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Biomedical subjects

J L Goldner

Publications and source records attributed to J L Goldner.

98 records · Page 6Linked to original sources
PubMedDate not supplied

Computed tomography of the normal patellofemoral joint.

Radiographic assessment of the patellofemoral joint (PFJ) is problematic because conventional views are cumbersome, difficult to standardize, and not reliable for displaying this joint with flexion of the knee less than about 30 degrees. We used computed tomography (CT) to obtain conveniently a direct transaxial view of the PFJ in ten normal human volunteers at different 0 degree, 20 degrees, and 45 degrees of knee flexion and during both contraction and relaxation of the quadriceps muscle. From the CT images we measured femoral trochlear angle, patellar centralization, femoral trochlear depth, and patella tilt angle. In full extension, with the quadriceps muscle relaxed, 19 of 20 knees showed the patella well centered in the femoral trochlear groove. The tilt and centralization of the patella were largely unchanged at 20 and 45 degrees of knee flexion with quadriceps contraction. CT appears to be an optimal method of studying the PFJ. The normal relationships described in this report can be the basis for evaluating patients with known or suspicious history of recurrent subluxation or dislocation of the patella.

Adult↗
PubMedDate not supplied

Magnetic resonance imaging of traumatic knee articular cartilage injuries.

The purpose of this study was to assess the sensitivity of magnetic resonance imaging in determining the presence of articular cartilage injuries of the knee with arthroscopy as the standard for comparison. Forty-nine articular cartilage lesions were documented in 28 knees (27 patients) by arthroscopy. There were 22 men and 5 women with an average age of 29 years. Multiplanar magnetic resonance imaging was performed with spin echo and gradient-refocused acquisition in a steady state pulse technique. All of the knees had magnetic resonance imaging done within 4 weeks prior to arthroscopy. The magnetic resonance images were interpreted before arthroscopy and interpreted again after the results of arthroscopy were known to better define the potential learning curve for evaluating chondral lesions and to identify the technical limits of the existing imaging protocol/software. For full-thickness articular cartilage lesions, the prearthroscopy sensitivity of magnetic resonance imaging was 41% (12/29) and the postarthroscopy sensitivity was 83% (24/29). For partial-thickness chondral injury, the prearthroscopy sensitivity of magnetic resonance imaging was 15% (3/20) and the postarthroscopy sensitivity was 55% (11/20). The presence of an intraarticular effusion assisted the detection of chondral lesions because of an "arthrogram" effect. As a noninvasive method of evaluating articular cartilage and despite experienced interpretation and the benefit of retrospective analysis, both the prearthroscopy and the postarthroscopy sensitivity of magnetic resonance imaging was low using the imaging parameters described. Injury to articular cartilage is a frequent cause of knee pain and knee surgery; it is important to note at this time that magnetic resonance imaging cannot reliably exclude the presence of an articular cartilage injury.

Adolescent↗
PubMedDate not supplied

A review of lateral ankle ligamentous reconstructions.

We have performed on ongoing retrospective and prospective multi-institutional review of 50 patients who underwent 53 lateral ligamentous reconstructive procedures of the ankle. The point grading system used for postoperative evaluation of our patients allowed for classification of functional activity. The grading system included evaluation of the patient's return to preinjury activities and athletics, degree of pain, degree of swelling, number of recurrent sprains, and any disability that the patient incurred secondary to the tendon transfer. Preoperative and postoperative stress radiographs were obtained to evaluate the talar tilt angle. Of our 53 lateral ankle ligamentous reconstructions, we consider 45 to be excellent, with the patients returning to full activity and athletics. Our results show no statistically significant difference in long-term function among the five ligamentous repairs employed in this series (Pearson Chi-square test; chi 2 = 2.30, df = 4, P = 0.68). No correlation could be made between the long-term clinical response of the various procedures and the postoperative talar tilt angle. We conclude that lateral ligamentous reconstructive repairs of the ankle are indicated, and that good or excellent clinical results, greater than 91%, can be obtained with any of the five reconstructive procedures, performed correctly.

Adolescent↗
PubMedDate not supplied

Free flap coverage of deep tissue defects of the foot.

This is a review of seven cutaneous or myocutaneous free flaps performed at the Duke University Medical Center for coverage of foot defects. The average follow-up is 19.3 months. The average anesthetic time was 7 h and 45 min. The average length of hospitalization was 14.1 days. There were no failures. The flaps provided excellent skin coverage and a good bed for further reconstructive procedures. Free myocutaneous and cutaneous flaps are useful tools in reconstructive surgery of the foot. The recently developed cutaneous scapular free flap is the authors' preference for foot defect coverage.

Adolescent↗
PubMedDate not supplied

Electrical stimulation of peripheral nerves for relief of intractable chronic pain.

Electrostimulation of peripheral nerves was used in patients to relieve chronic pain due to nerve injury. After follow-up for periods of 6 to 48 months, most of the patients exhibited some degree of pain alleviation. This paper details the circumstances of some of the cases and cites precautions to be taken in the use of this therapeutic mode.

Aged↗