The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Dec 2008
Randomized Controlled TrialThe geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint.
The geometry of the tibial plateau is complex and asymmetric. Previous research has characterized subject-to-subject differences in the tibial plateau geometry in the sagittal plane on the basis of a single parameter, the posterior slope. We hypothesized that (1) there are large subject-to-subject variations in terms of slopes, the depth of concavity of the medial plateau, and the extent of convexity of the lateral plateau; (2) medial tibial slope and lateral tibial slope are different within subjects; (3) there are sex-based differences in the slopes as well as concavities and convexities of the tibial plateau; and (4) age is not associated with any of the measured parameters. ⋯ The geometry of the osseous portion of the tibial plateau is more robustly explained by three slopes and the depth of the medial tibial condyle.
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J Bone Joint Surg Am · Dec 2008
Controlled Clinical TrialThe value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome.
There is no clear-cut consensus on the best diagnostic criteria for carpal tunnel syndrome. The objective of this study was to compare the probability of carpal tunnel syndrome being present following electrodiagnostic testing with the probability of it being present after the diagnosis was established on the basis of a clinical evaluation alone. ⋯ For the majority of patients who are considered to have carpal tunnel syndrome on the basis of their history and physical examination alone, electrodiagnostic tests do not change the probability of diagnosing this condition to an extent that is clinically relevant.
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J Bone Joint Surg Am · Dec 2008
The healing potential of stable juvenile osteochondritis dissecans knee lesions.
The purpose of the present study was to determine if patient age, lesion size, lesion location, presenting knee symptoms, and sex predict the healing status after six months of a standard protocol of nonoperative treatment for stable juvenile osteochondritis dissecans of the knee. ⋯ In two-thirds of immature patients, six months of nonoperative treatment that includes activity modification and immobilization results in progressive healing of stable osteochondritis dissecans lesions. Lesions with an increased size and associated swelling and/or mechanical symptoms at presentation are less likely to heal.
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J Bone Joint Surg Am · Dec 2008
Spinal growth modulation with use of a tether in an immature porcine model.
Spinal growth modulation by tethering the anterolateral aspect of the spine, as previously demonstrated in a nonscoliotic calf model, may be a viable fusionless treatment method for idiopathic scoliosis. The purpose of the present study was to evaluate the radiographic, histologic, and biomechanical results after six and twelve months of spinal growth modulation in a porcine model with a growth rate similar to that of adolescent patients. ⋯ In this porcine model, mechanical tethering during growth altered spinal morphology in the coronal and sagittal planes, leading to vertebral and disc wedging proportional to the duration of tethering. The resulting concave thickening of the disc in response to the tether was not anticipated and may suggest a capacity for the nucleus pulposus to respond to the compressive loads created by growth against the tether.
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J Bone Joint Surg Am · Dec 2008
Treatment of scaphoid waist nonunions with an avascular proximal pole and carpal collapse. A comparison of two vascularized bone grafts.
Surgically, it is difficult to achieve union of a scaphoid nonunion that is associated with osteonecrosis of the proximal pole, and those with carpal collapse are especially difficult to treat. A variety of vascularized bone grafts can be used. The purpose of this study was to compare the effectiveness of two types of vascularized bone graft--a distal radial pedicle graft and a free vascularized medial femoral condyle graft--in the treatment of scaphoid waist nonunions associated with proximal pole osteonecrosis and carpal collapse. ⋯ A vascularized interposition graft from the medial femoral condyle is the recommended vascularized bone graft for the surgical treatment of scaphoid waist nonunion with avascularity of the proximal pole and carpal collapse.