Biomedical subjects
Publications and source records attributed to Brian D Busconi.
Hip pain is a common problem seen by orthopaedic surgeons. The current authors provide an approach to the patient with hip pain, including important information to be gained from the history and physical examination and relevant radiographic studies and laboratory tests. A differential diagnosis for patients presenting with the complaint of hip pain and indications for hip arthroscopy are provided.
The hip is the most deeply recessed joint in the body making it difficult to access arthroscopically. However, for the patient with a symptomatic loose body or labral tear open techniques are less advantageous. It is for this reason that, however difficult, minimally-invasive approaches to the hip have been developed. Meticulous attention to proper positioning and portal placement is paramount for safe and successful arthroscopy of the hip. The current authors will review the seminal features of positioning and minimally-invasive surgical approaches to the hip.
Hip arthroscopy has obvious advantages over arthrotomy in the pediatric population. Hip arthroscopy, used as a diagnostic or therapeutic tool, is significantly less invasive than arthrotomy and allows for quicker recovery and return to activities. In addition, arthroscopy avoids dislocation of the femoral head and the corresponding risk of osteonecrosis. Current indications for hip arthroscopy in pediatric patients include septic arthritis, labral disorders, slipped capital femoral epiphysis, and Legg-Calvé-Perthes disease. The role of hip arthroscopy in the pediatric population will continue to expand because of its attractiveness as a less invasive option for evaluating the hip.
Our retrospective study of 12 skeletally immature athletes with type III intercondylar eminence fractures showed that arthroscopic evaluation with mini-open arthrotomy and repair of the tibial intercondylar eminence fracture with absorbable suture can be successful in repairing anterior cruciate ligament avulsion fractures and in helping such patients return to their athletic endeavors.
Interest in using radiofrequency energy devices in orthopedics has been growing recently. The basic science of this intervention is similar to that of laser energy application and involves the heating of tissue. Collagen responds characteristically to heat--it becomes denatured, and its configuration becomes disorganized. Thus, this application of heat can be used to shorten collagenous soft tissue. Radiofrequency energy can also be used at higher parameters for tissue ablation. Although early clinical trials have shown promising results for many applications, long-term study is needed.
OBJECTIVES: To compare the bone mineral density (BMD) of competitive female teenage figure skaters with a history of fracture with the BMD of skaters without fracture and to compare each group to age-matched, nonathletic controls. DESIGN: Retrospective age-matched cohort. SETTING: Tertiary care medical center and 3 local skating clubs. PARTICIPANTS: Thirty-six adolescent female competitive skaters (10 with fracture, 26 without fracture) to 22 age-matched controls. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: BMD was estimated by quantitative ultrasound. RESULTS: Skaters who had suffered stress fractures had BMD values comparable with those of healthy nonathletic controls. However, skaters who had not suffered stress fractures had calcaneal BMD values 15% to 24% greater than either the controls or skaters with fractures. Among the skaters without fracture, there was a 14% to 19% higher calcaneal BMD in skaters who executed triple jumps relative to skaters who performed only double jumps. Furthermore, there was 7% to 11% greater BMD in the landing foot of the skaters relative to the takeoff foot. CONCLUSIONS: Stress fractures in adolescent skaters are not caused by low bone mass but may result from excessive forces placed on a normal skeleton. Our findings also support the hypothesis that higher peak forces are applied to the landing foot relative to the takeoff foot.
PURPOSE: Debridment is used to treat Outerbridge grades 2 and 3 lesions in a mechanically aligned and properly tracking patella. It removes fibrillation and provides a stable rim of chondral tissue. Recent basic science reports suggest that radiofrequency probes are superior to mechanical shavers for articular cartilage debridement. The goal of this study was to compare the clinical outcomes of debridement of patellar grade 2 and 3 chondral lesions using radiofrequency and mechanical devices. TYPE OF STUDY: Patients were prospectively randomized into 2 treatment groups. METHODS: Consecutive female patients undergoing arthroscopy for symptomatic, isolated patellar cartilage lesions without evidence of instability, malalignment, or patellar tracking dysfunction were prospectively randomized into radiofrequency and mechanical debridement groups based on medical record number. All patients had failed a 6-month course of conservative treatment and had chondral pathology documented by magnetic resonance imaging. Patients were assessed before and after surgery using the Fulkerson-Shea Patellofemoral Joint Evaluation Score. RESULTS: Nineteen patients (mean age, 37.5 years) underwent chondral debridement using a mechanical shaver and 20 patients (mean age, 36.9 years) underwent chondral debridement using a bipolar radiofrequency probe at nonablative energy levels. The mechanical group had a mean preoperative score of 59.2 and the radiofrequency group had a mean preoperative score of 59.6. Postoperative scores at 12-month follow-up were 80.0 for the mechanical group and 87.9 for the radiofrequency group (P =.0031). At 24 months, the mean score of the mechanical group was 77.5 and the mean of the radiofrequency group was 86.6 (P =.0006). CONCLUSIONS: This study presents clear evidence of superior clinical outcome of debridement of patellar grade 2 and 3 chondral lesions with the use of bipolar radiofrequency versus a mechanical shaver.