The Experts below are selected from a list of 525 Experts worldwide ranked by ideXlab platform
David R. Diduch - One of the best experts on this subject based on the ideXlab platform.
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All-Inside Meniscal Repair Using a New Flexible, Tensionable Device
The American journal of sports medicine, 2006Co-Authors: J. Scott Quinby, S. Raymond Golish, Jennifer A. Hart, David R. DiduchAbstract:BackgroundA new generation of flexible all-inside meniscal repair devices is available, but clinical studies with these devices are lacking.HypothesisThe RapidLoc has an intermediate-term meniscal healing rate that is equivalent to literature reports of inside-out suture technique in patients undergoing concurrent anterior cruciate ligament reconstruction.Study DesignCase series; Level of evidence, 4.MethodsRetrospective analysis was performed for 75 meniscal tears in 66 consecutive patients undergoing anterior cruciate ligament reconstruction who underwent meniscal repair with the RapidLoc. Patients with at least 2 years’ follow-up were evaluated for symptoms suggestive of a meniscal tear and were assessed with the International Knee Documentation Committee form and the Knee Disorders Subjective History visual analog scale. Subjects were asked to return for a clinical examination to include evaluation for an effusion and joint line tenderness as well as McMurray test and KT-1000 Arthrometry readings. Pat...
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deteriorating outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction increased failure rate with long term follow up
American Journal of Sports Medicine, 2005Co-Authors: Gregory P Lee, David R. DiduchAbstract:BackgroundAn increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness.HypothesisThe Meniscus Arrow is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears.Study DesignCase series; Level of evidence, 4.MethodsThis study is an extended follow-up of an original series of 32 patients withoutcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, Arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The me...
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outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction
Arthroscopy, 2002Co-Authors: Sanjitpal S Gill, David R. DiduchAbstract:Abstract Purpose: To determine the healing rate of meniscal repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS). Type of Study: Case series with outcomes analysis. Methods: We retrospectively analyzed 38 consecutive patients with 39 meniscal tears in knees undergoing concurrent endoscopic ACL reconstruction whose menisci were repaired with the Meniscus Arrow system. All meniscal tears were deemed amenable to repair according to length, stability, morphology, and zone of tear. There were 31 medial and 8 lateral meniscal tears, with an average tear length of 2.1 cm. An average of 2.5 arrows were used to repair each tear. All 39 tears were located in the posterior horn of the meniscus or extending into the body of the meniscus from the posterior horn. Follow-up was assessed by clinical examination, the knee disorders subjective history, VAS, and the IKDC evaluation form. Reconstructed ACL laxity was assessed by KT-2000 Arthrometry and clinical evaluation. Results: At an average follow-up of 2.3 years (range, 18-39 months), 32 patients have been surveyed to date. The success rate was 90.6% (29 of 32 patients) with 3 patients going on to arthroscopic partial meniscectomy. KT-2000 Arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. Clinical criteria for success in the rest of the repaired menisci included (1) the absence of locking, catching, or giving way; (2) no history of recurrent effusions; (3) no joint line tenderness; (4) a negative McMurray test; and (5) no subsequent surgical procedures on the repaired meniscus. Additionally, the VAS showed the ability of these patients to return to a high level of activity, including competitive sports, without symptoms suggestive of a meniscal tear. The IKDC showed normal or nearly normal function of all success knees. Conclusions: The study shows that a high rate of meniscus healing can be achieved by the all-inside, bioabsorbable Meniscus Arrow system in conjunction with ACL reconstruction. Also, patients have excellent function of their knee and are able to return to a high level of activity. Our healing rates are comparable to those previously reported with the inside-out suture techniques without the need for an additional posterior incision that would increase operative time and risk to neurovascular structures. Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp 569–577
Rab Mollan - One of the best experts on this subject based on the ideXlab platform.
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The Continuing Development of Vibration Arthrometry as a Screening Method in Developmental Dysplasia of the Hip
HIP International, 1994Co-Authors: W. G. Kernohan, P. E. Haugh, B. Trainor, A. Johnston, I. Turner, Rab MollanAbstract:As part of the continuing development of a non-invasive, objective screening method to achieve efficient early detection of developmental dysplasia of the hip (DDH), we determined the diagnostic se...
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SENSITIVITY OF MANUAL PALPATION IN TESTING THE NEONATAL HIP
Clinical orthopaedics and related research, 1993Co-Authors: W. G. Kernohan, G. E. M. Nugent, P. E. Haugh, Bernadette P. Trainor, Rab MollanAbstract:Developmental dysplasia of the hip (DDH) is a term used to describe a group of disorders of the neonatal hip in which the head of the femur is unstable or incongruous in relation to the acetabulum. Early detection and treatment of the condition generally results in normal development, whereas late diagnosis has poor success. In Northern Ireland, despite all neonates being manually examined for hip disorders by a medical officer before hospital discharge, there is an unacceptable late diagnostic rate of almost 50% of all cases. To help reduce the number of late presentations, vibration Arthrometry, a noninvasive form of screening for DDH, has been used to record hip vibration events during clinical testing. In a comparative study, 300 infants were examined by nurses and medical officers to establish the sensitivity of manual palpation to neonatal hip vibrations detected by the objective detection system. Experienced research nurses detected 86% of the signals; doctors in training detected less than 10%. This suggests that objective, noninvasive screening by vibration Arthrometry would detect a higher proportion of vibration events in neonates during the early stages of DDH. More time should be invested in training medical officers and others involved in DDH screening.
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Low-frequency vibration emitted from unstable hip in human neonate.
Clinical orthopaedics and related research, 1993Co-Authors: W. George Kernohan, Bernadette P. Trainor, Gwen Nugent, Pauline Walker, Mark Timoney, Rab MollanAbstract:Developmental dysplasia of the hip (DDH) continues to be an orthopedic enigma. Some authors still believe it is a purely birth phenomenon. Even with widespread birth screening, however, DDH continues to become evident later than three months of age, long after a satisfactory outcome can be guaranteed. In an effort to reduce the number of late manifestations, the authors have developed a noninvasive form of screening for DDH called vibration Arthrometry. Five hundred neonates were examined in local maternity hospitals, according to the guidelines of Ortolani and Barlow. The new method involves the attachment of miniature accelerometers around the infant's pelvis. Using this method, it was possible to elicit vibration events from approximately one fourth (255 hips) of the hips tested; vibrations were recorded from normal hips (125), from `'clicky'' hips (128), and from unstable hips (two). Differences between `'nil-felt'' (clinically silent) and `'click-felt'' (palpable clicking on testing) were significant. Vibration testing can be seen as an aid in the manual palpation necessary to detect this crippling condition.
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Vibration Arthrometry in congenital dislocation of the hip.
Clinical orthopaedics and related research, 1991Co-Authors: W. G. Kernohan, G. H. Cowie, Rab MollanAbstract:Three hundred six neonates referred to a research clinic for vibration Arthrometry were studied to determine whether the application of objective methods could enhance the accuracy of hip examinations. A total of 629 vibration episodes (hip ``clicks'' and ``clunks'') were detected using miniature accelerometers and recorded during testing for congenital dislocation of the hip. Five categories of congenital dislocations of the hip (CDH) were defined: normal (53 cases), safe click (201 cases), click associated with later CDH (16 cases), unstable (14 cases), and late CDH (22 cases). Follow-up examinations were performed over a four-year period. Detailed measurement of vibration signals was possible and resulted in the resolution of eight variables for each episode. Two variables, pulse area and peak frequency, were selected for their power to discriminate between the five clinical groups. The pulse area values were higher for the late and unstable groups. In addition, the vibrations were examined using Fourier analysis, and the safe click group demonstrated higher frequency components than any other group. Vibration Arthrometry is proposed as a possible adjunct in screening for CDH, as it may pick up cases that would be missed by an average examiner and it could monitor clicks, thus avoiding nonessential splintage.
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Vibration Arthrometry in assessment of knee disorders: the problem of angular velocity.
Journal of biomedical engineering, 1991Co-Authors: W. G. Kernohan, G. F. Mccoy, Da Barr, Rab MollanAbstract:A knee joint that has sustained a painful injury will typically require skillful examination, by an orthopaedic surgeon, for signs of internal damage. These signs include characteristic sounds and vibrations, which are produced by the knee when it is stressed. The technique of vibration Arthrometry is being developed to assist the clinical examiner in identifying these vibrations and to improve diagnostic accuracy. To detect and record the knee vibrations, small lightweight accelerometers are positioned on various bony prominences around the knee. These produce electronic signals which permit objective analysis of the vibration characteristics. It has been found that varying the investigative procedure can affect the magnitude of some parameters of the vibration signal. If these parameters are to be used in evidence of knee pathology, the effect of the investigative procedure must be normalized. The effect of speed of joint movement has been quantified in a pilot study involving 24 patients with internal knee damage. Custom-designed hardware was used to measure joint speed as the rate of change of joint angle, which was measured by an electrogoniometer. It was found that the energy content of the vibration, reflected by the peak amplitude and root mean square value was strongly affected by joint speed. However, the characteristic shape of the vibration, reflected by the peak frequency in the harmonic spectrum of the signal, remained similar for the range of joint speed in the investigation.
Ching-chuan Jiang - One of the best experts on this subject based on the ideXlab platform.
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Development of the equine vibration Arthrometry system (EVAS) for the study of equine lameness
Computers and Electronics in Agriculture, 2013Co-Authors: Shao-wen Lai, Ching-chuan Jiang, Ju-hong Lee, Yuan-yu Chan, Chen-kang HuangAbstract:Friction caused at different articular surfaces in horses' joints can produce various vibration signals. In this study, we collected and analyzed the articular vibration signals in the fetlock joints of a healthy horse, an aged horse, and a horse with laminitis using the equine vibration Arthrometry system (EVAS). The data obtained from the EVAS enabled the researchers to easily understand the condition of the horses' inner joints and to differentiate between the joints of healthy limbs and those of diseased limbs with musculoskeletal disorders. Furthermore, we also developed mathematical algorithms to analyze the data from the EVAS in this study. We identified two periodic waveform cycles for each horse's step in the time domain. The negative waveform cycle first appeared at each aged horse's step. The root-mean-square (RMS) values of both the positive and negative waveform cycles were significantly larger at the first periodic waveform in the aged horse. In contrast, the positive waveform cycle first appeared in each healthy horse's step and the RMS values of the positive waveform cycle were significantly larger in the healthy horse. We also measured the energy of the articular vibration signals of the healthy and aged horses in the first and second periodic waveform cycle during each horse's step. By analyzing and comparing articular vibration signals in these horses, we were able to determine which of the horses had a musculoskeletal disorder. EVAS is a simple, convenient and non-invasive method of identifying articular problems in equine joints.
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Vibration Arthrometry in the patients with failed total knee replacement
IEEE Transactions on Biomedical Engineering, 2000Co-Authors: Ching-chuan Jiang, Tung-tai YuanAbstract:This is a preliminary research on the vibration Arthrometry of artificial knee joint in vitro. Analyzing the vibration signals measured from the accelerometer on patella, there are 2 speed protocols in knee kinematics: 1) 20/s, the signal is called "physiological patellofemoral crepitus (PPC", and 2) 67/spl deg//s, the signal is called "vibration signal in rapid knee motion" The study has collected 14 patients who had revision total knee arthroplasty due to prosthetic wear or malalignment represent the failed total knee replacement (FTKR), and 12 patients who had just undergone the primary total knee arthroplasty in the past 2 to 6 months and have currently no knee pain represent the normal total knee replacement (NTKR). FTKR is clinically divided into 3 categories: metal wear, polyethylene wear of the patellar component, and no wear but with prosthesis malalignment. In PPC, the value of root mean square (rms) is used as a parameter; in vibration signals in rapid knee motion, autoregressive modeling is used for adaptive segmentation and extracting the dominant pole of each signal segment to calculate the spectral power ratios in f500 Hz. It was found that in the case of metal wear, the rms value of PPC signal is far greater than a knee joint with polyethylene wear and without wear, i.e., PPC signal appears only in metal wear. As for vibration signals in rapid knee motion, prominent time-domain vibration signals could be found in the FTKR patients with either polyethylene or metal wear of the patellar component. The authors also found that for normal knee joint, the spectral power ratio of dominant poles has nearly 80% distribution in f500 Hz, spectral power ratio of dominant poles has over 30% distribution in metal wear but only nonsignificant distribution in polyethylene wear, no wear, and normal knee. The results show that vibration signals in rapid knee motion can be used for effectively detecting polyethylene wear of the patellar component in the early stage, while PPC signals can only be used to detect prosthetic metal wear in the late stage.
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Vibration Arthrometry in patients with knee joint disorders
IEEE Transactions on Biomedical Engineering, 2000Co-Authors: Ching-chuan Jiang, Tung-tai YuanAbstract:Physiological patellofemoral crepitus (PPC) is the vibration signal produced by the knee joint during slow motion (less than 50 per second), which can be measured by vibration Arthrometry (VAM). By using the autoregressive (AR) model for the PPC signals of patients with knee osteoarthritis, the study analyzes the PPC signals to evaluate the condition of patellar-femoral joint cartilage. Accordingly, one can divide osteoarthritis into three types, type 1: the cartilage of patellar-femoral joint is intact, the osteoarthritis found in the femoral-tibial joint surface; type 2: degeneration occurs in the surface cartilage of both the femoral-tibial joint and the femoral trochlea, but not on the patellar surface; type 3: both patellar-femoral and femoral-tibial joints have osteoarthritis. For the analysis, the intraclass distance of AR coefficients and spectral power ratio of dominant poles are adopted. Based on the proposed method, two cases of type 1, six of type 2, and 28 of type 3 were found in 36 eases of knee osteoarthritis. This is in agreement with the operative findings. For comparison, the PPC signals of 10 subjects with normal knees (without pain or wound history) were also measured. The results of analysis of the 10 normal subjects were consistent and clearly differentiable from those of the osteoarthritis patients. Therefore, the proposed method is efficient for the analysis of the condition of patellar-femoral joint cartilage and VAM may become an alternative way of noninvasive diagnosis of knee osteoarthritis.
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Vibration Arthrometry of the knee with torn meniscus: a preliminary report.
Journal of the Formosan Medical Association = Taiwan yi zhi, 1994Co-Authors: Ching-chuan JiangAbstract:Although projects using vibration signals generated by the joint to detect joint disorders are still experimental, vibration Arthrometry has been shown to be useful in assessing meniscal pathology. A prospective study using vibration Arthrometry to diagnose meniscal tears was carried out in 25 consecutive patients with knee injuries. They comprised 20 males and five females with an average age of 34 years. An arthroscopic examination of the injured knee was given to every patient. Six cases of medial meniscal tear, 12 lateral meniscal tear, and two torn discoid menisci were found. The remaining five cases had normal menisci. By correlating the vibration arthrography of the patients to their corresponding arthroscopic findings, 15 were found to be true-positive, five true-negative and five false-negative. There were no false-positive readings. The accuracy, sensitivity and specificity of the vibration Arthrometry in diagnosing meniscal tear was 80%, 75% and 100%, respectively. Vibration Arthrometry was shown to be a reliable, non-invasive diagnostic tool in diagnosing meniscal tear of the knee.
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Physiological patellofemoral crepitus in knee joint disorders.
Bulletin (Hospital for Joint Diseases (New York N.Y.)), 1Co-Authors: Ching-chuan Jiang, Wu EAbstract:Vibration waves produced by the knee joint during extension-flexion may be recorded by vibration Arthrometry. When the speed of this motion is less than 5 degrees per second, the vibration produced by the patella is referred to as physiological patellofemoral crepitus (PPC), which reflects the integrity of articular cartilage. PPC signals were recorded before a scheduled arthroscopic examination or operations in 17 patients whose patellofemoral joint cartilage was found subsequently to be normal, and in 25 patients (36 knee joints) who underwent arthroscopic debridement, osteotomy, or total knee replacement due to degenerative osteoarthritis. The PPC signals of five normal adults (10 knees) without any knee problems were also recorded as a control group. The root mean square (RMS) values of the PPC signals of the control group, the group with knee injuries, and the osteoarthritic patients were 0.69, 0.17, and 0.04 m/sec2, respectively. Differences among these groups were statistically significant (P
Frank C. Mccue - One of the best experts on this subject based on the ideXlab platform.
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Instrumented Arthrometry for Diagnosing Partial Versus Complete Anterior Cruciate Ligament Tears
The American journal of sports medicine, 1994Co-Authors: Arie M. Rijke, David H. Perrin, Henry T. Goitz, Frank C. MccueAbstract:Abstract: Nineteen patients with the clinical diagnosis of anterior cruciate ligament injury were examined by KT-1000 Arthrometry before arthroscopy in an effort to differentiate partial from complete tears. To this end, the KT-1000 arthrometer was equipped with a strain gauge and processor that permitted the required force to increase the anterior displacement by 1-mm increments, to be read on a light-emitting diode. The measured force has been plotted against anterior displacement expressed in nonlinear increments along the x-axis to allow for the viscoelastic nature of the ligament. The results show that stress-strain diagrams of partially torn and completely torn ligaments are similar to those obtained by graded stress radiography. Using arthroscopy as the standard of measurement, partial tears can be differentiated from complete tears with a sensitivity of 80% and a specificity of 100%. The figures for complete tears versus partial tears are 100% and 80%, respectively. Graded Arthrometry with x-y recording of the force-displacement relationship that allows for the viscoelastic qualities of ligament further extends the capabilities of instrumented Arthrometry.
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Tibial rotation affects anterior displacement of the knee
Journal of Sport Rehabilitation, 1994Co-Authors: David E. Martin, David H. Perrin, Kevin M. Guskiewicz, David M. Kahler, Frank C. MccueAbstract:The purpose of this study was to assess anterior translation of the tibia using the Tibial Fixator Device (a mechanical leg stabilizer that controls tibial alignment) with the leg in three positions: neutral (N), internal rotation of 15° (IR), and external rotation of 15° (ER). Displacement was measured using a modified KT-1000 arthrometer. Eleven subjects with anterior cruciate ligament lesions were examined bilaterally in the three positions at 45, 67, and 89 newtons of anterior force. Three-factor repeated-measures ANOVA revealed a significant position effect regardless of force (p < .001). This effect was significant in the injured and noninjured legs. Displacement was greatest in ER and least in IR. These data indicate that the position of the tibia, maintained with an external leg restraint, has a significant effect on anterior displacement of the knee. Control of tibiofemoral alignment and modifications to the KT-1000 provide new potentials for instrumented Arthrometry.
Jane Johnson - One of the best experts on this subject based on the ideXlab platform.
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Posterior cruciate recession in total knee arthroplasty
The Journal of arthroplasty, 1997Co-Authors: Richard L. Worland, Douglas E. Jessup, Jane JohnsonAbstract:Incremental recession of the posterior cruciate ligament (PCL), as a part of ligamentous balancing in total knee arthroplasty, is critical if the PCL is too tight. This study was undertaken to evaluate any possible untoward effects of PCL recession. Twenty-one patients who underwent simultaneous bilateral total knee arthroplasty between 1988 and 1992 with a PCL recession performed only on one side (necessary to balance the knee) served as the study group. The average follow-up period was 4 years. The patients were evaluated subjectively, by manual physical testing, by radiography, and by KT-1000 Arthrometry (Medmetric, San Diego, CA). There were no significant differences between the recessed and nonrecessed knees. The conclusion is that PCL recession is appropriate and safe long-term for the patient in whom the PCL is found to be too tight at the time of knee arthroplasty.
