Spiegl U.J.,University of Leipzig |
Josten C.,University of Leipzig |
Devitt B.M.,OrthoSport Victoria |
Heyde C.-E.,University of Leipzig
European Spine Journal | Year: 2017
Purpose: The purpose of this review was to analyze the biomechanical basis of incomplete burst fractures of the thoracolumbar spine, summarize the available treatment options with evidence from the literature, and to propose a method to differentiate fracture severity. Methods: The injury pattern, classification, and treatment strategies of incomplete burst fractures of the thoracolumbal spine have been described following a review of the literature. All level I–III studies, studies with long-term results and comparative studies were included and summarized. Results: Details of five randomized control trials were included. Additionally, three comparative studies and two studies with long-term outcomes were detailed in this review. The fracture severity reported in the included studies varied tremendously. Most classification used did not adequately describe the complexity of fracture configuration. A wide variety of treatment strategies were outlined, ranging from non-operative therapy to aggressive surgical intervention with combined anterior-posterior approaches. Thus, the treatment of incomplete burst fractures of the thoracolumbar spine is quite diverse and remains controversial. Conclusions: Incomplete burst fractures can differ tremendously regarding the degree of instability they confer to the thoracolumbar spine. Based on a detailed review of the literature, it is clear that good results can be obtained with both non-operative and operative strategies to treat these injuries. In the authors’ opinion, the intervertebral disc plays a key role in determining the long-term clinical and radiological outcome. Thus, an incorporation of the intervertebral disc pathology into the existing classification systems would be a valuable prognostic factor. © 2017 Springer-Verlag Berlin Heidelberg
Webster K.E.,La Trobe University |
Feller J.A.,OrthoSport Victoria
Clinical Orthopaedics and Related Research | Year: 2017
Background: There is some evidence that functional performance and validated outcome scores differ according to the gender, age, and sport participation status of a patient after anterior cruciate ligament (ACL) reconstruction. However, the impact of these three factors, and interaction among them, has not been studied across a large relatively homogeneous group of patients to better elucidate their impact. Questions/purposes: We reviewed a large cohort of patients who had undergone ACL reconstruction to determine if ROM, knee laxity, objective performance measures, and validated outcome scores differed according to (1) gender; (2) age; and (3) sport participation status. Methods: This was a retrospective analysis of prospectively collected data. Between 2007 and 2016, we performed 3452 single-bundle ACL reconstructions in patients who participated in sport before ACL injury. Of those, complete followup (including preoperative scores and scores at 1 year after surgery; mean, 14 months; range, 12–20 months) was available on 2672 (77%) of patients. Those lost to followup and those accounted for were not different in terms of age, gender, and sports participation at baseline. The study group consisted of 1726 (65%) men and 946 (35%) women with a mean ± SD age of 28 ± 10 years. For these patients, the following measures were obtained: knee ROM (flexion and extension deficit), instrumented knee laxity, single and triple hop for distance limb symmetry index (LSI), International Knee Documentation Committee (IKDC) subjective evaluation, and Single Assessment Numeric Evaluation score. Mean scores and measures of variability were calculated for each outcome measure. Comparisons were made among gender, age, and sport status. Results: Men had less knee laxity after reconstruction (men 1.1 ± 2.2 mm, women 1.3 ± 2.4 mm; mean difference 0.2 mm [0.1–0.4], p < 0.001), greater limb symmetry (single limb hop men: 94% ± 12%, women 91% ± 13%, mean difference 3% [2%–4%], p < 0.001), and higher IKDC scores than did women (men 84 ± 12, women 82 ± 12, mean difference 2 [1–3], p < 0.001). With the exception of instrumented laxity, all outcome measures showed reduced deficits and higher scores in younger patients. This was most marked for LSI scores between the youngest and oldest aged patient groups (crossover hop: < 16 years 99% ± 10%, > 45 years 90% ± 16%, mean difference: 9 [5–11], p < 0.001). Patients who had returned to their preinjury sport also scored higher and had smaller deficits for all outcomes except ROM compared with patients who had not returned to sport at the time of followup (IKDC subjective: returned 90 ± 9, no sport 79 ± 12, mean difference 11 points [9–12], p < 0.001; single limb hop: returned 97 ± 10, no sport 91 ± 14, mean difference 6% [5%–7%], p < 0.001). Conclusions: This study showed that some of the most commonly used functional performance and validated clinical scores for ACL reconstruction are superior for patients who are younger, male, and have returned to preinjury sport. Reference to these data allows clinicians to more effectively evaluate a patient based on their age, gender, and sport status when making return to sport and rehabilitation decisions. Level of Evidence: Level III, therapeutic study. © 2017 The Association of Bone and Joint Surgeons®
PubMed | OrthoSport Victoria, BoxHill Public Hospital, Royal Infirmary, The Alfred Hospital and Orthopaedic Surgery
Type: Journal Article | Journal: Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons | Year: 2016
A cadaveric and clinical study was performed to assess whether a minimally invasive technique is a potentially safer alternative compared to a calcaneal osteotomy through an open lateral approach.Cadaveric: A minimally invasive calcaneal osteotomy (MICO) was performed on nine cadaveric specimens. These were examined to identify any nerve injury and to quantify the displacement achieved with the osteotomy. Clinical: A retrospective review of a sequential case series of medializing MICOs performed by the senior author between October 2011 and November 2014 was undertaken.Cadaveric: Neurological structures remained uninjured in all specimens. The distance of the sural nerve and the main trunk of the tibial nerve to the superior limb of the oblique osteotomy was 6.24.8mm (range 0-14mm) and 7.33.6mm (range 4-12mm), respectively. The mean coronal shift achieved was 16.73.4mm (range 12-21mm). Clinical: The senior author carried out 35 medializing MICO procedures. Radiological and clinical union occurred in all 35 cases (100%). There were no neurovascular or wound complications.Minimally invasive calcaneal osteotomy offers a safe alternative to an open procedure with promising clinical results.
Feller J.A.,OrthoSport Victoria
Sports Medicine and Arthroscopy Review | Year: 2012
Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans. Copyright © 2012 by Lippincott Williams & Wilkins.
Feller J.,OrthoSport Victoria |
Webster K.E.,La Trobe University
International Orthopaedics | Year: 2013
Rates of return to pre-injury sport following anterior cruciate ligament (ACL) reconstruction are less than might be expected from standard outcome measures and there appears to be a rapid decline in sporting participation after two to three years. There are many factors that influence whether an individual will return to sport following this type of surgery. They include not only surgical details and rehabilitation, but also social and psychological factors, as well as demographic characteristics. Age is of particular importance with older patients being less likely to resume their pre-injury sport. It is important that future research clearly identify the pre-injury characteristics of the study cohort when investigating return to sport, and also that there is consistent and precise terminology used to report rates of return to sporting activities. Little is known about how to determine when it is safe to return to sport following ACL reconstruction or how to predict whether an athlete will be able to successfully return to sport. Finally, it needs to be recognised that return to sport following ACL reconstruction is associated with a risk of further injury and the development of osteoarthritis. © 2012 Springer-Verlag Berlin Heidelberg.
Ardern C.L.,La Trobe University |
Taylor N.F.,La Trobe University |
Feller J.A.,OrthoSport Victoria |
Feller J.A.,La Trobe University |
And 2 more authors.
American Journal of Sports Medicine | Year: 2013
Background: Up to two-thirds of athletes may not return to their preinjury level of sport by 12 months after anterior cruciate ligament (ACL) reconstruction surgery, despite being physically recovered. This has led to questions about what other factors may influence return to sport. Purpose: To determine whether psychological factors predicted return to preinjury level of sport by 12 months after ACL reconstruction surgery. Study Design: Case control study; Level of evidence, 3. Methods: Recreational and competitive-level athletes seen at a private orthopaedic clinic with an ACL injury were consecutively recruited. The primary outcome was return to the preinjury level of sports participation. The psychological factors evaluated were psychological readiness to return to sport, fear of reinjury, mood, emotions, sport locus of control, and recovery expectations. Participants were followed up preoperatively and at 4 and 12 months postoperatively. Results: In total, 187 athletes participated. At 12 months, 56 athletes (31%) had returned to their preinjury level of sports participation. Significant independent contributions to returning to the preinjury level by 12 months after surgery were made by psychological readiness to return to sport, fear of reinjury, sport locus of control, and the athletes estimate of the number of months it would take to return to sport, as measured preoperatively (x2 2 = 18.3, P<.001, classification accuracy = 70%) and at 4 months postoperatively (x24 = 38.7, P<.001, classification accuracy = 86%). Conclusion: Psychological responses before surgery and in early recovery were associated with returning to preinjury level of sport at 12 months, suggesting that attention to psychological recovery in addition to physical recovery after ACL injury and reconstruction surgery may be warranted. Clinical screening for maladaptive psychological responses in athletes before and soon after surgery may help clinicians identify athletes at risk of not returning to their preinjury level of sport by 12 months. © 2013 The Author(s).
Julian A. F.,OrthoSport Victoria
Operative Techniques in Sports Medicine | Year: 2015
Planning the management for a patient with recurrent patellar instability should be based on information gained from a thorough history and physical examination and supplemented with relevant radiological investigations. In taking the history it is important to distinguish between pain and instability and an open mind should be kept regarding the source of instability symptoms. Recurrent episodes should be distinguished from a single event and the initial episode should be well understood, particularly in relation to the degree of trauma involved and the response of the knee. Symptoms in the other knee and in other family members suggest the presence of predisposing factors.Important components of the physical examination include static and dynamic alignment, a general knee examination, and assessment of patellar height, mobility, and apprehension, as well as patellar tracking. An assessment of femoral version and tibial torsion should be made. The radiological assessment of patellar instability continues to evolve. Although plain radiographs, computerized tomography, and magnetic resonance imaging are all used, a good-quality lateral radiograph with the knee in 20°-30° flexion provides information about the 2 most important factors. -patellar height and trochlear dysplasia. The importance and role of the tibial tuberosity-trochlear groove distance has been questioned in recent research. If surgery is undertaken it should be tailored to the specific needs of the individual patient. No universally accepted algorithm exists for the planning of surgery. There appears to be a trend to use medial patellofemoral ligament reconstruction as the mainstay of surgery with an apparent reduction in the use of medial tibial tuberosity transfer. Additional procedures, particularly tibial tuberosity distalization and. -in some centers. -trochleoplasty, can be used to address predisposing factors that are felt to be significant contributors to the patient's problem. Procedures may need to be modified in the skeletally immature or individuals with hyperlaxity. Femoral and tibial osteotomies may have a role in habitual and permanent patellar dislocation. © 2015 Elsevier Inc.
PubMed | University of The Sunshine Coast, OrthoSport Victoria, La Trobe University, University of Queensland and St Vincents Private Hospital
Type: | Journal: Gait & posture | Year: 2016
Following anterior cruciate ligament (ACL) rupture, reconstructive surgery (ALCR) is often performed to mechanically stabilise the knee, however functional deficits often persist long after surgery. Impaired single-limb standing balance has been observed in the ACLR limb compared to healthy individuals. However, it remains inconclusive as to whether these same balance deficits exist between the injured and contralateral uninjured limbs, during challenging balance tasks, and at a time when patients are permitted to return to sport. 100 adults who had undergone a primary hamstring-tendon ACLR 12 months previously (68 male; median[IQR] age: 28.1[14.1] years) performed tests of single-limb standing with the knee in a functional position of 20-30 flexion, with their eyes closed, over 20s (Nintendo Wii Balance Board). Two repetitions were performed on the ACLR and uninjured limb. Measures of postural control included centre of pressure (CoP) path velocity, anterior-posterior and mediolateral range and standard deviation, and were averaged across the two trials. Wilcoxon signed-rank tests showed no significant between-leg differences in single-limb balance for any of the CoP measures of interest (all P values>0.686). Further, multiple linear regression analyses showed no significant associations between concomitant meniscectomy or chondral lesions noted at the time of ACLR and measures of single-limb balance on the ACLR limb one year later (all P values>0.213). In the context of prior research, these findings suggest bilateral balance deficits may exist prior to ACL injury, or appear post ACL-injury or ACLR. Treatment of balance deficits should therefore consider both limbs after ACLR.
PubMed | OrthoSport Victoria, Monash University, The Alfred Hospital and obe University
Type: Journal Article | Journal: Foot & ankle international | Year: 2016
Achilles tendinopathy is a frequent problem in high-level athletes. Recent research has proposed a combined etiologic role for the plantaris tendon and neovascularization. Both pathologies can be observed on ultrasound imaging.(1,13) However, little is known about the change in structure of the Achilles tendon following the surgical treatment of these issues. The purpose of the study was to assess if excising the plantaris and performing ventral paratendinous scraping of the neovascularization improved symptoms of Achilles tendinopathy and whether there was a change in the fibrillar structure of the tendon with ultrasound tissue characterization (UTC) following this operation.This prospective consecutive case series included 15 professional/semiprofessional athletes (17 Achilles tendons) who underwent plantaris excision and paratendinous scraping to treat noninsertional Achilles tendinopathy. The plantaris tendon was excised if adherent to the Achilles tendon, and the area of neovascularization for scraping was demarcated on preoperative imaging. Preoperative and postoperative Victorian Institute of Sports Assessment-Achilles (VISA-A) scores were taken. UTC was performed on 11 of 17 tendons preoperatively and postoperatively. The mean follow-up was for 25 months.Fourteen of 15 patients had a successful outcome after the surgery. The mean VISA-A improved from 51 to 95 (p=.0001). There was a statistically significant (p=.04) improvement in the aligned fibrillar structure of the tendon confirmed with UTC scanning following surgery from 90% (8) to 96% (5).This group of high-level athletes derived an excellent clinical result from this operation. Furthermore, UTC scanning offered an objective method to evaluate the healing of Achilles tendons.Level IV, case series.
PubMed | Boston University, OrthoSport Victoria, La Trobe University, St Vincents Private Hospital and University of Melbourne
Type: Journal Article | Journal: Osteoarthritis and cartilage | Year: 2016
Patellofemoral osteoarthritis (PFOA) commonly occurs following anterior cruciate ligament reconstruction (ACLR). Our study aimed to compare knee kinematics and kinetics during a hop-landing task between individuals with and without early PFOA post-ACLR.Forty-five individuals (meanSD 265 years) 1-2 years post-ACLR underwent 3T isotropic MRI scans and 3D biomechanical assessment of a standardised forward hop task. Knee kinematics (initial contact, peak, excursion) in all three planes and sagittal plane kinetics (peak) were compared between 15 participants with early PFOA (MRI-defined patellofemoral cartilage lesion) and 30 participants with no PFOA (absence of patellofemoral cartilage lesion on MRI) using analysis of covariance (ANCOVA), adjusted for age, BMI, sex and the presence of early tibiofemoral OA.Compared to participants without PFOA, those with early PFOA exhibited smaller peak knee flexion angles (mean difference, 95% confidence interval [CI]: -5.2, -9.9 to-0.4; P=0.035) and moments (-4.2Nm/kg.m, -7.8 to-0.6; P=0.024), and greater knee internal rotation excursion (5.3, 2.0 to 8.6; P=0.002).Individuals with early PFOA within the first 2-years following ACLR exhibit distinct kinematic and kinetic features during a high-load landing task. These findings provide new information regarding common post-ACLR biomechanical patterns and PFOA. Since management strategies, such as altering knee load, are more effective during the early stages of disease, this knowledge will help to inform clinical management of early PFOA post-ACLR.