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Biomedical subjects

R Seil

Publications and source records attributed to R Seil.

At least 37 records · Page 2Linked to original sources
PubMed2000

Extracorporal shock wave therapy in patients with tennis elbow and painful heel.

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel. Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent ESWT. Both groups received 3000 shock waves of 0.12 mJ/mm2 three times at weekly intervals. After a follow-up of 5 and 6 months respectively, pain measured on a visual analogue scale (VAS) decreased significantly in both groups. The success rate (excellent and good results) was 63% in tennis elbows and 70% in painful heels. ESWT seems to be a useful conservative alternative in the treatment of both conditions.

Adult↗
PubMed2000

Chondral lesions after arthroscopic meniscus repair using meniscus arrows.

Meniscus repair using bioabsorbable devices has become popular in the last few years. Good clinical results have been reported and few complications have been published. This report describes the case of a 37-year-old male patient with a lateral meniscus repair using 4 Meniscus Arrows (Bionx Implants, Blue Bell, PA). Postoperatively, repeated episodes of intra-articular effusions have occurred. A second-look arthroscopy 8 months after the reconstruction showed that the meniscus tear had not healed and revealed the presence of chondral damage corresponding to the location of the arrows in the posterior area of the lateral femoral condyle. Surgeons using the Meniscus Arrow should be aware of this possible postoperative complication.

Absorbable Implants↗
PubMed2000

The influence of avascularity on the mechanical properties of human bone-patellar-tendon-bone grafts.

Our aim was to analyse the effect of avascularity on the morphology and mechanical properties (tensile strength, viscoelasticity) of human bone-patellar-tendon-bone (BPTB) grafts in vitro. These were harvested at postmortem and stored submerged in denaturated human plasma at a constant pH, pO2, pCO2, temperature and humidity under sterile conditions. Mechanical testing was performed two and four weeks after removal of the graft. The mean ultimate strength was 1085.7 +/- 255.8 N (control), 1009.0 +/- 314.9 N (two weeks cultured) and 1076.8 +/- 414.8 N (four weeks cultured). There was no significant difference in linear stiffness or deformation to failure between the groups. There was a difference in viscoelasticity between the control group and the avascular grafts and the latter had significant lower peak load-to-load ratios after 15 minutes compared with the control group. After two and four weeks the graft contained viable fibroblasts. There was regular cellularity in the superficial layers and decreased cellularity in the midportion. The structure of the collagen including the crimp pattern appeared to be normal in polarised light. We conclude that avascularity does not significantly affect ultimate failure loads or stiffness of BPTB grafts. Slight changes in viscoelasticity were induced, but the significance of the increased stress relaxation is not fully understood.

Adult↗
PubMed2000

[In Process Citation]

Calcifying tendinitis of the rotator cuff is a common||| disorder of the shoulder which affects mainly individuals between 30 and 50||| years of age. The etiology is still a matter of speculation. The calcification||| is a reactive process actively mediated by cells in a viable environment. The||| deposit undergoes an evolution (precalcific stage--calcific stage with||| formative phase, resting period and resorption--postcalcific stage), which||| ultimately remodels normal tendon tissue. However, the evolutionary stages of||| the disease do not always follow the typical sequence. A symptomatic deposit||| may persist or postcalcific tendinitis develop. The treatment should be based||| on the knowledge of the natural history of the disease, which shows a strong||| tendency towards self-healing by spontaneous resorption of the deposit. The||| stage of evolution of the disease should be judged, combining pain history,||| morphology of the deposit on plain X-rays, and ultrasound findings. The||| therapeutic approach depends on the evolution of the disease. During the||| resorption phase we favor a conservative approach. For deposits which are not||| under resorption we propose a concept which consists of three steps: a||| conservative approach, extracorporal shock wave therapy (ESWT) or needling, and||| arthroscopic surgery. The efficacy of ESWT and needling has still to be proven.||| Patients with persisting pain after steps 1 and 2 are candidates for surgical||| removal of the deposit. We prefer the arthroscopic approach. In some cases an||| additional arthroscopic subacromial decompression (ASD) is||| indicated.

Journal Article↗
PubMed2000

[Tendinosis calcarea of the rotator cuff].

Calcifying tendinitis of the rotator cuff is a common disorder of the shoulder which affects mainly individuals between 30 and 50 years of age. The etiology is still a matter of speculation. The calcification is a reactive process actively mediated by cells in a viable environment. The deposit undergoes an evolution (precalcific stage--calcific stage with formative phase, resting period and resorption--postcalcific stage), which ultimately remodels normal tendon tissue. However, the evolutionary stages of the disease do not always follow the typical sequence. A symptomatic deposit may persist or postcalcific tendinitis develop. The treatment should be based on the knowledge of the natural history of the disease, which shows a strong tendency towards self-healing by spontaneous resorption of the deposit. The stage of evolution of the disease should be judged, combining pain history, morphology of the deposit on plain X-rays, and ultrasound findings. The therapeutic approach depends on the evolution of the disease. During the resorption phase we favor a conservative approach. For deposits which are not under resorption we propose a concept which consists of three steps: a conservative approach, extracorporal shock wave therapy (ESWT) or needling, and arthroscopic surgery. The efficacy of ESWT and needling has still to be proven. Patients with persisting pain after steps 1 and 2 are candidates for surgical removal of the deposit. We prefer the arthroscopic approach. In some cases an additional arthroscopic subacromial decompression (ASD) is indicated.

Adult↗
PubMed2000

[Ruptures of the anterior cruciate ligament (ACL) during growth].

Tears of the anterior cruciate ligament (ACL) in skeletally immature patients with open physes are becoming more frequent. The two main variants of this lesion include tibial eminence fractures with an avulsion of the bony avulsions of the ACL on the tibia and midsubstance ligament injuries. The treatment of bony avulsions is generally accepted. In complete midsubstance tears conservative treatment is insufficient, resulting in multiple giving way episodes and meniscal lesions. Controversy exists regarding the surgical treatment of complete midsubstance ruptures. Especially in younger patients with wide open physes, the risk of a growth disturbance due to transphyseal drilling has not been completely evaluated. In patients approaching physeal closure intraarticular ACL replacement using an autogenous bone-patellar tendon-bone graft has been shown to yield good short-term to mid-term results. There is a growing concern regarding the long-term outcome of ACL grafts with higher rerupture rates being suspected in children compared to adults. For these reasons more clinical and experimental data are needed in forthcoming studies.

Adult↗
PubMed1999

Ligament graft initial fixation strength using biodegradable interference screws.

The objective of this study was to evaluate the initial fixation strength of three types of biodegradable interference screws [an Endo Fix, 7 x 25 mm polyglycolic acid, non-self-tapping (Acufex); a biodegradable interference screw, 7 x 23 mm poly-L-lactic acid, self-tapping (Arthrex); a Bioscrew, 7 x 25 mm poly-L-lactic acid, self-tapping (Linvatec)] in comparison to a titanium interference screw (Linvatec, 7 x 25 mm) in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. To control for specimen related bias, bone mineral density of each tibia was measured. All specimens were loaded to failure. Failure mode was determined by visual analysis. The maximum load to failure [mean (SD)] was 785 (87) N (titanium screw), 555 (60) N (Acufex), 592 (211) N (Arthrex), and 844 N (Linvatec). The primary fixation strength of the titanium screw and the Linvatec screw was significantly higher (p < 0.05) than the primary fixation strength of the Arthrex screw and the Acufex screw. There was no difference in bone mineral density between the groups. With respect to primary fixation strength, all biodegradable screws were strong enough to allow accelerated rehabilitation. From this point of view the biodegradable screws may be a reasonable alternative to titanium interference screws.

Absorbable Implants↗
PubMed1999

[Arthroscopy for diagnosis and therapy of early osteoarthritis of the hip].

Failure to conservative treatment in patients with less advanced radiographic signs of osteoarthritis of the hip (Danielsson grade 2-5) confronts with the decision of further treatment. Since radiographic imaging has not been proved very useful in demonstrating intraarticular structures and results of hip arthroscopies have been promising, arthroscopies have been performed in 17 hips from November 1997 to September 1998. Arthroscopic findings were exceeding preoperative imaging. In addition to cartilage degeneration, concomitant loose bodies, impinging osteophytes, degeneration of the labrum and synovial disease were found. Removal of loose bodies and osteophytes, partial resection of labral tears and partial synovectomy were performed. 1 month after arthroscopy (n = 15), mean Harris-Hip-Score was increased by 13 points und pain reduced by 39 % on average. 6 months after arthroscopy (n = 9), mean Harris-Hip-Score was increased by 14 points and pain reduced by 32 % on average. In addition to its therapeutic benefit, arthroscopy offers direct visualisation of the hip providing important information for the decision of further treatment.

Arthroscopy↗
PubMed1999

Popliteal cyst accompanied by an intra-articular cartilage lesion in a child.

The case of an 11-year-old girl presenting with a symptomatic popliteal cyst is described. There was no previous knee trauma nor could any inflammation be found. On MRI a concomitant retropatellar cartilage lesion had been detected preoperatively and was confirmed and treated by arthroscopy. The prevalence and treatment of popliteal cysts in children are discussed. Whereas in adults popliteal cysts are generally accompanied by intra-articular lesions, the presence of a concomitant intraarticular lesion in children is an extremely rare finding. We conclude that intraarticular lesions in the presence of popliteal cysts might have been underestimated as most of the studies regarding popliteal cysts in children were undertaken before the advent of arthroscopy, ultrasound, or MRI.

Child↗
PubMed1999

Prevalence of popliteal cysts in children. A sonographic study and review of the literature.

Popliteal cysts in children differ from those in adults. They are considered to be less frequent and usually appear in the absence of intra-articular lesions. However, their prevalence in asymptomatic children is unknown. We present a prospective epidemiological study of 168 asymptomatic children under 15 years of age hospitalised for various pathologies. Children with knee problems and rheumatic diseases were excluded from the study. The children were examined ultrasonographically with a 7.5 MHz linear scanner. A popliteal cyst could be identified in 4 patients. The prevalence of asymptomatic popliteal cysts was thus 2.4%. For 2 of these patients, we obtained magnetic resonance image of the knee which showed no concommitant intra-articular pathology.

Adolescent↗
PubMed1999

Resulting tensile forces in the human bone-patellar tendon-bone graft: direct force measurement in vitro.

The objective of this study was to measure the resultant force in the human bone-patellar tendon-bone graft after reconstruction of the anterior cruciate ligament under various conditions in vitro. Seven fresh-frozen cadaver lower extremities were used. Force measurement was made with a quartz force transducer mounted in a specially designed load cell. The effect of passive extension movement, quadriceps pull, varus torque, and valgus torque on the resultant force in the ligament were investigated. Passive extension of the joint generated a rapid increase of force in the graft between 30 degrees and 0 degrees of flexion, reaching its maximum (128+/-25 N) at full extension. When quadriceps pull was applied to extend the joint, resultant force increased at 50 degrees of flexion and reached its maximum (219+/-25 N) at full extension. Additional resistance applied to the level of the ankle joint generated an additional load of the graft. Increase of forces in the ligament resulted from both varus and valgus applied moments.

Aged↗
PubMed1999

Meniscal substitutes--animal experience.

Animal studies have shown that meniscus allografts and tendon autografts generally heal to the capsule, are revascularized and repopulated with host cells. In animals, neither meniscal allografts nor tendon or fat autografts gain the properties of a normal meniscus. Meniscus allografts and tendon autografts are promising as both seem to offer some protection to the cartilage of the tibial plateau. There is no evidence that meniscal transplantation can prevent cartilage degenerative changes, and the long-term effect of meniscal transplantation on articular cartilage remains unknown. Whether cellular repopulation of the meniscal allograft is sufficient to restore its biomechanical properties is unknown. Collagen scaffolds and tissue engineered grafts are still under investigation, showing promising results especially for the former. Viable meniscal allografts should be implanted within 1 to 2 weeks after harvesting, as the production of proteoglycans decreases after 2 weeks.

Animals↗
PubMed1999

Postoperative follow-up and rehabilitation after meniscus replacement.

Even though basic scientific knowledge about the meniscal loading pattern may advocate restrictive rehabilitation after meniscus repair, experience and one controlled study favour accelerated rehabilitation. The current protocols for rehabilitation after meniscal substitution follow personal experience with parameters such as pain, effusion, locking, and gait pattern used as clinical guidance. Controlled clinical studies on rehabilitation should be encouraged. An example of a rehabilitation protocol is given. As meniscus replacement is a new treatment option, it is essential to document details about the graft, the knee status at operation and the surgical procedure. The goal of a postoperative follow-up is to control quality, to measure patient satisfaction and to show whether meniscus replacement is beneficial in relation to the natural history of meniscectomy cases. There is a need for a standard follow-up evaluation of patients after meniscus replacement, and the development of a meniscus transplantation score including subjective and objective data is suggested.

Humans↗
PubMed1997

[Injuries during handball. A comparative, retrospective study between regional and upper league teams].

To evaluate the injuries in Team Handball 186 male players out of 16 teams were questioned retrospectively at the end of a season. An important difference between practice and competition injuries could be found with an injury rate of 0.8 injuries per 1000 training hours and 13.5 injuries per 1000 playing hours. Injuries were predominant at the lower extremities with ankle injuries being the most frequent injury type. 2/3 of the playing injuries occurred in offense. 1/3 of these offense injuries could be attributed to a counter-attack. These injuries were generally more severe which lead us to a proposition of changing the rules of the game in foul plays in this situation. Elbow injuries in goalkeepers and shoulder injuries in throwers were specific for these types of players. Prophylactic braces were used by nearly 2/3 of the players.

Adult↗
PubMedDate not supplied

Cortical versus cancellous interference fixation for bone-patellar tendon-bone grafts.

The objective of this study was to evaluate the initial fixation strength of a metal interference screw (9 x 25 mm; Arthrex, Naples, FL) with respect to its position relative to the bone plug in anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft. Porcine lower limbs were used. In group 1 (n = 20) the screw was placed adjacent to the cortex of the bone plug. In group 2 (n = 20) the screw was placed between the cancellous surfaces of the tibial tunnel and the bone plug. Specimens were loaded to failure using an universal material testing machine. Failure mode was defined by visual analysis of the specimens after loading. Primary fixation strength was not significantly different for both groups. Maximum force was 779 +/- 179 N (group 1, cortical side) and 743 +/- 143 N (group 2, cancellous side). There was a difference in failure modes. In group 1, testing resulted predominantly in tendon ruptures and bone plug fractures (70%). In group 2, bone plug pullouts were predominant (75%). From these data we conclude that the position of the screw relative to the bone plug influences failure mode but not the initial fixation strength.

Animals↗
PubMedDate not supplied

Preoperative ultrasonographic mapping of calcium deposits facilitates localization during arthroscopic surgery for calcifying tendinitis of the rotator cuff.

Calcifying tendinitis is a relatively common disorder of the rotator cuff. For symptomatic patients, excision of the calcium deposits offers reliable pain relief. The arthroscopic technique is demanding. Arthroscopic localization of the deposit is frequently demanding. The technique described in this article facilitates the localization of calcium deposits based on preoperative ultrasonography. Knowing the exact topography of the deposit relative to the visible landmarks allows the surgeon to localize the site of the deposit from the intra-articular view. Probing the rotator cuff with a spinal needle and looking for calcific material at the tip of the needle is an important step in verifying the location of the deposit.

Arthroscopy↗
PubMedDate not supplied

Age-related prevalence of rotator cuff tears in asymptomatic shoulders.

To determine the prevalence of rotator cuff tears in asymptomatic shoulders we conducted a prospective clinical and ultrasonographic study of 411 volunteers. We anticipated an age-dependent outcome and divided the patients into 4 age-groups. Overall, we found evidence of a rotator cuff tear in 23% of the patients. In group 1 (aged 50 to 59 years), 13% (22 of 167) of the patients had tears; in group 2 (aged 60 to 69 years), 20% (22 of 108) of the patients had tears; in group 3 (aged 70 to 79 years), 31% (27 of 87) of the patients had tears; and in group 4 (age > 80 years), 51% (25 of 49) of the patients had tears. An astonishingly high rate of rotator cuff tears in patients with asymptomatic shoulders was thus demonstrated with increasing patient age. At this stage it remains unclear, however, which parameters convert an asymptomatic rotator cuff tear into a symptomatic tear. As a result, rotator cuff tears must to a certain extent be regarded as "normal" degenerative attrition, not necessarily causing pain and functional impairment.

Aged↗