Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 mont... more Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 months after total hip arthroplasty. All patients received a single irradiation dose of 7Gy the day before the operation, followed by oral indomethacin (3x25mg/day) for six weeks. Continuous passive mobilization under epidural anesthesia was started immediately post-operatively. At an average follow-up of 2 years none of them had radiographic or clinical evidence of recurrence. Consequently we recommend resection as soon as there are severe clinical implications, even when bone scans indicate immaturity of the heterotopic ossification and provided that the resection is combined with proper non-surgical treatment consisting of irradiation and oral indomethacin and immediate extensive rehabilitation program.
Intramedullary nailing has become the gold standard for treatment of femoral diaphyseal fractures... more Intramedullary nailing has become the gold standard for treatment of femoral diaphyseal fractures. Between March 1995 and December 1998 we performed 40 intramedullary nailings using the ACE femoral nail (De Puy). The patients were followed for an average of 27.9 months (range: 6-54 months). The mean age was 33.2 years (range: 17-87 years); the sex distribution was 33 males and 7 females. All fractures were unilateral (right 18, left 22). Most of the fractures were caused by traffic accidents (35), the others originated from sports, work and gunshot (1). Thirty-five fractures were closed and 5 were open: 1 was grade I, 2 were grade II and 2 grade IIIa according to Gustilo's classification. According to the AO classification 18 fractures were type A, 13 type B and 9 type C. The majority of patients had associated injuries: neurotrauma 2, chest trauma 2, and other fractures e.g. of the clavicula, lumbar spine, patella, tibia. Immediate surgery was performed in 34 cases, delayed sur...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 1991
The authors describe a technique in which a free patellar tendon graft is used for intraarticular... more The authors describe a technique in which a free patellar tendon graft is used for intraarticular reconstruction of the posterior cruciate ligament through an anterior and posterior approach. Only patients under 50 years of age with functional instability not responding to exercise therapy were elected for this type of surgery. Between November 1982 and May 1988, 12 patients were operated upon. In 9 patients the follow-up averaged 34 months. The subjective results were evaluated following the Lysholm rating system; the objective results were assessed by means of a clinical examination which was always performed by the same physician. The results were very encouraging and warrant a continued use of the technique with proper indications.
ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconst... more ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconstructions were performed using a Dacron graft. Evaluation was done using the Lysholm rating system and Tegner scale. The Lysholm score averaged 84.2. Regarding the level of performance, the patients had lost an average of 2.1 points on the Tegner scale. 18 of the 57 patients developed a synovitis. In 11 patients (19 per cent) the implant had to be removed. CT scan of the operated knee proved the Dacron graft to be nonfunctioning in as many as 40 per cent of the patients. Because of this high complication rate, the authors started to use deep-frozen (-70 degrees C) tendon allograft material. Both Achilles and Tibialis Posterior tendons were implanted using the over-the-top technique with or without an additional extra-articular procedure. Complications as seen with the rigid synthetic ligaments were absent. The preliminary results seem satisfactory in that the functional demands placed on ...
Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel... more Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel decompression can be a source of confusion, particularly for the less experienced surgeon. We investigated how frequently muscle fibres crossed the line of incision on the palmar surface of the flexor retinaculum at carpal tunnel decompression in 143 hands, and dissected 103 cadaver hands to study the origin and insertion of these muscle fibres. The line of incision was defined as a longitudinal line between thenar and hypothenar eminences along the third web space, with the wrist in neutral radioulnar deviation and the fingers in extension. Muscle fibres crossing the line of incision were absent in 50% of the operated hands, 2–10 mm wide in 39% and more than 10 mm wide in 11%. In the cadaver hands the proportions were similar at 50%, 35% and 15%, respectively. The fibres were extensions of the thenar and hypothenar muscles and did not appear to represent a separate anomalous muscle.
Background As the natural healing capacity of damaged articular cartilage is poor, joint surface ... more Background As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. Purpose To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. Study Design Randomized controlled trial; Level of evidence, 1. Methods Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1...
The objective of this review is to give a state of affairs of meniscal transplantation, with the ... more The objective of this review is to give a state of affairs of meniscal transplantation, with the accent on preservation and surgical techniques. All articles were selected by performing a search on the literature by using relevant keywords. The most relevant articles were selected with close attention to the publication date. When a meniscal tear is diagnosed, suture can be an option in the vascular zone, whereas the more frequently affected avascular zone heals poorly. A meniscectomy however is not without consequences, wherefore meniscal transplantation can be seen as a therapeutic option for pain reduction and improvement of function when the meniscus is lost. The meniscal scaffold, allograft and autograft can be currently withheld as possible grafts, where the meniscal scaffolds hold great promise as an alternative to the allograft. Various fixation techniques are therefore developed, where viable, deep frozen as well as cryopreservated allografts seem to give the most promising...
Verhandelingen - Koninklijke Academie voor Geneeskunde van België, 2004
Aging of the population and thus of loadbearing cartilage produces a number of degenerative sympt... more Aging of the population and thus of loadbearing cartilage produces a number of degenerative symptoms. At the knee, considerable macroscopic asymmetry of the joint underlies these degenerative changes, were it not for two menisci that somewhat neutralize this discongruency. Microscopically, cartilage is a structure within the knee joint that allows for low friction and congruent movement. Repetitive microtrauma rather than macrotrauma can affect its integrity. Both microscopically and macroscopically reconstruction of a cartilage-like structure is achieved through implantation of cultured cells or auto- and allografts either by minimally invasive or classical surgery, which theoretically could have a beneficial effect on the natural course of degeneration.
Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 mont... more Early excision of heterotopic ossification was performed in 8 patients at an average of 10.2 months after total hip arthroplasty. All patients received a single irradiation dose of 7Gy the day before the operation, followed by oral indomethacin (3x25mg/day) for six weeks. Continuous passive mobilization under epidural anesthesia was started immediately post-operatively. At an average follow-up of 2 years none of them had radiographic or clinical evidence of recurrence. Consequently we recommend resection as soon as there are severe clinical implications, even when bone scans indicate immaturity of the heterotopic ossification and provided that the resection is combined with proper non-surgical treatment consisting of irradiation and oral indomethacin and immediate extensive rehabilitation program.
Intramedullary nailing has become the gold standard for treatment of femoral diaphyseal fractures... more Intramedullary nailing has become the gold standard for treatment of femoral diaphyseal fractures. Between March 1995 and December 1998 we performed 40 intramedullary nailings using the ACE femoral nail (De Puy). The patients were followed for an average of 27.9 months (range: 6-54 months). The mean age was 33.2 years (range: 17-87 years); the sex distribution was 33 males and 7 females. All fractures were unilateral (right 18, left 22). Most of the fractures were caused by traffic accidents (35), the others originated from sports, work and gunshot (1). Thirty-five fractures were closed and 5 were open: 1 was grade I, 2 were grade II and 2 grade IIIa according to Gustilo's classification. According to the AO classification 18 fractures were type A, 13 type B and 9 type C. The majority of patients had associated injuries: neurotrauma 2, chest trauma 2, and other fractures e.g. of the clavicula, lumbar spine, patella, tibia. Immediate surgery was performed in 34 cases, delayed sur...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 1991
The authors describe a technique in which a free patellar tendon graft is used for intraarticular... more The authors describe a technique in which a free patellar tendon graft is used for intraarticular reconstruction of the posterior cruciate ligament through an anterior and posterior approach. Only patients under 50 years of age with functional instability not responding to exercise therapy were elected for this type of surgery. Between November 1982 and May 1988, 12 patients were operated upon. In 9 patients the follow-up averaged 34 months. The subjective results were evaluated following the Lysholm rating system; the objective results were assessed by means of a clinical examination which was always performed by the same physician. The results were very encouraging and warrant a continued use of the technique with proper indications.
ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconst... more ACL reconstruction is still controversial. Between November 1985 and October 1987, 57 ACL reconstructions were performed using a Dacron graft. Evaluation was done using the Lysholm rating system and Tegner scale. The Lysholm score averaged 84.2. Regarding the level of performance, the patients had lost an average of 2.1 points on the Tegner scale. 18 of the 57 patients developed a synovitis. In 11 patients (19 per cent) the implant had to be removed. CT scan of the operated knee proved the Dacron graft to be nonfunctioning in as many as 40 per cent of the patients. Because of this high complication rate, the authors started to use deep-frozen (-70 degrees C) tendon allograft material. Both Achilles and Tibialis Posterior tendons were implanted using the over-the-top technique with or without an additional extra-articular procedure. Complications as seen with the rigid synthetic ligaments were absent. The preliminary results seem satisfactory in that the functional demands placed on ...
Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel... more Muscle fibres that cross the proposed line of incision of the flexor retinaculum at carpal tunnel decompression can be a source of confusion, particularly for the less experienced surgeon. We investigated how frequently muscle fibres crossed the line of incision on the palmar surface of the flexor retinaculum at carpal tunnel decompression in 143 hands, and dissected 103 cadaver hands to study the origin and insertion of these muscle fibres. The line of incision was defined as a longitudinal line between thenar and hypothenar eminences along the third web space, with the wrist in neutral radioulnar deviation and the fingers in extension. Muscle fibres crossing the line of incision were absent in 50% of the operated hands, 2–10 mm wide in 39% and more than 10 mm wide in 11%. In the cadaver hands the proportions were similar at 50%, 35% and 15%, respectively. The fibres were extensions of the thenar and hypothenar muscles and did not appear to represent a separate anomalous muscle.
Background As the natural healing capacity of damaged articular cartilage is poor, joint surface ... more Background As the natural healing capacity of damaged articular cartilage is poor, joint surface injuries are a prime target for regenerative medicine. Characterized chondrocyte implantation uses an autologous cartilage cell therapy product that has been optimized for its biological potency to form stable cartilage tissue in vivo. Purpose To determine whether, in symptomatic cartilage defects of the femoral condyle, structural regeneration with characterized chondrocyte implantation is superior to repair with microfracture. Study Design Randomized controlled trial; Level of evidence, 1. Methods Characterized chondrocyte implantation was compared with microfracture in patients with single grade III to IV symptomatic cartilage defects of the femoral condyles in a multicenter trial. Patients aged 18 to 50 years were randomized to characterized chondrocyte implantation (n = 57) or microfracture (n = 61). Structural repair was blindly assessed in biopsy specimens taken at 1 year using (1...
The objective of this review is to give a state of affairs of meniscal transplantation, with the ... more The objective of this review is to give a state of affairs of meniscal transplantation, with the accent on preservation and surgical techniques. All articles were selected by performing a search on the literature by using relevant keywords. The most relevant articles were selected with close attention to the publication date. When a meniscal tear is diagnosed, suture can be an option in the vascular zone, whereas the more frequently affected avascular zone heals poorly. A meniscectomy however is not without consequences, wherefore meniscal transplantation can be seen as a therapeutic option for pain reduction and improvement of function when the meniscus is lost. The meniscal scaffold, allograft and autograft can be currently withheld as possible grafts, where the meniscal scaffolds hold great promise as an alternative to the allograft. Various fixation techniques are therefore developed, where viable, deep frozen as well as cryopreservated allografts seem to give the most promising...
Verhandelingen - Koninklijke Academie voor Geneeskunde van België, 2004
Aging of the population and thus of loadbearing cartilage produces a number of degenerative sympt... more Aging of the population and thus of loadbearing cartilage produces a number of degenerative symptoms. At the knee, considerable macroscopic asymmetry of the joint underlies these degenerative changes, were it not for two menisci that somewhat neutralize this discongruency. Microscopically, cartilage is a structure within the knee joint that allows for low friction and congruent movement. Repetitive microtrauma rather than macrotrauma can affect its integrity. Both microscopically and macroscopically reconstruction of a cartilage-like structure is achieved through implantation of cultured cells or auto- and allografts either by minimally invasive or classical surgery, which theoretically could have a beneficial effect on the natural course of degeneration.
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Papers by R. Verdonk