Biomedical subjects

Shane J Nho

Publications and source records attributed to Shane J Nho.

11 recordsLinked to original sources

PubMed2007

Biomechanical fixation in arthroscopic rotator cuff repair.

Rotator cuff repair remains a challenging and rapidly evolving field. Several recent studies have shown that arthroscopic repair yields functional results similar to those of mini-open and open procedures, with all of the benefits of minimally invasive surgery. However, the "best" repair construct remains relatively unknown, with wide variations in surgeon preference and conflicting evidence in the literature. The most recent developments in basic science, suture and suture anchor technology, and innovative prospects for arthroscopic rotator cuff repair are reviewed.

Arthroscopy↗

PubMed2007

Innovations in the management of displaced proximal humerus fractures.

The management of displaced proximal humerus fractures has evolved toward humeral head preservation, with treatment decisions based on careful assessment of vascular status, bone quality, fracture pattern, degree of displacement, and patient age and activity level. The AO/ASIF fracture classification is helpful in guiding treatment and in stratifying the risk for associated disruption of the humeral head blood supply. Nonsurgical treatment consists of sling immobilization. For patients requiring surgery, options include closed reduction and percutaneous fixation; transosseous suture fixation; open reduction and internal fixation, with either conventional or locking plate fixation; bone graft; and hemiarthroplasty. Proximal humerus fractures must be evaluated on an individual basis, with treatment tailored according to patient and fracture characteristics.

Algorithms↗

PubMed2006

Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes.

BACKGROUND: Medial ulnar collateral ligament insufficiency of the elbow can be a devastating injury in the throwing athlete. Reconstruction of the medial ulnar collateral ligament was initially described by Jobe and associates; good clinical results have been described after this procedure. The authors' experience with this technique raised several concerns, and thus the "docking" procedure was developed as an alternative method for medial ulnar collateral ligament reconstruction of the elbow. The early results of the docking technique were good. The authors wish to investigate the intermediate-term clinical results of this method in a large group of athletes. HYPOTHESIS: The docking technique can return overhead-throwing athletes to sport with minimal perioperative morbidity. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: During a 3-year period, 100 consecutive overhead-throwing athletes were treated with surgical reconstruction using the docking technique. The inclusion criteria were as follows: (1) a history of medial elbow pain that prevented throwing, (2) a preoperative standard noncontrast magnetic resonance image demonstrating medial ulnar collateral ligament injury, (3) clinically apparent medial ulnar collateral ligament insufficiency, and (4) an overhead-throwing athlete. At the time of surgery, all patients underwent routine arthroscopic assessment. The ulnar nerve was transposed in 22 cases. The mean follow-up was 36 months (range, 24-60 months). RESULTS: Ninety of 100 (90%) patients were able to compete at the same or a higher level than before medial ulnar collateral ligament injury for more than 12 months as noted at the follow-up interval; 7 patients were able to compete at a lower level. Only 3 patients suffered postoperative complications. CONCLUSION: The docking technique reliably returns athletes to competitive throwing with a low perioperative morbidity.

Adolescent↗

PubMed2006

Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up.

BACKGROUND: Clinical and biomechanical studies have demonstrated the increase in contact pressure and progressive deterioration of the tibiofemoral compartments that occur after partial or complete meniscectomy. Meniscus transplantation has been indicated for the symptomatic postmeniscectomy patient to alleviate symptoms and potentially prevent the progression of articular degeneration. PURPOSE: To report the early-term results after allograft meniscus transplantations from a single institution performed by a single surgeon. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Forty-four meniscus transplants in 39 patients were evaluated at minimum 2-year follow-up using the Lysholm, Tegner, International Knee Documentation Committee, Knee Injury and Osteoarthritis Outcome Score, Noyes symptom rating and sports activity, and SF-12 scoring systems; visual analog pain scales; patient satisfaction; and physical examination. Four transplants failed early, leaving 40 transplants in 36 patients for review. Patients were grouped into medial and lateral transplant groups as well as those with isolated and combined procedures. Twenty-one menisci were transplanted in isolation (52.5%), and 19 were combined with other procedures (47.5%) to address concomitant articular cartilage injury. RESULTS: Patients demonstrated statistically significant improvements in standardized outcomes surveys and visual analog pain and satisfaction scales. In 7 patients, treatment had failed at final follow-up. Overall, 77.5% of patients reported they were completely or mostly satisfied with the procedure, and 90% of patients were classified as normal or nearly normal using the International Knee Documentation Committee knee examination score at final follow-up. There were no significant differences in the medial and lateral subgroups, although the lateral subgroup did demonstrate a trend toward greater improvement. No significant differences were noted in the isolated and combined subgroups. CONCLUSION: Meniscus transplantation alone or in combination with other reconstructive procedures results in reliable improvements in knee pain and function at minimum 2-year follow-up. Longer term studies are necessary to determine if transplantation can prevent the articular degeneration associated with meniscectomy.

Adolescent↗

PubMed2006

The two-step maneuver for closed reduction of inferior glenohumeral dislocation (luxatio erecta to anterior dislocation to reduction).

The 2-step closed reduction maneuver was developed to aid in the rarely encountered inferior shoulder dislocation. The maneuver converts the humeral head from an inferior dislocation to an anterior dislocation and then reduces the humeral head into the glenoid. The operator places one hand on the shaft of the humerus and the other hand on the medial condyle. The hand on the shaft initiates an anteriorly directed force rotating the humeral head from an inferior to an anterior position. Once this is accomplished, the humerus is adducted against the body. The humerus is then external rotated reducing the humeral head into the glenoid. Two cases of inferior shoulder dislocation were closed reduced by using the described technique with minimal analgesia and without a change in the postreduction neurovascular status.

Humans↗

PubMed2006

Temporary intentional leg shortening and deformation to facilitate wound closure using the Ilizarov/Taylor spatial frame.

Infected tibial nonunions with bone loss pose an extremely challenging problem for the orthopaedic surgeon. A comprehensive approach that addresses the infection, bone quality, and overlying soft-tissue integrity must be considered for a successful outcome. Acute shortening with an Ilizarov frame has been shown to be helpful in the treatment of open tibia fractures with simultaneous bone and soft-tissue loss. Cases in which the soft-tissue defect considerably exceeds bone loss may require an Ilizarov frame along with a concomitant soft-tissue procedure; however, there are a number of potential difficulties with vascularized pedicle flaps and free tissue flaps, including anastomotic complications, partial flap necrosis, and flap failure. The technique described in this report involves acute shortening and temporary bony deformation with the Ilizarov apparatus to facilitate wound closure and does not require a concomitant soft-tissue reconstructive procedure. Once the wound is healed, osseous deformity and length are gradually corrected by distraction osteogenesis with the Ilizarov/Taylor Spatial frame.

Fractures, Open↗

PubMed2005

The effect of radiofrequency energy on nonweight-bearing areas of bone following shoulder and knee arthroscopy.

This prospective randomized clinical trial evaluated whether the use of radiofrequency energy (RFE) devices for soft-tissue ablation and coagulation cause thermal injury to bone. Fifty patients underwent one of three treatment modalities: electrocautery, monopolar RFE, or bipolar RFE. Preoperative and postoperative magnetic resonance imaging was compared to evaluate for evidence of osteonecrosis. Postoperative MRI of all patients did not reveal any osteonecrosis or subchondral edema. These findings indicate electrocautery, monopolar RFE, and bipolar RFE devices can be used safely for soft-tissue blation and hemostasis.

Acromion↗

PubMed2004

Postoperative pain management after anterior cruciate ligament reconstruction.

This study compared pain and its management in four groups of patients after anterior cruciate ligament (ACL) surgery. Group 1 consisted of primary ACL reconstruction, group 2 primary ACL reconstruction with meniscal repair, group 3 primary ACL reconstruction with meniscal resection, and group 4 revision ACL reconstruction with patellar tendon allograft. Each patient was instructed to record his or her pain level on a visual analog pain scale (VAS) prior to the procedure and for 7 days postoperatively. All patients received a prescribed narcotic to be taken orally as needed every 4-6 hours. Each patient was instructed to taper its use and supplement with non-narcotic as symptoms allowed. The VAS score for all groups peaked at postoperative day 1 and remained elevated at postoperative day 2. At postoperative day 7, the VAS scores for groups 1, 2, and 3 began to show signs of further decline, whereas group 4 persisted at postoperative day 5 levels. A general trend of decreasing narcotic use over time and increasing non-narcotic use was noted in each group; however, these findings were not statistically significant. All four groups had nearly identical mean VAS scores and corresponding narcotic use for each postoperative day despite the differing levels of complexity of surgical intervention in each group.

Adult↗

PubMed2003

Marrow stimulating technique to augment meniscus repair.

Several techniques exist to increase the rate of healing of meniscal tears after repair. We describe a simple arthroscopic technique of microfracture to the intercondylar notch. This technique can provide marrow elements to the site of meniscus repair to aid in meniscal healing at the time of repair.

Arthroscopy↗

PubMed2002

Chondral injuries.

Chondral injures are present in up to 10 to 12% of all individuals. When symptomatic, chondral lesions manifest in knee pain, swelling, and loss of function. Cartilage loss may be partial or complete, and it may affect one or multiple locations. The natural history of untreated lesions most likely results in increased disability and progression of cartilage loss. Lesions are classified according to location, depth, and size. Nonsurgical treatment modalities include oral medications, injections, bracing, or physical therapy. Surgical treatment ranges from arthroscopic debridement to implantation of autologous chondrocytes beneath a periosteal patch covering the lesion. The patient's symptoms, age, activity level, and lesion characteristics must be considered and matched with a suitable procedure.

Arthroscopy↗

PubMedDate not supplied

Comparison of ultrasonic suture welding and traditional knot tying in a rabbit rotator cuff repair model.

The purpose of this study is to evaluate ultrasonic suture welding of monofilament suture in an animal model of rotator cuff repair with biomechanical and histologic analyses. We randomly assigned 46 shoulders in 23 rabbits to 1 of 3 treatment groups: sham-operated (n = 15), knotted (n = 15), and welded (n = 16). Supraspinatus defects were surgically created and acutely repaired with suture anchors loaded with either No. 2-0 Ethibond for knotted group or No. 2-0 nylon for welded shoulders. Eighteen weeks postoperatively, all animals were killed, and the shoulders underwent either biomechanical testing or histologic analysis. The maximum stress of the sham-operated group (20.6 N/mm2) was significantly greater than that of both the knotted (10.2 N/mm2) and welded (8.3 N/mm2) groups (P < .05), but no differences were observed between the knotted and welded groups. Although some histologic changes were noted, none was considered to be significant to distinguish either group.

Animals↗