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At least 397 records · Page 22Linked to original sources
PubMed2003

Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro.

Patellofemoral joint instability is a common clinical problem. However, little quantitative data are available describing the stability characteristics of this joint. We measured the stability of the patella against both lateral and medial displacements across a range of knee flexion angles while the quadriceps were loaded physiologically. For eight fresh-frozen knee specimens a materials testing machine was used to displace the patella 10 mm laterally and 10 mm medially while measuring the required force, with 175 N quadriceps tension. The patella was connected via a ball-bearing patellar mounting 10 mm deep to the anterior surface to allow natural tilt and other rotations. Patellar force-displacement behavior was tested at flexion angles of 0 degrees, 10 degrees, 20 degrees, 30 degrees, 45 degrees, 60 degrees, and 90 degrees. Significant differences were found between the lateral and medial restraining forces at 10 mm displacement. For lateral displacement, the restraining force was least at 20 degrees of knee flexion (74 N at 10 mm displacement), rising to 125 N at 0 degrees and 90 degrees of knee flexion. The restraining force increased progressively with knee flexion for medial patellar displacement, from 147 N at 0 degrees to 238 N at 90 degrees. With quadriceps tension, the patella was more resistant to medial than lateral displacement. Our finding that lateral patellar displacement occurred at the lowest restraining force when the knee was flexed 20 degrees agrees with clinical experience of patellar instability.

Aged↗
PubMed1992

Vascularized joint transfers. Indications and results.

Vascularized joint transfer can be beneficial in restoring joint function and maintaining growth. It is sometimes indicated in patients with painful post-traumatic arthritis, post-traumatic joint instability, and post-traumatic deformity. The best indication for this procedure is in children whose joint injury is associated with damage to growth plates in any of the digits; however, the complications associated with this procedure should not be overlooked. Extensor lag is common. This complication may be prevented during the surgical procedure by using a step-cut osteotomy to preserve the insertion of the extensor tendon, resecting the volar plate of the finger, harvesting the transferred joint with enough length to keep the extensor tendon tight, and placing the transferred joint in a maximally extended position to counteract the flexible trend of the toe joints. We believe this procedure holds promise for the future. Further improvement in surgical technique and clarification of its indications will likely enhance overall results.

Arthrodesis↗
PubMed1996

[Shoulder arthroscopy using the holmium-YAG laser method. State of the art 1994].

The Ho:YAG laser has been found to be a safe and efficacious adjunct to many arthroscopic shoulder procedures. The curved, thin handpieces are easily manipulated around the surfaces of the joint. Postoperative inflammation is minimized, and a versatile instrument that can cut, coagulate, ablate, and cauterize has obvious benefit where optimal visualization is required. The potential for chondral contouring and bone resection is currently being studied, and the use of laser-induced thermal contraction of soft tissue collagen may add some exciting possibilities to the treatment of joint instabilities.

Arthroscopy↗
PubMedDate not supplied

Evaluation of joint stabilization for treatment of shearing injuries of the tarsus in 20 dogs.

Medical records of 20 dogs with 23 shearing injuries of the tarsus leading to joint instability were reviewed. A transarticular external skeletal fixation device or prosthetic ligament was used to stabilize the joints. The most common complications were fixator failure and implant infection. The median times for wound healing and maximal joint function were 10 and 12 weeks, respectively. Clinical outcome was excellent in 22%, good in 56%, and poor in 22%. Comparison of the two stabilization methods showed no statistically significant differences in healing time, time to regain function, or clinical outcome.

Animals↗
PubMedDate not supplied

[Diagnosis and treatment of osteogenic sarcomas, techniques of reconstructions. Future prospects].

PATIENTS AND METHODS: We have performed 34 massive bone-cartilage grafts with a follow-up of 2 to 7 years (1988-1993) including 5 complete joint grafts of the knee. Between 1988 and 1993, 8 massive diaphyso-metaphyseal bone grafts were performed. Joint reconstructions using massive bone-cartilage allografts are increasingly used in routine oncology surgery. Long-term rehabilitation and possibilities of immediate anatomic reconstruction of the articular surface, together with mid-term results suggest that the functional results are promising compared with major reconstruction prostheses. Indications for operations are being increasingly widened to younger subjects who have undergone partial or total joint exeresis for tumour. Sleeved prostheses were used for 12 reconstructions (1988-1993) for sarcoma of the knee. RESULTS The risk of sepsis are comparable for the different groups and are mainly related to the quality of the skin repair during chemotherapy. Fractures of the graft occur when the fixation is insufficient or when rehabilitation exercises were too aggressive. Non-consolidation was exceptional when the junction between the allograft and the receiver bone is not surrounded with autologous spongious autografts. Joint instability and arthrosis depend on the stability of the ligament reconstruction. To this day, no Charcot type joint disease has been demonstrated, periarticular innervation has maintained joint trophism. DISCUSSION: There are still some incompletely resolved problems concerning the revascularization of the graft, its integration into the skeleton, the outcome of the grafted cartilage and that of the ligament formations attached to the graft or used as allografts. These massive grafts must be studied over a longer period of time but the early results are encouraging. Sleeved grafts using bone-bank specimens could be an intermediary solution which appears to be indicated in cases where the tumoural resection was particularly large removing bone, cartilage, ligaments and muscles. With these sleeved prostheses, the muscles can be refixed onto the graft thus reducing the risk of shank fracture and loosening. The use of a tibial graft with the patellar tendon is helpful in reconstructing the extensor apparatus. However, if rehabilitation is not undertaken rapidly and followed regularly for several months, the graft favours the development of muscular adherances which can be a major limitation to joint mobility.

Adolescent↗
PubMed2000

Understanding multidirectional instability of the shoulder.

OBJECTIVE: To provide an overview of the evaluation and treatment of the patient with multidirectional shoulder instability. DATA SOURCES: I searched MEDLINE for the years from 1980 to 2000 using the key words "shoulder joint," "instability," "dislocation," "multidirectional shoulder instability," and "inferior capsular shift." DATA SYNTHESIS: Multidirectional instability is symptomatic glenohumeral subluxation or dislocation in more than 1 direction: anterior, inferior, or posterior. The primary pathology is a loose and patulous capsule, and the entity is more common than previously recognized. Multidirectional instability affects young, sedentary patients with generalized ligamentous laxity, often with bilateral symptoms and an atraumatic history, but it also affects athletes, many of whom have sustained injuries. Patients with multidirectional instability may also have Bankart lesions and humeral head impression defects. CONCLUSIONS/RECOMMENDATIONS: Patients with multidirectional instability must be identified before appropriate treatment can be initiated. If a course of rehabilitation fails to improve the patient's symptoms, an inferior capsular shift procedure has been demonstrated to be an effective surgical option.

Journal Article↗
PubMed1991

[The correlations of dysplastic hip joint pathology with fetal breech presentation].

In the article are discussed the causes of hip joint instability at breech presentation. In the article are presented the results of examination of 116 probands with hip joint dysplasia, aged 5-15 years, and 69 breech presentation born probands, It has been carried out genetic-correlative analysis on the basis of population frequency and frequency among the probands' relatives, differentiated in accordance with the signs discussed. The principal cause of the hip joint dysplastic pathology formation at breech presentation is the mechanical factor.

Adolescent↗
PubMed1989

Rehabilitation of common athletic injuries of the hand and wrist.

Rehabilitation of athletic injuries of the hand and wrist should begin at the time of injury. Early recognition and prompt medical attention can serve to minimize the initial effects of injury. A systematic evaluation should include assessment of deformity, joint instability, active and passive motion, edema, and nerve and tendon function. In spite of initial negative findings, painful joints should be protected. Joints of the hand and wrist are particularly vulnerable to the effects of aggressive rehabilitation. Signs of reaction to exercises should be closely observed. Upgrading of activity should only occur as soft-tissue healing will allow.

Athletic Injuries↗
PubMed2001

Sonographic measurement of instability of the subtalar joint.

A sonographic method of measuring instability of the subtalar joint was developed. After defining reference points, we determined a sonographic fibulo-trochlear angle. This angle was measured in a neutral position and under an inversion stress position. A ratio q representing the relationship between the fibulo-trochlear angle measured in the neutral position and under stress, was determined. The method was tested on volunteers with clinically and radiologically stable subtalar joints and a control group with unstable subtalar joints. The stress radiograph using the Zwipp method was utilized for radiologic correlation. A sonographic ratio q>1.6 correlated with a radiological unstable subtalar joint. The borderline zone in which there was an overlap of stable and unstable subtalar joints was characterized by a q value of 1.2-1.6. A ratio q<1.2 correlated with a stable subtalar joint.

Cadaver↗
PubMed1993

Ligamentous injuries of multiple interphalangeal joints of the little finger: case report.

Ligamentous injuries to multiple interphalangeal joints of an extremity have seldom been reported. We treated a patient with multiple ligamentous injuries in the little finger. Manual reduction of the distal interphalangeal (DIP) joint and surgical repair of the radial collateral ligament were performed to correct multidimensional joint instability and to allow for rehabilitation.

Finger Injuries↗
PubMed1989

Massive allografts in surgery of bone tumors.

Large osseous and osteoarticular allografts have provided the orthopedic oncologist with a useful biological reconstructive alternative following wide en-bloc resection of bone tumors. Although the surgical procedures are complex, meticulous surgical techniques in terms of graft selection, allograft fixation, reconstruction of joint ligaments and tendons, and adequate skin coverage would produce satisfactory results in about three quarters of the patients. The potential causes of failure include allograft fracture, infection, nonunion and joint instability.

Adult↗
PubMed2004

Does osteoarthritis of the lumbar spine cause chronic low back pain?

The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.

Biomechanical Phenomena↗
PubMed2004

Does osteoarthritis of the lumbar spine cause chronic low back pain?

The lumbar spine is a common location for osteoarthritis. The axial skeleton demonstrates the same classic alterations of cartilage loss, joint instability, and osteophytosis characteristic of symptomatic disease in the appendages. Despite these similarities, questions remain regarding the lumbar spine facet joints as a source of chronic back pain. The facet joints undergo a progression of degeneration that may result in pain. The facet joints have sensory input from two spinal levels that makes localization of pain difficult. Radiographic studies describe intervertebral disc abnormalities in asymptomatic individuals that are associated with, but not synonymous for, osteoarthritis. Patients who do not have osteoarthritis of the facet joints on magnetic resonance scan do not have back pain. Single photon emission computed tomography scans of the axial skeleton are able to identify painful facet joints with increased activity that may be helped by local anesthetic injections. Low back pain is responsive to therapies that are effective for osteoarthritis in other locations. Osteoarthritis of the lumbar spine does cause low back pain.

Biomechanical Phenomena↗
PubMed1991

Cartilage lesions in the knee of adolescents and young adults: arthroscopic analysis.

In this article, the mechanism of occurrence and development of cartilage lesions as well as the relationship between pain and conditions of cartilage lesions will be discussed. The study was based on the findings from arthroscopic analyses, plain radiographs, and arthrograms. Sixty-five joints of 63 patients with cartilage lesions were examined. We have made the following conclusions. Cartilage lesions do not start necessarily from the surface layers of the cartilage. Lesions may originate in the subchondral bone and develop toward the surface, causing severe pain. Cartilage lesions, resulting in little pain, are related closely to joint instability, indicating that the lesion occurrence is affected by unnatural shearing stress rather than by direct force applied to the joint surface. Thus, prevention and treatment should focus on removing the shearing stress. The purpose of this article is to examine how cartilage lesions relate to patient symptoms. Additionally, untreated lesions possibly could develop into the early stage of osteoarthrosis of the knee, causing exposure of the subchondral bone and thus continuous pain.

Adolescent↗
PubMed1998

Triangular fibrocartilage injuries in pediatric and adolescent patients.

This is a retrospective review of 29 posttraumatic pediatric and adolescent patients with surgically documented triangular fibrocartilage complex tears. All patients complained of ulnar wrist pain. Fifteen patients (52%) sustained distal radius fracture at the time of the original injury. Twenty-three (79%) of the triangular fibrocartilage complex tears were Palmer 1B lesions. There were 31A, 11C, and 21D lesions. All 1B, 1C, and 1D tears were repaired. Coexisting pathology was present in 25 patients (86%). This pathology included ulnar styloid nonunion, distal radioulnar joint instability, ulnocarpal impaction, distal radius deformity, and intercarpal ligament tears, which were treated by ulnar styloid nonunion excision, distal radioulnar joint stabilization, ulnar shortening, radius corrective osteotomy, and intercarpal ligament debridement, respectively. The length of the follow-up period averaged 21 months. Three patients were lost to follow-up. Outcomes were graded by a modification of the Mayo wrist score. Twenty-four patients (89%) had excellent results, 3 had good results.

Accidental Falls↗
PubMed1996

[Diagnostic imaging of instability of the shoulder joint].

The diagnosis of glenohumeral instability is based on the patient's history and physical examination. The main objective in using imaging techniques is to define the type and extent of the underlying pathology for therapeutic planning. Plain radiography is the initial step in the diagnostic procedure but can miss typical lesions of the glenohumeral joint structures. CT arthrography and MR imaging offer great sensitivity and accuracy for the detection of traumatic abnormalities of the labral-capsular complex, fractures of the glenoid rim and Hill-Sachs lesions. The advantages and pitfalls of both imaging techniques are discussed.

Chronic Disease↗
PubMed2003

The relation of the coracoclavicular ligament insertion to the acromioclavicular joint: a cadaver study of relevance to lateral clavicle resection.

Resection of the lateral end of the clavicle is a common procedure for arthrosis of the acromioclavicular joint (AC-joint). However, no anatomical data on the distance between the insertions of the coracoclavicular ligaments and the AC-joint have been reported. In 36 cadaver shoulders (18 male), we studied the relation between the AC-joint and the insertions of the joint capsule, trapezoid and conoid ligaments. The distance from the AC-joint to the medial end of its capsule was, on average, 0.7 cm (0.4-0.9) cm in women and 0.8 (0.4-1.2) cm in men. In women, the trapezoid ligament began, on average, at 0.9 (0.4-1.6) cm and ended at 2.4 (2.0-2.8) cm and in men, it began at 1.1 (0.8-1.6) cm and ended at 2.9 (2.1-3.8) cm medial to the AC joint. The corresponding figures for the conoid ligament were 2.6 (2.0-3.7) cm and 4.7 (3.9-6.2) cm. A resection of 1 cm of the lateral clavicle detaches 8%, a resection of 2 cm 60% and a resection of 2.5 cm 90% of the trapezoid ligament. We recommend a maximum resection of 1 cm of the lateral clavicle because a resection of 2 cm or more may cause postoperative AC-joint instability and related pain.

Acromioclavicular Joint↗
PubMed1994

Plantar dislocation of the metatarsophalangeal joint: case report.

Dislocations of lesser metatarsophalangeal joints are rare and are almost always dorsal hyperextension injuries. The patient reported sustained plantar dislocations of the second and third metatarsophalangeal joints in a motor vehicle accident; the mechanism of injury was hyperflexion. Closed reduction was not possible, and at the time of open reduction, the extensor digitorum longus and brevis tendons to the third toe were trapped beneath the plantar aspect of the third metatarsal head. Once the tendons were retracted dorsomedially, the joint was easily reduced. Fixation with a Kirschner wire was necessary because of joint instability.

Adult↗