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Biomedical subjects

R B Caspari

Publications and source records attributed to R B Caspari.

At least 19 recordsLinked to original sources
PubMed1997

The arthroscopic treatment of multidirectional shoulder instability: two-year results of a multiple suture technique.

Nineteen consecutive shoulders in 19 patients were treated for multidirectional shoulder instability with an arthroscopic capsular shift. Indications for the procedure included complaints of pain, instability, or both that was unresponsive to a prescribed exercise program that stressed rotator cuff and scapular stabilizer strengthening. All patients had evidence of increased joint laxity on physical examination; 17 had a 2+ or greater sulcus test and 2 had 3+ laxity both anteriorly and posteriorly. Fourteen of the 19 patients were injured during athletic activity. All surgeries were performed in an outpatient setting. All the patients were evaluated at an average of 34 months postoperatively with a minimum follow-up of 25 months. Based on the outcome scale described by Tibone and Bradley, the average postoperative score was 91 out of a possible 100 with 13 excellent, 5 good, and 1 fair result. All but 1 of the athletes returned to their previous level of performance but none were elite throwers. One patient had recurrent anterior subluxations treated with a repeat arthroscopic capsular shift and was rated as good. The patient rated as fair had no improvement in her pain after surgery. One patient complained of a painful supraclavicular suture that resolved spontaneously. There were no neurovascular complications or infections. Visualization of intra-articular pathology was enhanced with the arthroscope and aided in the diagnosis of multidirectional instability. The described technique proved safe and effective in treating multidirectional instability and enabling athletes to return to their previous level of function.

Adult↗
PubMed1997

The arthroscopic treatment of posterior shoulder instability: two-year results of a multiple suture technique.

This study was undertaken to review the results of an arthroscopic posterior capsular shift procedure. Twenty consecutive shoulders in 19 patients were treated with an arthroscopic posterior capsular shift for symptomatic posterior shoulder instability. Patients underwent the procedure if they exhibited a posterior Bankart lesion or had complaints of posterior instability and evidence of increased posterior joint laxity on physical examination and examination under anesthesia. Twelve of the 20 patients were injured during athletic activity. All surgeries were performed in an outpatient setting. Twelve of the 20 patients had posterior Bankart lesions and 10 had anterior Hill-Sachs lesions. The procedure entails releasing the posterior labroligamentous structures from the posterior glenoid and freshening the glenoid neck with a bur. A suture punch is used to place multiple absorbable monofilament stitches in the ligament complex. The stitches are brought through a supraclavicular portal and tied over the clavicle or scapular spine. All 20 shoulders were evaluated at an average of 31 months postoperatively with a minimum follow-up of 24 months. Based on the outcome scale described by Tibone and Bradley, the average postoperative score was 83 out of a possible 100, with 15 excellent, 2 good, 1 fair, and 3 poor results. There were two recurrent dislocations and three subluxations for an overall recurrence rate of 25%. All the recurrences occurred in patients with posterior Bankart lesions and four of the five had a voluntary component to their instability. There were no neurovascular complications or infections. Arthroscopic evaluation facilitated the diagnosis of posterior instability with the visualization of intra-articular pathology that is difficult to identify during open procedures. Although the majority of patients were able to return to vigorous activities, a recurrence rate of 25% is disturbing and consistent with recurrence rates for open procedures.

Adult↗
PubMed1997

Arthroscopic transglenoid multiple suture repair: 2 to 8 year results in 150 shoulders.

One hundred fifty-six arthroscopic transglenoid multiple suture repairs were performed for chronic anterior shoulder instability. In 150 shoulders (96% follow-up), the outcome with respect to recurrence of instability and the Bankart Score was determined a minimum of 2 years and a mean of 4.1 years after surgery (range, 2 to 8.2 years). During the follow-up interval, 11 shoulders (7.3%) redislocated. Fourteen other shoulders (9.3%) had at least one episode that we interpreted as recurrent subluxation. Shoulders with a Bankart lesion and younger patients had a higher probability of recurrent instability (P < .05). We concluded that this method is most effective in shoulders without a Bankart lesion and in patients older than 25 years of age (regardless of pathology).

Adult↗
PubMed1993

Arthroscopic management of rotator cuff disease.

The etiology of rotator cuff disease is controversial, but is not always secondary to cuff impingement between the humeral head and the coracoacromial arch. Rotator cuff disease, and not impingement syndrome, more accurately describes this process. The spectrum of rotator cuff disease begins with rotator cuff inflammation (Stage I) and progresses to tendinitis (Stage II) and partial or full thickness tears (Stage III). Refractory Stage II and III disease without rotator cuff tears undergoes subacromial bursectomy and acromioplasty. Partial thickness tears are debrided with an acromioplasty, bursectomy, and removal of inferior clavicular osteophytes. Full thickness tears are treated arthroscopically or open, depending on the tear size and the patient expectations. In general, tears from 0 to 5 cm in active patients undergo subacromial decompression and a mini-open repair. Low demand patients with 0 to 5 cm tears or tears greater than 5 cm are treated with subacromial decompression and rotator cuff debridement.

Acromion↗
PubMed1993

Arthroscopic manifestations of shoulder subluxation and dislocation.

Instruction in the arthroscopy of the normal and pathologic anatomy of various structures of the shoulder associated with instability syndromes is absolutely essential. Arthroscopy is not a substitute for a thorough clinical evaluation and physical examination of the shoulder, however. It provides confirmation of the clinical impression, especially in subtle cases of instability.

Arthroscopy↗
PubMed1992

Arthroscopic evaluation of allograft anterior cruciate ligament reconstruction.

In a previous study, we evaluated the findings of arthroscopic second looks at open anterior cruciate ligament reconstructions using autogenous tissue. We were disappointed at the variable quality of the ligaments and the presence of articular cartilage lesions. These findings led us to change our treatment protocol. Since 1983, we have used freeze-dried allografts for arthroscopic intraarticular ACL reconstructions. We have started protected motion in a brace immediately postoperatively and delayed weightbearing for 12-16 weeks. A total of 54 patients with at least a 2-year follow-up were evaluated subjectively (Lysholm scale) and objectively (KT 1000). Some 78% were rated good or excellent, and 87% were satisfied with their surgery. Of these 54 patients, 28 underwent subsequent surgery for hardware removal, manipulation, or removal of adhesions. All 28 had an arthroscopy, and an evaluation of ligamentous tissue and articular cartilage at the time of the second surgery. The graft resembled a normal anterior cruciate ligament in 18 patients. The graft was slightly lax in two of these patients, but their clinical examination revealed normal stability. In six patients, the intercondylar notch was covered by a sheath of dense, fibrous tissue, but the knees were stable. In two cases, there was slight fraying of the lateral aspect of the graft from impingement on the lateral femoral condyle. In two cases the graft failed. The condition of the articular cartilage was documented and compared with the condition of the articular cartilage at the time of cruciate reconstruction. In 19 cases, the articular cartilage had been normal and remained normal at the time of reevaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Anterior Cruciate Ligament↗
PubMed1992

A technique for arthroscopic subacromial decompression.

The control of bleeding and the determination of the appropriate amount of bone to resect are two common technical difficulties in performing arthroscopic subacromial decompression. We describe a technique that simplifies the procedure while providing more precise bone resection and contouring. First, the coracoacromial ligament is released by sectioning the anterior margin of the acromion. Bleeding is minimized with this technique because the coracoacromial ligament itself is not being cut, but rather its bony attachment is resected. An acromioplasty is then performed with the arthroscope in the lateral portal and the burr in the posterior portal. The shank of the cutter is rested against the posterior lip of the acromion, which acts as a fulcrum. The tip of the burr is placed at the deepest point of the concavity of the acromion. Bone is resected by sweeping the cutter from lateral to medial and progressing anteriorly while maintaining the angle of the burr, using the angle of the posterior acromion as a guide. In this way the appropriate amount of bone is automatically resected, resulting in a flat acromion which is tapered anteriorly and has a smooth transition to normal bone posteriorly.

Acromioclavicular Joint↗
PubMed1992

Isolated rupture of the popliteus with posterior tibial nerve palsy.

We report the case of a 59-year-old man with severe knee pain and inability to flex his toes or invert his plantar flexed foot after an external rotation injury to his knee. MRI showed rupture of the popliteus with a haematoma compressing the neurovascular bundle in the proximal calf, and electromyography demonstrated signs of an axonotmesis of the posterior tibial nerve. There was progressive nerve recovery over 24 weeks. Isolated rupture of the popliteus should be considered in any patient with an acute haemarthrosis, lateral tenderness and a stable knee, especially after an external rotation injury.

Hematoma↗
PubMed1989

A biochemical evaluation of the restraints to posterior shoulder dislocation.

The biomechanics of posterior dislocation of the shoulder was evaluated using nine cadaver shoulders. Each was arthroscoped, roentgenograms were obtained, and then each was dislocated in a testing device. Force displacement data was obtained during testing, and posttesting roentgenograms, arthroscopic evaluation, and subsequent open dissections were performed to evaluate the pathology created. Although instability was created in all cases with displacement of the humerus to the diameter of the humeral head, force displacement of the humerus to the diameter of the humeral head, force displacement curves did not show an inflection point, implying a continuum between subluxation and dislocation. All shoulders had posterior Bankart lesions or posterior capsular lesions, or both. Anterior pathology was not seen. Posterior instability is most likely a continuum between subluxation dislocation with progressive injury to the posterior capsule and attachments such as the labrum as the principal restraint to posterior displacement.

Aged↗
PubMed1987

Electron microscopy of CO2-laser-induced effects in human fibrocartilage.

Previous reports of effects of CO2 laser energy on human fibrocartilage suggest thermal injury extends to a depth of approximately 70 microns from the target surface with power settings of 35 W and exposure times of 0.5 seconds. The present study was undertaken to look for more subtle evidence of thermal alteration of human fibrocartilage treated with CO2 laser irradiation. Fifteen human menisci were irradiated at power settings of 10, 20, and 30 W with exposure times of 0.1 and 0.5 seconds. The specimens were immediately fixed and sectioned for electron microscopic examination. Loss of a normal cross banding, and marginal clarity of individual collagen fibers were observed in the extracellular matrix and were observed at distances up to 300 microns from the exposed tissue surface. In addition, cellular changes at similar tissue depth consisted of cell membrane invaginations, clumping of nuclear chromatin, breakdown of endoplasmic reticulum architecture, and loss of mitochondria and Golgi complexes from the cytoplasm were observed. This study demonstrates deeper penetration of a radiation that was previously appreciated by light microscopy in irradiated human fibrocartilage, although the implications with respect to contraside viability and healing potential of the tissue in vivo is not known.

Cartilage, Articular↗
PubMed1987

Current development of instrumentation for arthroscopy.

The advances in the field of arthroscopy have been keyed to the development of instrumentation. The most significant innovation has occurred in conjunction with the visualization system itself--cutting instrumentation for resection of soft tissues in bone and, more recently, in joints other than the knee. A brief history of the development of arthroscopic instrumentation is provided in this article.

Arthroscopes↗
PubMed1986

Evaluation of electrosurgical meniscectomy in rabbits.

Recently, electrosurgical cutting instruments utilizing radiofrequency energy have been designed as arthroscopic devices for cutting meniscal tissue. This study attempted to determine the in vivo gross and microscopic effects of radiofrequency energy on meniscal tissue in rabbits. Twelve adult New Zealand white rabbits (48 menisci) underwent bilateral knee arthrotomies. Ten rabbits (40 menisci) underwent partial meniscectomies in which one half of each meniscus in the longitudinal plane was removed with the electrosurgical generator. Two control rabbits underwent arthrotomy without resection of meniscal tissue. At specific time intervals, the rabbits were killed, and the menisci were removed. The gross specimens were photographed, and microscopic sections of each meniscus were fixed and stained. Specimens were evaluated to determine the cellular and vascular response to the electrosurgical cut edge of each meniscus. The microscopic specimens revealed that the radiofrequency cutting instruments produced a small degree of direct thermal damage to the cut meniscus. A tissue response producing a hypercellular dense collagen matrix was present for approximately 3 months. The spontaneous repair of tissue was complete by 6 months, and the histologic 6-month specimens could not be distinguished from the 6-month control specimens except with respect to the overall width of the specimens.

Animals↗
PubMed1986

Arthroscopic evaluation of anterior cruciate ligament reconstructions.

Fourteen patients who underwent anterior cruciate ligament (ACL) reconstruction, using fascia lata or patellar tendon, were examined arthroscopically at a mean time of 16 months following surgery. The postoperative care and rehabilitation program was standardized for all patients. Eleven of these 14 patients were recalled for a functional evaluation. Nine of these 11 patients were satisfied with the outcome of their reconstruction. Two patients complained of an occasional giving way of the knee. The arthroscopic findings were disappointing. Four patients appeared to have viable ligamentous structures in the intercondylar notch. Four patients had lax ligamentous tissue in the notch. In other cases, the notch was filled with varying degrees of amorphous scar tissue. The tissue was tested by palpation with a probe and with an anterior drawer test applied. The scar tissue did develop tension and give a firm end point to the drawer test. Other arthroscopic findings included instances of Grade II, III, and IV chondromalacia of the articular cartilage, adhesions, and capsular scarring not seen at the time of original surgery. While the patient satisfaction and functional results were generally good, we were disappointed with the arthroscopic findings. Based on the generally poor quality of the reconstructed tissue and the articular cartilage lesions, we have changed our surgical technique and postoperative regime.

Adult↗
PubMed1986

Neurovascular anatomy and elbow arthroscopy: inherent risks.

Five cadaver elbows were examined arthroscopically. Detailed dissections of superficial cutaneous nerves and of deeper neurovascular structures were carried out either before or after arthroscopic examination. Normal neurovascular anatomy and variants were defined in relation to standard portal placement. The danger of neurovascular injury is emphasized due to inappropriate portals, direction of entry, or elbow position. A safe, reliable, and reproducible technique is defined.

Arthroscopy↗
PubMed1985

The role of arthroscopy in the management of tibial plateau fractures.

The value of arthroscopy in the management of tibial plateau fractures was evaluated in a series of 29 patients from 1979 to 1984. It was determined that arthroscopy is of value in the management of these fractures; acute fractures and associated soft tissue injuries can be precisely defined, allowing for timely management decisions; based on direct arthroscopic observation, selected fractures can be reduced and stabilized, and appropriate postoperative management determined; and healed but symptomatic fractures may benefit from arthroscopic surgery.

Adolescent↗