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Biomedical subjects

Carlos A Guanche

Publications and source records attributed to Carlos A Guanche.

14 recordsLinked to original sources
PubMed2006

Arthroscopic treatment of femoroacetabular impingement.

The etiology of degenerative joint disease of the hip remains unsolved. A precursor for some patients, especially younger ones, may be hip impingement. Repetitive microtrauma at maximal flexion can cause chronic pain from the abutment at the femoral head-neck junction caused by an abnormal offset. Chronic impingement from an aspherical head can lead to degenerative labral tears and acetabular chondral degeneration, which may contribute to the degenerative cascade. Arthroscopic treatment of hip impingement caused by an abnormal head-neck offset improves symptoms, restores hip morphology, and ultimately may halt the progression toward degenerative joint disease in certain patients. Early results show that if debridement of the impinging lesion and injured labrum is performed in the setting of normal femoral and acetabular articular surfaces, the results are promising.

Acetabulum↗
PubMed2005

Arthroscopic single-row versus double-row suture anchor rotator cuff repair.

BACKGROUND: Recurrent defects after open and arthroscopic rotator cuff repair are common. Double-row repair techniques may improve initial fixation and quality of rotator cuff repair. PURPOSE: To evaluate the load to failure, cyclic displacement, and anatomical footprint of 4 arthroscopic rotator cuff repair techniques. HYPOTHESIS: Double-row suture anchor repair would have superior structural properties and would create a larger footprint compared to single-row repair. STUDY DESIGN: Controlled laboratory study. METHODS: Twenty fresh-frozen cadaveric shoulders were randomly assigned to 4 arthroscopic repair techniques. The repair was performed as either a single-row technique or 1 of 3 double-row techniques: diamond, mattress double anchor, or modified mattress double anchor. Angle of loading, anchor type, bone mineral density, anchor distribution, angle of anchor insertion, arthroscopic technique, and suture type and size were all controlled. Footprint length and width were quantified before and after repair. Displacement with cyclic loading and load to failure were determined. RESULTS: There were no differences in load to failure and displacement with cyclic loading between the single-row repair and each double-row repair. All repair groups demonstrated load to failure greater than 250 N. A significantly greater supraspinatus footprint width was seen with double-row techniques compared to single-row repair. CONCLUSIONS: The single-row repair technique was similar to the double-row techniques in load to failure, cyclic displacement, and gap formation. The double-row anchor repairs consistently restored a larger footprint than did the single-row method. CLINICAL RELEVANCE: The arthroscopic techniques studied have strong structural properties that approached the reported performance of open repair techniques. Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.

Absorbable Implants↗
PubMed2005

Acetabular labral tears with underlying chondromalacia: a possible association with high-level running.

PURPOSE: The use of hip arthroscopy has helped delineate intra-articular pathology and has enabled clinicians to further elucidate the factors responsible for injuries, such as running. The subtle development of degenerative changes may be a result of repetitive impact loading associated with this sport. This study presents a population of runners with common pathologic acetabular changes. TYPE OF STUDY: Case series. METHODS: Eight high-level runners with an average age of 36 years (range, 19 to 45 years) were seen for complaints of increasing hip pain with running without any history of macrotrauma. All of the patients had either run several marathons (4), were triathletes (1), Olympic middle distance runners (1), or had run more than 10 miles per week for longer than 5 years (2). Plain radiographic analysis revealed no degenerative changes and an average center-edge (CE) angle of 36.7 degrees (range, 28 degrees to 44 degrees). RESULTS: All patients underwent hip arthroscopy with labral debridement. In 6 patients (75%), a chondral injury of the acetabular cartilage underlying the labral tear was noted. In addition, 3 patients had ligamentum teres disruptions. CONCLUSIONS: It is possible that the development of these tears is the result of subtle instability, which may be exacerbated by running, eventually leading to labral tearing and possible ligamentum teres disruption. While perhaps concurrently, subtle acetabular dysplasia may play a role. Although this study does not confirm an association between running and the development of labral tears or chondral lesions in the hip, it certainly questions whether there is an injury pattern common to this population, a "runner's hip." LEVEL OF EVIDENCE: Level IV.

Acetabulum↗
PubMed2004

Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique.

In an effort to increase the immediate strength of a rotator cuff repair and to simulate the standard open reconstruction with its effective suture fixation, we have developed a novel technique for suture anchor reconstruction of the rotator cuff. The technique, termed mattress double anchor (MDA), is simple and adaptable. It makes use of 2 suture anchors that are placed independently and then connected by a suture loop. The technique produces a repair construct that distributes the stress across 2 anchors. The method also restores a large surface area for healing between the rotator cuff and the tuberosity.

Arthroscopy↗
PubMed2003

Shoulder kinematics in subjects with frozen shoulder.

OBJECTIVES: To describe 3-dimensional humeral motion in subjects with frozen shoulder and to determine whether a consistent capsular pattern of restriction was present. DESIGN: Descriptive study including repeated measurements of shoulder kinematics. SETTING: Motion-analysis laboratory. PARTICIPANTS: Ten (9 women, 1 man) volunteers with a diagnosis of idiopathic adhesive capsulitis and 10 (9 women, 1 man) subjects with asymptomatic shoulders as comparison subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Electromagnetic tracking sensors monitored the 3-dimensional position of the trunk, scapula, and humerus throughout active shoulder motions. Peak humeral positions relative to the trunk and scapula were determined for shoulder flexion, abduction, scapular plane abduction, external rotation (ER), and internal rotation (IR). Descriptive statistics (means, standard deviations, percentage of normal) were calculated and capsular patterns described. RESULTS: For humeral position relative to the trunk, subjects' mean peak motion was as follows: abduction, 98.4 degrees; ER at the side, 4.5 degrees; ER with the arm abducted, 33.5 degrees; flexion, 116.9 degrees; IR at the side, 54.3 degrees; IR with the arm abducted, 17.8 degrees; and scapular plane abduction, 113.4 degrees. For humeral position relative to the scapula, subjects' mean peak motion was as follows: abduction, 46.4 degrees; ER at the side, 34.7 degrees; ER with the arm abducted, 45.3 degrees; flexion, 70.5 degrees; IR at the side, 10.3 degrees; IR with the arm abducted, -6.4 degrees; and scapular plane abduction, 61.7 degrees. CONCLUSIONS: Symptomatic subjects demonstrated substantial kinematic deficits during humeral range of motion. No single capsular pattern emerged.

Biomechanical Phenomena↗
PubMed2003

Arthroscopic treatment of a symptomatic hip plica.

Synovial plicae are detected most readily by diagnostic arthroscopy. As arthroscopic techniques are applied more frequently to various joints, it should be expected that the diagnosis of plica syndrome will become more common. The authors present a case of symptomatic plica in the hip of a competitive runner, who was treated with arthroscopic resection.

Adult↗
PubMedDate not supplied

Evaluation of an anesthetic pump for postoperative care after shoulder surgery.

In theory, a prolonged, local infusion of anesthetic into a surgical field should reduce postoperative pain. Recently, disposable products have become available to implement this, but the balance between cost and benefit is controversial. This study evaluated such a device in two specific types of arthroscopic surgery of the shoulder: decompression of the subacromial space and repair of a torn labrum in the glenohumeral joint. Placement of the catheter into the glenohumeral joint resulted in problems in removing the device from some cases so that application is not recommended. When the catheter was placed in the subacromial space, the infusion pump was associated with significantly shorter stays in the recovery room, but there was no benefit over placebo with regard to pain, demand for rescue narcotic, or recovery of motion. Furthermore, use of the device presented some inconveniences to the surgical staff and the patient. It was concluded that use of this particular device in these particular applications is not justified.

Adolescent↗
PubMedDate not supplied

Clinical testing for tears of the glenoid labrum.

PURPOSE: With the increasing use of shoulder arthroscopy, diagnosis of glenoid labral lesions has become increasingly common. However, a physical examination maneuver that would allow a definitive clinical diagnosis of a glenoid labral tear, and more specifically a SLAP lesion, has been elusive. This study correlated the results of commonly used examination maneuvers with findings at shoulder arthroscopy. The working hypothesis was that 7 commonly used clinical tests, alone or in logical combinations, would provide diagnoses with reliability greater than the accepted standards for magnetic resonance imaging arthrography; i.e., greater than 95% sensitivity and specificity. TYPE OF STUDY: Consecutive sample, sensitivity-specificity study. METHODS: Sixty shoulders undergoing arthroscopy for a variety of pathologies were examined before surgery. All subjects submitted to the Speed test, an anterior apprehension maneuver, Yergason test, O'Brien test, Jobe relocation test, the crank test, and a test for tenderness of the bicipital groove. The examination results were compared with surgical findings and analyzed for sensitivity and specificity in the diagnosis of SLAP lesions and other glenoid labral tears. RESULTS: The results of the O'Brien test (63% sensitive, 73% specific) and Jobe relocation test (44% sensitive, 87% specific) were statistically correlated with presence of a tear in the labrum and the apprehension test approached statistical significance. Performing all 3 tests and accepting a positive result for any of them increased the statistical value, although the sensitivity and specificity were still disappointingly low (72% and 73%, respectively). The other 4 tests were not found to be useful for labral tears, and none of the tests or combinations were statistically valid for specific detection of a SLAP lesion. CONCLUSIONS: Clinical testing is useful in strengthening a diagnosis of a glenoid labral lesion, but the sensitivity and specificity are relatively low. Thus a decision to proceed with surgery should not be based on clinical examination alone.

Acromioclavicular Joint↗