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Biomedical subjects

S H Treacy

Publications and source records attributed to S H Treacy.

12 recordsLinked to original sources
PubMed1998

The effect of partial lateral meniscectomy in patients > or = 60 years.

To determine the benefit, if any, of meniscectomy in an older population, all patients > or = 60 years who underwent partial lateral meniscectomy were evaluated. Thirty-five patients (36 knees) were available for follow-up. The average patient age was 64.9 years. Patients were divided into two groups based on the degree of articular cartilage damage. Patients in group 1 had no damage worse than grade II and underwent arthroscopic partial meniscectomy only, while patients in Group 2 had grade III or IV damage and underwent arthroscopic debridement as well as partial meniscectomy. With an average follow-up of 36.8 months, the overall failure rate was 13.9%. Eighty-six percent of the patients reported the overall assessment of their knee as improved (94% and 80% in groups 1 and 2, respectively). While patients in group 2 tended to have less favorable results than patients in group 1, these results indicate that this procedure is warranted and that both groups benefited significantly from partial meniscectomy.

Aged↗
PubMed1997

Preliminary results of the T-fix endoscopic meniscus repair technique in an anterior cruciate ligament reconstruction population.

In a study to evaluate the preliminary results of endoscopic meniscus repair using the T-fix suture anchor (Acufex Microsurgical Inc, Mansfield, MA), 21 mensiscus repairs in 20 patients were prospectively followed-up for a minimum of 1 year. There were 11 medial and 10 lateral tears; 14 were in the peripheral third (zones 0-1) and 7 were in the central third (zone 2) of the meniscus. All patients had associated anterior cruciate ligament reconstructions. At follow-up, 4 patients were symptomatic, 3 of whom had tears that were complex and in zone 2. Radiographic follow-up showed that 3 patients had a mild progression Fairbank's change. One patient required removal of all sutures because of infection. Second-look arthroscopy on 4 cases revealed that 3 had healed and 1 had not healed. Meniscus healing can be accomplished with T-fix endoscopic technique if principals of meniscus repair are adhered to (i.e., blood supply, synovial rasping, stable fixation).

Adolescent↗
PubMed1997

Rotator interval capsule closure: an arthroscopic technique.

The importance of the rotator interval in glenohumeral instability has become increasingly apparent as anatomic studies have illustrated a significant increase in inferior and posterior translations after sectioning of the coracohumeral and superior glenohumeral ligaments. Limited reports of this lesion exist in the literature, and all such lesions have been treated with open procedures, with good clinical results. This report describes an arthroscopic technique for imbrication of the rotator interval in treating symptomatic defects and laxity in the anterosuperior shoulder capsule.

Arthroscopy↗
PubMed1997

Assessing the need for extensive supervised rehabilitation following arthroscopic ACL reconstruction.

To determine the necessity of extensive supervised therapy, we reviewed the records of 39 consecutive patients who underwent arthroscopic anterior cruciate ligament reconstruction using mid-1/3 bone-patellar tendon-bone autograft, followed by a minimal therapy program. This study group was subdivided into a noncompliant group averaging 1.7 visits over 6 months (range, 0 to 5), (subgroup I), and a minimally compliant group averaging 12 visits over 6 months (range, 5 to 24), (subgroup II). Thirty patients who underwent similar surgeries and postoperative protocols, but participated in an extensive supervised outpatient therapy program, served as controls. The control group was fully compliant and averaged 60 visits over 6 months. After 6 months, the minimally compliant study subgroup was equivalent to the fully compliant control group in Lysholm score, patient satisfaction, and return to preoperative activity level. Both of these groups fared better in all of these indices than did the noncompliant subgroup. These results suggest that extensive supervised rehabilitation does not afford a measurable advantage over a minimally supervised program of two visits monthly. Complete noncompliance, however, was associated with suboptimal outcome.

Adolescent↗
PubMed1996

Use of the T-fix suture anchor in fascial sheath reconstruction of complex meniscal tears.

The importance of preserving meniscal tissue has become increasingly apparent as studies have demonstrated early arthritic changes in the knee. To increase the healing rate of complex tears, the use of a fascial sheath to encapsulate the exogenous clot around the tear has previously been proposed. This report describes the placement of a fascial sheath over a repaired meniscal tear using a T-fix anchor suture. With the increased use of fascial sheaths in combination with an exogenous blood clot, meniscal repair rates in complex tears can be increased.

Arthroscopy↗
PubMed1996

The effect of intraoperative isometric measurement on the outcome of anterior cruciate ligament reconstruction: a clinical analysis.

The concept of isometry is based on the measurement of displacement between potential femoral and tibial anterior cruciate ligament (ACL) graft attachment sites while the knee is taken through a range of motion. To evaluate the clinical benefit of intraoperative isometry measurements in ACL reconstruction, we prospectively compared 59 patients (58% acute) in whom isometry was tested (group I) with 35 patients (77% acute) in whom isometry was not tested (group II). All patients underwent arthroscopically assisted ACL reconstruction using autogenous bone-patella tendon-bone graft and interference screw fixation, and were followed-up for a minimum of 24 months (mean, 30 months). With 88% follow-up, no significant differences were found in objective testing, which included the pivot shift test, the Lachman test, KT-1000 arthrometer measurements, and range of motion. A significant difference was found between the two groups when Lysholm scores (P = .04) and Tegner Scores (P = .02) were compared, with group II having higher scores. In addition, one of 15 visual analog scales, "gives way," showed a significant difference between the two groups (P = .01). On a scale of 1 to 10 with 1 being "no giving way" and 10 being "very frequent giving way", group I had an average of 1.68 and group II had an average of 0.58. These differences were related to the greater percentage of chronic cases in group I. Analysis of only those patients with acute injuries from each group showed no significant differences in any objective or subjective measurement. Group I had an overall failure rate of 13%, and group II had a failure rate of 6.7% (chi 2 = .848). These results indicate that, in the hands of a surgeon experienced in ACL reconstruction, intraoperative assessment of isometry has little effect on the clinical outcome.

Adolescent↗
PubMed1987

The effect of 2-[(aminopropyl)amino] ethanethiol (WR-1065) on radiation induced DNA double strand damage and repair in V79 cells.

Radiation induced DNA double strand breaks are believed to be important lesions involved in processes related to cell killing, induction of chromosome aberrations and carcinogenesis. This paper reports the effects of the radioprotector 2-[(aminopropyl)amino]ethanethiol (WR-1065) on radiation-induced DNA damage and repair in V79 cells using the neutral elution method performed at pH 7.2 or pH 9.6. WR-1065 (4 mM) was added to the culture medium either 30 minutes prior to and during irradiation with Cobalt-60 gamma rays (for dose response experiments) or during the repair times tested (for DNA rejoining experiments). The results indicate that WR-1065 is an effective protector against the formation of radiation-induced double-strand breaks in DNA as measured using a neutral elution technique at either pH. The protector reduced the strand scission factors by 1.44 and 1.77 in experiments run at pH 9.6 and pH 7.2, respectively. The kinetics of DNA double-strand rejoining were dependent upon the pH at which the neutral elution procedure was performed. Unlike the results obtained with alkaline elution, rejoining of DNA breaks was unaffected by the presence of WR-1065 at either pH.

Animals↗
PubMedDate not supplied

Clinical results of meniscus repair in patients 40 years and older.

The critical role that the meniscus plays in the knee along with the advantages of preserving as much of the meniscus as possible have both been well documented. Whenever possible, meniscus repair has become the procedure of choice for treatment of meniscal tears. However, some researchers have reported less favorable results in older patients. To determine the results of meniscus repair in older patients, patients 40 years and older who underwent arthroscopically assisted meniscus repair were prospectively followed up. Thirty-seven patients were included in the study, all of which had a minimum 2-year follow-up (average, 26.5 months). The average age of the patients at the time of the repair was 44.2 years (range, 40 to 52 years); 26 were males and 11 were females. There were 19 left knees and 18 right knees included in the study. Twenty-two patients had associated anterior cruciate ligament reconstructions. Physical examination at follow-up included swelling, joint line tenderness, locking, and McMurray testing and radiographs. Five of 37 menisci repaired (13.5%) were symptomatic at latest follow-up. All of these patients had joint line tenderness and two had a positive McMurray test. Three of these patients had repeat arthroscopy confirming that the meniscus had not healed. Because of the small number of patients with symptoms at follow-up, the authors feel that meniscus repair in patients 40 years and older is an effective treatment for peripherally located meniscus tears. With 86.5% of the patients having good clinical results, these findings are comparable with other studies with a younger population and signify that repair of peripheral tears is indicated in this age group especially in conjunction with anterior cruciate ligament reconstruction. The findings suggest that the location and meniscal tear, rather than the age of the patient, determine the potential for successful repair.

Adult↗
PubMedDate not supplied

Arthroscopic treatment of multidirectional instability.

Multidirectional instability of the shoulder, described by Neer and Foster, has been treated surgically with the inferior capsular shift procedure. The small number of reports on mid-term outcomes indicate that good to excellent results have been obtained in 75% to 100% of cases. Arthroscopic treatment of multidirectional instability has been previously described. The purpose of this study was to review the results of the arthroscopic capsular shift procedure with a minimum follow-up of 2 years. A retrospective study was performed on 25 patients who underwent an arthroscopic capsular shift performed with the transglenoid technique between January 1990 and December 1993. All patients had earlier not responded to an extensive course of physical therapy. Excluded from the study were patients who had undergone a previous arthroscopic capsular shift or any other procedure, arthroscopic or open, for the shoulder. Average patient age was 26.4 years. There were 20 male and 5 female patients. Sixteen of the affected shoulders involved the dominant extremity. All patients had a history of asymptomatic subluxation that slowly progressed to symptomatic subluxation. Eleven patients had a history of dislocation. Thirteen patients were athletes who were symptomatic in their chosen sport, whereas the other patients were symptomatic in activities of daily living. All patients were examined while they were under anesthesia and had positive results on the sulcus test in abduction with associated anterior instability, posterior instability, or both. Follow-up evaluation was performed with patient interview and examination. All 25 patients were available for follow-up, which occurred an average of 60 months (range 36 to 80 months) after operation. Three patients had episodes of instability after the operation. The average Bankart score was 95 (range of 50 to 100). All but 1 patient had regained full symmetric range of motion by follow-up. Twenty-one (88%) patients had a satisfactory result according to the Neer system. Results of treatment with the arthroscopic capsular shift procedure for multidirectional instability of the shoulder appear to be comparable to those of the open inferior capsular shift.

Adolescent↗
PubMedDate not supplied

Use of allografts in knee reconstruction: I. Basic science aspects and current status.

Allografts were first used in reconstructive surgery of the knee early in this century. Their widespread use and acceptance paralleled the development of modern tissue banks and our increased understanding of the immune system. Advantages of allogeneic tissue use include less surgical morbidity, shorter surgical time, smaller incisions, and the wider selection of graft sizes and types of tissue. Disadvantages include the risk of disease transmission, a slower biologic remodeling process, and the potential for a subclinical immune response. Allografts can be obtained in several forms, including fresh, fresh-frozen, freeze-dried, and cryopreserved, each with its own advantages and disadvantages. Graft sterility is most commonly ensured by aseptic techniques of harvest and procurement. Other methods, such as irradiation and chemical sterilization, have the potential to damage the collagen structure of the graft and must be used with care. Surgeons who use allografts should make sure that the tissue bank supplying their graft adheres to any applicable guidelines of the Food and Drug Administration and the American Association of Tissue Banks, and uses top-quality testing procedures. In addition, the physician should thoroughly understand the structural and biologic influence of the preservation technique used for that tissue.

Cartilage, Articular↗
PubMedDate not supplied

Use of allografts in knee reconstruction: II. Surgical considerations.

The first allograft used in the knee was articular cartilage. The need to use fresh grafts and the absence of proper instruments for shaping and sizing implants have prevented widespread usage of articular cartilage allografts. Patient selection is very important; young, active, well-motivated individuals with defects smaller than 4 cm2 caused by trauma or osteochondritis dissecans have the best results. Failure is evidenced by crumbling of the supporting bone and fragmentation of the graft, a process identical to that seen in osteonecrosis. The use of allografts to reconstruct knee ligaments has gained wider acceptance. The availability of high-quality tissue from modern tissue banks, excellent preservation methods, a decrease in short-term surgical morbidity, and results at 2- to 5-year follow-up that are essentially equivalent to those obtained with autogenous grafts have combined to make allografts an alternative to using the patient's own tissue. However, long-term stability results are needed for comparison with autogenous grafts. Replacing an unsalvageable meniscus with an allograft is an appealing concept, with the potential for restoring normal load distribution, lubrication, and stability in the knee. Healing of the grafts and pain reduction have been reported by several investigators, but concerns about graft shrinkage, central hypocellularity, and long-term functional survival remain.

Cartilage, Articular↗