Effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement.

It is not clear whether femoral neck osteochondroplasty achieves its objective of increasing femoroacetabular clearance. We used an upright open magnetic resonance imaging scanner to image the hip joint in multiple postures to explore the effect of posture and femoral neck osteochondroplasty on femur-acetabulum clearance in patients with cam-type femoroacetabular impingement. We recruited 13 consecutive patients scheduled to undergo arthroscopic femoral neck osteochondroplasty and completed assessments on 10 patients.

Trunk and lower limb biomechanics during stair climbing in people with and without symptomatic femoroacetabular impingement.

Background: Femoroacetabular impingement is a pathomechanical hip condition leading to pain and impaired physical function. It has been shown that those with femoroacetabular impingement exhibit altered gait characteristics during level walking and stair climbing, and decreased muscle force production during isometric muscle contractions. However, no studies to-date have looked at trunk kinematics or muscle activation during dynamic movements such as stair climbing in this patient population.

A Pre-Operative Exercise Intervention Can Be Safely Delivered to People with Femoroacetabular Impingement and Improve Clinical and Biomechanical Outcomes.

This study aimed to investigate the effects of a pre-hip arthroscopy exercise intervention on hip strength, pain, and function in individuals with femoroacetabular impingement (FAI). A total of 20 individuals with FAI completed a 10-week, partially supervised exercise programme; this included three phases of increasing resistance and functionality, consisting of four to six exercises per phase. Hip strength in all six directions; hip pain; function, as measured by the Hip disability and Osteoarthritis Outcome Score (HOOS); and objective physical function, as measured by the Timed Stair Climb test, were determined before and after the intervention.

Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

Study Design: Single-subject research design using 4 consecutive patients.

Objective: To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin.

Background: Acetabular labral tears cause pain in some but not all patients.

Kinematic and kinetic differences during walking in patients with and without symptomatic femoroacetabular impingement.

Background: Femoroacetabular impingement is a common hip pathology resulting in pain and impaired physical function. However, very little is known about gait differences between those with and without femoroacetabular impingement. Thus, the purpose of this study was to compare three-dimensional gait kinematics and kinetics between those with femoroacetabular impingement and a healthy, pain-free control group.

Non-iterative partial view 3D ultrasound to CT registration in ultrasound-guided computer-assisted orthopedic surgery.

Purpose: In image-guided orthopedic surgery, rigid registration of intra-operative ultrasound (US) to a pre-operative plan, developed using computed tomography (CT) scans, is an important step for providing real time surgical guidance. The ability to perform this registration accurately, automatically, and in real time is critical for enabling more effective image guidance and anatomic restoration in a number of orthopedic procedures. Several surface-based and intensity-based registration methods have been proposed before to align the US and CT data.

Patient-reported outcome instruments for femoroacetabular impingement and hip labral pathology: a systematic review of the clinimetric evidence.

Purpose: The purpose of this study is to systematically review the content and clinimetric evidence (rigor of rating scales and indexes for the description of clinical phenomena) of published patient-reported outcome (PRO) instruments used to assess femoroacetabular impingement (FAI) and labral hip pathology.

Methods: We used Medical Subject Heading terms related to FAI and labrum/labral tears to search the Medline, Embase, and Cochrane databases for studies of FAI and labral hip pathology. Studies with hip-related PRO instruments, with any operative intervention except total hip arthroplasty, were included.

Effect of acetabular labral tears, repair and resection on hip cartilage strain: A 7T MR study.

Background: Tears of the acetabular labrum are frequently present in patients with groin pain. While it is clear that the labrum contributes to the surface area articulating with the femoral head, it is not clear whether labral repair yields different load distribution in the hip compared to labral resection.

Purpose: Determine whether labral repair reduces cartilage strain more effectively than labral resection.

Non-purulent low-grade infection as cause of pain following shoulder surgery: preliminary results.

Low-grade infection was systematically searched for in all revision shoulder surgeries by harvesting tissue samples. Ten consecutive patients were identified with a non-purulent low-grade infection of the shoulder. All of these patients suffered from pain and eight were stiff.

Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials.

Purpose: The purposes of this study were to (1) perform a systematic review of randomized controlled trials evaluating graft tensioning in anterior cruciate ligament (ACL) reconstruction, and (2) determine the scientific quality of published randomized controlled trials evaluating graft tensioning in ACL reconstruction.

Methods: The search strategy included a computerized literature search, a citation search, and a manual search of key journals and conference proceedings. Eligible studies were randomized controlled trials evaluating the effect of graft tensioning on the outcomes of ACL reconstruction.

Deformation and recovery of cartilage in the intact hip under physiological loads using 7T MRI.

Unlabelled: Accurate measurement of cartilage deformation in loaded cadaver hip joints could be a valuable tool to answer clinically relevant research questions. MRI is a promising tool, but its use requires an understanding of cartilage deformation and recovery properties in the intact hip. Our objective was to answer the following questions: (1) How long does it take for hip cartilage to reach a deformed steady-state thickness distribution under simulated physiological load, and how much does the cartilage deform? (2) How long does it take for hip cartilage to return to the original cartilage thickness distribution once the load is removed?

Methods: Five human hip specimens were axially loaded to 1980N in a 7T MR scanner and scanned every 15min throughout loading.

Latissimus dorsi tendon transfer for massive irreparable cuff tears: an anatomic study.

The purpose of this study was to describe landmarks for latissimus dorsi tendon transfer in massive irreparable tears of the rotator cuff. Nine pairs of embalmed cadaveric shoulders were dissected. Crucial structures were identified, and their relationship with various bony and soft-tissue reference points was documented.

Comparison of the subjective shoulder value and the Constant score.

The purpose of this study was to evaluate the subjective shoulder value (SSV) and to compare it with the Constant score (CS). The SSV is defined as a patient's subjective shoulder assessment expressed as a percentage of an entirely normal shoulder, which would score 100%. Patients who underwent operative treatment for rotator cuff repair (n = 247), arthroplasty (n = 83), or stabilization for recurrent anterior instability (n = 111) were included in this study.

Clinical and structural results of open repair of an isolated one-tendon tear of the rotator cuff.

Background: The clinical outcomes of open rotator cuff repair are well established, but the structural results and their effect on clinical outcome are poorly known. We assessed the structural changes in the musculotendinous units after open rotator cuff repair and correlated these findings with the clinical outcome to establish a benchmark for future series.

Methods: Thirty-two consecutive standardized open repairs of a single tendon tear of the rotator cuff were analyzed in twenty-one men and eleven women with an average age of 59.

Treatment of painful pseudoparesis due to irreparable rotator cuff dysfunction with the Delta III reverse-ball-and-socket total shoulder prosthesis.

Background: The Delta III reverse-ball-and-socket total shoulder implant is designed to restore overhead shoulder function in the presence of irreparable rotator cuff deficiency by using the intact deltoid muscle and the stability provided by the prosthetic design. Our purpose was to evaluate the clinical and radiographic results of this arthroplasty in a consecutive series of shoulders with painful pseudoparesis due to irreversible loss of rotator cuff function.

Methods: Fifty-eight consecutive patients with moderate-to-severe shoulder pain and active anterior elevation of <90 degrees due to an irreparable rotator cuff tear were treated with a Delta III total shoulder replacement at an average age of sixty-eight years.

Surgery of the hand in severe systemic sclerosis.

Ten patients with scleroderma and severe hand problems required surgery, and seven were available for follow-up (two died from scleroderma-related complications and one was lost to follow-up). The mean duration of follow-up was 4 (range 1.5-9) years.

Evaluating surgical resident selection procedures.

Purpose: The purposes of this study were to develop and assess a rating form for selection of surgical residents, determine the criteria most important in selection, determine the reliability of the assessment form and process both within and across sites, and document differences in procedure and structure of resident selection processes across Canada.

Methods: Twelve of 13 English-speaking orthopedic surgery training programs in Canada participated during the 1999 selection year. The critical incident technique was utilized to determine the criteria most important in selection.

A needs assessment of surgical residents as teachers.

Objective: To determine the needs of surgical residents as teachers of clinical clerks.

Design: A needs assessment survey.

Setting: Department of Surgery, University of Toronto.

A computer-based trauma simulator for teaching trauma management skills.

Background: The management of multiply injured trauma patients is a skill requiring broad knowledge, sound judgment, and leadership capabilities. The purpose of this study was to evaluate the effectiveness of a computer-based trauma simulator as a teaching tool for senior medical students.

Methods: All year-4 clinical clerks at the University of Toronto were approached to participate in a focused, 2-hour trauma management course.

Endoscopic bursal resection: the olecranon bursa and prepatellar bursa.

We treated 31 cases of olecranon bursitis and 19 cases of prepatellar bursitis. The average duration of symptoms before surgery was 1.1 years with a range of 3 months to 4 years.

Chronic pain following ankle sprains in athletes: the role of arthroscopic surgery.

We reviewed 100 patients treated arthroscopically for symptoms of chronic ankle pain associated with sprains of the ankle. All had pain that had failed to respond to conservative treatment for at least 6 months. The pathology in 95 of the 100 ankles studied could be categorized into one of three groups: the instabilities (lateral and syndesmotic), the impingements (anterior and anterolateral), and articular lesions (chondral and osteochondral).

Anterior tibial compartment pressures during intermittent sequential pneumatic compression therapy.

We studied the anterior tibial compartment pressures during the application of a JOBST sequential intermittent pneumatic compression device on 5 healthy human volunteers (10 legs). Intracompartmental pressures were measured using a slit catheter. The measurements of interstitial pressures were highest at maximal calf inflation, and pressures were increased for approximately 120 seconds during each cycle.

Treatment modalities for soft tissue injuries of the ankle: a critical review.

We reviewed the English language medical literature on soft tissue injuries of the ankle published between 1966 and 1993. There were 150 articles reviewed of which 84 dealt substantially with ankle soft tissue injuries. The papers were analyzed for quality and it was found that there were significant weaknesses throughout the literature.