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PubMedDate not supplied

Treatment of the sequelae of septic osteoarthritis of the hip during pediatric age.

A total of 69 cases (73 hips) of the sequelae of septic osteoarthritis of the hip are studied. The sequelae are classified based on whether or not the femoral epiphysis is present, and on stability of the joint according to Hunka (1982). Three of the hips were treated non-surgically. All of the others were submitted to from a minimum of 2 to maximum of 5 operations with the purpose of re-establishing joint relationships. The results were: good: 50 hips (72.5%); fair 12 (17.4%); poor: 11 (16%). The most significant sequelae were hip instability, joint function limitation, and shortening of the limb.

Arthritis, Infectious↗
PubMed2000

Multidirectional instability of the glenohumeral joint.

The concept of multidirectional instability (MDI) was introduced as an important clinical entity in 1980. Previously, it had received little mention in the literature and was not considered to be clinically relevant. MDI is a symptomatic glenohumeral subluxation or dislocation occurring in more than one direction. The basic pathology of this condition is a loose and redundant joint capsule. Most patients with MDI can be treated successfully by conservative methods, such as patient education, a shoulder girdle strengthening program, or modification of the patient's routine activity.

Arthroscopy↗
PubMed2006

[Minimally invasive implantation of a unicondylar knee system].

OBJECTIVE: Unicondylar medial surface replacement of the knee joint by arthrotomy with short incision and in bone-sparing resection technique. INDICATIONS: Unicompartmental medial arthritis of the joint knee. Unilateral osteonecrosis. Posttraumatic unicompartmental gonarthrosis. CONTRAINDICATIONS: Pangonarthrosis. Rheumatoid arthritis. Knee joint instability. Status following osteotomy of the tibial head. SURGICAL TECHNIQUE: The patient should be placed in the supine position with the knee joint uncovered and freely mobile. Short anteromedial skin incision and arthrotomy. Bone-sparing resection at the tibia and femur. Axial malalignment (varus deformity) is not completely corrected. The implants are centered perpendicular to one another. POSTOPERATIVE MANAGEMENT: Early functional postoperative management adapted to the symptoms with pain therapy, local application of ice, passive mobilization on an electric exercise splint and physiotherapy. Full weight bearing is usually possible from the 2nd postoperative day. RESULTS: 28 Accuris unicondylar knee systems were implanted medially in 26 patients (14 women, twelve men) in minimally invasive technique from March 2003 to July 2004. One patient was not included in the evaluation because the operation was changed to a bicondylar surface replacement due to a deep-seated infection. The patients' average age at the time of the operation was 73.8 years. On average, the operation scar was 8.2 cm long. The average quantity of secretion in the Redon drain was 155 ml. The hemoglobin value fell from 13.3 to 12.3 g/dl. The total HSS (Hospital for Special Surgery) Score increased significantly from 55.5 (34-75) to 87.4 (71-95) points. In the follow-up examination, 21 unicondylar knee systems (77.8%) were evaluated as excellent and six (22.2%) as good.

Aged↗
PubMed1991

Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint.

An anatomic and radiographic study of the osteoarthritic trapeziometacarpal joint was conducted on 27 surgical specimens harvested during basal joint arthroplasty. Surface wear patterns were analyzed by hyaline cartilage staining, and relative involvement of trapezium and metacarpal was calculated as the trapezium/metacarpal eburnation ratio. Eburnation occurred only on facing trapeziometacarpal surfaces in contact areas of the palmar compartment. Metacarpal degeneration began at the palmar joint margin adjacent to the beak ligament and extended dorsally, while trapezial degeneration originated on the central palmar slope and spread centrifugally with more advanced disease. Eburnation consistently involved a greater surface area on the trapezium than on the metacarpal in a ratio of nearly 3:1. A decreasing trapezium/metacarpal eburnation ratio correlated closely with worsening radiographic stage. These observations suggest translation of metacarpal on trapezium in the production of arthritic surface lesions and support a hypothesis of pathologic joint instability as the cause of trapeziometacarpal osteoarthritis.

Carpal Bones↗
PubMed2002

[Technique and diagnostic value of musculoskeletal ultrasonography in rheumatology. Part 6: ultrasonography of the wrist/hand].

Sonography of the hands is especially helpful in the diagnosis of early arthritis. Sonography allows for a very sensitive detection of small joint-effusion, tenosynovitis and small erosive bone lesions earlier than conventional radiography. Musculoskeletal sonography is also helpful in morphological analysis of changes of the median nerve in patients with carpal tunnel syndrome. The following standard scans are suggested for the sonographic evaluation of the wrist: 1. dorsal longitudinal scan along the radio-carpal joint, 2) along the ulno-carpal joint, and 3) dorsal transverse scan along the wrist to detect joint fluid collection, synovitis, tenosynovitis, ganglia, irregularities of the bone surface in osteoarthritis, and erosions due to inflammatory disease, 4) volar longitudinal scan along the radio-carpal joint, and 5) along the ulno-carpal joint, and 6) volar transverse scan along the wrist to diagnose the same objective as the above mentioned scans and to evaluate the median nerve in cases of carpal tunnel syndrome. Optional scans are the following: 7) ulnar longitudinal 8) transverse scan along the ulnar joint space and the extensor carpi ulnaris muscle to detect tenosynovitis and caput ulnae syndrome, 9) radial longitudinal, and 10). transverse scan along the joint space to diagnose synovitis and tenosynovitis. The following standard scans are suggested for the sonographic evaluation of the fingers: 1) volar longitudinal, 2) volar transverse scan in extension along the finger joints to detect effusion and synovial proliferation, tenosynovitis, irregularities of the bone surface (osteophytes, erosions), 3) dorsal longitudinal scans in extension and flexion >70 degrees along the CMC I, MCP, PIP and DIP joints to evaluate effusion and synovial proliferation, tenosynovitis or tendinitis, irregularities of the bone surface (osteophytes, erosions), and 4) dorsal transverse scans along the finger joints to evaluate these structures in an additional dimension. Optional 5) scans include the following: medial longitudinal scan along the MCP I, II, PIP and DIP joints, and 6) lateral longitudinal scan along the MCP V, PIP and DIP joints to evaluate the erosive bone process and joint instability. A linear transducer with a frequency of between 7.5 and 12 MHz is recommendable. The anterior distance between the bone and the joint-capsule of the wrist is > or = 3 mm in probable and > or = 4 mm in definite synovitis or effusions. Synovitis or effusions are probable if the difference between right and left wrist is > or = 1 mm, and they are definite if the difference is > or = 2 mm. A carpal tunnel syndrome is probable with a cross-sectional area of the median nerve of > or = 12 mm(2).

Arthritis, Rheumatoid↗
PubMed2000

Anterior oblique ligament reconstruction of the thumb using the transverse carpal ligament: description of a new procedure.

Traumatic dislocation of the thumb carpometacarpal joint is an uncommon injury that may have long-term sequelae after treatment. Joint instability may cause pain, weakness of pinch, and the increased likelihood of development of posttraumatic arthritis. The anterior oblique ligament has generally been accepted as the most important static stabilizer of the trapeziometacarpal joint. Numerous operative techniques have been described to reconstruct this ligament. The author introduces a novel operative procedure to reconstruct the anterior oblique ligament of the thumb using the transverse carpal ligament (AOLR-T). This procedure was performed on 5 fresh-frozen cadaveric hands to assess its feasibility and potential efficacy. No technical difficulties were encountered. AOLR-T may be indicated for the treatment of thumb carpometacarpal instability of primary or secondary etiology and may avoid many of the disadvantages of traditional ligament reconstruction.

Cadaver↗
PubMedDate not supplied

Managing the stiff elbow: operative, nonoperative, and postoperative techniques.

Elbow contracture may be caused by intrinsic or extrinsic limitations or a combination of both. Evaluation of the specific structures guides the development of an effective therapy treatment program. Intrinsic contractures are by definition due to joint/intra-articular incongruency, and therefore therapy and splinting cannot provide increase in joint motion. Nonoperative therapy treatment options include heat modalities, myofascial soft tissue mobilization, joint mobilization, muscle energy techniques, passive range of motion, active range of motion, extensive use of corrective splinting, and strengthening exercise. All operative candidates must participate in a preoperative therapy program of six to eight weeks to reduce extrinsic contractures as feasible and to assess patient compliance with an intensive postoperative therapy program. Corrective splinting may be needed for as long as six months to maintain gains made in surgery. The therapy following manipulation under anesthesia and open contracture release is similar. The therapist must know the details of the procedure. Operative treatment for the stiff elbow progresses in a sequential fashion to progressively release tissue structures limiting motion and reconstruct any structures as needed to provide joint stability. Postoperative therapy consists of continuous passive motion , corrective splinting, modalities, and specific exercise techniques to maintain passive gains achieved in surgery. The therapy is extensive and requires full participation from the patient to maximize motion and function. Complications of elbow contracture release include nerve palsy or nerve injury, seroma, joint instability, heterotopic ossification, and recurrence of elbow contracture.

Contracture↗
PubMed2003

Nontraumatic multidirectional instability of the scaphotrapeziotrapezoid joint: a cause of scaphotrapeziotrapezoid osteoarthritis and static distal intercalated segment instability.

We report a case of bilateral multidirectional instability of the scaphotrapeziotrapezoid joint associated with osteoarthritis of the same joint and static dorsal intercalated segment instability. Because there is no previous trauma it is likely that this is a case of nontraumatic instability at the scaphotrapeziotrapezoid joint causing a dorsal intercalated segment instability deformity of carpal malalignment and secondary scaphotrapeziotrapezoid osteoarthritis.

Humans↗
PubMed1997

[Replantation in childhood and adolescence. Long-term outcome].

In 31 (out of 48) patients with 43 (out of 63) replanted or revascularized digits or parts of the extremities a study of long-term results was performed. Their ages were below 16 years at the time of injury. The results concerning function, sensitivity, cold intolerance, growth disturbance, patient acceptance and occupational changes were evaluated. Early complications consisted of venous stasis in 10.6% (n = 4), skin necrosis of the wound margin in 5.3% (n = 2) and in finger-tip necrosis in 5.3% (n = 2). One lower arm and one finger replanted (5.3%, n = 2) were lost after several revisions due to venous problems. In no case did arterial problems occur. Tendon adhesions were the most common complication in 28.9% (n = 11), followed by deviation of the axis in a frontal plane of more than 20 degrees in 13.3% (n = 5) and by joint instability in 5.3% (n = 2). Only twice (5.3%) did ankylosis or in another case osteomyelitis of the proximal phalanx result. At amputation level II (between the DIP joint and the nail root), 37.5% (n = 3) developed a reduction of range of active movement (RAM) with a mean of 31.7 degrees, and once an arthrodesis was necessary, whereas 50% (n = 4) of the patients have full range of active motion. At amputation level III (between the MP and DIP joint) 52.7% (n = 10) developed a reduction of RAM at the PIP joint with a mean of 29.5 degrees, and twice an arthrodesis was necessary, whereas 26.4% (n = 5) of the patients have full range of active motion. Of the patients 78.9% (n = 15) developed a reduction of RAM at the DIP joint with a mean of 35.7 degrees, and twice an arthrodesis was necessary. Only twice was ankylosis present, but 10.5% (n = 2) of the patients have full range of active motion. Excellent sensory recovery was observed with a mean dynamic two-point discrimination of 4.8 mm. In addition, only 29% (n = 9) of the patients report a surprisingly low incidence of cold intolerance, which is in contrast to adults with up to 100% cold intolerance in replanted digits. In 67.7% a radiologically measured difference of length with a mean of 3.8 mm and clinically measured a difference in the length of the digits with a mean of 4.9 mm was observed without complaints by the patients, instead, there was moderate discontent with the aesthetically disturbing fingertip atrophy, which was up to 30% in 48.4% of the patients. Of the patients who are now adult, 16.7% (n = 4) changed their choice of profession due to the trauma or because of the dissatisfactory result. These results and the success rate of 94.7% suggest the conclusion that one should not hesitate to perform a replantation or revascularization in children with even multiple amputations as the results are excellent.

Adolescent↗
PubMed1988

Arthrodesis of digital joints in children.

Many procedures have been described for treatment of unstable, deformed, or painful digital joints; most of these are various types of arthrodeses. These procedures have not been applied to children who have an open epiphysis for fear of damage to the growth plate. This study evaluates an arthrodesis technique that can be used for digital joint instability or deformity in skeletally immature patients. The diagnosis in most of the children in this series was related to non-traumatic congenital or developmental conditions. The joint most often fused was the thumb metacarpophalangeal joint. Results show a high rate of fusion with no interference in digital growth. Complications were minimal.

Adolescent↗
PubMed1990

Prevention and treatment of ligamentous sports injuries to the hand.

Sports-related injuries to the intricate small joints of the hand are quite frequent. The majority of such injuries result in joint contusions, partial tears or ligament sprains which do not jeopardise the basic stability of the joint and readily respond to a short course of protective splinting with rapid recovery of motion, strength and function. In fact, many patients never seek medical attention unless persisting pain, chronic swelling or restriction of motion persuade them to do so. Partial tears or sprains need to be distinguished from more serious injuries that cause profound ligamentous and capsular disruption resulting in dislocations, articular incongruency, joint instability or fracture-dislocations. While simple dislocations are readily reducible and generally stable, a complex dislocation by definition implies irreducibility by closed means. This category of complex joint injury requires prompt diagnosis, as optimal management warrants active surgical intervention to achieve a stable and congruous reduction. Following surgical repairs the injured joint is immobilised for a variable length of time, determined by the type, extent and the nature of the specific injury, prior to initiating remobilisation efforts. A supervised and well-executed rehabilitation programme should encompass all the various modalities of physical therapy that are effective in increasing mobility, correcting deformity and restoring strength and function to the injured hand. The ultimate goal of treatment is to enable the athlete to resume sports, unimpaired with the same skill, dexterity and competitive edge as before.

Athletic Injuries↗
PubMedDate not supplied

Medial collateral ligament replacement with a partially absorbable tissue scaffold.

The medial collateral ligaments and medial capsular structures of canines were resected and replaced with a carbon fiber-polylactic acid polymer tissue scaffold or allowed simply to "scar-in." After 4, 8, 12, and 26 weeks in vivo, the stability of the knees was quantitatively evaluated and the mechanical properties of the regrown structures determined. Histological sections of the regrown structures were examined after 26 weeks in vivo. At all time periods, the knees receiving tissue scaffold ligaments were significantly more stable than those knees allowed to stabilize with scar tissue. Initial strength, rapid ingrowth, and benign tissue reaction suggest this new composite material may be useful in the treatment of joint instability.

Animals↗
PubMed1994

Pressure distribution in the knee joint. Influence of flexion with and without ligament dissection.

Biomechanical factors influencing the patterns of pressure distribution at the articular surface and the subchondral bone are suggested to be most important in the pathogenesis of osteoarthritis and osteochondritis dissecans at the knee joint. Besides this, chronic joint instability is another important factor under discussion in the etiology of osteoarthritis of the knee. The patterns of pressure distribution on the femoral condyles of weight-bearing knee joints were investigated in a biostatic cadaver model. The pressure on the femoral condyles was evaluated using pressure-sensitive films with the knee in different physiological joint positions (extension, 15 degrees and 30 degrees flexion) with and without division of either the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the MCL and the anterior cruciate ligament (ACL), or the LCL and the ACL. Results showed that the location of the contact area and peak pressure depended on the joint position and stage of ligament division. Without ligament division the maximum peak pressure was always observed on the medial condyle. Only after MCL and combined MCL + ACL division did the lateral condyle show in extension a higher peak pressure than the medial condyle. Division of the LCL and LCL + ACL resulted in an increase in peak pressure on the medial condyle, particularly in flexion. The highest peak pressure of all was measured in the 30 degrees flexion position on the medial condyle after division of the LCL. The lowest at all was found on the lateral condyle in 15 degrees flexion after LCL division. Additional ACL division resulted in only minor further changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed2002

Kinesthesia at the knee: the effect of osteoarthritis and bandage application.

OBJECTIVE: To investigate whether osteoarthritis (OA) of the knee or bandaging of the knee affects movement detection. METHODS: Movement detection levels were determined in 10 women aged > 65 years with moderate to severe knee OA and 10 healthy women matched for age, body mass index, and activity levels. Movements were imposed at 0.5 degrees /second, 1.0 degrees /second, and 2.5 degrees /second. Additionally, detection levels were compared with and without the knee bandaged at a single velocity, (0.5 degrees /second). RESULTS: Controls perceived significantly smaller movements than OA subjects at all test velocities (P < 0.01). However, the bandage did not affect movement detection (P > 0.05). CONCLUSIONS: Detection of movement at the knee was impaired in subjects with severe knee OA, and a bandage did not improve detection. Thus, considering previous findings that position sense is impaired, a generalized proprioceptive deficit appears to be associated with OA. This deficit could result from loss of receptors, altered muscle function, or the consequent joint instability.

Aged↗
PubMed2002

Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers.

Sonography is a valuable method for imaging superficial tendons and ligaments. The ability to obtain comparison images easily with dynamic stress allows assessment of ligament and tendon integrity. We studied the medial elbow joints of two baseball pitchers using MR imaging and dynamic sonography. Both sonography and MR imaging identified the ulnar collateral ligament tears. Dynamic sonography uniquely demonstrated the medial joint instability.

Adolescent↗
PubMed1981

Anterolateral rotational instability in the ankle joint. An experimental study of anterolateral rotational instability, talar tilt, and anterior drawer sign in relation to injuries to the lateral ligaments.

In seven amputated legs the ankle region was dissected free, and anterolateral rotational instability, talar tilt, and anterior drawer sign in the talocrural joint were studied in relation to varying degrees of injury to the lateral ligaments of the ankle and in relation to various positions of the foot. This revealed a good correlation between the degree of ligamentous injury and the degree of the three different types of instability. Anterolateral rotational instability was maximal when the investigation was performed with the ankle joint in the plantar flexion, whereas the talar tilt was more pronounced with the ankle joint in the neutral position and the anterior drawer sign most distinct when the ankle joint was in dorsal flexion. Compared with the other two signs, the anterior drawer sign proved to be a relatively inconstant type of instability.

Ankle Joint↗
PubMed2003

The role of muscles in joint adaptation and degeneration.

BACKGROUND: Muscles are the primary contributors to joint loading. Loading is typically associated with the onset and progression of joint degeneration, and in turn, joint degeneration is known to affect negatively the control of muscle forces and co-ordination patterns. Nevertheless, the role of muscles in joint adaptation and degeneration has been largely ignored. Here, we review some of our research on the in vivo changes in muscular forces and joint loading in animal models of osteoarthritis and in patients with joint injury and disease. We attempt to emphasize the close dependence of muscle forces, joint loading and degeneration and, vice versa, try to point out how joint degeneration affects muscle forces and joint loading. MATERIAL AND METHODS: We measured the forces and electromyographic signals in normal and anterior cruciate ligament transected feline knees and measured (1) a consistent decrease in the knee extensor and ankle extensor muscle forces for weeks following intervention; (2) a corresponding decrease in the static and dynamic external ground reaction forces; and (3) a change in the electromyographic signals (in terms of the firing patterns of individual muscles and of the co-ordination of extensors and flexors during locomotion). We introduced results on the biosynthetic response of articular cartilage to controlled, in vivo, loading and discuss preliminary results from an experimental animal model of muscle weakness. In contrast to much of the published literature, loading, in our case, is introduced by controlled nerve stimulation and the corresponding muscular forces that load the joint in its in vivo configuration. RESULTS: We found that short-term loading (30-60 min) in the cat knee produces distinct up-regulation of mRNA of specific metalloproteinases (MMPs) and some of the MMP inhibitors. In our newly developed muscle-weakness model, we confirmed that controlled Botox injections in the rabbit knee extensor muscles cause a 60-80% decrease in muscle force, and that these changes in muscle force are associated with changes in the external ground reaction forces, and most importantly, that muscle weakness seems to be associated with degeneration of the knee in the absence of joint instability or any other intervention. CONCLUSION: From the results of our research, we conclude that muscle health and muscle rehabilitation are key components for the successful prevention of, and recovery from, joint injury and disease.

Adaptation, Physiological↗