Tendon problems in athletic individuals.
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Achilles Tendon↗
Biomedical subjects
R A Mann
Publications and source records attributed to R A Mann.
Adult acquired flatfoot deformity. Treatment of dysfunction of the posterior tibial tendon.
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Adult↗
[Treatment of hallux valgus. Distal soft-tissue procedures and proximal metatarsal osteotomy].
Correction of the hallux valgus deformity is dependent upon recognition of the specific anatomic deformity, followed by selection of a procedure that addresses the specific deformity. A hallux valgus deformity with a subluxated metatarsophalangeal joint has a soft tissue and bony component, both of which need to be corrected, or a recurrence may result. The distal soft tissue procedure addresses the lateral soft tissue contracture by releasing the adductor hallucis, lateral joint capsule and transverse metatarsal ligament. The capsule is medially elongated and the medial eminence needs to be excised. When metatarsus adductus is present, a proximal metatarsal osteotomy should be carried out to correct the bony deformity. If the intermetatarsal angle is not corrected adequately, a recurrence of the hallux valgus is likely since a soft tissue procedure alone could not be expected to correct the bony deformity created by the increased intermetatarsal angle. Postoperatively the correction needs to be supported with a firm compression dressing for 8 weeks to be sure the corrected alignment is maintained until healing of the soft tissues and osteotomy occurs.
Hallux Valgus↗
The effect of erythropoietin administration on murine bone marrow chimeras.
All patients develop anemia after autologous or allogeneic bone marrow transplantation and red blood cell transfusion is almost always required in the post-transplant period. Recently Epo therapy has been employed in the setting of bone marrow transplantation. As bone marrow transplant patients typically suffer from malignancies and are immunocompromised, further immunosuppression should be avoided. Recent reports have suggested that Epo may modulate immune response. We have studied the effects of Epo on immune response in murine bone marrow chimeras. Epo administration resulted in an increase in hematocrit. There was no significant alteration in lymphocyte numbers, although a shift in lymphocytes toward T cell predominance was observed. Epo administration resulted in enhanced cell proliferation in response to T and B cell mitogens, although no alteration in cytotoxicity or natural killer cell activity was observed. No example of Epo-induced impaired immunity was observed.
Animals↗
Management of the foot and ankle in rheumatoid arthritis.
Rheumatoid arthritis frequently involves the foot and ankle, resulting in pain, deformity, and difficulty with ambulation. This article outlines clinical, radiographic, and gait evaluation in the management of foot and ankle problems in rheumatoid arthritis. Conservative nonsurgical management of foot deformities is presented including available shoewear and orthotic options. Surgical considerations including indications, biomechanic implications, and specific operative procedures are discussed.
Ankle Joint↗
Advanced hallux valgus deformity: long-term results utilizing the distal soft tissue procedure and proximal metatarsal osteotomy.
A series of 28 cases with a moderate to severe hallux valgus deformity and intermetatarsal angle of 14 degrees or greater was followed an average of 5 1/2 years to determine whether any significant loss of correction occurred. All feet were treated with a distal soft tissue procedure and proximal metatarsal osteotomy. The average correction of the intermetatarsal angle was 13.2 degrees (7-20 degrees), and the average loss of correction was 1.4 degrees; the average correction of the hallux valgus angle was 26.7 degrees (-2 degrees to 48 degrees), and the average loss of correction was 3.8 degrees. In three cases, a recurrent deformity developed; in three other cases, a hallux varus deformity developed, two of which were symptomatic. Patient satisfaction was 85%. This study indicates that in most patients with a hallux valgus deformity and an intermetatarsal angle of 14 degrees or greater, there is sufficient inherent stability of the first metatarsocuneiform joint that it does not require stabilization to obtain a satisfactory long-term result.
Adolescent↗
Radiographic assessment of the second metatarsal: measure of first ray hypermobility.
Hypermobility of the first metatarsal cuneiform joint has been implicated as a cause of the hallux valgus deformity. The objective definition of hypermobility at this joint, however, has not been clearly defined. We used a modified Coleman block test to accentuate motion at the first metatarsal cuneiform joint in order to measure physiologic limits of motion in vivo. This motion was compared with radiographic analysis of the feet, which included the hallux valgus angle, intermetatarsal angle, and medial cortical thickening at the midshaft of the second metatarsal. This assessment was performed on 100 feet (50 right feet and 50 left feet in 50 patients). The average intermetatarsal angle was 8.7 degrees (range, 4-14 degrees), the average hallux valgus angle was 11 degrees (range, 4 degrees of varus to 30 degrees of valgus), and the average midshaft medial cortical thickness was 3.2 mm (range, 2.0-5.5 mm). Pearson's correlation coefficient was calculated to compare these factors. The relationship between variables was found to be small (r < or = 0.2). Motion was noted to occur in the normal foot at this joint and a range of normal values for medial cortical thickness was identified.
Adult↗
Popliteal sciatic nerve block for postoperative analgesia.
Eighty-six patients were evaluated prospectively following the placement of a sciatic nerve block in the popliteal fossa after a major foot or ankle operation. Needle placement was guided by a peripheral nerve stimulator and 30 ml of 0.5% bupivacaine with epinephrine was used. Ninety-seven percent of patients had a successful block. Only one patient had severe discomfort during the block placement. The block lasted an average of 20 hours. During the first 24 hours after surgery, patients took an average of three hydrocodone tablets. Twenty-two of the 23 patients who had had previous major foot or ankle surgery found that the block was better than their previous pain control regimen. No patient had complications related to the block and 95% were satisfied and would have the block again.
Adolescent↗
Kenneth A. Johnson Memorial Lecture. What makes for effective orthopaedic teaching?
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Foot↗
Mid-tarsal and tarsometatarsal arthrodesis for primary degenerative osteoarthrosis or osteoarthrosis after trauma.
We report the long-term results of arthrodesis of the mid-tarsal and tarsometatarsal joints, performed for osteoarthrosis after dislocation with or without a fracture (seventeen patients [seventeen feet]), for primary degenerative osteoarthrosis (twenty-one patients [twenty-two feet]), or for inflammatory arthritis (two patients [two feet]). All forty patients (forty-one feet) had a severe loss of function because of pain. The average age of the patients who had primary degenerative osteoarthrosis was sixty years (range, twenty-seven to seventy-five years) and that of the patients who had post-traumatic osteoarthrosis was forty years (range, twenty-three to sixty-seven years); the two patients who had inflammatory arthritis were forty-four and seventy years old. Thirty-seven patients (thirty-eight feet; 93 per cent) were satisfied with the results of the procedure after an average duration of follow-up of six years (range, two to seventeen years). Union was achieved after 176 (98 per cent) of the 179 attempted arthrodeses, and only one of the three non-unions necessitated an operative repair. A skin slough developed in two patients, one of whom needed operative débridement. Five patients noted at least one prominent metatarsal head postoperatively, but none of these patients needed débridement because of abnormal callus formation. A stress fracture of the second metatarsal developed in three patients, but all three fractures responded to immobilization of the foot. An incisional neuroma developed in three patients, but none of these patients needed additional treatment. We believe that patients who have a severe loss of function due to osteoarthrosis of the mid-tarsal or tarsometatarsal joints can be managed successfully with tarsometatarsal or mid-tarsal arthrodesis, or both.
Adult↗
The host response in graft versus host disease. III. The in vitro induction of regulatory cells in chronic murine graft versus host disease.
Murine graft versus host (GVH) disease takes two forms depending upon the parental/F1 strain combination employed. Acute lethal GVH disease is characterized by anemia, lymphopenia, hypogammaglobulinemia, profound anti-F1 cytotoxicity, and the loss of cytotoxic potential against third-party alloantigen. In contrast to this, chronic GVH disease is characterized by polyclonal B cell activation, autoantibody production, no anti-F1 cytotoxicity, and retained cytotoxicity against allotargets. We have previously reported that this marked disparity in disease expression results from a radiosensitive host cell which protects the F1 mouse from parental anti-F1 CTX in mice undergoing CGVH disease. Using an in vitro system to induce the host protective cell, we now demonstrate that two distinct Thy-1+ cells emerge which regulate CTX against the host. One cell is of host origin, radiation sensitive, and functionally resembles a veto cell. The second regulatory cell, of parental origin, is radiation resistant and restricted in its ability to suppress anti-F1 CTX. We further demonstrate that the emergence of these cells is modulated by competitive immunoregulatory influences mediated by T contrasuppressor and I-J+ cells.
Animals↗
Surgical correction of rheumatoid forefoot deformities.
Surgical correction of severe rheumatoid forefoot deformities with resection arthroplasties of the lesser metatarsal phalangeal joints and arthrodesis of the first metatarsal phalangeal joint resulted in a significant long-term improvement with respect to shoe wear, pain, and the ability to stand and walk in 95% of the patients. Ninety percent had a good or excellent functional result. There was minimal recurrence of deformity. Modifications of the procedure with maintenance of the proximal phalangeal bases and K-wire fixation of the metatarsal phalangeal arthroplasty and interphalangeal joints resulted in an improved cosmetic result and simplified postoperative management with an equal functional result and no increase in recurrence of deformity or complications.
Adult↗
A method to facilitate suture removal.
Suture removal is facilitated when the strands are kept long and tied together. At removal, tension is applied to the long strands to pull the knot up from the skin surface, and the suture is cut with a scalpel. This method obviates the potential difficulty of finding a short suture tip with a forceps or passing the scissor tip under the knot of a tight suture, both potential causes of patient discomfort.
Dermatologic Surgical Procedures↗
Surgical management for intractable metatarsalgia.
We reviewed the results of arthrodesis of the first metatarsophalangeal joint and excisional arthroplasty of the lesser metatarsophalangeal joints performed on patients who presented intractable metatarsalgia and forefoot deformities. The study included 18 feet (15 patients) in 12 women and 3 men. The follow-up averaged 5.2 years. A good to excellent result was achieved in 15 (83%) feet; pain, which had been moderate to severe before surgery, was reduced to none to mild, and function, which had been severely limited before surgery, was improved to virtually unlimited. The fusion rate of the first metatarsophalangeal joint was 94% (17 of 18 feet). Thirteen of the 15 patients (87%) stated they would have the procedure again. This repair has been demonstrated to be a useful salvage procedure in nonrheumatoid patients with severe metatarsalgia secondary to failed forefoot surgery.
Adult↗
Tibiocalcaneal arthrodesis.
A review of eight patients who underwent nine tibiocalcaneal arthrodeses was performed. The surgical indications were failed previous surgery, posttraumatic talar avascular necrosis, and rheumatoid arthritis. The average age at the time of operation was 54 years. The average time of follow-up was 40 months after the operation. Fusion was achieved in all nine feet, with an average time of fusion of 5 months. Results were excellent in three feet, good in four feet, fair in one foot, and poor in one foot. The average leg length discrepancy was 2 cm. The average position of fusion was 6 degrees of valgus and 2 degrees of plantarflexion. All patients stated that they had improvement of pain and function. Seven of the eight patients stated that they would have the procedure done again. Complications were local infection in two patients, malunion in two patients, wound slough in one patient, and a prominent fibula in one patient. Tibiocalcaneal arthrodesis should be reserved as a salvage procedure because it is technically difficult and has a significant risk of complications.
Adult↗
In vitro generation of soluble suppressor factor in murine chronic graft versus host (GVH) disease.
Veto cells are cells which suppress self directed cytotoxicity (CTX) regardless of the strain of origin of the cytotoxic effector cell. The mechanism by which veto cells inhibit self directed CTX is largely unknown. We have previously described the emergence of a veto cell in murine chronic graft versus host (CGVH) disease both in vivo and in vitro. Using an in vitro system in which veto cells are induced, we now report that a soluble factor is also induced which is capable of suppressing CTX. This cytotoxicity suppressing factor (CsF) is heat labile and has a molecular weight above 50 kD. The factor prevents the emergence of a cytotoxic effector cell. but is largely ineffective once the effector cell has functionally emerged. CsF is irreversible and is not restricted in its ability to inhibit anti-self CTX.
Animals↗
The host response in graft versus host disease. I. Radiosensitive T cells of host origin inhibit parental anti-F1 cytotoxicity in murine chronic graft versus host disease.
Murine graft versus host (GVH) disease takes two forms depending on the parental/F1 strain combination employed. Acute lethal GVH disease is characterized by anemia, lymphopenia, hypogammaglobulinemia, profound anti-F1 cytotoxicity, and the loss of cytotoxic potential against third-party alloantigen. In contrast to this, chronic GVH disease is characterized by polyclonal B cell activation, auto-antibody production, no anti-F1 cytotoxicity, and retained cytotoxicity against allotargets. We now report that this marked disparity in disease expression results from a radio-sensitive host mechanism which protects the F1 mouse from parental anti-F1 cytotoxicity in mice undergoing chronic GVH disease. Cellular analysis revealed that protection in chronic GVH disease is mediated by a phenotypically complex system of genetically unrestricted radiosensitive T cells of F1 origin. These cells fail to functionally emerge in mice undergoing acute lethal GVH disease.
Acute Disease↗
The host response in graft versus host disease. II. The emergence of host protective cells is in part determined by background genomic compatibility.
Murine graft versus host (GVH) disease takes two forms depending on the parental/F1 strain combination employed. In an accompanying paper (Singh et al., Clin. Immunol. 151, 1993) many of the clinical features of these two forms of GVH disease are described. In addition to these clinical characteristics, acute lethal GVH (ALGVH) disease is characterized by diminished natural killer cell activity, whereas chronic GVH disease is characterized by normal or increased natural killer cell activity. Previously we have reported that this marked disparity in disease expression can be attributed to radiosensitive host cells which protect the F1 mouse from parental anti-F1 cytotoxicity (CTX) in mice undergoing chronic GVH (CGVH) disease. These cells fail to functionally emerge in mice undergoing ALGVH disease. We now report that the background genome, presumably the minor lymphocyte stimulatory loci, of the donor cells determines whether these host cells emerge and thereby dictates the form of GVH disease which is induced. C57BL/6 (B6) cells (H-2b, minor lymphocyte stimulatory locus (Mls)b) and B10.D2 cells (H-2d, Mlsb) were found to induce ALGVH disease when adoptively transferred to [C57BL/6xDBA/2]F1 (B6D2) (H-2b/d, Mls-1a/b, Mls-2a/b) recipient mice. DBA/2 cells (H-2d, Mls-1a, Mls-2a) and Balb/c cells (H-2d, Mls-1a, Mls-2b) induced CGVH disease in B6D2 mice. Using Mls congenic strains we have demonstrated that donor cell reactivity against Mls-2a was necessary and sufficient to induce ALGVH disease as determined by anemia, lymphopenia, anti-F1 cytotoxicity, and loss of cytotoxicity against allogeneic targets. Such Mls-2a reactivity correlated with the impaired induction of a host protective cell capable of vetoing self-directed CTX. Failure of this host protective cell to emerge in turn correlated with donor anti-host CTX and the emergence of ALGVH disease.
Acute Disease↗