Shahrulazua Ahmad - Academia.edu (original) (raw)

Papers by Shahrulazua Ahmad

"Gamat", a local term for sea cucumber, is widely used and had been shown in various st... more "Gamat", a local term for sea cucumber, is widely used and had been shown in various studies to have many therapeutic effects. However, its action on osteoblast cells had never been investigated before. Hence, in-vitro study utilising a commercially produced gamat extract of Stichopus sp 1 as the test substance was performed to elucidate the effects on the osteoblast cell line proliferation and functional activity, using MTT colorimetric assay and alkaline phosphatase (ALP) assay respectively. In the preliminary study, osteoblast cells were mixed with a series of two-fold dilutions of gamat concentration in standard culture media from lOOmg/ml down to 1.6mg/ml, and with negative as well as positive controls. Results that were noted after 72 hours incubation period showed an inverse relationship between the gamat concentration and its effect on the osteoblast cell proliferation. The exact ICso was estimated to be approximately 75mg/ml. There was a positive promoting effect ...

We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit syst... more We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit system. 9 patients underwent PCL reconstruction using our pressfit system. The surgical procedure is described in detail. Post-operatively, 5 patients were available for assessment and review. Four patients gave a final Lysholm score of 92 – 100%. Three patients gave a Hospital for Special Surgery (HSS) score of excellent, one fair and one poor. Two patients gave a reduced Tegner activity score post-operatively while the other three gave a similar score post-operatively. Assessment using KT-1000 revealed four patients with a side-to-side difference of less than 3 mm (average side-to-side difference, 1.87 mm), while one patient exhibited a side-to-side difference of 5.8 mm. We believe that our technique enhances tunnel healing through usage of a bone-plug fixation and provides a cheap alternative for graft fixation on the femoral side in PCL reconstruction.

Journal of Biomechanical Engineering, 2019

As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability aft... more As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill–Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modeling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill–Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions. The distribution of Von Mises (VM) stresses and the factor of safety (FOS) for each of the configurations were calculated. The greatest peak in VM stresses was generated when the glenoid was loaded with a small Hill–Sachs lesion. The VM stresses were lessened and the FOS increased (reducing likelihood of failure) with increasing size of th...

La Clinica terapeutica, 2014

To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstr... more To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in compet...

BMJ case reports, Jan 23, 2014

Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications,... more Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications, including injury to the neurovascular structures at the popliteal region. We describe a delayed presentation of the right leg and foot compartment syndrome following rupture of popliteal artery pseudoaneurysm, which presented 9 days after an arthroscopic transtibial PCL reconstructive surgery. Fasciotomy, surgical exploration, repair of an injured popliteal vein and revascularisation of the popliteal artery with autogenous great saphenous vein interposition graft were performed. Owing to the close proximity of vessels to the tibial tunnel, special care should be taken in patients who undergo arthroscopic PCL reconstruction, especially if there is extensive scarring of the posterior capsule following previous injury. Emergency fasciotomy should not be delayed and is justified when the diagnosis of compartment syndrome is clinically made.

Journal of Orthopaedic Surgery, Dec 1, 2014

To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) ... more To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel. Methods. Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3-104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor.

Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary ... more Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary orthopaedic procedures. However, it has rarely been described following manipulation, reduction of fracture, and application of external fixator. Furthermore, bilateral ocular blindness is seldom the first manifestation; instead respiratory and other cerebral symptoms being most common. We describe a case with this rare presentation in a patient who underwent a trial of closed reduction, then open reduction of a femur fracture, followed by external fixation performed at day 47 post-initial trauma.

The Medical journal of Malaysia

Anterior cruciate ligament (ACL) injuries are common among Malaysian military patients but has no... more Anterior cruciate ligament (ACL) injuries are common among Malaysian military patients but has not been studied closely. The purpose of this study was to assess the type of activities leading to the ACL injury and the outcome of reconstructive ACL surgery at one year follow up. From the registry record, military patients who had undergone ACL reconstruction in two Malaysian military hospitals were identified. Their medical records were reviewed. The activities that they performed when the ACL injury occurred were identified. After ACL reconstruction, the patients' ability to resume previous duty at one year follow up was evaluated. From 111 patients, 82% of the ACL injuries were due to sporting activities whereas military activities and road traffic accident accounted for 14% and 4% respectively. Out of 69 patients with isolated ACL injury who were followed up at one year, all except two were able to resume their previous duty. Among the military patients who underwent ACL recon...

Despite its claimed therapeutic effects, the action of sea cucumber (known as gamat in the Malay ... more Despite its claimed therapeutic effects, the action of sea cucumber (known as gamat in the Malay language) on human osteoblast cells is still unknown. We performed in vitro studies utilising extract of Stichopus sp1 (gamat) to elucidate its effects on cell viability and functional activity. We found an inverse relationship between gamat concentration and its effect on osteoblast cell viability (p<0.001). Only gamat concentration at 1mg/ml significantly promoted cell viability at day 3 of incubation. There was a trend towards increased osteoblast cell function in the presence of gamat at 5mg/ml and 10mg/ml but this observation was not consistent at different incubation periods. Alkaline phosphatase, Stichopus, Sea Cucumbers, Osteoblasts, Tetrazolium Salts.

We present a case in which a patient with well-differentiated squamous cell carcinoma of the domi... more We present a case in which a patient with well-differentiated squamous cell carcinoma of the dominant thumb underwent resection at the level of metacarpo-phalangeal joint and primary reconstructive surgery using a tricortical iliac bone graft with radial forearm wrapped around pedicle flap. This single stage resection and reconstructive procedure was simple and relatively easy to perform, without the need for microsurgical expertise. Detailed surgical procedures and excellent functional result are described.

Singapore medical journal

The purpose of this study was to evaluate the early functional outcome following the use of a bio... more The purpose of this study was to evaluate the early functional outcome following the use of a bioabsorbable suture anchor to simplify the repair of injured lateral ankle structures as a variation of an established technique known as the Brostrom-Gould procedure. This was a prospective study of 30 ankles with chronic lateral instability that underwent a modified Brostrom-Gould surgery using a bioabsorbable suture anchor, performed by a single surgeon. A total of 29 patients, aged 15 to 52 (mean is 33) years, were enrolled in the study. The follow-up period ranged from three to six (mean is four) months. The function of the patients' ankles was scored using the Kaikkonen Functional Scale, both preoperatively and postoperatively. Preoperatively, all ankles had poor scores (less than 50). Postoperatively, 28 ankles showed excellent scores and two ankles showed good scores, while none obtained a fair or poor score. The difference in the overall means between the postoperative and pre...

La Clinica terapeutica

The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations af... more The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations after a symptom-free period following an initial arthroscopic shoulder stabilisation using PEEK suture anchors to repair the Bankart and SLAP lesions. The MRI and CT scans showed perianchor radiolucency around all of the previously placed PEEK suture anchors. It is believed that his recurrent shoulder instability was related to this radiological finding although the exact pathomechanism of the osteolysis is not clear. To our knowledge, this is the first reported case of perianchor radiolucency after the use of a PEEK suture anchor.

BMJ case reports, 2014

Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications,... more Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications, including injury to the neurovascular structures at the popliteal region. We describe a delayed presentation of the right leg and foot compartment syndrome following rupture of popliteal artery pseudoaneurysm, which presented 9 days after an arthroscopic transtibial PCL reconstructive surgery. Fasciotomy, surgical exploration, repair of an injured popliteal vein and revascularisation of the popliteal artery with autogenous great saphenous vein interposition graft were performed. Owing to the close proximity of vessels to the tibial tunnel, special care should be taken in patients who undergo arthroscopic PCL reconstruction, especially if there is extensive scarring of the posterior capsule following previous injury. Emergency fasciotomy should not be delayed and is justified when the diagnosis of compartment syndrome is clinically made.

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2015

The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative... more The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative period and to investigate the clinical factors that might predispose to an early cuff re-tear. All patients with rotator cuff (supraspinatus ± infraspinatus) tear that required arthroscopic repair during the period between June 1, 2010, and May 31, 2012, with completed serial ultrasound examinations at 6 weeks, 12 weeks, and 26 weeks postoperatively were included. Intraoperative findings were noted. Functional clinical outcomes were assessed by Constant score, Western Ontario Rotator Cuff Index, and Oxford score. Compliance of patients with postoperative rehabilitation was established. There were 127 cases; the mean age of patients was 60 years. Overall re-tear rate was 29.1%. The percentage of new re-tears was significantly higher in the first 12 weeks than in the second 12 weeks postoperatively (25.2% and 3.9%, respectively). The patient's postoperative compliance was a significan...

To investigate the effects of 12 weeks concentric-type isokinetic resistance training using two d... more To investigate the effects of 12 weeks concentric-type isokinetic resistance training using two different angular velocities (120°/s and 240°/s) on isokinetic knee strength and functional ability of patients with chronic (more than three months post-trauma) grade 3 anterior cruciate ligament deficiencies. Materials and Methods: Nineteen male patients were included in the study. They were randomly assigned into three groups: control, 120°/s group and 240°/s group. The 120°/s intervention group (mean age: 36.8 ± 7.9 years) and 240°/s intervention group (mean age: 33.0 ± 11.4 years) participated in the prescribed training programme along with their existing conventional physiotherapy which were carried out twice a week. The control group (mean age: 33.5 ± 6.8 years) continued with their conventional physiotherapy only. Results: In all the groups, there was a significant improvement (p<0.05) in: (i) isokinetic peak torque after 6 weeks and 12 weeks of training periods; (ii) the International Knee Documentation Committee (IKDC) Subjective Knee scores after 12 weeks of training. Although not statistically significant, a trend of an increased knee peak torque and functional outcome was observed in the intervention groups when compared to the control group, with the 120°/s and 240°/s group showing the highest improvement in the isokinetic knee extension strength and knee flexion strength, respectively. Conclusions: Knee strength and physical functions improved in all three groups after 12 weeks of training, independently of the treatment applied. Rehabilitation is essential in the management of the chronic grade 3 anterior cruciate ligament deficient patients.

Journal of orthopaedic surgery (Hong Kong), 2014

PURPOSE. To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligame... more PURPOSE. To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel. METHODS. Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3-104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor. RESULTS. At th...

Surgical and Radiologic Anatomy, 2010

Background To study the morphological difference between the lumbar pedicle in adolescent and adu... more Background To study the morphological difference between the lumbar pedicle in adolescent and adult groups as only less information is known about their pedicle morphology, especially in Malaysian population. Methods The pedicle parameters of the lumbar spine in adolescent and adult groups including transverse outer pedicle diameter, transverse inner pedicle diameters, medial wall cortical thickness, lateral wall cortical thickness, pedicle length, transverse pedicle angle and sagittal pedicle angle were measured using computerised tomography (CT) scanning. The measurements in both groups were compared and analysed using statistical method. Results In adolescent group, the mean transverse outer diameter was 8.9 ± 1.2 mm, transverse inner diameter was 6.3 ± 1.2 mm, medial cortical thickness was 1.6 ± 1.2 mm, lateral cortical thickness was 1.3 ± 1.2 mm, pedicle length was 41.7 ± 3.8 mm, transverse angle was 20.0 ± 2.5°and sagittal angle was 16.0 ± 1.7°. In adult group, the mean transverse outer diameter was 9.8 ± 1.3 mm, transverse inner diameter was 7.0 ± 1.2 mm, medial cortical thickness was 1.7 ± 1.2 mm, lateral cortical thickness was 1.4 ± 1.6 mm, pedicle length was 44.8 ± 5.0 mm, transverse angle was 21.7 ± 2.3°and sagittal angle was 17.4 ± 1.7°. Comparing the mean of the two age groups, all the measurements were significantly smaller (p \ 0.05) in the adolescent patients. Conclusions Pedicle morphology in adolescent and adult population is different in all parameters, especially in males. Understanding of specific pedicle morphology for each group is imperative for safety in spinal procedures using pedicle route.

British Journal of Sports Medicine, 2010

The purpose of the present study was to investigate if 12 weeks of isokinetic resistance training... more The purpose of the present study was to investigate if 12 weeks of isokinetic resistance training programme at two different angular velocities (120 and 240°/s) would improve functional abilities of patients with grade III anterior cruciate ligament (ACL) injury without reconstruction. 19 ...

La Clinica terapeutica

To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstr... more To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in compet...

"Gamat", a local term for sea cucumber, is widely used and had been shown in various st... more "Gamat", a local term for sea cucumber, is widely used and had been shown in various studies to have many therapeutic effects. However, its action on osteoblast cells had never been investigated before. Hence, in-vitro study utilising a commercially produced gamat extract of Stichopus sp 1 as the test substance was performed to elucidate the effects on the osteoblast cell line proliferation and functional activity, using MTT colorimetric assay and alkaline phosphatase (ALP) assay respectively. In the preliminary study, osteoblast cells were mixed with a series of two-fold dilutions of gamat concentration in standard culture media from lOOmg/ml down to 1.6mg/ml, and with negative as well as positive controls. Results that were noted after 72 hours incubation period showed an inverse relationship between the gamat concentration and its effect on the osteoblast cell proliferation. The exact ICso was estimated to be approximately 75mg/ml. There was a positive promoting effect ...

We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit syst... more We describe our technique of single-bundle PCL reconstruction using a bony femoral press-fit system. 9 patients underwent PCL reconstruction using our pressfit system. The surgical procedure is described in detail. Post-operatively, 5 patients were available for assessment and review. Four patients gave a final Lysholm score of 92 – 100%. Three patients gave a Hospital for Special Surgery (HSS) score of excellent, one fair and one poor. Two patients gave a reduced Tegner activity score post-operatively while the other three gave a similar score post-operatively. Assessment using KT-1000 revealed four patients with a side-to-side difference of less than 3 mm (average side-to-side difference, 1.87 mm), while one patient exhibited a side-to-side difference of 5.8 mm. We believe that our technique enhances tunnel healing through usage of a bone-plug fixation and provides a cheap alternative for graft fixation on the femoral side in PCL reconstruction.

Journal of Biomechanical Engineering, 2019

As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability aft... more As the use of glenoid suture anchors in arthroscopic and open reconstruction, for instability after Bankart lesions of the shoulder, increases, an emerging problem has been the incidence of glenoid rim fractures through suture drill holes. Very little is known regarding the effect of the Hill–Sachs lesion on the glenoid's susceptibility to fracture and how drill hole location can further affect this. This study used finite element modeling techniques to investigate the risk of fracture of the glenoid rim in relation to variable sized Hill–Sachs defects impacting on the anterior glenoid edge with suture anchor holes placed in varying positions. The distribution of Von Mises (VM) stresses and the factor of safety (FOS) for each of the configurations were calculated. The greatest peak in VM stresses was generated when the glenoid was loaded with a small Hill–Sachs lesion. The VM stresses were lessened and the FOS increased (reducing likelihood of failure) with increasing size of th...

La Clinica terapeutica, 2014

To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstr... more To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in compet...

BMJ case reports, Jan 23, 2014

Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications,... more Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications, including injury to the neurovascular structures at the popliteal region. We describe a delayed presentation of the right leg and foot compartment syndrome following rupture of popliteal artery pseudoaneurysm, which presented 9 days after an arthroscopic transtibial PCL reconstructive surgery. Fasciotomy, surgical exploration, repair of an injured popliteal vein and revascularisation of the popliteal artery with autogenous great saphenous vein interposition graft were performed. Owing to the close proximity of vessels to the tibial tunnel, special care should be taken in patients who undergo arthroscopic PCL reconstruction, especially if there is extensive scarring of the posterior capsule following previous injury. Emergency fasciotomy should not be delayed and is justified when the diagnosis of compartment syndrome is clinically made.

Journal of Orthopaedic Surgery, Dec 1, 2014

To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) ... more To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel. Methods. Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3-104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor.

Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary ... more Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary orthopaedic procedures. However, it has rarely been described following manipulation, reduction of fracture, and application of external fixator. Furthermore, bilateral ocular blindness is seldom the first manifestation; instead respiratory and other cerebral symptoms being most common. We describe a case with this rare presentation in a patient who underwent a trial of closed reduction, then open reduction of a femur fracture, followed by external fixation performed at day 47 post-initial trauma.

The Medical journal of Malaysia

Anterior cruciate ligament (ACL) injuries are common among Malaysian military patients but has no... more Anterior cruciate ligament (ACL) injuries are common among Malaysian military patients but has not been studied closely. The purpose of this study was to assess the type of activities leading to the ACL injury and the outcome of reconstructive ACL surgery at one year follow up. From the registry record, military patients who had undergone ACL reconstruction in two Malaysian military hospitals were identified. Their medical records were reviewed. The activities that they performed when the ACL injury occurred were identified. After ACL reconstruction, the patients' ability to resume previous duty at one year follow up was evaluated. From 111 patients, 82% of the ACL injuries were due to sporting activities whereas military activities and road traffic accident accounted for 14% and 4% respectively. Out of 69 patients with isolated ACL injury who were followed up at one year, all except two were able to resume their previous duty. Among the military patients who underwent ACL recon...

Despite its claimed therapeutic effects, the action of sea cucumber (known as gamat in the Malay ... more Despite its claimed therapeutic effects, the action of sea cucumber (known as gamat in the Malay language) on human osteoblast cells is still unknown. We performed in vitro studies utilising extract of Stichopus sp1 (gamat) to elucidate its effects on cell viability and functional activity. We found an inverse relationship between gamat concentration and its effect on osteoblast cell viability (p<0.001). Only gamat concentration at 1mg/ml significantly promoted cell viability at day 3 of incubation. There was a trend towards increased osteoblast cell function in the presence of gamat at 5mg/ml and 10mg/ml but this observation was not consistent at different incubation periods. Alkaline phosphatase, Stichopus, Sea Cucumbers, Osteoblasts, Tetrazolium Salts.

We present a case in which a patient with well-differentiated squamous cell carcinoma of the domi... more We present a case in which a patient with well-differentiated squamous cell carcinoma of the dominant thumb underwent resection at the level of metacarpo-phalangeal joint and primary reconstructive surgery using a tricortical iliac bone graft with radial forearm wrapped around pedicle flap. This single stage resection and reconstructive procedure was simple and relatively easy to perform, without the need for microsurgical expertise. Detailed surgical procedures and excellent functional result are described.

Singapore medical journal

The purpose of this study was to evaluate the early functional outcome following the use of a bio... more The purpose of this study was to evaluate the early functional outcome following the use of a bioabsorbable suture anchor to simplify the repair of injured lateral ankle structures as a variation of an established technique known as the Brostrom-Gould procedure. This was a prospective study of 30 ankles with chronic lateral instability that underwent a modified Brostrom-Gould surgery using a bioabsorbable suture anchor, performed by a single surgeon. A total of 29 patients, aged 15 to 52 (mean is 33) years, were enrolled in the study. The follow-up period ranged from three to six (mean is four) months. The function of the patients' ankles was scored using the Kaikkonen Functional Scale, both preoperatively and postoperatively. Preoperatively, all ankles had poor scores (less than 50). Postoperatively, 28 ankles showed excellent scores and two ankles showed good scores, while none obtained a fair or poor score. The difference in the overall means between the postoperative and pre...

La Clinica terapeutica

The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations af... more The authors describe a case of a 25 year old male who suffered recurrent shoulder dislocations after a symptom-free period following an initial arthroscopic shoulder stabilisation using PEEK suture anchors to repair the Bankart and SLAP lesions. The MRI and CT scans showed perianchor radiolucency around all of the previously placed PEEK suture anchors. It is believed that his recurrent shoulder instability was related to this radiological finding although the exact pathomechanism of the osteolysis is not clear. To our knowledge, this is the first reported case of perianchor radiolucency after the use of a PEEK suture anchor.

BMJ case reports, 2014

Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications,... more Arthroscopic posterior cruciate ligament (PCL) reconstruction carries some risk of complications, including injury to the neurovascular structures at the popliteal region. We describe a delayed presentation of the right leg and foot compartment syndrome following rupture of popliteal artery pseudoaneurysm, which presented 9 days after an arthroscopic transtibial PCL reconstructive surgery. Fasciotomy, surgical exploration, repair of an injured popliteal vein and revascularisation of the popliteal artery with autogenous great saphenous vein interposition graft were performed. Owing to the close proximity of vessels to the tibial tunnel, special care should be taken in patients who undergo arthroscopic PCL reconstruction, especially if there is extensive scarring of the posterior capsule following previous injury. Emergency fasciotomy should not be delayed and is justified when the diagnosis of compartment syndrome is clinically made.

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.], 2015

The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative... more The purpose of this study was to determine when cuff re-tear commonly occurs in the postoperative period and to investigate the clinical factors that might predispose to an early cuff re-tear. All patients with rotator cuff (supraspinatus ± infraspinatus) tear that required arthroscopic repair during the period between June 1, 2010, and May 31, 2012, with completed serial ultrasound examinations at 6 weeks, 12 weeks, and 26 weeks postoperatively were included. Intraoperative findings were noted. Functional clinical outcomes were assessed by Constant score, Western Ontario Rotator Cuff Index, and Oxford score. Compliance of patients with postoperative rehabilitation was established. There were 127 cases; the mean age of patients was 60 years. Overall re-tear rate was 29.1%. The percentage of new re-tears was significantly higher in the first 12 weeks than in the second 12 weeks postoperatively (25.2% and 3.9%, respectively). The patient's postoperative compliance was a significan...

To investigate the effects of 12 weeks concentric-type isokinetic resistance training using two d... more To investigate the effects of 12 weeks concentric-type isokinetic resistance training using two different angular velocities (120°/s and 240°/s) on isokinetic knee strength and functional ability of patients with chronic (more than three months post-trauma) grade 3 anterior cruciate ligament deficiencies. Materials and Methods: Nineteen male patients were included in the study. They were randomly assigned into three groups: control, 120°/s group and 240°/s group. The 120°/s intervention group (mean age: 36.8 ± 7.9 years) and 240°/s intervention group (mean age: 33.0 ± 11.4 years) participated in the prescribed training programme along with their existing conventional physiotherapy which were carried out twice a week. The control group (mean age: 33.5 ± 6.8 years) continued with their conventional physiotherapy only. Results: In all the groups, there was a significant improvement (p<0.05) in: (i) isokinetic peak torque after 6 weeks and 12 weeks of training periods; (ii) the International Knee Documentation Committee (IKDC) Subjective Knee scores after 12 weeks of training. Although not statistically significant, a trend of an increased knee peak torque and functional outcome was observed in the intervention groups when compared to the control group, with the 120°/s and 240°/s group showing the highest improvement in the isokinetic knee extension strength and knee flexion strength, respectively. Conclusions: Knee strength and physical functions improved in all three groups after 12 weeks of training, independently of the treatment applied. Rehabilitation is essential in the management of the chronic grade 3 anterior cruciate ligament deficient patients.

Journal of orthopaedic surgery (Hong Kong), 2014

PURPOSE. To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligame... more PURPOSE. To evaluate the outcome of reconstruction for chronic grade-II posterior cruciate ligament (PCL) deficiency in Malaysian military personnel. METHODS. Medical records of 16 male military personnel aged 25 to 41 years who underwent reconstruction for chronic grade-II PCL deficiency using the quadruple hamstrings tendon by a single surgeon were reviewed. The mean time from injury to surgery was 43.6 (range, 3-104) months. 10 patients had grade-I (n=4), grade-III (n=2), and grade-IV (n=4) lesions of the medial femoral condyles. Seven patients had medial (n=6) and lateral (n=1) meniscus tears. At the 2-year follow-up, patients were asked to complete a questionnaire consisting of the Lysholm score, Tegner activity level, and International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form. Posterior drawer test, KT-2000 arthrometer test for posterior translation of the tibia, and military health grade (MHG) were assessed by an independent assessor. RESULTS. At th...

Surgical and Radiologic Anatomy, 2010

Background To study the morphological difference between the lumbar pedicle in adolescent and adu... more Background To study the morphological difference between the lumbar pedicle in adolescent and adult groups as only less information is known about their pedicle morphology, especially in Malaysian population. Methods The pedicle parameters of the lumbar spine in adolescent and adult groups including transverse outer pedicle diameter, transverse inner pedicle diameters, medial wall cortical thickness, lateral wall cortical thickness, pedicle length, transverse pedicle angle and sagittal pedicle angle were measured using computerised tomography (CT) scanning. The measurements in both groups were compared and analysed using statistical method. Results In adolescent group, the mean transverse outer diameter was 8.9 ± 1.2 mm, transverse inner diameter was 6.3 ± 1.2 mm, medial cortical thickness was 1.6 ± 1.2 mm, lateral cortical thickness was 1.3 ± 1.2 mm, pedicle length was 41.7 ± 3.8 mm, transverse angle was 20.0 ± 2.5°and sagittal angle was 16.0 ± 1.7°. In adult group, the mean transverse outer diameter was 9.8 ± 1.3 mm, transverse inner diameter was 7.0 ± 1.2 mm, medial cortical thickness was 1.7 ± 1.2 mm, lateral cortical thickness was 1.4 ± 1.6 mm, pedicle length was 44.8 ± 5.0 mm, transverse angle was 21.7 ± 2.3°and sagittal angle was 17.4 ± 1.7°. Comparing the mean of the two age groups, all the measurements were significantly smaller (p \ 0.05) in the adolescent patients. Conclusions Pedicle morphology in adolescent and adult population is different in all parameters, especially in males. Understanding of specific pedicle morphology for each group is imperative for safety in spinal procedures using pedicle route.

British Journal of Sports Medicine, 2010

The purpose of the present study was to investigate if 12 weeks of isokinetic resistance training... more The purpose of the present study was to investigate if 12 weeks of isokinetic resistance training programme at two different angular velocities (120 and 240°/s) would improve functional abilities of patients with grade III anterior cruciate ligament (ACL) injury without reconstruction. 19 ...

La Clinica terapeutica

To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstr... more To evaluate the functional outcomes of a delayed (>6 months post-injury) and combined reconstruction of grade III posterior cruciate ligament (PCL) and grade III posterolateral corner (PLC) deficiencies. Between March 2006 and October 2009, a delayed surgery consisting of arthroscopically-assisted PCL reconstruction and open reconstruction of the PLC was performed on 19 men and 2 women (average age, 29 years). The mean time-to-surgery was 18 months (range, 7-51 months) and duration of follow-up was 22 months (range, 12-48 months). Postoperatively, patients were evaluated using Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) subjective and objective scores. At the final follow-up, majority of the knees (61.9%) achieved either normal or nearly normal rating objective IKDC score. The means of IKDC subjective score, Lysholm score and Tegner activity level were 62.09, 74.35 and 5.14 respectively. One patient was able to participate in compet...