Showing papers in "International Orthopaedics in 1999"
TL;DR: It is concluded that incompetence of the medial patello-femoral ligament is a major factor in the occurrence of recurrent patellar dislocation and/or an unstable patella following an acute patellAR dislocation.
Abstract: The remnants of the medial patello-femoral ligament (MPFL) of 67 knees, 18 with acute patellar dislocation and 49 with chronic patellar dislocation, were studied. The MPFL injuries of the acute cases were categorised into 2 groups: an avulsion tear type and a substantial tear type. The chronic cases were put into 3 groups: those with loose femoral attachment (9 knees), those with scar tissue formation or abnormal scar branch formation (29 knees), and those with no evidence or continuity of the ligament (absent type) (11 knees). It is concluded that incompetence of the medial patello-femoral ligament is a major factor in the occurrence of recurrent patellar dislocation and/or an unstable patella following an acute patellar dislocation.
270 citations
TL;DR: In Hong Kong excellent results were achieved by the radical resection and the disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy.
Abstract: The five-year assessment of three randomised trials of short course (6, 9 or 18 months) chemotherapy for tuberculosis of the spine is reported. In Hong Kong patients were randomised to isoniazid plus rifampicin (HR) daily for 6 or 9 months, combined with radical surgical resection with bone grafting and streptomycin for 6 months for all patients. In Madras patients were randomised to chemotherapy with HR for 6 or 9 months, or 6 months HR chemotherapy combined with surgical resection. In Korea all patients were ambulatory and were randomised to different regimens of chemotherapy 6 or 9 months HR, or 9 or 18 months isoniazid plus ethambutol (EH) or isoniazid plus PAS (PH). In all centres the results of the 6- and 9-month regimens of HR were excellent and similar to the 18-month EH and PH regimens. The 9-month EH/PH regimens were clearly inferior. In Hong Kong excellent results were achieved by the radical resection. The disease was however less extensive than in Madras, where the results after surgery were no better than with ambulatory chemotherapy. Chemotherapy is the critical factor in the management of tuberculosis of the spine. Efforts should be concentrated on ensuring that appropriate regimens are given under adequate supervision.
111 citations
TL;DR: The clinical and functional outcome of limb preserving surgery and endoprosthetic reconstruction of the distal tibia and ankle joint in five patients who declined amputation is reported.
Abstract: Below knee amputation remains the treatment of choice for most patients with aggressive tumours of the distal tibia. We report the clinical and functional outcome of limb preserving surgery and endoprosthetic reconstruction of the distal tibia and ankle joint in five patients who declined amputation. The mean age was 32 years. Two had osteosarcoma, one Ewing’s sarcoma, leiomyosarcoma and Giant cell tumour. Three patients developed significant complications including local recurrence, wound dehiscence and infection, and fibula impingement. Despite these complications the patients declined amputation even in the presence of significant discomfort. Early function was excellent in all patients but deteriorated with time. The patients still maintained an Enneking Score of more than 50%. Some patients are unwilling to undergo amputation for aggressive tumours of the distal tibia. For these, excision and reconstruction with endoprosthesis allow early functional recovery but there is significant medium term morbidity and functional deterioration.
72 citations
TL;DR: It is described two patients with ochronotic arthropathy who presented with progressive and advanced degenerative changes in the lumbo-sacral spine who are described as ”ochronosis”.
Abstract: Alkoptonuria is an inherited metabolic disorder which is associated with various systemic abnormalities and related to the deposition of homogentisic acid pigment in connective tissues. These pigmentary changes are termed ”ochronosis”. We describe two patients with ochronotic arthropathy who presented with progressive and advanced degenerative changes in the lumbo-sacral spine. The literature, differential diagnosis and management of this rare condition are reviewed in this article. Management is usually conservative, but replacement surgery may be offered for severely affected major joints.
69 citations
TL;DR: An unusual case of bilateral anterior shoulder dislocation following trauma, with a three part fracture dislocation on the right, is reported.
Abstract: We report an unusual case of bilateral anterior shoulder dislocation following trauma. Previously reported cases were either of bilateral dislocations or bilateral fracture dislocations. In our case the patient suffered bilateral anterior dislocation with a three part fracture dislocation on the right. A review of the literature is presented.
67 citations
TL;DR: Growth factors are present in bone formation and in areas of re-modelling during callotasis and their relation to proliferous activity and radiographic density supports their involvement in osteogenesis.
Abstract: Although growth factors have been demonstrated during bone healing, their presence has not yet been confirmed in callus distraction. Therefore, in 3 patients we searched for cytokines during callus distraction. Bone biopsies were immuno-histochemically stained for TGF-β1, IGF-I, TGF-β type II receptor, IGF receptor, and proliferating cell nuclear antigen (PCNA). Histologically we found immature woven bone in the middle of the callus zone and increasing calcification and lamellar bone in the re-modelling zone. Osteoblasts and fibroblast-like cells in the middle zone, and osteoblasts in all zones stained for TGF-β and its receptor. The number of positive staining cells related to proliferous activity as assessed both by PCNA, and by bone density in radiographs. IGF-I could be detected everywhere. In conclusion, growth factors are present in bone formation and in areas of re-modelling during callotasis. Their relation to proliferous activity and radiographic density supports their involvement in osteogenesis.
65 citations
TL;DR: It is believed that physical examination remains essential to the evaluation of knee pathology and the diagnostic accuracy of five clinical tests for meniscal pathology was prospectively evaluated in 160 patients, who thereafter underwent arthroscopy.
Abstract: Although magnetic resonance imaging (MRI) has improved the diagnostic accuracy of meniscal pathology, the authors believe that physical examination remains essential to the evaluation of knee pathology. In this study, the diagnostic accuracy of five clinical tests for meniscal pathology was prospectively evaluated in 160 patients, who thereafter underwent arthroscopy. 69% (109 knees) of the knees tested had associated ACL deficiency. There were 144 meniscal lesions in 130 of the 160 knees which were examined. The sensitivity of the tests was lower than the specificity. Conventional tests such as McMurray and Apley tests showed a low accuracy rate of 45% and 28% respectively. The diagnostic value of the axially loaded pivot shift test was significantly higher, indicating that this remains a useful diagnostic aid.
60 citations
TL;DR: Three cases of para-articular chondroma and osteochondroma in the region of infrapatellar fat pad are reported, and it is concluded that these lesions are not the same.
Abstract: We report three cases of para-articular chondroma and osteochondroma in the region of infrapatellar fat pad. All three lesions were resected and examined histologically. Two of them were primarily cartilaginous with a lobular pattern internally, and one uniformly osseous with peripheral cartilage. We conclude that these lesions are not the same. The former should be designated para-articular chondroma after Jaffe and the latter, osteochondroma.
59 citations
TL;DR: DXA has shown differences in periprosthetic adaptive bone remodelling between implants of different design and composition as a function of time.
Abstract: The objective of this prospective study was to determine if bone densitometry can detect disparities in regional adaptive bone remodelling surrounding the cementless porous-coated femoral component of a hip prosthesis in two titanium alloy implants of different design . These prostheses were the S-ROM™ (n=69) and the Multilock™ (n=65). The Multilock™ implants consisted of two groups; 25 had a 50 micron layer of hydroxyapatite (HA) sprayed over the porous surface of the femoral component and the remaining 40 femoral components were not coated with HA. Densitometry was performed with dual energy X-ray absorptiometry (DXA) utilizing the LUNAR ORTHO™ software to analyse the seven Gruen zones. Bone mineral density measurements were obtained within a week of surgery as a baseline reference and at 6, 12, 24, 36 and 48 months thereafter. At 6 months there was significant mineral loss in all Gruen zones in the three prostheses. By 48 months there were differences in mineral loss between the three prostheses. In the zones adjacent to the porous surface, predominantly zones 1 and 7, the S-ROM™ exhibited 60% less mineral loss than the Multilock™ in zone 1, and there was no significant difference in zone 7. Compared to the Multilock-HA, the S-ROM lost 35% less mineral in zone 1, but the Multilock™ lost 70% less mineral than the S-ROM™ in zone 7. The Multilock-HA lost 37% and 75% less mineral than the Multilock in zones 1 and 7, respectively, i.e., hydroxyapatite coating tended to preserve bone stalk. Using the Gruen zone area measurements provided by the software, the S-ROM had significantly greater bone resorption in zone 7 at 24 months than either of the Multilocks, which did not differ from each other. In conclusion, DXA has shown differences in periprosthetic adaptive bone remodelling between implants of different design and composition as a function of time.
58 citations
TL;DR: Patients with early reconstruction had fewer degenerative changes in the tibio-femoral joint and were more satisfied with the result, and returned to their pre-injury level of sports activity more often than those patients in the late reconstruction group.
Abstract: Ninety-one patients were assessed 5–9 years after an anterior cruciate ligament reconstruction (bone patella-tendon bone autograft). Forty-eight patients had been treated within 6 weeks of the injury (Group I) and 43 patients more than 3 months after the injury (Group II). 73 patients had either a normal or nearly normal final outcome. The mean Lysholm score was 82 and the mean Marshall score was 42. Eighty nine patients had normal or nearly normal stability in the operated knee when compared to the contralateral joint. In none of these results was there any significant difference between the groups. Results of functional and of isokinetic strength tests, as well as the presence of anterior knee pain, were also similar in both groups. However, patients with early reconstruction had fewer degenerative changes in the tibio-femoral joint and were more satisfied with the result. They also returned to their pre-injury level of sports activity more often than those patients in the late reconstruction group.
56 citations
TL;DR: Subjects with a Type I configuration, and severe narrowing of the coracoid space, appear to be predisposed to coraco-humeral impingement, and these morphometric characteristics may be easily evaluated on CT scans.
Abstract: Anatomical morphometric studies of the coracoid process and coraco-glenoid space were carried out on 204 dry scapulae. No statistically significant correlations were found between length, or thickness of the coracoid process, prominence of the coracoid tip, coracoid slope, coraco-glenoid distance, or position of the coracoid tip with respect to the uppermost point of the glenoid. These anatomical characteristics were independent of the dimensions of the scapulae. Three configurations of the coraco-glenoid space were identified. Type I configuration was found in 45% of scapulae and Type II and Type III, in 34% and 21% of specimens, respectively. The lowest value of the coraco-glenoid distance were seen in Type I scapulae. Morphometric characteristics which might predispose to subcoracoid impingement were found in 4% of Type I scapulae. A total of 27 scapulae, nine with each type of configuration were submitted to CT scanning. Scapulae with a Type I configuration were found to have low values for the coraco-glenoid angle and coracoid overlap, which are known to be associated with a short coraco-humeral distance. Subjects with a Type I configuration, and severe narrowing of the coraco-glenoid space, appear to be predisposed to coraco-humeral impingement. These morphometric characteristics may be easily evaluated on CT scans.
TL;DR: The study shows that excessive retroversion and flatness of the glenoids in persons with atraumatic posterior instability can be successfully treated by a posterior glenoid osteotomy, Nevertheless, the high rate of postoperative degenerative changes must be taken into account.
Abstract: In this investigation, patients with atraumatic posterior instability of the shoulder were appraised in order to evaluate the effectiveness of glenoid osteotomy in the correction of excessive retroversion and flatness of the glenoid. In a series of 32 patients, 17 with posterior instability had no history of trauma. Posterior glenoid osteotomy was performed to correct excessive retroversion and to deepen the glenoid; 95% were re-examined after 5 years. In 81% the results were rated as good or excellent (Constant-Murley and Rowe scores), only 12,5% having had a recurrence. The glenoid could be deepened and on average the angle could be altered from −9.35° to −4,62°. In comparison, 50 volunteers had average angles of −4,4°, thus differing significantly from the preoperative group. Twenty-five per cent of the patiens showed postoperative degenerative changes in the glenohumeral joint. The study shows that excessive retroversion and flatness of the glenoid in persons with atraumatic posterior instability can be successfully treated by a posterior glenoid osteotomy. Nevertheless, the high rate of postoperative degenerative changes must be taken into account.
TL;DR: Thumb pinch strength was improved by 40% compared to preoperative values, but still remained 22% weaker than the non-operated side.
Abstract: A consecutive series of 40 trapeziectomies in 30 patients with basal thumb joint osteoarthritis was reviewed. Sixteen thumbs had pan-trapezial and 24 thumbs trapeziometacarpal osteoarthritis. Simple excision without soft tissue interposition was performed by the same surgeon using an identical surgical technique. Twenty-eight patients were female (mean age 57 years) with a mean follow-up of 11 (3–19) years. Twenty-eight patients were satisfied with their operation, with 26 thumbs being pain free. Thumb pinch strength was improved by 40% compared to preoperative values, but still remained 22% weaker than the non-operated side.
TL;DR: Although cervical spine motion ranges may remain within normal limits in patients, motion patterns were altered qualitatively and quantitatively and might prove a useful discrimination parameter in patients in whom anatomical lesions are not clearly identifiable.
Abstract: Cervical spine motion was investigated by three-dimensional electrogoniometry in 257 asymptomatic volunteers and in 32 patients with cervical disc hernia or whiplash syndrome. Maximal ranges of main and coupled motions were considered. Motion curves were analysed qualitatively and using fitting of sixth degree polynomials. Motion ranges obtained were in agreement with previous observations. Significant differences between patients and volunteers concerned several primary and coupled components but not all. Qualitatively, patients displayed less harmonic curves, with irregularities and plateau-like appearances. Root mean square differences between data and fit were significantly modified in patients. Although cervical spine motion ranges may remain within normal limits in patients, motion patterns were altered qualitatively and quantitatively. Motion pattern analysis might prove a useful discrimination parameter in patients in whom anatomical lesions are not clearly identifiable.
TL;DR: Traditional bone setter’s gangrene (TBSG) is the term used to describe the sequelae sometimes seen after treatment with native fracture splints, recorded in 25 patients aged between 5–50 years with a median age of 10 years.
Abstract: Traditional bone setter’s gangrene (TBSG) is the term we use to describe the sequelae sometimes seen after treatment with native fracture splints. Twenty five consecutive complications were recorded in 25 patients aged between 5–50 years with a median age of 10 years. The major complication of the native fracture splint treatment was distal limb gangrene necessitating proximal amputations in 15 cases.
TL;DR: Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur.
Abstract: Thirty-three patients with bone tumours were treated by resection of the growth and reconstruction with a Kotz modular endoprosthesis. The average follow-up was for 50 months, ranging from 14 to 79 months. At the last review, 12 patients (36%) had died due to the tumour and 9 others (27%) had metastases. All 4 patients with proximal tibial reconstruction had poor functional results, due to an extension lag or to knee stiffness. Four of the six tumours of the proximal femur were complicated by local recurrence or dislocation of the hip, and had poor or fair functional results. Of the patients with distal femoral reconstruction, 17 out of 22 had excellent or good functional results. Reconstruction with a modular prosthesis after resection of a tumour gives excellent or good functional results in more than three-fourths of the cases of distal femur reconstruction, but it should be used with caution in the proximal tibia and proximal femur.
TL;DR: It is calculated that up to 76% encroachment of the spinal canal by tubercular pathological tissue is compatible with undisturbed neural status and compatible a with theétat neurologique non derangé ou intact.
Abstract: CT scans of fifteen patients with tuberculosis of the spine without neurological deficit were analysed for canal encroachment. We calculated that up to 76% encroachment of the spinal canal by tubercular pathological tissue is compatible with undisturbed neural status.
TL;DR: Clinical review showed an increased range of passive dorsiflexion from 10° to 50° postoperatively, and patients reported less pain or no pain and activity levels that were increased or maintained following replacement arthroplasty.
Abstract: 21 patients underwent replacement arthroplasty of the metatarsophalangeal joint of the great toe. The indication for surgery was hallux rigidus in 16 patients and failed resection arthroplasty in 5 patients. The minimum follow-up period was 24 months. Clinical review showed an increased range of passive dorsiflexion from 10° to 50° postoperatively. 17 patients reported less pain or no pain and activity levels that were increased or maintained. Functional complications such as lack of toe purchase (n=5) or metatarsalgia (n=4) were successfully treated with orthotics.
TL;DR: Bone-peg grafting is a reliable method for treating osteochondritis dissecans of the elbow and was effective in limiting the development of osteoarthritis in 15 patients followed for a minimum of 5 years.
Abstract: In the treatment of osteochondritis dissecans involving the elbow, we have used a bone-peg graft taken from the proximal part of the ulna and inserted into the defect. Thirty-two patients were followed from 2 to 10.5 years. The graft was utilised in 20 elbows, and 6 of these also had concomitant removal of a loose body. Another 6 elbows had removal of a loose body only. Ten elbows were treated conservatively in 5 of these the outcome was unsatisfactory, including 4 in which a bone-peg graft was later necessary. The bone-peg graft gave the best short-term results. Bony union of the dissecans site and reconstitution of subchondral bone required an average of 6.5 months. In 15 patients followed for a minimum of 5 years, the bone-peg graft was effective in limiting the development of osteoarthritis. Bone-peg grafting is a reliable method for treating osteochondritis dissecans of the elbow.
TL;DR: The results suggest that the brace acts by transferring the forces across the knee joint from the medial to the lateral side, and increases in bone mineral density were seen more in the lateral tibial condyle than in the medial.
Abstract: We assessed the clinical knee score and bone mineral density of the proximal tibia in an attempt to evaluate the efficacy of valgus knee bracing. The knee score improved after 3 months, and increases in bone mineral density were seen more in the lateral tibial condyle than in the medial. These results suggest that the brace acts by transferring the forces across the knee joint from the medial to the lateral side.
TL;DR: It is illustrated that patients with hip fractures can be effectively treated and discharged home or to a short-term rehabilitation facility with restoration of their pre-fracture functional status and the possibilité of un retour à l’état fonctionnel antérieur is confirmed.
Abstract: A prospective outcome study was performed of 100 hip fracture patients at an urban medical center in the United States. After hospitalization 19% were discharged to a rehabilitation facility and 59% were discharged home. At a mean follow-up of 8 months, 81% of patients lived at home, compared to 89% who lived at home prior to the fracture. At follow-up 71% of the patients were able to walk outside with one cane or no aids at all, and 81% were able to perform basic activities of daily living. Half of all patients did not require any home assistance at follow-up. Ten patients had died at follow-up. The goal of operatively treating the patient with a hip fracture is fixation of the fracture with a return to the patient’s pre-fracture functional ability. This study illustrates that patients with hip fractures can be effectively treated and discharged home or to a short-term rehabilitation facility with restoration of their pre-fracture functional status.
TL;DR: The results of core decompression are good when the preoperative lesion is at Steinberg stage 0, I and II and the patient does not present with other risk factors and in cases with risk factors the outcome is significantly less good.
Abstract: The results of core decompression of the femoral head in the treatment of osteonecrosis are analyzed. This study includes 94 hips in 74 patients with a follow-up time ranging between 18 months and 15 years (average 6 years). There had been no need for further surgery 2 years postoperatively in 85% of the hips with preoperative Steinberg stages 0, I and II when compared with 66% with preoperative stages III, IV and V. At 4 years postoperatively the corresponding figures are 73 compared to 55%; and 6 years postoperatively 69 compared to 49%. This difference was significant (P=0.0402). Further significant risk factors are corticosteroid administration, smoking and alcohol intake. The results of core decompression are good when the preoperative lesion is at Steinberg stage 0, I and II and the patient does not present with other risk factors. In cases with risk factors the outcome is significantly less good. The procedure is not indicated in the presence of advanced disease.
TL;DR: Imaging techniques need to be improved if the assessment of cartilage thickness by this means is to be of clinical relevance, and the correlation seemed not to be dependent on the grade of osteoarthritic cartilage lesions.
Abstract: We studied human specimens and compared data on cartilage thickness measurements with magnetic resonance imaging by using an image analysing system with corresponding histological sections in the middle of each sector. The findings are based on 768 measurements in 26 knee joints. Overall, there was very good magnetic resonance/anatomic correlation (r=0.88). The poorest correlation was in the sectors of the femur (r=0.69). The correlation seemed not to be dependent on the grade of osteoarthritic cartilage lesions. Despite good correlation rates, the mean magnetic resonance/anatomic difference (absolute values) was 0.41 mm (standard deviation (SD) 0.34 mm) or 18.08% (SD 18.9%). Imaging techniques need to be improved if the assessment of cartilage thickness by this means is to be of clinical relevance .
TL;DR: A prospective study on 64 patients who underwent unilateral total hip arthroplasty to evaluate the efficacy of intraoperative measurement of limb length inequality (LLI) on patients divided into 2 groups.
Abstract: In order to evaluate the efficacy of intraoperative measurement of limb length inequality (LLI), we performed a prospective study on 64 patients who underwent unilateral total hip arthroplasty. The patients were divided into 2 groups. In Group I, the LLI was evaluated by the Shuck test, and in Group II by intraoperative measurement using a Steinman pin and an adjustable caliper. Preoperative LLIs assessed on radiographs averaged 1.18 cm in Group I and 0.37 cm in Group II.
TL;DR: In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant.
Abstract: We studied DNA ploidy by smear cytophotometry and proliferation activity by Ki-67 MIB immunohistochemistry in 69 primary and recurrent giant cell tumors (GCT) from 50 randomly selected patients. The obtained results were evaluated with comparisons made to the available clinical data. From the 46 primary tumors 63% showed diploidy and 37% aneuploidy. A significantly (P=0.026) higher recurrence rate (64%) was observed in aneuploid than in diploid tumors (31%). In the course of the recurrences, both the ratio of aneuploid tumors as well as the proliferation index of the tumors increased, though the degree of the latter was non-significant. Aneuploidy did not mean an unambiguous tendency towards malignant transformation; however, a close follow-up of recurrent aneuploid tumors, and wide excision of the recurrence instead of intralesional curettage are the recommended procedures. The DNA cytophotometry and proliferation index of GCTs – as compared to other histologic examinations – are of prognostic value in the evaluation of the recurrence potential of the GCTs.
TL;DR: The data provide evidence that intraoperative histology is useful tool in the diagnosis of infected total hip arthroplasty, and that l’histologie Peroperatoire peut être un instrument utile dans the diagnostique d’infection de prothèse d”hanche.
Abstract: Intraoperative histology showed a sensitivity of 100% and a specificity of 98%. These results were better than those observed for the other tests evaluated. Our data provide evidence that intraoperative histology is useful tool in the diagnosis of infected total hip arthroplasty.
TL;DR: The results suggest that anterior knee pain might be a psychosomatic syndrome associated with sub-clinical patellar instability and with little if any relation to levels of physical activity.
Abstract: The aim of this study was to correlate the distribution of substance-P nerve fibres within the knee joint in 20 patients complaining of anterior knee pain syndrome, with the clinical picture, patellar motion, power of the quadriceps mechanism, and the psychological profile. A comparison was made with 2 similar groups of patients with knee problems (patients with osteoarthrosis and patients with anterior cruciate ligament rupture or meniscal lesions), and with a further group of 20 healthy volunteers. The results suggest that anterior knee pain might be a psychosomatic syndrome associated with sub-clinical patellar instability and with little if any relation to levels of physical activity.
TL;DR: A medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game is reported and he was succesfully treated with closed reduction and cast immobilization.
Abstract: We report a medial subtalar dislocation without fracture in an eighteen year old male injured during basketball game. He was succesfully treated with closed reduction and cast immobilization. At one year follow-up he was symptomless.
TL;DR: The purpose of this study was to determine the early subjective and functional results after primary endoprosthesis replacement for comminuted humeral head fractures in patients over 60 years old.
Abstract: The purpose of this study was to determine the early subjective and functional results after primary endoprosthesis replacement for comminuted humeral head fractures in patients over 60 years old. Twenty comminuted humeral head fractures in 20 patients were treated primarily (within 3.5 days (range 0–17 days) with a Neer II modular shoulder prosthesis, and were then followed up for an average of 32.5 months (range 17–44 months). The average age of the patients was 77 years (range 63–91 years). The average post-operative Constant score was 52 points (range 30–76). This was significantly less than that of the contralateral side where the score was 80 points (range 53–100), P=0.0001. The average active abduction was 90° (contralateral 157°) and active flexion 99° (contralateral 161°). Eighteen of the 20 patients experienced relief of pain and would accept the same procedure again.