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William A Grana

Publications and source records attributed to William A Grana.

17 recordsLinked to original sources
PubMed2006

Factors associated with decreased muscle strength after anterior cruciate ligament reconstruction with hamstring tendon grafts.

PURPOSE: To identify factors associated with decreased muscle strength and activity after anterior cruciate ligament (ACL) reconstruction with semitendinosus-gracilis tendon (ST-G) grafts. TYPE OF STUDY: Retrospective review. METHODS: Eighty-five patients who underwent ACL reconstruction with ST-G grafts were evaluated at a mean of 44.4 months after surgery. Patients underwent isokinetic testing, physical examination, radiographs, instrumented laxity testing, and Lysholm, Cincinnati, and International Knee Documentation Committee (IKDC) ratings. Cartilage and meniscal pathology at surgery was reviewed. Strength group 1 (n = 30) showed greater than 20% deficits in strength; strength group 2 (n = 55) had less than 20% strength deficits. Activity group 1 (n = 60) maintained their IKDC activity level at final follow-up relative to preinjury level; activity group 2 (n = 25) decreased activity by 1 or more levels. RESULTS: With all patients combined, there was less than a 4% difference in mean hamstring and quadriceps strength between the reconstructed and contralateral legs at follow-up. Knee flexion deficits were associated with decreased hamstring strength. Subjective giving way and squatting/kneeling discomfort were associated with decreased quadriceps strength. Patients in strength group 1 were more likely to have squatting/kneeling discomfort and lower Cincinnati Function scores. Activity group 2 had a longer interval from injury to surgery and more chondromalacia at surgery. At follow-up, activity group 2 had lower subjective scores and was more likely to have pain, swelling, giving way, and flexion deficits. Activity group 2 also had greater deficits in quadriceps strength. CONCLUSIONS: Articular cartilage injury and meniscal pathology were not associated with decreased muscle strength. ACL reconstruction with ST-G grafts has a 38% incidence of squatting/kneeling pain that occurs secondary to patellofemoral crepitus, harvest site symptoms, and tibial hardware sensitivity. LEVEL OF EVIDENCE: Level IV, therapeutic, case series, no control group.

Anterior Cruciate Ligament↗
PubMed2006

A comparison of the effects of radiofrequency treatment and mechanical shaving for meniscectomy.

PURPOSE: The goal of this ex vivo pilot study was to compare radiofrequency treatment with cutting and shaving treatment of meniscal tears by use of a mechanical testing procedure and electron microscopy to establish the mechanical characteristics and qualitative appearance of meniscal tissue after the use of each of these procedures. METHODS: In this study 136 menisci were explanted and divided into 4 groups: a damaged, untreated control group; a group damaged in the same way as the control group and treated by mechanical shaving of the meniscal tear; a group damaged in a similar way and then treated by radiofrequency by use of a radiofrequency wand; and a fourth group in which plunge-cutting by use of the radiofrequency wand was used to resect the tissue, beginning at the superior surface of the meniscus in a place that corresponded to the location of the meniscal tears. The menisci were then tested for strength by applying radial tension to the tear. Electron microscopy at low and high magnification was used to evaluate the appearance of the surface of the menisci after shaving or radiofrequency treatment. RESULTS: Static mechanical testing to failure showed no significant difference between the control group and the 3 test groups. However, there was a statistically significant difference between the radiofrequency-treated groups and the mechanically shaved group at the .033 level. On fatigue testing, there was no statistically significant difference in the failure cycles, but the coefficient of variation was 8 times greater for the mechanically shaved menisci versus the radiofrequency-treated menisci. Scanning electron microscopy showed that the mechanically treated menisci had flat surfaces with clefts or fissures. The radiofrequency-treated menisci had a homogeneous appearance without clefts. CONCLUSIONS: This study showed that radiofrequency-treated damaged tissue leaves a qualitatively different surface from the mechanically treated menisci, which failed at a significantly higher load on static testing. On fatigue testing, there was greater variation in the number of cycles to failure of mechanically treated specimens versus the radiofrequency-treated menisci. CLINICAL RELEVANCE: Although recurrent meniscal tears are uncommon, they may be of value in evaluating different methods of meniscectomy. This study points out mechanical and qualitative differences between shaved and radiofrequency-treated meniscectomy.

Animals↗
PubMed2006

Assessment of musculoskeletal knowledge in primary care residents.

We assessed musculoskeletal training in primary care residency programs at the University of Arizona to determine whether formal orthopedic instruction increased musculoskeletal knowledge. The University of Pennsylvania Basic Competency Examination in Musculoskeletal Medicine was administered to 38 of 52 primary care resident volunteers. The established "passing" score to demonstrate basic competency on this test is 73.1%. The overall score of the residents tested was 56.3% (range, 21%-88%). Eight of 38 residents had a score of 73.1% or higher. The mean scores were 61.5% with orthopedic rotation and 47.3% without orthopedic rotation. The difference was statistically significant (P=.05). Pediatric residents had the least exposure to musculoskeletal training, and none of them "passed" the competency examination. Primary care providers have a larger role in managing musculoskeletal problems with current managed health care systems in the United States. Many primary care residency programs do not provide adequate training in musculoskeletal medicine. The majority of exiting primary care residents do not have basic competency in managing musculoskeletal problems. Our study results show that residents who take an orthopedic rotation have a larger knowledge base. It seems reasonable to increase primary care residents' formal education regarding musculoskeletal problems.

Arizona↗
PubMed2005

Patellofemoral pain and functional outcome after anterior cruciate ligament reconstruction: an analysis of the literature.

We reviewed the literature for reports on anterior knee pain and function after endoscopic single-incision anterior cruciate ligament reconstruction. The risk for developing a range-of-motion extension deficit of more than 3 degrees 2 years after surgery was 62% higher for patients who underwent a patellar tendon procedure than for patients who underwent a hamstring graft procedure, and the risk for having an abnormal International Knee Documentation Committee score was 9% higher. There were no statistically significant functional differences between the 2 groups. We also concluded that studies done from "high-quality randomized trials" are insufficient alone; clinicians should evaluate results from meta-analyses to determine whether data from individual studies were properly combined.

Anterior Cruciate Ligament↗
PubMed2005

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Certification↗
PubMed2003

Rings and things on upper extremity radiographs of emergency patients.

Rings, intravenous lines, and other objects on the injured upper extremities of trauma patients are frequently overlooked by radiology and emergency department (ED) personnel. This can impair proper radiologic evaluation of the injured extremity as well as negatively affect the quality of the patient's treatment. A 1-week sample of radiographs of injured upper extremities from the ED of University Medical Center (UMC), Tucson, Arizona, showed that 20% of the studies (19 of 95) contained at least one object on the injured upper extremity, but only one radiology report (1.1%) mentioned such an object. A review of 2489 upper extremity ED radiology reports from January to June 2002 showed only 47 reports (1.9%) that mentioned the presence of an overlying object. It is important to educate radiology department and ED personnel to remove upper extremity jewelry and place necessary medical devices on noninjured extremities.

Journal Article↗