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Shiraz A Younas

Publications and source records attributed to Shiraz A Younas.

5 recordsLinked to original sources
PubMed2005

Chronic anterior midtibial stress fractures in athletes treated with reamed intramedullary nailing.

BACKGROUND: A chronic anterior midtibial stress fracture is a serious, difficult-to-treat injury that can adversely affect an athlete's career. HYPOTHESIS: The use of a reamed intramedullary nail for a chronic anterior tibial stress fracture is a safe and effective treatment for an athlete. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Seven collegiate-level athletes with 11 chronic anterior midtibial stress fractures were treated with reamed intramedullary nailing between 1997 and 2000. These patients were followed for a mean duration of 17 months. RESULTS: The mean age of the patients at the time of stress fracture diagnosis was 17 years. Seven of the fractures occurred in male athletes, whereas 4 occurred in female athletes. All patients had failed nonoperative treatment, including rest, activity modification, use of an orthosis, and low-intensity ultrasound stimulation, for a minimum of 4 months. Patients had experienced symptoms for a mean duration of 12 months. Clinical and radiological union occurred at a mean of 2.7 and 3 months, respectively. The mean duration for return to sports after surgery was 4 months. At last follow-up, all patients had full range of motion at the knee and ankle joints and were satisfied with the results. One patient developed bursitis at the tibial nail insertion site that was resolved with a steroid injection. Another patient sustained a traumatic fracture of the distal tibia 1 year after intramedullary nailing of the tibial stress fracture. This fracture healed with nonoperative treatment. No other complications were observed. CONCLUSION: Intramedullary nailing of the tibia for chronic stress fracture has a high union rate, allows for a low complication rate, and allows for an early return to competitive sports. This procedure is an excellent alternative treatment for those fractures that have failed nonsurgical treatment.

Adolescent↗
PubMed2004

Cyclic testing of arthroscopic knot security.

PURPOSE: Arthroscopic soft tissue repairs undergo many cycles of tensioning and relaxation before significant tissue healing occurs, and knot security under cyclic loads is essential for good results after these repairs. The current study was designed to assess the security of arthroscopic knots under stepwise cyclic loading. TYPE OF STUDY: In vitro materials testing. METHODS: Three types of arthroscopic knots--sliding knots with loop reversal but without post switching (S=SxSxSxS), modified Revo knots with loop reversal and post switching twice (S=S//xSxS//xS), and the SMC knot backed by 2 throws with loop reversal and post switching (S//xS//xS)--were compared with five-throw square knots tied with an open technique. All knots were tied with No. 2 braided nonabsorbable suture around 2 aluminum rods. They were pretensioned to 10 N, and initial displacement was recorded. The knots were then cycled at 1 Hz for 9 different load levels, with 250 cycles at each level, followed by a 30-second rest period to allow recording of permanent laxity of the suture loop. The first step of cyclic loading was from 10 to 40 N, and the upper limit was increased by 10 N for each successive load level. Any knot surviving cyclical loading was pulled to failure. RESULTS: Ten knots of each configuration were tested. All 3 arthroscopic slip knots showed significantly less initial displacement compared with the square knots (0.26 mm compared with 0.45 mm, respectively, P <.005). All square and modified Revo knots reached the ninth (120 N) loading level, whereas only 6 of the SMC knots and 3 of the arthroscopic knots without post switching reached the ninth loading level. Furthermore, all square and modified Revo knots failed by suture breakage at the knot, whereas 8 arthroscopic knots without post switching and 5 SMC knots failed by slipping. In fact, 3 of the arthroscopic knots without post switching and 1 of the SMC knots failed during the initial cyclic loading from 10 to 40 N. The modified Revo knots reached 3 mm of permanent laxity at significantly higher load levels than the square knots tied with an open technique (96 N v 78 N, P <.005). The SMC knots reached 3 mm of permanent laxity at statistically similar load levels compared with the square knots, but showed considerably more variability. None of the arthroscopic knots without post switching survived the entire cyclic-loading protocol. Four square, 5 modified Revo, and 5 SMC knots that survived cyclic loading reached ultimate failure at statistically similar load levels (157, 156, and 152 N, respectively). CONCLUSIONS: Post switching and loop reversal are key to arthroscopic knot security. Arthroscopic slip knots may be tighter at the time of knot construction than openly hand-tied square knots. The modified Revo knots appear to be as durable as openly hand-tied square knots regarding resistance to loosening under cyclic loading conditions. Security of arthroscopic knots without post switching is quite variable, making these knots less reliable. The SMC knot also proved not to be as reliable as the square and modified Revo knots when cyclically tested.

Arthroscopy↗
PubMed2003

Prevalence of ganglion cysts originating from the proximal tibiofibular joint: A magnetic resonance imaging study.

PURPOSE: To determine the prevalence of proximal tibiofibular ganglion cysts in patients undergoing outpatient magnetic resonance imaging (MRI) of the knee. TYPE OF STUDY: Observational cross-sectional study. METHODS: From November 2000 to June 2001, every MRI of the knee performed at an outpatient imaging center was reviewed by a single examiner for the presence of a proximal tibiofibular ganglion cyst. In addition to the reason for ordering the MRI, demographic information on all patients was gathered. RESULTS: A total of 654 knee MRI scans were performed at the outpatient imaging center during the study period. This study population consisted of 310 men and 344 women, with an average age of 43.4 years (range, 11 to 88 years). There were 308 left and 346 right knees imaged. The most common clinical diagnosis in these 654 patients was meniscal tear (42.8%). A total of 5 patients had a proximal tibiofibular ganglion cyst detected on MRI, yielding a prevalence of 0.76% (95% confidence interval [CI] = 0.1% to 1.4%). These cysts ranged in size from 1.0 to 2.8 cm in maximum diameter. Three were found in men and 2 in women. The mean age of these patients was 47.6 years (range, 42 to 54 years). The most common preimaging diagnosis in these patients was a medial meniscal tear (in 3 of 5). CONCLUSIONS: This study is the first to provide data on the prevalence of proximal tibiofibular ganglion cysts in a population of patients with knee pain significant enough to warrant MRI. Over half of the patients found to have proximal tibiofibular ganglion cysts had no symptoms or signs attributable to them.

Adolescent↗
PubMed2003

Anatomic and radiographic analysis of arthroscopic tack placement into the anteroinferior glenoid.

Tack location within the anteroinferior aspect of the glenoid when performing simulated repairs of anteroinferior capsulolabral avulsions (Bankart lesions) was evaluated anatomically and radiographically. Arthroscopy was performed on six fresh-frozen cadaveric shoulders, and bioabsorbable tacks were placed through an accessory anteroinferior portal coming into the joint just above the subscapularis tendon using an outside-in technique. Tack location was studied after removal of all soft tissues. In addition to their position on the glenoid, the tacks were also evaluated for being partially or completely within bone. The tacks were recannulated with guide pins and anteroposterior, axillary, and en face glenoid radiographs of each specimen were obtained. This study provides quantitative data about the inferior placement limitations of the insertion angle and location of fixation devices within the anteroinferior glenoid through the anteroinferior accessory portal.

Aged↗