17 results on '"Heikki Nurmi"'
Search Results
2. The influence of primary treatment approach on outcomes in patients with osteochondral fracture after patellar dislocation: a case series
- Author
-
Mikko Uimonen, Ville Ponkilainen, Ville M. Mattila, Heikki Nurmi, Juha Paloneva, and Jussi P. Repo
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Abstract Background We characterized the relation of primary treatment approaches to the need of later surgical interventions and the outcomes of patellar dislocation in patients with patellofemoral osteochondral fracture (OCF). Methods Overall, 134 patients with OCF were categorized in two groups according to treatment approach: primary surgery (operation within 90 days from injury) and conservative treatment. Data on surgical procedures, OCF characteristics, and patellofemoral anatomy were retrospectively collected. To measure subjective outcomes, 54 patients completed the knee-specific patient-reported outcome measures (PROMs) Kujala score, Tegner activity scale, the knee injury and osteoarthritis outcome score (KOOS) quality of life (QoL) subscale, and visual analog scale pain items. Results The mean follow-up time was 4.9 years [standard deviation (SD) 2.7 years]. The primary treatment approach was surgery in 73 patients (54%) and conservative in 61 patients (46%) of whim 18 (30%) needed late surgery. Of primary surgery patients, the OCF was reimplanted in 45 patients (62%) and removed in the rest. Of all patients, 31 needed surgery in the later phase after the primary treatment approach (either reoperation or surgery after insufficient outcome of conservative treatment). In conservatively treated patients, OCF was smaller and patellofemoral joint malformation was more severe than in surgery group. Among patients who completed the PROMs, the outcomes appeared generally acceptable in both groups. Conclusions Although a majority of the primary treatment approaches for OCF after patellar dislocation were definitive, one-fourth of patients required surgery in the later phase. PROMs did not indicate major differences between the study groups.
- Published
- 2023
- Full Text
- View/download PDF
3. Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation
- Author
-
Jussi P. Repo, Mikko M. Uimonen, Mika T. Nevalainen, Heikki Nurmi, Ville T. Ponkilainen, Antti Tuominen, and Juha Paloneva
- Subjects
Patella ,Dislocation ,MPFL ,Reconstruction ,Fracture ,Knee ,Orthopedic surgery ,RD701-811 - Abstract
Abstract Purpose We examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation. Methods Patients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS). Results During 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures. Conclusion The removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The short-term outcomes are encouraging. Level of evidence: Level IV, retrospective case series.
- Published
- 2022
- Full Text
- View/download PDF
4. Water droplet friction and rolling dynamics on superhydrophobic surfaces
- Author
-
Matilda Backholm, Daniel Molpeceres, Maja Vuckovac, Heikki Nurmi, Matti J. Hokkanen, Ville Jokinen, Jaakko V. I. Timonen, and Robin H. A. Ras
- Subjects
Materials of engineering and construction. Mechanics of materials ,TA401-492 - Abstract
Hydrophobic coatings are increasingly important in modern technology, but hard to study in the extreme non-wetting limit. Here, micropipette force sensors can directly measure nN-scale friction forces and, combined with particle image velocimetry, reveal pure rolling dynamics of slow water droplets.
- Published
- 2020
- Full Text
- View/download PDF
5. The risk of osteochondral fracture after patellar dislocation is related to patellofemoral anatomy
- Author
-
Jussi P. Repo, Gilber Kask, Ville M. Mattila, Mikko M. Uimonen, Ville T. Ponkilainen, Susanna Hirvinen, Heikki Nurmi, and Juha Paloneva
- Subjects
030222 orthopedics ,medicine.medical_specialty ,medicine.diagnostic_test ,Sports medicine ,business.industry ,Magnetic resonance imaging ,030229 sport sciences ,Anatomy ,Logistic regression ,Condyle ,03 medical and health sciences ,0302 clinical medicine ,Propensity score matching ,Orthopedic surgery ,medicine ,Orthopedics and Sports Medicine ,Surgery ,Patella ,business ,Osteochondral fracture - Abstract
Despite the comprehensive literature on the anatomical risk factors for patellar dislocation, knowledge on the risk factors for subsequent osteochondral fracture (OCF) remains limited. Magnetic resonance imaging was used to compare measures of patellofemoral anatomy in patients with OCF after patellar dislocation and propensity score matched patients without OCF. For differing measures, limit values showing a 50% probability for the occurrence of OCF were calculated using predictive logistic regression modelling. Proportions of abnormal measures in the groups were compared using Chi-square test. The association of anatomical measures with OCF location was examined by comparing subgroup mean values in the different OCF locations. Propensity score matching provided a total of 111 matched pairs of patients with OCF and patients without OCF. The patients with and without OCF differed in patellotrochlear index (PTI; 0.54 [95% CI 0.52–0.57] vs. 0.47 [95% CI 0.45–0.49]; p 0.51 for PTI > 21.1 mm for TT-PCL 0.48 for trochlear facet asymmetry ratio and
- Published
- 2021
6. Surgery for patellar dislocation has evolved towards anatomical reconstructions with assessment and treatment of anatomical risk factors
- Author
-
Tuomas T. Huttunen, Ville M. Mattila, Juha Paloneva, Jussi P. Repo, Mikko M. Uimonen, Heikki Nurmi, Tampere University, Clinical Medicine, Department of Prehospital Emergency Care, Pain Management and Anaesthesiology, and Department of Musculoskeletal Diseases
- Subjects
Adult ,Joint Instability ,Male ,medicine.medical_specialty ,Adolescent ,Sports medicine ,Patellar Dislocation ,Arthroplasty ,Patellofemoral Joint ,Young Adult ,Risk Factors ,Dislocation (syntax) ,Hospital discharge ,medicine ,Humans ,Knee ,Orthopedics and Sports Medicine ,Registries ,Finland ,business.industry ,Incidence ,Incidence (epidemiology) ,Patellar dislocation surgery ,3126 Surgery, anesthesiology, intensive care, radiology ,musculoskeletal system ,Surgery ,medicine.anatomical_structure ,Orthopedic surgery ,Ligament ,Female ,Patella ,Diagnosis code ,Knee injury ,business - Abstract
PurposeIncreasing knowledge on the treatment of patellar dislocation has resulted in the development of new surgical techniques for patella stabilisation. National incidence and trends in surgery for patellar dislocation were examined using data from the Finnish National Hospital Discharge Register (NHDR). The hypothesis was that an increased understanding of the pathophysiology of patellar instability has increased the popularity of reconstructing damaged structures and modification of anatomical risk factors.MethodsData from the years 1997–2016 were collected from the NHDR database using ICD-10 diagnostic codes and the Nomesco Classification of Surgical Procedures (NCSP) codes. Surgical procedures were categorised into subgroups representing the main surgical approaches of patellar dislocation. Total incidence of surgery for patellar dislocation and change in incidence during the study period were calculated.ResultsA total of 9702 operations for patellar dislocation were performed during the study period. Median (IQR) patient age at time of primary surgery was 23 (18–34) years. The total incidence of surgeries remained stable across the study period at of 8.9 per 100,000 person-years. Incidences of ligament reconstruction, femoral osteotomies and osteochondral fragment reimplantation operations multiplied during the study period. Ligament reconstruction procedures were the most performed operations at the end of the study period.ConclusionThe incidence of surgical procedures for patellar dislocation remained unchanged during the years 1997–2016. Ligament reconstruction procedures increased in popularity. Surgical techniques have shifted towards the reconstruction of damaged structures and the modification of congenital anatomical risk factors for patellar dislocation. Diversified surgical techniques have enabled the tailoring and combining of stabilizing procedures according to the patient’s individual anatomy.
- Published
- 2020
7. Arthroscopic partial meniscectomy for a degenerative meniscus tear: a 5 year follow-up of the placebo-surgery controlled FIDELITY (Finnish Degenerative Meniscus Lesion Study) trial
- Author
-
Raine, Sihvonen, Mika, Paavola, Antti, Malmivaara, Ari, Itälä, Antti, Joukainen, Juha, Kalske, Heikki, Nurmi, Jaanika, Kumm, Niko, Sillanpää, Tommi, Kiekara, Aleksandra, Turkiewicz, Pirjo, Toivonen, Martin, Englund, Simo, Taimela, Teppo L N, Järvinen, Ville, Äärimaa, FICEBO, University of Helsinki, HUS Musculoskeletal and Plastic Surgery, I kirurgian klinikka (Töölö), Department of Surgery, Helsinki University Hospital Area, Tampere University, Verisuoni- ja toimenpideradiologinen keskus, Clinical Medicine, and Department of Radiology
- Subjects
Osteoarthritis ,law.invention ,Arthroscopy ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,meniscus ,law ,Risk Factors ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,315 Sport and fitness sciences ,Finland ,Original Research ,Lysholm Knee Score ,MIDDLE-AGED PATIENTS ,Absolute risk reduction ,General Medicine ,Osteoarthritis, Knee ,Middle Aged ,MECHANICAL SYMPTOMS ,Magnetic Resonance Imaging ,3. Good health ,Tibial Meniscus Injuries ,medicine.anatomical_structure ,RELIABILITY ,Disease Progression ,medicine.symptom ,Medial meniscus ,Adult ,medicine.medical_specialty ,VERTEBROPLASTY ,Physical Therapy, Sports Therapy and Rehabilitation ,KNEE OSTEOARTHRITIS ,Placebo ,3121 Internal medicine ,CLASSIFICATION ,03 medical and health sciences ,medicine ,Humans ,Patient Reported Outcome Measures ,Aged ,Meniscectomy ,Surgeons ,business.industry ,MEDICINE ,030229 sport sciences ,CARE ,medicine.disease ,RANDOMIZED-TRIAL ,Surgery ,Radiography ,PATHOLOGY ,osteoarthritis ,Knee pain ,Orthopedic surgery ,business ,Follow-Up Studies - Abstract
ObjectivesTo assess the long-term effects of arthroscopic partial meniscectomy (APM) on the development of radiographic knee osteoarthritis, and on knee symptoms and function, at 5 years follow-up.DesignMulticentre, randomised, participant- and outcome assessor-blinded, placebo-surgery controlled trial.SettingOrthopaedic departments in five public hospitals in Finland.Participants146 adults, mean age 52 years (range 35–65 years), with knee symptoms consistent with degenerative medial meniscus tear verified by MRI scan and arthroscopically, and no clinical signs of knee osteoarthritis were randomised.InterventionsAPM or placebo surgery (diagnostic knee arthroscopy).Main outcome measuresWe used two indices of radiographic knee osteoarthritis (increase in Kellgren and Lawrence grade ≥1, and increase in Osteoarthritis Research Society International (OARSI) atlas radiographic joint space narrowing and osteophyte sum score, respectively), and three validated patient-relevant measures of knee symptoms and function (Western Ontario Meniscal Evaluation Tool (WOMET), Lysholm, and knee pain after exercise using a numerical rating scale).ResultsThere was a consistent, slightly greater risk for progression of radiographic knee osteoarthritis in the APM group as compared with the placebo surgery group (adjusted absolute risk difference in increase in Kellgren-Lawrence grade ≥1 of 13%, 95% CI −2% to 28%; adjusted absolute mean difference in OARSI sum score 0.7, 95% CI 0.1 to 1.3). There were no relevant between-group differences in the three patient-reported outcomes: adjusted absolute mean differences (APM vs placebo surgery), −1.7 (95% CI −7.7 to 4.3) in WOMET, −2.1 (95% CI −6.8 to 2.6) in Lysholm knee score, and −0.04 (95% CI −0.81 to 0.72) in knee pain after exercise, respectively. The corresponding adjusted absolute risk difference in the presence of mechanical symptoms was 18% (95% CI 5% to 31%); there were more symptoms reported in the APM group. All other secondary outcomes comparisons were similar.ConclusionsAPM was associated with a slightly increased risk of developing radiographic knee osteoarthritis and no concomitant benefit in patient-relevant outcomes, at 5 years after surgery.Trial registrationClinicalTrials.gov (NCT01052233andNCT00549172).
- Published
- 2020
8. Biomechanical Changes of Repair Tissue after Autologous Chondrocyte Implantation at Long-Term Follow-Up
- Author
-
Anna Vasara, Teemu Paatela, Hannu Kautiainen, Ilkka Kiviranta, Jukka S. Jurvelin, and Heikki Nurmi
- Subjects
Cartilage, Articular ,medicine.medical_specialty ,0206 medical engineering ,Biomedical Engineering ,Physical Therapy, Sports Therapy and Rehabilitation ,02 engineering and technology ,Transplantation, Autologous ,Lesion ,03 medical and health sciences ,Chondrocytes ,0302 clinical medicine ,medicine ,Humans ,Immunology and Allergy ,Autologous chondrocyte implantation ,Clinical Research papers ,medicine.diagnostic_test ,business.industry ,Cartilage ,Arthroscopy ,Stiffness ,030229 sport sciences ,medicine.disease ,Osteochondritis Dissecans ,020601 biomedical engineering ,Osteochondritis dissecans ,Surgery ,Transplantation ,medicine.anatomical_structure ,Repair tissue ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Objective. This study aims to describe biomechanical maturation process of repair tissue after cartilage repair with autologous chondrocyte implantation (ACI) at long-term follow-up. Design. After ACI, 40 patients underwent altogether 60 arthroscopic biomechanical measurements of the repair tissue at various time points during an up to 11-year follow-up period. Of these patients, 30 patients had full-thickness cartilage lesions and 10 had an osteochondritis dissecans (OCD) defect. The mean lesion area was 6.5 cm2 (SD 3.2). A relative indentation stiffness value for each individually measured lesion was calculated as a ratio of repair tissue and surrounding cartilage indentation value to enable interindividual comparison. Results. Repair tissue stiffness improved during approximately 5 years after surgery. Most of the increase in stiffness occurred during the first 2 years. The curvilinear correlation between relative stiffness values and the follow-up time was 0.31 (95% CI 0.07-0.52), P = 0.017. The interindividual variation of the stiffness was high. Lesion properties or demographic factors showed no significant correlation to biomechanical outcome. The overall postoperative average relative stiffness was 0.75 (SD 0.47). Conclusions. Our clinical study describes a biomechanical maturation process of cartilage repair that may continue even longer than expected. A substantial increase in tissue stiffness proceeds for the first two years postoperatively. Minor progression proceeds for even longer. In some repairs, the biomechanical result was equal to native cartilage, suggesting hyaline-type repair. The variation in biomechanical results suggests substantial inconsistency in the structural outcome following ACI.
- Published
- 2020
9. Outcomes following the operative treatment of intra-articular fracture combined with medial patellofemoral ligament reconstruction after patellar dislocation
- Author
-
Jussi P. Repo, Mikko M. Uimonen, Mika T. Nevalainen, Heikki Nurmi, Ville T. Ponkilainen, Antti Tuominen, Juha Paloneva, Tampere University, Department of Musculoskeletal Diseases, and Clinical Medicine
- Subjects
Orthopedics and Sports Medicine ,Surgery ,3126 Surgery, anesthesiology, intensive care, radiology - Abstract
Purpose We examine the outcomes following operative treatment of intra-articular fracture combined with medial patellofemoral ligament (MPFL) reconstruction after patella dislocation. Methods Patients were retrospectively identified from medical records using diagnostic and surgical procedure codes. Radiological anatomical parameters and bony abnormalities of injured knees were assessed from magnetic resonance images (MRI). Inclusion criteria were traumatic patellar dislocation with chondral or osteochondral fracture and MPFL rupture, operative treatment of a chondral or osteochondral fracture combined with MPFL reconstruction, and minimum follow-up of 2 years. Outcomes were measured using the Kujala score, Tegner activity scale, and the Knee injury and Osteoarthritis Outcome Score Quality-of-Life subscale (KOOS-QLS). Results During 2012 and 2015, 322 patients were treated because of patellar dislocation. Thirty-three patients had chondral or osteochondral fracture. Eleven patients (five males and six females) with a mean [standard deviation (SD)] age of 17.0 (6.5) years at the time of surgery met the inclusion criteria and were included. Five of the 11 patients had a subchondral and six an osteochondral fracture. Eight patients had a fracture in the patella and three in the femur. All patients had bony abnormalities in the knee. Nine out of 11 patients scored over 90/100 points on the Kujala scale and had good results on the Tegner scale [before surgery 5.0 (2.7) points versus after surgery 5.3 (1.6) points] and the KOOS-QLS [4.1 (4.2) points] outcome measures. Conclusion The removal or fixation of the fracture fragment combined with MPFL reconstruction is a feasible option in the treatment of symptomatic osteochondral or subchondral fragment in traumatic patellar dislocation. The short-term outcomes are encouraging. Level of evidence: Level IV, retrospective case series.
- Published
- 2021
10. Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial
- Author
-
Hannes Keemu, Konsta Pamilo, Jani Knifsund, Tuukka Niinimäki, Tero Vahlberg, Antti Liukas, Alar Toom, Matti Seppänen, Ville Äärimaa, Keijo T Mäkelä, Inari Laaksonen, and Heikki Nurmi
- Subjects
medicine.medical_specialty ,Knee Joint ,medicine.medical_treatment ,Population ,knee ,Osteoarthritis ,adult orthopaedics ,orthopaedic & trauma surgery ,03 medical and health sciences ,0302 clinical medicine ,Superiority Trial ,Quality of life ,medicine ,Outpatient clinic ,Humans ,030212 general & internal medicine ,Prospective Studies ,Unicompartmental knee arthroplasty ,education ,Arthroplasty, Replacement, Knee ,Finland ,030222 orthopedics ,education.field_of_study ,business.industry ,General Medicine ,Osteoarthritis, Knee ,medicine.disease ,Arthroplasty ,Surgery ,Treatment Outcome ,Quality of Life ,musculoskeletal disorders ,business ,Knee Prosthesis ,Oxford knee score - Abstract
ObjectiveThe primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee.DesignProspective, randomised, 2 years, assessor-blind, multicentre, superiority trial.SettingThe patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland).ParticipantsWe recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis.InterventionsAll patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up.Main outcome measuresPrimary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements.ResultsThe primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI −0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI −4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI −0.6 to 9.2) for function in daily living, 4.3 points (95% CI −3.0 to 11.6) for function in sports, and 2.1 points (95% CI −4.8 to 9.1) for knee-related quality of life.ConclusionsThe recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years.Trial registration numberNCT02481427.
- Published
- 2021
11. Assessment of Cartilage Repair Quality With the International Cartilage Repair Society Score and the Oswestry Arthroscopy Score
- Author
-
Anna Vasara, Heikki Nurmi, Teemu Paatela, Ilkka Kiviranta, Hannu Kautiainen, HUS Musculoskeletal and Plastic Surgery, Clinicum, I kirurgian klinikka (Töölö), University of Helsinki, and Department of Surgery
- Subjects
Cartilage, Articular ,Male ,Internationality ,Intraclass correlation ,02 engineering and technology ,Severity of Illness Index ,Arthroscopy ,0302 clinical medicine ,Medicine ,Orthopedics and Sports Medicine ,Autologous chondrocyte implantation ,Observer Variation ,CORRELATE ,medicine.diagnostic_test ,AUTOLOGOUS CHONDROCYTE IMPLANTATION ,DEFECTS ,Middle Aged ,cartilage repair ,KNEE ,Female ,MRI ,Adult ,medicine.medical_specialty ,0206 medical engineering ,repair tissue quality ,03 medical and health sciences ,Chondrocytes ,Cronbach's alpha ,SYSTEMS ,Humans ,International Cartilage Repair Society Score ,Cartilage repair ,030203 arthritis & rheumatology ,Wound Healing ,TRANSPLANTATION ,business.industry ,Reproducibility of Results ,3126 Surgery, anesthesiology, intensive care, radiology ,RELIABILITY GENERALIZATION ,BIOMECHANICS ,020601 biomedical engineering ,Confidence interval ,Surgery ,Transplantation ,Cartilage ,Repair tissue ,Second-Look Surgery ,business ,Oswestry Arthroscopic Score - Abstract
The International Cartilage Repair Society (ICRS) score and the Oswestry Arthroscopic Score (OAS) have been validated to evaluate repair tissue quality. However, the performance of these scores has not been studied in typical patients undergoing cartilage repair and who have lesions of varying sizes. In this study, we compared the performance of the ICRS and the OAS scores and analyzed the effect of lesion characteristics on the performance of these two scores. Cartilage repair quality was assessed in a total of 104 arthroscopic observations of cartilage repair sites of the knee in 62 patients after autologous chondrocyte implantation. Two observers scored the repair areas independently with the ICRS and the OAS scores. The performance of both scores was evaluated according to internal consistency and inter-rater reliability and correlation between the scores. The frequency and proportion of disagreements were analyzed according to the repair site area and the given score. The correlation between the scores was good (r = 0.91, 95% confidence interval [CI]: 0.87-0.94). Both scores showed moderate internal consistency and inter-rater reliability. Cronbach's alpha was 0.88 (95% CI: 0.80-0.92) for the ICRS score and 0.79 (95% CI: 0.70-0.86) for the OAS score. The intraclass correlation coefficient was 0.89 (95% CI: 0.84-0.92) for the ICRS and 0.81 (95% CI: 0.74-0.87) for the OAS scores. The frequency and proportion of disagreements were higher in larger repair sites. In arthroscopic use, both ICRS and OAS scores perform similarly, however, their reliability deteriorates as the lesion size increases. (c) 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res
- Published
- 2019
12. The risk of osteochondral fracture after patellar dislocation is related to patellofemoral anatomy
- Author
-
Mikko, Uimonen, Ville, Ponkilainen, Susanna, Hirvinen, Ville M, Mattila, Gilber, Kask, Heikki, Nurmi, Juha, Paloneva, and Jussi P, Repo
- Subjects
Joint Instability ,Patellofemoral Joint ,Tibia ,Risk Factors ,Patellar Dislocation ,Humans ,Patella ,Magnetic Resonance Imaging - Abstract
Despite the comprehensive literature on the anatomical risk factors for patellar dislocation, knowledge on the risk factors for subsequent osteochondral fracture (OCF) remains limited.Magnetic resonance imaging was used to compare measures of patellofemoral anatomy in patients with OCF after patellar dislocation and propensity score matched patients without OCF. For differing measures, limit values showing a 50% probability for the occurrence of OCF were calculated using predictive logistic regression modelling. Proportions of abnormal measures in the groups were compared using Chi-square test. The association of anatomical measures with OCF location was examined by comparing subgroup mean values in the different OCF locations.Propensity score matching provided a total of 111 matched pairs of patients with OCF and patients without OCF. The patients with and without OCF differed in patellotrochlear index (PTI; 0.54 [95% CI 0.52-0.57] vs. 0.47 [95% CI 0.45-0.49]; p 0.001), tibial tubercle-posterior cruciate ligament distance (TT-PCL; 21.6 mm [95% CI 21.0-22.3 mm] vs. 20.5 mm [95% CI 20.0-21.1 mm]; p = 0.013), trochlear depth (2.5 mm [95% CI 2.3-2.7 mm] vs. 3.0 mm [95% CI 2.8-3.2 mm]; p 0.001) trochlear facet asymmetry ratio (0.54 [95% CI 0.51-0.57] vs. 0.43 [95% CI 0.42-0.45]; p 0.001) and trochlear condyle asymmetry ratio (1.04 [95% CI 1.03-1.04] vs. 1.05 [95% CI 1.04-1.05]; 0.013. Thresholds for increased OCF risk were 0.51 for PTI 21.1 mm for TT-PCL 2.8 mm for trochlear depth 0.48 for trochlear facet asymmetry ratio and 1.04 for trochlear condyle asymmetry ratio.In patients with OCF after patellar dislocation, trochlear configuration and patella vertical location were closer to normal anatomy, whereas patella lateralization was more severe when compared to patients without OCF. These anatomical factors contribute to the risk of OCF during patellar dislocation.III.
- Published
- 2020
13. Chondral and Osteochondritis Dissecans Lesions Treated by Autologous Chondrocytes Implantation: A Mid- to Long-Term Nonrandomized Comparison
- Author
-
Anna Vasara, Teemu Paatela, Ilkka Kiviranta, Heikki Nurmi, Markus J. Sormaala, and Hannu Kautiainen
- Subjects
Cartilage, Articular ,medicine.medical_specialty ,Biomedical Engineering ,Physical Therapy, Sports Therapy and Rehabilitation ,Osteoarthritis ,Transplantation, Autologous ,03 medical and health sciences ,0302 clinical medicine ,Chondrocytes ,medicine ,Immunology and Allergy ,Humans ,In patient ,Cartilage repair ,Autologous chondrocyte implantation ,Clinical Research papers ,Retrospective Studies ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Arthroscopy ,030229 sport sciences ,medicine.disease ,Osteochondritis dissecans ,Osteochondritis Dissecans ,Surgery ,business - Abstract
Objective The aim of this study was to compare the clinical outcome of cartilage repair with autologous chondrocyte implantation (ACI) in patients with osteochondritis dissecans (OCD) lesions and full-thickness cartilage lesions. Design This study included a cohort of 115 consecutive patients with a cartilage lesion of the knee treated with ACI. Of the patients, 35 had an OCD lesion and 80 a full-thickness cartilage lesion. During a follow-up period from 2 to 13 years all treatment failures were identified. The failure rate between OCD lesions and full-thickness cartilage lesions was compared with Kaplan-Meier analysis. Patient-reported outcome was evaluated 2 years postoperatively with the Lysholm score. Results During the follow-up 21 out of 115 patients encountered a treatment failure. The failure rate for full-thickness cartilage lesions was 19.1% and for OCD lesions 43.3% over the 10-year follow-up. Patient-reported outcome improved from baseline to 2 years postoperatively. The improvement from baseline was statistically significant, and the Lysholm score improved more than the minimal clinically important difference. The patient-reported outcome showed no difference between lesion types at 2 years. Conclusions In the presented retrospective study, the failure rate of first-generation ACI was higher in OCD lesions than in large full-thickness cartilage lesions, suggesting that OCD lesions may associate with properties that affect the durability of repair tissue. Future prospective studies are needed to tell us how to best repair OCD lesions with biological tissue engineering.
- Published
- 2020
14. Risk Factors for Failed Nonoperative Treatment and Rerupture in Acute Achilles Tendon Rupture
- Author
-
Juha Paloneva, Heikki Nurmi, Hanna-Liina Logren, Katri Ahonen, and Aleksi Reito
- Subjects
Rupture ,030222 orthopedics ,medicine.medical_specialty ,Achilles tendon ,business.industry ,030229 sport sciences ,Achilles Tendon ,Nonoperative treatment ,Surgery ,Weight-Bearing ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,Treatment Outcome ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Treatment Failure ,Achilles tendon rupture ,medicine.symptom ,business ,Physical Therapy Modalities - Abstract
Background: Nonoperative treatment is feasible in most patients with acute Achilles tendon rupture. Risk factors associated with failed nonoperative treatment are poorly understood. We investigated risk factors associated with rerupture after nonoperative treatment and otherwise failed nonoperative treatment of Achilles tendon rupture. Methods: All patients diagnosed with acute Achilles tendon rupture between January 2009 and June 2016 and who underwent 8 weeks of nonoperative treatment with functional rehabilitation were included in the study. Patients with rerupture or otherwise failed nonoperative treatment were identified retrospectively. Time to rerupture and association of age, sex, time from injury, diabetes, and visits to the physiotherapist for cases of reruptures and otherwise failed nonoperative treatment were investigated. A total of 210 patients were included in the study. Results: Fifteen patients sustained a rerupture. Rerupture incidence was 7.1%. Incidence of late reruptures, those occurring after return to daily activities at 12 weeks, was 1.9%. Six patients had otherwise failed nonoperative treatment. Median time to rerupture was 23 days (6 to 61) after the end of the treatment. The incidence of all-cause failure was 10.0%. Male gender was associated with reruptures ( P = .013) and failed nonoperative treatment for any reason ( P = .029). Conclusion: It is important to highlight the increased risk of rerupture in male patients during the first month after the end of the nonoperative treatment. Age alone, even in male patients, was a poor indication for operative treatment since it did not predict early failure. Further studies will hopefully clarify the influence of activity level on the risk of rerupture. Level of Evidence: Level IV, retrospective case series.
- Published
- 2018
15. Treatment of acute Achilles tendon ruptures in Central Finland Central Hospital in 2010-2015
- Author
-
Aleksi, Reito, Hanna-Liina, Logren, Katri, Ahonen, Heikki, Nurmi, and Juha, Paloneva
- Subjects
Male ,Rupture ,Postoperative Complications ,Treatment Outcome ,Tendon Injuries ,Incidence ,Humans ,Female ,Conservative Treatment ,Achilles Tendon ,Finland - Abstract
The epidemiology of Achilles tendon ruptures and treatment strategies have undergone a major change in recent years. We investigated the incidence of acute Achilles tendon ruptures, the choice of treatment strategies and treatment implementation.The research material consisted of patients living in the catchment area of Central Finland Hospital District who had been diagnosed with an acute Achilles tendon rupture between 2010 and 2015.The final sample consisted of 266 patients. Conservative treatment was started for 207 patients, and the remaining 59 were referred for surgery. During the study period, the proportion of patients undergoing surgery fell from 41% to 10%. Three patients (1.4%) were referred for surgery during conservative treatment, and 10 patients (4.7%) developed deep vein thrombosis while wearing a cast or an orthosis. Twelve patients (5.8%) sustained a re-rupture after conservative treatment. Two surgically-treated patients (3.5%) sustained a re-rupture, and one patient (1.7%) developed deep vein thrombosis.The strategies for treating acute Achilles tendon ruptures have clearly become more conservative in our hospital. Conservative treatment is safe and rarely fails. However, it is important to bear in mind that surgery still has a role in the treatment of acute Achilles tendon ruptures.
- Published
- 2017
16. Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative Meniscal Tear
- Author
-
Juha Kalske, Abstr Act, Antti Malmivaara, Mika Paavola, Heikki Nurmi, Ari Itälä, Antti Joukainen, and Raine Sihvonen
- Subjects
ta3126 ,medicine.medical_specialty ,Intention-to-treat analysis ,business.industry ,Sham surgery ,General Medicine ,Osteoarthritis ,medicine.disease ,Surgery ,law.invention ,Knee pain ,medicine.anatomical_structure ,Tibial Meniscus Injuries ,Randomized controlled trial ,law ,Intensive care ,Medicine ,medicine.symptom ,business ,Medial meniscus - Abstract
Background Arthroscopic partial meniscectomy is one of the most common orthopedic procedures, yet rigorous evidence of its efficacy is lacking. Methods We conducted a multicenter, randomized, double-blind, sham-controlled trial in 146 patients 35 to 65 years of age who had knee symptoms consistent with a degenerative medial meniscus tear and no knee osteoarthritis. Patients were randomly assigned to arthroscopic partial meniscectomy or sham surgery. The primary outcomes were changes in the Lysholm and Western Ontario Meniscal Evaluation Tool (WOMET) scores (each ranging from 0 to 100, with lower scores indicating more severe symptoms) and in knee pain after exercise (rated on a scale from 0 to 10, with 0 denoting no pain) at 12 months after the procedure. Results In the intention-to-treat analysis, there were no significant between-group differences in the change from baseline to 12 months in any primary outcome. The mean changes (improvements) in the primary outcome measures were as follows: Lysholm score, 21.7 points in the partial-meniscectomy group as compared with 23.3 points in the sham-surgery group (between-group difference, −1.6 points; 95% confi dence interval [CI], −7.2 to 4.0); WOMET score, 24.6 and 27.1 points, respectively (between-group difference, −2.5 points; 95% CI, −9.2 to 4.1); and score for knee pain after exercise, 3.1 and 3.3 points, respectively (between-group difference, −0.1; 95% CI, −0.9 to 0.7). There were no significant differences between groups in the number of patients who required subsequent knee surgery (two in the partialmeniscectomy group and five in the sham-surgery group) or serious adverse events (one and zero, respectively). Conclusions In this trial involving patients without knee osteoarthritis but with symptoms of a degenerative medial meniscus tear, the outcomes after arthroscopic partial meniscectomy were no better than those after a sham surgical procedure. (Funded by the Sigrid Juselius Foundation and others; ClinicalTrials.gov number, NCT00549172.)
- Published
- 2013
17. Arthroscopic Partial Meniscectomy vs Sham Surgery for Degenerative Meniscus Tear
- Author
-
Teppo L. N. Järvinen, Antti Joukainen, Raine Sihvonen, Juha Kalske, Heikki Nurmi, Antti Malmivaara, Ari Itälä, and Mika Paavola
- Subjects
medicine.medical_specialty ,medicine.anatomical_structure ,business.industry ,medicine ,Sham surgery ,Orthopedics and Sports Medicine ,Meniscus (anatomy) ,business ,Surgery - Published
- 2014
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.