The surgical treatment of knee stiffness following anterior cruciate ligament reconstruction.

Knee stiffness following anterior cruciate ligament (ACL) reconstruction remains a common complication, which can substantially impair knee function. The aim of this study was to assess the effectiveness of arthroscopic arthrolysis, in conjunction with manipulation under anaesthetic (MUA), in treating stiffness post-ACL reconstruction. We reviewed the records of 18 patients who underwent arthroscopic arthrolysis to treat established stiffness following primary isolated ACL reconstruction. Eight of these patients underwent concomitant MUA at time of arthrolysis. The median time between reconstruction and arthrolysis was nine months. Seven patients had arthrolysis performed within eight months of reconstruction, while 11 patients underwent arthrolysis greater than eight months postreconstruction. Following arthrolysis, the mean extension loss improved from 7° to 1°. In patients with mild extension stiffness (prearthrolysis extension deficits <10°), the mean improvement to extension was 3°. In patients with severe extension stiffness (prearthrolysis extension deficit ≥10°), the mean improvement to extension was 10°. Arthroscopic arthrolysis was significantly more effective in restoring extension loss if carried out within eight months of the primary reconstruction (P < 0.03). In the patients who underwent MUA at time of arthrolysis, the mean flexion loss improved from 16° to 4°. In conclusion, arthroscopic arthrolysis, in conjunction with MUA, is an effective treatment for knee stiffness post-ACL reconstruction but ideally should be carried out within eight months.

Knee stiffness following anterior cruciate ligament reconstruction: the incidence and associated factors of knee stiffness following anterior cruciate ligament reconstruction.

We reviewed 100 patients retrospectively following primary ACL reconstruction with quadruple hamstring autografts to evaluate the incidence and factors associated with postoperative stiffness. Stiffness was defined as any loss of motion using the contra-lateral leg as a control. The median delay between injury and operation was 15 months. The incidence of stiffness was 12% at 6 months post-reconstruction. Both incomplete attendance at physiotherapy (p<0.005) and previous knee surgery (p<0.005) were the strongest predictors of the stiffness. Anterior knee pain was also associated with the stiffness (p<0.029). Factors that failed to show a significant association with the stiffness included associated MCL sprain at injury (p=0.32), post-injury stiffness (p=1.00) and concomitant menisectomy at reconstruction (p=0.54). Timing of surgery also did not appear to influence the onset of stiffness (median delays: 29 months for stiff patients; 14 months for non-stiff patients). The rate of stiffness fell to 5% at 12 months postreconstruction, without operative intervention.

The effect of different calculation methods of flywheel parameters on the Wingate Anaerobic Test.

Researchers compared different methods of calculating kinetic parameters of friction-braked cycle ergometers, and the subsequent effects on calculating power outputs in the Wingate Anaerobic Test (WAnT). Three methods of determining flywheel moment of inertia and frictional torque were investigated, requiring "run-down" tests and segmental geometry. Parameters were used to calculate corrected power outputs from 10 males in a 30-s WAnT against a load related to body mass (0.075 kg.kg-1). Wingate Indices of maximum (5 s) power, work, and fatigue index were also compared. Significant differences were found between uncorrected and corrected power outputs and between correction methods (p < .05). The same finding was evident for all Wingate Indices (p < .05). Results suggest that WAnT must be corrected to give true power outputs and that choosing an appropriate correction calculation is important. Determining flywheel moment of inertia and frictional torque using unloaded run-down tests is recommended.

Repair of avulsed insertion of biceps. A new technique in four cases.

We report the use of the Mitek anchor with a limited approach for repair of avulsion of the biceps tendon from the radius in four middle-aged men. All regained a full range of movement with minimal loss of power.

A three-dimensional cinematographical analysis of the volleyball spike.

The objectives of this study were to describe the volleyball spiking actions used by players in top-level competition, and also to examine the interrelationships between upper limb, lower limb and whole body kinematic variables, and post-impact ball speed in the spiking technique. Two Photosonics Biomechanics 500 cine-cameras operating at a nominal frame rate of 100 Hz were used to film the spiking actions of 10 male senior international volleyball players at the XVI Universiade (1991 World Student Games). Three-dimensional object space co-ordinates of digitized image co-ordinates were obtained using a DLT algorithm and an array of calibration points in the filmed volume. Relationships between lower limb angular kinematics at take-off, centre of mass vertical velocity at take-off and centre of mass vertical displacement (jump height) were examined. Relationships between angular kinematics of the hitting arm and post-impact ball speed were also determined. The mean (+/- S.E.) centre of mass vertical velocity at take-off was 3.59 +/- 0.05 m s-1 and the mean height jumped was 0.62 +/- 0.02 m. As expected, a significant correlation was found between the square of the centre of mass vertical velocity at take-off and jump height (r = 0.78; P < 0.01). No significant correlations were found between lower limb angular kinematics and centre of mass vertical velocity at take-off or jump height. The mean post-impact ball speed was 27.0 +/- 0.9 m s-1, and this was significantly correlated to maximum right humerus angular velocity (r = 0.75; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Nilutamide. A review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in prostate cancer.

Nilutamide is a nonsteroidal antiandrogen with affinity for androgen receptors but not for progestogen, estrogen, or glucocorticoid receptors. Consequently, nilutamide blocks the action of androgens of adrenal and testicular origin which stimulate the growth of normal and cancerous prostatic tissue. Nilutamide has a long half-life which permits once-daily administration. Nilutamide is usually given in combination with surgical or chemical castration using gonadotrophin-releasing hormone (GnRH) [luteinising hormone-releasing hormone (LHRH)] agonists. In castrated patients the addition of nilutamide improves objective response rates, bone pain, urinary symptoms, tumour markers and time to disease progression. The tolerance of nilutamide is generally acceptable. Adverse effects are usually mild and reversible and consistent with androgen depletion. Unexpected but reversible adverse effects of nilutamide include delayed adaption to dark after exposure to bright light, transient increases in transaminases, and more severe but rare interstitial pneumonitis. Thus, nilutamide is a welcome treatment option that may be particularly useful in patients to whom the convenience of once-daily administration is seen as a worthwhile benefit.