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Biomedical subjects

C D Harner

Publications and source records attributed to C D Harner.

16 recordsLinked to original sources
PubMed1995

Comparative study of the size and shape of human anterior and posterior cruciate ligaments.

As an important step toward determination of the function of cruciate ligaments, the cross-sectional shapes and areas of the anterior cruciate, posterior cruciate, and meniscofemoral ligaments were evaluated in situ within the same knee with use of a laser micrometer system. Measurements were made in eight human cadaveric knees at five levels along the midsubstance of each ligament, with the knee at 0 degree, 30 degrees, 60 degrees, and 90 degrees of flexion. The posterior cruciate ligament was found to be widest in the medial-lateral direction, whereas the anterior cruciate ligament usually was larger in the anterior-posterior direction. The cross-sectional shapes of the anterior cruciate ligament generally were noted to be more circular along the entire midsubstance than were those of the posterior cruciate ligament. In contrast, the cross-sectional shapes of the posterior cruciate ligament were more circular near the tibia, becoming progressively more elongated toward the femur. The meniscofemoral ligaments were more circular than the cruciate ligaments, with an occasional medial-lateral widening similar to that of the posterior cruciate ligament. The cross-sectional area of both the cruciate ligaments changed along the length of the midsubstance, with the anterior cruciate ligament becoming slightly larger distally and the posterior cruciate ligament enlarging proximally. The angle of flexion of the knee was not found to have a significant effect on the cross-sectional areas of the ligaments but was noted to alter the cross-sectional shapes.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1995

The Bankart lesion of the shoulder: a biomechanical analysis following repair.

The Bankart lesion of the shoulder has long been associated with anterior instability. Our laboratory has developed a biomechanical model of the human shoulder which was used to determine the effects of creating a Bankart lesion on cadaveric specimens and then to compare the effects of two repair techniques. The model simulates the abducted, externally rotated position of the glenohumeral joint and uses pneumatic cylinders to simulate the rotator cuff forces. Specimens were tested intact following a partial Bankart lesion, following a complete Bankart lesion, and after performing a Bankart repair using three Mitek suture anchors. Finally, both the traditional and Mitek repairs were tested until failure. Strain in the inferior glenohumeral ligament (IGHL) and torque resistance was measured as an indication of instability of the joint. Strain was noted to decrease with increasing depth of lesion of the IGHL. Torsional rigidity of the shoulder decreased with increasing depth of lesion as well. Repairing the shoulder restores the strain and rigidity to control conditions. The mean load until failure was greater with the traditional repair than with the suture anchor technique. This study quantitates the effects of a Bankart lesion of the shoulder, and demonstrates that repairing the lesion with a suture anchor technique restores the biomechanics of the shoulder.

Biomechanical Phenomena↗
PubMed1995

Insertion-site anatomy of the human menisci: gross, arthroscopic, and topographical anatomy as a basis for meniscal transplantation.

A cadaveric study was performed to determine the insertion-site anatomy of the human menisci, their topographical relationships to adjacent intra-articular structures, and which arthroscopic portal provides for optimal visualization of each insertion site. Fifteen fresh-frozen cadaver knees were studied (ages 48 to 63 years). Ten knees underwent arthroscopy using four standard arthroscopic portals. Visualization and placement of an arthroscopic guide over each meniscal horn insertion site was attempted through the four arthroscopic portals. Guide wires were drilled to mark horn insertions followed by a gross dissection to evaluate accuracy of the guide wire gross dissection to evaluate accuracy of the guide wire placement and to isolate meniscal horn insertion sites. Insertion sites were outlined and evaluated for size and topographical relationships to other intra-articular structures. Five additional knees were dissected free of all soft tissues except the tibial insertions of the meniscal roots and anterior cruciate ligament/posterior cruciate ligament. Each tibia was mounted in a jig and a digitizing system was used to record coordinates of points along the outline of each bony meniscal horn insertion site, the ACL tibial insertion, and the articular surface of each tibial plateau. The x, y, z coordinates for each point were calculated and loaded into a computer program allowing for surface area determination and computer-generated topographical maps to assess relative position of each specific insertion site. Placement of the arthroscope in the anterolateral portal allows optimal visualization and guide wire placement for both lateral meniscal horn insertion sites. Medial meniscal anterior and posterior horn insertion sites are best visualized with the arthroscope in the anteromedial and posteromedial portals respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopy↗
PubMed1995

Loss of motion following knee ligament reconstruction.

Loss of motion following knee ligament surgery is a common and potentially serious complication. Loss of extension is most common following anterior cruciate ligament reconstruction, and loss of flexion is most common after posterior cruciate ligament reconstruction. The aetiology of loss of motion is multifactorial and includes impingement and capsulitis. The risk for loss of motion can be minimised by appropriate preoperative, intraoperative and postoperative intervention. Management of loss of motion depends on the cause and length of time following surgery.

Anterior Cruciate Ligament↗
PubMed1995

Knee ligament and meniscal injuries. Current concepts.

Assessment of knee injuries is a common component of a busy orthopaedic practice. After critical evaluation, a number of patients will be found to have meniscal or ligament pathology. This article reviews the vital roles these structures play in normal knee function. In addition, the potentially deleterious effects of knee ligament and meniscal injuries are discussed, along with providing a rationale for the currently recommended treatment of these injuries.

Adolescent↗
PubMed1994

Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique.

The purpose of this study was to compare the single-incision, "endoscopic" (ENDO) anterior cruciate ligament (ACL) reconstruction technique with the two-incision, "rear-entry" technique (RE). Sixty patients were entered into a prospective study. Thirty patients underwent ACL reconstruction by the RE technique, followed by 30 consecutive patients using the ENDO procedure. Postoperatively all patients followed a standardized rehabilitation protocol. Follow-up evaluation consisted of a detailed physical examination, range of motion, thigh girth, vertical leap, hop test, KT-1000 testing, and patient interview. They were scored according to the International Knee Documentation Committee (IKDC) protocol, which takes objective and subjective data into account. Patients were also assessed for level of sports activity including frequency and type. Finally, anteroposterior and lateral x-ray films were evaluated with a scoring system for tunnel location. Of the initial 60 patients entered into the study, 50 were available for a detailed clinical and functional review (83%). Demographic comparisons revealed 24 RE patients and 26 ENDO patients. There were 16 men and 8 women in the RE group. The ENDO group comprised 16 men and 10 women. There were 14 right knees and 10 left knees in the RE group. In the ENDO group there were 13 right knees and 13 left knees. The average age in the RE group was 24 years and 25 years in the ENDO group. The average follow-up was 35 months (range 31-40 months) in the RE group and 29 months (range 24-35 months) in the ENDO group. Complications included two patients with loss of motion in the RE group and three in the ENDO group. There were no significant differences between the two groups tested with respect to the overall IKDC rating scale. Anteroposterior and lateral x-ray films revealed no significant differences in femoral and tibial tunnel placement. In conclusion, no significant functional or radiographic differences at a minimum 2-year follow-up could be identified when comparing the two ACL reconstructive techniques.

Adult↗
PubMed1992

Clinical use of fresh, frozen soft tissue allografts.

Fresh frozen allograft tissue provides a good alternative to autogenous tissue for the treatment of patients with symptomatic ligamentous deficiency. While transmission of AIDS and other infectious diseases remains a small possibility, allografts provide the advantages of shorter operative time, small incisions, no damage to a patient's own tissues, and superior usefulness in multiple reconstructions, as well as revision of failed autogenous reconstructions. An independent, critical evaluation of the 4-year results of patients with allograft ACL reconstructions is presented. Issues important in allograft tissue recovery, banking, and intraoperative preparation are reviewed.

Adolescent↗
PubMed1991

Shoulder impingement syndrome. A critical review.

Impingement syndrome is an ill-defined term for a variety of disorders of the shoulder that manifest as anterior shoulder pain, especially during overhead activities. These disorders each have a common pathologic course that includes rotator cuff tendinitis (RCT), and, if untreated, may proceed to cuff rupture. RCT has at least two distinct etiologies. Primary impingement of the supraspinatus tendon on the coracoacromial arch is responsible in the majority of nonathletic cases. Overhead movements in sports are prone to developing secondary mechanical impingement because of an instability pattern that is common in this population. Information from this review and clinical practice permits differentiation of the two distinct etiologies of RCT which is important in treatment planning. Much work still needs to be done in defining the microscopic pathology of RCT.

Humans↗
PubMed1988

The well-leg support.

The authors present a method of support for the well leg that allows total circumferential access to the knee, especially the medial and posteromedial sides. The method is inexpensive, easy to use, and safe. It appears to relieve stress on the lower back, which can occur with standard support. In addition, hyperextension of the hip and possible femoral nerve traction injury are avoided.

Arthroscopes↗
PubMed1987

Discoid lateral meniscus: case report of arthroscopic attachment of a symptomatic Wrisberg-ligament type.

The symptomatic discoid lateral meniscus is a well-known congenital anomaly that is of three different types: complete, incomplete, and Wrisberg-ligament type. The Wrisberg-ligament type has no meniscotibial attachment posteriorly, and in the past has been treated by total (open or arthroscopic) meniscectomy. In this article, we review the literature and report a previously unreported case of arthroscopic peripheral attachment after central partial meniscectomy of a Wrisberg-ligament type discoid lateral meniscus, with documentation of healing at arthroscopic second look 1 year following surgery.

Adult↗
PubMedDate not supplied

Cidex-induced synovitis.

Microscopic evidence of inflammation was observed in the synovium of rabbit knees that had been injected with 10 ppm of Cidex (2% glutaraldehyde). Initial changes were synovial hypertrophy, subsynovial edema, and vascular congestion. At concentrations of 100 ppm or greater, focal synovial necrosis, hemorrhage, and gross diffuse synovitis were observed. The degree of synovial inflammation was proportional to the concentration of Cidex. Observation of synovial response versus time demonstrated this reaction to be a chemical synovitis without histologic evidence of a delayed hypersensitivity allergic component. Significant intraoperative levels of Cidex were noted in the rise solutions at several hospitals. When a single rinse is used, the concentration of Cidex present in the rinse basin is 100 to 300 ppm. If the same rinse is used for subsequent cases, the Cidex concentration is on the order of 1,000 ppm by the fifth arthroscopic procedure. If a double rinse is used and the rinse changed with each operative case, the Cidex concentration in the second rinse is less than 10 ppm. After irrigation of the knee joint with 1 liter of saline, the intraarticular concentration of Cidex is less than 10 ppm regardless of the rinse technique.

Aldehydes↗
PubMedDate not supplied

Biomechanical evaluation of rotator cuff fixation methods.

Initial fixation strength and failure mode for various rotator cuff reattachment techniques (variations of the McLaughlin technique) were evaluated. Repair methods included standard suture (control), reinforced suture [expanded polytetrafluoroethylene (PTFE) patch and polydioxanone (PDS) tape augmentation] and stapling (nonarthroscopic and arthroscopic soft-tissue staples). The average strength of intact rotator cuff tissue (supraspinatus tendon) was also determined. The different rotator cuff repairs, including at least one control, were performed on fresh-frozen human cadaver shoulder pairs. Repairs were tested to failure in pure tension with the shoulder fixed in 60 degrees of abduction. Load and displacement data were normalized to controls, grouped according to failure modes, and statistically analyzed. The two basic failure modes observed were 1) bone failure, or suture tearing through the bone (indicating weak bone stock) and 2) tendon failure, or suture tearing of the rotator cuff. Gross comparisons between intact and repaired tendons indicated that the intact tendon was two to three times stronger than the repaired tendon. Based on the mode of failure and lack of increased strength after repair, the use of staples for cuff attachment is discouraged. PDS tape suture reinforcement did not increase fixation strength. In contrast, PTFE patch suture augmentation demonstrated statistically higher initial failure loads than did the control and was of specific benefit for shoulders with weak bone stock.

Adult↗
PubMedDate not supplied

Modification of the Bankart reconstruction with a suture anchor. Report of a new technique.

We assessed the effectiveness of a new suture anchor that has been designed to anchor sutures into a blind, straight hole drilled in bone. The strength of fixation in glenoid bone is 67 N for the No. 0 anchor and suture, and 82 N for the No. 2 device with suture. During 1988 and 1989, 32 patients underwent a modified Bankart reconstruction for recurrent anterior glenohumeral instability at two centers as part of a prospective study of this modified technique. There were no complications as a result of the technique. The four surgeons involved agreed that the suture anchor simplified the procedure. Seventeen patients have been reviewed, with more than 1 year followup. Ninety-four percent had good to excellent results according to the Bankart rating scale. There was one recurrent dislocation in a football player.

Adolescent↗
PubMedDate not supplied

Loss of motion after anterior cruciate ligament reconstruction.

We did a retrospective review and follow-up examination to investigate the incidence, risk factors, and outcome of patients who developed loss of motion after arthroscopic anterior cruciate ligament reconstruction. Two hundred forty-four patients with a minimum followup of 1 year were reviewed. Loss of motion (defined as a loss of extension of more than 10 degrees or flexion of less than 125 degrees) was identified in 27 patients for an overall incidence of 11.1%. Factors associated with loss of motion included acute reconstruction (less than 1 month from initial injury), male sex, and concomitant medial collateral ligament repair or posterior oblique ligament reefing or both. Twenty-one patients required surgery to regain their motion; three patients required a second procedure. Twenty-one of 27 patients with loss of motion underwent a detailed followup and were compared with 24 randomly chosen controls who had a normal range of motion after anterior cruciate ligament reconstruction. At followup, patients who experienced loss of motion had a significant decrease in noninvolved to involved knee extension and flexion compared to the control patients. There was no difference between our patients and the controls regarding patellofemoral problems, anterior knee laxity, and functional strength. Sixty-seven percent of patients with loss of motion had a good or excellent result in comparison to 80% of the controls.

Adolescent↗