Biomedical subjects
Publications and source records attributed to P M O'Meara.
A closely supervised rehabilitation program is mandatory if maximum benefit is to be derived from anterior cruciate ligament (ACL) reconstruction. The author describes a postoperative rehabilitation protocol based on kinesiologic, histologic, and biomechanical factors affecting the ACL.
The meniscus transmits load and reduces stress and compression of the articular cartilage and subchondral bone of the knee during weight bearing. Removal of even small portions of the meniscus may increase joint contact forces dramatically and lead to early degenerative changes in the knee. The goal of meniscus surgery is to preserve as much functional meniscus tissue as possible in the hope of decreasing the risk of late degenerative sequelae and still relieve the symptoms associated with the tear. The indication for repair of any meniscus tear should depend solely on the ability to technically stabilize and coaptate the tear. This article reviews the basic treatment principles of meniscal tears.
Meniscus repair surgery should involve: (1) concomitant anterior cruciate ligament (ACL) reconstruction in ACL-deficient knees, (2) rasping of the perimeniscal synovium and both tear surfaces, (3) the use of a posterior incision and popliteal retractor, (4) closely spaced, vertically placed suture repair with good coaptation of the tear surfaces, (5) the implantation of an exogenous fibrin clot in the defect, and (6) a well-supervised rehabilitation program. This article reviews the different surgical techniques for arthroscopic meniscal repair.
An open fracture is an orthopaedic emergency that can lead to devastating complications and prolonged rehabilitation. The goals of treatment are to prevent infection, achieve bone union, and restore function. The treatment should involve the use of antibiotics, repeated thorough irrigation and debridement, early fracture stabilization, early wound closure, and aggressive rehabilitation. The result of treatment is largely affected by the initial soft-tissue loss, wound contamination, fracture stability, and neurovascular status.
A comparison was made of the stability of isometric versus nonisometric anterior cruciate ligament (ACL) reconstructions when subjected to immediate postoperative continuous passive motion (CPM). Anterior cruciate ligament reconstructions were performed on 13 anatomic specimen knees using bone/patellar tendon/bone grafts. Nine ACL substitutions were considered isometric with maximum graft length changes of less than 1 mm. Four ACL substitutions were nonisometric with graft length changes of 3 mm or greater resulting from tightening in flexion. The specimens were subjected to CPM through 0 degrees-95 degrees knee flexion. Knee stability was remeasured with a knee arthrometer at three and 14 days after beginning CPM. All four nonisometric specimens had failed within three days, with increased anterior laxity of 2-9 mm in both the Lachman (20 degrees) and anterior drawer (90 degrees) positions. All nine isometric reconstructions successfully retained pre-CPM anterior stability within 1 mm after 14 days of CPM. This investigation illustrates the importance of isometric graft placement for ACL reconstruction success. Continuous passive motion does not appear to adversely affect immediate ACL-substitute integrity or fixation if graft placement is isometric (less than 1 mm of graft excursion through 0 degrees-110 degrees of knee motion). Continuous passive motion may cause graft deformation, fixation failure, or both, with resultant loss of knee stability if the graft is not isometrically positioned (greater than 3 mm of graft excursion resulting from tightening in flexion).
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Septic arthritis is a serious infection that can lead to truly devastating complications. The key to minimizing irreversible damage is rapid initiation of treatment. The best results are obtained when treatment is instituted within 1 week of the onset of symptoms. Effective treatment involves antibiotics, joint drainage and decompression, and immobilization followed by rehabilitation of the affected joint. The best choice of empiric antibiotics can be made by considering the patient's age, the synovial fluid gram stain results, and any preexisting conditions (eg, alcoholism, hypogammaglobulinemia). An episode of septic arthritis requires long-term follow up to check for relapses and to assess the outcome of any residual joint damage.
Because of the virulence of human oral flora, complications from relatively common human bites can be far more serious than those caused by animal bites. Types of infection of various kinds of human bites, the common pathways of extension of these infections and the appropriate treatment for these injuries as well as the prevention of what may be devastating and crippling sequelae are reviewed.