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Biomedical subjects

Albert W Pearsall

Publications and source records attributed to Albert W Pearsall.

14 recordsLinked to original sources
PubMed2005

A salvage procedure for refractory shoulder instability.

We present the case of a patient with symptomatic refractory multidirectional shoulder instability who was treated with staged bilateral anterior and posterior glenoid bone augmentation after previous failed arthroscopic and open procedures. The patient was pain free postoperatively and has not had symptoms of instability in either shoulder. At her most recent followup, 24 months after surgery, she had nearly full symmetric shoulder range of motion without anterior or posterior apprehension signs. Her Constant-Murley scores were 77 and 79 on the right and left, respectively, with UCLA scores of 29 on the right and the left shoulders. Her Short Form-36 overall score was 105, indicating overall satisfaction. Currently, the patient states that she can do all daily activities without restrictions. In carefully selected patients, the use of anterior and posterior glenoid bone augmentation may be effective as a salvage procedure in rare cases of refractory multidirectional shoulder instability.

Adult↗
PubMed2005

Medicolegal issues affecting sports medicine practitioners.

The practice of sports medicine represents a unique subspecialty within the discipline of medicine. Practitioners provide care for athletes who engage in activities that may put the athletes at risk for serious injury. Physicians may be held legally liable for not doing a standardized pre-participation evaluation, for not administering adequate on-site or after injury care, or for violating an individual's civil rights by refusing to allow continued participation because of medical risk. The courts now are being asked to define obvious and necessary risks. Medical law addresses the behavior, obligation, and liability-affecting physicians who provide care for athletes. Many ethical and medicolegal issues must be resolved by the legal system because coaches, athletic trainers, on-call physicians, physicians providing pre-participation physicals, and the team physician are being held responsible for injuries sustained during athletic competition. This review is intended to assist all physicians who take care of athletes by outlining their legal obligations and risks. Armed with this knowledge, we expect that the sports medicine physician will be better able to focus on patient care within the context of medicolegal obligations.

Athletic Injuries↗
PubMed2003

A biomechanical comparison of three lower extremity tendons for ligamentous reconstruction about the knee.

PURPOSE: The purpose of this investigation was to evaluate 3 previously unreported allograft tendons for use in knee surgery. These are the doubled tibialis anterior (TA), doubled tibialis posterior (TP), and doubled peroneus longus (PL) tendons. TYPE OF STUDY: A biomechanical evaluation of the properties of the TA, TP, and PL. METHODS: Sixteen fresh-frozen cadaveric lower limbs were used for testing. All specimens had the TA, TP, and PL tendons harvested. All specimens were tested in a custom-designed hydraulic testing machine using dry ice clamps. Each tendon was elongated at a rate of 1 mm/s. Load and displacement were recorded with an analog to digital interface board. Stiffness, modulus of elasticity, and stress and strain at failure were calculated. RESULTS: The average tested lengths of the TA, TP, and PL were 37 cm (range, 13-68 cm), 33 cm (range, 7-74 cm), and 42 cm (range, 17-69 cm), respectively. The average cross-sectional areas of the doubled TA, TP, and PL were 38 mm2, 48 mm2, and 37 mm2, respectively. The average failure loads for the doubled TA, TP, and PL tendons were 3,412 N, 3,391 N, and 2,483 N, respectively. The maximum stresses of the 3 tendons did not differ significantly (85-108 Mpa). The TA had the greatest stiffness (344 N/mm), followed by the TP (302 N/mm) and the PL (244 N/mm). Previous authors have documented the biomechanical strength of grafts for ACL reconstruction between 1,700 and 2,900 Newtons. The ultimate tensile strength and stiffness reported for the TA and TP grafts exceeded that for all previously reported grafts, including the doubled semitendinosus-gracilis. CONCLUSIONS: The TA, TP, and PL tendons showed excellent biomechanical properties when compared with historical data evaluating other graft sources. The biomechanical properties observed for the TA, TP, and PL were noted in specimens despite an average age of 78.3 years.

Aged↗
PubMed2002

Biomechanical comparison of reconstruction techniques for disruption of the acromioclavicular and coracoclavicular ligaments.

Injuries to the acromioclavicular joint are common. For selected injuries, operative reconstruction is recommended. The purpose of the current study was to compare three reconstruction procedures: (1) nine strands of woven polydioxanonsulphate (PDS II) suture passed through the clavicle and around the coracoid; (2) procedure No. 1 with 50% of the coracoacromioclavicular ligament placed through 2 clavicular drill holes; (3) No. 5 Merselene tape passed through 2 drill holes in the clavicle and acromion, with 50% of the coracoacromial ligament transferred to the clavicle. Fourteen fresh frozen human shoulders were tested using a 6 degree-of-freedom testing device. The intact shoulder showed significantly less displacement than any of the reconstructions. Merselene tape plus ligament showed the largest displacement, and PDS II braid plus ligament showed the least displacement. None of the procedures reconstituted acromioclavicular joint stiffness to intact state levels, though improved acromioclavicular joint stiffness was noted with a PDS braid plus ligament.

Acromioclavicular Joint↗
PubMed2002

Fresh osteochondral grafting in the treatment of osteochondritis dissecans of the talus.

We present a review of the literature on classification and treatment of osteochondral defects of the talus. We report the case of an isolated Berndt and Harty grade II lesion treated with a fresh osteochondral allograft. We believe that fresh allograft osteochondral grafting of the talus is an excellent technique for symptomatic Berndt and Harty grade II or higher lesion of the talus without significant tibiotalar arthritis. In selected patients, this procedure can provide excellent functional results.

Adolescent↗
PubMed2002

Assessment of Ankle-Subtalar-Joint-Complex Laxity Using an Instrumented Ankle Arthrometer: An Experimental Cadaveric Investigation.

OBJECTIVE: To show the relationship between direct measurements of tibial-calcaneal bone motion and instrumented measurements of ankle-subtalar-joint-complex laxity using a portable ankle arthrometer; to assess within and between-tester measurement reliability; and to determine if the ankle arthrometer can detect increased mechanical laxity of the ankle-subtalar-joint-complex after simulated injury of the lateral ankle ligaments. DESIGN AND SETTING: We used linear regression analysis to examine the relationship between direct measurements of tibial-calcaneal bone motion and instrumented measurements of ankle-subtalar-joint-complex laxity. An intraclass correlation coefficient (2,1) was calculated to determine intratester and intertester reliability for instrumented measurements of ankle-subtalar-joint-complex laxity. In addition, 2 separate, one-way, repeated-measures analyses of variance were used to compare instrumented measures of anteroposterior displacement and inversion-eversion rotation among the intact ankles after sectioning the anterior talofibular ligament and both the anterior talofibular and calcaneofibular ligaments. Data were collected in a biomechanics laboratory setting. SUBJECTS: Six fresh-frozen human-cadaver ankle specimens were studied. MEASUREMENTS: Testing involved the concurrent measurement of tibial-calcaneal bone motion and ankle-subtalar-joint-complex motion during the application of external loads. An instrumented ankle arthrometer was used to load the ankle in a controlled manner. Two spatial kinematic linkages measured the 3-dimensional motion of the calcaneus relative to the tibia and the motion of the arthrometer's footplate relative to the tibia. RESULTS: The correlation between tibial-calcaneal bone motion and instrumented measurement for anterior-posterior displacement was.878 (P =.0001). Its linear relationship with bone motion accounted for approximately 77% of the variance of the instrumented measurement. The correlation between tibial-calcaneal bone motion and instrumented measurement for inversion-eversion rotation was.858 (P =.0001), with approximately 74% of the variance of the instrumented measurement accounted for by its linear relationship with bone motion. High intratester and intertester reliability coefficients (ICC [2,1] =.80 to.97) were observed for instrumented measurements of ankle-subtalar-joint-complex laxity. In addition, ligamentous sectioning resulted in significantly increased ankle-subtalar-joint-complex laxity. When compared with the intact condition, sectioning both the anterior talofibular and calcaneofibular ligaments produced significant increases in anterior-posterior displacement (P =.0001) and inversion-eversion rotation (P =.002). CONCLUSIONS: We found a strong relationship between tibial-calcaneal bone motion and arthrometric measurements of ankle-subtalar-joint-complex laxity. The instrumented ankle arthrometer may be suitable as a diagnostic tool for the evaluation of lateral ankle-ligament laxity.

Journal Article↗
PubMedDate not supplied

Radiographic findings associated with symptomatic rotator cuff tears.

This study compared shoulder radiographs of patients with a documented rotator cuff tear with those of asymptomatic age-matched controls. Radiographs of 40 subjects with documented rotator cuff tears were evaluated along with similar films of 84 asymptomatic age-matched controls. Three radiographs were taken of each shoulder: (1) acromioclavicular joint view, (2) anterior-posterior view with 30 degrees of external rotation, and (3) supraspinatus outlet view. Two fellowship-trained radiologists interpreted 14 radiographic areas in a blinded fashion. Inspection of the greater tuberosity showed large positive abnormal ratings for sclerosis, osteophytes, subchondral cysts, and osteolysis. No association was noted between acromial morphology and rotator cuff tears. These results indicate that shoulder radiographs of subjects with a documented rotator cuff tear have greater tuberosity radiographic abnormalities that are not noted in asymptomatic subjects without a rotator cuff tear. No relationship was found between tear length and any of the degenerative conditions.

Acromion↗
PubMedDate not supplied

Chondrocyte viability in refrigerated osteochondral allografts used for transplantation within the knee.

PURPOSE: To evaluate cell viability and matrix characteristics of refrigerated osteochondral allografts implanted up to 44 days after harvest. METHODS: Sixteen refrigerated allografts underwent histologic and ultrastructural examination and fluorescence excitation analysis prior to implantation. The average size of the graft implanted was 6.2 cm(2) (+/-3.4 cm(2)). Refrigerated allografts averaged 30 days (range, 17 to 44 days) from donor expiration to implantation. Nine specimens underwent cell viability testing. The percent viability of refrigerated allografts prior to implantation averaged 67%. RESULTS: No significant correlations were noted between histologic score, electron microscopy score, matrix staining percent (MSP) score, and viability. When time to implantation was assessed, an inverse correlation was noted with MSP score (r =.539) (P < 0.05), indicating less matrix staining in grafts refrigerated longer after harvest. CONCLUSION: The current data indicate that refrigerated osteochondral allografts can be maintained for up to 44 days with average chondrocyte viability of 67%.

Cartilage, Articular↗
PubMedDate not supplied

The effect of posterior cruciate ligament injury and reconstruction on meniscal strain.

BACKGROUND: The relationship between posterior cruciate ligament insufficiency and meniscal injury is unclear. HYPOTHESIS: Posterior cruciate ligament insufficiency results in increased medial and lateral meniscal strain. STUDY DESIGN: Descriptive anatomic study. METHODS: Eight cadaveric specimens were evaluated with a 6-axis load cell and differential variable reluctance transducer strain gauges placed in both menisci. Data were recorded in the posterior cruciate ligament-intact state after posterior cruciate ligament transection and after posterior cruciate ligament reconstruction. RESULTS: The effect of posterior cruciate ligament state on meniscal strain was more pronounced at higher flexion angles. At 60 degrees and 90 degrees of flexion, there was a significant effect of posterior cruciate ligament sectioning and reconstruction on meniscal strain (P < .026). Average meniscal strain for both medial and lateral menisci increased between the intact and the posterior cruciate ligament-cut states. Posterior cruciate ligament reconstruction decreased strain values to that of the intact knee. CONCLUSIONS: Meniscal strain increases with complete posterior cruciate ligament injury and is returned to posterior cruciate ligament-intact levels after posterior cruciate ligament reconstruction. CLINICAL RELEVANCE: Posterior cruciate ligament reconstruction may play an important role in reducing meniscal strain and subsequent degeneration within the posterior cruciate ligament-injured knee.

Biomechanical Phenomena↗