Publications by authors named "R L Loomer"

18 Publications

Nonoperatively managed stage 5 osteochondral talar lesions.

Foot Ankle Int 2002 Jul;23(7):651-4

New Westminster Orthopaedic and Sports Medicine Clinic, BC, Canada.

Thirty-five ankles in 34 subjects with non-surgically managed stage 5 (chronic) osteochondral lesions of the talus (OLT) were reassessed an average of 38 months post diagnosis--88 months post symptom onset. The overall clinical result was rated good or excellent in 54%, fair in 17% and poor in 29%. Six patients opted for surgery--arthroscopic drilling--after a trial of one year of nonsurgical treatment and were therefore rated as poor. Tomogram or CT scans at the time of diagnosis and follow-up were compared in 25 patients. We found no significant change in lesion size and there was a poor correlation between change in lesion size and clinical outcome. X-rays performed at follow-up on 20 patients showed mild degenerative changes in 13 of 20 ankles with OLT. No correlation was found between the presence of degenerative changes and the clinical outcome. We conclude that: 1. Non-surgical management of stage 5 OLT is a viable option with little or no risk of developing significant osteoarthritis. 2. Most lesions remain radiographically stable. 3. There is a poor correlation between changes in lesion size and clinical outcome. However, the few patients with lesions which decrease significantly in size tend to do well and those with lesions which increase significantly in size do poorly. 4. The development of mild radiographic changes of OA does not correlate with clinical outcome. 5. The general course of stage 5 OLT is benign with over half of the patients improving to good or excellent results with non-surgical management. 6. Lateral lesions tend to do better than medial ones. 7. Adult onset lesions tend to do better than juvenile onset lesions.
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http://dx.doi.org/10.1177/107110070202300712DOI Listing
July 2002

Arthroscopic versus open acromioplasty: a prospective, randomized, blinded study.

J Shoulder Elbow Surg 2002 Mar-Apr;11(2):101-7

Department of Orthopaedics, University of British Columbia, Vancouver, Canada.

The purpose of this study is to determine whether arthroscopic acromioplasty is equivalent or superior to open acromioplasty, in a prospective, randomized, controlled, blinded clinical trial. Seventy-one patients with a clinical diagnosis of impingement syndrome were randomized to arthroscopic or open acromioplasty. Nine were excluded because of full-thickness rotator cuff tears diagnosed after randomization. Sixty-two patients (49 men and 13 women) with a minimum follow-up of 12 months (mean, 25 months) were included. The patient groups were virtually identical with regard to duration of symptoms, shoulder functional demands, age, sex, hand dominance, mechanism of onset, range of motion, strength, joint laxity, and the presence of a compensation claim. Patients were prospectively randomized to arthroscopic or open acromioplasty after stratification for age (>50 years),associated ligamentous laxity, and the presence of an ongoing compensation claim. The main outcome measure was visual analog scales for pain and function. Also recorded were UCLA shoulder scores and visual analog scales for postoperative improvement, patient satisfaction, and a variety of clinical measures. An independent blinded examiner assessed all patients. There was no significant difference between open and arthroscopic acromioplasty in visual analog scales for postoperative improvement (P =.30), patient satisfaction (P =.94), UCLA shoulder score (P =.69), or strength (P =.62); however, open was superior to arthroscopic acromioplasty for pain and function (P =.01). Overall, 67% of patients had a good or excellent result. This increased to 87% when unsettled compensation claims were excluded. Repeat (open) acromioplasty was performed in 5 patients in the unsuccessful arthroscopic group without improvement. Open acromioplasty was equivalent to arthroscopic acromioplasty for UCLA scores and patient satisfaction. For pain and function, both gave significant improvement but the open technique may be superior. Unsettled compensation is a predictor of poor outcome.
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http://dx.doi.org/10.1067/mse.2002.120915DOI Listing
July 2002

Kinematics of valgus bracing for medial gonarthrosis: technical report.

Clin Biomech (Bristol, Avon) 1998 Sep;13(6):414-419

University of British Columbia Biomechanics Laboratory, School of Human Kinetics, British Columbia, Canada.

OBJECTIVE: To determine whether a valgus knee brace altered the alignment of the shank segment with respect to the thigh segment of patients with medial gonarthrosis of the knee. DESIGN: Twelve (subject) x 2 (brace condition) x 2 (speed) repeated measures design. METHODS: Twelve male subjects (mean age 55 yr, SD 5 yr) who were prescribed a valgus knee brace for medial gonarthrosis walked on a treadmill at normal (mean 1.5 m/s, SD 0.3 m/s) and fast walking speed (mean 2.1 m/s, SD 0.2 m/s) while filmed by two gen-locked video cameras. Flexion, coronal and axial rotation angles of the thigh and shank segments in a global co-ordinate system were determined from kinematic data of reflective markers on the affected leg. Data were calibrated with respect to the standing 'no-brace' condition and averaged over five step cycles at four specific points in time during the stance phase. RESULTS: The brace had no effect on thigh coronal angle but reduced shank coronal angle at toe-off (statistically significant). The brace also prevented full extension (statistically significant) during mid-stance by resisting valgus forces in the coronal plane transmitted though the brace's helical strap. This same strap was believed to be responsible for axial forces that created statistically significant external rotation of the thigh axial angle throughout the stance phase and internal rotation of the shank axial angle during knee extension at heel strike and mid-stance. The brace hinge may explain the unexpected external rotation of the shank axial angle that accompanied knee flexion. CONCLUSION: This study demonstrated that the brace altered the kinematics in all three planes of motion and transmitted forces from one plane to another. This study also indicates that the subject-brace interaction was more complex in nature than initially anticipated. RELEVANCE: Clinical evidence suggests that there can be a reduction of knee pain by wearing a valgus brace for medial gonarthrosis and that the brace alters the orientation of thigh and shank segments during gait in such a manner to reduce the inter-joint pressure of the afflicted compartment. Therefore a biomechanical analysis of a possible kinematic effect was warranted.
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http://dx.doi.org/10.1016/s0268-0033(98)00093-xDOI Listing
September 1998

Osteochondral lesions of the talus.

Am J Sports Med 1993 Jan-Feb;21(1):13-9

Department of Orthopedics, University of British Columbia, Canada.

We report demographic, clinical, and imaging data on 92 patients with osteochondral lesions of the talus collected in one center between 1981 and 1992. All patients reported pain as their primary symptom. Ninety-four percent of the patients reported pain with activity. Physical examination was unhelpful. Using newer imaging techniques (bone scan and computed tomography) and with increased awareness, we have observed a sevenfold increase in the diagnostic frequency of osteochondral lesions of the talus between the years 1981 to 1986 and 1987 to 1992. Bone scan is an excellent screening tool for patients with chronic ankle pain and has 99% sensitivity in depicting osteochondral lesions. Computed tomography demonstrated a previously unclassified lesion, the radiolucent defect, which accounts for 77% of the lesions in this series. We have therefore modified the Berndt and Harty classification system, basing it on radiographic appearance (principally computed tomography) and adding the radiolucent lesion. Fifty-eight patients were treated surgically. Anterior and midtalar lesions are now approached arthroscopically. Surgical treatment of the radiolucent lesion, consisting of curettage and drilling, gives 42% excellent and 32% good results. Pain relief often occurs within months of surgery, but healing of the lesion requires years, and some may persist indefinitely.
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http://dx.doi.org/10.1177/036354659302100103DOI Listing
March 1993

The role of bone scintigraphy in the evaluation of talar dome fractures.

J Nucl Med 1991 Dec;32(12):2241-4

Department of Radiology, Sports Medicine Clinic, University of British Columbia, Vancouver.

We undertook a retrospective study of 122 patients with ankle pain to determine the accuracy of bone scintigraphy using 99mTc-methylene diphosphonate (MDP) for detection of osteochondral talar dome fractures (OCTDF). Plain radiographs, which were available in 97 patients, had not revealed any abnormality in the talar dome. Bone scintigraphy was followed by CT, which was considered to be the reference test in diagnosing OCTDF. Analysis of our data showed that when the bone scan findings in the two highest confidence categories (high and moderate probability) were accepted as abnormal, the sensitivity and the specificity of the test were 0.94 and 0.76, respectively. Although CT is mandatory to establish the stage of OCTDF, it cannot be used routinely due to its high cost. Bone scintigraphy appears to be a good screening procedure that will identify patients who are likely to benefit from further radiographic studies such as CT. These findings are subject to further confirmation in a prospective study.
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December 1991
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