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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-nine fresh osteochondral allografts were consecutively transplanted into the knees of fifty-eight patients. The preoperative diagnoses were chondromalacia or degenerative arthritis of the patella, osteochondritis dissecans, a traumatic defect or osteonecrosis of the femoral condyle, a painful healed depressed fracture or traumatic defect of the tibial plateau, and unicompartmental traumatic arthritis of the knee. All of the patients had disabling pain after the failure of previous attempts to correct the problem surgically. Thirty-nine patients (forty knees) were available for follow-up at two to ten years after the allograft was transplanted. Nine transplants (22.5 per cent) failed and thirty-one (77.5 per cent) were successful. The result was rated excellent after thirteen of the successful transplants, good after fourteen, and fair after four. Transplantation of a fresh osteochondral allograft proved to be a satisfactory intermediate procedure for the treatment of the disabling conditions, except unicompartmental traumatic arthritis, in the young patients in this series. For the patients who had unicompartmental traumatic arthritis, the rate of success was only 30 per cent.
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PMID:Resurfacing of the knee with fresh osteochondral allograft. 265 99

Ankle arthroscopy is rapidly gaining in popularity as an important diagnostic and therapeutic procedure. Indications for this technique include pain, swelling, stiffness, instability, hemarthrosis, and locking of the ankle. The anteromedial, anterolateral, and posterolateral portals are most commonly used. The use of a short, 30 degrees oblique arthroscope, with an ankle holder and distractor, permits visualization of the entire joint. Operative treatment is facilitated by small joint shavers, burrs, knives, and baskets. Intraarticular problems such as chondromalacia, osteophytes, loose bodies, synovitis, osteoarthritis, fracture, and instability all can be addressed arthroscopically. Prior to this technique, the cause of chronic ankle pain was poorly understood. Now, lateral ankle impingement is a well-recognized entity that responds well to arthroscopic treatment. Ankle arthroscopy provides a safe, effective method of diagnosis and treatment with few complications. Further advances in equipment and technique should expand indications for this procedure.
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PMID:Progress in ankle arthroscopy. 291 35

During the period 1978-1984, 38 patients aged 23-55 years were treated for patellofemoral pain by the Maquet procedure. The mean postoperative observation time was 5(3-9) years. Thirty-three of the 38 patients were available for follow-up including functional and activity scoring, clinical examination, and Cybex II dynamometer muscle-strength measurement. Ten patients improved, 17 were unchanged, and 6 were worse. Characteristic for the improved group was Grades III and IV chondromalacia - mainly involving the lateral facet - whereas the group with no improvement or deterioration exhibited a low-grade chondromalacia, chiefly affecting the medial patellar facet.
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PMID:Advancement of the tibial tuberosity for patellar pain. A 5-year follow-up. 292 87

The understanding and treatment of the young athlete's knee has improved and continues to do so as arthroscopy and good long-term follow-up studies guide the process. In the management of epiphyseal fractures about the knee the presence of associated ligament injury and the high likelihood of a growth plate injury is now well documented. In the management of ligament injuries and internal derangements, arthroscopy has profoundly changed diagnosis and treatment. Pathology can be precisely identified and the appropriate treatment initiated to preserve an athletic career and possibly prevent degenerative arthritis in adulthood. Lastly, patellofemoral pain continues to be a difficult problem to treat, but a more scientific approach is evolving. This has been facilitated by a better understanding of the varied etiologies for anterior knee pain, and a trend away from classifying all such conditions as chondromalacia.
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PMID:The young athlete's knee: recent advances. 304 60

Hip problems form about 10% (7.0 to 14.2%) of most published series of ballet injuries. The abnormally large range of external rotation needed for a perfect turnout is primarily due to soft tissue adaptation, more readily achieved in the young dancer. Insufficient range of motion at the hip throws considerable stress on the other lower limb segments. The snapping hip syndrome is common (43.8% of hip problems), with about one-third associated with pain. A tight iliotibial band may contribute to this, and balanced flexibility requires special attention to abductor stretching. The external clicking hip must be distinguished from the internal clicking hip, which is associated with the joint and psoas tendon. Stress fractures of the hip are easily overlooked and, if undetected, they may progress to a complete fracture. Knee problems account for 14.0 to 20% of complaints, and over 50% of these are peri- or retropatellar problems. This includes synovial plica, medial chondromalacia, lateral patella facet syndrome, subluxing patella and the fat pad syndrome. Specific diagnosis leads to specific treatment and the best chance of cure. Mild hyperextension of the knee may be aesthetically desirable, but excessive range leads to symptoms in the posterior capsule and poor control. Young dancers with a tendency to very lax joint structures should be identified early and protected from overstretching. In the author's series, meniscal lesions did not appear to be as big a problem as reported elsewhere in the literature. Ballerinas appear to have less leg strength than other groups of athletes, having only 77% of the weight-predicted norms. The introduction of strength training for male and female dancers may reduce injuries and improve balance, but it requires an intensive educational programme to dispense with the many myths. There are several references to the development of early arthritis but, while relatively common in the foot, symptomatic arthrosis in ballet dancers' hips and knees is not more prevalent than in the general population. The young age at which serious dance training begins, the long and rigorous hours of practice, the thin ballet slipper, dancing en pointe and unusual dietary regimens may all contribute to injury patterns in varying degrees.
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PMID:Prevention of hip and knee injuries in ballet dancers. 306 38

One hundred ACL insufficient knees were followed for an average of 3.5 years after arthroscopic partial meniscectomy had been performed. Fifty-two percent of the patients obtained a satisfactory result and 41% were able to participate in strenuous sports activities. The arthroscopic partial meniscectomy reduced pain and swelling in a high proportion of cases, but stability was only marginally improved. Negative prognostic factors were: sex (female), generalized laxity, contralateral recurvatum of more than 10 degrees, complete as opposed to partial ACL lesions, Grade III tibiofemoral or patellar chondromalacia, associated peripheral ligamentous laxity, pivot shift of Grade II or greater, and anterior tibial displacement of more than 5 mm as measured with the KT-1000 knee arthrometer.
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PMID:Arthroscopic partial meniscectomy in the anterior cruciate deficient knee. 307 Nov 51

One hundred seven patients were examined who had undergone patellectomies between 1965 and 1983 (113 patellectomies). The mean follow-up time was 10.5 years (3-17.5 years) and the average age of the patients 42.6 years. There were three distinct groups of operative techniques: (1) the purse-string technique in 40 patellectomies; (2) the vastus medialis technique in 24 patellectomies; (3) other techniques in 49 patellectomies. The indications for patellectomy were: chondromalacia, 56 cases; comminuted patellar fractures, 32 cases; arthritis, 17 cases; recurrent patellar dislocations, 8 cases. The patients were examined for pain, rage of motion, giving way, swelling, quadriceps strength, activity and cosmetic results (interview, physical examination, Cybex and radiographic study). In the purse-string technique group, 81% of the cases ended up with good or excellent results; in the vastus medialis group there were 79% and in the third group only 73% good or excellent results. Among the patellectomies for comminuted fractures, 75% had excellent results. The clinical outcome of patelletomy for arthritis is fair, for recurrent dislocation favorable, and for chondromalacia variable and not predictable.
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PMID:[Patellectomy as a salvage operation]. 330 92

For a study of the ultrastructural pathology of chondromalacia patellae, we studied biopsy specimens that had been obtained at operation in twelve young patients who had pain in the anterior aspect of the knee due to mechanical derangement and also had the pathological changes in articular cartilage that are characteristic of chondromalacia. The initial pathological finding was swelling of the superficial matrix associated with breakdown of the collagen fiber network, especially at matrix streaks in the superficial and transitional zones. Fibrillated cartilage contained surface fissures that penetrated the middle layers. Amorphous electron-dense material was found covering the internal surfaces of the fissures; this appeared to contain degraded components of the matrix. In association with these changes, there were formation of nests of cells (clusters of chondrocytes) and increased numbers of organelles in the chondrocytes. A limited repair reaction also was observed in some specimens; this was characterized by the migration of fibroblast-like cells over the surface of the cartilage. The ultrastructural observations on these specimens from patients who had chondromalacia were compatible with a pathogenesis resulting from mechanical overload.
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PMID:An electron microscopic study of early pathology in chondromalacia of the patella. 273 74

Eighty patients who complained of retropatellar pain underwent evaluation by bone scintigraphy, intraosseous pressure determination, radiography, arthroscopy and physical diagnostic tests. The bone scans showed that 48% of the painful knees had an increased uptake compared with 9% for the normal joints. A highly significant correlation was evident between an increased uptake and established chondromalacia. For the diagnosis of a high pressure patella, radiography was only 7% sensitive (6/88), compared with 44% (39/88) for bone scintigraphy and 78% for the clinical "sustained flexion" test. The positive predictive value of a bone scan for detecting a high pressure patella was 0.72 (39/54). The best predictor was a positive sustained flexion test with a predictive value of 0.85 (69/81).
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PMID:Bone scan in the patellofemoral pain syndrome. 355 53

The anterior cruciate ligament of the knee was reconstructed in 14 patients using doubled semitendinosus tendon graft put through one hole in the femur and two separate holes in the tibia. This was done in an attempt to duplicate the anatomic insertion of the anterior cruciate ligament on the tibia, to increase the strength of the tendon graft, and to reconstruct the anterior and posterior bundles of the anterior cruciate ligament. The follow-up period ranged from two and one-half to five years (average, 3.6 years). Before surgery, all patients complained of varying degrees of pain. Four were not able to participate in sports, seven had pain on walking, and nine complained of recurrent swelling. Lachman's test was positive in 14 patients; anterior drawer test was 3+ in ten patients and 2+ in four patients; and pivot shift test was positive in 13 patients. Anteromedial instability of 1+ was present in five patients; combined straight, anteromedial, and posterolateral instability in four patients; and anterolateral in one patient. Ten patients sustained a tear of the medial meniscus, two of the medial and lateral menisci, and one of the lateral meniscus. Chondromalacia and degenerative changes of the knee were noted in nine patients. After operation, four patients complained of aching sensation during weather changes and two of aching in the patellar region after strenuous sports activities. The Lachman test was negative in 11 patients and was less than 1+ in three patients. The anterior drawer test was negative in four patients, trace in two patients, less than 1+ in five patients, and 1+ in three patients. The pivot shift test was negative in all patients. All patients were able to return to their previous occupations; eight patients were able to participate in recreational sports and one in intercollegiate soccer. Using a standard rating system, after operation 12 patients were rated as excellent or good and two as fair (+).
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PMID:Reconstruction of the anterior cruciate ligament of the knee using a doubled tendon graft. 359 87


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