The Experts below are selected from a list of 2577 Experts worldwide ranked by ideXlab platform
Ronny Lorentzon - One of the best experts on this subject based on the ideXlab platform.
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superior results with Continuous Passive Motion compared to active Motion after periosteal transplantation a retrospective study of human patella cartilage defect treatment
Knee Surgery Sports Traumatology Arthroscopy, 1999Co-Authors: Hakan Alfredson, Ronny LorentzonAbstract:Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16–53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with Continuous Passive Motion (CPM), and the next 19 consecutive patients (group B) were treated with active Motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active Motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33–92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14–28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active Motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.
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treatment of deep cartilage defects of the patella with periosteal transplantation
Knee Surgery Sports Traumatology Arthroscopy, 1998Co-Authors: Ronny Lorentzon, Hakan Alfredson, Christer HildingssonAbstract:Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19–52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11–144 months). During the first 5 postoperative days all patients were treated with Continuous Passive Motion (CPM). This was followed by active Motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24–76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.
Dario Tedesco - One of the best experts on this subject based on the ideXlab platform.
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drug free interventions to reduce pain or opioid consumption after total knee arthroplasty a systematic review and meta analysis
JAMA Surgery, 2017Co-Authors: Dario Tedesco, Davide Gori, Karishma Desai, Steven M Asch, Ian Carroll, Catherine Curtin, Kathryn M Mcdonald, Maria Pia Fantini, Tina HernandezboussardAbstract:Importance There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. Data Sources Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials.gov for the period between January 1946 and April 2016. Study Selection Randomized clinical trials comparing nonpharmacological interventions with other interventions in combination with standard care were included. Data Extraction and Synthesis Two reviewers independently extracted the data from selected articles using a standardized form and assessed the risk of bias. A random-effects model was used for the analyses. Main Outcomes and Measures Postoperative pain and consumption of opioids and analgesics. Results Of 5509 studies, 39 randomized clinical trials were included in the meta-analysis (2391 patients). The most commonly performed interventions included Continuous Passive Motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids (mean difference, −3.50; 95% CI, −5.90 to −1.10 morphine equivalents in milligrams per kilogram per 48 hours; P = .004; I2 = 17%) and that acupuncture delayed opioid use (mean difference, 46.17; 95% CI, 20.84 to 71.50 minutes to the first patient-controlled analgesia; P I2 = 19%). There was low-certainty evidence that acupuncture improved pain (mean difference, −1.14; 95% CI, −1.90 to −0.38 on a visual analog scale at 2 days; P = .003; I2 = 0%). Very low-certainty evidence showed that cryotherapy was associated with a reduction in opioid consumption (mean difference, −0.13; 95% CI, −0.26 to −0.01 morphine equivalents in milligrams per kilogram per 48 hours; P = .03; I2 = 86%) and in pain improvement (mean difference, −0.51; 95% CI, −1.00 to −0.02 on the visual analog scale; P I2 = 62%). Low-certainty or very low-certainty evidence showed that Continuous Passive Motion and preoperative exercise had no pain improvement and reduction in opioid consumption: for Continuous Passive Motion, the mean differences were −0.05 (95% CI, −0.35 to 0.25) on the visual analog scale ( P = .74; I2 = 52%) and 6.58 (95% CI, −6.33 to 19.49) opioid consumption at 1 and 2 weeks ( P = .32, I2 = 87%), and for preoperative exercise, the mean difference was −0.14 (95% CI, −1.11 to 0.84) on the Western Ontario and McMaster Universities Arthritis Index Scale ( P = .78, I2 = 65%). Conclusions and Relevance In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
Peter J Mcnair - One of the best experts on this subject based on the ideXlab platform.
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the effect of prolonged static and cyclic stretching on ankle joint stiffness torque relaxation and gait in people with stroke
Physical Therapy, 2002Co-Authors: Eadric Bressel, Peter J McnairAbstract:Background and Purpose. Continuous Passive Motion (cyclic stretching applied to the subject's limb) has been used for the rehabilitation of some orthopedic impairments; however, few researchers have considered its application in the management of neurological disorders such as stroke. The purpose of this study was to examine the short-term effects of prolonged static and cyclic calf stretching on Passive ankle joint stiffness, torque relaxation, and gait in people with ischemic stroke. Subjects. Ten community-dwelling people (mean age=64.6 years, SD=8.76, range=53–76) who were diagnosed with a cerebrovascular accident volunteered to be subjects. Methods. Participants engaged in one 30-minute static stretch and one 30-minute cyclic stretch of the calf muscle, using an isokinetic dynamometer that also collected torque and angle measurements. Before and after treatments, 10-m walking times were collected. Ankle joint stiffness was calculated from the slope of the torque and angle curves before and immediately after treatments, and torque relaxation was calculated as the percentage of decrease in peak Passive torque over the 30-minute stretch durations. Results. Ankle joint stiffness decreased by 35% and 30% after the static and cyclic stretches, respectively. Stiffness values and 10-m walk times were not different between conditions. The amount of torque relaxation was 53% greater for static stretching than for cyclic stretching. Discussion and Conclusion. These preliminary data from a very small sample of people with stroke indicate that ankle joint stiffness decreases after both prolonged static and cyclic stretches; however, neither technique appears to be better at reducing stiffness in people with stroke. Torque relaxation is greater after static stretching than after cyclic stretching, and walking speed does not appear to be influenced by the stretching treatments used in our study.
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stretching at the ankle joint viscoelastic responses to holds and Continuous Passive Motion
Medicine and Science in Sports and Exercise, 2001Co-Authors: Peter J Mcnair, Erik Dombroski, David J Hewson, Stephen N StanleyAbstract:MCNAIR P. J., E. W. DOMBROSKI, D. J. HEWSON, and S. N. STANLEY. Stretching at the ankle joint: viscoelastic responses to holds and Continuous Passive Motion. Med. Sci. Sports Exerc., Vol. 33, No. 3, 2000, pp. 354–358. Purpose:To compare the effect of static holds and Continuous Passive Motion on sti
Tina Hernandezboussard - One of the best experts on this subject based on the ideXlab platform.
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drug free interventions to reduce pain or opioid consumption after total knee arthroplasty a systematic review and meta analysis
JAMA Surgery, 2017Co-Authors: Dario Tedesco, Davide Gori, Karishma Desai, Steven M Asch, Ian Carroll, Catherine Curtin, Kathryn M Mcdonald, Maria Pia Fantini, Tina HernandezboussardAbstract:Importance There is increased interest in nonpharmacological treatments to reduce pain after total knee arthroplasty. Yet, little consensus supports the effectiveness of these interventions. Objective To systematically review and meta-analyze evidence of nonpharmacological interventions for postoperative pain management after total knee arthroplasty. Data Sources Database searches of MEDLINE (PubMed), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Web of Science (ISI database), Physiotherapy Evidence (PEDRO) database, and ClinicalTrials.gov for the period between January 1946 and April 2016. Study Selection Randomized clinical trials comparing nonpharmacological interventions with other interventions in combination with standard care were included. Data Extraction and Synthesis Two reviewers independently extracted the data from selected articles using a standardized form and assessed the risk of bias. A random-effects model was used for the analyses. Main Outcomes and Measures Postoperative pain and consumption of opioids and analgesics. Results Of 5509 studies, 39 randomized clinical trials were included in the meta-analysis (2391 patients). The most commonly performed interventions included Continuous Passive Motion, preoperative exercise, cryotherapy, electrotherapy, and acupuncture. Moderate-certainty evidence showed that electrotherapy reduced the use of opioids (mean difference, −3.50; 95% CI, −5.90 to −1.10 morphine equivalents in milligrams per kilogram per 48 hours; P = .004; I2 = 17%) and that acupuncture delayed opioid use (mean difference, 46.17; 95% CI, 20.84 to 71.50 minutes to the first patient-controlled analgesia; P I2 = 19%). There was low-certainty evidence that acupuncture improved pain (mean difference, −1.14; 95% CI, −1.90 to −0.38 on a visual analog scale at 2 days; P = .003; I2 = 0%). Very low-certainty evidence showed that cryotherapy was associated with a reduction in opioid consumption (mean difference, −0.13; 95% CI, −0.26 to −0.01 morphine equivalents in milligrams per kilogram per 48 hours; P = .03; I2 = 86%) and in pain improvement (mean difference, −0.51; 95% CI, −1.00 to −0.02 on the visual analog scale; P I2 = 62%). Low-certainty or very low-certainty evidence showed that Continuous Passive Motion and preoperative exercise had no pain improvement and reduction in opioid consumption: for Continuous Passive Motion, the mean differences were −0.05 (95% CI, −0.35 to 0.25) on the visual analog scale ( P = .74; I2 = 52%) and 6.58 (95% CI, −6.33 to 19.49) opioid consumption at 1 and 2 weeks ( P = .32, I2 = 87%), and for preoperative exercise, the mean difference was −0.14 (95% CI, −1.11 to 0.84) on the Western Ontario and McMaster Universities Arthritis Index Scale ( P = .78, I2 = 65%). Conclusions and Relevance In this meta-analysis, electrotherapy and acupuncture after total knee arthroplasty were associated with reduced and delayed opioid consumption.
Hakan Alfredson - One of the best experts on this subject based on the ideXlab platform.
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superior results with Continuous Passive Motion compared to active Motion after periosteal transplantation a retrospective study of human patella cartilage defect treatment
Knee Surgery Sports Traumatology Arthroscopy, 1999Co-Authors: Hakan Alfredson, Ronny LorentzonAbstract:Fifty-seven consecutive patients (33 men and 24 women), with a mean age of 32 years (range 16–53 years), who suffered from an isolated full-thickness cartilage defect of the patella and disabling knee pain of long duration, were treated by autologous periosteal transplantation to the cartilage defect. The first 38 consecutive patients (group A) were postoperatively treated with Continuous Passive Motion (CPM), and the next 19 consecutive patients (group B) were treated with active Motion for the first 5 days postoperatively. In both groups, the initial regimens were followed by active Motion, slowly progressive strength training, and slowly progressive weight bearing. In group A, after a mean follow-up of 51 months (range 33–92 months), 29 patients (76%) were graded as excellent or good, 7 patients (19%) were graded as fair, and 2 patients (5%) were graded as poor. In group B, after a mean follow-up of 21 months (range 14–28 months), 10 patients (53%) were graded as excellent or good, 6 patients (32%) were graded as fair, and 3 patients (15%) were graded as poor. Altogether, nine of the fair or poor cases (50%) were diagnosed with chondromalacia of the patella. Our results, after performing autologous periosteal transplantation in patients with full-thickness cartilage defects of the patella and disabling knee pain, are good if CPM is used postoperatively. The clinical results using active Motion postoperatively are not acceptable, especially not in patients with chondromalacia of the patella.
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treatment of deep cartilage defects of the patella with periosteal transplantation
Knee Surgery Sports Traumatology Arthroscopy, 1998Co-Authors: Ronny Lorentzon, Hakan Alfredson, Christer HildingssonAbstract:Twenty-six consecutive patients (19 men and 7 women) with a mean age of 31.5 years (range 19–52 years) who suffered from an isolated full-thickness cartilage defect of the patella (area ranged from 0.75 to 20.0 cm2) and disabling knee pain were treated with autologous periosteal transplantation (without any chondrocytes). The duration of symptoms was 59 months (range 11–144 months). During the first 5 postoperative days all patients were treated with Continuous Passive Motion (CPM). This was followed by active Motion, slowly progressive strength training, and slowly progressive weight-bearing. After a mean follow-up of 42 months (range 24–76 months), 17 patients (65%) were graded as excellent (were painfree), 8 patients (31%) as good (had pain with strenous knee-loading activities), and 1 patient as poor (had pain at rest). Twenty-two patients (85%) had returned to their previous occupation. Twelve patients (46%) had resumed sports or recreational activities at their former level. Repeated magnetic resonance imaging (MRI) investigations showed progressive, and finally complete, filling of the articular defects. Biopsies taken in five randomly selected cases showed hyaline-like cartilage. Patients with full-thickness cartilage defects of the patella and disabling knee pain can be treated with autologous periosteal transplantation (without any chondrocytes), followed by CPM, and slowly progressive strength training and weight-bearing. We believe this is a good method to accomplish regeneration of articular cartilage and satisfactory clinical results.