bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of chronic Achilles tendinitis
Authors: Nelen G. , Martens M. , Burssens A. 
Published: June 2007

Between 1977 and 1985, 170 patients suffering from chronic Achilles tendinitis were treated surgically. Ninety-one patients with 143 tendons returned for fol lowup. The duration of preoperative symptoms aver aged 18 months. In all cases, conservative treatment was first attempted but failed to alleviate symptoms. Only those patients whose lesions and symptoms were confined to the Achilles tendon segment 2 to 6 cm proximal of the insertion were included in this study. All athletes who had an insertion tendinopathy or a lesion at the musculotendinous junction were excluded from this study. The surgical procedure depended on the lesion. For 93 tendons exhibiting pure peritendinitis, treatment consisted of a simple release of the fascia cruris and the peritenon. For the 50 tendons with tendinosis, a resection of diseased tendon tissue was performed. The defect could be sutured side to side in 26 cases but in the other 24 cases, reinforcement with a turned- down tendon flap was necessary because of the exten sive debridement. Of the 93 cases in which only dorsal release was performed, results were considered excellent in 54 cases, good in 28, fair in 8, and poor in 3 cases. Of the 26 cases in which side-to-side suture was performed, 15 cases were rated as having excellent results, 4 as good, 4 as fair, and 3 as poor. For the 24 cases in which a turned down tendon flap procedure was per formed, the result was excellent in 12 cases, good in 9, fair in 2, and poor in 1 case. The group of 170 patients treated surgically is part of a total number of 980 patients seen over this period in our hospital. The high percentage of operated cases for this group of 980 patients is explained by the fact that these 980 patients were a selected group of pa tients not including mild cases or patients with a tran sient Achilles tendinitis. Since the University Hospitals are mainly referral hospitals, many cases were referred because of complaints resistant to conservative treat ment.
Evaluation of claw toe deformity, weakness of the foot intrinsics, and posteromedial shin pain
Authors: Garth William P. , Miller Sylvia T. 
Published: June 2007

Posteromedial middle one-third tibial pain and tender ness associated with stressful activities has been pre viously recognized as occurring at the origin of the flexor digitorum longus muscle. Seventeen running ath letes with this clinical syndrome were evaluated with regard to second toe range of motion and foot intrinsic muscle strength. The results were compared to results obtained from a comparable group of asymptomatic athletes. Statistical analysis of the results of the evaluation indicated a significant displacement of the arc of motion of the second toe in the symptomatic athletes toward extension of the metatarsophalangeal joint and a de crease in flexion. Weakness or dysfunction of the intrin sic muscles in the symptomatic athletes was also found to be significant. This analysis supports the hypothesis that posteromedial middle one-third tibial stress symp toms may be related to overuse of the flexor digitorum longus muscle associated with mild claw toe deformity.
Arthroscopic evaluation of acute initial anterior shoulder dislocations
Authors: Baker Champ L. , Uribe John W. , Whitman Courtenay 
Published: June 2007

Arthroscopic evaluation of patients with an acute an terior shoulder dislocation was done to identify and classify the intraarticular lesions that might predict re current dislocations. Forty-five shoulders fit the follow ing criteria for inclusion in our study: initial dislocation with no prior history of shoulder problems; confirmation of the dislocation radiographically or reduction by a physician; and arthroscopy within 10 days. The 42 men and 3 women had an average age of 21.2 years (range, 14 to 28 years). Mechanism of injury was a twisting of the arm into forced abduction and external rotation, a fall on the outstretched arm, or a direct blow to the shoulder. Based on this preliminary study of 45 shoulders, we present a classification of the lesions found in the acute shoulder dislocation. Group 1 (six shoulders) had cap sular tears with no labral lesions: these shoulders were stable under anesthesia and had no or minimal hemar throsis. Group 2 (11 shoulders) had capsular tears and partial labral detachments: these shoulders were mildly unstable and had mild to moderate hemarthrosis. Group 3 (28 shoulders) had capsular tears with labral detach ments : these shoulders were grossly unstable and had large hemarthrosis. They had complete capsular/labral detachments. In the past, redislocation rates have been primarily related to age at the time of initial dislocation and, to a lesser degree, the period of immobilization. We have identified the intraarticular lesions in 45 patients with an initial anterior glenohumeral dislocation and classi fied these shoulders into three groups based on the lesions found. By doing so, we can develop a more accurate method of determining which shoulders are prone to recurrent dislocation. We can then adjust the patient's treatment to prevent recurrent dislocation.
Biomechanical and histological observations of the dog patellar tendon after removal of its central one-third
Authors: Burks Robert T. , Haut Roger C. , Lancaster Ronald L. 
Published: June 2007

The use of a central one-third patellar tendon as an autograft for surgical reconstruction of a damaged cru ciate ligament is common. Few complications of its use have been reported. However, recent clinical studies indicate that decreased quadriceps strength, de creased range of motion, decreased thigh circumfer ence, and patellofemoral problems can be associated with this procedure. Some of these complications may result from alterations in the biomechanical properties of the remaining patellar tendon. The objective of this study was to examine biomechanically and histologi cally the fate of the remaining patellar tendon after removal of its central one-third. Three groups of dogs were used for this study. On one knee the central third of the patellar tendon was removed, while the contralateral side was used as a control. One group was immediately euthanized, while the other two groups were euthanized at 3 and 6 months. Control and operated patella-patellar tendon- tibia preparations were harvested and stretched to failure at 100% strain per second. The 3 and 6 month groups had a 10% decrease in length of the operated patellar tendon versus the con tralateral control. There was a very significant increase in cross-sectional area of the patellar tendon at 3 months, and a further increase at 6 months. The failure load was 70% of the controls at 3 months and 60% of the controls at 6 months. The stiffness and modulus of the operated tendon within the physiologic range were dramatically reduced to 70% and 33% of controls at 6 months, respectively. These overall results were observed with the central one-third defect closed or left open in surgery. This study indicated that the canine patellar tendon had not fully recovered 6 months after removal of its central third. The biomechanical changes observed in the remaining tendon may help explain the loss of quadriceps strength that has been documented in re cent clinical studies after using patellar tendon grafts.
The effect of joint velocity on the contribution of the antagonist musculature to knee stiffness and laxity
Authors: Hagood S. , Solomonow M. , Baratta R. , Zhou B.H. , D'Ambrosia R. 
Published: June 2007

The electromyographic (EMG) coactivation patterns of the knee flexors and extensors when acting as antag onists were studied as a function of limb velocity to assess their contribution to joint stiffness and laxity. Normalized antagonist coactivation patterns devel oped from surface EMG recordings from the hamstrings and quadriceps during maximal effort isokinetic exten sion and flexion, respectively, demonstrated character istic variations as the joint velocity increased from 15 deg/sec up to 240 deg/sec. The two-tailed t-test ( P < 0.1) was performed on the data obtained from eight normal knees. The results indicate that both hamstrings and quadriceps demonstrate a significant increase (>100%) in their antagonist coactivation pattern during the final 40° of fast extension and flexion movements, respectively, as limb velocity increases. A minor de crease in antagonist activity of the hamstrings (24%) and quadriceps (8%) was evident during the initial phase of the extension and flexion movements, respec tively, as joint velocity increased. We concluded that as limb velocity is increased, there is a substantial reflexive (unintentional) increase in the contribution of the antagonist musculature to joint stiff ness and reduction of laxity. The results also suggest that strength training of the hamstrings (rather than quadriceps) should be considered as a modality for conservative treatment of ACL deficiencies, as well as an adjunct to surgical reconstruction. Such training can also reduce the risk of high performance athletes in a reflexive manner by increasing joint stiffness.
Arthroscopic shoulder decompression development and application
Authors: Paulos Lonnie E. , Franklin Jonathan L. 
Published: June 2007

The purpose of this study was to critically evaluate the results of 80 consecutive subacromial decompressions in 76 patients with impingement syndrome and to as sess the value of arthroscopy for subacromial de compression. The average followup was 32 months. The charts, radiographs, and clinical findings of all patients were reviewed. There were 57 males and 19 females, with a mean age of 41 years. Subjective, objective, and functional results were assessed. The greatest improvement was seen in the areas of pain with activity, pain at night, and use of medications. Impingement signs had decreased significantly at final followup. The procedure allowed an early return to work and competitive athletics. Repeat surgery was necessary in eight cases: three full thickness rotator cuff repairs, two stabilization pro cedures, two open debridements, and one biceps ten odesis and excision of the distal clavicle. An important finding was the number of unsuspected diagnoses that were made during arthroscopy. Twelve patients had significant labral tears, seven patients had complete rotator cuff tears, four patients had biceps tendon fraying, and two patients had loose bodies in the gle nohumeral joint. In most of these shoulders the intra articular lesions would not have been diagnosed by open subacromial decompression. Radiographic evaluation suggested that the "outlet view" can be helpful in determining depth of bony resection and may be a prognostic indicator. Patients who underwent simple decompression rather than bony resection tended to be younger and had less Stage III impingement changes, and they generally had a slightly better final outcome. Patients who had compensation injuries generally had a poorer outcome. In reviewing our results, it appears that arthroscopic subacromial decompression can be a successful alternative to open decompression. The key to success for closed de compression is related to 1) accurate diagnosis, 2) selective treatment, 3) adequate bone resection when required, and 4) repair of full thickness rotator cuff tears in the active patient. Postoperative rehabilitation, which includes early range of motion, is critical.
An in vitro study of an intraarticular and extraarticular reconstruction in the anterior cruciate ligament deficient knee
Authors: Draganich Louis F. , Reider Bruce , Ling Mary , Samuelson Mathew 
Published: June 2007

The biomechanical effectiveness of an extraarticular ACL reconstruction, an intraarticular ACL reconstruc tion, and the combination of these on both anterior stability and internal rotational stability of the ACL de ficient knee was investigated in six cadaver knees. The extraarticular reconstruction consisted of the Müller anterolateral femorotibial ligament iliotibial band teno desis, and the intraarticular reconstruction used the middle third of the patellar tendon in the manner of Clancy. The extraarticular reconstruction was found to over- constrain internal tibial rotation of the ACL excised knee between 30° and 90° ( P < 0.05). While the isolated extraarticular reconstruction did not return normal an terior stability to the ACL deficient knee ( P < 0.05), it did significantly reduce the anterior laxity of the ACL deficient knee between 30° and 90° of knee flexion ( P < 0.05). For the combined reconstruction, the intraarticular procedure was performed and then only enough ten sion was applied to the extraarticular reconstruction to take up slack in the tenodesis without shifting the rotatory position of the tibia from that produced by the intraarticular procedure alone. Neither the intraarticular reconstruction nor the combined procedure resulted in any significant shifts from normal ( P < 0.05) in the rotatory position of the unloaded tibia; during loading neither resulted in rotational displacements significantly different from normal; and both of these procedures reduced the increased anterior laxity of the ACL defi cient knee to a level not statistically different from normal. Because the extraarticular reconstruction shared the load when performed with the intraarticular reconstruc tion as part of a combined procedure, we concluded that it would be useful as an adjunctive procedure in appropriate clinical situations.
Reproducibility of Genucom knee analysis system testing
Authors: Wroble Randall R. , Grood Edward S. , Noyes Frank R. , Schmitt David J. 
Published: June 2007

The Genucom knee analysis system was studied to determine the reproducibility of test results. In the first phase of the study we investigated the reproducibility of anterior/posterior stress tests at 30° and 90° of flexion and varus/valgus stress tests at 20° of flexion in 10 control subjects during three seatings on 3 sep arate days. In the second phase we studied the effect of errors in the digitization procedure (a part of the patient installation process) on anterior/posterior trans lation measurements. In the third phase we studied the reproducibility of a battery of tests in patients with chronic unilateral ACL deficient knees. The test battery was repeated 8 times on each knee on 6 separate days. In Phase I, analysis of variance revealed no significant differences between tests within a single seating. The day-to-day variance of all subjects was not significant, but we found a significant interaction between day and subject which was due to significant day-to-day differ ences in individual subjects. We found in Phase II that changing the location of the tibial joint line digitization points in the anterior/ posterior or proximal/distal direction affected anterior/ posterior translation measurements. Effects were larger at 30° of flexion than at 90° and when both the medial and lateral points were moved. Movement of the femoral condylar points resulted in a similar pattern of effects. In Phase III, although we found significant differences between our two examiners, there were no significant intraexaminer test-to-test (within seating) effects. Ad ditionally, while there was no significant day-to-day variance overall, we found a significant interaction be tween day and subject. This was due to significant day- to-day differences in individual subjects. The results indicate that since measurements vary from day-to-day, care must be taken in interpreting the meaning of a single measurement or even of repeated measurements made within a single seating. We advise meticulous care in the digitization procedure, diligence in assuring patient relaxation, and attention to detail throughout.
The anatomy and histology of the inferior glenohumeral ligament complex of the shoulder
Authors: O'Brien Stephen J. , Neves Manuel C. , Arnoczky Steven P. , Rozbruck S. Robert , Dicarlo Edward F. , Warren Russell F. , Schwartz Robert , Wickiewicz Thomas L. 
Published: June 2007

The gross and histologic anatomy of the inferior glenohumeral ligament was studied in 11 fresh frozen cadaver shoulders. Arthroscopic observations of the joint capsule through the normal range of motion re vealed that the inferior glenohumeral ligament is actually a complex of structures consisting of an anterior band, a posterior band, and an interposed axillary pouch. While these components of the inferior glenohumeral ligament complex were present in all 11 specimens, they were best demonstrated in some shoulders by placing the humeral head in internal or external rotation in varying degrees of abduction. Histologic examination of the joint capsule revealed that the anterior and posterior bands of the inferior glenohumeral ligament complex were readily identifiable as distinct structures comprised of thickened bands of well-organized colla gen bundles. Although slight variations were noted in the attach ment sites of the anterior and posterior bands to the glenoid, the inferior glenohumeral ligament complex was observed to attach to the humeral neck in one of two distinct configurations. A collar-like attachment, in which the entire inferior glenohumeral ligament complex attaches just inferior to the articular edge of the humeral head, was observed in six specimens. In the remaining five specimens, the attachment was in the shape of a "V," with the anterior and posterior bands attaching adjacent to the articular edge of the humeral head and the axillary pouch attaching at the apex of the "V" distal to the articular edge. The orientation and design of the inferior glenohu meral ligament complex supports the functional con cept of this single structure as an important anterior and posterior stabilizer of the shoulder joint.
Anterior cruciate ligament injury: Evaluation of intraarticular reconstruction of acute tears without repair
Authors: Shelbourne K. Donald , Whitaker H. Jeffrey , McCarroll John R. , Rettig Arthur C. , Hirschman Lynne D. 
Published: June 2007

To evaluate the effectiveness of our treatment regimen, we retrospectively studied the surgically treated knees of 155 athletes, aged 15 to 42 years, who had sustained acute ACL tears. All were treated with ligament excision and intraarticular bone-patellar tendon-bone recon struction followed by early motion with emphasis on full extension. The follow-up period ranged from 2 to 7 years. Of the 155 patients, 140 were available for final followup at a minimum of 2 years after reconstruction. The patients were evaluated by objective measures (KT-1000, Cybex, Lachman test, range of motion, and postoperative competition level) and subjective assess ment scores (pain, swelling, stability, activity level, walk ing, stair climbing, running, jumping, or twisting). The subjective scores were tabulated for stability level, total score, and activity level. After the patients achieved full range of motion, the KT-1000 measurements at a 20 pound force revealed an average difference of 1.3 mm between the injured and noninjured knees. All but 3 of the 140 patients had a firm endpoint on the Lachman test, and the Cybex tests showed a mean hamstring strength of 98% and mean quadriceps strength of 90%. Sixty of the 69 varsity athletes who were eligible to play returned to preinjury competition level the following season. One had reconstruction failure and eight chose not to con tinue competition for academic reasons. The question naire score average was 92.7 (maximum, 100 points, normal athletic knee score 93.5). We concluded that the surgical procedure, with em phasis on early full extension postoperatively, achieved excellent results and provided a stable knee.
Chondromalacia and chronic anterior instabilities of the knee
Authors: Conteduca Fabio , Ferretti Andrea , Mariani Pier Paolo , Puddu Giancarlo , Perugia Lamberto 
Published: June 2007

In this study, we surveyed a consecutive series of 500 patients who had undergone an open procedure for chronic anteromedial and/or anterolateral instabilities. Those patients who had an open arthrotomy were separated for analysis. All of the patients were examined before and during surgery. A knee sheet, based on the kind used at the Hughston Orthopaedic Clinic in Columbus, Georgia, was used to record all clinical findings. Chondromalacia of the articular surface of the femur was detected at surgery in 161 patients (32%). A statistical analysis showed that the variables di rectly influencing degenerative changes of the cartilage are: a previous surgery that did not sufficiently restore joint kinematics (chi square = 20.238, P < 0.001) and a time lapse of more than 30 months between first trauma and surgery (chi square = 21.736; P = 0.001). A higher score on dynamic (jerk or pivot shift) and static (internal and external anterior drawer) tests, in dicating instability, or a meniscal tear alone do not statistically correlate with chondromalacia, but together they influence degenerative changes of the cartilage.
Impact biomechanics of lateral knee bracing
Authors: Paulos Lonnie E. , Cawley Patrick W. , France E. Paul 
Published: June 2007

We evaluated the effects of six different prophylactic braces on ACL ligament strain under dynamic valgus loads using a mechanical surrogate limb validated against human cadaveric specimens. Medial collateral ligament and anterior cruciate ligament peak forces, medial collateral ligament and anterior cruciate ligament tension initiation times, and impact safety factors were calculated for both braced and unbraced conditions. These tests were conducted to determine whether or not application of a prophylactic brace might provide protection to the anterior cruciate ligament under valgus loading conditions. The results of this study indicate that those braces that increased impact duration appear to differentially protect the anterior cruciate ligament more than the medial collateral ligament, and that most of the braces tested appear to provide some degree of protection to the anterior cruciate ligament under direct lateral im pacts. These findings should be confirmed clinically.