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Omer A Ilahi

Publications and source records attributed to Omer A Ilahi.

14 recordsLinked to original sources
PubMed2007

Intraosseous innervation of the human patella: a histologic study.

BACKGROUND: The soft tissue structures surrounding the human knee joint have been the subject of extensive anatomic study. The detailed histologic findings within the bone of the human patella, however, have not been systematically studied. While the nerves supplied to the periarticular soft tissues have been very well documented, the nerves supplied to the interior of the bony patella have never been described. HYPOTHESIS: This study tests the hypothesis that the patella contains an intraosseous nerve network. Further, the authors investigate the anatomic location of these intraosseous nerves to better understand their possible clinical relevance. STUDY DESIGN: Descriptive laboratory study. METHODS: Ten matched pairs of cadaveric patellae (left and right patellae from the same individual; 20 total) were prepared for evaluation by hematoxylin and eosin staining using a technique that allows the creation of complete, large histologic sections of individual patellae. The matched specimens were dissected free of soft tissue and then sectioned using a diamond-wafering saw into 3-mm sagittal (left patella) and transverse (right patella) sections. Sections were then decalcified and whole-mounted into paraffin blocks for further sectioning using a large-format microtome. All 20 specimens were prepared for evaluation. Age at death averaged 80 years (range, 64-91). All specimens demonstrated at least grade II chondromalacia. RESULTS: Nineteen of 20 (95%) specimens demonstrated intraosseous nerves. Of 248 sections studied, 116 (47%) demonstrated intraosseous nerves, with 227 individual nerves identified. The density of intraosseous nerves was greatest in the medial and central portions of the patella, with a significant paucity identified laterally. CONCLUSION: The primary intraosseous innervation of the patella derives from a medially based neurovascular bundle. CLINICAL RELEVANCE: A better understanding of the nerves within the human bony patella may improve understanding the patho-physiology of anterior knee pain syndromes.

Aged↗
PubMed2005

Arthroscopic debridement of acute periprosthetic septic arthritis of the knee.

PURPOSE: To evaluate the efficacy of a treatment protocol including arthroscopic irrigation and debridement in resolving acute periprosthetic septic arthritis of the knee. TYPE OF STUDY: Retrospective review. METHODS: During a 1-year period, patients presenting with acute septic arthritis of the knee after total knee arthroplasty were screened for suitability for treatment with an arthroscopic debridement protocol consisting of (1) arthroscopic debridement and synovectomy with at least 12 L of antibiotic irrigant, (2) suction drainage until minimum output, (3) repeat arthroscopy for fever persisting beyond 48 hours, and (4) intravenous antibiotics for 6 weeks. Only previously well-functioning arthroplasties presenting within 7 days of symptom onset in patients without immunocompromising factors and with radiographically stable prosthetic components were selected for this treatment protocol. Five knees in 4 patients met the inclusion criteria and were examined clinically and radiographically at minimum 36-month follow-up. RESULTS: The mean follow-up interval was 41 months (range, 36 to 43 months). No knee had been revised or had revision planned for infection, although 1 had undergone tibial insert exchange for polyethylene wear. Follow-up radiographs showed no prosthetic loosening, and Knee Society scores averaged 88 (range, 75-95) in the 4 retained knees, 3 of which were subjectively thought to have returned to their preinfection level of functioning. All knees were infected with a single organism not considered highly virulent. No patients required oral suppressive antibiotics for their knees. CONCLUSIONS: Early aggressive arthroscopic debridement as part of a treatment protocol of acute periprosthetic knee septic arthritis with well-fixed and functioning implants can be an effective treatment option in selected cases. LEVEL OF EVIDENCE: Level IV study (no, or historical control group).

Aged↗
PubMed2005

Deep venous thrombosis after knee arthroscopy: a meta-analysis.

PURPOSE: To better establish the incidence of deep venous thrombosis (DVT) after knee arthroscopy without prophylaxis. TYPE OF STUDY: Meta-analysis. METHODS: A MEDLINE search was performed to find published English-language studies of DVT following knee arthroscopy. Strict inclusion criteria required any investigation included for analysis to (1) be prospective, (2) include a population not given any antithrombotic prophylaxis, (3) perform universal screening of the lower extremity venous system using either ultrasound or venography, and (4) include a discrete population limited to unilateral arthroscopic knee surgery, exclusive of ligament surgery or open procedures. The results of the venographic studies were given additional weight mathematically to account for the increased sensitivity of this imaging modality compared with ultrasound in detecting DVT in asymptomatic lower extremities. RESULTS: The unprophylaxed patient populations in the 6 studies that met inclusion criteria ranged from 64 to 184 patients, and totaled 684. The total incidence rate of DVT in each study ranged from 3.1% to 17.9%, whereas the incidence rate of proximal DVT ranged from none detected to 4.9%. The total DVT rate was not related to the method of DVT detection, whereas proximal DVT was only noted in the 2 studies using contrast venography. Combining the 6 studies yields a total DVT incidence of 9.9% (95% confidence interval, 8.1%-11.7%), and a proximal DVT incidence of 2.1% (95% confidence interval, 1.2%-3.0%). CONCLUSIONS: DVT following knee arthroscopy is a consistent finding in studies of unprophylaxed patients when routine screening using ultrasound or contrast venography is used. Current data suggest an overall DVT rate of 9.9% and a proximal DVT rate of 2.1% after knee arthroscopy without antithrombosis prophylaxis. LEVEL OF EVIDENCE: Level II, Systematic Review of Levels I and II Diagnostic Studies.

Arthroscopy↗
PubMed2004

Cyclic testing of arthroscopic knot security.

PURPOSE: Arthroscopic soft tissue repairs undergo many cycles of tensioning and relaxation before significant tissue healing occurs, and knot security under cyclic loads is essential for good results after these repairs. The current study was designed to assess the security of arthroscopic knots under stepwise cyclic loading. TYPE OF STUDY: In vitro materials testing. METHODS: Three types of arthroscopic knots--sliding knots with loop reversal but without post switching (S=SxSxSxS), modified Revo knots with loop reversal and post switching twice (S=S//xSxS//xS), and the SMC knot backed by 2 throws with loop reversal and post switching (S//xS//xS)--were compared with five-throw square knots tied with an open technique. All knots were tied with No. 2 braided nonabsorbable suture around 2 aluminum rods. They were pretensioned to 10 N, and initial displacement was recorded. The knots were then cycled at 1 Hz for 9 different load levels, with 250 cycles at each level, followed by a 30-second rest period to allow recording of permanent laxity of the suture loop. The first step of cyclic loading was from 10 to 40 N, and the upper limit was increased by 10 N for each successive load level. Any knot surviving cyclical loading was pulled to failure. RESULTS: Ten knots of each configuration were tested. All 3 arthroscopic slip knots showed significantly less initial displacement compared with the square knots (0.26 mm compared with 0.45 mm, respectively, P <.005). All square and modified Revo knots reached the ninth (120 N) loading level, whereas only 6 of the SMC knots and 3 of the arthroscopic knots without post switching reached the ninth loading level. Furthermore, all square and modified Revo knots failed by suture breakage at the knot, whereas 8 arthroscopic knots without post switching and 5 SMC knots failed by slipping. In fact, 3 of the arthroscopic knots without post switching and 1 of the SMC knots failed during the initial cyclic loading from 10 to 40 N. The modified Revo knots reached 3 mm of permanent laxity at significantly higher load levels than the square knots tied with an open technique (96 N v 78 N, P <.005). The SMC knots reached 3 mm of permanent laxity at statistically similar load levels compared with the square knots, but showed considerably more variability. None of the arthroscopic knots without post switching survived the entire cyclic-loading protocol. Four square, 5 modified Revo, and 5 SMC knots that survived cyclic loading reached ultimate failure at statistically similar load levels (157, 156, and 152 N, respectively). CONCLUSIONS: Post switching and loop reversal are key to arthroscopic knot security. Arthroscopic slip knots may be tighter at the time of knot construction than openly hand-tied square knots. The modified Revo knots appear to be as durable as openly hand-tied square knots regarding resistance to loosening under cyclic loading conditions. Security of arthroscopic knots without post switching is quite variable, making these knots less reliable. The SMC knot also proved not to be as reliable as the square and modified Revo knots when cyclically tested.

Arthroscopy↗
PubMed2004

Glenoid suture anchor fixation strength: Effect of insertion angle.

PURPOSE: The purpose of this study was to determine the effect of varying insertion angles on the fixation strength of screw-in devices placed in the glenoid rim. Type of study Cadaveric biomechanical analysis. METHODS: Eighteen cadaveric glenoids had 3.0-mm cannulated screws inserted for a depth of 10 mm in all 4 quadrants: anterior superior (AS), anterior inferior (AI), posterior superior (PS), posterior inferior (PI). Screws were inserted along the orthogonal to the glenoid rim at the point of insertion or at angles that deviated from this vector by 20 degrees and 40 degrees. Load to failure was performed at 10 mm/s along the orthogonal to the point of insertion. RESULTS: For screws inserted orthogonal to the glenoid rim, the average load to failure was highest for the PS quadrant (733 +/- 369 N) and lowest for the AI quadrant (272 +/- 69 N). The AS and PI quadrants showed intermediate values (549 +/- 334 N and 484 +/- 141 N, respectively). Deviation from orthogonal correlated with decreased fixation strength. This decrease was statistically significant in the AS and PI quadrants, with deviation of 40 degrees, and in the AI quadrant, with deviation of 20 degrees, as well as 40 degrees. Conclusions Insertion angles for screw-in fixation devices should be orthogonal to the glenoid rim at the point of insertion to maximize strength. Deviation of 40 degrees from orthogonal compromises fixation in most quadrants and deviation as little as 20 degrees can compromise fixation in the AI quadrant. CLINICAL RELEVANCE: To maximize strength of labral reattachment to the bony glenoid, screw-in type fixation devices should be inserted as orthogonal to the glenoid rim as possible. This is especially true for Bankart repairs, because device pullout occurs at significantly lower loads in the anteroinferior quadrant compared with the other 3 quadrants. Deviating as little as 20 degrees further decreases fixation strength significantly.

Aged↗
PubMed2003

Internal impingement in the etiology of rotator cuff tendinosis revisited.

PURPOSE: The theory of internal impingement holds that, in overhead athletes, repeated contact between the undersurface of the rotator cuff and the posterosuperior glenoid rim leads to articular-sided partial-thickness rotator cuff tears and superior labral lesions. However, we have noted this same constellation of lesions in our general patient population. These recreational athletic patients do not routinely assume the position of extreme abduction and external rotation, and thus are unlikely to experience significant internal impingement forces. The goal of this study was to document the prevalence of superior labral lesions in patients being treated for partial-thickness undersurface rotator cuff tears. TYPE OF STUDY: Retrospective case series. METHODS: We retrospectively reviewed the records of 75 shoulders arthroscopically treated for partial-thickness articular-sided rotator cuff tears. With the exception of one professional tennis player, no patients were playing sports at a professional or major college level. No professional or collegiate throwing athletes were included. The prevalence of these lesions and their association with recreational athletics was noted. RESULTS: We found that 55 of 75 (73.3%) shoulders with articular-sided partial-thickness rotator cuff tears also had superior labral lesions. A statistically significant increased prevalence of superior labral lesions in the dominant shoulder was seen (P =.03). In addition, our patients who engaged in overhand throwing had significantly fewer superior labral lesions in the dominant shoulders than did nonthrowers (P =.017). CONCLUSIONS: The "kissing lesions" of undersurface rotator cuff tears and posterosuperior labral damage may be explained by mechanisms other than "internal impingement."

Adolescent↗
PubMed2003

Prevalence of ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study.

PURPOSE: To determine the prevalence of proximal tibiofibular ganglion cysts in patients undergoing outpatient magnetic resonance imaging (MRI) of the knee. TYPE OF STUDY: Observational cross-sectional study. METHODS: From November 2000 to June 2001, every MRI of the knee performed at an outpatient imaging center was reviewed by a single examiner for the presence of a proximal tibiofibular ganglion cyst. In addition to the reason for ordering the MRI, demographic information on all patients was gathered. RESULTS: A total of 654 knee MRI scans were performed at the outpatient imaging center during the study period. This study population consisted of 310 men and 344 women, with an average age of 43.4 years (range, 11 to 88 years). There were 308 left and 346 right knees imaged. The most common clinical diagnosis in these 654 patients was meniscal tear (42.8%). A total of 5 patients had a proximal tibiofibular ganglion cyst detected on MRI, yielding a prevalence of 0.76% (95% confidence interval [CI] = 0.1% to 1.4%). These cysts ranged in size from 1.0 to 2.8 cm in maximum diameter. Three were found in men and 2 in women. The mean age of these patients was 47.6 years (range, 42 to 54 years). The most common preimaging diagnosis in these patients was a medial meniscal tear (in 3 of 5). CONCLUSIONS: This study is the first to provide data on the prevalence of proximal tibiofibular ganglion cysts in a population of patients with knee pain significant enough to warrant MRI. Over half of the patients found to have proximal tibiofibular ganglion cysts had no symptoms or signs attributable to them.

Adolescent↗
PubMed2003

Quadriceps tendon impingement from a femoral interference screw.

Interference screws are a popular method of securing tendon grafts during anterior cruciate ligament reconstruction. This report describes the case of a patient with anterior knee pain, limited flexion, and partial-thickness tear of the quadriceps tendon caused by a protruding femoral interference screw following hamstring tendon anterior cruciate ligament reconstruction. The interference screw was radiolucent, requiring magnetic resonance imaging to visualize its location. Removal of the protruding portion of the interference screw and debridement of the partial-thickness tear of the quadriceps tendon led to rapid restoration of knee flexion and alleviation of the anterior knee pain.

Adult↗
PubMed2003

Interobserver variability of the Insall-Salvati ratio.

Thirty six patients presenting with knee pain were enrolled in a prospective study to assess the variability of the radiographic measurement of patellar height by the traditional and modified Insall-Salvati ratios. The traditional and modified Insall-Salvati ratios were measured from a lateral knee radiograph using a standard hand-held ruler by four physicians in varying order. The observers were in agreement in classifying the radiographs in two thirds of the cases When the traditional method was used but in less than one-half of the cases when the modified ratio was used. The source of the difference in the two ratios is a greater variability in measuring the distance from the inferior margin of the articular surface to the tibial tubercle.

Adult↗
PubMed2003

Anatomic and radiographic analysis of arthroscopic tack placement into the anteroinferior glenoid.

Tack location within the anteroinferior aspect of the glenoid when performing simulated repairs of anteroinferior capsulolabral avulsions (Bankart lesions) was evaluated anatomically and radiographically. Arthroscopy was performed on six fresh-frozen cadaveric shoulders, and bioabsorbable tacks were placed through an accessory anteroinferior portal coming into the joint just above the subscapularis tendon using an outside-in technique. Tack location was studied after removal of all soft tissues. In addition to their position on the glenoid, the tacks were also evaluated for being partially or completely within bone. The tacks were recannulated with guide pins and anteroposterior, axillary, and en face glenoid radiographs of each specimen were obtained. This study provides quantitative data about the inferior placement limitations of the insertion angle and location of fixation devices within the anteroinferior glenoid through the anteroinferior accessory portal.

Aged↗
PubMed2002

Anatomic and radiographic analysis of arthroscopic tack placement into the superior glenoid.

PURPOSE: To anatomically and radiographically describe tack location within the anterosuperior (AS) and posterosuperior (PS) aspects of the glenoid when performing simulated repairs of type II SLAP lesions. TYPE OF STUDY: Cadaveric anatomic and radiographic analysis. METHODS: Arthroscopy was performed on 7 fresh-frozen cadaveric shoulders and bioabsorbable tacks were placed in the AS and PS aspects of the glenoid to simulate repair of a type II SLAP lesion. The PS tack was placed through an accessory portal 1 cm lateral and 1 cm anterior to the posterolateral corner of the acromion. Dissection was then performed, and the incision made in the rotator cuff when creating the posterolateral accessory portal (PLAP) was identified and measured. Tack location within the glenoid was visually studied after removal of all soft tissues and recorded as being either completely within bone or partially within bone. The tacks were recannulated with guide pins and 3 radiographs were then taken of each specimen (true anteroposterior, axillary, and en face glenoid views) and angles of entry determined. In addition, the angle of deviation from the orthogonal at the point of entry of each tack was measured on the en face glenoid view. RESULTS: The average incision made in the rotator cuff for creation of the PLAP measured 10.3 mm in maximum diameter. In 6 of 7 specimens, this incision was made through muscle and not tendon. Seven of 7 AS tacks were completely within bone, and only 5 of 7 PS tacks remained completely within bone. On the true anteroposterior view, the average angle of entry from the vertical for the AS tack was 64 degrees. For the PS tack, this angle measured 86 degrees. On the axillary view, the angle of placement from the coronal averaged 22 degrees for the AS tack and 42 degrees for the PS tack. For the en face glenoid view, the angle of entry from the vertical was 34 degrees for the AS tack and 93 degrees for the PS tack. Lastly, the angle of deviation from the orthogonal on the en face glenoid view was 12 degrees and 35 degrees for the AS and PS tacks, respectively. This difference was statistically significant at P <.001. CONCLUSIONS: This study provides quantitative data on the angle of placement and location of tacks within the superior glenoid when performing repairs of type II SLAP lesions. It also shows the PLAP to be a safe portal for the placement of devices into the posterosuperior aspect of the glenoid. Furthermore, the data show the AS tack to be more reliably placed than the PS tack.

Absorbable Implants↗
PubMed2002

Variants of the anterosuperior glenoid labrum and associated pathology.

PURPOSE: The study goal was to determine the incidence of the sublabral foramen and the Buford complex and to assess their association with superior labral pathology. TYPE OF STUDY: Prospective case series. METHODS: The surgical findings of 108 consecutive shoulder arthroscopies performed by the same surgeon were collected, along with patient demographics. During surgery, special attention was directed towards the anterosuperior labrum. The presence of a sublabral foramen or Buford complex was correlated with the morphology of the superior, middle, and inferior glenohumeral ligaments and the presence of superior labral pathology. RESULTS: A total of 20 shoulders (18.5%) were found to have a sublabral foramen, and 7 (6.5%) had the Buford complex. The incidence of significant SLAP lesions was significantly higher in these 27 shoulders than in the rest of the study population (56% v 12%, P <.005). A thick, cord-like middle glenohumeral ligament was significantly associated with the presence of a sublabral foramen (P <.005). CONCLUSIONS: The sublabral foramen and the Buford complex may be more common than previously thought. Furthermore, these variants of anterosuperior glenoid labrum anatomy appear to be associated with superior labral pathology. The presence of a cord-like middle glenohumeral ligament is associated with a sublabral foramen variant as well as the Buford complex.

Adolescent↗