Biomedical subjects

F Alan Barber

Publications and source records attributed to F Alan Barber.

At least 19 recordsLinked to original sources

PubMed2006

Arthroscopic chondral osseous autograft transplantation (COR procedure) for femoral defects.

PURPOSE: Localized, full-thickness articular cartilage defects of the femoral condyle are often found unexpectedly. An arthroscopic repair technique that transplants chondral osseous replacement plugs to fill the defect (the COR technique; Mitek Products, Westwood, MA) offers an immediate solution for these lesions. The purpose of this study was to review the clinical and radiographic results of femoral chondral osseous replacement for full-thickness articular cartilage lesions between 2.5 and 1.0 cm in diameter. TYPE OF STUDY: Case series. METHODS: A retrospective review of a consecutive series of patients from 2 centers treated for full-thickness femoral articular cartilage lesions using a chondral osseous autograft transplantation technique was performed. All knees were evaluated both preoperatively and postoperatively by physical examination, radiographs, and Lysholm and Tegner knee scores. Inclusion criteria were full-thickness femoral condyle defects greater than 1 cm and less than 2.5 cm in diameter, and a minimum 24-month follow-up. Exclusion criteria were associated tibial defects, patellar defects, or generalized arthritic change. Grafts harvested from the superior, lateral femoral notch were press-fit into drilled holes to fill the femoral defects. RESULTS: Thirty-six patients met the inclusion criteria with an average follow-up of 48 months (range, 24 to 89 months). Their average age was 43 years and there were 20 men and 16 women. The medial femoral condyle was involved in 27 cases and the lateral femoral condyle in 9. The average Lysholm score increased from 44 preoperatively to 84 at follow-up. The average Tegner score at follow-up was 5. Repeat arthroscopy was performed in 14 patients and showed good incorporation of the grafts in all cases. Radiographic examinations revealed no arthritic changes at follow-up. CONCLUSIONS: This technique successfully transplants chondral osseous grafts within the knee that remain viable. No radiographic arthritic changes were observed and the midterm clinical result was favorable for these patients. Further investigation of the long-term results is required. LEVEL OF EVIDENCE: Level 4, no or historical control.

Arthroscopy↗

PubMed2006

Thermal medial retinaculum shrinkage and lateral release for the treatment of recurrent patellar instability.

PURPOSE: To study a technique of medial retinacular thermal shrinkage and evaluate the clinical effectiveness of this technique. TYPE OF STUDY: Nonrandomized prospective case series. METHODS: A consecutive series of patients with recurrent patellar instability treated with arthroscopic lateral release and medial thermal retinaculum shrinkage using a monopolar radiofrequency probe was assessed subjectively by visual analog scale and both preoperatively and postoperatively by physical examination and Lysholm and Fulkerson knee scores. RESULTS: We evaluated 53 knees with an average follow-up of 53 months (range, 24 to 88 months). The mean Lysholm and Fulkerson scores improved from 45 and 41 to 81 and 82, respectively. Subjectively, 48 of 53 knees (90%) were reported as excellent or good. The average visual analog scale score was 8 out of 10. Five patients failed because of recurrent dislocation (9% recurrence). Additional stabilization procedures were performed in 4 patients. CONCLUSIONS: Medial shrinkage using monopolar thermal energy is effective in treating recurrent patellar instability. Our results were comparable with prior studies using suture plication. The technique avoids additional incisions and decreases operative time. LEVEL OF EVIDENCE: Level IV, therapeutic prospective cohort study.

Adolescent↗

PubMed2006

Long-term results of acromioclavicular joint coplaning.

PURPOSE: Coplaning removes medial acromial spurs and portions of the distal clavicle with an arthroscopic subacromial decompression (ASD). Concerns exist that this violates inferior acromioclavicular (AC) ligaments and increases AC joint mobility, resulting in long-term problems. The purpose of this study was to re-evaluate 3 cohorts of patients who underwent ASD with various degrees of coplaning and to determine if late AC joint tenderness or reoperation had occurred. TYPE OF STUDY: Nonrandomized control study. METHODS: Eighty-one patients undergoing ASD were divided into 3 groups. Group 1 (24) underwent removal of inferior clavicle osteophytes, group 2 (34) had a distal clavicle hemiresection with up to 50% of the articular cartilage removed, and group 3 (23) had complete distal clavicle resection. Radiographs, charts, and arthroscopic videotapes were reviewed to determine the amount of clavicle removed. Follow-up evaluations included Constant-Murley, American Shoulder and Elbow Surgeons (ASES), SANE, and Rowe shoulder scores with special attention given to AC joint pain and additional procedures. RESULTS: The average patient age was 46 years (range, 19 to 81 years) and follow-up was 73 months. At follow-up, the average Constant, ASES, Row, and SANE scores were: for group 1, 97.1, 97.5, 96.9, and 95.8, respectively; for group 2, 95.1, 97.4, 96, and 92.8, respectively; and for group 3, 96.3, 98.3, 96.1, and 95.7. No patient required additional shoulder surgery. CONCLUSIONS: Coplaning did not increase AC joint symptoms, compromise clinical results, or lead to additional surgery at an average follow-up of 6 years. LEVEL OF EVIDENCE: Level IV, therapeutic case series study.

Acromioclavicular Joint↗

PubMed2006

Trinion meniscal screw.

All-inside meniscal repair devices require no accessory incisions, allow faster repairs, and are widely used. The purpose of this study was to determine the in vitro load to failure strength of one new recently released meniscal repair device. Using an established protocol, a vertical longitudinal tear 3 mm from the meniscus periphery was created in 15 porcine menisci and each tear repaired by a single 10-mm Trinion meniscal screw. This repair was pulled apart with loads parallel to the repair axis. Loads to failure and modes of failure were evaluated. The mean load to failure was 38.9 N (SD +/- 9.04) (range, 23.1 to 55.2 N). Two modes of failure were observed: puling out of the inner piece (6 of 15) and of the outer (peripheral) rim (9 of 15). No devices broke. The Trinion meniscal screw is a dual-head design made of trimethylene carbonate, poly L-lactic acid, and poly D, L lactic acid. Its load to failure is similar to other tested devices. The mechanisms of failure were consistent with other all-inside meniscal repair devices. The material properties of a repair device are only one indication of device performance and may not correlate with clinical results.

Animals↗

PubMed2006

Midterm results of meniscal repair using the BioStinger meniscal repair device.

PURPOSE: The purpose of this study was to evaluate the midterm healing rate and any adverse events from meniscus repair using the BioStinger meniscus repair device (Linvatec, Largo, FL). METHODS: A retrospective review of a consecutive series of meniscal repairs performed by a single surgeon using the BioStinger was conducted. The BioStinger is cannulated, made of molded poly L-lactic acid, and inserted over a needle into the meniscus tissue. Clinical results and adverse events were noted, and Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee (IKDC) activity scores were obtained on all patients. RESULTS: Forty-one patients underwent 41 meniscal repairs with an average follow-up of 38.6 months (range, 24 to 69 months); 35 meniscus repairs were performed in conjunction with anterior cruciate ligament reconstruction and 6 in stable knees. Tears repaired were peripheral, posterior horn tears with an average length of 2 cm. Clinical evidence of meniscal healing was observed in 95% at the time of last follow-up. Six second-look arthroscopies were performed and 2 failures were found. All other patients were symptom free. At follow-up, the mean Tegner score was 6.1 (2.8 preoperative), IKDC activity score was 3.3 (2.1 preoperative), Lysholm score was 90.6 (48.7 preoperative), and the mean Cincinnati score was 86.7 (41.3 preoperative). Four patients had peripheral migration of the device without skin tenting or perforation; 3 underwent removal of the BioStinger from the soft tissues and the other resolved after 12 months. CONCLUSIONS: The midterm clinical success rate was 95% using the BioStinger device. Adverse events were observed in few cases. LEVEL OF EVIDENCE: Level IV, cases series.

Absorbable Implants↗

PubMed2006

Tendon augmentation grafts: biomechanical failure loads and failure patterns.

PURPOSE: The purpose of this study was to determine the load to failure strengths and modes of failure of various commercially available tendon augmentation xenografts and allografts. TYPE OF STUDY: Experimental laboratory study. METHODS: GraftJacket (Wright Medical Technology, Arlington, TN), CuffPatch (Arthrotek, Warsaw, IN), Restore (Depuy, Warsaw, IN), Permacol (Tissue Science Laboratories, Covington, GA; licensed to Zimmer, Warsaw, IN), and TissueMend (TEI Biosciences, Boston, MA; licensed to Stryker Howmedica Osteonics, Kalamazoo, MI) measuring 2 x 5 cm were hydrated according to manufacturers guidelines, a horizontal mattress stitch 5-mm wide was placed 5 mm from the narrow edge of the graft. Tensile loads to failure were applied on the suture while an Instron machine held the graft material and mean loads to failure of the suture graft construct were obtained and modes of graft failure noted. RESULTS: The mean loads to failure were obtained: GraftJacket thin (157 N), GraftJacket MaxForce (182 N), GraftJacket Extreme (229 N), CuffPatch (32 N), Restore (38 N), Permacol (128 N), and TissueMend (70 to 76 N). Failure occurred principally by suture pull-through in all specimens and patterns tended to vary by implant type. CuffPatch and TissueMend tended to fail by isthmus pullout, whereas Restore and Graft jacket failed by end pullout. The tissues were statistically stratified into four groups depending on the material. Human skin (GraftJacket) was the strongest followed by porcine skin (Permacol) and bovine skin (TissueMend). Both in turn were stronger than the porcine small intestine submucosa (Restore and CuffPatch) (P < 0.001). CONCLUSIONS: Suture retention can be reliably tested with a narrow range of standard error utilizing this testing methodology. Skin has higher loads to failure than intestine submucosa. Failure modes differed significantly among the implant types, suggesting that suturing methods for each implant should be considered independently before use. These data cannot be interpreted to suggest that one graft material is clinically superior to another. Rather, each has different properties that the surgeon should recognize when considering their use. CLINICAL RELEVANCE: These grafts have been used as augmentations and substitutions in tendon repairs and as a material for interpositional arthroplasty. These data show that the successful use of these materials requires adequate separation of the fixation sutures and provides an understanding of how each material will fail if subjected to excessive loading during the rehabilitation period.

Bioprosthesis↗

PubMed2006

Long-term absorption of poly-L-lactic Acid interference screws.

PURPOSE: To evaluate the long term in vivo degradation of poly-L-lactic acid (PLLA) interference screws with computed tomography (CT) and radiography as used in patellar tendon autograft anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 20 patients who had undergone patellar tendon autograft ACL reconstruction fixed with PLLA screws at least 7 years earlier were evaluated by physical examination, radiography, and CT to determine whether PLLA screw reabsorption and bone ingrowth had occurred. This study was granted Institutional Review Board approval. Lysholm, Tegner, Cincinnati, and International Knee Documentation Committee (IKDC) scores were obtained. CT data were measured in Hounsfield units. RESULTS: In all, 15 men and 5 women were evaluated 104 months after surgery (range, 89 to 124 months). CT and radiography demonstrated that the bone plug had fused to the tunnel wall, and that no intact interference screw was left. A parallel, threaded, and corticated screw tract was visible adjacent to the bone plug. No bone ingrowth had occurred at the screw site, although, occasionally, minimal calcification was seen. This was never as dense as cancellous bone, and no trabeculae were ever present. No positive pivot-shift test results were obtained. Lysholm, Tegner, and Cincinnati scores were 83, 5.6, and 75, respectively, at follow-up. Average KT difference was 0.7 mm. DISCUSSION: PLLA interference screws completely degraded, and the resulting area demonstrated a low Hounsfield count, consistent with soft tissue 7 years after insertion. No significant bone ingrowth occurred at the screw site. Femoral and tibial ACL tunnels were absent of anything but fibrous tissue and usually had a sclerotic cortical lining. CONCLUSION: PLLA biodegradable ACL screws eventually disappear completely. PLLA material is not replaced by bone. ACL graft tunnels are filled with nonossified material. This study provides a baseline for comparison with other biodegradable interference screws that may encourage bone ingrowth as they degrade. LEVEL OF EVIDENCE: Level IV (no or historical control).

Absorbable Implants↗

PubMed2006

Sutures and suture anchors--update 2006.

PURPOSE: To evaluate recently introduced sutures and suture anchors for single pull load to failure strength and failure mode. METHODS: Suture anchors were tested in fresh porcine metaphyseal cortex and cancellous troughs with the use of an established protocol. An Instron machine applied tensile loads parallel to the axis of insertion at a rate of 12.5 mm/sec until failure, and mean anchor failure strengths were calculated. The mode of failure (anchor pull-out, suture eyelet cut-out, or suture failure) was recorded. Anchors tested included the BioRaptor 2.9, BioZip, Super Revo, Impact, Allograft cortical anchor, SpiraLok, Herculon, AxyaLoop titanium anchors 3, 5, and 6.5 mm, AxyaLoop bioabsorbable anchors 3, 5, and 6.5, ParaFix titanium anchors 3, 5, and 6.5, ParaSorb BioAnchors 3, 5.5, and 6.5, and Bio-Corkscrew FT. Sutures were also tested through an established protocol for load to failure. Sutures tested consisted of Orthocord, Ultrabraid (White and CoBraid), ForceFiber, Hi-Fi, MagnumWire, and Maxbraid Polyethylene Plus. RESULTS: Mean failure loads were as follows: BioRaptor 238 N, BioZip 366 N, double-loaded Super Revo 486 N, triple-loaded Super Revo 362 N, Impact 202 N, Allograft cortical anchor 240 N, SpiraLok 289 N, Herculon 819 N, AxyaLoop titanium anchors 3.0 (335 N), 5.0 (485 N), and 6.5 mm (465 N), AxyaLoop bioabsorbable anchors 3 (143 N), 5 (395 N), and 6.5 (369 N), ParaFix titanium anchors 3 (335 N), 5 (485 N), and 6.5 (465 N), ParaSorb BioAnchors 3 (143 N), 5.5 (395 N), and 6.5 (369 N), and Bio-Corkscrew FT (260 N). The sutures all broke at the mid point of their tested strands away from the grips. Mean suture strength for No. 2 Orthocord was 92 N; for No. 2 Ultrabraid CoBraid and White, strengths were 265 N and 280 N, respectively; strength for No. 2 Force Fiber was 289 N, for No. 2 Hi-Fi 250 N, for No. 2 MagnumWire 303 N, and for No. 2 Maxbraid Polyethylene Plus 256 N. CONCLUSIONS: Newer suture products showed significant improvements in load to failure values when compared with braided polyester sutures. Higher load to failure values continue to be seen in metal versus biodegradable anchors and in screw-type versus nonscrew designs. CLINICAL RELEVANCE: Surgeons who prefer stronger sutures now have several high-strength suture options from which to choose. Most of the new anchors tested performed very well.

Animals↗

PubMed2006

Meniscal repair with the RapidLoc meniscal repair device.

BACKGROUND: The RapidLoc is an all-inside, self-adjusting, flexible meniscal repair device that combines a suture with an anchor component and, by using a reinforced sliding knot, allows for tightening to compress and hold the repaired meniscal segments. The purpose of this study was to evaluate the clinical success of the RapidLoc device. METHODS: A prospective consecutive series of meniscal repairs performed with the RapidLoc device was studied. Lysholm, Tegner, Cincinnati, IKDC (International Knee Documentation Committee) activity scores, clinical examination findings, and adverse events were recorded on all patients. Associated procedures were recorded. An accelerated postoperative rehabilitation program was followed, independent of whether anterior cruciate ligament (ACL) surgery was also performed. RESULTS: A total of 32 patients underwent 32 meniscal repairs, with an average follow-up of 31 months (18 to 48 months). In all, 23 repairs were done in conjunction with ACL reconstruction, and 9 repairs were carried out in stable knees. Repairs were made to 25 medial menisci and 7 lateral menisci. Tears repaired consisted of peripheral longitudinal tears with an average length of 2 cm (range, 15 to 30 mm). Four failures (12.5%) were arthroscopically documented. Clinical success occurred in 87.5% at the time of last follow-up. At follow-up, mean Tegner score was 5.1 (2.8 preoperative), IKDC activity score was 3.1 (1.8 preoperative), Lysholm score was 93.6 (48.4 preoperative), and mean Cincinnati score was 88.1 (43.7 preoperative). The most common adverse event was cutting of the suture during RapidLoc insertion. One patient had excoriation and grooving of the medial femoral condyle associated with failed repair. Another patient developed a postoperative infection. CONCLUSIONS: The early clinical success rate was 87.5% with the RapidLoc device. Chondral grooving was observed in a single case. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopy↗

PubMed2006

Triple-loaded single-anchor stitch configurations: an analysis of cyclically loaded suture-tendon interface security.

PURPOSE: This study evaluated the strength and suture-tendon interface security of different suture configurations from triple-suture-loaded anchors. METHODS: A juvenile bovine infraspinatus tendon was detached and repaired by use of 4 different suture combinations from 2 suture anchors: 3 simple sutures in each anchor (ThreeVo anchor; Linvatec, Largo, FL); 2 peripheral simple stitches and 1 central horizontal mattress suture passed deeper into the tendon, creating a larger footprint (bigfoot-print anchor); 2 peripheral simple stitches with 1 central horizontal mattress stitch passed through the same holes as the simple sutures (stitch-of-Burns); and 2 simple stitches (TwoVo anchor; Linvatec). The constructs were cyclically loaded between 10 N and 180 N for 3,500 cycles and then destructively tested. The number of cycles required to create a 5-mm gap and a 10-mm gap and the ultimate load to failure and failure mode were recorded. RESULTS: The ThreeVo anchor was strongest and most resistant to cyclic loading (P < .01). The TwoVo anchor was least resistant to cyclic loading. The stitch-of-Burns anchor was more resistant to cyclic loading than both the bigfoot-print anchor and the TwoVo anchor (P < .03). The ThreeVo, stitch-of-Burns, and TwoVo anchors were stronger than the bigfoot-print anchor (P < .05). CONCLUSIONS: Three simple sutures in an anchor hold better than two simple sutures. Three simple sutures provide superior suture-tendon security than combinations of one mattress and two simple stitches subjected to cyclic loading. A central mattress stitch placed more medially than two peripheral simple stitches (bigfoot-print anchor) configured to enlarge the tendon-suture footprint was not as resistant to cyclic loading or destructive testing as three simple stitches (ThreeVo anchor). CLINICAL RELEVANCE: Placing a central mattress stitch more medially than 2 peripheral simple stitches to enlarge the tendon-suture footprint was not as resistant to cyclic loading or destructive testing as 3 simple stitches.

Animals↗

PubMed2006

Treatment of grade III femoral chondral lesions: mechanical chondroplasty versus monopolar radiofrequency probe.

PURPOSE: Articular cartilage defects are commonly found on the femoral condyle, and their treatment with thermal energy is thought to provide a smoother surface, sealing the damaged articular cartilage and possibly decreasing the progression of these lesions. Reports of femoral avascular necrosis (AVN) developing after bipolar thermal chondroplasty are worrisome. The purpose of this study was to compare the effects on subchondral bone and the early clinical effectiveness of mechanical shaving versus mechanical shaving plus monopolar radiofrequency (MRF) on grade III femoral chondromalacia. TYPE OF STUDY: Randomized, prospective, controlled trial. METHODS: In this trial 60 subjects were treated by either mechanical shaving alone (n = 30) or mechanical shaving plus MRF (n = 30). Preoperative and 12-month postoperative magnetic resonance imaging (MRI) evaluations and Tegner, Lysholm, Cincinnati, International Knee Documentation Committee, and visual analog scale assessments at 12 and 24 months were obtained. RESULTS: Of the subjects, 56 were available for the final analysis (28 treated by shaver and 28 treated by shaver plus MRF). Baseline demographics were similar between treatment groups. Postoperative MRI findings were similar between groups, including no incidents of AVN. At a mean of 19 months postoperatively, Tegner, Lysholm, Cincinnati, International Knee Documentation Committee, and visual analog scale assessments improved significantly from pretreatment levels in both groups. No difference in mean improvement was observed between groups. CONCLUSIONS: The primary endpoint was to look for AVN. No subchondral bone effects attributable to either mechanical shaving or radiofrequency energy were noted. The secondary endpoint was a clinical evaluation. Both groups showed significant improvements in pain and function outcomes with no discernible differences between groups. The use of monopolar radiofrequency as an adjuvant to mechanical chondroplasty with a shaver for the treatment of grade III chondral lesions did not affect MRI findings or pain and function outcomes when compared with mechanical chondroplasty by use of a shaver only. LEVEL OF EVIDENCE: Level II, randomized controlled trial with confidence intervals not reported.

Adult↗

PubMed2006

New sutures and suture anchors in sports medicine.

Arthroscopic surgery requires appropriate surgical implants for effective fixation of tendons and ligaments to bone. Biodegradable suture anchors are being used with increasing frequency for various procedures in sports medicine. As companions to these biodegradable suture anchors, new sutures have been developed which possess greater strength and different material properties from the conventional braided polyester suture. Biodegradable polymers currently found in sutures and suture anchors include poly-L-lactic acid, poly-D, L lactic acid, polydioxanone, polyglycolic acid and their copolymers. Suture anchors are now available preloaded with a choice of conventional braided polyester sutures or some version of ultrahigh molecular weight polyethylene ("super") sutures. Most new suture anchors come with 2 sutures. The manner in which these sutures are attached to the anchor varies and may consist of 2 separate eyelets or 2 slots either parallel to one another or at different angles to one another. Some anchors have a very large single eyelet that allows for 2 or more sutures.

Arthroscopy↗

PubMed2006

Tendon graft substitutes-rotator cuff patches.

Over the past few years, many biologic patches have been developed to augment repairs of large or complex tendon tears. These patches include both allograft and xenografts. Regardless of their origins, these products are primarily composed of purified type I collagen. Many factors should be considered when choosing an augmentation patch including tissue origin, graft processing, cross-linking, clinical experience, and physical properties. The purpose of this article is to familiarize the sports medicine community with several tendon augmentation grafts: GraftJacket (Wright Medical Technology, Arlington, TN), CuffPatch (Organogenesis, Canton, MA, licensed to Arthrotek, Warsaw, IN), Restore (Depuy, Warsaw, IN), Zimmer Collagen Repair (Permacol) patch (Tissue Science Laboratories Covington, GA, licensed to Zimmer, Warsaw, IN), TissueMend (TEI Biosciences, Boston, MA, licensed to Stryker Howmedica Osteonics, Kalamazoo, MI), OrthoADAPT (Pegasus Biologics, Irvine, CA), and BioBlanket (Kensey Nash, Exton, PA).

Arthroscopy↗

PubMed2005

Arthroscopic meniscal repair using the BioStinger.

PURPOSE: Biodegradable devices are available for all-inside meniscal repairs. One device, the BioStinger (Linvatec, Largo, FL), is made of molded poly-L-lactic acid. The purpose of this study was to evaluate the effectiveness of and any adverse events associated with meniscus repair using this device. TYPE OF STUDY: Nonrandomized prospective cohort study. METHODS: A prospective, consecutive, 3-center meniscal repair series using BioStingers (group 1), vertical inside-out sutures (group 2), or hybrid repairs combining BioStingers and sutures (group 3) was studied. Lysholm, Tegner, Cincinnati, and IKDC activity scores were obtained and clinical outcomes and adverse events documented. RESULTS: There were 85 patients who underwent 89 meniscus repairs with an average 26.5 months of follow-up. There were 47 BioStinger repairs (group 1), 29 suture repairs (group 2), and 13 hybrid repairs (group 3). The tear length was statistically greater for the hybrid repair group (P < .5). There were 73 repairs associated with anterior cruciate ligament reconstructions and 12 repeat arthroscopies were performed. Meniscal healing failed in 6 knees (4 in group 1, 0 in group 2, and 2 in group 3). The meniscal healing failed in 7% of those associated with anterior cruciate ligament reconstructions. Mean Tegner scores improved from 2.8 to 6.3, the final IKDC activity score was 3.2 out of 4, the mean Lysholm score improved from 51 to 88, and the mean Cincinnati score improved from 44 to 84. Two BioStinger repair cases had joint-line tenderness from device migration confirmed by magnetic resonance imaging. No tenting of the skin or articular cartilage scuffing was observed. CONCLUSIONS: The success rate for the 29 suture repairs was 100% and for the 47 BioStinger repairs was 91%. These preliminary results are consistent with other repair techniques. LEVEL OF EVIDENCE: Level II, Therapeutic Prospective Cohort Study.

Absorbable Implants↗

PubMed2005

Poly-D,L-lactide interference screws for anterior cruciate ligament reconstruction.

PURPOSE: Biodegradable interference fixation screws are widely used for anterior cruciate ligament surgery. This study evaluated 2 issues: the clinical effectiveness of a poly-D,L-lactide interference screw and the radiographic response. TYPE OF STUDY: Prospective case series. METHODS: A prospective series of anterior cruciate ligament reconstructions fixed with poly-D(2%),L(98%)-lactide screws were evaluated at annual intervals. Inclusion criteria were unilateral knee instability, positive Lachman and pivot-shift tests, minimum age of 16 years, and adequate bone density. Exclusionary criteria included posterior cruciate ligament tears and previous ligament surgery on the same knee. Tegner, Lysholm, International Knee Documentation Committee (IKDC) activity scores, Lachman and pivot-shift tests, and radiographs were obtained. Postoperative KT-2000 examinations were performed. RESULTS: Sixty-one patients with 63 knees met these criteria (39 male, 22 female), at an average follow-up of 24 months (range, 12 to 42 months). The average postoperative Cincinnati score was 86 (45 preoperative), median Tegner score was 6 (2 preoperative), average Lysholm score was 89 (53 preoperative), and average IKDC activity score was 3.3 out of 4 (1.5 preoperative). Two patients had positive postoperative Lachman tests (+1) with no positive pivot-shift tests. The average KT-2000 manual-maximum difference was 0.7 mm. Only 1 KT-2000 value was greater than 3 mm (4 mm). No adverse events were encountered during screw insertion and postoperative radiographs showed bone plug consolidation and tunnel obliteration with bone in-growth increasingly apparent at 2 and 3 years (significantly earlier than published reports using pure poly-L-lactide screws). CONCLUSIONS: This is the first clinical report of a poly-D(2%),L(98%)-lactide interference fixation screw. This copolymer is zinc catalyzed, instead of the conventional tin, making the polymer more hydrophilic. The "D" isomer speeds the degradation process. These screws worked well with no adverse events. Graft tunnel obliteration was observed at 2 and 3 years. LEVEL OF EVIDENCE: Level 4, no or historical control.

Anterior Cruciate Ligament↗

PubMed2005

Suprascapular nerve block for shoulder arthroscopy.

The suprascapular nerve (SSN) originates from the C5 and C6 nerve roots and provides sensation for the posterior shoulder capsule, acromioclavicular joint, subacromial bursa, and coracoclavicular ligament. Blocking it provides pre-emptive anesthesia, decreased intraoperative pain, and postoperative pain relief in shoulder arthroscopy. Under general anesthesia, 25 mL of 0.5% bupivacaine is injected by a spinal needle placed 1 cm medial to the convergence of the spine and clavicle, angling toward the coracoid. At a depth of 3 to 4 cm, the needle strikes the scapula body. The surgeon probes with the needle anteriorly until the scapula is no longer felt, then moves the needle back posteriorly until the bone is felt again. This places the needle at the coracoid base in the supraspinatus fossa where the SSN curves around the coracoid and heads to the glenohumeral joint. At this point, the anesthetic is injected, "flooding" the SSN location. In addition to the SSN block, other pain-control procedures should be performed, including bupivacaine injection of all portals and an intra-articular injection of morphine sulfate at the end of the procedure. The SSN block is an effective technique and can reduce postoperative medication needs and allow earlier patient discharge from the surgery center.

Anesthetics, Local↗

PubMed2005

Compressive loads in longitudinal lateral meniscus tears: a biomechanical study in porcine knees.

PURPOSE: To determine the displacement forces across a lateral meniscal tear during motion. TYPE OF STUDY: Experimental laboratory biomechanical study. METHODS: A middle third longitudinal lateral meniscal cut was created arthroscopically at the "red-white" junction in 5 intact porcine knees. With a pressure transducer in the tear, the knees were repeatedly cycled through a full range of motion. Pressure data were gathered with the knees held at neutral, internal rotation (IRot), and external rotation (ERot) and matched to the specific flexion angle measured by electronic goniometer. Averaged pressure measurements were calculated at each 5 degrees interval. RESULTS: The highest pressures were seen at full extension (neutral, 589 mm Hg; IRot, 1,110 mm Hg; ERot, 337 mm Hg) and declined to a low at 90 degrees of flexion (neutral, 133 mm Hg; IRot, 314 mm Hg; ERot, 187 mm Hg). Then the pressures increased steadily after 100 degrees as the knees were further flexed. The highest pressure was always seen with IRot. IRot during flexion resulted in higher lateral meniscus compressive loads than ERot. CONCLUSIONS: This model demonstrated that a middle third longitudinal lateral meniscal cut is compressed throughout the full range of knee motion. At no time were negative intrameniscal tear pressures registered that would suggest meniscal cut separation. CLINICAL RELEVANCE: These data suggest that meniscal compressive loads, not distractive loads, occur throughout knee flexion and extension. The absence of distractive loads across a meniscal cut suggests that the ability of a repair to align the meniscal fragment may be more important than a high load to failure strength.

Animals↗

PubMed2005

Arthroscopic osteochondral autografting.

Arthroscopic osteochondral autografting is indicated for unipolar, full thickness articular cartilage lesions between 1 and 2.5 cm in diameter. A stable properly aligned knee is important to a good outcome. This procedure should not be performed in the presence of generalized osteoarthritis. Arthroscopic osteochondral autografting allows the restoration of hyaline articular cartilage with zonal matching of the graft. It is cost-effective, can be performed on an outpatient basis, and results in durable resurfacing with excellent long-term results.

Arthroscopy↗