-five of 41 consecutive patients were followed for 5 years after early primary suture of the acutely torn anterior cruciate ligament and repair of all other injured structures; three early failures were excluded from the series, and three patients were lost to follow-up. Twenty-three of the patients also had an early follow-up 2 years postoperatively. From the early to the late follow-up, the function of the operated knees decreased significantly.
Arthroscopy of the knee in children.
A review was carried out of arthroscopy of the knee in children. During a 34-month period, 2,378 arthroscopies were performed, 80 of these on children less than 16 years of age. Seventy-one cases were reviewed, which is approximately 2% of all children seen at the clinic. Thirty procedures were carried out in patients with hemarthrosis. Eleven patients required operative repair or reconstruction. There were 13 ruptures of the anterior cruciate ligament (43%), 4 ruptures of the posterior cruciate ligament, 14 ruptures of the medial collateral or posterior oblique ligament, and 5 ruptures of the lateral meniscus. Forty-one arthroscopies were done in patients without hemarthrosis or history of acute trauma. A clinical diagnosis of meniscus tear was correct in only 20%. Only one meniscectomy was performed and another meniscus tear was repaired. The most common diagnostic finding was abnormality of the patellofemoral articulation, which was diagnosed in 31 patients. Arthroscopic shaving of the patella was rarely indicated. As in adults, hemarthrosis indicates significant injury to the knee. Meniscus lesions are rare.
Comparison of open and endoscopic meniscectomy.
Fifty-eight patients who had undergone meniscal surgery were reviewed. Half had undergone conventional open meniscectomy, and half had been treated by arthroscopic meniscectomy. Each patient in the open group was matched with a patient in the endoscopic group by age, sex, and type of meniscal lesion. Patients with ligamentous injuries were excluded. Twelve patients in the endoscopic group were operated on as outpatients; the mean post-operative hospital stay in the 17 hospitalized patients in the endoscopic group was one day as compared with a mean of 3.3 days for the patients in the open group. Sick leave for the endoscopic group was only one-third of that of the open group. Operating time was 74.5 +/- 38.7 minutes in the open group compared with 55.9 +/- 25.0 minutes in the endoscopic group. At follow-up evaluation (mean follow-up period, 38 months) the percutaneous group showed a knee function score (88.7 points) similar to that of the open group (85.3 points) at 51 months. A three-year follow-up study of patients operated on endoscopically for a single meniscal lesion demonstrated that results with endoscopy are as satisfactory as those obtained by conventional surgery. Advantages of endoscopy include decreased hospitalization and shorter sick leave, with a corresponding reduction in the cost of patient care.
[Treatment of meniscus lesions in athletes].
Explore the source record for details and available documents.
Instruments for routine arthroscopic surgery of the knee.
The use of operating instruments for routine arthroscopic operations was analysed on 2397 arthroscopies with 986 operations. The biggest group was meniscectomy (n = 358). The most common instrument combination was knife, a straight 4 mm grasper, a 3-4 mm basket forceps and a suction device, which was used in 53% of the cases. Instrument breakage rates were analysed and found to be rather high especially for straight basket forceps (2/100 operations) and grasping forceps (3.6/100 operations). In two cases arthrotomy had to be done to retrieve a broken piece of grasping forceps. 30 degree telescopes used together with a TV-system had to be replaced at a rate of 0.8/100 operations and 70 degree telescopes at 0.2/100 operations.
Stabilometry in functional instability of the ankle and its value in predicting injury.
Stabilometry is an objective method used for studying postural equilibrium quantitatively. Stabilometric recordings were made in 127 soccer players to demonstrate functional instability of the ankle joint. The presence of previous ankle joint injuries, i.e., sprains or fractures, was documented. Reference values for stabilometry were obtained from a group of 30 normally-active non-soccer players without a history of injury to the ankle joint. A pathological stabilometric value was defined as one exceeding the mean value of the reference group by 2 SD. In players with a history of previous ankle joint injury no increased postural sway was found. On the other hand, players showing abnormal stabilometric values ran a significantly (P less than 0.001) higher risk of sustaining an ankle injury during the following season compared to players with normal values. Players with a history of previous ankle joint injury did not run a higher risk compared to players without previous injury. The findings indicate that an ankle joint injury did not result in a persistent functional instability; however, such instability did increase the risk of ankle joint injury.
[Considerably decreased amount of soccer injuries after introduction of a preventive program].
Explore the source record for details and available documents.
The avoidability of soccer injuries.
One hundred eighty players in a male soccer division were followed prospectively for 1 year to assess etiologic factors in soccer injuries. Range of motion and muscle strength in the lower extremities were measured in a preseason test. All injuries during 1 year were examined by the same orthopaedic surgeon. 42% of the injuries were considered to be due to player factors, such as joint instability, muscle tightness, inadequate rehabilitation, or lack of training. Ankle sprains were commoner in players with previous ankle sprains or clinical instability. 35% of the moderate (absence from practice greater than 1 week, less than 1 month) or major (absence greater than 1 month) injuries were preceded by minor (absence less than 1 week) injuries, reflecting inadequate rehabilitation. Players sustaining knee sprains not due to collision had reduced muscle strength in the injured leg. No other strength differences between injured and uninjured players were found. 63% of players had tight muscles. Strains more commonly affected players with muscle tightness. 71% of the injuries proved to be explicable by and associated with player factors, equipment, playing ground, or rules.
Thyroid hormone secretion rates: response to endogenous and exogenous TSH in man during surgery.
The thyroid hormone secretory response to TSH was studied in twenty-eight patients undergoing thyroid and parathyroid surgery. Eighteen patients received bovine or human exogenous TSH by injection into a thyroid artery, and 10 received TRH to stimulate endogenous TSH secretion. Thyroid secretion rates of T4, T3, and rT3 were determined directly from measurement of blood flow and the hormone gradient across the gland. A significant secretory response was seen for all three hormones following TSH increase. T3 secretion accelerated more rapidly than that of T4 and rT3, thus reducing the T4/T3 and rT3/T3 ratios. The T4/rT3 ratio fell during the first 30 min but then increased. The responses correlated with the area under the curve of the TSH serum concentration, and were similar after administration of bovine and human exogenous TSH, and TRH. Conclusions regarding preferential secretion ought to be made by comparing ratios of thyroid hormone secretion with those of the hormone content of the gland, but our results indicate that TSH induces preferential secretion of triiodothyronines in man.