PubMed Health⌕ Search

Biomedical subjects

P D Fadale

Publications and source records attributed to P D Fadale.

16 recordsLinked to original sources
PubMed1996

Influence of steroid injection on ligament healing in the rat.

The effect of a single local injection of long acting corticosteroid on the healing of acute rat medial collateral ligament injuries was studied. The medial collateral ligaments of 81 adult female rats were exposed surgically. In 32 rats, the ligament was transected sharply, the overlying muscle was closed, and a human equivalent dose of dexamethasone was injected under the muscle layer, bathing the injured ligament. The identical operation with no corticosteroid injection was done in 32 additional rats: in the remaining 17 animals, the incision was closed without ligament transection or injection. The rats were divided into 3 groups of 25. Each group consisted of 10 rats that were injected, 10 that were not injected, and 5 that underwent sham operations. One group was euthanized 6 days after surgery, 1 group after 10 days, and 1 group after 20 days. Histologic evaluation and biomechanical testing were performed for each subgroup. A cellular pathologist examined a smaller group of 6 rats (2 from each group) for histologic changes 40 days after surgery. No histologic differences were noted between the injected and noninjected ligaments 6, 10, or 20 days after injury. At 40 days, the injected specimens showed a slightly more mature crimp pattern than the noninjected specimens. Mechanical testing demonstrated no significant difference in ultimate load or ultimate stress between the injected and noninjected groups. There were no detrimental effects of a single dose administration of dexamethasone on the histologic appearance or biomechanical strength of healing rat medial collateral ligaments.

Animals↗
PubMed1996

Meniscal and nonosseous ACL injuries in children and adolescents.

Meniscal and nonosseous anterior cruciate ligament (ACL) injuries are being recognized in children and adolescents more frequently. This increase appears to be the result of better diagnostic skills, newer imaging techniques, and the ever-increasing physical demands of organized youth sports. We retrospectively reviewed all cases of knee arthroscopy performed at Brown University School of Medicine from August 1991 to April 1994 in patients < or = 15 years. Of the 24 patients with suspected meniscal or nonosseous ACL injuries based on history and physical examination, 18 (75%) were confirmed at arthroscopy. Fifty-six percent of the patients with nonosseous ACL tears had coexistent meniscal lesions. Twenty-one percent of the meniscal tears were peripheral and showed evidence of spontaneous healing at time of arthroscopy. Seventeen of these patients underwent preoperative magnetic resonance imaging (MRI). Four of the five patients with lateral meniscal tears, all three of the patients with medial meniscal tears, and both of the patients with ACL tears were identified correctly by MRI. This study suggests that a history and physical examination consistent with a meniscal or nonosseous ACL injury will be confirmed by arthroscopy in up to three quarters of adolescent patients. Therefore, the use of MRI should be reserved for those patients in whom the clinical findings are still in question after a careful history and physical examination has been completed.

Adolescent↗
PubMed1995

Effects of a delayed steroid injection on ligament healing using a rabbit medial collateral ligament model.

Corticosteroids are known to inhibit collagen synthesis in vitro as well as having a deleterious effect on ligament healing when applied immediately following injury. An acute injection of betamethasone into a transected rabbit medial collateral ligament significantly impaired the biomechanical and histological properties compared to non-injected transected ligaments. Differences in mechanical, histological and biochemical properties were observed up to 3 months following injury and an acute steroid injection. The present study explored the effects of a corticosteroid (betamethasone) injection 7 days following the initial injury. Biomechanical and histomorphometric analyses were carried determine if the previously observed deleterious effects of a corticosteroid injection immediately following injury can be linked to an interference in the inflammatory phase of healing due to the presence of the corticosteroid.

Analysis of Variance↗
PubMed1995

Incidence of deep vein thrombosis after arthroscopic knee surgery: a prospective study.

Deep vein thrombosis (DVT) with subsequent pulmonary emboli (PE) is the most life-threatening complication of knee arthroscopy. Although the incidence of clinically diagnosed DVT after arthroscopy is low, clinical examination is less sensitive and specific than other diagnostic modalities for the detection of venous clot. This study used compression ultrasound to prospectively evaluate patients before and after arthroscopic surgery for the presence of DVT. Preoperatively, patients were screened for DVT risk factors. Eighty-five patients completed the study. Three asymptomatic "silent" DVTs were identified, for an incidence of 3.5%. There was no statistically significant difference between those with and without risk factors for the development of DVT.

Adolescent↗
PubMed1995

Repair of patellar tendon disruptions without hardware.

Acute repair of disruptions of the knee extensor mechanism is indicated to reestablish extensor continuity and allow for early motion. This study reviews the results of acute primary repair of patellar tendon ruptures augmented by a nonabsorbable polyester tape (Mersilene; Ethicon, Inc.) followed by immediate mobilization. Twenty-four patients with disruptions of their patellar tendons were treated using the described technique. The ruptured tendon was initially approximated using an end-to-end suture repair with no. 5 Ticron suture in a whipstitch manner. An O Vicryl suture was used to approximate the free tendon edges. A 5-mm Mersilene tape was then used in a cerclage manner to augment and protect the repair. Postsurgery, passive range of motion (ROM) was begun immediately in the knees with isolated injury or in those patients whose concomitant injuries would allow for early motion. Using clinical and radiographic criteria, follow-up evaluations of 19 patients were performed at an average of 22.4 months. In patients with isolated injuries, active ROM was from 0 degrees extension to 132 degrees flexion (contralateral knee 0-135 degrees). Two patients had prominent knots: in one, the knots were painful and were removed surgically. Six patients developed patellofemoral chondrosis. Five patients had the Mersilene tape tied with the knee in full extension, and all developed patellofemoral pain. The other repairs were done with the knee flexed to 90 degrees before tying; one patient in this group developed patellofemoral symptoms. All patients with isolated injuries have returned to employment. There were no reruptures or infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

Effects of local injection of corticosteroids on the healing of ligaments. A follow-up report.

One hundred and one skeletally mature New Zealand White rabbits were used to study the long-term effects of a single injection of corticosteroid on the biomechanical, histological, and biochemical properties of ligament-healing. Two steroid doses were studied, as previously described. The injections were made into a fascial pocket immediately after transection of the ligament. The animals were killed forty-two and eighty-four days after the injury. In our previous investigation, in which we examined the early (inflammatory and proliferative) phases of ligament-healing, the specimens that had been injected with a dose of steroids equivalent to that given to humans demonstrated significantly inferior biomechanical properties and histological organization relative to controls that had not received an injection. In the current study, we examined the later (remodeling and maturation) phases of ligament-healing and found that the tensile strength (the ultimate stress) of the specimens that had been injected with the steroids returned to a value that was equal to that of the controls that had not received an injection; however, the peak load of the specimens that had been injected with steroids remained inferior to that of the controls. This was accompanied by a lag in the histological maturation.

Animals↗
PubMed1995

Arthroscopic anatomy of the shoulder.

The importance of a thorough knowledge of regional anatomy in any surgical discipline cannot be overemphasized. This is particularly true for the orthopedist as arthroscopic procedures continue to evolve with our increased understanding of shoulder pathology and as we attempt to improve patient outcomes. Surface and bony anatomy allow the arthroscopist to infer the location of the glenohumeral joint and subacromial space. Proper portal placement allows access to these regions without risk of neurovascular, tendon, or articular injury. Glenohumeral and subacromial anatomy can be clearly seen arthroscopically with many normal variants. Knowledge of normal shoulder anatomy allows the orthopedic surgeon to safely and successfully treat pathologic conditions.

Arthroscopy↗
PubMed1993

Biomechanical evaluation of interference screw fixation in a bovine patellar bone-tendon-bone autograft complex for anterior cruciate ligament reconstruction.

A bovine model was developed for biomechanical evaluation of anterior cruciate ligament (ACL) reconstruction using patellar bone-tendon-bone (b-t-b) autograft to examine the differences in time zero fixation mechanical properties of different interference screw lengths and diameters. The surgical technique of interference screw fixation of the b-t-b complex performed clinically was reproduced in a controlled animal model. The femur-patellar tendon graft-tibia complex was tested with anterior displacement of the tibia in 30 degrees of knee flexion to allow examination of the femoral and tibial fixation properties simultaneously. The statistical model concurrently explored differences between screw length and diameter while accounting for variations between graft properties. No statistically significant differences were found between the 7- and 9-mm screws with respect to peak load or energy to failure when using a 10-mm triangular graft in a 10-mm tunnel. The 7- and 9-mm screws were superior to the 5.5-mm screws with respect to these same parameters. Based on our results, the 7-mm interference screws can be used with equal confidence as the 9-mm screw, and the 20-mm length can be similarly exchanged for 30-mm length for patellar b-t-b graft fixation.

Animals↗
PubMed1993

Tears of the anterior cruciate ligament: primary and secondary signs at MR imaging.

To investigate primary and secondary signs of anterior cruciate ligament (ACL) tear at magnetic resonance (MR) imaging, the authors retrospectively reviewed 103 MR imaging examinations obtained in 99 patients, the original interpretations of these examinations, clinical records, and arthroscopy reports. Fifty cases of arthroscopy-documented complete ACL tear were included. The primary signs of ACL tear (ie, abnormal ACL morphologic features or signal intensity) had respective sensitivity and specificity values of 96% (48 of 50 examinations) and 94% (50 of 53) on sagittal images and 92% (46 of 50) and 83% (43 of 52) on coronal images. As a secondary sign of ACL tear, bone bruise involving the lateral compartment of the knee was found in 40% (20 of 50) of cases of ACL tear and in 4% (2 of 53) of cases of normal ACL. The mean curvature of the posterior cruciate ligament was increased (0.40 vs 0.27; P < .0001) in cases of ACL tear. An abnormal appearance of the ACL on sagittal images remains the single most sensitive and specific sign of ACL tear.

Adolescent↗
PubMed1993

The basic science of anterior cruciate ligament surgery.

Surgery for ligamentous injuries of the knee continues to be one of the most common procedures performed by orthopaedists. Anterior cruciate ligament (ACL) reconstructions are addressed specifically. Basic science and laboratory research have had a dramatic effect on our understanding of the underlying pathology of the injury, and this information has been used in the development of the clinical procedures most commonly used today. The classic stages of ligament healing are contrasted with the limited potential of the ACL. Surgical options using autografts, allografts, augmentation devices, and primary repair are discussed. Present research is examined for possible future directions in the treatment of ligament injuries.

Animals↗
PubMed1989

Subacromial anatomy for the arthroscopist.

One of the most significant recent advances in arthroscopic surgery of the shoulder has been in the evaluation of the subacromial space and the anatomical structures within. Arthroscopic visualization of this area provides an unusual perspective of the anatomy that was not heretofore appreciated through open surgical techniques. This study was undertaken to attempt to define better the anatomy of the subacromial space as it pertains to arthroscopic surgery. Clinical arthroscopic evaluation of the subacromial space was correlated with gross anatomical dissections of 12 fresh cadaver shoulders and a review of the pertinent anatomical and surgical literature. By doing so, we have attempted to define better the boundaries of the subacromial space, the portions of the rotator cuff that are readily visualized arthroscopically, as well as those areas that are "blind" to arthroscopic evaluation. In addition, the anatomy of the coracoacromial ligament, the inferior surface of the acromion, and the acromioclavicular (AC) joint as viewed arthroscopically is presented with gross anatomical correlation. We feel that this information will help arthroscopists better understand the advantages as well as the limitation of arthroscopy of the subacromial space.

Acromioclavicular Joint↗
PubMedDate not supplied

Thoracic spine fracture in a football player. A case report.

Compression fractures of the thoracic spine are less common than injuries to the cervical, thoracolumbar, or lumbar regions because of the inherent stability and geometry of the thoracic spinal region. This injury may be difficult to detect acutely because of the lack of localizing symptoms. An appropriate index of suspicion should be present when examining a player experiencing acute back pain associated with localized spinal tenderness. Early recognition and appropriate treatment are needed to maximize the patient's chances of return to normal function while avoiding further injury from lack of recognition of the injury or too early return to play.

Adult↗
PubMedDate not supplied

Healing characteristics of a type I collagenous structure treated with corticosteroids.

One hundred twenty-eight skeletally mature New Zealand White rabbits were used to study the effect of a single corticosteroid injection on the biomechanical, biochemical, and histologic aspects of ligamentous healing. Two steroid dosages were used. The amount of the low-dose steroid was calculated by determining the corticosteroid concentration at which fibroblastic synthesis of collagen was inhibited in vitro. A human equivalent dose of betamethasone was used as the high-dose steroid injection. These two steroid doses and a saline control were injected around a transected medial collateral ligament. At 10 days all groups showed significantly inferior biomechanical properties relative to noninjected controls. By 3 weeks the human equivalent steroid dose group continued to demonstrate significantly inferior properties. Histologic and biochemical analyses confirmed the biomechanical results. The clinical relevance of the study was that the delivery of a human equivalent steroid dose into an acutely injured ligament significantly impairs the healing process relative to a noninjected ligament at 10 days and at 3 weeks after injury. This implies that a corticosteroid-treated injured ligament may not be able to withstand the mechanical loads of early vigorous rehabilitation.

Animals↗
PubMedDate not supplied

The effect of protective football equipment on alignment of the injured cervical spine. Radiographic analysis in a cadaveric model.

No universally accepted management protocol is available for dealing with the protective equipment worn by a neck-injured football player. The purpose of this cadaveric study was to determine the effects of the helmet and shoulder pads on the alignment of 1) the intact lower cervical spine and 2) the partially destabilized C5-6 motion segment. In Group I cadavers (N = 15), the lower cervical spine was tested in an intact condition. In Group II (N = 8), the C5-6 motion segment was tested in both an intact and a partially destabilized condition. Each cadaver was placed supine on a backboard and four lateral cervical radiographs were obtained as follows: no protective equipment, helmet only, helmet and shoulder pads, and shoulder pads only. Results for Group I showed that wearing both helmet and shoulder pads did not result in a significant change in cervical lordosis when compared with the neutral position (i.e., the no-equipment test). Cervical lordosis was significantly decreased in the helmet-only category (mean, 9.6 degrees) and significantly increased in the shoulder pads-only category (mean, 13.6 degrees). In Group II, destabilized specimens under the helmet test situation showed a significant mean increase in C5-6 forward angulation (16.5 degrees), posterior disk space height (3.8 mm), and dorsal element distraction (8.3 mm). Immobilizing the neck-injured football player with only the helmet or only the shoulder pads in place violates the principle of splinting the cervical spine in neutral alignment, according to our findings. We support the concept that removal of the helmet and shoulder pads should be an all-or-none proposition.

Aged↗