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Biomedical subjects

Eric C McCarty

Publications and source records attributed to Eric C McCarty.

16 recordsLinked to original sources
PubMed2006

Comparison of fresh osteochondral autografts and allografts: a canine model.

BACKGROUND: Osteochondral autografts and allografts have been widely used in the treatment of isolated grade IV articular cartilage lesions of the knee. However, the authors are not aware of any study that has prospectively compared fresh osteochondral autografts to fresh allografts with regard to imaging, biomechanical testing, and histology. HYPOTHESIS: The imaging, biomechanical properties, and histologic appearance of fresh osteochondral autograft and fresh allograft are similar with respect to bony incorporation into host bone, articular cartilage composition, and biomechanical properties. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen adult dogs underwent bilateral knee osteochondral graft implantation after creation of an Outerbridge grade IV cartilage defect. One knee received an autograft, and the contralateral knee received a fresh allograft. Nine dogs were sacrificed at 3 months, and 9 dogs were sacrificed at 6 months. Graft analysis included gross examination, radiographs, magnetic resonance imaging, biomechanical testing, and histology. RESULTS: Magnetic resonance imaging demonstrated excellent bony incorporation of both autografts and allografts. Biomechanical testing demonstrated no significant difference between autografts versus allografts versus control at 3 or 6 months (P = .36-.91). A post hoc calculation showed 80% power to detect a 30% difference between allograft and control. Histologic examination showed normal cartilage structure for both autografts and allografts. CONCLUSION: Fresh osteochondral autograft and fresh allograft tissues are not statistically different with respect to bony incorporation, articular cartilage composition, or biomechanical properties up to 6 months after implantation. CLINICAL RELEVANCE: The use of fresh allograft tissue to treat osteochondral defects eliminates morbidity associated with harvesting autograft tissue without compromising the results of the surgical procedure.

Animals↗
PubMed2006

The pathophysiology of stress fractures.

Stress fractures can occur in any active individual, from the weekend warrior to the elite athlete. As these injuries occur, it is important to understand how bones respond to the stresses placed on them. The understanding of potential intrinsic and extrinsic causes is important in treatment of these injuries. The proper identification and prevention of these stress injuries allows for athletes to return to activity expeditiously.

Adolescent↗
PubMed2006

Radiographs are not useful in detecting arthroscopically confirmed mild chondral damage.

UNLABELLED: Preoperatively predicting chondral damage is important. Weightbearing radiographs, including the standing anteroposterior and 45 degrees flexion posteroanterior views traditionally have been used for this purpose. We wanted to determine if one radiograph had superior sensitivity or specificity in detecting arthroscopically confirmed Grade II chondromalacia (mild arthritis). A standard prospective standing radiographic protocol was designed for all patients who presented to a sports medicine center with knee complaints. Patients who had subsequent arthroscopic surgery had their radiographs measured in a blinded manner for articular cartilage intervals in millimeters to detect joint-space narrowing. Intraarticular chondral damage was correlated with the radiographic findings. Three hundred forty-nine of a possible 411 (87%) patients during a 2-year period had both radiographs and subsequent arthroscopic grading of chondromalacia. This has been the largest study that correlated arthroscopic chondromalacia grades with two commonly preferred weightbearing radiograph projections. Despite specificities greater than 90%, the sensitivity was extremely low and neither standing radiograph was superior. Neither radiograph was useful in detecting Grade II chondral damage. LEVEL OF EVIDENCE: Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗
PubMed2005

Multirater agreement of arthroscopic grading of knee articular cartilage.

BACKGROUND: Acute and chronic cartilage injury of the knee has an important impact on prognosis. The validity of the classification of such injuries is critical for prospective multicenter studies. The agreement among multiple surgeons at different institutions for articular cartilage lesions has not been established. HYPOTHESIS: Arthroscopic classification of articular cartilage lesions is reliable and reproducible and can be used for multicenter studies involving multiple surgeons. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 1. METHODS: A total of 6 surgeons from 5 centers reviewed 31 videos of articular cartilage lesions. With grade 2 and grade 3 combined for the analysis, observed agreement ranged from 81% to 94%, and kappa ranged from 0.34 to 0.87. An additional 22 videos comprising grade 2 and grade 3 lesions were analyzed, and the observed agreement was 80%, with an overall kappa of 0.47. CONCLUSION: Arthroscopic grading of articular cartilage lesions is reproducible among surgeons at different centers. CLINICAL RELEVANCE: Articular cartilage lesions can be reliably classified among surgeons at different sites. Such reliability is important for multicenter clinical research studies involving arthroscopic knee surgery.

Arthroscopy↗
PubMed2005

Intra-articular findings in the reconstructed multiligament-injured knee.

PURPOSE: Intra-articular chondral and meniscal injury in the multiligament-injured knee has not been examined. The purpose of this study was to determine the pattern of intra-articular chondral and meniscal damage in subjects with multiligament knee injuries undergoing surgery. TYPE OF STUDY: Prospective cohort study. METHODS: Analysis was performed on prospectively collected data for the presence of meniscal tears and significant chondral injury on subjects who underwent knee ligament surgery. Subjects were grouped by their multiligament injury combination. Chondral injury was graded using the Modified Outerbridge Classification system. Criteria for significant chondral defect were any grade 2 lesion involving 50% or more of condylar width and all grade 3 or 4 lesions. Groups with more than 10 subjects were compared against the anterior cruciate ligament (ACL)-only group. RESULTS: Data were collected on 2,265 subjects. The ACL/medial collateral ligament (MCL) injury pattern was the most common multiligament injury, comprising 70.5% of all multiligament injuries. Lateral meniscal damage was significantly higher in the ACL/MCL group (P < .01). Medial meniscal damage was significantly lower in the ACL/MCL group (P < .01). Medial and lateral meniscal damage was significantly lower in the ACL/lateral collateral ligament (LCL) group (P < .01). Articular damage to the medial tibial plateau was significantly lower in the ACL/MCL group (P < .01). All other multiligament injury patterns showed chondral damage similar to the ACL-only group. Ligament injuries repaired acutely had significantly less articular and medial meniscal damage than chronic repairs (P < .01). CONCLUSIONS: The ACL/MCL injury pattern was the most common multiligament injury pattern and showed a high incidence of lateral meniscal tears. ACL/LCL injuries had fewer meniscal injuries. Multiligament-injured knees showed increased risk of a torn medial meniscus as chronicity increased. LEVEL OF EVIDENCE: Level IV.

Adult↗
PubMed2005

Surgical management of cartilage defects in athletes.

The synovial joints provide a unique environment in which to carry out their critical mechanical function. The complex architecture of the articular cartilage normally provides painless motion throughout a variety of activities. Fluids secreted by cells in the superficial layers of the articular cartilage as well as in the synovium provide an almost frictionless articulation. The synovium also helps to maintain the aseptic environment found within the joint. The cartilage and fluid provide critical protection to the underlying bone. If any of these structures are damaged, or lose their efficiency, the ensuing cascade of damage inflicted on the joint can lead to catastrophic failure.

Athletic Injuries↗
PubMed2005

Height, weight, and BMI predict intra-articular injuries observed during ACL reconstruction: evaluation of 456 cases from a prospective ACL database.

OBJECTIVE: To identify demographic and anthropometric risk factors for intra-articular (IA) injuries observed during ACL reconstruction. We hypothesize that significant associations exist among height, weight, and body mass index (BMI) with IA injuries when ACL tear occurs. DESIGN: This observational study of a prospective multi-investigator ACL database used logistic and Poisson regression analysis to assess independent predictors of IA injuries. SETTING: Vanderbilt Sports Medicine and affiliated tertiary care center. PATIENTS: Patients undergoing unilateral ACL reconstruction without prior injury to either knee were identified from a detailed prospective ACL reconstruction database. Four hundred fifty-six patients met inclusion/exclusion criteria. INTERVENTIONS: Per inclusion criteria, all patients underwent unilateral ACL reconstruction after assessment of injury profile. MAIN OUTCOME MEASUREMENTS: The ACL database was initiated in 1990 to identify demographic, anthropometric, and mechanistic variables associated with intra-articular injury. RESULTS: Height best predicted tibial and patellar damage. BMI better predicted medial femoral condyle lesions, whereas weight better predicted lateral and patellofemoral injury. BMI and weight equally predicted injury to menisci and medial tibial plateau. Through different outcomes, age (odd ratio [OR], 1.49; 95% CI, 1.02-2.16), height (OR, 2.66; 95% CI, 1.52-4.65), weight (OR, 1.02; 95% CI, 1.01-1.04), and BMI (OR, 1.24; 95% CI, 1.004-1.53) were all significant predictors of intra-articular injury. CONCLUSIONS: This is the first report using multivariable analysis of age, height, weight, and BMI to evaluate associations with IA injuries after ACL rupture observed during ACL reconstruction. We hypothesize that athletes possibly could reduce risk of certain IA pathologies with maintenance of lower body weight and BMI and thus potentially improve long-term functional outcomes after ACL reconstruction.

Adult↗
PubMed2004

Shoulder instability: return to play.

Shoulder instability in the competitive athlete is a relatively common problem. The etiology of glenohumeral instability that can affect the athlete runs a wide spectrum, from an isolated traumatic dislocation to repeated microtrauma or congenital laxity. Although many athletes are able to adapt to a mild laxity that might only occasionally affect them, it can be much more difficult to adapt or return to play after a dislocation or repeated subluxation episodes. This article focuses on the return to play for competitive individuals after a glenohumeral dislocation or reconstructive surgery for shoulder instability.

Athletic Injuries↗
PubMed2004

A simple, accurate method to confirm placement of intra-articular knee injection.

BACKGROUND: Intra-articular knee injections are routinely performed in clinical practice without documenting intra-articular placement. HYPOTHESIS: A small amount of air to an intra-articular knee injection produces an audible "squishing" sound with range of motion. STUDY DESIGN: Prospective nonrandomized clinical trial. METHODS: The study group (20 knees from 20 patients) received an intra-articular injection with a mixture of local anesthetic, corticosteroid, contrast dye, and 1 to 2 cc of air. The control group (10 knees from 5 patients) received extra-articular injections of a mixture of local anesthetic, contrast dye, and 2 cc of air. All knees were examined immediately after injection for a squishing sound with range of motion. Postinjection arthrographic radiographs were taken to verify the actual placement. RESULT: All study group knees and no control group knees had intra-articular contrast by radiograph. Clearly audible squishing sounds were heard in 17 of 20 study knees (sensitivity of 85%). Squishing sounds were audible in none of the control knees (specificity of 100%). CONCLUSION: Adding 1 to 2 cc of air to knee injections provides a no-cost, reliable, sensitive, and specific method of confirming accurate placement. CLINICAL RELEVANCE: This simple method is easily reproduced, can confirm accurate placement, and can eliminate extra-articular injection as the reason for clinical response failure.

Air↗
PubMed2004

Intra-articular knee temperature changes: ice versus cryotherapy device.

BACKGROUND: Cryotherapy is commonly applied without research documenting the intra-articular (IA) temperature changes or subject discomfort between ice and a cryotherapy device. HYPOTHESIS: The null hypothesis is that no difference would be observed in IA temperature decline or subject tolerance between ice and the cryotherapy device in normal knees. STUDY DESIGN: Prospective, within-subject controlled clinical trial. METHODS: Twelve subjects had IA temperature in suprapatellar pouch and skin recorded bilaterally after application of cryotherapy versus ice. Subject tolerance was recorded by 10-cm visual analog scale (VAS). Statistical evaluation was by Spearman's correlation analysis and paired, nonparametric Wilcoxon's signed rank test. RESULTS: Both significantly lowered (P < 0.001) skin and IA temperature with median decreases (ice/cryotherapy) at 30 (3.3 degrees C/2.2 degrees C), 60 (12.8 degrees C/7.1 degrees C), and 90 (15.2 degrees C/9.7 degrees C) minutes. However, ice lowered the IA temperature significantly more than the cryotherapy device (P < 0.001) and was more painful by VAS at 30 and 60 minutes (P < 0.01). CONCLUSIONS: Both methods produced large declines in skin and IA temperatures. However, ice was more effective yet resulted in higher pain scores. The authors hypothesize that IA temperatures below a threshold are associated with increased perceived pain.

Adult↗
PubMed2004

Temperature along the axillary nerve during radiofrequency-induced thermal capsular shrinkage.

BACKGROUND: There have been reports of axillary nerve palsy after thermal capsular shrinkage with radiofrequency energy-generating devices. The exact cause of this is unknown. HYPOTHESIS: The temperature of the axillary nerve increases during shoulder capsular shrinkage at various degrees of shoulder abduction. STUDY DESIGN: Laboratory study. METHODS: Fifteen cadaveric shoulders had fiberoptic thermometer probes placed at various points along the axillary nerve and major branches under the capsule. The shoulders underwent thermal capsular shrinkage with a radiofrequency energy-inducing device at various positions of abduction. RESULTS: With the arm at the side, temperatures above 50 degrees C (56 degrees -61 degrees C) were evident along the teres minor branch of the axillary nerve in 4 of 6 specimens. The increase in temperature was noted in the middle to posterior aspect of the inferior capsule. At 45 degrees of abduction, 4 of 5 shoulders demonstrated increases in temperature greater or equal to 50 degrees. Three of 4 shoulders tested at 90 degrees of abduction revealed similar temperature increases. CONCLUSIONS: The arthroscopic technique of thermal capsular shrinkage causes an increase in the temperature of the axillary nerve and its branches in 11 of 15 cadaveric specimens tested at various arm positions-particularly affected is the teres minor branch. CLINICAL RELEVANCE: Orthopaedic surgeons using the radiofrequency device for thermal capsular shrinkage need to be aware of the possible increase in temperature along the axillary nerve and its branches during this procedure. The clinical effect of this type of increase on the nerve is unknown.

Adult↗
PubMed2004

Multirater agreement of arthroscopic meniscal lesions.

BACKGROUND: Establishing the validity of classification schemes is a crucial preparatory step that should precede multicenter studies. There are no studies investigating the reproducibility of arthroscopic classification of meniscal pathology among multiple surgeons at different institutions. HYPOTHESIS: Arthroscopic classification of meniscal pathology is reliable and reproducible and suitable for multicenter studies that involve multiple surgeons. STUDY DESIGN: Multirater agreement study. METHODS: Seven surgeons reviewed a video of 18 meniscal tears and completed a meniscal classification questionnaire. Multirater agreement was calculated based on the proportion of agreement, the kappa coefficient, and the intraclass correlation coefficient. RESULTS: There was a 46% agreement on the central/peripheral location of tears (kappa = 0.30), an 80% agreement on the depth of tears (kappa = 0.46), a 72% agreement on the presence of a degenerative component (kappa = 0.44), a 71% agreement on whether lateral tears were central to the popliteal hiatus (kappa = 0.42), a 73% agreement on the type of tear (kappa = 0.63), an 87% agreement on the location of the tear (kappa = 0.61), and an 84% agreement on the treatment of tears (kappa = 0.66). There was considerable agreement among surgeons on length, with an intraclass correlation coefficient of 0.78, 95% confidence interval of 0.57 to 0.92, and P < .001. CONCLUSIONS: Arthroscopic grading of meniscal pathology is reliable and reproducible. CLINICAL RELEVANCE: Surgeons can reliably classify meniscal pathology and agree on treatment, which is important for multicenter trials.

Arthroscopy↗
PubMed2002

Meniscus repair: considerations in treatment and update of clinical results.

The meniscus plays an important role in the function of the knee. Preservation of the meniscus is preferred if possible when considering treatment of a meniscus tear. A thorough understanding of the anatomy of the meniscus, the structure, the mechanics, and other factors of meniscal healing are critical when evaluating the torn meniscus for a reparative procedure. Many options for meniscus repair exist for the orthopaedist. Options such as open repair or arthroscopically-assisted inside-out techniques have long-term favorable results. The all-inside techniques are attractive because of the decrease in operative time and ease of the technique. Short-term results are positive for the all-inside technique; however, good long-term data on these techniques are lacking. Few well-designed prospective studies exist on any of the meniscus repair techniques. Future directions include the potential use of growth factors and gene therapy to augment meniscus repair.

Arthroscopy↗
PubMedDate not supplied

Development of arthrosis following dislocation of the shoulder: a case-control study.

The goal of this study was to document whether an association exists between shoulder dislocation and the development of arthrosis and to quantify this association, if present. Patients with osteoarthrosis who had undergone hemi-shoulder or total shoulder arthroplasty (TSA) were studied. Patients who had undergone total knee arthroplasty for arthrosis and who had no history of shoulder symptoms served as control subjects. All patients were asked if they had ever sustained a shoulder dislocation. Ninety-one TSA patients and 282 control subjects responded. The odds ratio for developing arthrosis after a shoulder dislocation was 19.3 (P =.000006). With the 5 patients who had shoulder surgery prior to TSA excluded, the odds ratio was 10.5 (P =.003). The risk of developing severe arthrosis of the shoulder is between 10 and 20 times greater for individuals who have had a dislocation of the shoulder.

Aged↗
PubMedDate not supplied

Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows.

BACKGROUND: Medial meniscal repairs are commonly performed with inside-out sutures and entirely arthroscopic with arrows, but few comparative evaluations on failures have been performed. HYPOTHESIS: No differences in failure rates exist between medial meniscal repairs performed with inside-out suture or entirely arthroscopic at the time of anterior cruciate ligament reconstruction. STUDY DESIGN: Prospective cohort study. MATERIALS: A single surgeon performed 47 consecutive inside-out suture repairs from August 1991 to June 1996 and 98 consecutive entirely arthroscopic repairs with arrows from June 1996 to December 1999. All data were derived from a prospective database and rehabilitation was held constant (nonweightbearing 5 weeks). Clinical success was defined as no reoperation for failed medial meniscal repair. Statistical evaluation was by Kaplan-Meier curves and Cox proportional hazards model. RESULTS: The inside-out suture group had 85% follow-up (40 of 47) with a median 68 months and the entirely arthroscopic group had 87% follow-up (85 of 98) with a median 27 months. There were seven failures in each group. Both Kaplan-Meier curves and the Cox proportional hazards model showed no difference in time to reoperation between techniques (P = 0.85). Three-year success rates (proportions with no reoperations) were 88% for sutures versus 89% for arrows. CONCLUSIONS: Repairs of the longitudinal posterior horn of the medial meniscus during an anterior cruciate ligament reconstruction with nonweightbearing for 5 weeks can be performed with an equivalent high degree of clinical success for both repair techniques.

Absorbable Implants↗