Showing papers by "Nicola Maffulli published in 1998"

Overuse tendon conditions : Time to change a confusing terminology

Abstract: In overuse clinical conditions in and around tendons, frank inflammation is infrequent, and is associated mostly with tendon ruptures. Tendinosis implies tendon degeneration without clinical or histological signs of intratendinous inflammation, and is not necessarily symptomatic. Patients undergoing an operation for Achilles tendinopathy show similar areas of degeneration. When the term tendinitis is used in a clinical context, it does not refer to a specific histopathological entity. However, tendinitis is commonly used for conditions that are truly tendinoses, and this leads athletes and coaches to underestimate the proven chronicity of the condition. Paratenonitis is characterized by acute edema and hypermia of the paratenon, with infiltration of inflammatory cells, possibly with production of a fibrinous exudate that fills the tendon sheath, causing the typical crepitus that can be felt on clinical examination. The term partial tear of a tendon should describe a macroscopically evident subcutaneous partial tear of a tendon, an uncommon acute lesion. Most articles describing the surgical treatment of 'partial tears' of a given tendon in reality deal with degenerative tendinopathies. The combination of pain, swelling, and impaired performance should be labeled tendinopathy. According to the tissues affected, the terms tendinopathy, paratendinopathy, or pantendinopathy should be used.

Patellar tendinopathy: some aspects of basic science and clinical management.

Abstract: Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

The Clinical Diagnosis of Subcutaneous Tear of the Achilles Tendon A Prospective Study in 174 Patients

Abstract: A study to determine the sensitivity, specificity, and positive and negative predictive values of several clinical diagnostic tests of subcutaneous Achilles tendon rupture was performed during a 13-year period. There were 174 patients with clinical diagnosis of unilateral complete subcutaneous Achilles tendon tear and 28 patients with unilateral suspected but no actual Achilles tendon tear. The following tests were used: palpation, calf squeeze, Matles, Copeland, and O'Brien. Palpation of the gap was the least sensitive clinical test with the patient awake (0.73), increasing to 0.81 when the test was performed under anesthesia; the Copeland and O'Brien tests showed a sensitivity of 0.8. Both the calf squeeze and Matles tests were significantly more sensitive than the other tests (0.96 and 0.88, respectively; 0.022 < P < 0.05). All tests showed a high positive predictive value, with no statistically significant difference between the various tests. In the 28 patients with no evidence of a subcutaneous Achilles tendon tear on imaging, the tests showed a high capability to detect that the Achilles tendon was intact (gap palpation specificity, 0.89; calf squeeze test specificity, 0.93; Matles test specificity, 0.85). Whichever tests were performed, at least two of them were positive for a subcutaneous tear of the Achilles tendon in all patients in this study.

Percutaneous intramedullary Kirschner wiring for displaced diaphyseal forearm fractures in children

Abstract: Displaced fractures of the forearm in children are often treated conservatively, but there is a relatively high incidence of redisplacement, malunion and consequent limitation of function. We have performed percutaneous Kirschner (K) wire fixation in 72 such children under the age of 14 years, of which 57 were reviewed for our study. Both the radius and ulna were fractured in 45 (79%), the radius only in eight and the ulna only in four. The mean initial angulation was 19 degrees in the lateral plane and 9 degrees in the anteroposterior plane for the radius and 15 degrees and 9 degrees, respectively, for the ulna. In 42 patients (74%) we performed closed reduction. In the remaining 15 (26%) closed reduction failed and an open reduction, through a minimal approach, was required before K wiring. At a mean follow-up of 20 months all patients had good functional results with an excellent range of movement. Only five had angulation of from 10 degrees to 15 degrees and none had nonunion, premature epiphyseal closure or deep infection. Percutaneous intramedullary K wiring for forearm diaphyseal fracture is a convenient, effective and safe operation, with minimal complications.

Determinants of axial and peripheral bone mass in Chinese adolescents

Abstract: OBJECTIVE To determine the relation of puberty, physical activity, physical fitness, and calcium intake with bone mineral content (BMC) of the distal radius, and on bone mineral density (BMD) of the L2 to L4 vertebrae in a group of healthy Chinese adolescents. DESIGN Cross sectional survey. SUBJECTS A group of 179 healthy Chinese adolescents (92 boys and 87 girls) aged 12 to 13 years enrolled in the first year of the Tii Junior High School in Shatin, Hong Kong. Ninety four of the pupils enrolled were in the physical education major class (PE), and the other 85 were in the art major class (ARTS). MAIN OUTCOME MEASURES Correlation of BMC of the distal radius and BMD of the L2 to L4 vertebrae with level of physical activity, physical fitness (isometric and isokinetic), muscle strength of the upper and lower limb, and calcium intake. RESULTS BMC of the distal radius and BMD of the L2 to L4 vertebrae were significantly positively correlated. Univariate and regression analysis showed that age, pubertal staging, physical fitness, and muscle strength were significantly associated with bone mass in a positive way. Calcium intake and type of sport practised did not exert a significant influence on BMC of the distal radius and BMD of the L2 to L4 vertebrae in boys. The results for the BMD of the L2 to L4 vertebrae were similar in girls and boys; however, in girls, the BMC of the distal radius had a negative correlation with calcium intake. Physical fitness was a significant positive predictor of BMD of the L2 to L4 vertebrae. CONCLUSIONS Among Chinese adolescents bone mass was positively influenced by certain measures of physical fitness as well as by age, weight, and pubertal stage.

Achilles tendon rupture and sciatica: a possible correlation.

Abstract: The association between Achilles tendon rupture and sciatica was investigated by questionnaire in 138 patients who underwent repair of an Achilles tendon rupture, and in a group of individuals nominated by the patients, matched for age, sex, and occupation. A total of 102 patients (74%) and 128 peer nominated controls (71%) replied to the questionnaire. Of the 102 respondent patients, 18 had an officebased job, 47 were involved in skilled nonmanual work, and 16 were retired. Back pain had been experienced by 63 of the patients who replied to the questionnaire, and by 91 (75%) of the individuals in the control group (difference not significant). In about 30% of both groups, the pain confined them to bed for at least two days, and resulted in absence from work. Thirteen of the patients and 16 of the controls had undergone thoracic, lumbar, or sacral radiography. One individual in each group had received surgery for back pain. However, 35 of 102 patients had experienced sciatic pain before Achilles tendon rupture. Pain of a similar nature had been experienced by only 15 individuals in the control group (12%) (p < 0.001). Using this study design, we found a highly significant association between Achilles tendon rupture and sciatica. We propose that this association could be due to impaired afferent signals from the lower leg, or to similar collagen or vascular anomalies of the vertebral disc and the Achilles tendon.

Articular cartilage lesions of the knee following immobilisation or destabilisation for 6 or 12 weeks in rabbits.

Abstract: Eighty mature female New Zealand White rabbits were sacrificed 6 or 12 weeks after either section of the medial collateral and the anterior cruciate ligaments with removal of the anterior third of the medial meniscus of one knee, or immobilisation of one knee, using the contralateral non-treated knee as the control. The area of degenerated joint surface of the distal femur, and water and proteoglycan content were measured, and the articular cartilage stained using haematoxylin and eosin and safranin O. Destabilisation resulted in a significantly larger time-dependent degenerated joint surface area. Water content significantly increased after 6 weeks with no significant differences between immobilisation and destabilisation. Destabilisation resulted in a significantly greater decrease in proteoglycan content. At 12 weeks, the control knees of the animals undergoing destabilisation showed significant degenerative changes. There were more extensive lesions in destabilisation, while 6 weeks of immobilisation produced moderate degenerative joint disease.

Naht der rupturierten Achillessehne

Abstract: Operationsziel Sichere Naht der gerissenen Achillessehne mit einer modifizierten Kessler-Naht.

The suspected scaphoid fracture. How useful is a unit policy

Abstract: The records of 196 patients presenting with a clinical suspicion of scaphoid injury were reviewed to evaluate how junior accident and emergency doctors in a teaching hospital managed these patients. The management that was provided was assessed, and it was ascertained whether the presence of a unit policy meant that accident and emergency junior trainees managed patients accordingly. We found that 82% of patients were immobilized for 2 to 13 weeks, with 60 patients (37%) being immobilized for 6 weeks or more. Of the 196 patients presenting with clinical suspicion of scaphoid fracture, a definite scaphoid fracture was found in only 12%. Less than half of the patients (46%) were reviewed by senior accident and emergency doctors or by senior orthopaedic surgeons. Despite the presence of a unit policy, patients were being immobilized for prolonged periods in the absence of a radiographically evident scaphoid fracture. Advice from more experienced members of the staff was not being sought in dubious cases.

A prospective randomized trial of suture of the patellar tendon defect after harvesting

Abstract: In a rabbit model, we studied the long-term biomechanical and biochemical effects of leaving the patellar tendon unsutured, or closing the defect with absorbable sutures, after harvesting one third. Using a prospective randomized design, after harvest of its central third, the patellar tendon was either sutured side to side with absorbable sutures, or left unsutured in 112 skeletally mature rabbits. The rabbits were killed at 2 and 6 weeks, and 6 and 9 months postoperatively. After an initial increase in both groups (.001 P P P P P P Arthroscopy 1998 Oct;14(7):682-9

The disappearing exostosis : A report of an unusual case

Abstract: A girl aged 11 years was referred to us with a medial upper right tibial exostosis. As the lesion was asymptomatic, surgery was not undertaken. The patient defaulted from follow up, and, when reviewed 32 months later, there was no clinical or radiographic evidence of the exostosis. Spontaneous involution of an exostosis may occasionally occur in childhood.