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Biomedical subjects

G R Barrett

Publications and source records attributed to G R Barrett.

At least 19 recordsLinked to original sources
PubMed2001

The effect of Workers' Compensation on clinical outcomes of arthroscopic-assisted autogenous patellar tendon anterior cruciate ligament reconstruction in an acute population.

PURPOSE: To assess the effect of Workers' Compensation (WC) benefits on subjective outcomes of patients following anterior cruciate ligament (ACL) reconstruction. TYPE OF STUDY: Prospective study of ACL reconstruction with bone-patellar tendon-bone in an acute population. METHODS: From October 1991 through June 1997, 1,015 patients underwent ACL reconstruction, 769 with bone-patellar tendon-bone autografts; 235 met the criteria for this study. All chronic injuries, failed and/or bilateral reconstructions were excluded making the total population 139. The final populations included 115 patients in a non-WC group and 24 patients in a WC group. Average follow-up for was 34.5 months for the WC group and 33.6 months for the non-WC group. All patients had equal objective evaluations, which allowed the subjective criteria to be analyzed. RESULTS: The results revealed a significant difference in the subjective data of patients with WC benefits. Uniformly, WC patients rated subjective criteria as far worse than the non-WC group in postoperative stages. The average of the 15-item visual analog scale showed statistically significant (P <.01) differences between the WC and non-WC groups. Average postoperative Tegner scores were 3.05 for the WC group and 6.02 for the non-WC group, which was statistically significant. The WC group did not return to their preinjury Tegner score. CONCLUSIONS: The data show that the patients' perception of their knee function drastically differs from the objective findings on examination; therefore, it should be anticipated that the WC patient might have lower subjective outcomes from surgical treatment when compared with their non-WC counterparts.

Adult↗
PubMed1998

The effect of partial lateral meniscectomy in patients > or = 60 years.

To determine the benefit, if any, of meniscectomy in an older population, all patients > or = 60 years who underwent partial lateral meniscectomy were evaluated. Thirty-five patients (36 knees) were available for follow-up. The average patient age was 64.9 years. Patients were divided into two groups based on the degree of articular cartilage damage. Patients in group 1 had no damage worse than grade II and underwent arthroscopic partial meniscectomy only, while patients in Group 2 had grade III or IV damage and underwent arthroscopic debridement as well as partial meniscectomy. With an average follow-up of 36.8 months, the overall failure rate was 13.9%. Eighty-six percent of the patients reported the overall assessment of their knee as improved (94% and 80% in groups 1 and 2, respectively). While patients in group 2 tended to have less favorable results than patients in group 1, these results indicate that this procedure is warranted and that both groups benefited significantly from partial meniscectomy.

Aged↗
PubMed1997

The effect of anterior cruciate ligament reconstruction on symptoms of pain and instability in patients who have previously undergone meniscectomy: a prereconstruction and postreconstruction comparison.

To determine the effect of anterior cruciate ligament (ACL) reconstruction on symptoms of pain and instability in patients with chronic ACL insufficiency who had previously undergone meniscectomy, we reviewed a series of 21 symptomatic, previously meniscectomized patients with chronic ACL deficiency (average age, 31 years). Arthroscopically assisted intra-articular ACL reconstruction using a middle, one-third patella-tendon autograft was performed in all cases. All patients had radiographic evidence of degenerative changes before ACL reconstruction. The average time from meniscectomy to ACL reconstruction was 6.6 years. Preoperative and postoperative range of motion, stability, and subjective evaluations were compared. Follow-up averaged 37.4 months (range, 24 to 67 months). Physical examination and postoperative KT-1000 side-to-side measurements revealed three patients (14%) with pathological ligament laxity. One patient had a 2+ Lachman, a 2+ pivot shift, and > 5 mm difference on KT-1000 maximum manual test, and two patients had a 1+ Lachman and a 1+ pivot shift. Range of motion measurements taken at follow-up were not significantly different from preoperative measurements (extension, P = .14; flexion, P = .46). Subjectively, all items on a panel of 15 visual analog scales were improved, but intensity of pain and instability were significantly improved after statistical analysis (P < .05). This review suggests that symptoms of pain and instability in patients with chronic ACL deficiency who have previously undergone meniscectomy can be improved by ACL reconstruction if objective stability is obtained.

Adolescent↗
PubMed1997

Preliminary results of the T-fix endoscopic meniscus repair technique in an anterior cruciate ligament reconstruction population.

In a study to evaluate the preliminary results of endoscopic meniscus repair using the T-fix suture anchor (Acufex Microsurgical Inc, Mansfield, MA), 21 mensiscus repairs in 20 patients were prospectively followed-up for a minimum of 1 year. There were 11 medial and 10 lateral tears; 14 were in the peripheral third (zones 0-1) and 7 were in the central third (zone 2) of the meniscus. All patients had associated anterior cruciate ligament reconstructions. At follow-up, 4 patients were symptomatic, 3 of whom had tears that were complex and in zone 2. Radiographic follow-up showed that 3 patients had a mild progression Fairbank's change. One patient required removal of all sutures because of infection. Second-look arthroscopy on 4 cases revealed that 3 had healed and 1 had not healed. Meniscus healing can be accomplished with T-fix endoscopic technique if principals of meniscus repair are adhered to (i.e., blood supply, synovial rasping, stable fixation).

Adolescent↗
PubMed1997

The effect of suture type on meniscus repair. A clinical analysis.

To test the hypothesis that use of permanent suture for meniscus repair allows longer, more stable fixation and more complete healing than absorbable suture, 89 patients (90 meniscus repairs) undergoing repair between 1990 and 1993 were evaluated. Eight patients were lost to follow-up, leaving 81 patients with 82 meniscal repairs. All patients underwent meniscus repair with either absorbable or permanent suture and were re-evaluated at an average of 24.1 months follow-up. The tears were within 5 mm of the peripheral meniscal rim and communicated with the peripheral blood supply (either red-red or red-white zone). Group 1 (absorbable suture) was comprised of 50 patients (38 males and 12 females; 19 right and 31 left knees). There were 36 medial and 14 lateral repairs. Group 2 (permanent suture) was comprised of 31 patients with 32 meniscus repairs (23 males and 8 females; 17 right knees and 14 left knees). There were 23 medial and 9 lateral meniscus repairs. Follow-up consisted of objective (clinical examination, range of motion, McMurray test, detectable swelling, locking, and joint-line tenderness) and subjective evaluations (15 question series of visual analog scales). Success or failure of the meniscal repair was based on the degree of symptoms present at follow-up. Group 1 had 9 failures, while Group 2 had none. All of the failures were rescoped and required additional surgical procedures. Group 1 had higher scores on all subjective questions. Data were analyzed using the two-sample t-test and the chi-squared test. The absolute failure rate was statistically significant. In this study, menisci repaired with permanent sutures had a lower incidence of clinical symptoms and a much lower failure rate. Thus, permanent suture is recommended for meniscus repair as it appears to allow for longer and more stable fixation, permitting more complete maturation and remodeling of the meniscus.

Absorption↗
PubMed1996

Use of the T-fix suture anchor in fascial sheath reconstruction of complex meniscal tears.

The importance of preserving meniscal tissue has become increasingly apparent as studies have demonstrated early arthritic changes in the knee. To increase the healing rate of complex tears, the use of a fascial sheath to encapsulate the exogenous clot around the tear has previously been proposed. This report describes the placement of a fascial sheath over a repaired meniscal tear using a T-fix anchor suture. With the increased use of fascial sheaths in combination with an exogenous blood clot, meniscal repair rates in complex tears can be increased.

Arthroscopy↗
PubMed1996

The effect of intraoperative isometric measurement on the outcome of anterior cruciate ligament reconstruction: a clinical analysis.

The concept of isometry is based on the measurement of displacement between potential femoral and tibial anterior cruciate ligament (ACL) graft attachment sites while the knee is taken through a range of motion. To evaluate the clinical benefit of intraoperative isometry measurements in ACL reconstruction, we prospectively compared 59 patients (58% acute) in whom isometry was tested (group I) with 35 patients (77% acute) in whom isometry was not tested (group II). All patients underwent arthroscopically assisted ACL reconstruction using autogenous bone-patella tendon-bone graft and interference screw fixation, and were followed-up for a minimum of 24 months (mean, 30 months). With 88% follow-up, no significant differences were found in objective testing, which included the pivot shift test, the Lachman test, KT-1000 arthrometer measurements, and range of motion. A significant difference was found between the two groups when Lysholm scores (P = .04) and Tegner Scores (P = .02) were compared, with group II having higher scores. In addition, one of 15 visual analog scales, "gives way," showed a significant difference between the two groups (P = .01). On a scale of 1 to 10 with 1 being "no giving way" and 10 being "very frequent giving way", group I had an average of 1.68 and group II had an average of 0.58. These differences were related to the greater percentage of chronic cases in group I. Analysis of only those patients with acute injuries from each group showed no significant differences in any objective or subjective measurement. Group I had an overall failure rate of 13%, and group II had a failure rate of 6.7% (chi 2 = .848). These results indicate that, in the hands of a surgeon experienced in ACL reconstruction, intraoperative assessment of isometry has little effect on the clinical outcome.

Adolescent↗
PubMed1996

Comparison of rear-entry (two-incision) and endoscopic techniques for reconstruction of the anterior cruciate ligament.

In this series of patients having reconstruction of the anterior cruciate ligament (ACL), the rear-entry (two-incision) technique with fixation from lateral incision into cortical bone was compared with the endoscopic technique with fixation from inside to more cancellous bone. The rear-entry technique was used in 44 cases of ACL deficiency (8 chronic and 36 acute), and the endoscopic technique was used in 42 cases (19 chronic and 23 acute). Both groups had similar demographics. Objective and subjective criteria were evaluated at an average of 22 months postoperatively. Follow-up KT-1000 arthrometer findings, range of motion, and results of the Lachman and pivot shift tests were compared. There were no significant differences between the two groups at 22 months' follow-up. Subjective assessment of intensity of pain, swelling, and giving way was done by visual analog scales (0 to 10 rating). None of these parameters showed any statistically significant differences between the two techniques. This study shows that both of these techniques for reconstruction of the ACL render satisfactory objective and subjective results.

Adult↗
PubMed1995

Endobutton button endoscopic fixation technique in anterior cruciate ligament reconstruction.

The surgical technique of Endobutton (Acufex Microsurgical, Inc, Mansfield, MA) button fixation for anterior cruciate ligament reconstruction is described. This technique avoids the potential pitfalls of interference screw fixation, avoids a second incision, and is adaptable to a variety of graft materials (autograft or allograft bone-patellar tendon-bond and hamstring).

Anterior Cruciate Ligament↗
PubMed1995

T-Fix endoscopic meniscal repair: technique and approach to different types of tears.

Endoscopic meniscus repair using the T-Fix suture device (Acufex Microsurgical, Inc, Mansfield, MA) allows ease of suture placement for meniscus stability without the problems associated with ancillary incisions such as neurovascular compromise. It is ideal for the central posterior horn tears that are difficult using conventional techniques. Vertical tears, bucket handle tears, flap tears, and horizontal tears can be approached using a temporary "anchor stitch" to stabilize the meniscus before T-Fix repair. The basic method of repair and our approach to these different types of tears is presented.

Humans↗
PubMed1995

The effect of added extra-articular procedure on results of ACL reconstruction.

To determine the efficacy of added extraarticular backup procedure to an intra-articular ligament reconstruction, 70 patients who underwent surgery between July 1988 and May 1991 were reviewed retrospectively. Each patient had undergone either an intra-articular patellar tendon autograft anterior cruciate ligament (ACL) reconstruction alone or with added extra-articular augmentation. Patients were excluded if they had a history of knee problems, if they had ACL surgeries on either knee, or if they became unavailable for followup for an adequate period of time. Thirty-two patients underwent ACL reconstruction with an extra-articular augmentation added (group 1), and 38 patients underwent intra-articular reconstruction alone (group 2). Objective testing consisted of a clinical examination, radiographs, instrumented knee laxity, and subjective evaluation using visual analog scales. There were no statistically significant differences in the clinical or subjective findings between the two groups.

Adolescent↗
PubMed1995

Combined single-strand distal semitendinosus-iliotibial band tenodesis (Puddu) for anterior cruciate ligament augmentation.

Anterior cruciate ligament (ACL) reconstruction using the semitendinosus tendon has seen renewed interest recently. Puddu described a procedure in which the tendon is harvested at its insertion on the tibia with a bone plug. This study evaluates the efficacy of this approach and examines the long-term results. Between 1982 and 1986, 77 patients underwent this type of procedure; 51 (66%) patients who were reexamined comprised the study group. Thirty-five patients had acute tears, and 16 patients had chronic tears. Follow-up was both objective and subjective with an average follow-up of 7 years and 3 months (range: 5.8 to 9.2 years). In the acute group, six patients (17%) had a 2+ Lachman and seven (22%) had a 1+ Lachman. Pivot shift was 2+ to 3+ in three patients (8.6%) and 1+ in seven patients (22%). KT-100 results were > 5 mm in eight patients (23.3%). In the chronic group, four patients (25%) had 2+ and four had a 1+ Lachman. Seven patients (44%) had a positive pivot shift test. Five patients had > 5 mm difference. Using regression analysis, the KT-1000 results correlated well with the Lachman and pivot shift tests. Chronicity and partial meniscectomy were associated with a poor result. Although this technique has undergone an evolution and improvement to a four-strand reconstruction in recent years, the results of this review indicate satisfactory results can be obtained, especially in the acute setting.

Acute Disease↗
PubMed1993

Comparison of patella tendon versus patella tendon/Kennedy ligament augmentation device for anterior cruciate ligament reconstruction: study of results, morbidity, and complications.

In a study designed to evaluate the efficacy of supplementing patellar tendon bone-tendon-bone intraarticular anterior cruciate ligament (ACL) reconstructions with the polypropylene braid ligament augmentation device (Kennedy LAD; 3M, Minneapolis, MN), 75 consecutive patients treated between July 1988 and January 1990 with isolated ACL disruptions in whom no associated ligament injury was present were offered the LAD as part of their preoperative consent. Interference screws at both bone plugs were used. Group I was composed of 25 patients (10 acute, 15 chronic) with ACL disruptions who had the LAD added to their reconstruction. Group II was composed of 50 patients (24 acute, 26 chronic) who underwent an identical surgical procedure except that the LAD was not used. Objective and subjective assessments were made throughout the postoperative course, with the longest follow-up an average of 24 months postoperatively. Statistical analysis of these findings failed to show any statistically significant differences between the groups. Complications that occurred among the augmented group included infection, synovitis, effusion, and recurrence of instability, intraarticular adhesions, hemarthrosis, and painful hardware. This study demonstrates that the LAD added to the morbidity and severity in this series. It does not seem to improve results and is therefore not recommended for use in this manner.

Adolescent↗
PubMed1992

Maisonneuve fracture dislocation of the ankle.

Ligamentous injuries of the ankle are usually benign and may be managed satisfactorily by nonoperative measures. This is not true, however, of the Maisonneuve variant. In this paper we present a case report of a high school athlete who sustained a Maisonneuve fracture dislocation of the ankle. The diagnosis was missed initially, because of an incomplete examination. The subsequent physical and radiographic examination revealed the proper diagnosis. Guidelines for the evaluation and appropriate treatment are discussed.

Journal Article↗
PubMed1991

Rib fractures in athletes.

Rib fractures are the most common serious injury of the chest. They occur most commonly in the middle and lower ribs with blunt trauma, and also with direct force to a small area of the chest wall and violent muscle contractions. Diagnosis is generally not difficult. The athlete should have a chest x-ray to confirm the diagnosis. Differential diagnosis includes severe rib contusion, costochondral separations, muscle strains and pneumothorax. If no internal problems exist, treatment consists of ice, NSAIDs, analgesics and a rib belt or tape. Healing should be well on its way before a return to sports. Fractures of the first 4 ribs or the last 2 ribs, multiple fractures and flail segments are less benign than other fractures, and may result in injury to surrounding structures. First rib and floating rib fractures are uniquely athletic fractures; they are avulsion fractures caused by a sudden vigorous contraction in different directions of pull.

Athletic Injuries↗
PubMed1991

Operative management of acute PCL injuries with associated pathology: long-term results.

Eighteen consecutive patients with posterior cruciate ligament injury and associated pathology were reviewed. All were re-examined with an average follow up of 5.4 years (range: 3.5 to 7.5). Six posterior cruciate ligaments were repaired to the femur with multiple #2 nonabsorbable suture, and one "mop end" mid-substance tear was repaired with sutures in each stump. Seven mid-substance tears were repaired and augmented with the semitendinosus tendon, while four additional mid-substance tears were repaired and augmented with the semitendinosus tendon and a Dacron stent (Meadox). One medial meniscus was repaired and one was partially excised, and one lateral meniscus tear was partially excised. The anterior cruciate ligament was repaired to the tibia in two knees, left alone (interstitial tear) in two, and excised with extraarticular iliotibial band tenodesis augmentation in five. At follow up, arthrometer readings (Stryker) correlated well with clinical examination. The four knees with Dacron stent had a 0 to 1 mm difference at 90 degrees, while the failures had greater than 5 to 6 mm. Six of these were in the repair alone group and two were in the repair with semitendinosus augmentation group. Eight knees (44.5%) had radiographic changes primarily in the medial compartment. Using Hughston's perimeters to evaluate the results, objective 55.5% were rated good, 27.8% were rated fair, and 16.7% were rated poor or failures. Using Clancy's criteria, 22.2% were excellent, 22.2% were good, 44.5% were fair, and 11.1% were rated failures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗