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Biomedical subjects

J C Richmond

Publications and source records attributed to J C Richmond.

At least 19 recordsLinked to original sources
PubMed2001

Arthroscopic vs. open Bankart reconstruction: a comparison using expected value decision analysis.

The reporting of midterm failure rates following arthroscopic shoulder stabilization for recurrent anterior instability of the glenohumeral joint has shown that the risk of failure may be higher with arthroscopic techniques than with traditional open methods. The use of expected value decision analysis offers an explicit, consistent, and structured means to assist the clinician in determining which stabilization technique to utilize. Decision analysis reveals that the surgical technique that is favored for a given patient depends on the value that the patient assigns to various potential outcomes following surgery, the perioperative morbidity of each of the two procedures, and the surgeon's probability of success with either technique

Arthroscopy↗
PubMed2000

The menisci: basic science and advances in treatment.

Once described as a muscle remnant, and therefore treated with disrespect, the meniscus is now known to be a vital structure within the knee. Minimal partial meniscectomy performed arthroscopically, or meniscal repair when practical, have become the standard treatments. In spite of the advancements in understanding meniscal function and its preservation, much remains to be studied. In the future, availability of better repair techniques and the option of meniscal replacement with allograft or prosthetic menisci are expected to improve outcomes.

Anterior Cruciate Ligament Injuries↗
PubMed1993

The effect of meniscal status on knee stability and function after anterior cruciate ligament reconstruction.

The purpose of this study was to examine the relationship of meniscal status at the time of anterior cruciate ligament (ACL) reconstruction with the ultimate function and stability of the knee joint. Seventy-one patients were studied prospectively following bone-patellar tendon-bone ACL reconstruction. Subjects were divided into six subgroups relative to the integrity (intact, partial meniscectomy, complete meniscectomy) of the two menisci. After a minimum of 2 years of follow-up (range 2-4.1 years), 56 subjects were available for subjective, objective, and radiographic assessment. Meniscal status at the time of ACL reconstruction proved to have no significant bearing on the ultimate stability of the knee. However, individuals who had undergone meniscal excision reported subjective complaints and activity limitations more commonly than those with intact menisci (p < 0.05). Radiographic changes also were more common in the meniscectomized subset.

Adolescent↗
PubMed1991

Continuous passive motion after arthroscopically assisted anterior cruciate ligament reconstruction: comparison of short- versus long-term use.

The use of continuous passive motion (CPM) following anterior cruciate ligament (ACL) reconstruction has become common. The duration of use of CPM for maximal therapeutic benefit is not known. This study compared 4-day CPM use with 14-day CPM use following arthroscopic ACL reconstruction using a bone-patellar tendon-bone autograft prospectively in 20 patients. The patients were randomly allocated to the CPM 4-day group [6 h daily CPM for 4 days in hospital followed by intermittent passive motion (IPM) at home] or to the CPM 14-day group (6 h daily CPM for 14 days). The objective parameters measured were girth measurements at four lower limb locations for joint swelling and muscle atrophy; range of motion of the knee, measured goniometrically; and KT-1000 arthrometry measurements for joint laxity. The measurements were made prior to surgery, and on days 2, 7, 14, and 42, postoperatively. There were no statistically significant differences (p greater than 0.05) at 42 days postoperatively between groups in all parameters measured with the exception of KT-1000 laxity at 42 days.

Anterior Cruciate Ligament↗
PubMed1991

Arthroscopic management of arthrofibrosis of the knee, including infrapatellar contraction syndrome.

Infrapatellar contracture syndrome (IPCS) has been defined as a subcategory of arthrofibrosis of the knee following surgery. We present a systematic, wholly arthroscopic surgical approach to this difficult problem. The technique includes assessment of patellar mobility, resection of intraarticular adhesions, release of possible extracapsular bands, resection of fibrotic fat pad, and lateral and medial releases if indicated. We obtained satisfactory results with increased total range of motion of 45 degrees in 12 patients with IPCS. This is comparable to the results in routine arthrofibrosis of the knee, where the mean increase in total range of motion was 50 degrees for the seven patients in this series.

Adult↗
PubMed1988

Arthroscopic treatment of medial meniscal avulsion fractures.

The meniscal ossicle is an infrequent radiographic finding in humans. It has long been recognized in relation to trauma to the meniscus. Previous theories as to the etiology of these ossicles have been that they are vestigial or result from metaplastic change in an area of injury. We present four patients with meniscal ossicles associated with a longitudinal tear of the medial meniscus. The origin of the ossicle was an avulsion of the insertion of the posterior horn of the medial meniscus. Arthroscopic resection in these patients resolved their symptoms.

Adolescent↗
PubMed1983

Segmental arthroscopic resection of the hypertrophic mediopatellar plica.

In a retrospective review of 64 knees (58 patients) treated during a 36-month period by segmental arthroscopic resection of a hypertrophic mediopatellar plica, each patient was questioned and/or examined a minimum of one year after surgery. Medial or retropatellar pain (95%), buckling (32%), swelling (25%), and snapping (16%) were symptoms associated with a hypertrophic mediopatellar plica. Findings during physical examination of medial and retropatellar tenderness (74%) suggest the presence of the condition. Thirty percent of knees had localized chondromalacia of the medial femoral condyle, while in 13% chondromalacia was localized to the medial patellar facet. Good to excellent results were obtained in 86% of knees with a hypertrophic mediopatellar plica, with or without localized chondromalacia. In patients who had associated conditions, the lesions were also treated arthroscopically; good to excellent results were obtained in 69% of these knees.

Arthroscopy↗
PubMed1982

Superficial anterior transposition of the ulnar nerve at the elbow for ulnar neuritis.

Superficial anterior transposition of the ulnar nerve at the elbow was carried out for ulnar neuritis in 18 extremities. Epineural neurolysis and superficial stabilization by suture of the epineurium to the fascia were performed in all cases. The procedure, as described, prevents muscle scarring, kinking of the nerve over the intermuscular septum, and fascial sling. It does not require muscular dissection and allows rapid return to occupational and athletic activity. Our 83% good or excellent results compares favorably with other series in the literature.

Adolescent↗
PubMedDate not supplied

Transient laxity of an anterior cruciate ligament-reconstructed knee related to pregnancy.

Transient laxity was documented around the end of pregnancy in a woman who had undergone anterior cruciate ligament (ACL) reconstruction 2 months before conception. This temporary laxity in the 3rd trimester and a few months postpartum corresponded to a time when substantial remodeling from large diameter to small diameter collagen fibers has been noted in the ACL graft ligamentization process. This is also a time of high levels of the hormone relaxin (member of the family of insulin-like growth factors), whose action in animals leads to dissociation of large collagen fibrils to smaller disorganized fibrils. The temporary laxity resolved. Careful observation of women who become pregnant in the first few months after ACL reconstruction is recommended.

Adult↗
PubMedDate not supplied

Contractile actin expression in torn human menisci.

The human meniscus is subject to injury that necessitates repair or removal. Many aspects of the cellular response to injury have not been well characterized. The purpose of this study was to describe the cellular distributions within the torn human meniscus. In addition to evaluating the cell density in selected regions, we investigated the cellular expression of a contractile actin isoform that has recently been found in the intact human meniscus. Included as a contemporaneous comparative group were torn human meniscal allografts. We hypothesized that a hypercellular surface zone would be found in the torn menisci, with a higher percentage of cells in this peripheral region expressing alpha-smooth muscle actin compared with other locations in the interior of the remnant. The rationale for this hypothesis was based on prior immunohistochemical investigations of the distribution of alpha-smooth muscle actin-containing cells in the torn human anterior cruciate ligament. Eighteen torn meniscal specimens were obtained from 17 patients, 0.5 to 84 months after injury, and four torn allograft meniscal samples were retrieved from three patients, 11 to 49 months after implantation. Microtomed sections of paraffin-embedded tissue were stained with hematoxylin and eosin and a monoclonal antibody to alpha-smooth muscle actin. The cell density and percentage of cells containing alpha-smooth muscle actin were determined in the following zones: synovial, vascular, hypercellular with loose collagen, hypocellular with dense collagen, and organized collagen. A cellular layer that resembled synovium was present on the surface of all but two of the specimens. Vascular regions were often continuous with the synovium abutting the more interior loose collagen zones. The total cell density was greatest in each of the zones closest to the periphery (synovium, vascular, and loose collagen; p < 0.001), when compared to the interior of the tissue. The synovium-like layer was found to have the highest percentage of alpha-smooth muscle actin-expressing cells and the highest alpha-smooth muscle actin-containing cell density (p < 0.05). Similar results were found for the torn allograft menisci. These findings confirm the working hypothesis and suggest that the torn human meniscus is capable of mounting a reparative response, including the proliferation of cells capable of contributing to wound closure. This underscores the importance of providing a bridging scaffold into which such cells can migrate.

Actins↗
PubMedDate not supplied

A comparison of ultrasonic suture welding and traditional knot tying.

The slippage of knots and the technical challenge of tying them securely are potential impediments to certain arthroscopic procedures. Ultrasonic energy delivered at 70 kHz can be used to weld No. 2 polypropylene suture. This method was compared with a traditional knot (surgeon's knot with four alternating half hitches) tied with an open technique to determine whether welding of sutures is comparable, in mechanical properties, to hand-tied knots. Both loops were fashioned around a 0.25-inch mandrel and then tested. The load to reach 3-mm elongation (point of likely biologic failure of a repair) was significantly greater for welded sutures than for knots. The elongation at ultimate failure was significantly less for welded sutures than for knots. The number of cycles to failure and the creep after initial displacement were similar for both welded and knotted suture loops. The ultimate load to failure was significantly greater for the knotted than for the welded suture. The welding of suture for the repair of musculoskeletal soft tissue presents an attractive alternative to traditional knot tying, particularly for arthroscopic applications.

Equipment Failure Analysis↗
PubMedDate not supplied

Meniscal allograft transplantation. Two- to eight-year results.

We evaluated 18 of 23 patients who had undergone cryopreserved meniscal allograft transplantation for compartmental pain after total meniscectomy 2 to 8 years (mean, 5.4) after the operation. The Short Form-36 scores revealed a decrease in pain with a significant improvement in function, although function remained limited. There was no significant decrease in joint space on 45 degrees posteroanterior weightbearing radiographs through the duration of the study. Eight of 22 allograft menisci (36%) tore during the study period, necessitating 6 partial and 2 total meniscectomies. Two patients subsequently underwent reimplantation. Histologic examination of the removed tissue revealed reduced cellularity as compared with normal or torn native menisci. Four specimens also underwent detailed cytokine evaluation and demonstrated reduced cytokine expression compared with controls. While successful in alleviating compartmental pain that may be a late consequence of major meniscectomy, allograft menisci are repopulated with fewer cells than are present in normal or torn native menisci. These cells also demonstrate potentially reduced function, as measured by decreased growth factor production. This decreased biologic activity may be a factor that contributes to the high frequency of retears noted in this and prior studies.

Adult↗
PubMedDate not supplied

Development and validation of the international knee documentation committee subjective knee form.

A committee of international knee experts created the International Knee Documentation Committee Subjective Knee Form, which is a knee-specific, rather than a disease-specific, measure of symptoms, function, and sports activity. The purpose of this study was to evaluate the reliability and validity of the new International Knee Documentation Committee Subjective Knee Form. To provide evidence for reliability and validity, we administered the final version of the form, along with the Short Form-36, to 533 patients with a variety of knee problems. Analyses were performed to determine reliability, validity, and differential item function related to age, sex, and diagnosis. Factor analysis revealed a single dominant component, making it reasonable to combine all questions into a single score. Internal consistency and test-retest reliability were 0.92 and 0.95, respectively. Based on test-retest reliability, the value for a true change in the score was 9.0 points. The International Knee Documentation Committee Subjective Knee Form score was related to concurrent measures of physical function (r = 0.47 to 0.66) but not to emotional function (r = 0.16 to 0.26). Analysis of differential item function indicated that the questions functioned similarly for men versus women, young versus old, and for those with different diagnoses. In conclusion, the International Knee Documentation Committee Subjective Knee Form is a reliable and valid knee-specific measure of symptoms, function, and sports activity that is appropriate for patients with a wide variety of knee problems. Use of this instrument will permit comparisons of outcome across groups with different knee problems.

Factor Analysis, Statistical↗
PubMedDate not supplied

A multicenter study on the results of anterior cruciate ligament reconstruction using a Dacron ligament prosthesis in "salvage" cases.

A multicenter study is presented on 80 patients who underwent ACL reconstruction using a Dacron (E.I. Du Pont de Nemours and Co., Wilmington, DE) ligament prosthesis. Patient selection was based on a history of a failed autologous reconstruction and/or primary repair of the ACL. These selection criteria are unique and have not been previously reported in the literature. The frequency of prior intraarticular ACL surgery was 1.24 procedures per patient and 1.68 when combined with prior extraarticular reconstructions. Forty-one patients had a mean followup of 28 months (24 to 42 months). The mean followup for all of the patients was 21 months. The graft was augmented with autologous tissue in 59 cases and used as a pure prosthesis in the rest. Functionally, the mean Lysholm score improved from 40 to 81 points. The percentage of a combined excellent/good Lysholm rating increased from 6% to 60%. The Tegner activity rating level improved from 2 to 4. The percentage of a negative Lachman sign, anterior drawer, and pivot shift was approximately 75% at followup. There was no significant difference between the results of augmentation and nonaugmentation cases, indicating that the graft acts as a permanent prosthesis rather than as a scaffold or stint. The patients showed a significant improvement considering their preoperative global instability.

Adult↗
PubMedDate not supplied

Modification of the Bankart reconstruction with a suture anchor. Report of a new technique.

We assessed the effectiveness of a new suture anchor that has been designed to anchor sutures into a blind, straight hole drilled in bone. The strength of fixation in glenoid bone is 67 N for the No. 0 anchor and suture, and 82 N for the No. 2 device with suture. During 1988 and 1989, 32 patients underwent a modified Bankart reconstruction for recurrent anterior glenohumeral instability at two centers as part of a prospective study of this modified technique. There were no complications as a result of the technique. The four surgeons involved agreed that the suture anchor simplified the procedure. Seventeen patients have been reviewed, with more than 1 year followup. Ninety-four percent had good to excellent results according to the Bankart rating scale. There was one recurrent dislocation in a football player.

Adolescent↗
PubMedDate not supplied

Anterior cruciate reconstruction using a Dacron ligament prosthesis. A long-term study.

A single-center prospective study is presented on 35 patients who underwent anterior cruciate ligament reconstruction using a Dacron ligament prosthesis. All of the reconstructions were performed by the same surgeon, using the same technique. All of the patients had a history of symptomatic chronic ACL insufficiency. The mean follow-up interval for all patients was 50 months. There was an overall failure rate of 37.1% (13 patients), based on the presence of at least one of the following criteria: the presence of a pivot shift; a 2+ or greater anterior drawer or Lachman; instrumented laxity of greater than 3 mm side-to-side translation in 20 degrees of flexion at 89 N; or by arthroscopic documentation. Six of these 13 patients were documented by arthroscopy and 7 were clinical failures. There were 26 patients with only anterior cruciate ligament laxity, and 9 patients with multiple instabilities or failed previous ACL reconstruction ("salvage"). In the group with isolated anterior cruciate ligament insufficiency, the failure rate was 23% (6 patients). In the salvage group, the failure rate was 78% (7 patients). There was a significant improvement in patient performance with respect to clinical laxity, Lysholm scores, and Tegner activity levels at 2 years postoperatively. There has been a subsequent deterioration in the performance of these patients through time.

Adolescent↗