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D B O'Neill
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ABSTRACT: The purpose of this study was to further delineate the outcome of arthroscopically assisted anterior cruciate ligament reconstruction in 125 patients who had previously been followed for two to five years. One of the original 125 patients was excluded from the present study because of insufficient follow-up, and an additional group of 101 patients was added. All 225 patients in the present study were followed for a minimum of six years.
Patients were randomly assigned to reconstruction with a double-stranded semitendinosus-gracilis graft with use of a two-incision technique (group I), reconstruction with a patellar ligament graft with use of a two-incision technique (group II), or reconstruction with a patellar ligament graft with use of a single-incision endoscopic technique (group III). The groups were compared with regard to the rate of graft failure, the amount of instability, knee strength, radiographic signs of degenerative changes, and functional outcome.
There was no significant difference among the three groups with regard to the rate of graft failure, the amount of knee instability, or the functional outcome. A normal or nearly normal functional outcome was recorded for 208 (92%) of the 225 patients. There were significant differences among the groups with regard to quadriceps muscle-strength deficits: group I had fewer patients with deficits than group III, and groups I and III both had fewer patients with deficits than group II (p = 0.04). There also were significant differences among the groups with regard to hamstring muscle-strength deficits: group III had fewer patients with deficits than group II, and group II had fewer patients with deficits than group I (p < 0.01). Twelve knees (16%) in group I, six knees (8%) in group II, and eight knees (11%) in group III showed radiographic evidence of progressive degenerative changes, but the differences among the three groups were not significant.
Although 11.6% of the 225 knees had radiographic evidence of degenerative arthritis at a minimum of six years after arthroscopically assisted reconstruction of the anterior cruciate ligament, the choice of graft and the technique of reconstruction did not seem to affect the rate of development of these changes.
The Journal of Bone and Joint Surgery 09/2001; 83-A(9):1329-32. · 3.27 Impact Factor
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D B O'Neill
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ABSTRACT: The purpose of this study was to evaluate the results of an arthroscopic transglenoid suture-stabilization procedure in athletically active patients who had recurrent, unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum.
Forty-one patients who had unilateral, unidirectional anterior dislocations of the shoulder and an isolated anterior detachment of the glenoid labrum were managed with arthroscopic repair. All patients were athletic, and seventeen of the male patients were football players. No patient had inferior or posterior laxity or a posterior detachment. The sutures were anchored to the posterior aspect of the scapula, and the knots were tied anteriorly to secure the detached region of the labrum and the inferior glenohumeral ligament to the anterior aspect of the scapula. The mean duration of follow-up was fifty-two months (range, twenty-five months to seven years). The patients were evaluated annually with a physical examination, radiographs, isokinetic strength-testing, the modified shoulder-rating scale of Rowe and Zarins, and the scoring system of the American Shoulder and Elbow Surgeons.
Forty (98 percent) of the forty-one athletes returned to their preoperative sport postoperatively. Thirty-nine patients (95 percent) had no additional dislocations or subluxations, and two (5 percent), both of whom were football players, had a single episode of subluxation. Thirty-seven patients (90 percent) had a score of at least 80 points on the scale of Rowe and Zarins, and thirty-four (83 percent) had a score of at least 90 points. Thirty-nine patients (95 percent) had a score of at least 80 points on the scale of the American Shoulder and Elbow Surgeons, and twenty-five (61 percent) had a score of at least 90 points. Lower scores were associated with loose bodies seen on arthroscopy (p = 0.001), osseous lesions seen on postoperative radiographs (p = 0.036), and subluxation (p = 0.000). Twenty-two shoulders (54 percent) had a full range of motion in all planes, and eighteen (44 percent) had no strength deficit in any position on isokinetic testing. With the numbers available for study, no significant association was found between the presence of a Hill-Sachs or an osseous Bankart lesion on preoperative radiographs and the overall score on the scale of Rowe and Zarins or the scale of the American Shoulder and Elbow Surgeons; however, there was a significant association between the range of motion and an osseous Bankart lesion on preoperative radiographs (p = 0.002) and between decreased strength on isokinetic testing and a Hill-Sachs lesion on preoperative radiographs and an osseous lesion on postoperative radiographs (p = 0.022). There also was a significant association between a decreased range of motion (p < 0.002) and decreased strength (p = 0.014) and the arthroscopic finding of loose bodies. Muscle strength also was affected by arm dominance and the number of preoperative dislocations.
Arthroscopic transglenoid repair of isolated anterior labral detachments restored stability of the shoulder and led to a favorable outcome in thirty-nine (95 percent) of the forty-one athletes. Only the two football players who had postoperative subluxation had a score of less than 80 points according to the scale of the American Shoulder and Elbow Surgeons.
The Journal of Bone and Joint Surgery 11/1999; 81(10):1357-66. · 3.27 Impact Factor
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D B O'Neill
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ABSTRACT: A prospective, randomized study was performed to compare the results of arthroscopic lateral retinacular release (Group I) with those of open lateral retinacular lengthening (Group II). The study included eighty-six patients (eighty-six knees) who had had pain in the anterior peripatellar aspect of the knee and lateral patellar tilting (rotational malalignment), as seen on Merchant tangential patellofemoral radiographs, that had not improved after participation in a structured rehabilitation program for the quadriceps and the hamstrings for a minimum of six months. The mean duration of follow-up after the operative procedures was forty-six months (range, two to six years). At the time of the latest follow-up evaluation, forty (93 per cent) of the forty-three patients in Group I and all forty-three (100 per cent) of the patients in Group II had resumed the level of athletic activity that they had engaged in before the onset of symptoms (p = 0.08, analysis of variance). With the numbers available for study, no significant difference could be detected between the groups with regard to deficits in the range of motion, atrophy (the circumference) of the thigh, operative or postoperative complications, or the need for subsequent operative procedures. Additionally, no significant difference could be detected between the groups with regard to the results of open or closed-chain testing with an isokinetic dynamometer. According to the knee-rating system of Lysholm and Gillquist as modified by Tegner and Lysholm, thirty-three knees (77 per cent) in Group I had a score of 80 points or more compared with thirty-eight knees (88 per cent) in Group II. Six knees (14 per cent) in Group I had a score of less than 70 points compared with no knees in Group II. The difference in the knee ratings between the two groups was significant (p = 0.028, analysis of variance). Although there seemed to be a definite trend toward improved function of the knee in association with a longer duration of follow-up, no significant association could be detected between the duration of follow-up and improvement in the outcome measures in either group.
The Journal of Bone and Joint Surgery 01/1998; 79(12):1759-69. · 3.27 Impact Factor
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D B O'Neill
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ABSTRACT: One hundred and twenty-seven patients who had a rupture of the anterior cruciate ligament agreed to participate in a prospective, randomized study of three arthroscopically assisted reconstruction techniques. One hundred and twenty-five patients (125 reconstructions) were evaluated after a mean duration of follow-up of forty-two months (range, two to five years). Group I included forty patients who had a two-incision reconstruction with use of an autogenous semitendinosus-gracilis graft, group II consisted of forty patients who had a two-incision reconstruction with use of an autogenous patellar-ligament graft, and group III included forty-five patients who had a single-incision reconstruction (endoscopic technique) with use of an autogenous patellar-ligament graft. The male-female ratio, age range, level of athletic activity, interval between the injury and the reconstruction, previous operative procedures, and associated injuries were similar in all three groups. The same postoperative rehabilitation protocol was followed for all patients. Testing with a KT-2000 arthrometer at maximum manual force was done at the follow-up evaluation; the difference in laxity between the involved knee and the contralateral knee was three millimeters or less in thirty-three patients (83 per cent) in group I, thirty-seven patients (93 per cent) in group II, and thirty-nine patients (87 per cent) in group III. A difference of two millimeters or less was found in thirty patients (75 per cent) in group I, thirty-one patients (78 per cent) in group II, and thirty-five patients (78 per cent) in group III. Thirty-five patients (88 per cent) in group I, thirty-eight patients (95 per cent) in group II, and forty patients (89 per cent) in group III returned to at least the same level of athletic activity. Four grafts (two in group I and two in group II) failed as a result of trauma. There was one additional failure in groups I and III, as evidenced by a difference of nine and seven millimeters, respectively, on instrumented testing of laxity. The significant findings were that no knee was rated D according to the system of the International Knee Documentation Committee (p < 0.002, 94 per cent confidence level) and that fewer additional operative procedures were done on patients in group III (p < 0.08). Also, it was found that the patients in group II returned to a greater level of athletic activity (p < 0.02) and that a higher percentage of the patients in this group had a difference of three millimeters or less on testing with the KT-2000 arthrometer than in the other two groups (p < 0.08). However, with the numbers available, there were no significant differences in the over-all outcome among the three groups (p > 0.1). Importantly, the rate of failure was not greater and the outcomes were not less satisfactory for the late reconstructions than they were for the acute reconstructions (those performed less than three weeks after the injury), including those done with an autogenous semitendinosus-gracilis graft in a chronically unstable knee.
The Journal of Bone and Joint Surgery 06/1996; 78(6):803-13. · 3.27 Impact Factor
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ABSTRACT: Patellofemoral stress syndrome is a condition of peripatellar pain without anatomic malalignment, history of trauma, patellar instability or clinical evidence of patellofemoral crepitus. These patients demonstrate lateral retinacular and iliotibial band tightness. Frequently, the patient's pain occurs when sitting for prolonged periods of time with the knee flexed, and most commonly with sporting events. A complete history and physical evaluation is necessary for an accurate diagnosis. This evaluation should include the following radiographs: anterior-posterior, lateral, and most importantly, the tangential views. Once diagnosed, patellofemoral stress syndrome is usually treated conservatively. Studies indicate that 60 to 80% of knees will respond favourably to conservative treatment. The exercise programme should include iliotibial band stretching, hamstring stretching, gastrocnemius stretching, progressive resistance straight leg raising and hip adduction strengthening. These exercises should be performed 2 times/day until symptoms subside and then 3 times/week as long as the patient is active in sports. If the conservative programme fails, surgical management may be considered. A lateral retinacular release or possibly lateral retinacular lengthening are surgical procedures recommended as reliable solutions in the majority of patients. These procedures require continuation of the exercise programme to be successful.
Sports Medicine 01/1994; 16(6):449-59. · 5.16 Impact Factor
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The Journal of Bone and Joint Surgery 09/1990; 72(7):1100-2. · 3.27 Impact Factor
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D B O'Neill
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ABSTRACT: When fractures require small amounts of cancellous bone graft for healing but do not permit local bone harvesting, a simple percutaneous method may be used to obtain the graft from iliac crest. Using a winged iliac crest trephine (or any iliac crest biopsy trocar), the technique described is effective and markedly decreases morbidity.
Orthopaedic review 05/1990; 19(4):383-4.
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ABSTRACT: The postoperative radiographs of 48 patients who underwent posterolateral in situ fusion for spondylolysis and Grade 1 or less spondylolisthesis over an 11-year period showed healing of the pars defects in 90% of the cases. The patients who showed healing had an average preoperative duration of symptoms of 17 months (mean, 12 months). The five patients whose radiographs showed persistent defects postoperatively were found to have had preoperative symptoms for an average of 47 months (mean, 48 months). This significantly greater (P 0.05) duration of symptoms prior to stabilization was the only variable that proved to be statistically significant. Controversy continues to exist as to the etiology of spondylolysis; however, the ability to heal the defect with lumbar spinal stability certainly supports the theory that the defect is a result of fatigue stresses, which finally manifest as a fracture seen on radiographs as the spondylolytic defect. Posterior spinal stabilization in those patients with symptoms for a period of less than 2 years who have failed conservative management can be expected to heal the pars defects.
Spine 01/1990; 14(12):1342-55. · 2.08 Impact Factor
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The Journal of Bone and Joint Surgery 08/1989; 71(6):941-4. · 3.27 Impact Factor
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ABSTRACT: Difficulty is frequently encountered in separating the rotator cuff tendons, particularly the subscapularis tendon, from the underlying and often adherent capsule. A safe and quick method of dissecting the tendon from the capsule using a Cobb elevator has proven effective without causing capsular penetration in well over 100 consecutive primary shoulder stabilizations.
Orthopaedic review 05/1989; 18(4):504-7.
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ABSTRACT: Overuse injuries are now well known to sports enthusiasts at any age or level of competition. The seeming explosion of overuse stress fractures of lower extremity bones in high-profile professional basketball players has brought about widespread media attention and a better understanding of the phenomenon of "overuse syndrome" by the public. However, the spectrum of overuse injuries in the child or adolescent athlete has only recently been recognized. These injuries can range from the permanent disability of osteochondritis dissecans of the elbow to the completely nonspecific "growing pains" of active youngsters.
Clinics in Sports Medicine 08/1988; 7(3):591-610. · 1.55 Impact Factor
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ABSTRACT: A retrospective review was undertaken of 16 adolescent patients (20 feet) with tarsal coalitions. All patients were active in sports and were seen in the Sports Medicine Clinic. Ages ranged from 9 to 17 years (average, 13 years). Failing conservative therapy, 18 feet had resection of the tarsal bar; 1 patient (2 feet) had bilateral extraarticular subtalar arthrodeses. The patients were seen in followup an average of 5.1 years postoperatively (range, 2 to 10 years). An objective ankle/foot score was developed and all patients improved their score postoperatively, with the average score being improved 25%. Nineteen of 20 feet (95%) had excellent or good postoperative results by the ankle/foot score, while 17 of 20 (85%) had an excellent or good subjective result. Two bars in two feet (10%), both in the same patient, recurred. There were six patients with preoperative talar beaking, and all had an excellent or good followup result. All males returned to their previous level of competition in sports, while three female patients (three feet) gave up sports. Resection of tarsal coalitions, even in the presence of talar beaking without other degenerative changes, yields consistently good follow-up results.
The American Journal of Sports Medicine 17(4):544-9. · 3.79 Impact Factor
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ABSTRACT: Thirty patients, 13 skeletally immature individuals and 17 adults, participated in a prospective study designed to evaluate the effect of isometric quadriceps strengthening exercises on patellofemoral pain. Of the 30 patients with anatomically normal lower extremity alignment and no history of previous knee trauma or surgery, there were 34 knees that had a decrease in peripatellar knee pain with a structured exercise program. One additional patient had a decrease in pain after an arthroscopic lateral release and with continued exercises. An equal number of skeletally immature patients and adults had a decrease in peripatellar knee pain. However, 5 of the 17 adults had to limit their activities, while no adolescent patient had to limit activity. Additionally, eight skeletally immature knees had greater than 5 degrees change in their congruence angles, as measured on Merchant tangential radiographs, over the year-long course of this study. Only one adult knee had a similar radiographic improvement. We recommend immediate action to alleviate patellofemoral pain syndrome, even when extremity alignment is normal. An isometric, progressive resistance quadriceps program with iliotibial band and hamstring stretching exercises is the preferred initial treatment.
The American Journal of Sports Medicine 20(2):151-6. · 3.79 Impact Factor
