The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Oct 2004
Multicenter Study Comparative Study Clinical Trial Controlled Clinical TrialLegg-Calve-Perthes disease. Part II: Prospective multicenter study of the effect of treatment on outcome.
The treatment of Legg-Calve-Perthes disease has been based on uncontrolled retrospective studies with relatively small numbers of patients. This large, controlled, prospective, multicenter study was designed to determine the effect of treatment and other risk factors on the outcome in patients with this disorder. ⋯ The lateral pillar classification and age at the time of onset of the disease strongly correlate with outcome in patients with Legg-Calve-Perthes disease. Patients who are over the age of 8.0 years at the time of onset and have a hip in the lateral pillar B group or B/C border group have a better outcome with surgical treatment than they do with nonoperative treatment. Group-B hips in children who are less than 8.0 years of age at the time of onset have very favorable outcomes unrelated to treatment, whereas group-C hips in children of all ages frequently have poor outcomes, which also appear to be unrelated to treatment.
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J Bone Joint Surg Am · Oct 2004
Determining the relationship of the axillary nerve to the shoulder joint capsule from an arthroscopic perspective.
The axillary nerve is out of the field of view during shoulder arthroscopy, but certain procedures require manipulation of capsular tissue that can threaten the function or integrity of the nerve. We studied fresh cadavers to identify the course of the axillary nerve in relation to the glenoid rim from an intra-articular perspective and to determine how close the nerve travels in relation to the glenoid rim and the inferior glenohumeral ligament. ⋯ We used two novel approaches to map the axillary nerve from an intra-articular perspective. Our analysis of the position of the nerve with use of these methods provides the shoulder arthroscopist with essential information regarding the location, route, and morphology of the nerve as it passes inferior to the glenoid rim and shoulder capsule.
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J Bone Joint Surg Am · Oct 2004
Multicenter StudyPredicting the outcome of total knee arthroplasty.
The relief of pain and the restoration of functional activities are the main outcomes of primary total knee arthroplasty for the treatment of osteoarthritis. This paper examines the preoperative predictors of pain and functional outcome at one and two years following total knee arthroplasty. ⋯ Patients who have marked functional limitation, severe pain, low mental health score, and other comorbid conditions before total knee arthroplasty are more likely to have a worse outcome at one year and two years postoperatively. After adjusting for these predictors, it was found that patients from the United Kingdom had significantly worse functional outcomes but similar pain relief compared with those from the United States and Australia.
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J Bone Joint Surg Am · Oct 2004
Randomized Controlled Trial Comparative Study Clinical TrialAnterior cruciate ligament reconstruction: bone-patellar tendon-bone compared with double semitendinosus and gracilis tendon grafts. A prospective, randomized clinical trial.
The choice of graft for anterior cruciate ligament reconstruction is a matter of debate, with patellar and hamstring tendons being the two most popular autologous graft options. The objective of this study was to determine in a prospective, randomized clinical trial whether two grafts (bone-patellar tendon-bone or doubled hamstring tendons) fixed with modern devices affect the two-year minimum clinical and radiographic outcomes of anterior cruciate ligament reconstruction. ⋯ We believe that, with use of accurate and proven surgical and rehabilitation techniques, both grafts are an equivalent option for anterior cruciate ligament reconstruction.