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Biomedical subjects

W E Garrett

Publications and source records attributed to W E Garrett.

At least 55 records · Page 3Linked to original sources
PubMed1988

Immediate and delayed neurorrhaphy in a rabbit model: a functional, histologic, and biochemical comparison.

The effect of timing of neurorrhaphy on neuromuscular function was studied. The extensor digitorum longus neuromuscular units of 51 rabbits were used, with repairs performed immediately, 3 weeks, 3 months, and 6 months after nerve transection. Neuromuscular function was assessed 3 months after nerve repair, as was histology, histochemistry, and muscle hydroxyproline content. Force generated by immediately repaired units was 93% of unoperated controls. All functional delayed repairs produced approximately 50% of control force. Mild endomysial and perimysial fibrosis was present in the immediate neurorrhaphy group. Fibrosis was mild to moderate in the functional delayed repairs and moderate to severe in the nonfunctional repairs. Total and regional hydroxyproline content correlated to both function and timing of nerve repair. The data demonstrate that immediate repair of peripheral nerve lacerations gives the best functional recovery in this rabbit model. If immediate repairs are not performed in the rabbit, approximately 50% to 75% of normal function can be obtained when repairs are delayed for periods of 3 weeks to 6 months.

Animals↗
PubMed1988

MR imaging of the knee: preliminary results with a 3DFT GRASS pulse sequence.

The knees of 17 patients (18 extremities) with possible meniscal, cruciate ligament, and articular cartilage abnormalities were examined with a three-dimensional Fourier transform (3DFT), gradient-refocused acquisition in a steady state (GRASS) pulse sequence. Arthroscopic confirmation was available in all cases and was the standard for comparison. Thirteen of these extremities were also examined by using a two-dimensional Fourier transform spin-echo pulse sequence with a 2000-msec repetition time and 20- and 80-msec echo time. In these 13 cases, both pulse sequences correctly identified seven of eight meniscal abnormalities. However, interpretation of the 3DFT GRASS images resulted in fewer false-positive meniscal tears (three vs six). Cruciate ligament tears were detected more readily on the 3DFT GRASS images (six vs three with two possible tears on the spin-echo images). These preliminary findings suggest that the overall accuracy of MR imaging of the knee could be improved by including 3DFT gradient-refocused pulse sequences.

Adolescent↗
PubMed1988

Injuries to the muscle-tendon unit.

Injuries to muscles are very common in clinical practice. Our understanding of the pathophysiology lags far behind that of other orthopaedic injuries. The recent increase in research and emphasis on muscle injuries and sports medicine will, it is hoped, provide new data and a more scientific basis for treatment and prevention.

Animals↗
PubMed1987

Neurorrhaphy, nerve grafting, and neurotization: a functional comparison of nerve reconstruction techniques.

This study examines the efficacy of three methods of peripheral nerve reconstruction: neurorrhaphy, nerve grafting, and neurotization. The extensor digitorum longus (EDL) neuromuscular unit of 63 New Zealand rabbits was used as the experimental model. Neuromuscular function was examined after 2, 4, and 6-month recovery periods. Variable recovery was seen after 2 months of recovery. At 6 months postoperatively, nerve grafting and neurorrhaphy were not statistically different from the unoperated control neuromuscular units. Neurotization grafting demonstrated a recovery of function of no greater than 50% at 6 months.

Animals↗
PubMed1986

Promiscuous expression of myosin in myotonic dystrophy.

The pathologic changes in myotonic dystrophy (DM) skeletal muscle biopsies have been analyzed at both the histochemical and molecular level. A histochemical stain for pretyping single fibers in conjunction with sodium dodecyl sulphate-polyacrylamide gel electrophoresis allowed biochemical differences to be pinpointed in specific histochemical fiber types. These biochemical differences can be related to histochemical changes in fiber type observed in cross-section of the DM biopsies. Such changes included specific fiber type atrophy, hypertrophy, and disproportion. The pathogenesis of DM appears to be characterized by a large increase in the number of promiscuous fibers, that is, those fibers that express both fast and slow myosins. This promiscuity, which is rare in control muscle (less than 2%), is also prevalent at high levels in some family members at risk for DM. The observed promiscuity, although probably not a primary effect of DM, appears to be linked to the histochemical changes in fiber type observed in the DM biopsies.

Adolescent↗
PubMed1985

Biomechanical characteristics of human ankle ligaments.

The purpose of this study was to define the biomechanical characteristics of the isolated, individual bone-ligament-bone complexes of the human ankle. Twenty human ankles were dissected of all soft tissues to leave only the tibia, fibula, talus, and calcaneus with their intact anterior talofibular, calcaneofibular, posterior talofibular, and deep deltoid ligaments. Specimens were mounted and tested in a Minneapolis Testing System. Protocol consisted of cyclic loading of each isolated bone-ligament-bone preparation, followed by several constant velocity load-deflection tests at varying deflection rates, followed by a final, extremely rapid load to failure test. All ligaments exhibited nonlinearity and strain rate dependence in their load-deflection data. These properties were correlated with ligament function and trauma. The anterior talofibular ligament, the most commonly injured ankle ligament, had the lowest mean maximum load of the specimens tested, whereas the deep deltoid ligament, the least frequently completely disrupted ankle ligament, had the highest load to failure.

Adult↗
PubMed1984

Recovery of skeletal muscle after laceration and repair.

Few data are available regarding structural and functional recovery of lacerated skeletal muscle after repair. This study used the extensor digitorum longus muscle of rabbits to document recovery after laceration and repair and a healing period of 12 weeks. Completely lacerated muscles recovered approximately 50% of their ability to produce tension but were able to shorten to 80% of normal. Partially lacerated muscle bellies recovered approximately 60% of their ability to produce tension and normal ability to shorten. Histologic specimens revealed that the lacerations did not cause necrosis of either segment. After the recovery period, histologic and histochemical sections revealed that the distal segment initially isolated from the nerve supply showed histologic changes of fiber atrophy and size variability, increased fibrosis, and nuclear centralization suggestive of denervation. Dense scar separated the two fragments. Data show that skeletal muscle can recover useful but not normal function after laceration and repair.

Animals↗
PubMed1983

Strains and sprains in athletes.

Although often considered "minor" injuries, strains and sprains are the leading cause of time lost from athletics due to injury. Trainers, coaches, and physicians other than orthopedic surgeons are usually called on to manage these injuries and thus need to be aware of proper methods of diagnosis and treatment. Because of the tendency of these injuries to recur, treatment must be followed by adequate rehabilitation. Muscle sprains, in particular, require strengthening exercises to prevent recurrences.

Acromioclavicular Joint↗
PubMedDate not supplied

Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group).

The purpose of this study was to gain insight into the pathophysiologic processes of severe lower-abdominal or inguinal pain in high-performance athletes. We evaluated 276 patients; 175 underwent pelvic floor repairs. Of the 157 athletes who had not undergone previous surgery, 124 (79%) participated at a professional or other highly competitive level, and 138 patients (88%) had adductor pain that accompanied the lower-abdominal or inguinal pain. More patients underwent related adductor releases during the later operative period in the series. Evaluation revealed 38 other abnormalities, including severe hip problems and malignancies. There were 152 athletes (97%) who returned to previous levels of performance. The syndrome was uncommon in women and the results were less predictable in nonathletes. A distinct syndrome of lower-abdominal/adductor pain in male athletes appears correctable by a procedure designed to strengthen the anterior pelvic floor. The location and pattern of pain and the operative success suggest the cause to be a combination of abdominal hyperextension and thigh hyperabduction, with the pivot point being the pubic symphysis. Diagnosis of "athletic pubalgia" and surgery should be limited to a select group of high-performance athletes. The consideration of other causes of groin pain in the patient is critical.

Abdominal Pain↗
PubMedDate not supplied

Comparison of soccer shin guards in preventing tibia fracture.

The goal of this study was to evaluate the effectiveness of a number of shin guards in protecting against tibia fracture in soccer players. A secondary purpose was to determine the relationship between the material and structural differences in shin guard design and the protection provided. Twenty-three commercially available shin guards were tested on a model leg containing a synthetic tibia that had been calibrated against human cadaver specimens. Each guard was categorized into one of four material types: plastic (N = 9), fiberglass (N = 6), compressed air (N = 4), and Kevlar (N = 4). The maximum combined force at the ends of the tibia, the principal strain on the posterior side of the tibia, and the contact time of the impact were measured using a drop track impact simulation. Shin guards provided significant protection from tibia fracture at all drop heights. The average guard reduced force by 11% to 17% and strain by 45% to 51% compared with the unguarded leg. At the higher drop heights, material composition and structural characteristics of the shin guards showed significant differences in protective abilities. These findings indicate that all shin guards provide some measure of protection against tibia fracture, although the level of protection may vary significantly among the different guards.

Adult↗
PubMedDate not supplied

Epidemiology of concussion in collegiate and high school football players.

Despite evolutionary changes in protective equipment, head injury remains common in football. We investigated concussion in football and associated epidemiologic issues such as 1) incidence of injury, 2) common signs and symptoms, and 3) patterns in making return-to-play decisions. We received 242 of 392 surveys (62%) that were sent to high school and collegiate certified athletic trainers at the beginning of three football seasons. Of the 17,549 football players represented, 888 (5.1%) sustained at least one concussion, and 131 (14.7% of the 888) sustained a second injury during the same season. The greatest incidence of concussion was found at the high school (5.6%) and collegiate division III (5.5%) levels, suggesting that there is an association between level of play and the proportion of players injured. Players who sustained one concussion in a season were three times more likely to sustain a second concussion in the same season compared with uninjured players. Contact with artificial turf appears to be associated with a more serious concussion than contact with natural grass. Only 8.9% of all injuries involved loss of consciousness, while 86% involved a headache. Overall, 30.8% of all players sustaining a concussion returned to participation on the same day of injury.

Adolescent↗
PubMedDate not supplied

Histochemical correlates of hamstring injuries.

This study reports the histochemical fiber type composition of the human hamstring muscles. Muscle specimens from necropsy specimens were obtained from seven locations in the hamstring, four locations in the quadriceps, and one location in the adductor magnus. The hamstring muscles are shown to have a relatively high proportion of Type II fibers. Type II fibers are more involved with exercise of higher intensity and force production and it is postulated that the hamstrings are capable of high intrinsic force production. The hamstrings are two-joint muscles and are, therefore, subject to increased stretch and force production extrinsically by motion at the hip and knee. It is proposed that high levels of tension in the hamstrings produced by intrinsic force production and extrinsic stretch may make them prone to injury in periods of intense muscular activity. This proposal is also relevant to other frequent athletic muscle injuries.

Adenosine Triphosphatases↗
PubMedDate not supplied

A biomechanical study of human lateral ankle ligaments and autogenous reconstructive grafts.

The purpose of this study was to investigate the biomechanical behavior of human anterior talofibular and calcaneofibular ligaments, as well as peroneus brevis, split peroneus brevis, and toe extensor tendon grafts. This article represents the first published data comparing the most frequently injured ankle ligaments to the most commonly used autogenous reconstructive grafts. Twenty fresh human ankles provided the bone-ligament-bone and tendon graft specimens for biomechanical testing on a Minneapolis Testing System. Protocol consisted of cyclic loading at physiologic deflections, followed by several load-deflection tests at varying velocities, followed by a final extremely rapid load to failure test. The load-deflection data for all ligaments and tendons demonstrated nonlinearity and strain rate dependence. The maximum load to failure for the anterior talofibular ligament was the lowest of all specimens tested, while its strain to failure was the highest. The loads to failure of the peroneus brevis and split peroneus tendons were significantly greater than the anterior talofibular ligament and approximately equal to the calcaneofibular ligament. Strains to failure for all tendons were significantly less than ligament strains. The high strain to failure of the anterior talofibular ligament demonstrates its physiologic function of allowing increased ankle plantar flexion-internal rotation, while its low load to failure shows its propensity for injury. The greater strength of the tendon grafts explains the success of most reconstructive procedures in reestablishing stability in chronic ankle sprains; at the same time, the data presented suggest that those surgical procedures sacrificing the entire peroneus brevis tendon are unnecessary.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Biomechanical and histological evaluation of muscle after controlled strain injury.

This study correlates force generation and healing in muscle after controlled strain injury. Right tibialis anterior (TA) muscles from 30 rabbits were strained to approximately 80% of failure while the left TA muscles served as control. Both injured and control muscles were then tested for ability to generate force. Seven animals were sacrificed immediately after testing and the muscles were examined grossly and histologically. Remaining animals were retested at 24 hours (N = 7), 48 hours (N = 8), and 7 days (N = 8). Contractile ability following injury was 70.5% of control immediately, 51.1% at 24 hours, 74.5% at 48 hours, and 92.5% at 7 days. Immediate histology showed limited distal fiber rupture and hemorrhage. By 24 hours, histology showed fiber necrosis, infiltration of inflammatory cells, edema, and hemorrhage. At 48 hours there was complete fiber breakdown and intense inflammatory cell proliferation. At 7 days inflammation was reduced and collagen fibrosis more advanced. Our findings demonstrate that injured muscle begins functional recovery by 48 hours despite inflammation and active healing. This suggests that decreasing muscle function seen clinically between 24 and 48 hours following strain injury may result from pain due to inflammation. Scarring and fibrosis seen at 7 days may explain the frequent recurrence of injury to strained muscles.

Animals↗
PubMedDate not supplied

Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure.

We compared the biomechanical properties of passive and stimulated muscle rapidly lengthened to failure in an experimental animal model. The mechanical parameters compared were force to tear, change in length to tear, site of failure, and energy absorbed by the muscle-tendon unit before failure. Paired comparisons were made between 1) muscles stimulated at 64 Hz (tetanic stimulation) and passive (no stimulation) muscles, 2) muscles stimulated at 16 Hz (wave-summated stimulation) and passive muscles, and 3) muscles stimulated at 64 Hz and at 16 Hz. Both tetanically stimulated and wave-summation contracted muscles required a greater force to tear (at 64 Hz, 12.86 N more, P less than 0.0004; and at 16 Hz, 17.79 N more, P less than 0.003) than their nonstimulated controls, while there was no statistical difference in failure force between muscles stimulated at 16 Hz and 64 Hz. The energy absorbed was statistically greater for the stimulated muscles than for the passive muscles in Groups 1 and 2 (at 64 Hz, 100% more, P less than 0.0003; and 16 Hz, 88% more, P less than 0.0002). In Group 3, the tetanically contracted muscle-tendon units absorbed 18% more energy than the wave-summated stimulated muscles (P less than 0.01). All muscles tore at the distal musculotendinous junction, and there was no difference in the length increase at tear between muscles in each group. These findings may lead to enhanced understanding of the mechanism and physiology of muscle strain injuries.

Animals↗
PubMedDate not supplied

The effect of muscle architecture on the biomechanical failure properties of skeletal muscle under passive extension.

This study investigates the biomechanical failure properties of five architecturally different skeletal muscles and examines the role muscle structure plays in the passive extension characteristics of musculotendinous units. The muscles used in this study fall into four morphologic categories: fusiform, unipennate, bipennate, and multipennate. Each muscle was pulled to failure at three different rates of strain (1, 10, and 100 cm/min). Specimens of fusiform, unipennate, and bipennate muscles were pulled from their proximal as well as distal attachments. The relationship of elongation to failure of the entire musculotendinous unit to resting muscle fiber length was examined to determine the effect of angle of pennation and fiber length on the failure properties. Our results demonstrate that all four muscle types tested show injury and rupture at the musculotendinous junction whether pulled from proximal or distal attachment, regardless of muscle structure and rate of strain. There was a statistically significant difference (P less than 0.005) in the degree of elongation to failure relative to resting muscle fiber length, with a tendency to greater elongation relative to fiber length for muscles with more pennate structure (tibialis anterior, 72.7% +/- 1.0%; extensor digitorum longus, 113.1% +/- 3.5%; rectus femoris, 225.5% +/- 3.7% elongation in percent resting fiber length).

Animals↗
PubMedDate not supplied

The role of warmup in muscular injury prevention.

This study is an attempt to provide biomechanical support for the athletic practice of warming up prior to an exercise task to reduce the incidence of injury. Tears in isometrically preconditioned (stimulated before stretching) muscle were compared to tears in control (nonstimulated) muscle by examining four parameters: 1) force and 2) change of length required to tear the muscle, 3) site of failure, and 4) length-tension deformation. The tibialis anterior (TA), the extensor digitorum longus (EDL), and flexor digitorum longus (EDL) muscles from both hindlimbs of rabbits comprised our experimental model. Isometrically preconditioned TA (P less than 0.001), EDL (P less than 0.005), and FDL (P less than 0.01) muscles required more force to fail than their contralateral controls. Preconditioned TA (P less than 0.05), EDL (P less than 0.001), and FDL (P less than 0.01) muscles also stretched to a greater length from rest before failing than their nonpreconditioned controls. The site of failure in all of the muscles was the musculotendinous junction; thus, the site of failure was not altered by condition. The length-tension deformation curves for all three muscle types showed that in every case the preconditioned muscles attained a lesser force at each given increase in length before failure, showing a relative increase in elasticity, although only the EDL showed a statistically significant difference. From our data, it may be inferred that physiologic warming (isometric preconditioning) is of benefit in preventing muscular injury by increasing the and length to failure and elasticity of the muscle-tendon unit.

Animals↗