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Biomedical subjects

W G Clancy

Publications and source records attributed to W G Clancy.

At least 19 recordsLinked to original sources
PubMed2001

Treatment algorithm for osteochondral injuries of the knee.

The treatment of osteochondral fractures and OCD lesions in the knee is controversial. Many new procedures and techniques have been developed recently to address osteochondral lesions, indicating that no single procedure is accepted universally. Our treatment algorithm is based on the age of the patient, skeletal maturity, and the presence of adequate subchondral bone attached to the chondral lesion. Most nondisplaced lesions in the patient with open physes will heal with conservative treatment. The onset of skeletal maturity indicates a need for a more aggressive treatment approach. If adequate cortical bone is attached to the fragment, drilling of stable lesions, or drilling with fixation of unstable or loose fragments is appropriate. Autologous bone graft can be necessary to stimulate healing and properly reconstruct the subchondral bony contour. For failed fixation attempts or lesions not amenable to fixation, each treating surgeon must be proficient and comfortable with an articular surface reconstruction technique. The goal for the reconstructive procedure, to produce a smooth gliding articular surface of hyaline or hyaline-like cartilage, is possible using current techniques including mosaicplasty, osteochondral allograft transplantation, and autologous chondrocyte transplantation. Débridement, drilling, microfracture, and abrasion chondroplasty have been shown to result in fibrocartilage with inferior mechanical properties when compared with hyaline cartilage. No long-term studies have been published, however, to confirm the benefits of replacing osteochondral defects with hyaline cartilage rather than fibrocartilage. Although the results of many reconstructive procedures are quite encouraging with early follow up, the ultimate goal is to prevent long-term degenerative arthritis. Only well-designed prospective studies with long-term follow up will determine the adequacy of these procedures in reaching the ultimate goal. This treatment algorithm is based on the senior author's (WGC) experience with the complex dilemma of osteochondral lesions of the knee.

Adolescent↗
PubMed1998

Clinical classification of patellofemoral pain and dysfunction.

The patellofemoral joint is a complex articulation based on its dependence on both dynamic and static restraints for stability. Classification of patellofemoral disorders has been frought with confusion. However, progress has been made in the classification and understanding of these disorders by improved understanding of the biomechanics of the joint and by clarification of the terminology to describe patellofemoral pathology. The term chondromalacia patella, although once used as an all-inclusive term for anterior knee pain, is now widely accepted as a term used to describe pathologic lesions of the patellar articular cartilage found at arthroscopy or arthrotomy. An adequate classification system should aid in proper diagnosis and treatment of specific problems. If properly devised, it should also aid in the comparison of results between different treatment centers. In addition, it should be a system that is simple and useful in the clinical setting with minimal use of complicated imaging techniques. From a clinical perspective, patellofemoral problems in the skeletally mature patient fall into three broad categories: 1) patellofemoral instability, i.e., subluxation or dislocation; 2) patellofemoral pain with malalignment but no episodes of instability; and 3) patellofemoral pain without malalignment. The myriad of patellofemoral disorders then fall into subclassifications of these categories. Treatment algorithms can be broadly developed based on the general category, with specific treatments based on the subclassification. In this paper, the authors will present a review of the pertinent literature documenting patellofemoral classification systems and develop concepts of clinical classification of patellofemoral disorders based on the three categories described above.

Adolescent↗
PubMed1996

Tendinitis in golf.

The term tendinitis has been used in a universal fashion to describe a variety of pathologic conditions. This article examines the pathology of tendon failure. The anatomy of the tendon and the spectrum of tendon injuries are discussed. Histologic evaluation of injured tendons usually reveals areas of tendinosis, or tendon degeneration, with an occasional inflammatory infiltration the paratenon, the outer connective tissue lining layer. A variety of treatment options are presented.

Golf↗
PubMed1994

Alabama sports medicine experience with isolated and combined posterior cruciate ligament injuries.

Injuries to the posterior cruciate ligament (PCL) are an uncommon but significant instability pattern that eventually deteriorates the articular surface of the PLC-deficient knee. Although controversy persists regarding the appropriate treatment for the isolated PCL tear, patients with combined ligament injuries are best served by reconstruction of the PCL and surgical correction of the other injured tissues. The authors outline their experience with these complex ligamentous derangements.

Acute Disease↗
PubMed1994

Posterior cruciate ligament reconstruction with patellar tendon autograft.

Although the management of the PCL-injured knee remains controversial, there is a group of patients who will develop accelerated traumatic arthritis in whom surgical intervention is warranted. PCL reconstruction with a patellar tendon graft can reliably restore objective stability in over 90% of patients. Strict attention to detail, however, especially with respect to tunnel placement, is necessary to insure success.

Arthroscopy↗
PubMed1994

Combined posterior cruciate ligament injuries.

Management of posterior cruciate ligament injuries combined with other ligamentous knee injuries must begin with an understanding of the normal anatomy and biomechanics of the knee. Careful physical examinations and judicious use of ancillary tests allow delineation of the extent of knee injury. Each combined injury can then be approached with an organized and specific plan for reconstruction, optimizing knee stability and function.

Anterior Cruciate Ligament↗
PubMed1993

Quadriceps muscular strength after removal of the central third patellar tendon for contralateral anterior cruciate ligament reconstruction surgery: a case study.

Surgical reconstruction of the anterior cruciate ligament (ACL) using a patellar tendon autograft is a common orthopaedic procedure. Complications such as arthrofibrosis, patellar fracture, significant donor site pain, and quadriceps muscle weakness can occur from this procedure. Previous studies have not documented the effects of isolated graft procurement without concomitant ligamentous reconstruction on the donor extremity. This case study documents the clinical outcome results of an individual who underwent a central one-third graft harvest from his contralateral uninjured knee for an ACL graft of his injured ACL-deficient knee. The results indicate that at 4 months following graft procurement, the knee extensors were equal to the preoperative isokinetic test results of that leg. In addition, the patient exhibited full range of motion and no patellofemoral complaints of dysfunction. At 12 months postsurgery, the graft donor leg was 5-9% stronger than the preoperative test results. The results of this case study suggest that isolated harvesting of a 10-mm central patellar tendon free graft may not result in significant quadriceps muscle weakness or contribute to donor site pain.

Adult↗
PubMed1989

Back injuries in college athletes.

Frequency and types of back injuries sustained by intercollegiate athletes were determined by examining medical records of 4,790 athletes that competed in 17 varsity sports over a 10-year period. These athletes sustained 333 back injuries, an injury rate of 7 per 100 participants. Injury rates were significantly higher in football and gymnastics, and 80% of the injuries occurred in practice, 6% in competition, and 14% during preseason conditioning. Muscle strains occurred with much greater frequency than other types of injuries, and acute back injuries were much more prevalent (59%) than overuse injuries (12%) or injuries associated with pre-existing conditions (29%).

Athletic Injuries↗
PubMed1988

Diagnosis of acute and chronic anterior cruciate ligament tears.

The diagnosis of acute and chronic injuries of the ACL has been reviewed. Attention has been given to the history, physical examination, and other diagnostic tools available for evaluation of the ligamentous injury. Clinical correlations have been highlighted. Finally, our recommendations for surgical intervention have been presented.

Acute Disease↗
PubMed1988

Acute tears of the anterior cruciate ligament. Surgical versus conservative treatment.

In a prospective eight-year study comparing surgical and conservative treatment of acute tears of the anterior cruciate ligament, ninety-two patients in whom a tear had been confirmed either by arthroscopy or by arthrotomy were treated and could be followed. The choice of treatment was determined entirely by whether the result of a pivot-shift test was graded as absent, trace, or mild (non-operative treatment) or as moderate or severe (surgical treatment). Surgical treatment consisted of primary repair of the torn ligament and augmentation with a patellar tendon graft. Twenty-two patients were treated non-operatively, and the results were evaluated after twenty-four to eighty-two months (average, forty-eight months). Seventy patients were treated surgically, and fifty-two of them (approximately 70 per cent) returned for follow-up after twenty-four to 100 months (average, forty-eight months); an additional eighteen patients answered a questionnaire. In the non-operative group, about half of the results were graded as excellent or good and half, as fair or a failure. In the surgical group, all but two of the patients had an excellent or a good result; two patients had a fair result. No result was graded as a failure. The results of this study suggest that when the pivot-shift test is not strongly positive, half of the patients will do reasonably well after treatment with a non-operative program of functional rehabilitation. The patients in this study who had a more unstable knee had far better results after a repair and augmentation procedure than have been previously reported after primary repair alone.

Evaluation Studies as Topic↗
PubMed1986

Expanding applications for the Herbert scaphoid screw.

A distinctive new bone screw developed for the management of scaphoid fractures and nonunions promises to have expanding applicability. Its utilization for osteochondral fractures, small joint arthrodeses, osteochondritic lesions, and fractures involving small bones is described. Its unique design affords significant advantages over more conventional management techniques of these problems.

Arthrodesis↗
PubMed1985

Intra-articular reconstruction of the anterior cruciate ligament.

In this article, the author provides criteria for the recommendation of surgical intervention in acute and chronic anterior cruciate ligament insufficiency and describes various intra-articular procedures for both conditions. Intra-articular reconstruction of the anterior cruciate ligament with a vascularized patellar tendon graft is described in detail, as are the excellent results achieved with this procedure over the past 8 years.

Acute Disease↗