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Biomedical subjects

S D Barber-Westin

Publications and source records attributed to S D Barber-Westin.

At least 19 recordsLinked to original sources
PubMed2001

Revision anterior cruciate surgery with use of bone-patellar tendon-bone autogenous grafts.

BACKGROUND: A prospective study was done to determine the functional results, patient satisfaction, and graft failure rate after fifty-seven consecutive revision replacements of the anterior cruciate ligament with use of a bone-patellar tendon-bone autogenous graft. METHODS: Fifty-four patients (fifty-five operations) were followed in this study. Concurrent operative procedures were performed during the revision procedure in thirty-seven knees (67%). These procedures included repair of a meniscal tear in twenty knees (36%) and reconstruction of deficient posterolateral or medial ligament structures in seventeen knees (31%). Nine knees (16%) had a high tibial osteotomy to correct varus malalignment before the revision operation. The results were evaluated with the Cincinnati Knee Rating System. RESULTS: There were significant improvements in the scores for pain (p < 0.0001), activities of daily living (p < 0.01), sports participation (p < 0.001), patient satisfaction (p < 0.0001), and overall rating of the knee (p < 0.0001). Thirty-three (60%) of the replaced ligaments were functional, nine (16%) were partially functional, and thirteen (24%) had failed. CONCLUSIONS: Many knees (93%) had compounding problems, including articular cartilage damage, prior meniscectomy, loss of secondary ligament restraints, varus malalignment, and concomitant ligament replacement or meniscal repair. Therefore, the results were generally less favorable than those following primary operations. The rate of graft failure was three times higher than our previously reported failure rate after primary replacements of the anterior cruciate ligament with a bone-patellar tendon-bone autogenous graft. Even so, symptoms and functional limitations with regard to daily and sports activities were found to have decreased and patient satisfaction improved. We advocate correction of varus malalignment prior to anterior cruciate procedures. Associated posterolateral ligament deficiencies should be surgically corrected during anterior cruciate procedures to prevent excessive loading on the graft from abnormal lateral tibiofemoral joint opening. Meniscal tears, including complex tears that extend into the avascular zone, can be concurrently repaired successfully during the revision.

Activities of Daily Living↗
PubMed2000

Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees.

We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0 degrees to at least 135 degrees) was found in 436 knees (98%), and mild losses of extension (-5 degrees) were found in 7 knees. Twenty-three knees (5%) required interventions; 9 had extension casts, 9 had gentle manipulations under anesthesia, 3 had arthroscopic debridements, and 2 had continuous epidural anesthetic and inpatient therapy. All of these 23 knees regained full motion. The 7 patients with mild losses of extension had refused treatment intervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% reoperation rate for knee motion limitations, demonstrated the effectiveness of our program.

Adolescent↗
PubMed2000

Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older.

PURPOSE: The purpose of this study was to prospectively determine the outcome of meniscal repairs for tears that extended into the central one-third zone of the meniscus, or had a rim width of 4 mm or greater, in a case series of patients 40 years of age and older. TYPE OF STUDY: Prospective case series. MATERIALS AND METHODS: Thirty meniscal repairs in 29 patients were evaluated by a comprehensive examination (28 repairs) a mean of 34 months postoperatively, by follow-up arthroscopy (6 repairs) a mean of 24 months postoperatively, or both. The mean age of the patients at the time of the meniscal repair was 45 years (range, 40 to 58 years). Twenty-one patients (72%) also had ruptures of the anterior cruciate ligament, which were reconstructed at the time of the meniscal repair with bone-patellar tendon-bone autografts (16 patients) or allografts (5 patients). The Cincinnati Knee Rating System was used to rate symptoms, functional limitations with sports and daily activities, patient perception of the knee condition, and sports and occupational rating levels. RESULTS: At a mean of 33 months postoperatively, 26 meniscal repairs (87%) were asymptomatic for tibiofemoral joint symptoms and had not required subsequent surgery. Three repairs failed to heal, requiring partial meniscectomy, and 1 knee with tibiofemoral symptoms related to the repair was treated conservatively. There was no significant effect of the side of the meniscal repair, chronicity of injury, or condition of the articular cartilage on the presence of tibiofemoral symptoms or meniscal resection. Concomitant anterior cruciate ligament reconstruction appeared to increase the rate of asymptomatic meniscal repairs. The patient rating of overall knee condition was normal/very good in 76%, good in 12%, and fair/poor in 12%. CONCLUSIONS: In athletically active patients, we recommend the preservation of meniscal tissue wherever possible regardless of age, basing indications for the procedure on current and future activity levels.

Adult↗
PubMed1999

Assessment of sports participation levels following knee injuries.

Although there are many published instruments designed to determine outcome following the treatment of knee injuries, only a few incorporate specific assessments of sports activity level and participation into the evaluation. This article reviews 3 of the most commonly used sports activity outcome instruments: the scales devised by Tegner and Lysholm, the Hospital for Special Surgery and the International Knee Documentation Committee. Problems and potential study biases that can arise with improper questionnaire design and data reduction techniques are reviewed, and recommendations are made to correct these problems. The problems identified include: (i) the failure to precisely define sports activity levels according to a specific sport and intensity of participation; (ii) the failure to sort populations according to overall intensity of athletic participation both before and after treatment; (iii) the failure to detect and sort from the population patients who return to sports and experience significant symptoms; (iv) the combination of work and sports activities into the same scale; and (v) the failure to detect alterations in sports participation caused by changes in lifestyle or non-knee-related factors. We have developed a sports assessment instrument, the Cincinnati Sports Activity Scale (CSAS). The methodology used to create this scale, its use in the assessment of return to or change in sports activities, and the assessment of specific functions of daily and sports activities, are briefly reviewed. The CSAS is based on 2 criteria: (i) the frequency of participation; and (ii) the general types of forces experienced by the lower extremity during the sport. The assessment of change in sports activities accounts for modifications in lifestyle and can also detect patients who have returned to sports but are experiencing significant symptoms and problems. Examples of data reduction and reporting are provided to represent practical situations from a prior investigation.

Activities of Daily Living↗
PubMed1998

Arthroscopic-assisted outpatient anterior cruciate ligament reconstruction using the semitendinosus and gracilis tendons.

This study presents an average of 43-month results (range, 23 to 75 months) of 82 arthroscopically assisted, outpatient semitendinosus-gracilis anterior cruciate ligament reconstructions evaluated with the Cincinnati Knee Rating System. There were 44 acute and 38 chronic injuries. The results showed no significant effect of injury chronicity on all outcome variables except knee motion complications. Additionally, no significant difference was found between men and women in regards to outcome. At follow-up, 93% showed complete or partial graft function, 98% had a full range of knee motion, 83% had returned to sports with no problems, and 92% rated their knee condition as normal or very good. The mean overall point score (0 to 100 scale) for all patients was 92 +/- 10 points. All patients with chronic injuries showed improvement from their preoperative status, including 11 who had articular cartilage lesions. Complications were few; only five patients (6%) needed additional treatment for limitation of knee motion, and no patient had an increase in patellofemoral crepitus. We concluded that this procedure produced desirable results and that patients with long-standing functional limitations significantly improved and were able to return to an active lifestyle.

Acute Disease↗
PubMed1998

Decrease in knee joint pain and increase in function in patients with medial compartment arthrosis: a prospective analysis of valgus bracing.

We studied a brace designed to decrease loads on the medial tibiofemoral compartment in knees with chronic pain and arthrosis to determine if pain symptoms decreased, function improved, and dynamic gait characteristics altered during walking. Eighteen patients with symptomatic medial compartment arthrosis were fitted with a commercially available brace. All were evaluated after an average of 9 weeks of brace wear, and 13 patients were evaluated after 1 year of brace wear. The Cincinnati Knee Rating System and additional pain scales were used to analyze symptoms and functional limitations. Nine subjects underwent a dynamic gait analysis and were compared with a control group of 11 normal subjects matched for age and walking speed. The brace was worn an average of 7 hours a day, 5 days a week. Following 9 weeks of brace wear, statistically significant improvements were found for all pain parameters, and these improvements continued at the 1 year evaluation. Before brace wear, 78% had pain with activities of daily living, but after the first evaluation, only 39% continued to have such pain, and at the second evaluation, only 31% were so affected. Before brace wear, patients had a walking tolerance of 51 minutes prior to the onset of pain symptoms. At the first evaluation, patients could walk 138 minutes without pain, and after 1 year, they could walk 107 minutes without pain. Before brace wear, 78% rated their overall knee condition as fair or poor whereas at the first evaluation, only 33% continued to provide this rating. No differences were found in the dynamic gait parameters measured with and without the brace. While this brace did not provide the dramatic improvements in symptoms, function, and patient satisfaction obtainable after high tibial osteotomy, it did help the majority of patients. If the goal of brace use is to buy a short amount of time for patients who cannot undergo or wish to avoid osteotomy or knee arthroplasty, then bracing appears to offer a reasonable alternative for short-term pain relief and improved function.

Adult↗
PubMed1997

A comparison of results of arthroscopic-assisted anterior cruciate ligament reconstruction between workers' compensation and noncompensation patients.

This investigation compared the results of arthroscopic-assisted anterior cruciate ligament patellar tendon autogenous reconstruction in patients who received Workers' Compensation (WC) benefits with results of similar surgery in patients who did not receive such benefits, to determine if differences existed based on this variable alone. Thirty-eight patients (19 WC benefits, 19 NoWC) were matched for age, injury chronicity, number of prior operations, and months of follow-up. All had the same operation and rehabilitation. A significant difference was found between the groups in the mean number of days of lost employment preoperatively (WC, 122 days; NoWC, 3 days) and postoperatively (WC, 222 days; NoWC, 37 days). At follow-up (mean, 27 months), 17 patients in group WC had returned to work (6 with symptoms) and 2 were disabled. All patients in group NoWC had returned to work, 2 with symptoms. There was no significant difference between the groups for anterior-posterior displacements, functional limitations with daily or sports activities, patient perception of the knee condition, the overall rating score, or complications. The number of mean days of lost employment in group WC could not be accounted for from factors that normally effect anterior cruciate ligament reconstruction results. We hypothesize that other factors such as wage systems that support WC injuries long-term, inability of employers to modify job requirements, inability of employees to receive job retraining, or lack of proper immediate diagnosis and treatment of the injury, may have lead to the large number of lost working days in group WC.

Absenteeism↗
PubMed1997

Arthroscopic-assisted allograft anterior cruciate ligament reconstruction in patients with symptomatic arthrosis.

We reviewed the results of arthroscopic-assisted anterior cruciate ligament (ACL) allograft reconstruction in 40 patients who had advanced articular cartilage deterioration documented by arthroscopy during the reconstruction. A mean of 7 years had elapsed between the original injury and the reconstruction, and 102 prior operative procedures had been done in 34 of the 40 patients. A total of 64 articular cartilage lesions were noted; 34 knees had lesions in the medial or lateral tibiofemoral compartment. Postoperatively, all had immediate motion and early functional rehabilitation. The results were assessed using the Cincinnati Knee Rating System. At follow-up (mean, 37 months), significant improvements were found for pain, giving-way, and functional limitations with daily and sports activities (P < .01). Fifty-five percent had returned to mostly light athletics (avoiding high impact sports) based on our advice and were asymptomatic. The mean overall rating scores significantly improved (P < .0001, mean improvement 22 points). We concluded that the majority of patients in this study with chronic ACL rupture and post-traumatic arthrosis benefited short-term from arthroscopic-assisted ACL reconstruction.

Adult↗
PubMed1996

Revision anterior cruciate ligament surgery: experience from Cincinnati.

Prospective studies were done to determine the outcome of allografts and autografts used for revision anterior cruciate ligament reconstruction. The allograft group was comprised of 65 patients observed for a mean of 42 months postoperatively; the autograft (bone-patellar ligament-bone) group contained 20 patients observed for a mean of 27 months postoperatively. KT-2000 testing and a comprehensive knee examination were done on all the patients. The Cincinnati Knee Rating System was used for assessment. Significant improvements were noted in all patients for symptoms, functional limitations, anteroposterior displacements, pivot shift tests, and overall rating scores. KT-2000 results showed 53% of the allograft group and 67% of the autograft group had less than 3 mm increased displacement (not statistically significant). The overall failure rates were 33% for the allografts and 27% for the autografts. Preoperative planning and technical aspects of anterior cruciate ligament revision procedures are described. The authors prefer bone-patellar ligament-bone autografts for anterior cruciate ligament revision, although the data presented were considered preliminary. Bone-patellar ligament-bone allografts may be used when autogenous tissues are not available, because they offer reasonable success rates for patients who are symptomatic with daily activities.

Adolescent↗
PubMed1996

Reconstruction of the anterior cruciate ligament with human allograft. Comparison of early and later results.

Sixty-eight patients who had had reconstruction of an acute rupture of the anterior cruciate ligament with either a fascia lata or a bone-patellar ligament-bone allograft returned for two follow-up evaluations, at two to four years and at five to nine years (mean, seven years) postoperatively. The early (two to four-year) results in these patients have been reported previously. The mean time between the early and the later evaluation was fifty-six months (range, twenty to ninety-six months). At the early evaluation, fifty-two (78 per cent) of the sixty-seven patients who were tested with an arthrometer at eighty-nine newtons had less than three millimeters of increased anterior-posterior displacement compared with that of the contralateral limb; at the later evaluation, fifty-four (79 per cent) of the sixty-eight patients had this finding (p=0/97). With use of arthrometric and pivot-shift-test data, forty-eight (75 per cent) of sixty-four grafts were classified as functional at the early evaluation and fourteen (22 per cent), as partially functional; two (3 per cent) had failed. (Four grafts could not be classified because of incomplete data.) At the later examination, fifty (74 per cent) of the sixty-eight grafts were functional, thirteen (19 per cent) were partially functional, and five (7 per cent) had failed. At the early evaluation, sixty-two (93 percent) of sixty-seven patients had no palpable patellofemoral crepitus and five (7 per cent) had moderate crepitus. At the later evaluation, fifty-one (75 per cent) of the sixty-eight patients continued to have no crepitus, sixteen (24 per cent) had moderate crepitus, and on (1 per cent) had severe crepitus. An increase in crepitus between the early and the later evaluation was found in twelve (19 per cent) of the sixty-two patients who had normal crepitus at the early evaluation. With the numbers available, no factor, such as the type of graft, associated ligamentous injury, or meniscal repair, correlated significantly with the amount of patellofemoral crepitus at either follow-up evaluation. At the early evaluation, the result was rated excellent or good for thirty-eight (60 per cent) of sixty-three patients, fair for twenty-one (33 per cent), and poor for four (6 per cent). (The result could not be rated for four patients because of incomplete data.) At the later evaluation, the result was rated excellent or good for forty-five (66 per cent) of the sixty-eight patients, fair for eighteen (26 per cent), and poor for five (7 per cent). For nine patients (13 per cent), the over-all rating deteriorated from excellent or good at the early evaluation to fair or poor at the later examination. For six patients (9 per cent), the rating improved from fair at the early evaluation to excellent or good at the later evaluation. With the numbers available, we could detect no significant decrease in anterior-posterior displacement of the knee, patellofemoral crepitus, the pain or the jumping score, or the over-all knee rating over the time-period studied. While we currently recommend arthroscopically assisted reconstruction with a bone-patellar ligament-bone autogenous graft as the first choice for an acute rupture of the anterior cruciate ligament, our study shows that favorable results can be obtained with allografts and justifies their use when the surgeon and patient choose this approach.

Acute Disease↗
PubMed1996

Technical considerations in the management of complex meniscus tears.

Meniscal repair continues to be an important procedure in patients with meniscal tears. The orthopedic literature has recommended excision of complex tears or tears that are located in the central avascular region. For the past 13 years, the authors have repaired all meniscal tears that can be reduced anatomically and that have healthy tissue that will support the multiple sutures required for a stable repair, regardless of tear pattern or location. Correct patient selection criteria continue to be important. In all cases, the risks of complications and retear must be considered carefully and judged against the potential benefits of repair. A postoperative rehabilitation program that allows early range of motion, and progression of weight bearing is not detrimental to the healing process if the repair is stable. Close postoperative follow-up examinations are necessary to determine the incidence of meniscal symptoms; however, the absence of joint line pain, catching, locking, or effusion does not guarantee complete healing of the tear. Follow-up arthroscopy is currently the most accurate method to determine if complete or partial healing has occurred.

Adolescent↗
PubMed1994

Posterior cruciate ligament allograft reconstruction with and without a ligament augmentation device.

Twenty-five patients with posterior cruciate ligament ruptures were treated with either allograft reconstruction alone (10 patients) or with an allograft-ligament augmentation device composite (15 patients). At follow-up (mean 45 months) the results were assessed with the Cincinnati Knee Rating System. There were no significant differences between the two groups for symptoms, functional limitations, sports activity levels, or the overall rating score. The ligament augmentation device provided no benefit. In both groups, the allograft and the allograft composite restored posterior stability at lower functional knee flexion angles, but not uniformly at higher flexion angles (70 degrees). Patients with acute ruptures faired significantly better than did those with chronic ruptures because they had lower anterior-posterior displacements and fewer symptoms and functional limitations. We recommend consideration of early arthroscopic posterior cruciate ligament reconstruction for acute ruptures in active patients. An immediate knee motion program was not deleterious to graft fixation and is recommended.

Acute Disease↗
PubMed1994

Use of allografts after failed treatment of rupture of the anterior cruciate ligament.

A prospective study was done of the use of allogeneic tissue to reconstruct the anterior cruciate ligament in knees in which an intra-articular or an extra-articular operation had failed. Sixty-six consecutive patients (sixty-six knees) had such an operation with use of bone-patellar ligament-bone allografts; all but one returned for follow-up evaluation twenty-three to seventy-eight months (mean, forty-two months) after the operation. A total of 235 previous operations had been performed in these sixty-six knees, including eighty-one procedures for rupture of the anterior cruciate ligament. The results of the allograft procedure were evaluated with a subjective and objective system that rated twenty factors. The anterior-posterior displacement was substantially improved in most of the patients. According to data derived from arthrometric studies and pivot-shift tests of the fifty-seven patients who were so evaluated and in whom the condition was unilateral, 53 per cent (thirty) of the reconstructed ligaments were determined to be functional; 21 per cent (twelve ligaments), partially functional; and 26 per cent (fifteen ligaments), a failure. When we calculated the rate of failure by including ten failures that had occurred within two years after the operation with the fifteen that occurred in patients who had been followed for at least two years, the over-all rate of failure was 33 per cent (twenty-five of seventy-five operations). There was significant improvement in the subjective ratings of functional limitations and symptoms (p < 0.01) and in the over-all rating score (p < 0.0001). However, there was a significant difference between the scores of the patients in whom the surfaces of the articular cartilage had appeared normal at the index operation and those of the patients in whom there had been noteworthy fissuring and fragmentation or exposure of subchondral bone. After the program of rehabilitation, which included immediate motion of the knee, a range of motion of 0 to 135 degrees was restored in all but five knees, four of which lacked only 5 degrees of this extent of flexion or extension. The results demonstrate that bone-patellar ligament-bone allografts may be used when proper autogenous tissues are not available and that symptoms and abnormal displacement were reduced in most of our patients.

Activities of Daily Living↗
PubMedDate not supplied

The effect of injury chronicity and progressive rehabilitation on single-incision arthroscopic anterior cruciate ligament reconstruction.

We conducted a prospective study on 50 consecutive patients who received a single-incision arthroscopic patellar tendon autograft reconstruction for anterior cruciate ligament (ACL) rupture. The purposes were to determine if differences existed in results between patients with acute and chronic ACL ruptures, and if a progressive rehabilitation program could safely return patients to sports activities early without compromising knee stability. Forty-two patients (84%) returned for follow-up a mean of 31 months postoperatively. Twenty-one patients had acute ruptures, and 21, chronic ruptures. A progressive rehabilitation program was used by 28 patients (67%) who met strict criteria, which allowed early return to running and sports activities. The results were rated with the Cincinnati Knee Rating System. We found no effect of either injury chronicity or time to return to activity for 21 factors, including anterior-posterior displacement, patellofemoral crepitus, range of knee motion, quadriceps muscle strength, symptoms, functional limitations, or the patient rating of outcome. Using arthrometer and pivot-shift test data, 30 knees (71%) had a functional reconstruction; 8 knees (19%) had partial function; and 4 knees (10%) failed. Patients expressed satisfaction with the operation as follows: 23 (55%) rated their overall knee condition as normal; 16 (38%), very good; and 3 (7%), good. No patients rated their knee condition as fair or poor.

Acute Disease↗
PubMedDate not supplied

High tibial osteotomy and ligament reconstruction for varus angulated anterior cruciate ligament-deficient knees.

In a consecutive series, we treated 41 young patients who had anterior cruciate ligament deficiency, lower limb varus angulation, and varying amounts of posterolateral ligament deficiency. Seventy-three percent of the patients (N = 30) had lost the medial meniscus and 63% (N = 26) had marked articular cartilage damage in the medial compartment. All patients were treated with high tibial osteotomy and, in the majority (N = 34), anterior cruciate ligament reconstruction a mean of 8 months later. Posterolateral reconstructions were also required in 18 knees. A 100% follow-up was obtained at a mean of 4.5 years after osteotomy. Gait analysis testing was done in 17 knees before and after osteotomy. At follow-up, a reduction in pain was found in 71% (29 knees); elimination of giving way, in 85% (35 knees); and resumption of light recreational activities without symptoms, in 66% (27 knees). The patient rating of the knee condition was normal or very good in 37% (15 knees) and good in 34% (14 knees). The mean Cincinnati Knee Rating Score significantly improved from 63 to 82 points. The mean adduction moment, 35% higher than controls preoperatively, significantly decreased to below normal values postoperatively. Correction of varus alignment was maintained in 33 knees (80%). We recommend osteotomy in addition to ligament reconstructive procedures in these knees with complex injury patterns.

Adolescent↗