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Biomedical subjects

A Miniaci

Publications and source records attributed to A Miniaci.

At least 19 recordsLinked to original sources
PubMed1999

Femoral nerve block and ketorolac in patients undergoing anterior cruciate ligament reconstruction.

PURPOSE: The primary objective was to evaluate the analgesic effectiveness of femoral nerve block and ketorolac following ACL reconstruction. The secondary objective was to examine their effects on recovery milestones. METHODS: Prior to standard general anesthesia, 90 patients were randomized into three groups of preoperative treatment: 1) femoral nerve block (15 mL bupivacaine 0.5%) and 1 mL normal saline i.v. (FNB group); 2) placebo femoral nerve block (15 mL normal saline) and 30 mg (1 mL) ketorolac i.v. (KT group); 3) placebo femoral nerve block (15 mL normal saline) and 1 mL normal saline i.v. (PL group). Postoperatively, pain was assessed by visual analogue score, demand and consumption of morphine via patient-controlled analgesia pump. The times for patients to tolerate oral fluid, food, sit up, ambulate and void were also noted. RESULTS: Morphine consumption within one hour, three hours and until POD 1 in the FNB group was lower than the PL group (7 +/- 6, 11 +/- 9, 27 +/- 23 mg vs 13 +/- 5, 20 +/- 9, 49 +/- 28 mg respectively), whereas only that within one hour in the KT group was lower than the PL group. Pain score was lower in FNB and KT groups in the first postoperative hour than in the PL group (P < 0.05). There were no differences among the three groups in the times to meet recovery milestone and discharge criteria. CONCLUSION: Femoral nerve block provides superior analgesia than placebo for ACL reconstruction but was insufficient to facilitate early recovery.

Adolescent↗
PubMed1999

Treatment of unstable osteochondritis dissecans lesions of the knee using autogenous osteochondral grafts (mosaicplasty).

Symptomatic osteochondritis dissecans lesions with minimal fragmentation that may be replaced within their crater have classically been treated by reattachment. The choice for internal fixation is varied. This article reports on the treatment of unstable osteochondritis dissecans lesions using autogenous osteochondral plugs as a means of biological internal fixation. The appearance on magnetic resonance imaging of osteochondral plugs at 6 and 9 months after transplantation is also presented.

Adolescent↗
PubMed1999

Compartment pressure monitoring during anterior cruciate ligament reconstruction.

A prospective double blind randomized study was carried out using 20 healthy males with anterior cruciate ligament (ACL) insufficiency undergoing bone-patellar tendon-bone ACL reconstruction. The subjects were randomized into either water or saline irrigation and then underwent identical reconstructive procedures using an arthroscopic pump. Continuous preoperative, intraoperative, and postoperative pressures were monitored using the slit catheter technique. Blood pressure and compartment pressure measurements were continuously recorded and noted at all stages of the procedure. Mean preoperative anterior and posterior compartment pressures were similar in both groups. No significant differences were noted between the anterior and posterior compartments of each group. No difference between water and saline irrigation was identified throughout the procedure. In both groups, postoperative pressures were slightly lower in the anterior and posterior compartments compared with preoperative pressures, but not significantly.

Adolescent↗
PubMed1999

Transfer of the latissimus dorsi muscle after failed repair of a massive tear of the rotator cuff. A two to five-year review.

INTRODUCTION: Seventeen patients with an average age of fifty-five years (range, thirty-two to seventy-seven years) who had ongoing pain and impaired function following failed operative treatment of a massive tear of the rotator cuff were managed with a transfer of the latissimus dorsi muscle as a salvage operation. METHODS: The patients were examined at an average of fifty-one months (range, twenty-four to seventy-two months) after the operation. Pain, function, and satisfaction were assessed with use of a questionnaire, visual analog and ordinal scales, physical examination, and the University of California at Los Angeles shoulder score. RESULTS: Fourteen of the seventeen patients were found to have significant relief of pain (p<0.0001) and a significant improvement in function (p<0.001 for all activities except lifting more than fifteen pounds [6.8 kilograms], for which the p value was <0.0036) and were satisfied with the result of the operative procedure. Fifteen patients stated that they would have the operative procedure again under similar circumstances. Seven of eight patients with a detached or nonfunctional anterior portion of the deltoid had substantial improvement. Three operations were classified as failures because the patients were not satisfied with the result and had ongoing pain and impaired function. All three failures were in patients who had a work-related injury. Overall, six patients had a work-related injury, and only three of them had a satisfactory result. There were three complications, all related to contracture of a hypertrophic axillary scar. CONCLUSIONS: The results in this series indicate that transfer of the latissimus dorsi muscle is a reasonable approach for salvage after failed operative treatment of a massive tear of the rotator cuff.

Adult↗
PubMed1998

Clinical exam of the shoulder.

This paper outlines the important features of the clinical assessment of the shoulder in a systematic and thorough manner. We highlight the key symptoms, particularly pain and instability, and describe how they may be associated with the various different pathologies. The physical examination is detailed in order of inspection, palpation, and motion, and then considerable emphasis is given to specific shoulder tests looking for evidence of rotator cuff weakness, impingement, biceps pathology, and instability. A number of specific tests of instability are outlined including an examination technique for posterior instability that has not previously been described.

Diagnosis, Differential↗
PubMed1997

Rotator cuff evaluation: imaging and diagnosis.

A variety of disorders can lead to disease and pathology of the rotator cuff tendons. The most important information is obtained during a careful history and physical examination. With the judicious use of various diagnostic modalities, evaluation of the cause of the rotator cuff disease is possible.

Humans↗
PubMed1997

The rotator cuff. Commentary.

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Adult↗
PubMed1997

The outcome of operatively treated anterior cruciate ligament disruptions in the skeletally immature child.

The purpose of this study was to evaluate the outcome of transphyseal ligament reconstruction in skeletally immature children with midsubstance anterior cruciate ligament (ACL) disruption. Five consecutive patients (mean age, 12.9 years; range, 8 to 14 years) with radiographically documented "wide" open growth plates and a minimum of 5 cm of expected remaining growth, underwent intra-articular reconstruction of the ACL. Operative treatment included three ACL reconstructions using hamstring tendons and two with quadriceps patellar tendon. All involved a centrally placed 6-mm or smaller tibial drill hole through an open physis and graft placement in an over-the-top position on the femur. At an average follow-up of 7.4 years (range, 4.5 to 9.9 years), no patient had a positive anterior drawer, Lachman, or pivot shift test. On KT-1000 arthrometer testing, all patients had 3 mm or less of increased anterior-posterior displacement (mean +/- SD = 1.0 +/- 1.6 mm). Magnetic resonance imaging showed that four tibial physes had fused in a symmetric fashion and one was still open. Orthoroentgenograms showed that no patient had a significant leg length discrepancy (-0.8 mm +/- 3.4 mm). The mean increase in height postoperatively was 17.7 cm (range, 7.6 to 31.0 cm). Overall, using the International Knee Documentation Committee (IKDC) evaluation form, there were four patients with grade A and one with grade C. The one patient with a poor IKDC grade had sustained a subsequent patellar dislocation with osteochondral fracture. In conclusion, ACL reconstruction using small drill holes placed through open tibial physes does not seem to adversely affect outcome or future growth.

Adolescent↗
PubMed1997

Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality?

Arthroscopic shoulder surgery has a 45% incidence of severe postoperative pain. Opiates and interscalene nerve blocks have a high incidence of side effects, and intraarticular local anesthetic has been shown to be ineffective when used for postoperative pain relief. The suprascapular nerve supplies 70% of the sensory nerve supply to the shoulder joint, and local anesthetic block of this nerve is effective in certain shoulder pain disorders. To determine the efficacy of a suprascapular nerve block, subcutaneous saline was compared with a suprascapular nerve block using 10mL of 0.5% bupivacaine with 1:200,000 epinephrine before general anesthesia was induced. In the immediate postoperative period, a 51% reduction in demand and a 31% reduction in consumption of morphine delivered by a patient-controlled analgesic system was demonstrated. There was more than fivefold reduction in the incidence of nausea, as well as reduced visual analog and verbal pain scores for patients who received a suprascapular nerve block. The duration of hospital stay was reduced by 24% in the suprascapular nerve block group. A 24-h phone call interview revealed a 40% reduction in analgesic consumption and a reduction in verbal pain scores at rest and on abduction. There were no complications from the suprascapular nerve block. This study demonstrates that a suprascapular nerve block for pain relief in arthroscopic shoulder surgery is an effective and safe modality of postoperative pain relief.

Adult↗
PubMed1996

A biomechanical analysis of joint contact forces in the posterior cruciate deficient knee.

The approach to the posterior cruciate deficient knee is controversial. The purpose of this study is to document the biomechanical changes in the static cadaveric knee model with simulated physiological loads. Nine fresh cadaveric knees from young donors (aged under 45 years) were mounted on a materials testing machine. Loading was carried out at 0 degrees, 30 degrees and 60 degrees to 1.5 kN with low-pressure sensitive Prescale film (Fuji; Tokyo, Japan) inserted through arthrotomies into the medial and lateral compartments. Computerized analysis of the imprints on the film was then carried out. Tests were then repeated after cutting the posterior cruciate ligament (PCL). Results demonstrate a statistically significant posterior subluxation of the tibia on the femur at 60 degrees flexion. This causes a significant increase in contact pressure and pressure concentration on the medial compartment of the knee after cutting the PCL. This may help explain the long-term degenerative changes observed in the medial femoral condyle after cutting the PCL.

Adult↗
PubMed1995

Anterior cruciate ligament tear: prospective evaluation of diagnostic accuracy of middle- and high-field-strength MR imaging at 1.5 and 0.5 T.

PURPOSE: To compare the diagnostic efficacy of current-generation middle- and high-field-strength magnetic resonance (MR) imagers in the diagnosis of anterior cruciate ligament (ACL) tears. MATERIALS AND METHODS: In 114 of 230 patients referred for knee imaging, MR imaging at 0.5 and 1.5 T was performed with identical sequences but with a slightly longer total imaging time and bandwidth optimization at 0.5 T. Radiologists were blinded to diagnosis and field strength. Sensitivity, specificity, and accuracy were determined, and ACL tear was confirmed by means of arthroscopy and pathology. RESULTS: There was no difference between the field strengths in accuracy, sensitivity, or specificity for the diagnosis of ACL tears in 86 patients with disrupted ACLs and 28 patients with intact ACLs. Accuracy for all ACL tears was 90% at 0.5 T and 91% at 1.5 T. Similarly, there were no differences in diagnosis of meniscal tears (79 with, 149 without) or posterior cruciate ligament tears (seven with, 107 without). CONCLUSION: Higher field strength does not confer higher accuracy in the diagnosis of ACL tears at MR imaging.

Adolescent↗
PubMed1993

Impingement in the athlete.

There is no doubt that the understanding of shoulder mechanics and pathology will continue to evolve. It is not appropriate to consider that all patients, especially young athletes, who have shoulder pain have "impingement." Rather, a careful evaluation will result in the correct diagnosis and the institution of the appropriate treatment. A step-by-step assessment and management scheme is necessary for each health care professional dealing with athletes. If surgery is deemed necessary, the correction of the anatomic abnormality with minimal disruption of normal anatomy will be the key to allowing the athlete to return to his or her chosen sport.

Arthroscopy↗
PubMed1992

Release of the subscapularis for internal rotation contracture and pain after anterior repair for recurrent anterior dislocation of the shoulder.

Ten patients who had an internal rotation contracture and pain after an anterior repair for recurrent dislocation of the shoulder were treated by release of the subscapularis muscle. For six of the patients, radiographs demonstrated severe osteoarthrotic changes in the shoulder as well. The release was done an average of eleven years after the original procedure, which, for most patients, had been a Putti-Platt repair. After release of the subscapularis, each patient had less pain in the shoulder and an average increase of 27 degrees of external rotation. Release of the subscapularis can offer relief of pain and of functional limitations associated with the symptoms caused by an internal rotation contracture after an anterior repair of the shoulder.

Adult↗
PubMed1991

Four-part valgus impacted fractures of the proximal humerus.

There is a specific type of displaced four-part fracture of the proximal humerus which consists of valgus impaction of the head fragment; this deserves special consideration because the rate of avascular necrosis is lower than that of other displaced four-part fractures. Using either closed reduction or limited open reduction and minimal internal fixation, 74% satisfactory results can be achieved in this injury.

Adult↗
PubMed1991

Open surgical techniques in the athlete's shoulder.

Treatment of the athlete's shoulder is one of the greatest challenges facing the orthopedic specialist. Surgical procedures, and in particular, the open surgical techniques presented in this article, are always a last resort of treatment. The primary treatment is always nonoperative with a particular emphasis toward physiotherapy. In selected instances in which patients have failed rehabilitation, the techniques that are presented can achieve a relatively high degree of success if particular attention is paid to the specific indications, approaches, and details of each technique. Open surgical techniques for rotator cuff tendonitis, instability, and unusual problems in the athlete's shoulder are presented.

Arthroscopy↗