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PubMed1991

[Lateral instability of the ankle joint (2). Active training programs can prevent surgery].

One hundred consecutive patients with chronic lateral functional instability of the ankle were treated non-operatively with physiotherapy (active range-of-motion training, strengthening exercises and co-ordination training with a tilt-board). All patients were evaluated functionally with a special rating scale, and radiologically with standardised stress radiographs measuring anterior talar translation (ATT) and talar tilt (TT). Excellent or good functional results were obtained in 49 of the patients, fair or poor in the remainder. The outcome was better in those with painful functional instability or mild mechanical instability, while those with more pronounced mechanical instability required further treatment (i e, reconstructive surgery). Of 10 patients with generalised joint laxity, only fair or poor results were obtained in seven, all of whom had mechanical instability.

Adult↗
PubMed1993

[Treatment of posterior instability of the shoulder joint using an acromial stop with a pediculated deltoid flap].

Our purpose has been to describe an original surgical technique without describing all the problems concerning the posterior instability. The original technique has a double effect: active with the muscular flap and passively mechanic, if necessary, by the bone graft. Five patients have been treated with this technique with a follow-up of one year and a half. 4 females and 1 male with an average age of 32 years 1/2. 2 were recurrent posterior instability, one unintentional and 2 intentional subluxations. 2 were epileptics. In all cases, the disparition of the instability was obtained. Full range of movement and sport were resumed at the former level. On X-rays, the humeral head was centered. By its double mechanism, active with the muscular flap and possibly passive with the bone graft, this technic is reliable to treat the majority of posterior instability. It combines the way of action searched in physiotherapy and capsulomyoplasties to center the humeral head and this one by the bone graft in case of posterior glenoid fracture or dysplasia. It doesn't have the insufficiencies of physiotherapy or capsulomyoplasties in posterior traumatic instabilities, nor from the classical bone graft over the glenoid posterior wall, cause of osteoarthritis and pain.

Acromion↗
PubMed1992

[The value of dynamic examination methods in instability of the shoulder joint].

We prospectively examined 25 patients with shoulder instability by clinical examination and by fluoroscopic and sonographic imaging. 14 patients were classified as recurrent, posttraumatic instabilities, 12 of these anterior and two posterior. Clinical examination revealed the direction of instability in 5 patients, fluoroscopy in 5 and sonography in 3 patients. 11 patients had non-traumatic recurrent instabilities. Of these, clinical examination and fluoroscopy demonstrated identical directions of laxity in 8. Sonography concurred with the other techniques in only three cases. We recommend manual instability testing followed by fluoroscopy for evaluation and documentation of patients with non-traumatic, recurrent shoulder instability. Posttraumatic instabilities should be diagnosed with other, static procedures.

Adolescent↗
PubMed1990

[Suture of the meniscus in acute instability of the knee joint].

The authors describe a multiform function of the menisci and the causes of frequently occurring simultaneous injuries of the meniscus and of the ligament. In 26 cases of acute instability of the knee the authors put sutures over the meniscus. In all the cases the results were good, there were no complications and there was no need to make a repeated operation in any of the cases. Making use of the suture over the meniscus, it is possible to improve the results of the surgical treatment of instability of the knee to a greater extent.

Adolescent↗
PubMed1999

Anterior instability of the glenohumeral joint with humeral avulsion of the glenohumeral ligament. A review of 41 cases.

We studied retrospectively a consecutive series of 547 shoulders in 529 patients undergoing operation for instability. In 41, the cause of instability was considered to be lateral avulsion of the capsule, including the inferior glenohumeral ligament, from the neck of the humerus, the HAGL lesion. In 35, the lesion was found at first exploration, whereas in six it was noted at revision of a previous failed procedure. In both groups, the patients were older on average than those with instability from other causes. Of the primary cases, in 33 (94.3%) the cause of the first dislocation was a violent injury; six (17.4%) had evidence of damage to the rotator cuff and/or the subscapularis. Only four (11.4%) had a Bankart lesion. In patients undergoing a primary operation in whom the cause of the first dislocation was a violent injury, who did not have a Bankart lesion and had no suggestion of multidirectional laxity, the incidence of HAGL was 39%.

Adolescent↗
PubMed2004

[Surgical treatment of posterior instability of the shoulder joint using an iliac bone block or an acromial pediculated bone block: outcome in eighteen patients].

PURPOSE OF THE STUDY: The posterior bone block procedure is a popular option for the treatment of involuntary posterior instability of the shoulder. The purpose of this study was to analyze the long-term results of this procedure using an iliac bone graft and to point out the advantages of Kouvalchouk technique using an acromial pediculated block. MATERIAL AND METHODS: Eighteen patients, ten men and eight women, mean age 27 years, were reviewed: thirteen were active in sports activities including four at the competition level. The duration of symptoms before surgery was four years on the average. One patient experienced recurrent dislocation, twelve suffered regular involuntary subluxation, and five had painful shoulders possibly related to posterior instability considering the arthroscopic findings. For nine patients (group 1), an iliac block was combined with the soft-tissue procedure. In nine others (group 2), the procedure described by Kouvalchouk was used to create a posterolateral acromial bone block with pediculated deltoid fibers. Functional outcome was assessed with the 100-point Duplay score. The position of the bone block and osteoarthritis were assessed on plain x-rays. RESULTS: Mean follow-up was 13.5 years in group 1 and 3.5 years in group 2. Four patients needed a revision procedure to remove a screw. At last follow-up, the average Duplay score was 78 points. Nine patients returned to their former sports activities. Seven patients were pain free and ten had moderate discomfort at effort. We did not observe any recurrent dislocation no subluxation but did have six patients who described apprehension. The mean Duplay score was 70 points in group 1 and 86 points in group 2. In two patients in group 1, the x-rays showed signs of grade 3 or 4 osteoarthritis, which was related to an intra-articular screw in one; the other patient had had the same degenerative signs before surgery. Two patients developed grade 1 osteoarthritis. DISCUSSION AND CONCLUSION: The bone block procedure is effective for posterior instability of the shoulder. Occurrence of osteoarthritis, compared with the anterior bone block, is lower after long-term follow-up. The results of the Kouvalchouk procedure with an acromial pediculated bone block look promising. We recommend an additional capsuloplasty when inferior hyperlaxity is associated with posterior instability.

Acromion↗
PubMed2000

Anatomical reconstruction versus tenodesis for the treatment of chronic anterolateral instability of the ankle joint: a 2- to 10-year follow-up, multicenter study.

The clinical outcome of anatomical reconstruction or tenodesis in the treatment of chronic anterolateral ankle instability was assessed in a retrospective multicenter study. The anatomical reconstruction group (group A) consisted of 106 patients (mean age at operation 24 +/- 8.4 years) and the tenodesis group (group B) of 110 patients (mean age at operation 26 +/- 11.4 years). Patients were evaluated at a mean follow-up of 5.5 +/- 2.8 years in group A and 5.2 +/- 2.9 years in group B. The review protocol included patient characteristics, physical examination, two ankle scoring scales to evaluate the functional results, and standard anteroposterior and lateral radiographs to evaluate degenerative changes. Mechanical stability was evaluated using standardized stress radiographs. A larger number of reoperations was performed in group B (P = 0.008). At physical examination, more patients in group B had a smaller range of ankle motion than those in group A (P = 0.009). A larger proportion of patients in group B had medially located osteophytes, as seen on standard radiographs (P = 0.04). On stress radiographic examination, the mean talar tilt (P = 0.001) and mean anterior talar translation (P < 0.001) were seen to be significantly greater in group B than in group A. There were no differences in mean Karlsson score between the groups, but more patients in group A had an excellent result on the Good score (P = 0.011). Unlike anatomical reconstructions, tenodeses do not restore the normal anatomy of the lateral ankle ligaments. This results in restricted range of ankle motion, reduced long-term stability, an increased risk of medially located degenerative changes, a larger number of reoperations, and less satisfactory overall results.

Adolescent↗
PubMed2006

Flexor hallucis longus tendon transfer for hallux claw toe deformity and vertical instability of the metatarsophalangeal joint.

BACKGROUND: Historically, operative treatment of hallux claw toe deformity has been the Jones procedure or one of its modifications. Review of the literature confirms its ability to maintain alignment and achieve patient satisfaction; however, several complications have been reported. Many of these are related to altered biomechanics across the metatarsophalangeal (MTP) joint. A similar approach to this clinical problem involves restoration of the flexion moment across the MTP joint without an interphalangeal (IP) joint arthrodesis. METHODS: We conducted a retrospective review of 10 patients who had a flexor hallucis longus (FHL) tendon transfer to the proximal phalanx of the great toe for hallux claw toe deformity, as well as for symptomatic vertical instability. Four patients had a positive drawer test indicating vertical instability without static deformity. Two patients with vertical instability were found to have a dynamic deformity. Mean followup was 24 (SD 15.2) months. RESULTS: All deformities were corrected and alignment was maintained at the time of followup. Pain under the first metatarsal head was reliably improved in symptomatic patients (p < 0.05). Patient satisfaction also was assessed. All six patients treated for hallux claw deformity were satisfied with their outcomes. Two of the four patients treated for vertical instability were satisfied. The other two patients expressed dissatisfaction because of persistent pain that occurred during strenuous exercise. Their symptoms during routine activity were improved, however. CONCLUSION: Based on initial results, the FHL transfer to the proximal phalanx appears to be a viable treatment option for hallux claw deformity in terms of deformity correction, pain relief, and patient satisfaction. Further evaluation is warranted regarding the indication of vertical instability.

Adolescent↗
PubMed1998

Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint.

This was a quantitative study of the major anatomical structures associated with instability of the patellofemoral joint: the quadriceps muscles and the femoral trochlear groove. The attachments of the muscles to the patella, their lines of action, and their relative sizes (physiological cross-sectional areas) were found. On the basis of the physiological cross-sectional areas, it was estimated that the central muscles-the rectus femoris and vastus intermedius-contributed 35% of the quadriceps strength, with 40% from the vastus lateralis and 25% from the vastus medialis. The vastus lateralis had the most variable results, with the ratio of the lateralis to the medialis ranging from 0.90 to 2.18; this may be associated with patellar instability. Both the long and oblique parts of the vastus medialis were more oblique than the corresponding parts of the vastus lateralis. Photographic "skyline" views of the trochlear groove produced data on the sulcus angle and ratio of depth to width. The data showed that the trochlear groove did not deepen in the area contacted by the patella with progressive knee flexion (p > 0.53), contrary to popular belief. These data are useful for objective analysis of patellofemoral stability and related surgical interventions.

Aged↗
PubMed1986

Comparison of joint degeneration models. Surgical instability and repetitive impulsive loading.

We used surgical instability and repetitive impulsive loading in rabbits to initiate degenerative changes in knee joints. Synovial membrane and cartilage samples were examined by light and electron microscopy. Early synovial inflammation at three days postoperatively preceded cartilage destruction in the instability model. Synovial inflammation was only apparent after eight weeks in the loading model and increased subsequently to cartilage destruction. Cartilage breakdown was focal and limited to the weight-bearing area. Comparison of the histological data of the two arthrosis models suggests that different inductive mechanisms may be involved in cartilage degeneration, but in both models the inflammatory changes appeared to be secondary to mechanical factors.

Animals↗
PubMed1993

[Treatment of anterior instability of the knee joint with particular regard to free grafts of the specific patellar ligament].

48 patients with injuries of the anterior crucial ligament of the knee joint have been operated on. 27 patients were included the in control in the remote observation (1-3 years). In the evaluation of the results the following things were taken into consideration: feeling of stability of the knee, rest and exercise pains or lack of them, the degree of limitation of the function, lack of ability to practice sport, and the degree of improvement of the topical state in comparison with the period before the operation. As it can be seen from the obtained clinical results and the subjective evaluation the patients bore small residual anterior instability relatively well but they felt the same failure of the collateral ligament.

Adult↗
PubMed1984

Congenital hypoplastic thumb with absent thenar muscles: anomalous digital neurovascular bundle.

Congenital hypoplastic thumb with absent thenar muscles and an associated single midline digital neurovascular bundle is reported in four patients. Several other anomalies localized to the hand were encountered in all patients, including instability of the metacarpophalangeal joint of the thumb and anomalous extrinsic tendons of the involved thumb. Multiple congenital abnormalities were also found in all patients, especially in relation to the spine.

Abnormalities, Multiple↗
PubMed1991

Reconstruction for subtalar instability: a review.

Instability of the subtalar joint has become a more well-defined clinical entity in recent years. While there have been several articles which have discussed diagnosis of this condition, there has been little written on the surgical treatment. Reconstructive techniques with which we have had experience are presented. Technical aspects of these methods are described in detail.

Humans↗
PubMed1990

Effects of radioulnar instability on the radiocarpal joint: a biomechanical study.

Five fresh cadaver upper extremities were studied with use of a static positioning frame, pressure-sensitive film and a microcomputer-based videodigitizing system to assess the effect of increasing radioulnar instability on the load distribution within the proximal carpal joint. Three stages of radioulnar instability were studied: (1) an avulsion fracture at the base of the ulna styloid; (2) an avulsion fracture at the base of the ulna styloid plus disruption of the dorsal portion of the distal radioulnar joint capsule; and (3) an avulsion fracture at the base of the ulna styloid, disruption of the dorsal portion of the distal radioulnar joint capsule, and disruption of the radioulnar interosseous membrane. All stages of radioulnar instability demonstrated a decrease in the lunate contact area in positions with the forearm in supination. In stage 3 instability there was also less lunate contact area in positions with the forearm in neutral pronation/supination. In stage 3 instability the lunate high pressure area centroid was abnormally palmar in all positions and the scaphoid high pressure area centroid was abnormally palmar in positions with the forearm in pronation or supination.

Adult↗
PubMedDate not supplied

[Sports fitness of active handball and soccer players with anterior instability of the knee joint].

Based on an epidemiological study of 582 active handball and soccer players the abilities and limitations were analysed for sports activities of 24 athletes with an ACL-deficient knee. 22 of the 24 athletes suffered from a straight anterior instability. 50% attempted to avoid cutting mechanisms. The level of motivation was better than in the whole population. Handball players could continue their sports better and longer than soccer players. However, 19 athletes had to be classified as "knee-abusers" because they continued their sports inspite of having complaints. If athletic participation following ligament injuries of the knee should be rated, an accurate quantification and qualification is imperative.

Adolescent↗
PubMed1995

[Current status of diagnosis and therapy of chronic collateral ligament instability of the ankle joint: results of a survey of 267 German clinics in 1994].

A questionnaire was mailed to the heads of 400 German orthopaedic departments listed by the "Deutsche Gesellschaft für Unfallchirurgie", with the aim of evaluating the diagnostic and therapeutic approaches to chronic ankle instability that were current in 1994. The questionnaire was structured to focus on diagnostic imaging techniques, conservative and surgical management, and postoperative treatment. Evaluable questionnaires were returned from 267 hospitals (66.7%). The number of ligament reconstructions performed per institution ranged from 1 to over 100 (mean 17.5). Radiographic stress investigations and clinical examination were considered by 71.6% of the surgeons to be the most important criteria for surgical therapy. The methods most frequently used for primary reconstruction of the ligaments were: periosteal flaps (45.3%), anatomical repair (23.6%), different tenodeses (20.6%), and free anatomical implants of autologous or exogenous material (10.5%). Half the respondents used reconstruction procedures involving secondary repair of the injured ligament without augmentation or with periosteal flaps. The other half of the German surgeons preferred tenodeses or various other procedures. Conservative management of chronic ankle instability was considered by surgeons to be less appropriate for young active patients. Postoperative treatment includes casting and orthosis. The duration varied from 2 weeks to 8 weeks. The results of the nationwide survey demonstrate that more objective clinical methods of diagnosis are needed to allow preoperative differentiation between functional and mechanical instability. With better knowledge of the function of individual ligaments and more frequent exposure of the ligaments for simple overlap and direct suture, a lower rate of primary non-anatomical reconstructions may be possible in the future.

Adult↗
PubMed1991

[CT diagnosis in instability of the shoulder joint].

CT is able to demonstrate the predisposing factors for recurrent and posttraumatic subluxation of the shoulder. In addition to demonstrating bony changes in the glenoid (Bankart lesion) and in the humeral head (Hill-Sachs lesion), CT can measure the degree of retroversion of the glenoid and torsion of the humerus. Measurements on 17 shoulders with habitual and 24 shoulders with recurrent posttraumatic subluxation showed low values for glenoid retroversion as compared with a control group. Particularly patients with habitual anterior subluxation frequently showed anteversion of the glenoid. Measurements of humeral torsion showed wide scatter amongst all groups, indicating wide biological variability. The results were compared with those published in the literature and the indications and limitations of CT for the investigation of shoulder instability are discussed.

Humans↗