Search PubMed⌕ Search

Biomedical subjects

K D Shelbourne

Publications and source records attributed to K D Shelbourne.

At least 19 recordsLinked to original sources
PubMed2001

Patellar tendon rupture repair using Dall-Miles cable.

Ten patients underwent patellar tendon repair with end-to-end suture technique and medial and lateral retinacular repair, as well as reinforcement with a Dall-Miles cable through the patella and tibial tubercle. The cable was tensioned at 60 degrees of flexion to allow immediate range of motion to at least 100 degrees of flexion and to protect the repair from undue tension while healing. Accurate tendon length was obtained from a lateral radiograph of the noninvolved knee in 60 degrees of flexion. Patients were allowed to bear full weight as tolerated postoperatively. A knee immobilizer was worn for approximately 2 weeks when adequate muscular control of the leg was attained. The cable was removed 6-8 weeks postoperatively, at which time range of motion equal to the opposite extremity was sought. Full extension was obtained by 1 week postoperatively. Average postoperative knee flexion was 88 degrees at 2 weeks, 112 degrees at 1 month, 133 at 3 months, and 138 degrees at 6 months compared to flexion of 141 degrees in the noninvolved knee. Mean quadriceps muscle strength 1 year postoperatively was 72%+/-11% of the noninvolved leg. No patient had patella infera or rerupture after surgery. Repair of a patellar tendon rupture with end-to-end techniques reinforced with a Dall-Miles cable allows immediate rehabilitation without the need for prolonged immobilization. This technique allows restoration of full range of motion early postoperatively and enables patients to regain adequate quadriceps strength.

Accidental Falls↗
PubMed2001

The relationship of femoral intercondylar notch width to height, weight, and sex in patients with intact anterior cruciate ligaments.

Intercondylar notch width, femoral bicondylar width, height, and weight of patients with intact anterior cruciate ligaments were measured to determine whether intercondylar notch width was related to body size. A 45 degrees weight-bearing posteroanterior radiograph was obtained for 315 men and 163 women. Notch width and bicondylar width was measured at one-half notch height. Mean notch width for men was statistically significantly wider than for women (17.1 mm versus 14.7 mm, respectively; P<.01). There was no statistically significant correlation between height and notch width for men (r=-0.0019; P=.97) or women (r=0.1308; P=.10). No significant correlation existed between weight and notch width for men (r=-0.0311; P=.58) or women (r=0.0523; P=.51). Analysis of variance showed height and weight were not significant covariates in notch width for either men (P=.44) or women (P=.91). Women of the same height and weight as men had significantly narrower notches (P<.01). There was a statistically significant correlation between wider femoral bicondylar widths and higher weight for men (r=0.694; P<.01) and women (r=0.821; P<.01). Similarly, there was a statistically significant correlation between wider femoral bicondylar widths and increased height for men (r=0.670; P<.01) and women (r=0.785; P<.01). These data demonstrate height and weight are poor predictors of intercondylar notch width. Therefore, one cannot assume body size is a predictor of notch width. Furthermore, because mean notch width does not increase with increasing height and weight, the notch width index calculation cannot accurately reflect the size of the intercondylar notch.

Adolescent↗
PubMed2000

Low-velocity knee dislocation with sports injuries. Treatment principles.

Knowing that the injured MCL and PCL can heal and that the injured ACL and lateral side, predictably, will not heal are the bases for the treatment approach to these injuries. (1) Allow MCL healing nonoperatively. (2) Allow PCL healing to occur as long as PCL laxity is 2+ or less (reconstruct the PCL acutely if posterior drawer is > 2+ initially). (3) Initially delay ACL treatment and reconstruct later, if needed posterior drawer. (4) Perform acute lateral side repair to reattach structures to their distally torn site.

Athletic Injuries↗
PubMed1999

Early histologic appearance of human patellar tendon autografts used for anterior cruciate ligament reconstruction.

Nine patients underwent second-look arthroscopy and biopsy between 3 and 8 weeks after anterior cruciate ligament (ACL) reconstruction using autogenous patellar tendon. All nine biopsies were taken from the central region of the graft. Every biopsy revealed viable cells in two different patterns. As early as 3 weeks after ACL reconstruction, there were areas that were very similar to patellar tendon control specimens with low nuclear counts, mature collagen, and elongated, metabolically quiescent nuclear morphology. Other areas were hypercellular and associated intimately with neovascular invasion. Vascularity of the grafts was present as early as 3 weeks after reconstruction and increased in prevalence over the next 5 weeks. All specimens had areas of acellularity and degeneration. From these data, the authors conclude that the transplantation of nonvascularized, autogenous patellar tendon is characterized by early viability of the graft both from original fibroblasts and by new cells that arise from neovascularity that is present as early as 3 weeks after ACL reconstruction.

Anterior Cruciate Ligament↗
PubMed1999

Treatment of limited motion after anterior cruciate ligament reconstruction.

Limited motion or arthrofibrosis after anterior cruciate ligament (ACL) reconstruction causes significant pain and functional impairment. Based on physical findings and loss of motion compared with the opposite normal knee, classification systems for the diagnosis and treatment of arthrofibrosis have been developed. The operative techniques and preoperative and postoperative rehabilitation and management are discussed. Range of motion (ROM) problems after ACL reconstruction have been minimized by improved surgical techniques and perioperative rehabilitation programs. The most effective treatment for arthrofibrosis is prevention by delaying ACL reconstruction until the patient has a normal gait and full ROM and minimal swelling in the injured knee and by appropriate ROM exercises after surgery.

Anterior Cruciate Ligament↗
PubMed1999

Correlation of the intercondylar notch width of the femur to the width of the anterior and posterior cruciate ligaments.

The purpose of this study was to determine if a correlation exists between the intercondylar notch width (NW) of the femur and the width of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). A study group of 124 consecutive patients (mean age 36.6 +/- 15.2 years; 67 men, 57 women) underwent a magnetic resonance imaging evaluation for knee pain but did not have an ACL or PCL tear or arthrosis. A T2 weighted coronal cut was identified and was located at the middle of the tibial spine, which represented the plane where the ACL and PCL cross each other when the knee is in 10 degrees of flexion. The NW and the width of the ACL and PCL were measured at the level of the middle of the popliteal hiatus on a physician-independent console that allowed for digital measurements in millimeters. Our results showed a statistically significant correlation between NW and ACL width (r = 0.87; P < 0.001) and between NW and PCL width (r = 0.75; P < 0.001). The mean ACL width was 6.4 +/- 1.4 mm (range 3-10 mm). The mean PCL width was 10.2 +/- 2.0 mm (range 6-17 mm). The mean ACL width was 5.7 +/- 1.1 mm for women and 7.1 +/- 1.2 mm for men (P < 0.001). The mean PCL width was 9.5 +/- 1.7 mm for women and 10.9 +/- 2.0 for men (P < 0.001). Our results indicate that NW correlates with ACL and PCL width. In addition, ACL and PCL widths are narrower in women than men.

Adolescent↗
PubMed1999

Rehabilitation program for both knees when the contralateral autogenous patellar tendon graft is used for primary anterior cruciate ligament reconstruction: a case study.

STUDY DESIGN: Case study of a basketball player who underwent an alternative surgical procedure for anterior (cruciate ligament (ACL) reconstruction and outline of the rehabilitation process designed for this procedure. OBJECTIVES: To describe the surgical procedure, detail the rehabilitation program, and report on this patient's clinical outcome. BACKGROUND: Anterior cruciate ligament injury, its treatment, and rehabilitation continue to be an area of interest to both clinicians and researchers. Surgical procedures have been refined and rehabilitation programs are constantly being evaluated and updated to allow the safest and most predictable return to activity. Currently, the autogenous bone-patellar tendon-bone graft is the graft of choice for ACL reconstruction. Typically the graft is taken from the ipsilateral knee. An alternative procedure is to take the graft from the contralateral, noninvolved knee, allowing 2 separate rehabilitation programs to take place. METHODS AND MEASURES: The patient was followed from the time of injury to 2 years postoperatively. Data collected included range of motion, isokinetic strength scores, ligament stability scores, subjective evaluation, and functional measures. RESULTS: At 3 weeks postoperative the patient had nearly full range of motion in both knees, normal gait, and was beginning sport-specific drills. He was shooting the basketball and jumping by 5 weeks and returned to competitive sports 6 weeks after surgery. He was able to play in all 32 games of the season, starting in 23 of them. CONCLUSIONS: Using the contralateral patellar tendon graft may be appropriate for primary ACL reconstruction of patients, particularly those desiring an early expedient return to athletic competition.

Adult↗
PubMed1999

ACL reconstruction using an abnormally thick autogenous patellar tendon graft.

This prospective study measured the patellar tendon thickness of 543 patients who underwent anterior cruciate ligament (ACL) reconstruction with an autogenous bone-patellar tendon-bone graft to document the normal range of patellar tendon thickness and to determine if using thicker than normal patellar tendons as an ACL graft source affected postoperative outcome. The postoperative results of 55 patients who underwent ACL reconstruction with a patellar tendon > or =7 mm thick (thick tendon group) were compared with those of 488 patients who underwent ACL reconstruction with a patellar tendon < or =6 mm thick (normal tendon group). 5 mm (4.5 mm in women and 5.3 mm in men) with a range of 3-11 mm (3-7 mm in women and 3-11 mm in men). There was no statistically significant difference in the postoperative KT-1000 arthrometer mean manual maximum difference (2.0 mm for grafts < or =6 mm thick and 1.9 mm for grafts > or =7 mm thick), postoperative quadriceps muscle strength scores, modified Noyes questionnaire subjective scores (mean of 91 points for grafts < or =6 mm thick and 92 points for grafts > or =7 mm thick), or postoperative stability and pain scores. These results indicate that an abnormally thick patellar tendon should not preclude the use of this involved tendon as a graft source for ACL reconstruction.

Adolescent↗
PubMed1999

Magnetic resonance imaging of posterior cruciate ligament injuries: assessment of healing.

This study evaluated posterior cruciate ligament (PCL) healing using magnetic resonance imaging (MRI). Forty knees with acute PCL injuries underwent acute and follow-up (>6 months) MRI examinations. Twenty-three knees had isolated injuries, and 17 knees had associated ligament damage. The initial MRI scans showed 22 high-grade injuries with complete disruption, 14 with midgrade injuries with extensive edema on T2 images with some bridging fibers present, and 4 patients had low-grade injuries. At a mean time of 3.2+/-1.3 years after the initial MRI, the follow-up MRIs revealed the PCL healed with continuity in all of the low-grade and mid-grade injuries, and in 19 of 22 high-grade injuries. Of the 19 high-grade PCL tears that healed, 4 healed with normal contour and 15 were continuous with altered morphology at follow-up. Of 11 high-grade PCL-injured knees with associated ligament damage, only 1 PCL failed to regain continuity. The 3 PCLs that did not regain continuity were in 2 patients with isolated injuries and 1 patient with associated anterior cruciate and medial collateral ligament injuries. These results demonstrate that most nonoperatively treated PCL injuries, even in association with other knee ligament damage, can heal with continuity.

Humans↗
PubMed1997

Anterior cruciate ligament (ACL)-deficient knee with degenerative arthrosis: treatment with an isolated autogenous patellar tendon ACL reconstruction.

We evaluated 58 patients (mean age 30.4 years) who had undergone an isolated anterior cruciate ligament (ACL) reconstruction for chronic instability (mean time from injury to surgery, 8.2 +/- 5.2 years) and showed radiographic evidence of degenerative arthrosis. Objective evaluation at a mean of 4.1 years postoperatively included KT-1000 arthrometer stability, range of motion, and quadriceps muscle strength testing. Subjective analysis at a mean of 5.5 years postoperatively included rating of pain, stability, activity level, and a total score both preoperative and postoperative. Patients were divided into two groups: group 1 (n = 28) with a follow-up < or = 5 years (mean 3.3 years); group 2 (n = 30) with a follow-up > 5 years (mean 7.2 years). Results were analyzed by length of follow-up and by the grade and compartment of arthrosis. All patients enjoyed a full range of motion preoperatively and postoperatively. The mean KT-1000 arthrometer manual maximum difference improved from a mean of 8.2 mm preoperatively to 2.4 mm postoperatively. All subjective scores showed statistically significant improvement over the preoperative values. Patients with medial compartment arthrosis reported a better subjective total score (mean 87) than patients with lateral compartment (mean 73) or bicompartmental (mean 79) arthrosis, but there was not a statistically significant difference. There was no correlation between pain, stability, or total scores and time after surgery. Patients in groups 1 and 2 had equal objective stability and similar subjective scores, but group 2 reported a lower activity level. An isolated ACL reconstruction can provide long-term stability and symptomatic pain relief in patients with chronic instability and arthrosis. The procedure has low morbidity and does not compromise future tibial osteotomy or total knee replacement.

Adult↗
PubMed1997

Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears.

The purpose of this study was to compare the measurements of the intercondylar notch width (NW) in men and women radiographically and intraoperatively, and to determine if the radiograph would demonstrate a difference in the patients with unilateral and bilateral anterior cruciate ligament (ACL) tears compared with non-injured patients. The control groups consisted of 100 men and 100 women from our young adult clinic population without a history of knee injury or clinical evidence of ligamentous deficiency. The study group consisted of 90 men with bilateral and 297 with unilateral ACL reconstructions (mean age 25.1 years, range 13-53 years) and 41 women with bilateral and 129 with unilateral ACL reconstructions (mean age 22.3 years, range 13-48 years). On 45 degrees flexion weight-bearing radiographs, we measured the intercondylar NW in controls and patients at one-half notch height from the lateral edge of the articular margin of the medial femoral condyle to the apex of the intercondylar notch. Intraoperatively, the surgeon took a direct measurement at the same site with sterile calipers. The surgeon was unaware of the radiographic measurement. The mean radiographic NW measurements for women were 12.8 mm in the bilateral group, 13.8 mm in the unilateral group, and 14.5 mm in the control group (P < 0.05) and, for men, 15.3 mm in the bilateral group, 15.8 mm in the unilateral group, and 16.9 mm in the control group (P < 0.05). The preoperative radiographic NW measurements correlated with actual intraoperative measurements (r = 0.72, P < 0.01). We conclude that the intercondylar NW of the femur is narrower in women than men, and, in both men and women, the NW is narrower in patients who sustain ACL tears compared with controls.

Adolescent↗
PubMed1996

Management of anterior cruciate ligament injuries in skeletally immature adolescents.

Anterior cruciate ligament (ACL) injuries in skeletally immature adolescents are being diagnosed and reported with increasing frequency. Nonoperative management of mid-substance ACL injuries in adolescent athletes frequently results in a high incidence of giving-way episodes, recurrent meniscal tears, and early onset of osteoarthritis. An intraarticular ACL reconstruction (using the central 10-mm patellar tendon graft) in young athletes approaching skeletal maturity provides predictable excellent knee stability, and the athletes are able to return to competitive sports with a decreased risk of recurrent meniscal and/or chondral injury. Guidelines for the management of ACL injuries in skeletally immature adolescents are presented.

Adolescent↗
PubMed1996

Anterior cruciate ligament reconstruction in athletes with an ossicle associated with Osgood-Schlatter's disease.

We report a series of 20 athletes with an ossicle associated with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using autogenous, central-10-mm patellar-tendon graft. All patients had an Osgood Schlatter's lesion with an ossicle as seen on a plain radiograph. The patients were reviewed at an average follow-up of 44 months (range, 24 to 108 months). The postoperative assessment included clinical examination, KT-1000 testing, isokinetic testing, and subjective score (using the modified Noyes' questionnaire). At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm (range, 0 to 5 mm). Average time to return to full sporting activities was 5.2 months (range, 2.6 to 8.9 months). All patients returned to their previous level of activity. The mean modified Noyes' knee score was 96 (range, 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely undertaken in athletes with an ossicle associated with OSD without compromising the final knee function.

Adolescent↗
PubMed1996

Rehabilitation after autogenous bone-patellar tendon-bone ACL reconstruction.

In the past decade, changes in the rehabilitation of patients with ACL injuries have made a dramatic impact on the management of the surgically treated ACL-deficient knee. Our rehabilitation program following the ACL reconstruction has been developed over the past 12 years. With close follow-up of our patients, we have modified the rehabilitation program in an attempt to eliminate postoperative complications, ensure long-term knee stability, and allow a safe and rapid return to athletic activities. Our present rehabilitation protocol is divided into four phases. The initial phase encompasses the preoperative period. The second phase involves the first 2 weeks after ACL reconstruction. The third phase extends from 2 to 5 weeks postoperation, and the final phase (> than 5 weeks postoperation) involves a safe return to athletic activities. An aggressive preoperative phase and close attention to full hyperextension, control of swelling, and good leg control during the first postoperative phase are the cornerstones of the rehabilitation program. We continue to evaluate our results closely and to advance our rehabilitation program guided by our patients and continuous follow-up evaluations. We propose that the avoidance of immediate surgery and appropriate preoperative patient preparation, along with postoperative rehabilitation program that emphasizes extension and closed chain function exercises, will optimize the final result.

Adult↗