Journal of the Southern Orthopaedic Association最新文献

In 1995, it was reported that 60,000 to 75,000 anterior cruciate ligament (ACL) reconstructions were being performed annually in the United States. Successful long-term results are achieved in 75% to 95% of these patients, but 8% have unsatisfactory results due to recurrent instability and graft failure. With the increasing popularity of this procedure, ACL revision surgery has also become increasingly common. While the techniques described for ACL revision have been varied, the overall results in the literature do not compare favorably with primary ACL reconstruction. The proper execution of revision ACL reconstruction requires precise preoperative planning to assess the cause of initial failure and avoid repeating the same mistakes with revision reconstruction. Graft choice, hardware removal, revision notchplasty, tunnel placement, and method of fixation are key points for a successful result. The causes of ACL failure, the technical aspects of revision ACL surgery, and the reported results of revision ACL surgery are reviewed.

The use of botulinum toxin type A (BTX) in the management of spasticity in childhood cerebral palsy (CP) is increasing. This study examined annual health care service utilization and costs associated with BTX therapy for spastic CP in Medicaid-enrolled children receiving complete health care coverage (1997 to 1999). We used pair matching as well as recent statistical technique improvements (bootstrap method) to work with limited samples. The introduction of BTX was associated with an increase of approximately $62 per month in prescription costs for the patient. However, these costs were made up by reductions in hospitalization. When each year was examined individually, reimbursements for BTX users were not different from those for pair-matched non-BTX users. These data suggest that BTX therapy does not significantly add to the costs of treating Medicaid-enrolled children with CP.

The treatment of symptomatic multidirectional instability (MDI) of the shoulder has proven a challenge to orthopaedic surgeons. Patients who refuse activity modification often fail nonsurgical management, and traditional surgical approaches may trade the dysfunction of instability for that of decreased motion and possible future arthrosis. Recently, several methods of arthroscopic thermal capsulorrhaphy have gained popularity. Studies have shown that capsular shrinkage occurs due to the denaturation of type I collagen with maintenance of heat-stable intermolecular cross-links. Thermally treated tissues undergo a predictable healing response. The primary advantages of this procedure are the decreased surgical morbidity and ease of procedure compared with open capsular shift. Additionally, it may provide improved stability and decreased pain while maintaining range of motion. When radiofrequency treatment provides inadequate visualized capsular contracture, arthroscopic rotator interval closure can improve stability without resorting to an open procedure. While initial results in certain clinical series are promising, the long-term efficacy remains to be seen.

Investigations dedicated to examining relationships between low back pain (LBP) and factors specific to running and walking are limited. Current literature suggests runners and walkers may have a lower relative risk for significant LBP. The purpose of this study was to investigate the incidence, prevalence, and possible risk factors for LBP among a group of runners and walkers. A survey was administered to participants who registered for either a 10-kilometer run or 4-mile recreational walk. A total of 539 responses were received. Previous history of LBP was reported by 74% of respondents overall. Prevalence of LBP at the time of survey completion was 13.6%. Low back pain was experienced more frequently by obese runners and by those who reported certain patterns of shoe wear. Regular participation in aerobics correlated with a reduced lifetime risk for LBP. We believe these findings warrant further investigation. This knowledge may benefit not only athletes in training, but other fitness enthusiasts, including casual runners and walkers and those who jog or walk to rehabilitate low back injuries.

This study was designed to determine the best method for presenting the bone mineral content of cadaveric test specimens. A total of 59 bone samples were taken from the humeri, radii, and ulnae of 14 female cadavers. For each sample, the bone mineral content was determined with a dual-energy x-ray absorptiometry scanner, and the ash-weight ratio was calculated manually. A linear regression analysis was performed to compare the ash-weight ratio to the 3 methods for reporting bone mineral content as measured by a dual-energy x-ray absorptiometry scanner: by bone mineral content divided by sample length (in g/cm), by projected area (in g/cm2), or by sample volume (in g/cm3). The analysis revealed that the ash-weight ratio correlates best with the volumetric representation. Based on these data, a volumetric representation is suggested as the best representation of bone mineralization, due to its correlation with ash-weight ratio.

"Minimally invasive" total hip replacement has been promoted in the popular media and advertising despite a lack of peer-reviewed data. This article presents the author's early experience and preliminary outcomes with this new and potentially useful approach to total hip replacement.

Lumbar fusion has been criticized for variable patient outcomes, though little is known regarding how outcomes vary across procedures. We examined outcomes of posterolateral versus BAK interbody lumbar fusion in workers' compensation cases. A medical record review and a follow-up survey were completed. The sample included 185 posterolateral and 185 lumbar interbody fusions. An outcome survey was conducted an average of 5 years after surgery. Arthrodesis rates, satisfaction, function, and health were better for the BAK interbody lumbar fusion cohort. Results suggest greater efficacy of the BAK interbody approach over posterolateral approaches to lumbar fusion in compensated patients.

In the early 1970s, the condylar knee was developed independently in the United States and overseas. The concept of replacing the tibiofemoral condylar surfaces with cemented fixation, along with preservation of the cruciate ligaments, was developed and refined. To correct severe knee deformities, the condylar knee with posterior cruciate-sacrificing design was introduced, also in the early 1970s. By 1974, replacing the patellofemoral joint and either preserving or sacrificing the cruciate ligaments had become standard practice. Subsequently, condylar knee designs were improved to include modularity and noncemented fixation, with use of universal instrumentation. Today, over 19 companies in the United States distribute total knee implants of three different types: cruciate-preserving, cruciate-substituting, and TC-III. Six major companies are actively involved in designing mobile-bearing knees. Future developments, such as navigation-guided surgery, enhanced kinematics, and wear-resistant bearing surfaces with better fixation, promise a consistent evolution for the total knee replacement.

In 28 of 1656 total knee arthroplasties (TKAs) (1.7%) performed for osteoarthritis at this institution, the preoperative arc of motion was 60 degrees or less (average 47.5 degrees; range, 20-60 degrees). The outcome of 22 of the 28 TKAs (21 patients) is reported at a mean follow-up of 52.9 months (range, 24-144 months). Eighty-two percent of the cases were managed with standard soft-tissue releases and posterior cruciate-retaining implants and 18% with a cruciate-substituting design. The joint score rose from 28.8 to 82.2 and the Knee Society Score from 24.6 to 77 points. The mean postoperative arc of motion improved by 46 degrees-93.5 degrees. At latest follow-up, 68.2% of knees achieved maximal flexion of 90 degrees or more. Manipulation was performed in 22.7%. Complications were minimal. A functionally useful range of motion is possible after total knee arthroplasty in the majority of stiff osteoarthritic knees, often without the need for posterior cruciate substitution.