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Biomedical subjects

L E Paulos

Publications and source records attributed to L E Paulos.

At least 19 recordsLinked to original sources
PubMed2000

Bioscrew fixation of patellar tendon autografts.

Biodegradable interference screw fixation was studied using patellar tendon autografts in a randomized, prospective multicenter comparison of the PLLA Bioscrew and a metal interference screw. sixty-eight of 114 (60%) patients (34 Bioscrew and 34 metal screw) enrolled were available for follow up an average of 35 months after surgery (range 24-65). There were 42 males and 26 females with an average age of 29 years (16-50). Tourniquet times and associated surgical findings were similar for the two groups. Postoperative KT, Tegner, and Lysholm scores were not statistically different between the two groups. Average follow up KT maximum manual side-to-side difference was 0.9 mm for Bioscrews and 1.4 mm for metal screws. Postoperative Lachman and pivot shift testing were equivalent for the two groups. Other than six of the 7 mm Bioscrews breaking during insertion in the femoral tunnel, there were no problems related to the PLLA implants. No statistical difference was found between the Bioscrew and the metal screw groups, and there were no osteolytic or other reactive bone changes observed associated with the PLLA Bioscrew. These data indicate that the PLLA Bioscrew functions reliably as an interference fixation screw for patellar tendon autografts.

Adolescent↗
PubMed1996

Is an anterior cruciate ligament reconstruction outcome age dependent?

Treatment of a torn anterior cruciate ligament (ACL) in older patients must be considered in relation to healing delays, rehabilitation difficulties, stiffness, arthritis, and actual athletic demands. This study compares ACL reconstructions in patients 40-years old and older with those under 40-years old and contrasts these to published nonoperative data in the 40 and older patient. Patients undergoing ACL reconstruction between 1992 and 1994 were preoperatively and postoperatively assessed with Lysholm, Tegner, KT, radiographic, and clinical examinations. They were divided into two groups: those 40 years and older (group 1) and those 39 years and younger (group 2). Group 1 had 33 patients with an average age of 44 years (range, 40 to 52 years). Radiographic Fairbank changes were absent. Group 2 had 170 patients with an average age of 27 years (range, 16 to 39 years). Group 1 preoperative instability and intake data were not statistically different from those of group 2. Average follow-up was 21 months for both groups. Both groups showed significant improvement in all parameters at 12- and 24-month follow-up examinations. Lysholm scores, Tegner scores, average KT manual maximum side-to-side differences, Lachman tests, and pivot shift testing were not statistically different in either group. Using Lysholm criteria, in group 1, 89% had excellent/good results, and 11% fair/poor results. This was not statistically different from group 2, which showed 91% excellent/good results and 9% fair/poor results at 24-month follow-up examination. For this age group, nonoperative treatment reports indicate 57% excellent/good results and 43% fair/poor results. The outcomes between these groups are the same and fail to establish the age of 40 years as a barrier to successful ACL reconstruction.

Achilles Tendon↗
PubMed1996

A biomechanical and clinical evaluation of a patellofemoral knee brace.

A clinical and biomechanical evaluation of a patellofemoral knee brace was conducted to determine subjectively and objectively if the brace was effective in controlling knee motion and relieving patellofemoral pain symptoms. The subjective results indicated that the patellofemoral brace was able to significantly improve the level of perceived knee stability and decrease the level of pain experienced by all the subjects during their daily living and athletic activities. The objective results showed that the patellofemoral brace had no effect on knee flexion angle during gait or level walking, stair ascent, or stair descent for 2 groups of subjects (patellofemoral patients and controls). Joint pain and stability are affected by factors other than knee flexion angle.

Adolescent↗
PubMed1996

Why grafts fail.

Significant advances in anterior cruciate ligament reconstructive surgery have been made in the past decade and, as a result, the number of anterior cruciate ligament reconstructive procedures being done have increased. Unfortunately, graft failure continues to occur and has resulted in an emphasis on revision surgery. Successful anterior cruciate ligament reconstruction is dependent on a number of factors including: patient selection, surgical technique, postoperative rehabilitation, and associated secondary restraint ligamentous instability. A particular emphasis both in scientific and clinical research has been placed on surgical technique. Errors in graft selection, tunnel placement, tensioning, or fixation methods chosen may lead to graft failure. Improper postoperative rehabilitation may lead to graft failure; however, current protocols seem to minimize its occurrence. Finally, failure to recognize or treat a significant secondary restraint instability can place excessive stress on the anterior cruciate ligament graft which may lead to failure. Care must be taken at every step of the process to ensure graft failure does not occur, because revision anterior cruciate ligament surgery results are not as predictable as primary anterior cruciate ligament reconstruction.

Anterior Cruciate Ligament↗
PubMed1995

Preliminary results of an absorbable interference screw.

A randomized, prospective multicenter comparison was done of a bioabsorbable interference screw (Bioscrew; Linvatec Corp, Largo, FL) made from poly L-lactic acid and a metal interference screw produced by the same company. Assignment was randomized by sealed envelopes. A total of 110 patients underwent arthroscopic patellar tendon autografts. A minimum 12 months follow-up is available on 85 patients (mean 19 months, range 12 to 33) including 42 with Bioscrews and 43 with metal screws. There were 56 male and 29 female patients. The average age was 29 years (16 to 50 years). Tourniquet times and associated surgical findings were similar for the two groups. Postoperative Tegner and Lysholm scores were not statistically different between the two groups. KT tests at 1 year showed an average 20-lb laxity of 1.8 mm for the Bioscrew and 1.2 mm for the metal screw groups. The average 1-year KT maximum manual side-to-side difference was 1.6 mm for Bioscrews and 1.6 mm for metal screws. A pivot shift was absent in 83% of Bioscrews and 90% of metal screws at follow-up. Six of 85 Bioscrews inserted (7%) broke on insertion (all were 7-mm diameter screws at the femoral site). No additional fixation was required in four cases. In two, the broken screw was replaced. No lytic bone changes or tunnel widening were found with any Bioscrew. One metal screw had tibial tunnel widening. No statistical difference was found between the Bioscrew and the metal screw groups. Short-term data support the conclusion that the Bioscrew is a reasonable alternative to metal interference screws.

Absorption↗
PubMed1995

Common injuries of the shoulder. Diagnosis and treatment.

Shoulder pain is often the presenting complaint of patients seeing their primary care physicians. Overuse and traumatic injuries make up most of the causes. A physical examination with minimal diagnostic tests can lead to the correct diagnosis in most cases. Most conditions can be treated conservatively (nonsurgically). Appropriate referral to a specialist depends on the severity of the initial injury or the patient's lack of response to conservative treatment (or both). We discuss common injuries of the shoulder, emphasizing a practical diagnostic and therapeutic approach.

Cumulative Trauma Disorders↗
PubMed1994

Anterior labrum reconstruction with mini-capsular shift procedure.

An anterior labrum reconstruction and mini-capsular shift (ARMS) procedure was performed in 64 patients (69 shoulders) with traumatic anterior or anterior-inferior glenohumeral instability between 1984 and 1990. Sixty-three of the sixty-nine stabilizations were performed for recurrent dislocation and six were performed for recurrent subluxation. Eighty-eight percent of the patients (61 shoulders) were available for clinical follow-up at an average of 36 months (range 28-78). There were 44 males and 12 females with an average age of 28 years (range 15-46). Excellent range of motion was recorded at follow-up for the operated shoulder with an average of 180 degrees of forward elevation, 72 degrees of external rotation with the arm at the side, 92 degrees of external rotation with the arm in the 90 degree abducted position and 90 degrees of internal rotation with the arm in the 90 degree abducted position. The range of motion of the normal shoulder was 180 degrees, 76 degrees, 101 degrees and 94 degrees respectively. Utilizing the rating scale from the American Shoulder and Elbow Society, pain improved from 3.1 to 4.4, stability improved from 1.1 to 4.5, and function improved from 2.5 to 3.8 on the average. Subjective rating revealed 95% of the patients to be satisfied with the operative procedure. According to the criteria of Rowe et al, 90% of the results were good or excellent. Five patients (8%) suffered a recurrent dislocation at an average of 32 months after the surgery. Four resulted from significant trauma (6%). One patient (2%) complained of a single episode of subluxation during early recovery. Two patients required shoulder manipulations to improve motion. No other complications occurred. The patients reviewed in this study were actively involved in sports. The majority of pre- and postoperative Tegner ratings exceeded 7.0.

Adolescent↗
PubMed1994

Reconstruction of the posterior cruciate ligament with allograft.

PCL reconstruction is often a necessary procedure to regain functional knee stability. The procedures used are not able to precisely recreate normal anatomy but are able to provide functional stability to posteriorly destabilized knees when properly performed. Our arthroscopic-assisted procedure limits the soft tissue dissection required and enables the best possible visualization for accurate graft placement. This limits scarring and maximizes the ability of the surgeon to provide posterior knee stability. Allograft tissue, when used as an ACL substitute, was initially believed to be as good as autogenous tissue. It is now believed to be inferior because of slower healing and a tendency to attenuate. PCL allograft reconstructions have not been adequately studied to determine if this same tendency of graft attenuation occurs. In many knees, however, adequate autogenous tissue may not be available, and the only chance to regain stability requires using an allograft. It is in these circumstances that the authors recommend allograft reconstructions.

Arthroscopy↗
PubMed1992

Biceps tendon and superior labral injuries.

Twenty-two patients sustained injury to the biceps tendon, rotator cuff interval, or superior labrum. Seven patients with "interval lesions" underwent biceps tenodesis, one biceps repair, and three subscapularis repairs. All were satisfied, although one tenodesis failed with distal biceps retraction. Key arthroscopic findings included biceps or subscapularis fraying. Thirteen patients with "S.L.A.P. (superior labrum anterior to posterior) lesions" underwent labral debridement. All but one obtained pain relief. Eight cadaveric shoulders exhibited extreme anatomic variability of the bicipital origin/superior labral attachment. Biomechanical study showed anterior-superior and posterior-superior labral strain with simulated biceps contraction to be greatest in shoulder abduction (p < 0.01). Biceps tendon strain was greatest in shoulder adduction (p < 0.05). A continuum of injuries to the biceps tendon exist, from the rotator cuff interval to the labral attachment. Key arthroscopic findings may assist in the difficult diagnosis of interval lesions. Individual anatomy and mechanism of injury may determine the site of the lesion.

Adult↗
PubMed1992

Complications of patellofemoral joint surgery.

The goal of patellofemoral surgery, as is true in any surgical procedure, is the maximum benefit with the least morbidity. It is imperative that the surgeon be aware of the potential complications of operating on the patellofemoral joint. It was with this goal in mind that this review was undertaken. Complications specific to surgical therapy for LPCS, malalignment, degenerative arthritis, and trauma were covered. Procedure-specific complications were discussed, as well as IPCS and reflex sympathetic dystrophy. Recommendations on how to avoid these complications were made. Specific treatment recommendations, where appropriate, were also put forth.

Femur↗
PubMed1991

Rehabilitation following knee surgery. Recommendations.

Satisfactory results following knee surgery can be obtained only through the combined efforts of the surgeon, patient and therapist. A rehabilitative plan is based upon consideration of the effects of disuse and immobility on musculoskeletal tissues, and knowledge of the healing requirements following injury and specific surgical procedures. A balance must be made between simultaneous demands for protection against undue stress to facilitate healing and the need for stress to retard atrophy of musculoskeletal tissue. A thorough review of these concepts forms the basis for a rational approach to rehabilitation after specific surgical procedures. The phasic approach to knee rehabilitation is based upon progression in a logical fashion through the chronology of immobility, range of motion, progressive weight bearing and strengthening exercises. The latter category can be subdivided into its own progression from isometrics, isotonics, functional exercises through isokinetics. The ultimate goal and final phase is a safe return to full activity. By integrating a thorough knowledge of the healing parameters of musculoskeletal tissues and the simultaneous coexisting needs for protection and controlled stress, specific rehabilitative programmes can then be designed for the most common surgical procedures including: anterior and posterior cruciate ligament reconstruction, meniscal repair and meniscectomy, lateral release and hyaline cartilage procedures.

Braces↗
PubMed1991

Anterior cruciate ligament reconstruction with autografts.

Arthroscopically assisted ACL reconstruction has undergone rapid development in recent years. Although achievement of stability has been well-documented in open ACL reconstructive procedures, improved results may be obtained by reducing operative morbidity. Arthroscopically assisted ACL reconstruction appears to offer significantly diminished morbidity and thus offers more predictable rehabilitation, at least initially, after surgery. Improvements in instrumentation continue to refine the precision of this technique. Proper graft selection is an important issue that is paramount to the evolution of ligament reconstruction surgery. Although the central third patellar tendon is presently the operation by which all new techniques must be compared, the use of nonautogenous grafts may complement arthroscopic reconstruction by allowing further reduction in surgical morbidity. In this article we have expanded on some of the advantages of arthroscopic ACL reconstruction, given an overview of arthroscopic techniques, and described the techniques we prefer.

Anterior Cruciate Ligament↗
PubMed1991

Prophylactic lateral knee braces.

Since the first reported use of knee braces for prophylactic purposes in 1979, these braces have gone through a period of widespread popularity and use, followed by increasing skepticism as to their effectiveness. Early use was unsupported by significant clinical or laboratory data. Multiple studies regarding prophylactic knee braces have since been presented in the orthopedic and sports medicine literature, often with conflicting findings and conclusions. A review is presented with the purpose of educating the reader to the historical use and investigation of these braces, along with recommendations for their future.

Athletic Injuries↗
PubMed1991

Radiographic assessment of instability of the knee due to rupture of the anterior cruciate ligament. A quadriceps-contraction technique.

We compared the results of a radiographic technique for the measurement of instability of the knee with those obtained with a KT-1000 arthrometer. The study was conducted on both knees of sixty patients who had a ruptured anterior-cruciate ligament in one knee, as well as in ten control subjects. The radiographic technique included the examination of a true lateral radiograph, made while the knee was in full extension and the quadriceps was maximally contracted, with a 66.7-newton downward force produced by a 6.8-kilogram weight suspended from the ankle. As demonstrated by both techniques, the maximum difference between the displacements of the right and left knees in the control subjects was 2.5 millimeters and the mean difference between the displacements in the two knees in the patients was 7.5 millimeters. In fourteen of the sixty knees in which the ligament was ruptured, the injury was acute. The forward translation of the medial side in these fourteen knees was compared with that in the forty-six knees in which the injury was chronic. The mean difference in the displacement of the medial side in the right and left knees was 3.5 millimeters in the fourteen patients who had an acute injury and 5.0 millimeters in the forty-six patients who had a chronic injury. Thirteen of the sixty patients had disruption of the posteromedial corner of the injured knee, and the translation of the medial side in these knees was significantly increased compared with that in the intact knees of the same patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

The ballet technique shoe: a preliminary study of eleven differently modified ballet technique shoes using force and pressure plates.

Ballet dancers are vulnerable to various stress-related injuries; foot and ankle injuries are the most common. This study determined if the pressure across the foot could be more evenly distributed by wearing various modified technique shoes padded with PPT, Spenco, or Sorbathane, alone or in combinations. A professional ballet dancer performed a jump by taking a single step on his left foot, jumping and landing with his right foot on the force and pressure plates with each modified shoe plus one unmodified shoe. The results of this study revealed: (1) total force cannot be reduced, (2) center of gravity and the majority of the pressure is maintained over the first and second metatarsal heads, and (3) the modified technique shoe can more evenly distribute pressure to the medial arch and away from the toes, metatarsal heads, and heel.

Athletic Injuries↗
PubMed1990

[Arthroscopic surgery: meniscus refixation and meniscus healing].

The stabilizing function of the meniscus and the negative effect of a complete or partial meniscectomy have been demonstrated in many studies. On the other hand, it has also been shown that meniscus tears in certain locations can heal very well. The prerequisite is that the torn meniscus can be revascularized from the capsule. Revascularization can be achieved by stimulating the formation of new vessels, but also by the build-up of collagen after induction of fibrochondrocytes and fibroblasts. The requirements for meniscus reconstruction are: careful preparation of the tear, exact repositioning, and precise placement of the sutures. The additional activation of regenerating processes is promoted by using a fibrin clot. In this study, 54 patients underwent meniscus repair, but the results in this group that also received a fibrin clot are not included. In the case of longitudinal-vertical tears of the meniscus inside the 3-mm zone margin, it was decided that the procedure was indicated when tears longer than 1.5 cm were concerned. The inside-out technique was used. Subjective and objective examination of 52 patients showed that the clinical results were good to very good in 92%.

Adolescent↗
PubMed1990

Choosing functional knee braces.

Choosing a functional brace for knee injury is a complex issue complicated by a lack of quantitative research on the subject and an increasing number of braces currently on the market. The correct brace decision will be facilitated by a better understanding of knee injury biomechanics and by a thorough understanding of the choices available. The ultimate selection of a brace should be based on sound mechanical criteria and individualized for each patient. The brace must be mechanically effectual and one the patient likes, has confidence in, and will tolerate. In combination with aggressive rehabilitation, the functional brace can make a significant contribution to returning individuals to functional activity.

Anterior Cruciate Ligament↗