Fachry Ambia Tandjung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1989. / Bibliography: leaves 150-166.

Acetabular labral tears are associated with hip osteoarthritis. A current surgical treatment strategy for a torn labrum, labral resection, has recently shown poor patient outcomes with radiographic signs of osteoarthritis two-years post-operation. Since mechanical factors play a role in the etiology of osteoarthritis, identifying the mechanical role of the labrum may enhance current surgical treatment strategies. In this pilot study, we assessed the relationship between mean cartilage strain, maximum cartilage strain and the three-dimensional cartilage strain distribution in six human cadaver hips with various pathologic conditions of the labrum. We developed a novel technique of mapping cartilage strain using quantitative magnetic resonance imaging (qMRl). qMRl provides a non-invasive means of quantifying the cartilage strain distribution in the hip in three dimensions. Each specimen was assessed first with an intact labrum, then after surgically simulating a longitudinal peripheral labral tear, then after arthroscopically repairing the tear, and after labral resection. We validated the precision of the technique through use of an additional specimen which served as a control. To minimize motion artifact in the high-resolution MR images, we determined that 225 minutes was required for cartilage to reach a steady-state thickness under load. We also determined 16.5 hours was required for cartilage to recover to a steady-state unloaded thickness. The difference in mean and maximum cartilage strain when the labrum was repaired and resected was assessed using a paired t-test. We found that the resected group had an increased mean and maximum cartilage strain of 4% and 6%, respectively and the 3D cartilage strain distribution was elevated throughout the region of interest. When the condition of the intact labrum was compared to the torn labrum, we found no change in mean and maximum cartilage strain, and little obvious change in the 3D pattern of cartilage strain distribution. Based on our findings of increased cartilage strain after labral resection when compared to labral repair, we hypothesize that the labrum’s contribution of additional surface area assists in load distribution, which spares cartilage from excessive loads. We therefore recommend that the longitudinal peripheral torn labrum should not be resected if it is possible to be repaired, because in vivo, labral resection may create an environment with increased articular cartilage strain, which is thought to be associated with cartilage degeneration.

Acetabular labral tears are associated with hip osteoarthritis. A current surgical treatment strategy for a torn labrum, labral resection, has recently shown poor patient outcomes with radiographic signs of osteoarthritis two-years post-operation. Since mechanical factors play a role in the etiology of osteoarthritis, identifying the mechanical role of the labrum may enhance current surgical treatment strategies. In this pilot study, we assessed the relationship between mean cartilage strain, maximum cartilage strain and the three-dimensional cartilage strain distribution in six human cadaver hips with various pathologic conditions of the labrum. We developed a novel technique of mapping cartilage strain using quantitative magnetic resonance imaging (qMRl). qMRl provides a non-invasive means of quantifying the cartilage strain distribution in the hip in three dimensions. Each specimen was assessed first with an intact labrum, then after surgically simulating a longitudinal peripheral labral tear, then after arthroscopically repairing the tear, and after labral resection. We validated the precision of the technique through use of an additional specimen which served as a control. To minimize motion artifact in the high-resolution MR images, we determined that 225 minutes was required for cartilage to reach a steady-state thickness under load. We also determined 16.5 hours was required for cartilage to recover to a steady-state unloaded thickness. The difference in mean and maximum cartilage strain when the labrum was repaired and resected was assessed using a paired t-test. We found that the resected group had an increased mean and maximum cartilage strain of 4% and 6%, respectively and the 3D cartilage strain distribution was elevated throughout the region of interest. When the condition of the intact labrum was compared to the torn labrum, we found no change in mean and maximum cartilage strain, and little obvious change in the 3D pattern of cartilage strain distribution. Based on our findings of increased cartilage strain after labral resection when compared to labral repair, we hypothesize that the labrum’s contribution of additional surface area assists in load distribution, which spares cartilage from excessive loads. We therefore recommend that the longitudinal peripheral torn labrum should not be resected if it is possible to be repaired, because in vivo, labral resection may create an environment with increased articular cartilage strain, which is thought to be associated with cartilage degeneration.

Thesis (Ph. D.)--University of New South Wales, 2004. / Also available online.

Acetabular labral tears are associated with hip osteoarthritis. A current surgical treatment strategy for a torn labrum, labral resection, has recently shown poor patient outcomes with radiographic signs of osteoarthritis two-years post-operation. Since mechanical factors play a role in the etiology of osteoarthritis, identifying the mechanical role of the labrum may enhance current surgical treatment strategies. In this pilot study, we assessed the relationship between mean cartilage strain, maximum cartilage strain and the three-dimensional cartilage strain distribution in six human cadaver hips with various pathologic conditions of the labrum. We developed a novel technique of mapping cartilage strain using quantitative magnetic resonance imaging (qMRl). qMRl provides a non-invasive means of quantifying the cartilage strain distribution in the hip in three dimensions. Each specimen was assessed first with an intact labrum, then after surgically simulating a longitudinal peripheral labral tear, then after arthroscopically repairing the tear, and after labral resection. We validated the precision of the technique through use of an additional specimen which served as a control. To minimize motion artifact in the high-resolution MR images, we determined that 225 minutes was required for cartilage to reach a steady-state thickness under load. We also determined 16.5 hours was required for cartilage to recover to a steady-state unloaded thickness. The difference in mean and maximum cartilage strain when the labrum was repaired and resected was assessed using a paired t-test. We found that the resected group had an increased mean and maximum cartilage strain of 4% and 6%, respectively and the 3D cartilage strain distribution was elevated throughout the region of interest. When the condition of the intact labrum was compared to the torn labrum, we found no change in mean and maximum cartilage strain, and little obvious change in the 3D pattern of cartilage strain distribution. Based on our findings of increased cartilage strain after labral resection when compared to labral repair, we hypothesize that the labrum’s contribution of additional surface area assists in load distribution, which spares cartilage from excessive loads. We therefore recommend that the longitudinal peripheral torn labrum should not be resected if it is possible to be repaired, because in vivo, labral resection may create an environment with increased articular cartilage strain, which is thought to be associated with cartilage degeneration. / Applied Science, Faculty of / Mechanical Engineering, Department of / Graduate

Acute ankle sprains typically heal without significant medical intervention, but some percentage of patients will progress towards a condition called chronic ankle instability. While this condition can be improved with rehabilitation, a subset of patients will not respond to therapy and are considered for surgical treatment. The proffered surgical options throughout the twentieth century were largely limited to repairs that attempted to recreate the natural anatomy based off of Brostrom’s direct repair or those that aimed to reduce instability without adhering to the natural biomechanics. But within the last several decades, surgical treatment of chronic ankle instability has undergone significant advances, with many surgeons adopting strategies and implants originally used in other fields of orthopedic surgery. The use of arthroscopy, suture anchors, and suture tape augmentation have dramatically changed the approach previously taken to carry out the modified Brostrom repair, but the effects of these new strategies have not been widely studied. This review aims to assess the evidence supporting each of these “modern modifications” to the modified Brostrom procedure and identify areas for additional research.

The work described in this thesis was carried out by the author to address perceived deficiencies in the knowledge of wrist anatomy, imaging and arthroscopy that limited the surgical treatment of wrist disorders. The thesis encompasses studies of normal anatomy, imaging of the abnormal wrist and the development of wrist arthroscopy. At the commencement of this work problem areas identified, which were addressed, included (i) the morphology and kinematics of the normal wrist, (ii) imaging of scaphoid deformity and the clinical application of fluoroscopy in the management of the wrist disorders, and (iii) surgery of the wrist, which was usually performed as an open procedure, and the clinical application of wrist arthroscopy, which was in its first decade of development. To address these deficiencies, a radiological study was undertaken to determine how the morphology of the lunate affected the kinematics of the scaphoid. Lunate morphology was demonstrated to be associated with scaphoid kinematics. The result of this finding is that it is now possible to predict scaphoid kinematics because lunate type can be determined from plain radiographs. An anatomical study of the triquetro-hamate joint was undertaken to determine the morphology of this joint and whether it is related to the lunate morphology. Two types of triquetro-hamate joint were identified but these were not associated with the morphology of the lunate. One type had a helicoidal configuration and the other was relatively flat. These morphological differences are likely to have implications for wrist kinematics. To image deformity of the scaphoid, a standardised method of longitudinal computed tomography was developed. An inter-observer reliability study was undertaken to compare the previously reported intra-scaphoid angle to newly developed methods of assessing the humpback deformity. The height-to-length ratio and dorsal cortical angle were found to be more reliable than the intra-scaphoid angle. The concepts of partial volume averaging for the assessment of scaphoid fracture union and pre-operative templating of correction of scaphoid deformity were described. The role of arthroscopy was investigated in a number of clinical conditions. Patients withKienböck’s disease were assessed to determine whether characteristic patterns of articular changes could be identified at arthroscopy. Based on the findings, a classification of these arthroscopic findings was developed and used to direct future treatment. A study of arthroscopically assisted reduction of distal radius fractures was undertaken, which included development of new arthroscopically assisted and mini-open reduction and fixation techniques. Post-operative articular deformity was found to be associated with an increased incidence of pain. Arthroscopic debridement for scaphotrapezotrapezoidal joint arthritis was demonstrated to be a safe and effective treatment, with a lower complication and re-operation rate than with previously reported open procedures. New arthroscopic methods of capsular release of the wrist, arthroscopically assisted drilling of intra-osseous ganglion of the lunate and arthroscopic debridement of the ulnar styloid were developed. Fluoroscopy was valuable in pre-operative assessment as well as the intra-operative management using these new techniques. In summary, the work described in this thesis increases the knowledge of the normal and abnormal wrist morphology and advances the role of arthroscopy in the treatment of wrist conditions. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1321390 / Thesis (Ph.D.) - University of Adelaide, School of Medicine, 2008

This study compared lameness and post-operative recovery in animals undergoing arthroscopy or arthrotomy of the cubital joint. It was a prospective, randomized, experimental study in which fourteen mature, healthy dogs were evaluated. Dogs were randomly assigned to treatment groups with seven undergoing arthrotomy and seven undergoing arthroscopy of the left cubital joint. Dogs were evaluated using kinetic gait assessment, subjective evaluation scores, and cubital joint range of motion (ROM). Evaluations were performed prior to surgery and on days 2, 4, 7, 15, 22, and 29 after surgery. Preoperative radiographs of both cubital joints and postoperative radiographs of the operated limb were evaluated. Significant differences in peak vertical force and vertical impulse force were not observed between surgery groups (p=0.88 and 0.49, respectively). Joint ROM was not significantly different between groups (p = 0.09 for flexion and 0.91 for extension). For all dogs, joint ROM and radiographic evaluations remained within normal range throughout the study period. Additionally, significant differences in subjective lameness scores, weight bearing and pain were not observed between groups (p³ 0.19 for all variables). Therefore, post-operative morbidity may not be an important factor when making a decision to perform either arthroscopy or arthrotomy for exploration of the medial aspect of the canine cubital joint. / Master of Science

Chronic painful tendinopathy is a common cause for elite- and recreational athletes to stop or decrease the level of their sports activity. Recent research on innervation patterns, histopathology and possible pain mechanisms in tendons has led to an increased knowledge about the chronic painful tendon. Ultrasound (US) and colourDoppler (CD) examination showing localized high blood flow, inside and outside regions with structural tendon abnormalities, has been shown to be of importance for tendon pain. Immuno-histochemical analyses of biopsies have shown sensory and sympathetic nerves in close relation to the high blood flow outside the tendon. These findings have led to new ideas about development of new treatment methods for chronic painful tendinopathy. In study I, we evaluated the already in use, US-guided sclerosing polidocanol injection treatment of midportion Achilles tendinopathy, using two different concentrations of the substance. This study aimed to find out if there was a faster return to pain-free activity by using the concentration 10 mg/ml compared to the formerly used 5 mg/ml. There were no significant differences in the clinical results between the groups. In study II - Technical note, we aimed to develop a new one-stage surgical treatment method for patellar tendinopathy. This method was based on research concerning the innervation patterns and US and CD findings in patellar tendinopathy/ “jumper’s knee”. Technically we added ultrasound guidance to knee arthroscopy to identify and visualize the region of interest during a surgical shaving procedure. In study III, we tested the newly invented US and CD-guided arthroscopic shaving technique in a pilot study. The short-term clinical results were promising and the majority of the patients returned to pain-free activity after a short rehabilitation period. In study IV, we compared the US and CD-guided artrhroscopic shaving method with the already in use sclerosing polidocanol injection treatment in a randomized study. At short-term follow-up, the patients treated with US and CD-guided arthroscopic shaving had significantly less pain during rest and activity, were significantly more satisfied with the treatment, and had a faster return to sports, compared to the patients in the sclerosing injection group. There were no complications. In study V, at longer-term followup (endpoint 46 months) there was a significant decrease in pain during activity in both groups. There were no remaining significant differences in the pain levels during activity between the groups. The tendon structure had improved significantly in both groups. There was a significant decrease in the antero-posterior thickness of the proximal patellar tendon in patients treated with US and CD-guided arthroscopic shaving, but not in the sclerosing injection group. The CD flow had diminished significantly in both groups, and there was a correlation between low CD flow and high patient satisfaction in both groups, The CD flow decreased faster in the surgical group than in the injection group. In conclusion, this newly invented US and CD-guided arthroscopic shaving treatment, focusing on treatment outside the tendon, has shown good clinical results with pain relief and a fast return to sports activity, in patients with patellar tendinopathy.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.