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Biomedical subjects

R Verdonk

Publications and source records attributed to R Verdonk.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Long-term assessment of arthroscopic meniscus repair].

PURPOSE OF THE STUDY: A prospective study was set up to evaluate meniscal suturing using an inside-out technique. MATERIALS AND METHODS: Of an initial group of 20 patients who underwent closed meniscus repair between 1985 and 1988 using an inside-out technique, 13 were studied. All patients were subjected to a clinical examination and an magnetic resonance imaging (MRI) investigation. The findings were compared with those of their previous follow-up examination (1994). The Hospital for Special Surgery (HSS) knee rating system was used. The study included 7 men and 6 women, ranging in age from 29 years to 50 years (mean age: 35 years 6 months). The mean follow-up was 13 years 2 months (11 years 11 months-15 years 4 months). Six left and 7 right knees were involved. Seven patients also had an anterior cruciate ligament (ACL) injury of which one was repaired 6 years after meniscal repair. RESULTS: All patients obtained an HSS score of more than 75%. In all patients the site of the previous suture was still visible on MRI mainly by small metal artefacts in the meniscus. Patients with an unrepaired ACL lesion had an early onset of arthrosis and cartilage degeneration. CONCLUSION: Meniscal suturing gives good clinical long-term results. Magnetic resonance imaging, however, showed signs of mucoid degeneration or scar tissue in 46% of the patients.

Adult↗
PubMed2002

A correlation study of objective functionality and WOMAC in total knee arthroplasty.

Function studies after total knee arthroplasty (TKA) generally use either self-reported instruments or objective quantitative measurements of walking activities, but it is unclear how objective factors influence self-reports. This retrospective multicenter study assessed the impact of objective variables on subjective self-reported functional outcome after TKA in 128 patients at a mean of 41 months after TKA. Self-reported disability was measured by the Western Ontario and McMaster University (WOMAC) scale, and the quality of walking and representative daily activities were determined objectively by the DynaPort knee test. Objective assessment was found to be a poor predictor of WOMAC abnormality, with correlations of 0.343, 0.246, and 0.269 with WOMAC function, stiffness, and pain, respectively. The results of WOMAC are thus strongly influenced by factors other than quantitative parameters of the lower extremity. These findings provide support for including an objective assessment of activities of daily living together with a subjective self-report.

Activities of Daily Living↗
PubMed2002

Meniscal transplantation.

The aims of a meniscal replacement are: 1) to reduce the pain experienced by some patients following meniscus resection; 2) to prevent the degenerative changes of cartilage and the changes in subchondral bone following meniscus resection; 3) to avoid or reduce the risk of osteoarthritis following meniscus resection; 4) to restore optimally the mechanical properties of the knee joint after meniscal resection. The results of meniscus transplantation have been studied in animals. There is no proof from these experiments that replacement of a meniscus can reduce the risk of arthritis, but there are indications that it can decrease the development of cartilage degeneration. In humans, the results of meniscus transplantation have been reported in several series of patients, operated with different techniques. There are no controlled studies of meniscus replacement in humans. In case of meniscal allograft implantation surgery should be minimally invasive, not sacrificing the original meniscal insertion points. It appears preferable to use an open technique in medial transplantation, whereas the arthroscopic approach appears to allow for easier lateral implantation.

Animals↗
PubMed2002

[Results of an inverted shoulder prosthesis after resection for tumor of the proximal humerus].

PURPOSE OF THE STUDY: Treatment of primary bone tumors of the proximal humerus is a major challenge, both in terms of oncological cure and limitation of functional handicap. Extracorporal radiation and reimplantation have provided satisfactory results for the treatment of bone tumors and the inverted shoulder prosthesis has be found to be effective in treating rotator cuff deficiency. We therefore assessed patients treated with a combination of these two treatments in order to search for a better functional outcome. MATERIAL AND METHODS: Conservative resection of the tumor with reconstruction using an inverted shoulder prosthesis was performed in six patients with a tumor of the proximal humerus of type Ia or Ib in the Malawer classification or type S3-S4-S5 in the Musculoskeletal Tumor Society classification. Patients whose tumor involved the deltoid or the glenohumeral joint were not considered for this procedure. The series included four men and two women (4 left and 2 right shoulders) aged 51 years on the average at the time of surgery. RESULTS: Mean follow-up was 12 months. The mean age- and sex-adjusted Constant score was 74% (70-85%). The patients were generally satisfied and were able to continue their daily activities. There were two displacements, one of which was diagnosed immediately and reduced without anesthesia. An abduction pad was worn for six months after reduction. The post-operative period was uneventful. No local recurrence has been observed. DISCUSSION: Our results compared favorably with other therapeutic options for resection-reconstruction reported in the literature: functional outcome was better and more predictable, at least in the short term; oncological results were satisfactory although the follow-up is short, particularly for the three primary malignant tumors. It is known however that the long-term oncology result depends on the quality of the resection and the efficacy of the extracorporeal radiation. Shoulder motion outcome was the least satisfactory in patients who experienced peri-operative complications. We were unable to find any relation between less satisfactory functional outcome and the number of surgical procedures for local recurrence before extracorporeal radiation and arthroplasty (deltoid dystrophy). Normal deltoid function appeared to be crucial for optimal functional outcome with this prosthesis which allows sacrifice of the rotators. The rate of complications was low and recovery of active shoulder movement was more rapid. Despite the short-term nature of these results, and despite the risk of loosening, the inverted shoulder prosthesis appears to be an interesting therapeutic option for these patients.

Activities of Daily Living↗
PubMed2001

Patellar tendon vs. doubled semitendinosus and gracilis tendon for anterior cruciate ligament reconstruction.

In a prospective study on ACL reconstruction we treated 17 patients with a "central third-bone-patellar tendon-bone" autograft (PT group) and 32 patients with a doubled semitendinosus/doubled gracilis autograft (HS group). Patients were reviewed at 6 weeks, and at 3, 6, and 12 months postoperatively and the groups compared. Up till 6 months, the KT-1000 side-to-side difference was significantly greater in the HS group (P<0.05) and at 6 and 12 months isokinetic hamstrings strength was lower (P<0.05). No significant differences were noted at any stage with respect to quadriceps strength, functional scores, range of motion, or swelling.

Adolescent↗
PubMed2001

Culture of chondrocytes in alginate surrounded by fibrin gel: characteristics of the cells over a period of eight weeks.

OBJECTIVE: To produce tissue engineered cartilage by human articular chondrocytes in vitro for further use in in vivo manipulations for the treatment of cartilage defects. METHODS: Human articular chondrocytes were cultured in 0.5%, 1.0%, and 2.0% of alginate for up to four weeks. The optimal concentration of an alginate matrix for cell replication and for aggrecan synthesis by chondrocytes was determined. DNA content in the different culture conditions was measured after two and four weeks. Aggrecan synthesis rates and accumulation in the surrounding extracellular matrix were assessed by [(35)S]sulphate incorporation after the same periods of culture. To follow the outgrowth of chondrocytes from the alginate beads, chondrocytes were cultured for four weeks in 0.5 or 1.0% alginate surrounded by 0.25 or 0.5% fibrin gel. DNA content of each culture was measured after different culture periods. Finally, human chondrocytes in 1.0% alginate beads were embedded in 0.5% fibrin gel for eight weeks. Immunohistochemical analysis for aggrecan, type I and II collagen was performed weekly. RESULTS: At two weeks the DNA content in each culture significantly increased in 0.5 and 1.0% alginate cultures in comparison with baseline values. This increase continued until week 4 at the three alginate concentrations. Aggrecan synthesis at two weeks was highest in 0.5 and 1.0% alginate cell cultures. At four weeks aggrecan synthesis rates decreased independently of the alginate concentrations. Aggrecan mainly accumulated in the interterritorial matrix. Proliferation of chondrocytes in alginate and outgrowth of these cells in the surrounding fibrin gel were evident throughout the culture period. The accumulation of aggrecan and type II collagen around the cells, in alginate as well as in fibrin gel, gradually increased over the culture period. Type I collagen appeared after six weeks in alginate and in the surrounding fibrin. CONCLUSION: Human chondrocytes proliferate in this culture system, show an outgrowth into the surrounding fibrin, and synthesise a cartilage-like matrix for up to eight weeks.

Aggrecans↗
PubMed2001

Fluorine-18 fluorodeoxyglucose-position emission tomography: a highly accurate imaging modality for the diagnosis of chronic musculoskeletal infections.

BACKGROUND: The noninvasive diagnosis of chronic musculoskeletal infections remains a challenge. Recent studies have indicated that fluorine-18 fluorodeoxyglucose-positron emission tomography is a highly accurate imaging technique and is significantly more accurate than the combination of a bone scan and a white blood-cell scan for the diagnosis of chronic infection in the central skeleton (p < 0.05). However, patients who had had surgery within the previous two years were excluded from study. It was our aim to evaluate the technique in an unselected, clinically representative population. METHODS: Sixty patients with a suspected chronic musculoskeletal infection involving the central skeleton (thirty-three patients) or the peripheral skeleton (twenty-seven patients) were studied with fluorine-18 fluorodeoxyglucose-positron emission tomography. Thirty-five patients had had surgery within the previous two years. The fluorine-18 fluorodeoxyglucose-positron emission tomography studies were read in a blinded, independent manner by two experienced readers. The final diagnosis was based on histopathological studies or microbiological culture (eighteen patients) or on clinical findings after at least six months of follow-up (forty-two patients). RESULTS: On the final composite assessment, twenty-five patients had infection and thirty-five did not. All twenty-five infections were correctly identified by both readers. There were four false-positive findings; in two of these cases, surgery had been performed less than six months prior to the study. The sensitivity, specificity, and accuracy were 100%, 88%, and 93% for the whole group; 100%, 90%, and 94% for the subgroup of patients with a suspected infection of the central skeleton; and 100%, 86%, and 93% for the subgroup of patients with a suspected infection of the peripheral skeleton. Interobserver agreement was excellent (kappa = 0.97). CONCLUSIONS: Fluorine-18 fluorodeoxyglucose-positron emission tomography is highly accurate as a single technique for the evaluation of chronic musculoskeletal infections. It is especially valuable in the evaluation of the central skeleton, where white blood-cell scans are less useful. Because of its simplicity and high degree of accuracy, it has the potential to become a standard technique for the diagnosis of chronic musculoskeletal infections. Further studies are needed to assess its ability to identify infections at the sites of total joint replacements and to distinguish infection from aseptic loosening of these prostheses.

Adolescent↗
PubMed2001

Neurofibromatosis, gigantism, elephantiasis neuromatosa and recurrent massive subperiosteal hematoma: a new case report and review of 7 case reports from the literature.

The authors report the case of a 13-year-old patient with neurofibromatosis (NF-I), who suffered blunt trauma to the left tibia in 1993. The diagnosis of subperiosteal hematoma was made. Treatment consisted of temporary rest. There was a recurrence in 1996, and the subperiosteal hematoma was drained. In 1997, a shortening osteotomy of the left tibia was performed. However, massive gigantism with elephantiasis of the left leg remained, causing a serious functional and cosmetic problem. In 1999, the leg was amputated above the knee. The literature is reviewed and 7 case reports are compared. The pathogenesis of subperiosteal hematoma is discussed.

Adolescent↗
PubMed2001

Repair of chronic ruptures of the anterior cruciate ligament using allograft reconstruction and a ligament augmentation device.

A prospective study was performed to determine the effect of a ligament augmentation device (LAD) on the replacement of the anterior cruciate ligament (ACL) using tendon allografts. Twenty-five patients were followed for 66 to 98 months after tendon allograft replacement with LAD reinforcement for ACL rupture. The evaluation was done using the form of the International Knee Documentation Committee (IKDC), the Lysholm score and the Tegner scale. Two patients sustained a rerupture after major injury. Three other multiply-injured patients scored poorly because of associated injuries and fractures (IKDC grade D). Four patients scored normal (grade A), 12 patients nearly normal (grade B), and 5 patients abnormal (grade C). The Lysholm score showed 14 excellent (average 96), 5 good (average 86) and 4 fair results (average 76). Three patients with excellent results were IKDC grade C, solely because the xrays showed slight narrowing of the medial joint line, which might indeed indicate future problems. On the Tegner scale, the sports level decreased by an average of 1.4 points (from 7.25 to 5.83). Only five patients showed an anteroposterior displacement of more than 3 mm, of which only one was in the grade C group.

Adult↗
PubMed2001

Revision of shoulder replacement with a reversed shoulder prosthesis (Delta III): report of five cases.

The authors report on their experience in revision total shoulder arthroplasty using the Delta III shoulder prosthesis, a reversed constrained prosthesis which is known to give good functional results in the rotator cuff-deficient shoulder. It was implanted in patients with a failed total or hemishoulder prosthesis. The Constant-Murley score was used to assess the functional outcome. The preliminary results achieved in four patients (one bilaterally) are discussed and compared with the results of other treatments. After two years follow-up, the Constant-Murley score has improved from 14/100 preoperatively to 62/100 postoperatively. Although these initially good functional results may be temporary and loosening may occur over the longer term, the authors recommend the Delta III shoulder prosthesis as an alternative solution for revision shoulder arthroplasty.

Adult↗
PubMed2001

Parosteal osteosarcoma of the humerus.

The authors report the case of a 50-year-old man who presented with nontraumatic swelling of the left upper arm. The diagnosis of parosteal osteosarcoma of the humerus was made after diagnostic workup. A long diaphyseal segment of the humerus containing the tumor was resected with a healthy margin of soft tissues and was irradiated extracorporeally with a single dose of 30 Gray. The bony segment was then reimplanted after removal of the tumor using plate and screw fixation. Loosening of the proximal screws after one year required additional fixation and autologous cancellous bone grafting. The patient has a nearly three-year-follow-up and there are no signs of tumor recurrence or metastasis. The proximal osteotomy has healed nicely; the distal fixation osteotomy exhibits delayed healing. The pathogenesis of parosteal osteosarcoma is discussed.

Bone Neoplasms↗
PubMed2000

Biofix resorbable meniscus arrow for meniscal ruptures: results of a 1-year follow-up.

Modern individuals with a long and healthy life expectancy perform more and more physical activities both in daily life and in sport. This demanding life-style forces the surgeon to perform less radical surgery for meniscal ruptures, thus avoiding the early degenerative changes which frequently occur in totally or partially meniscectomized knees. When repair is possible, meniscal suture must be considered. Various arthroscopic techniques of meniscus suturing have been reported. "Inside-out," "outside-in," and more recently "all-inside" techniques can be used. Complications include saphenous and peroneal nerve damage and vascular lesions. The Biofix arrow fixation technique, which is an all-inside procedure, is easier and in our hands less time-consuming than other arthroscopic suturing techniques. Postoperatively, partial weight bearing is prescribed for 3 weeks. Progressive return to sport activity is allowed after 3 months. Twenty-five patients (26 meniscal repairs) with a mean age of 31.6 years (13-57) were reviewed. Follow-up averaged 16.7 months (12-22). The evaluation was based on the modified Marshall knee score. Three patients had an extra-articular reconstruction for anterior cruciate ligament deficiency, and five had an arthroscopic ACL reconstruction with a ligament allograft. The results were excellent or good in 22 patients (88% "satisfactory" outcome). Three patients had poor results. One patient with a new trauma presented a lateral meniscal lesion associated with an ACL rupture. The Biofix arrow fixation technique allows safe fixation of meniscal ruptures, specifically of posterior horn lesions where injury of neurovascular structures is not uncommon.

Adolescent↗
PubMed2000

The Oxford unicompartmental knee prosthesis: a 5-year follow-up.

We present our medium-term results with the Oxford unicompartmental knee prosthesis for unicompartmental osteoarthrosis. After an average of 58 months the mean on the Hospital for Special Surgery knee score in 38 medial and 3 lateral prostheses (39 patients) was 87. There were three revisions; in the remaining 36 patients the results were: 29 excellent, 3 good, 2 moderate, and 2 poor. In two of the three revisions and in two of the four poor and moderate results, the indications for the procedure were debatable. Our findings confirm the good results reported in other studies and underline the importance of adhering to strict indications to reduce the number of poor results.

Aged↗
PubMed2000

Closed intramedullary tibial nailing using the Marchetti-Vicenzi nail.

We present the results of using the Marchetti-Vicenzi nail in the management of 41 closed and 16 type I-III open tibial fractures in 56 patients. The treatment goals were to achieve stability and fracture alignment allowing early functional treatment of the knee and ankle by immediate partial or full weight-bearing. Early callus formation and rapid mobilisation were obtained in 84% of the patients. The mean time to clinical union was 9.8 weeks (radiological union 28.4 weeks) for closed fractures and also 9.8 weeks for open fractures (radiological union 28.7 weeks). No late rotational deformities were observed. We argue that intramedullary nailing with a Marchetti-Vicenzi nail is a quick and excellent method of treating selected closed and open tibial fractures.

Adolescent↗
PubMed2000

Comparison of palmar tilt, radial inclination and ulnar variance in left and right wrists.

Standard radiographs of both wrists of 50 healthy volunteers were taken. The mean differences between the right and left wrists were 1. 5 degrees for radial inclination, 0.5 mm for ulnar variance and 2.5 degrees for palmar tilt. The variability of the left-right differences were compared with the variability of the whole group and were significantly less for radial inclination, ulnar variance and palmar tilt. We conclude that both wrists of one individual can be considered as symmetrical for the tested parameters and that the contralateral wrist provides a better reference than population data.

Adult↗
PubMed2000

Treatment of bone and joint infections: recommendations of a Belgian panel.

A multidisciplinary panel of Belgian specialists describes the overall therapeutic approach for bone and joint infections. Classification, general methods of investigation, therapeutic options, special circumstances, the role of aminoglycosides and of glycopeptides are described. The possibility of home treatment is discussed, as well as some pharmaco-economic insights.

Ambulatory Care↗
PubMed2000

The role of osteoporosis in distal radius fractures.

Our study was designed to establish whether the degree of osteoporosis of the distal forearm affects the outcome of distal radius fractures in elderly women. We assessed the Gartland and Werley score, wrist mobility, grip strength, ulnar variance, radial inclination and palmar tilt of both wrists in 27 postmenopausal women who had sustained a unilateral distal radius fracture following a simple fall. Bone mineral density of the contralateral uninjured wrist and mid-tibial ultrasound velocity were measured. The Gartland and Werley score, wrist mobility, loss of grip strength and the radiological results of the fractured wrist did not correlate with bone mineral density of the uninjured distal radius or with mid-tibial ultrasound velocity. These results may indicate that the influence of osteoporosis on the radiological and clinical outcome in distal radius fractures is not very important.

Aged↗