Anterior cruciate ligament reconstruction with patellar tendon. An ex vivo study of wear-related damage and failure at the femoral tunnel.

Patellar tendon grafts used in the reconstruction of the anterior cruciate ligament may be subjected to thousands of knee flexion-extension cycles during the early postoperative period. The purpose of this study was to model experimentally the patellar tendon graft wear-related damage and failure at the femoral tunnel during simulated knee motion of 0 degrees to 112 degrees of flexion at 1 cycle/sec. To evaluate the effects of 2 different femoral tunnel orientations, tunnel chamfering, and 3 different graft loads on graft survival, 25 calf femurs and patellar tendons were used.

MR diagnosis of meniscal tears of the knee: importance of high signal in the meniscus that extends to the surface.

Objective: The presence of intrameniscal signal in contact with the surface is a commonly used criterion for the diagnosis of meniscal tear. This signal presumably represents the actual tear in the meniscus. However, some menisci with signal that contacts the surface are noted to be intact at arthroscopy whereas other menisci that have no signal in contact with the surface are found to be torn.

Anterior cruciate ligament reconstruction. The effect of tibial tunnel placement on range of motion.

In 111 patients who had anterior cruciate ligament reconstructions, postoperative radiographic measurements of anterior to posterior and medial to lateral location of the tibial tunnels were correlated with the final range of motion achieved. In the 25 patients with extension deficits of 10 degrees or more, placement of the tibial tunnel was more anterior (average, anterior 23% of the tibia) than in the remaining 86 patients with extension deficits of < 10 degrees (average, anterior 29% of tibia). This difference was statistically significant with P < 0.

"Bone bruises" on magnetic resonance imaging evaluation of anterior cruciate ligament injuries.

Magnetic resonance imaging of the knees of 98 consecutive patients with clinically diagnosed anterior cruciate ligament injuries revealed 47 patients (48%) with focal signal abnormalities consistent with the diagnosis of a "bone bruise." Seventy-one percent of the magnetic resonance images taken within 6 weeks of injury demonstrated a bone bruise, whereas no scans done longer than 6 weeks after injury showed a bruise (P < 0.0001).

Diagnosis of meniscal tears of the knee with MR imaging: effect of observer variation and sample size on sensitivity and specificity.

Objective: A wide range in the efficacy of MR imaging for the diagnosis of meniscal tears of the knee has been reported. To evaluate two possible causes for this variation, we studied how sensitivity and specificity are affected when different observers and sample sizes are used.

Materials And Methods: Two hundred MR examinations of the knee in patients for whom the results of arthroscopy were available were used for the study.

Evaluation of acute knee injuries.

Early, accurate diagnosis and aggressive treatment are important in returning a patient with an acute knee injury to full function. Although many problems, such as acute tendinitis and mild sprains, can be simply treated with short periods of rest, some disabilities may be chronic or recurrent and require more invasive treatment. Many acute injuries necessitate emergency treatment or early surgical intervention.

An OspA serotyping system for Borrelia burgdorferi based on reactivity with monoclonal antibodies and OspA sequence analysis.

A total of 136 Borrelia burgdorferi sensu latu strains from various biological sources (ticks, human skin, and cerebrospinal fluid) and geographical sources (Europe and North America) were investigated by Western blot (immunoblot) with eight monoclonal antibodies against different epitopes of the outer surface protein A (OspA). On the basis of the differential reactivities of these monoclonal antibodies, seven OspA serotypes were defined. As determined by 16S rRNA sequence analysis, these serotypes correlated well with recently delineated genospecies: serotype 1 corresponds to B.

The effects of knee effusion on quadriceps strength and knee intraarticular pressure.

The purpose of this study was to determine the effect of varied amounts of effusion on quadriceps strength and knee intraarticular pressure (IAP) during active knee movement. Five subjects had 60 ml of saline, in 20 ml increments, infused into the right knee. Quadriceps strength and knee IAP were continuously measured at each level of effusion, while the subject performed isokinetic knee exercises.

The effect of in situ freezing on rabbit patellar tendon. A histologic, biochemical, and biomechanical analysis.

Cell necrosis has been well documented as one of the many changes that occur in autogenous tendon when it is used to reconstruct the anterior cruciate ligament. The purpose of this experiment was to isolate cell necrosis as a variable and study its effect on the patellar tendon. To accomplish this, both knees of 25 New Zealand White rabbits were operated on.

[The incidence of silent myocardial ischemia].

Retrospectively evaluated was the patient population of the years 1982 to 1988 which underwent ergometric investigations concerning the appearance of silent myocardial ischaemias. In 256 reactions of exercise ischaemia of patients with definitive coronary disease in 47 cases angina pectoris appeared (18.4%).

Anterior cruciate ligament tears in skeletally immature patients: meniscal pathology at presentation and after attempted conservative treatment.

We evaluated 12 skeletally immature patients with acute, intrasubstance tears of the anterior cruciate ligament (ACL) and open physes for meniscal pathology. Arthrograms were completed in 10 of 12 patients, and subsequent arthroscopy confirmed 8 meniscal tears (4 medial, 4 lateral) in 6 patients. Four patients with repairable menisci underwent arthroscopic meniscal repair and stabilization.

Signs of patellar chondromalacia on sagittal T2-weighted magnetic resonance imaging.

We incidentally noted distinctive high signal defects or fissures in the patellar articular cartilage on sagittal T2-weighted magnetic resonance (MR) images in 4 patients. At subsequent arthroscopy all 4 patients were found to have patellar chondromalacia. To determine the reliability of these signs, we retrospectively evaluated, in a blinded manner, sagittal T2-weighted MR images of the knee in 75 patients who were undergoing arthroscopic assessment of their patellar articular cartilage.

Effect of knee joint laxity on long-loop postural reflexes: evidence for a human capsular-hamstring reflex.

The onset latency and discharge amplitude of preprogrammed postural responses were evaluated in order to determine if the structure of synergistic activation could be altered by ligamentous laxity at the knee joint. Twelve subjects with unilateral and one subject with bilateral anterior cruciate ligament (ACL) insufficiency were tested while standing on a moveable platform. External balance perturbations (6 cm anterior or posterior horizontal displacements of the platform) were presented at velocities ranging from 15 to 35 cm/s.

[Endogenous candida endophthalmitis: a new therapy].

A thirty-year-old patient underwent an extensive abdominal surgery because of a precancerosis due to a colitis ulcerosa. An accompanying smoldering panuveitis led under immunosuppressive therapy to the loss of sight of one eye. Only an increasing vitritis of the second eye allowed the diagnosis of an endogenous Candida endophthalmitis (ECE) following a vitrectomy.

A device to measure the cross-sectional area of soft connective tissues.

A device has been designed and fabricated to measure the cross-sectional area of soft connective tissues ex vivo. It consists of two displacement transducers; one sensing tissue thickness and the other sensing width. Outputs are recorded (via an analog to digital interface) using a personal computer.

[Pneumonia prevention in long-term mechanically ventilated patients: selective skin decontamination according to Stoutenbeek or prevention of colonization according to Unertl? A prospective randomized comparison of both treatments].

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.

Anxiety and intense running exercise in the presence and absence of interpersonal competition.

The purposes of this study were to evaluate the effects of intense running exercise in the presence and absence of interpersonal competition on both (a) pre-exercise anxiety levels and (b) alterations in anxiety as a consequence of the exercise. Seven females and 10 males performed a 5-mile run over the same outdoor course on two separate days. In one condition the subjects ran in a road-race in which intense exercise was combined with interpersonal competition.

[Effects of diltiazem in acute and long-term administration].

In 16 patients with unstable angina pectoris haemodynamic and clinical effects of diltiazem were investigated. In a second group patients (n = 11) with unstable or therapy-refractory course the long-term effect was tested. The acute intervention with injected and infused diltiazem via an improved oxygen balance due to decreased minute work and reduced product of cardiac frequency and pressure stabilized the clinical picture from the haemodynamic aspect.

Results of knee manipulations after anterior cruciate ligament reconstructions.

We analyzed the results of knee manipulations in 42 knees that had persistent flexion or extension deficits after intraarticular ACL reconstructions. All manipulations were done under a spinal or general anesthetic and, in 10 cases, arthroscopic debridement of adhesions also was performed. The average time from reconstruction to manipulation was 7 months (range, 3 to 14 months) and the average followup was 26 months (range, 6 to 56 months).

[Treatment indications of hypertensive blood pressure dysregulation (a 7-year follow-up)].

The results of the present course investigations by means of bicycle ergometry over seven years on patients with vitality-limiting load hypertension in normotensive and initial situation of the borderline blood pressure, respectively, render necessary from the point of view of the authors an increase of the former indications to treatment. Situative measurement of blood pressure only at rest are hereby not sufficient and demand a bicycle-ergometric objectivation of the possible hypertensive dysregulation of blood pressure in patients with anamnestically restricted range of physical efficacy. In patients with exclusively under load increased vitality-limiting blood pressure values the ergometry represents the diagnostic method of choice.

[A fatal hypertensive reaction during anesthesia in a patient with acute subarachnoid hemorrhage].

We describe the case of a 55-year-old female patient who presented for clipping of cerebral artery aneurysm that had ruptured 8 h before. Anesthesia induction was uneventful. After adequate positioning of the patient, two injections of a saline solution containing ornipressin (POR 8) were given into the scalp.

Osteochondritis dissecans of the knee: value of MR imaging in determining lesion stability and the presence of articular cartilage defects.

Osteochondritis dissecans is a lesion of articular surfaces that is of uncertain etiology. These lesions are seen on radiographs as a bony defect or fragmentation of the subchondral bone. A bony defect may be an actual surface hole or the defect may be filled with fibrous tissue or fibrocartilage.

Acute modification of biomechanical properties of the bone-ligament insertion to rat limb unweighting.

We investigated the acute adaptation of the rat femur-medial collateral ligament-tibia (FMT) complex to 7 days of limb unweighting by means of a hind-limb suspension protocol. Male, young adult, Harlan Sprague-Dawley rats were randomly assigned to either control or suspended groups. Rats deprived of hind limb-to-ground contact forces had a 42% decrease in soleus muscle mass compared with the control group.

Value of MR imaging in staging osteochondral lesions of the talus (osteochondritis dissecans): results in 14 patients.

Osteochondral lesions (osteochondritis dissecans) of the talus are common articular lesions that are usually traumatic in origin. Clinical management of these lesions is based on whether or not the fragments are attached. We studied the value of MR imaging in determining the stability of the osteochondral fragments.