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Biomedical subjects

S Orava

Publications and source records attributed to S Orava.

At least 19 recordsLinked to original sources
PubMed2006

Operative treatment of stress fractures of the proximal second metatarsal.

Proximal stress fractures of the second metatarsal are rare. They have been reported mainly in classical ballet dancers. Non-operative treatment has usually led to good results and rapid return to full activities. We present a series of nine cases with stress fractures of the proximal second metatarsal. The patients were all actively involved in sports. None of them were dancers. In all of these patients non-operative treatment lasting for an average of 13 months had failed. All of the patients were operated on using the same method. In the operation drilling was performed around and through the fracture line. The patients were followed for an average of 38 months. All except one of the patients were able to return to their prior level of activity within 4-6 months. In conclusion if non-operative treatment fails surgery seems to give good results in most patients with a stress fracture of the proximal second metatarsal.

Adolescent↗
PubMed2006

Surgical treatment of partial tears of the proximal origin of the hamstring muscles.

BACKGROUND: Hamstring injuries are common especially in athletes. Partial and complete tears of the proximal origin may cause pain and functional loss. OBJECTIVE: To evaluate the results of surgical treatment for partial proximal hamstring tears. METHODS: Between 1994 and 2005, 47 athletes (48 cases, 1 bilateral) with partial proximal hamstring tears were operated on. The cases were retrospectively analysed. Before surgery, 42 of the patients had undergone conservative treatment with unsatisfactory results, whereas in five patients the operation was performed within four weeks of the injury. RESULTS: The mean length of the follow up was 36 months (range 6-72). The result of the operation was rated excellent in 33 cases, good in nine, fair in four, and poor in two. Forty one patients were able to return to their former level of sport after an average of five months (range 1-12). CONCLUSION: In most cases, excellent or good results can be expected after surgical repair of partial proximal hamstring tears even after conservative treatment has failed.

Adolescent↗
PubMed2006

Total proximal tendon avulsion of the rectus femoris muscle.

Total proximal avulsions of the quadriceps femoris muscle group are rare injuries. Between the years 2001 and 2004 five patients with a total proximal avulsion of the tendon of the rectus femoris muscle were treated surgically in Mehiläinen Hospital in Turku, Finland. The median age of the patients was 21 years (range, 19-27) and the patients were all men. There were four soccer players and one hurdler. In all cases an avulsion of the proximal tendon of the rectus femoris muscle was confirmed by MRI. All of the patients were operated on and the delay from the injury to surgery ranged from 18 to 102 days. The result of the surgical treatment was rated good in all cases. All of the patients were able to return to their pre-injury level of activity 5-10 months after surgery. The median follow-up time was 20 months (range, 9-38). Surgical treatment of a total proximal avulsion of the tendon of the rectus femoris muscle seems to result in return to the pre-injury activity level in most cases.

Adult↗
PubMed2003

Acute traumatic extension deficit of the knee.

The purpose of this study was to evaluate the events leading to acute traumatic extension deficit of the knee and the arthroscopic findings in these patients. A total of 78 consecutive patients treated in the Turku university hospital during the years 1994-1996 were included. The mean annual incidence of acute traumatic extension deficits of the knee in our study was 1.1 per 10 000 inhabitants. The single most common (33%) event causing the extension deficit was non-sports related twisting of the knee. Various sports related activities accounted for 42% of the extension deficits, and soccer was the most common sport in this group. In conclusion, acute traumatic extension deficit of the knee is usually a sign of serious intra-articular damage, and the most likely finding (in 82% of the patients in our study) is either a meniscal rupture, an anterior cruciate ligament (ACL) rupture, a patellar dislocation, or a combination of these. The lesions in these knees require prompt evaluation by an orthopaedic surgeon mainly because of the high number of bucket-handle and menisco-capsular insertion ruptures of the menisci, which are possibly suitable for repair.

Acute Disease↗
PubMed2002

Surgical treatment for chronic Achilles tendinopathy: a prospective seven month follow up study.

OBJECTIVE: To prospectively assess the early results of surgical treatment of chronic Achilles tendinopathy. METHODS: This seven month prospective follow up study assessed the short term results of surgical treatment of chronic Achilles tendinopathy and compared the subjective and functional outcome of patients with Achilles tendinopathy without a local intratendinous lesion (group A) with that of similar patients with such a lesion (group B). Forty two of the initial 50 patients were examined before surgery and after the seven month follow up. Evaluation included an interview, subjective evaluation, clinical tests, and a performance test. RESULTS: At the follow up, physical activity was fully restored in 28 of the 42 patients (67%), and 35 patients (83%) were asymptomatic or had only mild pain during strenuous exercise. In clinical tests, significant improvements were observed in climbing up and down stairs and the rising on the toes test. Surgical treatment also seemed to be successful from the total test score, which was excellent or good in 35 patients, compared with before surgery when it was excellent or good in one patient only. Patients in group A fared better than those in group B, whether evaluated by recovery of physical activity after surgery (88% v 54%) or the complication rate (6% v 27%). CONCLUSIONS: Surgical treatment of chronic Achilles tendinopathy gives good and acceptable short term results. A lower complication rate and a trend to better recovery was observed in patients with peritendinous adhesions only than in those with peritendinous adhesions combined with an intratendinous lesion.

Achilles Tendon↗
PubMed2002

Acute traumatic hemarthrosis of the knee. Is routine arthroscopic examination necessary? A study of 320 consecutive patients.

BACKGROUND AND AIMS: Distortions and contusions of the knee are common. Fairly often they will result in hemarthrosis. The purpose of this study was to evaluate the findings in patients with acute traumatic hemarthrosis of the knee and based on these findings estimate the necessity of acute arthroscopic examination. MATERIAL AND METHODS: A total of 320 patients were examined arthroscopically between the years 1994 to 96 in the Turku University Hospital. Patients with other than chondral or osteochondral fractures were excluded. RESULTS: The most common arthroscopic findings were rupture of the ACL (45%), dislocation of the patella (23%) and meniscal tear (21%). In only 113 (35%) cases an immediate therapeutic procedure was performed in addition to the arthroscopic examination. CONCLUSIONS: Based on our findings we believe that routine arthroscopic examination is not necessary in patients with acute traumatic hemarthrosis of the knee. In our opinion the patient should be examined and followed by an orthopedic surgeon and if a lesion requiring operative treatment is diagnosed or suspected, an arthroscopic examination should be scheduled. The timing of the procedure should be such that all possible lesions encountered can be treated in the same operation.

Acute Disease↗
PubMed2001

Peroneal tendon injuries. Report of thirty-eight operated cases.

BACKGROUND AND AIMS: Peroneal tendon injuries are probably frequently overlooked causes of lateral ankle pain after distorsion trauma. We report a series of 38 patients with peroneal tendon injuries and outcome after operation. MATERIAL AND METHODS: The mean age of the patients was 30 years (range, 13 to 61). All patients were operated by the same orthopaedic surgeon (SO) and the final outcome was evaluated. RESULTS: Eighty-two per cent of the patients were competitive athletes. There were 11 partial and 3 total ruptures of the peroneus brevis tendon (PBT), 2 partial and 2 total ruptures of the peroneus longus tendon (PLT). Nine cases of subluxations or luxations were treated. There were also 5 cases of chronic peroneal tendinitis or tenosynovitis, 5 cases of peroneal tendon anomalies and 1 ganglion. The peroneal tendon lesion was associated to ankle instability in 19 cases (50%). In ninety percent of the cases the result of the operation was excellent or good. CONCLUSIONS: The lateral ligaments are usually damaged in ankle distorsion injuries, but peroneal tendon lesions are often overlooked and probably more common cause of persistent lateral ankle pain than previously thought. Ruptures and luxations of the peroneal tendons need operative treatment in most cases.

Adolescent↗
PubMed2000

Relationship between calf muscle size and strength after achilles rupture repair.

The object was to study the relationships between calf muscle size and strength in 85 patients an average of 3.1 years after repair of achilles tendon rupture. The isokinetic calf muscle strength results were excellent or good for 73% of the patients, whereas calf muscle size was normal in only 30%. The average plantar flexion peak torque per unit muscle cross-sectional area was higher on the injured side than on the uninjured side. The average calf muscle cross-sectional area deficit was 15+/-9% (p<0.001) of that on the unaffected side, while the average plantar flexion peak torque deficit was speed-dependent, being 9+/-18%, 10+/-18 and 2+/-13% of that on the unaffected side at 30, 90, and 240 degrees/sec (p<0.001). The correlation between cross-sectional area and peak torque varied in the range 0.52-0.61 at 30, 90 and 240 degrees/sec (p<0.001).

Achilles Tendon↗
PubMed2000

Results of surgical treatment of unresolved Osgood-Schlatter lesion.

BACKGROUND AND AIMS: We present our experience with surgical treatment of unresolved, painful, late Osgood-Schlatter disease. MATERIAL AND METHODS: In 70 operations performed in 67 patients (in three bilaterally) an ossicle under the distal patellar tendon was removed in 62 cases. In eight cases, excision of the prominent tibial tubercle and/or drilling of the epiphysis was performed. Additional procedures, such as rasping of the uneven anterior tibial surface, excision of inflammed bursa or the devitalized portion of the tendon, were done 21 times. Most patients were athletes or physically active young people. The mean age was 19.6 years. 54 operations were done on males and 16 on females. They had been followed preoperatively for 18 months and after surgery 2.2 years. RESULTS: The final results were excellent or good in 56, moderate in 9, poor in 3 and unknown in 2 cases. CONCLUSIONS: Osgood-Schlatter's disease may leave an ossicle under the distal patellar tendon, a prominent tibial tubercle or an uneven surface of anterior superior tibia. These may lead to pain and disability due to recurrent injuries or athletic exercises. Surgical treatment gives good results in chronic unresolved cases.

Adolescent↗
PubMed1999

Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis.

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0-100) among all the patients was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.

Adolescent↗
PubMed1998

Fasciotomy of the posterior femoral muscle compartment in athletes.

Over a period of 13 years fasciotomy was performed on 46 athletes with chronic pain located at the posterior femoral muscle compartment. The patients could be divided, according to the etiology, in two groups: exertion (26 patients) and trauma (20 patients). In the first group the symptoms appeared without any sudden trauma and most of the athletes competed in endurance sports (e.g. 16 long distance runners). In the second group there was a history of hamstring muscle rupture or recurrent injuries. The symptoms were dull pain, stiffness, cramps and weakness of the posterior thigh during and after training. Conservative treatment methods did not help to eliminate the symptoms during a long preoperative follow-up period. Posterior fasciotomy (minimum 20 cm) to the thigh was performed through one or two incisions. In four patients a simultaneous liberation, division or suturation of the muscle scar was done. The patients were followed up for 19 months and the results of the fasciotomy were good or excellent in 39 cases. Pain at the posterior thigh muscle compartment may sometimes become chronic and hamper the training of athletes. Fasciotomy seems to be an effective method to help these patients return to their previous level of sports.

Adolescent↗
PubMed1998

Ruptures of the Achilles tendon: relationship to inequality in length of legs and to patterns in the foot and ankle.

We studied 101 patients who were operated on at Oulu University Hospital for ruptured Achilles tendon from 1987 to 1992 (inclusive), and 87 healthy control patients from among Army conscripts. The mean inequality in length of legs (ILL) was 5 +/- 4 mm. Among the 48 patients with ILL > or = 5 mm, the side affected with ruptured tendon was longer in 48% of cases and shorter in 52%. An underpronating alignment of the ankle and foot (based on beta45 measurement of the angle < or = 4 degrees) was found in 21% of patients and 5% of controls (P < 0.001). A combination of high longitudinal arch and underpronating alignment of the ankle was seen in 10% of patients and 1% of controls (P < 0.001). About 37% of the patients' feet and 29% of feet in controls were classified as having a high arch (P = 0.001). ILL or hyperpronation of the ankle seem to not be predisposing factors for ruptures of the Achilles tendon. High longitudinal arches were somewhat overrepresented, being associated with less pronation of the ankle and less varus in the forefoot than was seen in controls.

Achilles Tendon↗
PubMed1998

Total Achilles tendon rupture. A review.

There are only a few epidemiological studies on the incidence of Achilles tendon (AT) ruptures. These show an increase in incidence in the West during the past few decades. The main reason is probably the increased popularity of recreational sports among middle-aged people. Ball games constitute the cause of over 60% of AT ruptures in many series. The 2 most frequently discussed pathophysiological theories involve chronic degeneration of the tendon and failure of the inhibitory mechanism of the musculotendinous unit. There are reports of AT ruptures related to the use of corticosteroids, either systemically or locally, but the role of corticosteroids in large patient series is marginal. In addition, recent studies do not confirm earlier findings of blood group O dominance in patients with AT rupture. Comparable series have been published with surgical versus nor surgical treatment and postoperative cast immobilisation versus early functional treatment. Although conservative treatment has its own supporters, surgical treatment seems to have been the method of choice in the late 1980s and the 1990s in athletes and young people and in cases of delayed ruptures. Early ruptures in non-athletes can also be treated conservatively. In small series of compliant, well motivated patients, functional postoperative treatment has been reported to be well tolerated, safe and effective. The lack of a universal, consistent protocol for subjective and objective evaluation of AT ruptures has prevented any direct comparison of the results. The results have been often assessed according to the criteria of Lindholm or Percy and Conochie, but no scoring is available for the analysis. We assessed a new scoring method and analysed the prognostic factors related to the results. There is also no single, uniformly accepted surgical technique. Although early ruptures have been treated successfully with simple end-to-end suture, many authors have combined simple tendon suture with plastic procedures of various types. No randomised study comparing simple suture technique and repair with augmentation could be found in the literature. The major complaint against surgical treatment has been the high rate of complications. Most are minor wound complications, which delay improvement but do not influence the final outcome. Major complications are rare, but often difficult to treat with minor procedures. For instance, large postoperative skin and soft tissue defects in the Achilles region can be treated successfully with a microvascular free flap reconstruction. The complications of conservative treatment include mostly reruptures and residual lengthening of the tendon, which may result in significant calf muscle weakness. It has been postulated that a physically inactive lifestyle leads to a decrease in tendon vascularisation, while maintenance of a continuous level of activity counteracts the structural changes within the musculotendinous unit induced by inactivity and aging. Proper warm-up and stretching are essential for preventing musculotendinous injuries, but improper or excessive stretching or warming-up can predispose to these injuries.

Achilles Tendon↗
PubMed1998

Outcome and prognostic factors of achilles rupture repair using a new scoring method.

A new clinical scoring system, including subjective assessment of symptoms and evaluation of ankle range of motion and isokinetic measurement of ankle plantar flexion and dorsiflexion strengths, is presented in 101 patients (86 men, 15 women) who had repair of a closed Achilles tendon rupture. Twenty-one patients were competitive athletes and 70 were recreational athletes. Eighty-one percent of the ruptures were related to sports, and 32% occurred while playing volleyball. Twenty-six patients had previous Achilles tendon symptoms. At followup, an average of 3.1 years after repair, the overall result scores were excellent in 34 cases, good in 46, fair in 17, and poor in four. Only age was a predictor of overall results. The isokinetic strength scores were excellent or good in 72 cases, fair in 18, and poor in 11. Presence of systemic diseases, activity level, previous Achilles tendon symptoms, and later return to physical exercise were predictors of strength results. Gender, body weight, height, period between rupture and operation, surgeon, rupture site, operative method, complications, and thickness, width, and area of the Achilles tendon at followup were not related significantly to the outcome.

Achilles Tendon↗
PubMed1998

Chronic compartment syndrome of the quadriceps femoris muscle in athletes. Diagnosis, imaging and treatment with fasciotomy.

BACKGROUND AND AIMS: Chronic quadriceps femoris muscle compartment syndrome is described. MATERIAL AND METHODS: Over a 13 year period nine patients were diagnosed, treated surgically by fasciotomy and followed up at a referral center specialized in sports traumatology. There were four power lifters, three body builders, one endurance walker and one cyclist in the series. The use of anabolic steroids was admitted by four of the nine patients. The patients complained of gradually worsening pain on the anterolateral side of the thigh during training. Initially the pain appeared only at the end of the training session. As the syndrome became more severe, the pain began earlier during exercise and gradually became worse preventing maximal training. Skeletal radiographs and ultrasound examinations were normal, except in two patients, who had a positive echography finding with local atrophy. MRI examination confirmed the US diagnosis. RESULTS AND CONCLUSIONS: As conservative treatment did not provide relief of symptoms, a fasciotomy anterior to the iliotibial tract was performed bilaterally to seven patients and unilaterally to two patients. Biopsies from the atrophied sites showed muscle cell necrosis. All the patients recovered well after the surgery and were able return to their original level of sport. The only complication of surgery was a postoperative hematoma in one patient, which delayed the beginning of the training, but did not result in any persistent complaints.

Adult↗