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Biomedical subjects

H E Cabaud

Publications and source records attributed to H E Cabaud.

At least 19 recordsLinked to original sources
PubMed1985

Philosophy and rationale for the management of anterior cruciate injuries and the resultant deficiencies.

Deficiency of the anterior cruciate ligament (ACL) results in the loss of the fine tuning of the knee joint. Either acute loss or chronic insufficiency of ACL function results in instability, tricking, and giving way, and subsequently the fluid gliding mechanics of the knee joint are significantly altered. Regardless of the length of time from injury to evaluation, it is imperative that a correct and complete diagnosis be made before a treatment program is selected. Functional stability, the goal, can be accomplished only by limiting clinical laxity through a combination of appropriate surgery and functional rehabilitation.

Acute Disease↗
PubMed1984

Nonligamentous problems of the athlete's knee.

Acute and chronic nonligamentous problems of the athlete's knee are outlined, emphasizing diagnosis and treatment. Most such problems can be managed by the family physician or general practitioner, and recommendations are made for the referral of more complex problems.

Adult↗
PubMed1983

Compression plate position. Extraperiosteal or subperiosteal?

Although compression plate fixation of diaphyseal long bone fractures is accepted treatment, surgical exposure and plate position in relation to the periosteum are controversial. Histologic, roentgenographic, and biomechanical methods were applied to investigate quality and chronology of healing in radial and ulnar fractures in adult dogs. Plate position was extraperiosteal in one limb and subperiosteal in the contralateral limb. There were no statistical differences in roentgenographic or histologic studies of healing between the two techniques, nor were significant statistical differences noted when comparing linear load, maximum load at failure, slope of the linear portion, energy absorbed to failure, stress, modulus of elasticity, strain at maximum linear load, strain at maximum load, and strain at failure. Thus, there was no appreciable difference in fracture healing between subperiosteal and extraperiosteal exposure with compression plate fixation of diaphyseal fractures in dogs. However, subperiosteal exposure is preferable because it is less likely to injure surrounding soft tissues.

Animals↗
PubMed1983

Tobramycin in bone cement. An in-depth analysis of wound, serum, and urine concentrations in patients undergoing total hip revision arthroplasty.

In this prospective clinical study, ten patients were treated by revision of total hip arthroplasties utilizing tobramycin-impregnated bone cement. After the operation, serum, urine, and wound suction drainage concentrations of tobramycin were determined serially by radioimmunoassay. Although high local wound concentrations, 5.7 micrograms/ml, were maintained for as long as 48 hours, serum concentration never reached even normal therapeutic ranges (greater than 2.0 micrograms/ml). There were no immediate postoperative infections; all patients are pain-free and ambulate without external support two years after surgery. One patient who had had a preoperative infection was successfully treated for late manifestation of infection 24 months after revision. Based on the evidence obtained in this study, tobramycin in bone cement is currently acceptable for clinical use.

Adult↗
PubMed1982

Progressive ultrastructural changes after peripheral nerve transection and repair.

Six rhesus monkeys (Macaca mulatta) underwent sharp transection and repair of the intrinsic motor fascicles of both ulnar nerves in order to determine the sequential events during reinnervation of the distal stamp. Light and electron microscopic sections were made at 2.0 mm increments distal to the neurorrhaphy at weekly intervals in separate monkeys. Neurite sprouts could be identified distal to the neurorrhaphy by 1 week and were clearly evident 40 mm distal by 3 weeks. Although some old endoneurial tubules persisted, they were less often used as conduits or scaffolds for the regenerating neurites than previously described. Most new fibers, whether myelinated or unmyelinated, passed down new endoneurial tubules, thus precluding perfect end-organ specificity because the regenerating neurites seldom utilized old endoneurial tubules. The clinical implication suggested by this study is that the ideal situation is the immediate repair of transected nerves. This allows neurite sprouts to cross a neurorrhaphy rapidly and reinnervate end organs.

Animals↗
PubMed1982

The anterior cruciate ligament: radiographic and clinical signs of successful and unsuccessful repairs.

Our ten-year observation of anterior cruciate ligament injuries in an active athlete population shows that radiographic evidence of instability and joint deterioration are reliable clinical signs. Radiographic findings in the rotatory unstable knee are subtle six months after injury, but on standard roentgenographic views, which include the notch view, they appear in a sequential order from peaking of the intercondylar tubercles to buttressing osteophytosis. These are objective signs of progressive deterioration that should be a warning to the patient. The early and progressive radiographic signs portend further deterioration if stability is not obtained by restriction of activities, bracing, or reconstruction. Physicians and sports injury specialists should recognize these findings early and offer counsel to the patient at risk.

Athletic Injuries↗
PubMed1980

Peripheral nerve injuries: studies in higher nonhuman primates.

Two skeletally mature baboons underwent comparative neurorrhapies following transsection of both ulnar nerves without loss of nerve tissue. In baboon 1 there was no difference in objective evaluations at 12 months when an epineurial neurorrhaphy was compared to a perineurial fascicular neurorrhaphy. In baboon 2, the one that had interfacicular grafts in one upper extremity and an epineurial neurorrhaphy on the other side, there was significantly better functional return on the epineurial side than one the graft side. Grass and histological evaluation showed that the grafts retained their integrity and regenerating axons transversed the grafts well.

Animals↗
PubMed1980

Neurorrhaphy after loss of a nerve segment: comparison of epineurial suture under tension versus multiple nerve grafts.

Epineural neurorrhaphy under tension and interfascicular grafting, two methods of bridging gaps associated with loss of a nerve segment, were compared. After resection of a 2 cm length of both ulnar nerves in cats, one nerve was sutured under tension using an epineurial technique, and the other was repaired using multiple interfascicular sural nerve grafts. Six months later return of nerve function was evaluated. Subjective evaluation included ambulation, sensation, and intrinsic function. Objective measurements included muscle efficiency, maximum strength, muscle weights, and total axon counts. No statistical difference was observed between these two techniques. Histochemically, there was marked fiber type grouping of the reinnervated muscles for both types of repairs. Histologically, perineurial fibrosis and axonal disorganization were equal for both techniques, but significantly greater suture granuloma formation occurred in the nerve repaired under tension. Individual grafts retained their identity and remained distinct grossly and microscopically.

Animals↗
PubMed1979

Tendon transfers in the paralytic hip.

We analyzed the results of transfers of the iliopsoas or external oblique muscles performed to augment the abductor power of the hips in 149 patients with flaccid paralysis of the hips. More than 800 supplemental procedures were performed on the lower extremities of these patients. Twenty-three of the thirty-eight hips that had been subluxated or dislocated became stable in the reduced position after the transfer operation. Every hip that had been stable before the transfer remained stable, and thirty-seven patients who had been brace-dependent became brace-free. We concluded that transfers of the iliopsoas or external oblique muscles are useful adjuncts in the treatment of paralytic disorders of the hips.

Adolescent↗
PubMed1976

Epineurial and perineurial fascicular nerve repairs: a critical comparison.

To compare the results of epineurial and intrafascicular perineurial nerve repair techniques, ulnar nerves of 20 domestic cats were severed proximal to the medical humeral epicondyle. One nerve was repaired with No.8-O nylon by standard epineurial technique with the aid of three to five magnifications; the other nerve was repaired with No. 10-O nylon by intrafascicular perineurial technique under higher magnification. Four to five months following neurorrhaphies, the ambulation pattern, fanning of claws, and sensation were evaluated subjectively. Objective measurements included efficiency, absolute strength, and exact weight of the flexor carpi ulnaris muscle. Proximally and distally to each neurorrhaphy, complete axon counts were taken. Histochemically and histologic analyses were made on reinnervated muscles and neuromas. No statistically significant differences were detected between the results of epineurial and intrafascicular perineurial neurorrhaphies. These findings indicate that, following acute nerve laceration in the cat, epineurial neurorrhaphy is as satisfactory as is intrafascicular perineurial neurorrhaphy.

Animals↗
PubMedDate not supplied

Experimental studies of acute anterior cruciate ligament injury and repair.

Ten dogs and six rhesus monkeys underwent transection and repair of the anterior cruciate ligament. One-half of the procedures involved the femoral end, the other half involved the tibial end of the ligament. Seven of the 10 canine and all of the primate ligaments, that had been transected and repaired, did heal. Functional and clinical instability was demonstrable in all repaired knees. The monkeys developed fewer degenerative changes with more grossly normal appearing ligaments after the repairs than did the dogs. Failure testing on an Instron materials testing machine revealed maximum strength of the repaired ligaments to be 10.4% for the repairs at the femoral end and 2.0% for repairs at the tibial ends in dogs when compared with the contralateral control knees. In monkeys the femoral repairs were 46.8% and the tibial repairs were 62.6% of the control knees. Inadequate immobilization and early stress were believed to be principal causes of the poorer results in dogs. The observations in monkeys support the suggestion that injured anterior cruciate ligaments that can be repaired, should be repaired.

Animals↗
PubMedDate not supplied

Exercise effects on the strength of the rat anterior cruciate ligament.

Seventy-five rats were divided into a control and four exercise groups of differing frequency and duration. After 8 weeks of endurance-type exercise on a motorized treadmill, the rats were sacrificed and the anterior cruciate ligaments were tested to failure on an Instron materials testing machine at a strain rate of 95% sec-1. Of the 121 ligaments tested, 119 failed by pure interstitial failure. There was significant increase in both the strength and stiffness of the anterior cruciate ligaments in the exercised rats but those rats exercised more frequently (daily vs. every other day) and for shorter duration (30 min rather than 60 min) had the greatest increase in strength. This study has shown that endurance-type exercise is beneficial to the anterior cruciate ligament as both strength and stiffness are increased and functionally the ligament remains unchanged by exercise.

Animals↗
PubMedDate not supplied

Acute anterior cruciate ligament injury and augmented repair. Experimental studies.

Eleven dogs underwent transection of the anterior cruciate ligament at the femoral origin of the stifle (knee) joint. The anterior cruciate ligaments were repaired in a conventional manner and augmented by transferring the medial one-third of the patellar tendon and inserting it into the lateral femoral condyle. The repairs were evaluated either 4 or 8 months postoperatively. All repaired and augmented anterior cruciate legaments in this series healed satisfactorily to provide clinical and functional stability to the knee joints. Instron testing of the repaired and augmented anterior cruciate ligaments showed maximum strength at 4 months of 46.2 +/- 10.9 kgf and at 8 months of 64.3 +/- 14.3 kgf as compared to the control of 122.7 +/- 11.6 kgf. Histologic evaluation showed that by 8 months the repaired and augmented anterior cruciate ligaments had healed by bony ingrowth. Thus, interstitial failure occurred during Instron testing. The transferred patellar tendon provided additonal blood supply, splinted the anterior cruciate ligament to allow healing, and increased the strength of the repaired complex.

Animals↗
PubMedDate not supplied

Medical meniscus repairs. An experimental and morphologic study.

In an effort to determine the healing potential of medial meniscus tears, 20 canine and 12 rhesus knee joints were subjected to transverse medial meniscus laceration and repair with a single Dexon suture (Davis & Geck, Pearl River, NY). At four months, 12 out of 32 (38%) had healed completely with restoration of the inner meniscal rim and 18 (56%) showed partial healing sufficient to protect the underlying articular cartilage. Only 2 (6%) of the menisci failed to heal. Histologic evaluation showed that the scar tissue present in the menisci was composed of unorganized collagen without common ground substance components. As a result of these studies, we believe that certain meniscal tears, particularly those involving the vascular periphery, can heal and may be repaired rather than treated by meniscectomy.

Animals↗
PubMedDate not supplied

Acute anterior cruciate ligament injury and repair reinforced with a biodegradable intraarticular ligament. Experimental studies.

The anterior cruciate ligament was transected at the femoral origin in the knee joint of 12 dogs. The ligaments were repaired in a conventional manner and reinforced with a polyglycolic acid (PGA) ligament of braided Dexon (Davis & Geck, Pearl River, NJ) suture. At two weeks the PGA ligament was still providing excellent support for the healing anterior cruciate ligament, and there was no synovitis within the knee joint. After five weeks, initial healing had firmly attached the repaired anterior cruciate ligament to the femoral condyle, and the PGA ligament had resorbed without inflammatory or fibrotic response. All repaired and reinforced ligaments in this series healed and provided functional stability to the knee joints. Biomechanical testing of the repaired anterior cruciate ligaments at four months produced a maximum strength of 54.2 +/- 6.3 kgf. Sulfur-35 uptake showed viable active collagen-producing cells in the repaired ligaments four months postoperatively. Thus, the biodegradable PGA ligament reinforced and splinted successfully the repaired anterior cruciate ligament.

Animals↗