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ABSTRACT: Degenerative and reactive structural alterations occurring after experimentally-induced disc degeneration were evaluated using a porcine model. A cranial perforation was made through the L4 vertebral endplate into the nucleus pulposus. Three months later, the lumbar intervertebral disc and adjacent vertebrae were dissected, fixed in formalin and further processed for histopathological analyses. The results showed that there were nucleus pulposus fragments, rather than a distinct border between the nucleus and annulus fibrosus. The central lamellae were distorted and delamination of the outer anterior layers was observed. Blood vessels emerged from the adjacent tissue, penetrated the annulus and branched into the residues of the nucleus. Nerve fibres accompanying the blood vessels could be recognized in the disc within the connective scar tissue. The epiphyseal cartilage plates in the vertebrae were hypertrophic in several areas and there was bone formation directed towards the centre of the vertebral body and the disc. Hypertrophic hyaline cartilage, newly formed bone and scar tissue filled the injury canal. A slight chronic inflammatory reaction was evident along vascular buds. The reactive changes dominated over the degenerated features in the operated disc. Physiological loading enhanced the infiltration of various tissue types characterizing immature cartilage formation. Prominent neovascularisation of the central parts of the disc is likely to be of key importance in turning the degenerative features of the remaining tissue into reactive healthy structures.
Veterinary and Comparative Orthopaedics and Traumatology 02/2007; 20(1):12-7. · 0.81 Impact Factor
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ABSTRACT: From 1996 to 1999, back pain and radiological changes in the thoraco-lumbar spine were investigated in 134 former top athletes, representing wrestling, gymnastics, soccer and tennis (age 27-39 years) and a group of 28 non-athletes of comparable age. This is a long-term follow-up investigation of a previous radiological study of the spine with clinical correlation. Despite significantly more radiological abnormalities among the athletes, they did not report higher frequency of back pain than the non-athletes. A decrease in disc height or new disc height reduction in one or more of the intervertebral discs between the two examinations correlated significantly with back pain at follow-up.
Scandinavian Journal of Medicine and Science in Sports 05/2001; 11(2):103-9. · 2.87 Impact Factor
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ABSTRACT: Recent studies of the spine in adolescents who have sustained trauma have shown injuries to the growth zone, whereas injuries to the vertebral body have been described in other studies of only adults. There are also reports on different clinical signs and radiological findings in adolescents with lumbar disc herniation when compared to adults. In order to find an explanation for these differences between adolescents and adults, this experimental study was performed. Six cadaveric lumbar motion segments (vertebral body-disc-vertebral body) obtained from three young male pigs and six lumbar motion segments obtained from three mature male pigs were tested in axial compression to failure. All units were examined with plain radiography and magnetic resonance imaging before and after compression. After the compression, histological samples were taken from the injury site. In the adolescents, a fracture was consistently found in the endplate through the posterior part of the growth zone, displacing the anulus fibrosus with a bony fragment at the point of insertion to the vertebra. This type of injury could not be detected in any of the adults; instead, there was a fracture of the vertebra in four cases, and in two cases, a rupture of the anulus fibrosus without a bony fragment was seen. This study showed that, when compressed to failure, the weakest part of the lumbar spine of the adolescent pig differs from that of the mature pig in the same way that studies on human spinal units have shown.
European Spine Journal 01/2001; 9(6):466-71. · 1.97 Impact Factor
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ABSTRACT: The aim of this prospective study was to compare two arthroscopic techniques for reconstructing the anterior cruciate ligament, the "outside-in" (two incisions) and the "all-inside" (one incision) techniques. The results obtained for 30 patients operated on using the "outside-in" technique (group I) were compared with those for 29 patients operated on using the "all-inside" technique (group II). Before surgery, there were no significant differences between the groups in terms of Lysholm score, Tegner activity level, patellofemoral pain score, or knee laxity. Both groups displayed significant improvements in Lysholm score after 24 months, from 69 (16) to 91 (9) in group I and from 70 (17) to 90 (15) in group II (means (SD)). There were also significant improvements in patellofemoral pain scores in both groups, from 13 (6) to 18 (5) in group I and from 14 (6) to 18 (4) in group II after 24 months. No difference was found between the groups in knee stability at the 24 month follow up. The IKDC score was identical in both groups at follow up. The operation took significantly longer for patients in group I (mean 94 (15)) than for those in group II (mean 86 (20)) (p = 0.03). The mean sick leave was 7.7 (6.2) weeks in group I and 12.3 (9.7) weeks in group II (p = 0.026), indicating that there may be a higher morbidity associated with the "all-inside" technique. It can be concluded that there were no significant differences between the two different techniques in terms of functional results, knee laxity, or postoperative complications. The results were satisfactory and the outcome was similar in both treatment groups.
British Journal of Sports Medicine 03/1999; 33(1):42-5. · 4.14 Impact Factor
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ABSTRACT: Seventy-eight patients (82 shoulders) with symptomatic, recurrent anterior post-traumatic shoulder instability and Bankart lesions were operated on with bioabsorbable tacks (Suretac fixators). All the patients were followed by an independent observer, with a median follow-up period of 27 (21-63) months. The recurrence rate was 8/82 (10%). The median Rowe score was 93 (37-100) points. The median Constant score for the index shoulders was 90 (34-100) points, compared with 93 (80-100) points for 59 non-operated healthy shoulders from the same cohort (P=0.03). The external rotation in abduction was 93 (50-135) degrees compared with 105 (75-145) degrees for the control shoulders (P=0.0018). Arthroscopic shoulder stabilization using bioabsorbable Suretac fixators appears to produce reliable results if used in patients with post-traumatic shoulder instability and a Bankart lesion.
Scandinavian Journal of Medicine and Science in Sports 01/1999; 8(6):411-5. · 2.87 Impact Factor
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ABSTRACT: In a cadaveric experiment, 16 functional spinal units (FSUs) obtained from 7 subjects with a mean age of 16.3 years were tested in compression to failure. The deformation rate was 5 mm/min. The bone mineral content (BMC) in the vertebrae was determined by using dual-photon absorptiometry (DPA). In 15 of the FSUs, traumatic changes were registered. Three different types of changes were seen. In nine vertebrae, there was a rupture in the cartilaginous end plate, in 12, a separation of the end plate from the vertebral body, and in three vertebrae, a compression fracture was registered. A close relation was found between BMC and the ultimate force (r2 = 0.63), the ultimate displacement (r2 = 0.73), and the energy absorption (r2 = 0.74). The weakest part of a spinal segment in this experimental situation is the growth plate.
Journal of Spinal Disorders 01/1999; 11(6):501-7. · 1.21 Impact Factor
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ABSTRACT: An experimental porcine study in which functional lumbar spinal units were tested in compression to failure. Biomechanical, radiographic, magnetic resonance imaging, and histological characteristics are described.
To explain the different patterns of injury seen in adults and adolescents resulting from traumatic injury to the vertebrae and to explain the mechanism behind traumatic displacement of the ring apophysis seen in athletes.
Recent investigations of the spine in adolescent who have sustained trauma have shown injuries to the growth zone, whereas studies of adults have shown injuries to the vertebral body. A higher frequency of abnormalities in the discs, the vertebral bodies, the endplates, and the ring apophyses has been demonstrated in athletes with high loads on the spine. There is controversy over the etiology of these changes.
Twelve functional lumbar spinal units (vertebra-disc-vertebra) obtained from six young male pigs were tested in compression to failure. All units were examined with plain radiography and magnetic resonance imaging before and after compression. After the compression, histologic samples were taken from the injury site.
Identical traumatic changes were seen in all functional lumbar spinal units, i.e., fracture in the endplate through the growth zone posteriorly and displacement of the anulus fibrosus with a bony fragment at the point of insertion of the vertebra. The nucleus pulposus was ruptured and displaced through the fracture line in all cases. The injuries were not seen on radiographs but were detected on magnetic resonance images, as confirmed on microscopic and histologic examination.
This study shows that the weakest part of the lumbar spine of the juvenile pig, when compressed, is the growth zone and the junction between the point of insertion of the anulus fibrosus and the vertebra. This location of weakness may explain the high frequency of disc degeneration and "persisting apophysis" seen in the spine of athletes.
Spine 01/1999; 23(23):2574-9. · 2.08 Impact Factor
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ABSTRACT: The objective of this study was to compare the analgesic effects of intra-articularly administered bupivacaine with bupivacaine/morphine during and after therapeutic knee arthroscopy. In a prospective, randomized study, 50 patients with clinical signs of medial meniscal injury were allocated to two groups, A and B. The patients in group A received 40 mL of 0.25% bupivacaine while the same dose of bupivacaine combined with 1 mg of morphine sulphate was administered in group B. Pain was estimated using the visual analogue scale (VAS) during surgery and at 2, 4, 6, and 24 hours after the operation was completed. Supplementary analgesic requirements were also registered, as well as the patients' overall rating of the entire procedure. The pain scores were significantly lower in Group B throughout the whole postoperative observation period. However, no significant differences were found between the two groups in terms of intraoperative pain scores, supplementary analgesic requirements, or the overall rating of the procedure. This study provides evidence that arthroscopic surgery can be performed in a safe manner after intra-articularly administered bupivacaine with or without low-dose morphine. The combination of low-dose morphine and bupivacaine did, however, produce a superior postoperative analgesic effect during the 24 hours following knee arthroscopy compared with bupivacaine alone.
Arthroscopy The Journal of Arthroscopic and Related Surgery 03/1998; 14(2):192-6. · 3.02 Impact Factor
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ABSTRACT: The most common graft in anterior cruciate ligament (ACL) surgery involves using the central one-third of the patellar tendon. Knowledge concerning the postoperative disability after harvesting the patellar tendon is, however, limited. The aim of this study was to evaluate the impact patellar tendon suture and bone grafting of the patellar bone defect might have in terms of functional outcome and patellofemoral pain after harvesting the bone-tendon-bone graft, compared with leaving the harvested site non-sutured and non-grafted. Sixty patients, scheduled for arthroscopically assisted ACL reconstruction, were randomly allocated to two groups. In group I, suture of the patellar tendon and bone grafting of the patellar defect were performed. In group II, the tendon gap and the patellar defect were left open. Preoperatively, there was no significant difference between the groups when comparing objective knee stability, as measured with a KT-1000 laxity meter, Lysholm score, Tegner activity level, IKDC score, or patello-femoral pain score. Both groups had a significantly improved Lysholm score at the 2-year follow-up, without any difference between them. Tegner's activity level was significantly lower at follow-up, compared with the pre-injury level in both groups. The patellofemoral pain score improved significantly after the reconstruction, without any difference between the groups. Ultrasonography did not reveal any difference between the groups in terms of healing of the tendon gap. This study revealed no differences in donor site morbidity, functional outcome, patellofemoral pain score or knee joint stability between the two treatment groups. The conclusion is that suture of the patellar tendon and bone grafting of the patellar defect do not improve the functional results or reduce donor site morbidity after arthroscopically assisted ACL.
Knee Surgery Sports Traumatology Arthroscopy 02/1998; 6(2):82-7. · 2.21 Impact Factor
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ABSTRACT: Although Achilles tendon injuries are common overuse injuries in sports, the exact incidence is unknown, primarily as a result of varying definitions and diagnoses of the underlying pathological changes. Despite numerous studies of treatment of the Achilles tendon injuries, the long-term results are not well known. The results after surgical treatment of chronic partial Achilles tendon ruptures in 64 patients with a follow-up of 6 (1.5-11) years were evaluated in a retrospective study. The ruptures were divided into three groups: (I) proximal (more than 3 cm above the calcaneus), (II) distal and (III) combined (proximal and distal). All patients underwent an operation involving the excision of the devitalized tendon tissue and, in groups (II) and (III), also the excision of the deep Achilles bursa and removal of the dorsal corner of the calcaneus. The functional results were satisfactory in 43 (67%) patients and unsatisfactory in 21 (33%). The results were better in patients with proximal ruptures than in patients with either distal or combined ruptures. Males experienced better results than females. Post-operative immobilization in a plaster cast had no significant influence on the final result. Nine (14%) patients with either a distal or a combined rupture were re-operated on and in seven of them the final result was satisfactory. The conclusion of this study is that partial Achilles tendon ruptures are often difficult to treat and only two out of three patients can be expected to obtain satisfactory results after surgical treatment.
Scandinavian Journal of Medicine and Science in Sports 11/1997; 7(5):299-303. · 2.87 Impact Factor
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ABSTRACT: Eighty-six patients with acute (< 24 h) grade II or III lateral ligament ruptures were randomized into two different non-surgical treatment groups. The main difference in treatment protocols between the two groups was during the first week after injury. Group I (n = 46) was to receive functional treatment using specially designed compression pads, elevation of the injured foot (24 h), repeated elastic wrapping (compression bandage followed by ankle tape), early full weight-bearing and proprioceptive range-of-motion training. Group II (n = 40) was to receive conventional treatment with an elastic bandage, partial weight bearing and crutches until the pain subsided. One week after the injury, patients from both groups were given identical rehabilitation instructions. No early surgery was performed. The mean follow-up period was 18 months. The functional results were satisfactory in 91% of the patients in group I and in 87% of the patients in group II (NS). Five patients had been operated on due to recurrent instability, two in group I and three in group II (NS). The mean sick leave was significantly shorter in group I; 5.6 +/- 4.2 days compared with 10.2 +/- 6.8 days in group II. Return to sports activities was also significantly earlier in group I, 9.6 +/- 4.8 days compared with 19.2 +/- 9.5 days in group II. In this study, non-surgical treatment of acute grade II and III ligament injuries of the ankle produced satisfactory results in the majority of patients. Early functional treatment resulted in shorter sick leave and facilitated an earlier return to sports, but it did not influence the final results.
Scandinavian Journal of Medicine and Science in Sports 12/1996; 6(6):341-5. · 2.87 Impact Factor
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ABSTRACT: The use of cryotherapy, i.e. the application of cold for the treatment of injury or disease, is widespread in sports medicine today. It is an established method when treating acute soft tissue injuries, but there is a discrepancy between the scientific basis for cryotherapy and clinical studies. Various methods such as ice packs, ice towels, ice massage, gel packs, refrigerant gases and inflatable splints can be used. Cold is also used to reduce the recovery time as part of the rehabilitation programme both after acute injuries and in the treatment of chronic injuries. Cryotherapy has also been shown to reduce pain effectively in the post-operative period after reconstructive surgery of the joints. Both superficial and deep temperature changes depend on the method of application, initial temperature and application time. The physiological and biological effects are due to the reduction in temperature in the various tissues, together with the neuromuscular action and relaxation of the muscles produced by the application of cold. Cold increases the pain threshold, the viscosity and the plastic deformation of the tissues but decreases the motor performance. The application of cold has also been found to decrease the inflammatory reaction in an experimental situation. Cold appears to be effective and harmless and few complications or side-effects after the use of cold therapy are reported. Prolonged application at very low temperatures should, however, be avoided as this may cause serious side-effects, such as frost-bite and nerve injuries. Practical applications, indications and contraindications are discussed.
Scandinavian Journal of Medicine and Science in Sports 09/1996; 6(4):193-200. · 2.87 Impact Factor
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ABSTRACT: Peroneal tendon dislocations occur in sports, particularly in skiing and soccer. This paper presents the outcome of 15 patients with post-traumatic recurrent peroneal tendon dislocations, operated on with a soft-tissue reconstruction of the superior peroneal retinaculum, i.e. reattachment and reinforcement, in combination with a retrofibular groove deepening. Mean follow-up was 3.5 (2-7) years after surgery. There were no redislocations and no neurovascular injuries. The functional results were satisfactory in 13/15 (87%) patients, with full range of ankle motion and no pain. The two patients with unsatisfactory functional results had restricted ankle motion and pain on exertion. This simple reconstruction seems to be a good alternative to other more complex procedures and can be recommended in patients with recurrent peroneal tendon dislocations. Conservative treatment is not an option in patients with recurrent peroneal tendon dislocations, due to persistent symptoms of instability and pain.
Scandinavian Journal of Medicine and Science in Sports 09/1996; 6(4):242-6. · 2.87 Impact Factor
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ABSTRACT: To evaluate the long-term results in patients with patello-femoral pain syndrome after expectant management.
Retrospective, case-control study.
Community study in Sweden from 1981 to 1994.
Forty-eight patients with patello-femoral pain syndrome were followed for a mean period of 11 years.
Patello-femoral joint evaluation scale (0-100 points) was used to evaluate the functional results. Arthroscopy for evaluation of cartilage damage according to Outerbridge, and clinical assessment of knee stability and, range of motion and Q-angle.
The functional results were excellent or good in 41 of 48 (85%) and poor in seven (15%). There was no correlation between the degree of cartilage damage and the level of knee function. Retropatellar cartilage damage was found in 28 patients during arthroscopy. There was no correlation between the degree of cartilage damage and the level of knee function. No patient has Outerbridge frade IV cartilage damage. The Q-angle was 2-23 degrees. There was no significant difference in Q-angle between patients with excellent/good results compared to those with poor.
Patients with patello-femoral pain syndrome should be managed nonsurgically as the natural course is benign in most cases. Surgical intervention should be used only if correction of anatomical malalignment is necessary and if the surgical methods have proven successful in well-controlled studies with a long follow-up period.
Clinical Journal of Sport Medicine 02/1996; 6(1):22-6. · 2.12 Impact Factor
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ABSTRACT: This study describes the 3-year results of Bankart reconstruction in 50 consecutive patients with posttraumatic, recurrent, anterior instability of the shoulder. A modified procedure, using suture anchors was used in all patients, to simplify the soft-tissue attachment to the glenoid rim. Forty-seven of 50 (94%) patients regained normal stability. Two recurrent dislocations and one subluxation occurred. The functional results according to the Rowe scoring system were satisfactory in 43 of 50 (86%) of the patients, and unsatisfactory in 7 of 50 (14%). Of the patients with unsatisfactory results, 3 had recurrent instability and 4 had not regained normal range of shoulder motion. The suture anchors were found to simplify the procedure, and no specific complications as a result of the modified technique were seen.
Scandinavian Journal of Medicine and Science in Sports 07/1995; 5(3):170-4. · 2.87 Impact Factor
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ABSTRACT: Intra-articular administration of local anaesthetics such as bupivacaine can produce short-term postoperative analgesia in patients undergoing diagnostic arthroscopy or arthroscopic meniscectomy. A peripheral anti-nociceptive effect may also be induced by the administration of intra-articular opiates interacting with local opioid receptors in inflamed peripheral tissue. In the present study we aimed to study the analgesic effects of intra-articularly given bupivacaine and morphine sulphate (as well as the combination of both drugs) on postoperative pain. In a prospective, randomized, double-blind manner 40 patients received one of the following: (a) morphine (1 mg in 20 ml NaCl), (b) bupivacaine (20 ml, 0.375%), (c) combination of both or (d) saline (20 ml, control group) intra-articularly at the end of arthroscopic anterior cruciate ligament (ACL) reconstruction. The postoperative pain was assessed via a visual analogue scale (VAS) during the first 48 h after surgery, and supplemental analgesic requirements were noted. All comparisons were made versus the control group receiving saline. The pain scores were significantly lower in the morphine group at 24 and 48 h, and in the bupivacaine group at 2, 4 and 6 h after surgery. In the group that received a combination of both bupivacaine and morphine, the pain scores were significantly reduced throughout the whole postoperative observation period. No side-effects or complications from therapy were seen in any of the groups. The conclusion of this study is that intra-articular morphine is effective in the postoperative period after arthroscopic ACL reconstruction.(ABSTRACT TRUNCATED AT 250 WORDS)
Knee Surgery Sports Traumatology Arthroscopy 02/1995; 3(1):55-9. · 2.21 Impact Factor
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ABSTRACT: Chronic muscle and tendon injuries to the groin are common sports injuries. The symptoms of groin injuries are often uncharacteristic which can result in a delay in the correct and specific diagnosis being reached. The most common injury is the overuse strain resulting in chronic tendinitis of the adductor muscle/tendon units, especially the adductor longus. The rectus femoris and rectus abdominous muscles and tendons are also commonly affected. Computed tomography, magnetic resonance imaging and ultrasonography have been widely adopted to diagnose muscle/tendon injuries to the groin. Ultrasonography has been shown to be accurate and sensitive in diagnosing tendon injuries in the groin region, especially small partial ruptures of the muscle/tendon unit. Ultrasonography has the advantage of being fast, inexpensive and widely available. Normal findings are readily distinguished from pathological findings providing valuable pre-operative information, such as location and extent of the injury. The differential diagnoses are many and often difficult to reach. The most commonly overlooked differential diagnoses are chronic prostatitis and hernias. A multidisciplinary approach is valuable in many cases. The recommended treatment is well planned and gradually increased rehabilitation programme during the first stages. Surgery for acute injuries is rarely indicated. Surgery, for example tenotomy of the adductor longus, has given satisfactory results in many athletes when nonsurgical treatment has failed.
Sports Medicine 03/1994; 17(2):141-8. · 5.16 Impact Factor
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ABSTRACT: Ankle ligamentous injuries are very common in sports. One of the most popular methods of supporting the weakened ankle is external support with ankle tape. The tape can be used to prevent ankle injuries, to stabilise the injured ankle to prevent further injury, and as a stabiliser during the rehabilitation phase. Of the various taping methods, basket weaves (combined with stirrup and a heel-lock) are the most effective for increasing the mechanical stability of the ankle, especially in the frontal plane (talar tilt). A combination of increased mechanical stability, decreased range of ankle motion and an improvement in the proprioceptive function of the ankle ligaments are factors associated with effectiveness of ankle taping. The major drawbacks of ankle taping are the high costs and decreased support after exercise.
Sports Medicine 10/1993; 16(3):210-5. · 5.16 Impact Factor
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L Swärd
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ABSTRACT: Due to the increased interest in physical fitness and to the fact that athletes start their training at younger ages the risk for injuries to the growing individual has increased. The spine, as with the rest of the skeleton, is at greater risk of injury during growth, especially during the adolescent growth spurt. Back pain is more common among athletes participating in sports with high demands on the back than other athletes and nonathletes. Disc degeneration, defined as disc height reduction on conventional radiographs and reduced disc signal intensity on MRI, has been found in a higher frequency among wrestlers and gymnasts than nonathletes. Abnormalities of the vertebral bodies including abnormal configuration, Schmorl's nodes and apophyseal changes are common among athletes. These abnormalities are similar to those found in Scheuermann's disease. Athletes with these types of abnormalities have more back pain than those without. Spondylolysis has been found in higher frequencies than expected among athletes representing many different sports. Spondylolysis has been reported in up to 50% of athletes with back pain. Scoliosis has been found in up to 80% of athletes with an asymmetric load on the trunk and shoulders, such as javelin throwers and tennis players. The scoliosis, however, is a small curvature and does not cause back pain.
Sports Medicine 06/1992; 13(5):357-64. · 5.16 Impact Factor
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ABSTRACT: Seventy-one patients with patello-femoral pain syndrome were re-examined an average of 10 (range 8-12) years after anterior advancement of the tibial tuberosity. The clinical results were excellent in 8 (11%), good in 20 (28%), fair in 16 (23%), and poor in 27 (38%). Twenty patients had had a second operation. The results were worse in patients with Outerbridge grade III-IV cartilage damage. Since the clinical results deteriorated with time, this surgical procedure should no longer be used to treat patients with patello-femoral pain syndrome.
Archives of Orthopaedic and Trauma Surgery 02/1992; 111(4):195-7. · 1.37 Impact Factor
