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N Maffulli

Publications and source records attributed to N Maffulli.

At least 19 recordsLinked to original sources
PubMed2001

Changes in knee motion following femoral and tibial lengthening using the Ilizarov apparatus: a cohort study.

We studied 46 patients undergoing tibial or femoral lengthening to correct limb-length discrepancy (LLD) to assess the effects of the procedure on the range of motion (ROM) of the knee. The ROM of the knee has decreased even before the lengthening process started, and was at its most pronounced by the end of the lengthening. Mean preoperative ROM was 125 degrees +/- 21 degrees, and at follow-up, at an average of 41 +/- 7.8 months from the beginning of the lengthening procedure, mean ROM was 117 degrees +/- 25 degrees (P = 0.31). There was no association between the worst ROM achieved during lengthening and the final ROM. Femoral lengthening resulted in a significantly greater loss of ROM for longer periods than tibial lengthening. Patients with congenital LLD were at risk of faster, more permanent loss of ROM than patients with posttraumatic or postinfective LLD. After the removal of the tibial or femoral Ilizarov frames, the ROM of the knee tended to return to prelengthening values.

Adolescent↗
PubMed2001

The effects of prolonged peritendinous administration of PGE1 to the rat Achilles tendon: a possible animal model of chronic Achilles tendinopathy.

We studied the effects of peritendinous Achilles tendon injections of prostaglandin E1 (PGE1) on the Achilles tendon of rats. Five groups of Sprague-Dawley rats (n = 24 each) were studied. Groups 1 to 4 received weekly peritendinous injections. In group 1, one side was injected with 800 ng of PGE1 in 0.5 ml of 0.9% NaCl and the contralateral side was injected with 0.5 ml of 0.9% NaCl. In group 2, one side was injected with 800 ng of PGE1. In group 3, one side was injected with 0.5 ml of 0.9% NaCl. In group 4, a syringe needle was inserted in the peritenon unilaterally, but no substances were administered. In groups 2, 3, and 4, the contralateral tendon was used as the control. In group 5, treatment was not administered. Eight rats in each group were killed at each time point, after 7, 21, and 35 days of treatment. On day 7, values for average water content and average wet weight of the tendons treated with PGE1 were significantly higher than those in the control tendons (analysis of variance [ANOVA]; P = 0.02), with a histological picture of acute inflammation. On day 21, approximately half of the PGE1-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration, with the other half still showing a picture of acute inflammation. On day 35, all of the PGE1-treated tendons showed fibrosis of the paratenon, with adhesions and intra-tendinous degeneration. At all time points, there was no evidence of pathology in the tendons that had not received PGE1. Sham peritendinous injections and injections of normal saline did not produce inflammation in the Achilles tendons. Initially, local administration of PGE1 produced acute inflammation of the tendon and its surrounding tissues. Prolonged PGE1 administration produced peri- and intra-tendinous degeneration, providing a cheap, reproducible model of Achilles tendinopathy, which would allow studies of the effects of conservative and surgical management of the condition.

Achilles Tendon↗
PubMed2001

Intra-articular hyaluronic acid following knee immobilisation for 6 weeks in rabbits.

Thirty-two mature female New Zealand White rabbits were immobilised in an aluminium splint on one knee, using the contralateral non-treated knee as control. After 6 weeks the splints were removed and the rabbits allowed unrestricted movement. On a random basis, 16 rabbits were given an intra-articular injection of 5 mg in 0.5 ml of hyaluronic acid (HA) in the knee of the immobilised hindlimb at weekly intervals for 6 weeks, starting 1 week after the joint had been remobilised, for a total of six injections. In the other 16 rabbits no further intervention was conducted. At the end of the experiment the rabbits were killed, the area of degenerated joint surface of the distal femur, and water and proteoglycan content were measured, and the articular cartilage stained with haematoxylin and eosin and safranin O. Remobilisation without HA administration resulted in a significantly larger degenerated joint surface area. By the end of the experiment both remobilisation and remobilisation and intra-articular HA injections had produced a greater but non-significant water cartilage content compared to the control side. The average cartilage glycosaminoglycan content of the remobilisation and intra-articular HA injection group was significantly greater than in the remobilisation group. In conclusion, in the rabbits with one knee immobilised for 6 weeks, 6 weeks of remobilisation alone are not sufficient to recover from the moderate articular surface changes produced, and the intra-articular administration of HA may produce a morphologically and biochemically more normal cartilage. More extensive animal and human studies should be performed before the routine use of intra-articular administration of HA following musculoskeletal injuries that required immobilisation can be recommended.

Animals↗
PubMed2001

Complex proximal humeral fractures in adults--a systematic review of management.

We performed a systematic review of the literature to compare the clinical outcomes of the management of three and four part fractures of the proximal humerus by conservative regimes, internal and external fixations and arthroplasty. We identified 147 reports of comparative trials and case series between 1969 and 1999. We selected only studies dealing exclusively with three and four part fractures of the proximal humerus, with at least 15 patients, treated within 48 h of injury by one of the three modalities studied, in which at least one of the outcomes of interest (pain, range of motion, infection and restoration of anatomy) was described. Also, to be included, studies had to have a follow-up period of at least 6 months, in which a minimum of 85% of patients were followed-up. Twenty four reports met our eligibility criteria. Conservatively managed patients had more pain and a poorer range of motion than those managed by either fixation or arthroplasty. Better restoration of anatomy was delivered in the fixation group. There was no significant difference in the functional range of motion between the arthroplasty and fixation groups, but there were very few studies available to compare infection rates in these two management modalities. The results from the present systematic review suggest that the data from the published literature are inadequate for evidence-based decision making with regards to the treatment of complex proximal humeral fractures.

Arthroplasty↗
PubMed2001

Isokinetic strength and anaerobic power of elite, subelite and amateur French soccer players.

Information about the influence of different practice levels on physical characteristics of a large number of soccer players is lacking. Therefore we assessed muscular strength and anaerobic power of elite, subelite and amateur soccer players to clarify what parameters distinguish the top players from the less successful. We tested 95 soccer players from the French first division (elite), second division (subelite), and amateurs and determined the isokinetic strength of the knee extensor and flexor muscles at angular velocities from -120 degrees x s(-1) to 300 degrees x s(-1). Vertical jump, 10 m sprint, 30 m sprint and maximum ball speed during shooting were also measured. The elite players had higher knee flexor torque than the amateurs at all angular velocities (p < 0.05), except at 300 degrees x s(-1). The hamstring/quadriceps ratios proposed with two different methods were significantly lower in the amateur group than in the elite group (p < 0.05), except at 300 degrees x s(-1). Maximum ball speed during shooting and speed over 30 m sprint were not different between elite, subelite, and amateur players while speed over a 10 m sprint was significantly slower in amateur players and faster in the elite group (p < 0.05). Although performance in soccer is not determined only by measurable variables, professional players differ from amateurs in terms of knee flexor muscle strength and short-distance sprinting speed. Based on these findings we conclude that hamstring strength is extremely important in soccer players for joint stabilization during various tasks, notably in eccentric action. Further, short-sprinting performance may mirror actual game situations at high level and could be an important determinant of match-winning actions.

Adult↗
PubMed2001

Peroneus brevis tendon transfer in neglected tears of the Achilles tendon.

BACKGROUND: We present the results of a single-center, single-surgeon study in 59 patients with a fresh (4 women and 23 men; mean age, 43.6 +/- 8.8 years) or a neglected (1 woman and 21 men; mean age, 41.3 +/- 7.4 years) Achilles tendon rupture. METHODS: Patients with a fresh rupture were operated on using end-to-end suture, and patients with a neglected rupture received the tendon of the peroneus brevis as an autologous graft. Patients were assessed during the sixth postoperative week, and during the sixth postoperative month. They were discharged within 1 year after the operation, and were reviewed at an average of 53 +/- 13 months after surgery. RESULTS: Patients were generally satisfied with the procedure, but those with a neglected rupture tended to have a greater postoperative complication rate, greater loss of isokinetic strength variables at high speeds, and greater loss of calf circumference. CONCLUSION: The management of acute and neglected subcutaneous tears of the Achilles tendon by peroneus tendon transfer is safe but technically demanding. It affords good recovery, even in patients with a neglected rupture of 6 weeks' to 9 months' duration. Patients with a neglected rupture are at a slightly greater risk of postoperative complications, and their ankle plantar flexion strength can be reduced.

Achilles Tendon↗
PubMed2001

Muscle transplant in the rabbit's Achilles tendon.

UNLABELLED: Achilles tendinopathy (AT) is a degenerative disorder resulting from functional overload, especially during running and jumping, with some inflammatory features at the insertions, bursae, and paratenon. The Achilles tendon is poorly vascularized, especially in the middle third, and the consequent slow metabolic rate allows it to work at very low oxygen tensions but prevents on the other hand a rapid healing. PURPOSE: To create an animal model to study a novel surgical technique employed in AT: transplanting some fibers of the soleus muscle into the tendon in order to improve its vascularization and healing and to study the histological appearance of the soleus graft incorporated in the tendon. METHODS: We operated on 10 white New Zealand rabbits (eight rabbits underwent the procedure, two rabbits the sham operation with incision of the tendon without graft). Two animals were euthanized at 1 wk, 1, 2, and 3 months. RESULTS: Histology showed that after 3 months the muscle fibers were still viable within the tendons, interspersed within connective tissue fibers. Tendon and muscle tissues were intimately fused. CONCLUSIONS: The persistence of the soleus muscle pedicle graft within the Achilles tendon tissue is an index of sound blood supply. This surgical model is suitable for application in further studies on tendon healing.

Achilles Tendon↗
PubMed2001

The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy.

BACKGROUND: There is no disease specific, reliable, and valid clinical measure of Achilles tendinopathy. OBJECTIVE: To develop and test a questionnaire based instrument that would serve as an index of severity of Achilles tendinopathy. METHODS: Item generation, item reduction, item scaling, and pretesting were used to develop a questionnaire to assess the severity of Achilles tendinopathy. The final version consisted of eight questions that measured the domains of pain, function in daily living, and sporting activity. Results range from 0 to 100, where 100 represents the perfect score. Its validity and reliability were then tested in a population of non-surgical patients with Achilles tendinopathy (n = 45), presurgical patients with Achilles tendinopathy (n = 14), and two normal control populations (total n = 87). RESULTS: The VISA-A questionnaire had good test-retest (r = 0.93), intrarater (three tests, r = 0.90), and interrater (r = 0.90) reliability as well as good stability when compared one week apart (r = 0.81). The mean (95% confidence interval) VISA-A score in the non-surgical patients was 64 (59-69), in presurgical patients 44 (28-60), and in control subjects it exceeded 96 (94-99). Thus the VISA-A score was higher in non-surgical than presurgical patients (p = 0.02) and higher in control subjects than in both patient populations (p<0.001). CONCLUSIONS: The VISA-A questionnaire is reliable and displayed construct validity when means were compared in patients with a range of severity of Achilles tendinopathy and control subjects. The continuous numerical result of the VISA-A questionnaire has the potential to provide utility in both the clinical setting and research. The test is not designed to be diagnostic. Further studies are needed to determine whether the VISA-A score predicts prognosis.

Achilles Tendon↗
PubMed2001

Bunionette.

The bunionette, or tailor's bunion, is a painful osseous prominence on the lateral aspect of the head of the fifth metatarsal. This prominence occurs in many individuals but seldom causes symptoms. Orthotic devices may be useful if a symptomatic bunionette results from excessive pronation of the subtalar joint. Operative management to decrease the width of the foot and the osseous prominence is indicated when nonoperative treatment can no longer control symptoms and when the patient has special demands, particularly in sports. A proximal osteotomy is able to correct most deformities. A distal osteotomy is recommended if medial translation of the head for one-third of the width of the metatarsal shaft produces a normal fourth-fifth intermetatarsal angle.

Adolescent↗
PubMed2001

Epidemiological features of supracondylar fractures of the humerus in Chinese children.

We studied 450 children with a supracondylar fracture of the humerus in the period 1991 to 1995, and were able to collect full management details in 403 of them (253 boys and 150 girls). The median age at presentation was 6 years (6.6 years in boys, and 5 years in girls), with the nondominant humerus 1.5 times more commonly injured. Fifteen percent of children presented more than 1 day after the injury. Garland type III fractures constituted 45% of cases, type I 30%, and type II 24%, with flexion type fractures present only in 1% of the children. A nerve injury was associated with the fracture in 19 cases. Although the radial pulse was not palpable at presentation in nine patients, only one child had diminished distal circulation requiring exploration. Concomitant fractures were present in 14 patients. Elbow hyperextension was greater than in a comparable group of noninjured children. Open reduction was necessary in 20% of these children, most being managed by manipulation under anaesthesia, at times associated with percutaneous Kirschner wiring. The hospital stay was 2 days or less in two-thirds of the patients, with more than 90% discharged home within 1 week of admission. In conclusion, many Chinese patients attend hospital later than their Western counterparts, and the rate of flexion-type injuries is low.

Adolescent↗
PubMed2001

Surgical management of radial head fractures.

OBJECTIVE: To compare the outcome of various surgical options exercised in the management of different types of radial head fractures. METHOD: A retrospective study of 29 patients with radial head fractures managed surgically was undertaken. Case notes were retrieved, and final assessment was performed through a telephone questionnaire. The results were analysed according to the classification of Wesley et al (1983), and compared with the patients' own rating. RESULTS: The best results were obtained in Mason type II fractures, followed by type III and type IV fractures. Comparing different operations, the best outcome was observed with screw fixation, followed by excision of the radial head, Kirschner wire fixation, partial excision, silastic implant, and plating, in that order. CONCLUSION: The less comminuted a radial head fracture is, the better the outcome. Screw fixation is to be preferred, if technically possible. Our method of outcome assessment closely reflected in patient satisfaction.

Adolescent↗
PubMed2001

Magnetic resonance imaging after operative repair of achilles tendon rupture.

We performed a magnetic resonance imaging (MRI) study in 16 consecutive patients who had undergone open repair of a unilateral Achilles tendon rupture (ATR) at an average of 32.5 (SD 3.2) (range 29-36) months from the operation. We measured the widest antero-posterior diameter of the tendon, the longest distance between the insertion of the Achilles tendon on the calcaneum and the musculo-tendinous junction of the soleus muscle on the Achilles tendon, the distance between the insertion of the Achilles tendon on the calcaneum and the point of maximal width of the tendon. We also ascertained whether areas of altered signal were present in and around the tendon. The operated tendons were always significantly thicker than the non-operated ones. There was a non-significant trend for the other measurements to be greater in the operated tendons. In five patients, areas of dishomogeneous signal were present in the operated tendon. These areas were less than 25% of the antero-posterior diameter of the tendon, and were clinically silent. These findings probably represent normal features of long-term tendon healing following open repair of an ATR.

Achilles Tendon↗
PubMed2001

Subungual glomus tumor of the hallux. A case report.

The authors report a rare case of subungual glomus tumor in the right hallux, which was excised with complete relief of symptoms. They provide a brief description of histological features and review the literature.

Adult↗
PubMed2000

[Current aspects of tendon healing].

This review describes structure, function and healing of tendinous tissue and discusses new biologically based treatment options to modulate tendon healing. The repair process after tendon rupture results in a morphologically different and biomechanically inferior structure compared to a normal tendon. The collagen fibril diameters are decreased months after the traumatic lesion and show also different phenotypes. We know that cytokines and growth factors are key components for normal tissue development and regulate wound healing processes. Some growth factors have been detected to influence tenocytes by promoting cell proliferation and matrix synthesis. Application of the adequate growth factors at certain periods during the repair process might improve the healing result after tendon rupture. However, most of these growth factors are proteins which are rapidly metabolized by the organism. Transfer of growth factor genes into tenocytes might eliminate this problem by a continuous local release of growth factors at the healing site.

Achilles Tendon↗
PubMed2000

Seasonal variation of hip fracture at three latitudes.

We studied the seasonal variation of hip fracture admissions at three different latitudes: Scotland (56 degrees North; 54,399 admissions); Shatin, Hong Kong (22 degrees North; 4180 admissions); and Auckland, New Zealand (36 degrees South; 2257 admissions). We calculated the extent of seasonal variation (amplitude) and the time of year of the peak value (acrophase) by fitting a sine curve to monthly data using cosinor analysis. A significant seasonal variation was found in all three countries, at a high level in Scotland (p < 0.01) and Hong Kong (p < 0.001), but just significant in New Zealand (p < 0.05). The extent of the seasonal change was very similar in Scotland and New Zealand, but, as expected, the peak in New Zealand (early September) was approximately six months ahead of Scotland (mid February). In Hong Kong, the amplitude was three times greater than in Scotland and the peak occurred a month earlier. There is neither snow nor ice in Hong Kong, and this provides powerful evidence against a major influence of conditions underfoot causing extra falls in winter. In Scotland there was a significant increase in the proportion of deaths in winter as compared to summer. The Scotland/Hong Kong amplitude difference is striking, but it is unknown whether this has a genetic or environmental explanation. The cause of seasonal death difference to a given injury is also unknown. Possible mechanisms are discussed, but the purpose is to report two new epidemiological features, without wild speculative hypotheses. The findings should be viewed as leads to further epidemiological, clinical and more basic research.

Female↗
PubMed2000

Lower limb injuries in children in sports.

This article presents an overview of sports-related injuries of the lower limb in children, with emphasis on the management. The special injury-related conditions of childhood, epidemiology, and the particular pattern of injuries are discussed. The increased participation of children in sports will continue. Permanent damage is a risk, and, as such, prevention should be the most important management in this age group. For example, stretching exercises should be performed with "warm" muscles. Excessive weight training has an unacceptable risk of injury. In endurance sports, the "10 percent rule," which consists of increasing activity by 10% each week, probably could be applied to prevent overuse injuries. A multifactorial approach may be helpful. The rationale for high performance, competitive sports for children is doubtful. The optimal levels of safe training will remain changeable and not predictable. It should be the responsibility of parents, coaches, and healthcare professionals to try and minimize the potential for injury and disability, and allow children to enjoy the benefits of sports.

Adolescent↗
PubMed2000

Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Victorian Institute of Sport Tendon Study Group.

Patellar tendinopathy is often treated surgically after failure of conservative treatment but clinical experience suggests that results are not uniformly excellent. The aim of this review was to (i) identify the different surgical techniques that have been reported and compare their success rates, and (ii) critically assess the methodology of studies that have reported surgical outcomes. Twenty-three papers and two abstracts were included in the review. Surgical procedures were categorized and outcomes summarized. Using ten criteria, an overall methodology score was derived for each paper. Criteria for which scores were generally low (indicating methodological deficiency) concerned the type of study, subject selection process and outcome measures. We found a negative correlation between papers' reported success rates and overall methodology scores (r= -0.57, P<0.01). There was a positive correlation between year of publication and overall methodology score (r=0.68, P<0.001). We conclude that study methodology may influence reported surgical outcome. We suggest practical guidelines for improving study design in this area of clinical research, as improved study design would provide clinicians with a more rigorous evidence-base for treating patients who have recalcitrant patellar tendinopathy.

Bias↗