Biomedical subjects

Anthony A Romeo

Publications and source records attributed to Anthony A Romeo.

At least 19 recordsLinked to original sources

PubMed2006

Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair.

BACKGROUND: Recent technical improvements have led the way to a resurgence of the single-incision approach for repair of distal biceps tendon injuries. There has been no biomechanical evaluation of all these techniques with comparison to the standard 2-incision bone tunnel technique. HYPOTHESIS: There will be no difference under cyclic loading and ultimate failure between the 2-incision bone tunnel technique, suture anchor repair, interference screw, and EndoButton techniques for the repair of distal biceps tendon ruptures. STUDY DESIGN: Controlled laboratory study. METHODS: Sixty-three fresh-frozen cadaveric elbows were randomly assigned to 4 treatment groups (bone tunnel, EndoButton, suture anchor, interference screw). Cyclic loading was then performed from 0 degrees to 90 degrees at 0.5 Hz for 3600 cycles with a 50-N load. A differential variable reductance transducer was placed between the radius and distal tendon to determine displacement. The construct was then pulled to failure at 120 mm/min. RESULTS: A multiple analysis of variance revealed no statistically significant difference for displacement among the 4 repair techniques. Displacement using the bone tunnel was 3.55 mm, EndoButton was 3.42 mm, suture anchor was 2.33 mm, and interference screw was 2.15 mm. There was a statistically significant greater load to failure with EndoButton (440 N) than suture anchor (381 N), bone tunnel (310 N), or interference screw (232 N) (P < .001). CONCLUSION: The EndoButton technique had the highest load to failure. CLINICAL RELEVANCE: These data demonstrate the EndoButton to be the strongest repair technique, with no failures during cycling at physiologic loads and with the largest load to failure. These findings are important in maximizing surgical results and stability and suggest that the construct can tolerate early postoperative active range of motion.

Arm↗

PubMed2006

Effect of lateral meniscus allograft on shoulder articular contact areas and pressures.

The objective of this study was to determine the effect of a lateral meniscus allograft on the articular contact area and pressures across the glenohumeral joint under compressive loads of 220 N and 440 N. Eight fresh-frozen shoulders were used, and contact areas and pressures were determined with a Tekscan flexible tactile force sensor. Testing conditions included a normal glenohumeral joint and one interposed with a lateral meniscus allograft. Using the Tekscan sensing equipment, we evaluated the total force (in Newtons), contact area (in square millimeters), mean contact pressure (in kilograms per square centimeter), peak force (in Newtons), and peak contact pressure (in kilograms per square centimeter). The interposed lateral meniscus allograft group showed a statistically significant decrease in total force at both 220 N and 440 N, as well as a decrease in contact area for the 220-N testing condition. There were no statistically significant differences between the two groups in contact area at 440 N or in peak forces or peak contact areas for either 220-N or 440-N testing condition. Biomechanically biologic resurfacing with a lateral meniscus allograft of the glenohumeral joint is supported by decreased forces on the glenoid surface.

Adult↗

PubMed2006

The anatomy of the bicipital tuberosity and distal biceps tendon.

The anatomy of the distal biceps tendon and bicipital tuberosity (BT) is important in the pathophysiology of tendon rupture, as well as surgical repair. Understanding the dimensions of the BT and its angular relationship to the radial head and radial styloid will facilitate surgical procedures such as reconstruction of the distal biceps tendon, radial head prosthesis implantation, and reconstruction of proximal radius trauma. We examined 178 dried cadaveric radii, and the following measurements were collected: radial length, length and width of the BT, diameter of the radius just distal to the BT, distance from the radial head to the BT, radial head diameter, width of the radius at the BT, radial neck-shaft angle, and styloid angle. Furthermore, the morphology of the BT ridge was defined as smooth (absent), small, medium, large, or bifid. Of the specimens, 48 were further analyzed with a computed tomography scanner at the level of the BT to determine the distance to traverse both the anterior and posterior cortex and the anterior cortex alone. Eighteen fresh-frozen cadaveric elbows were dissected, and the insertion footprint of the distal biceps tendon was defined. The BT has a mean length of 22 +/- 3 mm and a mean width of 15 +/- 2 mm. The tendon insertion footprint is a ribbon-shaped configuration on the most ulnar aspect of the BT, and it occupies 63% of the length and 13% of the width of the BT. The BT ridge is absent in 6% of specimens and bifid in 6%, and the remaining 88% of specimens have a single ridge that may be classified as small, medium, or large. The mean diameter of the radial head is 22 +/- 3 mm. The mean radial neck-shaft angle is 7 degrees +/- 3 degrees , and the mean BT-radial styloid angle is 123 degrees +/- 10 degrees . None of the measurements correlated with patient age, sex, or race. We concluded that the morphology of the BT ridge is variable. The insertion footprint of the distal biceps tendon is on the ulnar aspect of the BT ridge. The dimensions of the radius and BT are applicable to several surgical procedures about the elbow.

Cadaver↗

PubMed2006

Arthroscopic reduction and repair of a locked posterior shoulder dislocation.

Locked posterior shoulder dislocations are an uncommon but difficult problem for the orthopaedic clinician. Furthermore, they are often missed on initial presentation, resulting in significant delays in treatment. Traditional treatment has involved formal open reduction, most commonly from an anterior approach, followed by transfer of the lesser tuberosity or subscapularis tendon into the anterior humeral head defect. We present the case of a patient with locked posterior shoulder dislocation, who was treated with arthroscopically assisted reduction followed by arthroscopic posterior stabilization. Use of this technique allows the surgeon to reduce the dislocation without performing an open arthrotomy, thereby decreasing the patient's overall morbidity. Furthermore, an arthroscopic technique used for stabilization allows visualization of the entire glenohumeral joint and enables the surgeon to directly address posterior disease, rather than compensating for the defect with an anteriorly based transfer.

Adult↗

PubMed2006

A prospective outcome evaluation of arthroscopic Bankart repairs: minimum 2-year follow-up.

BACKGROUND: Arthroscopic treatment of anterior shoulder dislocation has become possible through improvements in instruments and techniques. OBJECTIVE: To prospectively evaluate results of arthroscopic Bankart repairs at a minimum 2-year follow-up for patients with histories of shoulder dislocation and an anterior-inferior labral tear at the time of diagnostic arthroscopy. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A consecutive series of 85 patients (70 men, 15 women; mean age, 26 years) with Bankart lesions were treated with arthroscopic repair using suture anchors; 18 patients (27%) had extension of the labral injury into the superior labrum affecting some or all of the biceps anchor. Anchors were loaded with no. 2 nonabsorbable braided suture and placed 2 mm into the edge of the glenoid surface. A low anterior (5-o'clock) portal through the subscapularis tendon was used in all patients; 72 patients were evaluated at a minimum of 2 years postoperatively (mean, 46 months). RESULTS: Seven patients (10%) experienced recurrent instability after repair. Four patients had redislocations; 3 experienced recurrent subluxations. One patient had pain with the apprehension test without a clear history of recurrent instability. Of 18 collision athletes, 2 had dislocations at 22 and 60 months postoperatively. There were no complications, including no neurologic deficits. Clinical strength testing of the subscapularis muscle was normal in all patients. The mean Rowe score was 88 of 100 points, with 90% excellent or good results. Simple Shoulder Test responses improved from 66% positive preoperatively to 88% positive postoperatively. The American Shoulder and Elbow Surgeons scoring index averaged 92 of 100 points postoperatively. Pain analog scales improved from 5.5 preoperatively to 0.35 postoperatively on a 10-point scale. SF-12 scores improved for physical function. Patient satisfaction was rated 8.9 on a 10-point visual analog scale. CONCLUSION: Bankart repairs performed arthroscopically using properly implanted suture anchors and nonabsorbable sutures and in which associated pathoanatomy is addressed demonstrate low recurrence rates (10%) similar to historical open controls.

Adult↗

PubMed2005

Subpectoral biceps tenodesis with interference screw fixation.

The proximal portion of the long head of the biceps is a recognized cause of anterior shoulder pain. This article presents a novel technique for tenodesing the proximal biceps tendon. The tendon is evaluated and tenodesed in the same anatomic position beneath the pectoralis tendon, and is removed entirely from the bicipital groove. The proximal portion of the long head of the biceps tendon is marked near its origin and lysed arthroscopically. The skin incision for the subpectoral open biceps tenodesis is made in the axilla exposing the inferior border of the pectoralis major muscle. The tendon is withdrawn from the joint and out of the incision. A Krackow or other type of interrupted tendon whipstitch is placed in the 10 to 15 mm of tendon proximal to the musculotendinous junction. A bone tunnel is created within the bicipital groove. The tendon/tenodesis driver complex is positioned to create a secure fit within the bone tunnel. Our current series includes 22 cases with short-term follow-up of 2 to 10 months. None of the repairs has pulled out and none of the patients reports persistent pain or loss of function. The subpectoral approach with interference screw fixation appears to be a promising, reproducible technique for tenodesing the biceps.

Bone Screws↗

PubMed2005

The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis.

PURPOSE: The purpose of this study was to compare the cyclic displacement and ultimate failure strength of 4 proximal biceps tendon tenodesis fixation methods: the open subpectoral bone tunnel (SBT) biceps tenodesis, the arthroscopic suture anchor (SA) tenodesis, the open subpectoral interference screw (SIS) fixation technique, and the arthroscopic interference screw (AIS) technique. TYPE OF STUDY: Biomechanical experimental control. METHODS: Twenty fresh-frozen cadaver shoulders were dissected free of soft tissues, leaving the proximal humerus and the proximal biceps tendon as a free graft. Specimens were randomized to 1 of 4 groups with 5 total specimens in each group. A proximal biceps tenodesis was performed according to the techniques listed above. The specimens were mounted for an axial pull of the biceps tendon on a servohydraulic materials testing system with a 100-N load cycled at 1 Hz for 5,000 cycles, followed by an axial load to failure test. Cyclic displacement, ultimate load to failure, and site of failure were recorded for each specimen. RESULTS: The mean cyclic displacement recorded for each experimental group was as follows: SBT group, 9.39 +/- 2.82 mm; AIS group, 5.26 +/- 2.60 mm; SIS group, 1.53 +/- 0.60 mm; and SA group, 3.87 +/- 2.11 mm. The mean ultimate failure loads after 5,000 cycles were as follows: SBT group, 242.4 +/- 51.33 N; AIS group, 237.6 +/- 27.58 N; SIS group, 252.4 +/- 68.63 N; and SA group, 164.8 +/- 37.47 N. Each specimen failed at the tenodesis site. CONCLUSIONS: The SBT group showed statistically significant greater displacement than the other tenodesis methods. There were no statistically significant differences in ultimate failure strength between any of the biceps tenodesis methods tested. CLINICAL RELEVANCE: The data serve as a guide to the surgeon performing a proximal biceps tenodesis in choosing a fixation method.

Aged↗

PubMed2005

Arthroscopic anterior shoulder stabilization of collision and contact athletes.

BACKGROUND: Repair of the anterior labrum (Bankart lesion) with tightening of the ligaments (capsulorrhaphy) is the recommended treatment for recurrent anterior glenohumeral dislocations. Current evidence suggests that arthroscopic anterior stabilization methods yield similar failure rates for resubluxation and redislocation when compared to open techniques. STUDY DESIGN: Case series; Level of evidence, 4 PURPOSE: To examine the results of arthroscopic anterior shoulder stabilization of high-demand collision and contact athletes. METHODS: Thirteen collision and 5 contact athletes were identified from the senior surgeon's case registry. Analysis was limited to patients younger than 20 years who were involved in collision (football) or contact (wrestling, soccer) athletics. Objective testing included preoperative and postoperative range of motion and stability. Outcome measures included the American Shoulder and Elbow Society shoulder score, Simple Shoulder Test, SF-36, and Rowe scores. The surgical procedure was performed in a consistent manner: suture anchor repair of the displaced labrum, capsulorrhaphy with suture placement supplemented with thermal treatment of the capsule when indicated, and occasional rotator interval closure. Average follow-up was 37 months (range, 24-66 months). RESULTS: Two of 18 contact and collision athletes (11%) experienced recurrent dislocations after the procedure; both were collision athletes. One returned to play 3 years of high school football but failed after diving into a pool. One patient failed in his second season after his stabilization (>2 years) when making a tackle. None of the contact athletes experienced a recurrent dislocation, with all of them returning to high school or college athletics. CONCLUSIONS: One hundred percent of all collision and contact athletes returned to organized high school or college sports. Fifteen percent of those collision athletes had a recurrence, which has not required treatment. Participation in collision and contact athletics is not a contraindication for arthroscopic anterior shoulder stabilization using suture anchors, proper suture placement, capsulorrhaphy, and occasional rotator interval plication.

Adolescent↗

PubMed2005

The effect of radiofrequency energy on nonweight-bearing areas of bone following shoulder and knee arthroscopy.

This prospective randomized clinical trial evaluated whether the use of radiofrequency energy (RFE) devices for soft-tissue ablation and coagulation cause thermal injury to bone. Fifty patients underwent one of three treatment modalities: electrocautery, monopolar RFE, or bipolar RFE. Preoperative and postoperative magnetic resonance imaging was compared to evaluate for evidence of osteonecrosis. Postoperative MRI of all patients did not reveal any osteonecrosis or subchondral edema. These findings indicate electrocautery, monopolar RFE, and bipolar RFE devices can be used safely for soft-tissue blation and hemostasis.

Acromion↗

PubMed2005

The glenoid center line.

This study sought to define a point on the anterior glenoid surface to serve as a marker for glenoid orientation and to present the concept of a glenoacromial version angle. Twenty fresh-frozen cadaver scapulas were examined. A line perpendicular to the glenoid surface exited the anterior scapular cortex in all specimens at an average distance of 29.3 +/- 3.9 mm. The average glenoacromial version angle was 60 degrees +/- 110 degrees. These numbers may allow better intraoperative assessment of glenoid version.

Aged↗

PubMed2005

Decision making in contemporary shoulder arthroplasty.

Clinical experience with humeral implants has evolved over the past decade, along with a better understanding of shoulder anatomy and function. There is no question that surgeons are getting better at restoring normal anatomic relationships than in preceding decades. Whether or not this impacts implant longevity will only be known with time and further follow-up. Even over the short term, it is difficult to ascertain whether new prosthetic designs have improved patient function as well as has been implied by the related biomechanical studies. Most surgeons with experience using old and new systems realize a greater sense of predictability in achieving their surgical goals when using more modern implants. Concerns over the durability of prosthetic systems with multiple moving parts and hand-tightened locking mechanisms have almost been forgotten in shoulder arthroplasty, but time will also reveal their importance. New glenoid designs have been less exciting, the major problem being one of developing appropriate materials. Polyethylene does not behave like normal cartilage, and its wear is constant and unforgiving. Surgeons now better understand how to reconstruct the normal glenoid position and achieve more secure early fixation than in the past, but this does not promise long-term durability and freedom from complications.

Arthroplasty, Replacement↗

PubMed2004

Open Bankart repair versus arthroscopic repair with transglenoid sutures or bioabsorbable tacks for Recurrent Anterior instability of the shoulder: a meta-analysis.

BACKGROUND: In published comparative studies, it remains unknown if arthroscopic techniques for performing Bankart repair for anterior shoulder instability equal the success of open repair. HYPOTHESIS: The current literature supports a lower rate of recurrent instability after open Bankart repair compared to arthroscopic repair with bioabsorbable tacks or transglenoid sutures. STUDY DESIGN: Meta-analysis. METHODS: A Medline search identified all randomized controlled trials or cohort studies that directly compared open repair to arthroscopic techniques of Bankart repair for traumatic, unilateral, recurrent anterior instability. Data collected from each study included patient demographics, surgical technique, rehabilitation, outcome, and complications. RESULTS: Six studies met all inclusion criteria. There were 172 patients in the arthroscopic group (90 patients with transglenoid sutures, 77 patients with arthroscopic tacks, and 5 patients with suture anchors) and 156 patients in the open group. The groups were similar in demographic characteristics. When comparing the arthroscopic to the open group, there was a significantly higher rate of recurrent dislocation (12.6% vs 3.4%; P = .01) and total recurrence (recurrent dislocation or subluxation) (20.3% vs 10.3%; P = .01). In addition, there was a higher proportion of patients with an excellent or good postoperative Rowe score in the open group (88%) than in the arthroscopic group (71%) (P = .01). CONCLUSIONS: Arthroscopic Bankart repair using transglenoid sutures or bioabsorbable tacks results in a higher rate of recurrence of instability compared to open techniques. Studies comparing open repair to newer arthroscopic techniques using suture anchor fixation and capsular plication are necessary.

Absorbable Implants↗

PubMed2004

Arthroscopic biceps tenodesis.

Arthroscopic biceps tenodesis is indicated for the treatment of severe biceps tendonopathy, partial- or full-thickness tendon tears, or biceps instability typically associated with rotator cuff tear, although there has been considerable debate on tenotomy versus tenodesis. We advocate tenodesis, for the following reasons: to re-establish the resting muscle length so as to avoid scaring and spasm, to allow biceps use for complex elbow motion, and to avoid cosmetic defects in cases in which deformity can sometimes equal disability. This technical note provides illustrations and detailed descriptions of our arthroscopic tenodesis technique using a Arthrex (Naples, FL) biotenodesis system.

Absorbable Implants↗

PubMed2004

Shoulder scoring scales for the evaluation of rotator cuff repair.

Various assessment tools have been proposed for evaluation of shoulder function. Analyses of comparability, validity, and reliability among shoulder assessment tools are lacking. The purpose of our investigation was to compare the results of three commonly used shoulder assessment tools in the evaluation of a specific shoulder condition. Seventy-two full-thickness rotator cuff tears were treated with an open rotator cuff repair from 1986-1993. The average age of the patients at surgery was 58 years (range, 24-92 years). The median duration of followup at the time of evaluation for this study was 55 months (range, 24-102 months; standard deviation, 22 months). Correlation among the results of the UCLA, Constant-Murley, and the Simple Shoulder Test scales was fair (range, 0.66-0.76). More importantly, the three systems were evaluated for their ability to accurately predict improved motion, strength, and patient satisfaction. The Simple Shoulder Test and the Constant-Murley scales showed the highest positive predictive values. The Simple Shoulder Test is a patient-based self-assessment device that easily can be incorporated into a busy clinical practice, providing outcome data comparable with complex evaluation systems when evaluating the results of rotator cuff repair.

Adult↗

PubMed2004

Arthroscopic treatment of anterior glenohumeral instability: indications and techniques.

The arthroscopic treatment of anterior glenohumeral instability is becoming increasingly accepted as a viable treatment option because reported success rates parallel those of open stabilization techniques. This improved success rate is largely the result of advances in surgical techniques and technology. An improved understanding of the pathoanatomy associated with shoulder instability and continuing education initiatives have also been instrumental in expanding the indications for arthroscopic stabilization of the unstable shoulder. Important considerations during arthroscopy include identifying all pathology, mobilizing soft tissue, enhancing the local biology to promote soft-tissue healing to bone or to itself, securing anatomic fixation, and respecting the healing period during postoperative rehabilitation efforts. Principal contraindications include significant bone deficits and the inability to repair capsular avulsions or rupture. Adherence to these basic principles should lead to excellent results with arthroscopic stabilization of the unstable shoulder.

Arthroscopy↗

PubMed2004

Evaluation and management of acromioclavicular joint injuries.

The acromioclavicular joint is stabilized by the coracoclavicular and acromioclavicular ligaments and by the trapezius and deltoid muscles. Joint dislocation commonly results from a direct blow to the acromion. Injury types I through III are generally treated nonoperatively, whereas types IV through VI are treated operatively. Nonoperative protocols should always begin with ice and immobilization. Operative techniques include acromioclavicular ligament repair, dynamic transfer of the conjoined tendon, coracoclavicular ligament reconstruction, and coracoacromial ligament transfer. The goal with any injury type should always be full return to the patient's preinjury condition.

Acromioclavicular Joint↗

PubMed2002

Autologous chondrocyte repair of an articular defect in the humeral head.

Articular cartilage lesions remain a difficult problem for the patient and physician. A variety of procedures and treatments have been proposed to lessen symptoms and restore the articular surface. The knee joint has been the focus of the vast majority of these cartilage restoration procedures. Articular cartilage lesions of the humerus are significantly less common, and their management remains poorly defined. This paper presents a case report of a young athlete with a large full-thickness articular cartilage defect of the proximal humerus and subsequent treatment using autologous chondrocyte implantation.

Adolescent↗

PubMedDate not supplied

Normalization of the Constant score.

The strength of the normal shoulder may differ by gender and deteriorate with age. Thus, the Constant score may also decrease in absolute value while still reflecting a normal score. To account for age- and gender-related differences, normal results for this scale must be determined across a population of patients without shoulder disease. Patients presenting for evaluation of nonshoulder conditions participated. A subjective questionnaire was completed. Range of motion and strength were measured. This analysis includes the data of 441 patients. The mean Constant score for men was significantly greater than that for women in each age group ( P < .05). Significant age-related differences were noted in each group ( P < .05). Normative values for the Constant score based on age and gender were determined. The adjusted score represents the gender- and age-matched function of the shoulder and is useful in the evaluation of shoulder outcomes.

Adolescent↗