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At least 361 records · Page 20Linked to original sources
PubMed2004

A soft tissue attempt to stabilize the multiply operated glenohumeral joint with multidirectional instability.

Treating patients with multidirectional instability who have had multiple failed stabilization procedures is a challenging problem. These patients have disability from instability and pain. Final treatment may be glenohumeral narthrodesis. We report on the results of a soft tissue operation for treatment of multidirectional instability in multiply operated shoulders. Since 1994, 28 patients have had what we term the kitchen sink operation for treatment of refractory multidirectional instability. After exclusion of patients with collagen abnormality, 10 patients who had at least three previous stabilizations were identified with recalcitrant multidirectional instability. The kitchen sink operation encompasses a humeral-based inferior capsular shift, Nicola biceps tenodesis, and coracohumeral ligament and rotator interval augmentation and/or reconstruction. All patients were immobilized for 8 weeks postoperatively. Minimum clinical and radiographic followup was 2 years (range, 2-6 years). Preoperatively, all patients had incapacitating pain and instability. Postoperatively, five patients (50%) had significant improvement of pain, and nine patients (90%) had successful reduction of instability. Four of the five patients with persistent disabling pain needed glenohumeral fusions. The kitchen sink operation is a final attempt to stabilize the shoulder with multidirectional instability. This procedure reduces instability (especially inferior) associated with multidirectional instability. However, pain remains unremitting in 50% of patients, therefore a glenohumeral arthrodesis may be needed as a last option.

Adult↗
PubMed2004

Treatment of dynamic scaphoid instability.

BACKGROUND: Chronic wrist pain attributable to scaphoid instability without fixed deformity (dynamic instability) presents a treatment dilemma. The diagnosis usually is delayed, missing the opportunity for direct repair. The intercarpal fusion, tenodesis, and capsulodesis procedures create a fixed deformity. This report presents an outcome study of a new treatment for dynamic scaphoid instability that spanned more than 5 years. METHODS: Arthroscopic evaluation was used to confirm the diagnosis for 105 wrists of 102 patients who had experienced wrist pain for an average of 24.4 months. The treatment for these patients involved transferring two thirds of the extensor carpi radialis longus through the distal pole of the reduced scaphoid volarly to the intact flexor carpi radialis. The postoperative follow-up period averaged 63 months. RESULTS: The average grip strength increased by 65%. The average active wrist extension-flexion increased by 9%, with an average radial deviation loss of 6 degrees. The overall results, as measured by the modified Green and O'Brien clinical wrist scale, were as follows: excellent (49%), good (24%), and fair (26%). Good to excellent results were reported by 85% of the patients. Pain relief was reported by 94% of the patients, and 93% of the patients would recommend the procedure to others. CONCLUSIONS: Scaphoid instability without fixed deformity is a complex problem. Conventional treatments have drawbacks. The new technique produced positive results that are quite promising for the management of dynamic scaphoid instability.

Arthroscopy↗
PubMed1998

A comparison between control methods for implanted FES hand-grasp systems.

Implanted neuroprostheses employing functional electrical stimulation (FES) provide grasp and release to individuals with tetraplegia. This paper describes and compares three methods of controlling the stimulated hand movement: shoulder position, wrist position and myoelectric activity from the wrist extensors. Three experienced neuroprosthesis users were evaluated with each of the control methods by performing a grasp release test (GRT). A significant improvement was found between each functional electrical stimulation (FES) method and tenodesis without FES. No significant difference in overall performance was found between the three FES methods of control. Each method of control demonstrated advantages and disadvantages which depend upon characteristics of the individual patient. Factors which must be considered are injury level, voluntary wrist strength, proximal upper limb strength, the level of cognition of the patient, hand-grasp characteristics, cosmeses, importance of using both arms, and personal preference. Due to the unique characteristics of each controller type, it is advantageous to have each type available for the FES patients to adapt the system to the needs and desires of the individual patient.

Electric Stimulation Therapy↗
PubMed1987

Surgical rehabilitation of the upper limb in quadriplegia.

Fifteen quadriplegic (tetraplegic) patients from the Spinal Injuries Unit of the Austin Hospital have had surgery to improve function in 17 of their upper limbs. Changes in strength, function, subjective ratings and the influence on 198 activities of daily living are reviewed. The posterior third of the deltoid muscle was transferred into 8 triceps tendons to provide active elbow extension in seven patients. Six patients had transfers of forearm muscles to provide grasp and lateral pinch or active extension of wrist and fingers. Other operations included transfer of the latissimus dorsi to the forearm producing elbow flexion, medial advancement of the anterior deltoid origin improving shoulder control (an operation which has not been described previously), and tenodesis for stabilizing the wrist. The objective results were satisfactory in 12 patients. Eleven patients had either good or excellent subjective results. The maximum force of active elbow extension achieved was 6.8 kg and the peak grip strength reached was 10.5 kg. Six patients achieved subjective results higher than would have been expected from objective assessment. All patients benefited in some way, 13 patients felt that surgery was worthwhile and no patient lost appreciable function. The results of this series indicate that upper limb surgery has a definite place in rehabilitation of the quadriplegic patient. Improved surgical technique may reduce the time required for postoperative rehabilitation and thus make these procedures feasible for a larger number of patients.

Activities of Daily Living↗
PubMed1999

Long-term functional outcome after surgery of chronic ankle instability. A 5-year follow-up study of the modified Evans procedure.

Chronic ankle instability is a rather common consequence of poorly healed rupture of the lateral ligaments of the ankle. In some rare cases, instability symptoms can be caused by general laxity of the joints, but since these cases are normally bilateral, they can easily be distinguished from posttraumatic instability. This report presents the long-term (average follow-up 4.6 years) functional outcome after a modified Evans tenodesis of 48 patients. The follow-up examination consisted of a questionnaire evaluating the subjective assessment of the ankle, and clinical examination measuring ankle stability, range of motion and swelling, and atrophy of the calf muscles. Additionally, the functional recovery of the ankle was assessed by a standardized performance test protocol. According to the subjective assessment, 25 subjects (52%) considered the ankle fully recovered, or at least much better than before surgery. In the performance test, however, only 17 subjects (35%) achieved an excellent or good score. In the performance test protocol, two functional tests, walking down a staircase and balancing on a square beam, best demonstrated the impaired function of the injured ankle. The modified Evans procedure could restore the stability of the ankle to the preinjury level, although the ankle range of motion was significantly impaired, and swelling of the ankle and atrophy of the calf muscles were frequent findings at the follow-up. In conclusion, surgical treatment of chronic ankle instability by the Evans procedure restores the mechanical stability of the joint, but too frequently the function of the ankle does not return to the pre-injury level.

Adolescent↗
PubMed2004

Rupture of the biceps brachii tendon sheath in two dogs.

Rupture of the biceps brachii tendon sheath was diagnosed in two dogs which were presented with chronic thoracic limb lameness. In each case, diagnosis was achieved by positive contrast arthrography, which revealed obvious leakage of contrast agent from the distal portion of the tendon sheath. Arthroscopy was performed in each affected shoulder joint and no other significant lesions were found. In one dog, concomitant bicipital tendinopathy was confirmed by histopathology. Both dogs were treated by bicipital tendon transposition, and tenodesis and both showed improvement in the degree of lameness following surgery. Tearing of the biceps brachii tendon sheath has not been reported previously but should be included in the differential diagnosis for shoulder lameness in the adult dog.

Animals↗
PubMed2006

Dorsal calcaneocuboid ligament versus lateral ankle ligament repair: a case-control study.

OBJECTIVE: Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures. METHODS: Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case-control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single-leg drop jumps, and single-leg long jumps. RESULTS: Outcome scores at follow up (5-61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non-affected legs or between groups with respect to the outcome measures. MRI exhibited ligament-like structures at the repaired dorsal calcaneocuboid joints in five out of six joints. CONCLUSIONS: Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.

Adolescent↗
PubMed2003

Analysis of Tsuge's procedure for the treatment of radial nerve paralysis.

Radial deviation and limited flexion of the wrist joint and a lack of abduction of the thumb have been noticed after the Riordan's procedure. Therefore, Tsuge et al. modified the Riordan's procedure, and their procedure includes transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi radialis (FCR) to the extensor digitorum communis (EDC), and the palmaris longus to the extensor pollicis longus, along with tenodesis of the abductor pollicis longus. We reviewed the charts of 21 patients with isolated radial nerve paralysis who were treated with the Tsuge's procedure. Mean follow-up period was 11.3 years. Postoperatively, patients showed good extension of the metacarpophalangeal joint measured at the middle finger, useful flexion of the wrist joint, and decreased radial deviation of the wrist. The FCR transfer to the EDC is an excellent procedure for extension of the fingers. However, reconstruction of active abduction of the thumb remains controversial.

Adolescent↗
PubMedDate not supplied

Diagnosis and treatment of patients with patellofemoral pain.

The patient-athlete with patellofemoral pain requires precise physical examination based on a thorough history. The nature of injury and specific physical findings, including detailed examination of the retinacular structure around the patella, will most accurately pinpoint the specific source of anterior knee pain or instability. Radiographs should include a standard 30 degrees to 45 degrees axial view of the patellae and a precise lateral radiograph. Nonoperative treatment is effective in most patients. Prone quadriceps muscle stretches, balanced strengthening, proprioceptive training, hip external rotator strengthening, patellar taping, orthotic devices, and effective bracing will help most patients avoid surgery. When surgery becomes necessary, indications must be specific. Lateral release is appropriate for patella tilt (abnormal rotation). Painful scar or retinaculum, neuromas, and pathologic plicae may require resection. Proximal patellar realignment may be accomplished using arthroscopic or a combined arthroscopic/mini-open approach. Symptomatic articular lesions and more profound malalignments may require medial or anteromedial tibial tubercle transfer. Clinicians should be particularly alert for symptoms of medial subluxation in postoperative patients and should use the provocative medial subluxation test followed by lateral displacement patellar bracing to confirm a diagnosis of medial patellar subluxation. This problem may be corrected in most patients using a lateral patellar tenodesis. Current thinking emphasizes precise diagnosis, rehabilitation involving the entire kinetic chain, restoration of patella homeostasis, minimal surgical intervention, and precise indications for more definitive corrective surgery.

Athletic Injuries↗
PubMedDate not supplied

Rotator cuff tears in middle-aged tennis players: results of surgical treatment.

BACKGROUND: Tennis players, like participants in other overhead sports, are vulnerable to rotator cuff tears. In players who continue to play into their middle-age years, the incidence of such injury increases. HYPOTHESIS: Surgical treatment of rotator cuff tears in middle-aged tennis players is largely successful in allowing return to tennis. STUDY DESIGN: Retrospective review. METHODS: We evaluated the results of surgical treatment of 51 middle-aged tennis players (average age, 51 years) with a rotator cuff tear in their dominant shoulder. Tennis participation among the group had averaged 3.5 hours per week for an average of 25 years. Forty-two patients underwent open repair of the tear with or without biceps tenodesis, whereas 9 patients underwent arthroscopic debridement of the tear with or without a biceps tenotomy. Patients were reviewed at an average of 57 months after surgery with an activities score, a subjective questionnaire, and a questionnaire regarding their postoperative participation in tennis. RESULTS: The activities score averaged 26.6 of 30 possible points. Forty-seven patients were satisfied with their result, and 40 patients were able to return to tennis at an average of 9.8 months after surgery. No difference was found in the ability to return to tennis between the open repair group and the arthroscopic debridement group. CONCLUSIONS: The results of this study indicate that it is possible for nearly 80% of middle-aged tennis players to return to participation after operative treatment of rotator cuff tears.

Adult↗
PubMedDate not supplied

Bone anchors or interference screws? A biomechanical evaluation for autograft ankle stabilization.

BACKGROUND: Autograft stabilization uses free semitendinosus tendon grafts to anatomically reconstruct the anterior talofibular ligament. Study aims were to evaluate the biomechanical properties of Mitek GII anchors compared with the Arthrex Bio-Tenodesis Screw for free tendon reconstruction of the anterior talofibular ligament. NULL HYPOTHESIS: There are no differences in load to failure and percentage specimen elongation at failure between the 2 methods. STUDY DESIGN: Controlled laboratory study using porcine models. METHODS: Sixty porcine tendon constructs were failure tested. Re-creating the pull of the anterior talofibular ligament, loads were applied at 70 degrees to the bones. Thirty-six tendons were fixed to porcine tali and tested using a single pull to failure; 10 were secured with anchors and No. 2 Ethibond, 10 with anchors and FiberWire, 10 with screws and Fiberwire, and 6 with partially gripped screws. Cyclic preloading was conducted on 6 tendons fixed by anchors and on 6 tendons fixed by screws before failure testing. Two groups of 6 components fixed to the fibula were also tested. RESULTS: The talus single-pull anchor group produced a mean load of 114 N and elongation of 37% at failure. The talus single-pull screw group produced a mean load of 227 N and elongation of 22% at failure (P <.05). Cyclic preloading at 65% failure load before failure testing produced increases in load and decreases in elongation at failure. Partially gripped screws produced a load of 133 N and elongation of 30% at failure. The fibula model produced significant increases in load to failure for both. The human anterior talofibular ligament has loads of 139 N at failure with instability occurring at 20% elongation. CONCLUSIONS: Interference screw fixation produced significantly greater failure strength and less elongation at failure than bone anchors. CLINICAL RELEVANCE: The improved biomechanics of interference screws suggests that these may be more suited to in vivo reconstruction of the anterior talofibular ligament than are bone anchors.

Animals↗
PubMed2005

Suture anchors and tacks for shoulder surgery, part 1: biology and biomechanics.

The development and successful clinical application of suture anchors and tacks have revolutionized the surgeon's ability to secure soft tissues to bone via open or arthroscopic surgical techniques. When used carefully and with proper technique, these devices provide viable options for the repair and reconstruction of many intra-articular and extra-articular abnormalities in the shoulder, including rotator cuff tears, shoulder instability, and biceps lesions that require labrum repair or biceps tendon tenodesis. Like many technologies, however, the successful application of these devices requires an understanding of the biology and biomechanics that affect their use in the shoulder as well as knowledge of the factors that can affect subsequent clinical outcomes, including complications.

Absorbable Implants↗
PubMedDate not supplied

Posterior problems in the knee. Posterior cruciate insufficiency and posterolateral rotatory insufficiency.

During a recent three-year period, 39 patients underwent surgical procedures for lesions of the posterior complex of the knee. The results in 28 followed for greater than six months (average followup, 16 months) are reported; eight are presently in the early rehabilitative phase and three have been lost to followup. In reconstruction for chronic laxity, a semitendinosus replacement of the posterior cruciate ligament with anterior advancement of the lateral arcuate complex is recommended. Use of the medial gastrocnemius tendon is still advised in selected cases. Reconstruction for posterolateral rotatory laxity with an intact posterior cruciate is performed with anterior advancement of the popliteus tendon and the arcuate complex. Pes anserinus transfer, imbrication of the posterior oblique ligament, and biceps tenodesis may be performed as supplemental procedures.

Follow-Up Studies↗
PubMedDate not supplied

Analysis of the Müller anterolateral femorotibial ligament reconstruction using a computerized knee model.

Iliotibial tract tenodesis has been described by Müller as part of the surgical treatment for anterolateral rotatory instability in the ACL deficient knee. The aim of this study was to use a previously described and validated computer model of the knee to calculate the effectiveness of Müller's extraarticular anterolateral femorotibial ligament (ALFTL) graft as a substitute for the ACL or as an adjunct to an intraarticular ACL reconstruction in the ACL deficient knee. This effectiveness was tested by simulating the application of a torque sufficient to create 15 degrees of internal rotation or 5 mm of anterior displacement of the tibia on the femur at 0 degrees, 15 degrees, and 30 degrees of knee flexion. The effects of moving the graft's proximal fixation point 1 cm superior, inferior, and anterior to the current surgical attachment site were examined to determine the amount of permissible surgical error in graft placement. The model predicts that the ALFTL is a useful restraint to internal rotation when it is performed with or without an intraarticular ACL reconstruction. The ALFTL graft took up greater amounts of tension and became more effective at increasing angles of knee flexion. Placement of the ALFTL graft 1 cm anterior to the current surgical attachment site decreases the vector component that lies perpendicular to the long axis of the tibia and consequently reduces resistance to internal rotation. The ALFTL graft at any attachment site was ineffective in resisting pure anterior displacement between 0 degrees and 30 degrees.

Humans↗
PubMedDate not supplied

Arthroscopic shoulder decompression development and application. A five year experience.

The purpose of this study was to critically evaluate the results of 80 consecutive subacromial decompressions in 76 patients with impingement syndrome and to assess the value of arthroscopy for subacromial decompression. The average followup was 32 months. The charts, radiographs, and clinical findings of all patients were reviewed. There were 57 males and 19 females, with a mean age of 41 years. Subjective, objective, and functional results were assessed. The greatest improvement was seen in the areas of pain with activity, pain at night, and use of medications. Impingement signs had decreased significantly at final followup. The procedure allowed an early return to work and competitive athletics. Repeat surgery was necessary in eight cases: three full thickness rotator cuff repairs, two stabilization procedures, two open debridements, and one biceps tenodesis and excision of the distal clavicle. An important finding was the number of unsuspected diagnoses that were made during arthroscopy. Twelve patients had significant labral tears, seven patients had complete rotator cuff tears, four patients had biceps tendon fraying, and two patients had loose bodies in the glenohumeral joint. In most of these shoulders the intraarticular lesions would not have been diagnosed by open subacromial decompression. Radiographic evaluation suggested that the "outlet view" can be helpful in determining depth of bony resection and may be a prognostic indicator. Patients who underwent simple decompression rather than bony resection tended to be younger and had less Stage III impingement changes, and they generally had a slightly better final outcome. Patients who had compensation injuries generally had a poorer outcome. In reviewing our results, it appears that arthroscopic subacromial decompression can be a successful alternative to open decompression. The key to success for closed decompression is related to 1) accurate diagnosis, 2) selective treatment, 3) adequate bone resection when required, and 4) repair of full thickness rotator cuff tears in the active patient. Postoperative rehabilitation, which includes early range of motion, is critical.

Acromion↗
PubMedDate not supplied

The GORE-TEX anterior cruciate ligament prosthesis. A long-term followup.

The GORE-TEX anterior cruciate ligament prosthesis has been implanted in 268 patients at our institution since April of 1984. Follow-up for this study was available on 70% of these patients (188). Eighty-one percent (152) of these had the ligament for chronic injuries, 14% (26) for acute, and 5% (10) for subacute injuries. The patient population had an average age of 27.6 years (SD = 8.4) and a Tegner activity score of 6.05 (SD = 1.53). Prior procedures had been performed on 56% (105) of the patients. Concomitant procedures were performed in 73% (137) and included iliotibial band tenodesis, partial meniscectomy, posterior oblique ligament advancement, or meniscal repair. Followup averaged 48 months (range, 24 to 68). Evaluation included a questionnaire, physical examination, radiographs, KT-1000 arthrometer testing, and an activity score. Results were graded as excellent, good, fair, and poor. Acceptable results (good and excellent) were obtained in 83 patients (44%). Fifty-eight patients (32%) were rated excellent and 25 (13%) were rated good. Unacceptable results (fair and poor) were obtained in 105 patients (56%). Twenty-five patients (13%) were rated fair and 80 (42%) were rated poor. Subjective improvement was indicated by 166 patients (88%). Activity levels postoperatively as rated by the Tegner Scale improved in 2 (1%), remained the same in 167 (89%), and decreased in 19 patients (10%). Effusions occurred in 63 patients (34%) and caused an unacceptable result in 22 (12%). Rupture occurred in 23 patients (12%). Loosening greater than 3 mm occurred in 64 patients (34%) and led to unacceptable results in 37 (20%). Infection occurred in 5 patients (2.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

Achilles tendon allograft reconstruction of the anterior cruciate ligament-deficient knee.

Thirty-five patients had reconstruction of the anterior cruciate ligament with intraarticular fresh-frozen Achilles tendon allograft and extraarticular tibial band tenodesis. Patients were followed 2 to 4 years (mean, 2.5). Evaluation included clinical and functional examinations, measurement of tibiofemoral displacement, and anteroposterior and lateral radiographs. Clinical results were considered satisfactory in 85% of the patients; 16 had arthroscopic examination after the allograft; allograft biopsies in 9 at this time showed cellular and vascular tissue without evidence of immune reaction. Clinical, arthroscopic, and biopsy results were favorable, but radiologic results were not. In most patients there was a significant size increase in femoral and tibial bone tunnels, as measured from radiographs. In the 6 most extreme cases, bone tunnels measured 20 mm or more in diameter, twice the initial size. Etiology and clinical significance of these bone tunnel changes remain unknown. Enlargement appears to occur early after operation; it stabilizes within 2 years. No statistical correlation was seen between tunnel enlargement and results of clinical and functional examinations; nevertheless, unexplained tunnel enlargement is cause for concern, and allograft replacement of the anterior cruciate ligament with fresh-frozen Achilles tendon allograft should be considered a salvage procedure.

Achilles Tendon↗
PubMedDate not supplied

Traumatic tears of the subscapularis tendon. Clinical diagnosis, magnetic resonance imaging findings, and operative treatment.

The study population consisted of 14 shoulders in 13 consecutive patients with surgically confirmed isolated subscapularis tendon tears. In all but three patients, the mechanism of injury was traumatic hyperextension or external rotation of the abducted arm. All patients reported pain and weakness in the affected shoulder. Physical findings revealed limited passive range of motion at maximal internal and external rotation due to pain, weakness of internal rotation of the shoulder, and tenderness in the region of the intertubercular groove. However, these findings did not conclusively point to the subscapularis tendon as the site of injury. Preoperative interpretation of magnetic resonance imaging studies was used to diagnose tears of the subscapularis tendon in 14 shoulders and biceps tendon subluxation or dislocation in 6 shoulders. On arthroscopic examination, one patient was found to have a partial-thickness tear that was treated with arthroscopic debridement. Six shoulders had full-thickness tears of the subscapularis tendon, and seven shoulders had full-thickness tears associated with concomitant biceps tendon pathologic conditions, including subluxation, dislocation, or rupture. The full-thickness subscapularis tendon tears were repaired via an open anterior approach to the shoulder through the deltopectoral groove. Associated biceps tendon injuries were treated with tenodesis of the tendon to the intertubercular groove. Our early followup results have shown that, with proper diagnoses and surgical treatments, patients have greatly decreased pain and marked improvement in shoulder function.

Adolescent↗