Biomedical subjects

Sumant G Krishnan

Publications and source records attributed to Sumant G Krishnan.

6 recordsLinked to original sources

PubMed2005

Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal?

BACKGROUND: Good functional results have been reported for arthroscopic repair of rotator cuff tears, but the rate of tendon-to-bone healing is still unknown. Our hypothesis was that arthroscopic repair of full-thickness supraspinatus tears achieves a rate of complete tendon healing equivalent to those reported in the literature with open or mini-open techniques. METHODS: Sixty-five consecutive shoulders with a chronic full-thickness supraspinatus tear were repaired arthroscopically in sixty-five patients with use of a tension-band suture technique. Patients ranged in age from twenty-nine to seventy-nine years. The average duration of follow-up was twenty-nine months. Fifty-one patients (fifty-one shoulders) had a computed tomographic arthrogram, and fourteen had a magnetic resonance imaging scan, performed between six months and three years after surgery. All patients were assessed with regard to function and the strength of the shoulder elevation. RESULTS: The rotator cuff was completely healed and watertight in forty-six (71%) of the sixty-five patients and was partially healed in three. Although the supraspinatus tendon did not heal to the tuberosity in sixteen shoulders, the size of the persistent defect was smaller than the initial tear in fifteen. Sixty-two of the sixty-five patients were satisfied with the result. The Constant score improved from an average (and standard deviation) of 51.6 +/- 10.6 points preoperatively to 83.8 +/- 10.3 points at the time of the last follow-up evaluation (p < 0.001), and the average University of California at Los Angeles score improved from 11.5 +/- 1.1 to 32.3 +/- 1.3 (p < 0.001). The average strength of the shoulder elevation was significantly better (p = 0.001) when the tendon had healed (7.3 +/- 2.9 kg) than when it had not (4.7 +/- 1.9 kg). Factors that were negatively associated with tendon healing were increasing age and associated delamination of the subscapularis or infraspinatus tendon. Only ten (43%) of twenty-three patients over the age of sixty-five years had completely healed tendons (p < 0.001). CONCLUSIONS: Arthroscopic repair of an isolated supraspinatus detachment commonly leads to complete tendon healing. The absence of healing of the repaired rotator cuff is associated with inferior strength. Patients over the age of sixty-five years (p = 0.001) and patients with associated delamination of the subscapularis and/or the infraspinatus (p = 0.02) have significantly lower rates of healing.

Adult↗

PubMed2005

Scapulothoracic arthrodesis: indications, technique, and results.

UNLABELLED: Twenty-two patients (24 shoulders) had a scapulothoracic arthrodesis for various clinical disorders including facioscapulohumeral muscular dystrophy, scapular winging from serratus anterior palsy, painful scapular crepitation, and cleidocranial dysostosis. All patients were extremely disabled with pain and loss of function because of their symptomatic scapular winging, and many of the patients had multiple previous procedures on their shoulders before the scapulothoracic arthrodesis. The surgical indication was stabilization of painful scapulothoracic articulation to provide pain relief and allow functional use of the involved arm for activities of daily living. The surgical technique involved use of a semitubular plate and wire construct along the medial border of the scapula with the use of autograft (iliac crest) or allograft bone or both between the scapula and the rib cage. Patients were immobilized postoperatively for 12 weeks. Complications occurred in more than (1/2) of the patients and included pulmonary complications, hardware failure, pseudarthrosis, and persistent pain. Postoperatively, 20 of 22 (91%) patients thought that the pain in their shoulder complex was improved and were satisfied with their functional outcome. Scapulothoracic arthrodesis can improve function and reduce pain in the shoulder complex in patients with debilitating complex scapulothoracic dysfunction. However, the high incidence of complications with this procedure is a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.

Adolescent↗

PubMed2004

A soft tissue attempt to stabilize the multiply operated glenohumeral joint with multidirectional instability.

Treating patients with multidirectional instability who have had multiple failed stabilization procedures is a challenging problem. These patients have disability from instability and pain. Final treatment may be glenohumeral narthrodesis. We report on the results of a soft tissue operation for treatment of multidirectional instability in multiply operated shoulders. Since 1994, 28 patients have had what we term the kitchen sink operation for treatment of refractory multidirectional instability. After exclusion of patients with collagen abnormality, 10 patients who had at least three previous stabilizations were identified with recalcitrant multidirectional instability. The kitchen sink operation encompasses a humeral-based inferior capsular shift, Nicola biceps tenodesis, and coracohumeral ligament and rotator interval augmentation and/or reconstruction. All patients were immobilized for 8 weeks postoperatively. Minimum clinical and radiographic followup was 2 years (range, 2-6 years). Preoperatively, all patients had incapacitating pain and instability. Postoperatively, five patients (50%) had significant improvement of pain, and nine patients (90%) had successful reduction of instability. Four of the five patients with persistent disabling pain needed glenohumeral fusions. The kitchen sink operation is a final attempt to stabilize the shoulder with multidirectional instability. This procedure reduces instability (especially inferior) associated with multidirectional instability. However, pain remains unremitting in 50% of patients, therefore a glenohumeral arthrodesis may be needed as a last option.

Adult↗

PubMed2002

Open iliac wing fracture caused by penetrating injury from a bicycle handlebar.

Bicycle accidents have been documented as one of the most common mechanisms of accidents in children. Several reports describe intra-abdominal injury secondary to bicycle handlebars. Reported injuries include liver and spleen trauma, bowel perforation, and pancreatitis. However, there are few reports of penetrating handlebar injuries. We report a case of a penetrating bicycle handlebar producing an open iliac wing fracture. A number of reports have stressed the dichotomy between the benign external appearance and the potential severity of the intra-abdominal injury after a bicycle handlebar injury. Thus, a high index of suspicion must be maintained when evaluating a child after such an injury. All patients with a significant mechanism should have a thorough and complete evaluation, including radiographs. As with all traumatic injuries, a multidisciplinary approach is often required to efficiently manage these injuries. Although uncommon, open pelvic injuries in children do occur. The principles of management are the same in children as they are in adults. All children with open pelvic fractures require emergent operative debridement and, if indicated, stabilization. Special attention should be given to ensure that the gastrointestinal and genitourinary tracts do not communicate with the fracture. With attention to these fundamental principles, severe pelvic injuries in children can be managed with few long-term sequelae.

Bicycling↗

PubMedDate not supplied

Arthroscopic biceps tenodesis: a new technique using bioabsorbable interference screw fixation.

PURPOSE: To report a new technique of arthroscopic biceps tenodesis using bioabsorbable interference screw fixation and the early results. TYPE OF STUDY: Prospective, nonrandomized study. METHODS TECHNIQUE: The principle of arthroscopic biceps tenodesis is simple: after biceps tenotomy, the tendon is exteriorized and doubled on a suture; the biceps tendon is then pulled into a humeral socket (7 or 8 mm x 25 mm) drilled at the top of the bicipital groove, and fixed using a bioabsorbable interference screw (8 or 9 mm x 25 mm) under arthroscopic control. PATIENTS: 43 patients treated with this technique between 1997 and 1999 were followed-up for at least 1 year. The technique was indicated in 3 clinical situations: (1) with arthroscopic cuff repair (3 cases), (2) in case of isolated pathology of the biceps tendon with an intact cuff (6 cases), and (3) as an alternative to biceps tenotomy in patients with massive, degenerative and irreparable cuff tears (34 cases). The biceps pathology was tenosynovitis (4 cases), prerupture (15 cases), subluxation (11 cases), and luxation (13 cases). RESULTS: The absolute Constant score improved from 43 points preoperatively to 79 points at review (P <.005). There was no loss of elbow movement and biceps strength was 90% of the strength of the other side. Two patients, operated on early in the series, presented with a rupture of the tenodesis. In both cases the bicipital tendon was very friable and the diameter of the screw proved to be insufficient (7 mm). No neurologic or vascular complications occurred. CONCLUSIONS: Arthroscopic biceps tenodesis using bioabsorbable screw fixation is technically possible and gives good clinical results. This technique can be used in cases of isolated pathologic biceps tendon or a cuff tear. A very thin, fragile, almost ruptured biceps tendon is the technical limit of this arthroscopic technique.

Absorbable Implants↗

PubMedDate not supplied

Cemented polyethylene versus uncemented metal-backed glenoid components in total shoulder arthroplasty: a prospective, double-blind, randomized study.

Thirty-nine patients (forty shoulders) with primary osteoarthritis consented to be randomized to receive either a cemented all-polyethylene glenoid component or a cementless metal-backed component at the time of total shoulder arthroplasty. Their mean age was 69 years. Preoperative and postoperative evaluations were completed at 3, 6, 12, 24, and 36 months by history, physical examination, radiographs, and Constant scoring system. The presence of periprosthetic radiolucent lines was significantly greater with polyethylene than with metal-backed glenoids (85% vs 25%, P <.01). Of 20 radiolucent lines, 12 (60%) around polyethylene glenoids were present on immediate postoperative radiographs and 25% were progressive. No significant correlation was found between the presence of radiolucent lines around polyethylene glenoids and functional results (P =.3). By contrast, periprosthetic radiolucent lines around metal-backed glenoids were rare but progressive when present. The incidence of loosening of metal-backed implants (4 cases, 20%) was significantly higher than that observed with polyethylene glenoids (0%, P <.001) and was associated with component shift and severe osteolysis. Metal-backed glenoid loosening significantly correlated with deteriorating functional results and increasing pain (P <.05). Revision surgery was required for 4 patients in the metal-backed group (P =.02), for a subscapularis tear (1 case) and metal-backed glenoid component loosening (3 cases). Computed tomography scan analysis and revision surgery revealed that preoperative posterior humeral subluxation may recur with time despite glenoid reorientation and may cause asymmetric accelerated polyethylene wear, resulting in metal-on-metal contact and severe osteolysis. Reimplantation of a stable cemented glenoid component was possible in 1 case, whereas the cavitary defect was packed with cancellous bone in the 2 other cases. At a minimum of 3 years' follow-up, the results of this study clearly show that (1) the survival rate of cementless, metal-backed glenoid components is inferior to cemented all-polyethylene components and (2) the incidence of radiolucency at the glenoid-cement interface with all-polyethylene components is high and remains a concern. The high rate of loosening, because of the absence of ingrowth and/or the accelerated polyethylene wear, has led us to abandon the use of metal-backed glenoids. Efforts must continue to improve glenoid component design and fixation.

Aged↗