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At least 1,225 records · Page 68Linked to original sources
PubMed2005

Silicone versus collagen plugs for treating dry eye: results of a prospective randomized trial including lacrimal scintigraphy.

PURPOSE: To compare the short-term efficacy of collagen and silicone plugs for treating dry eye using quantitative lacrimal scintigraphy. DESIGN: Prospective randomized clinical trial. METHODS: In this institutional study, 24 dry eye patients were evaluated in two groups: group I (n = 22 eyes) received collagen plugs and group II (n = 26 eyes) received silicone plugs. Comparisons were made with normal control subjects (n = 22 eyes). Data for the Schirmer I test, tear break-up time, and ocular surface staining with rose bengal dye were recorded before and after punctal occlusion. Lacrimal scintigraphy was performed at each time point, and the time to half maximum activity on the ocular surface (T(1/2)), and the percentage retention of activity on the ocular surface at the end of the dynamic study (RI) were recorded. RESULTS: In both patient groups, Schirmer I results, tear break-up times, and rose bengal staining scores improved significantly after plug insertion. Mean T(1/2) values and RI values increased significantly in both groups (P < .0001 for both). The differences for these values between groups I and II was statistically insignificant (P > .05). CONCLUSIONS: Collagen and silicone plugs both resulted in significant increases in aqueous tear volume, half-life of nuclear material on the ocular surface, and percentage of nuclear material retention. The groups' post-insertion values for all parameters were similar. These results suggest that these two plug types have similar efficacy as treatments for dry eye in the short term. Further studies evaluating long-term results are required.

Absorbable Implants↗
PubMed2006

One-year postoperative stability of LeFort I osteotomies with biodegradable fixation: a retrospective analysis of skeletal relapse.

INTRODUCTION: The purpose of this retrospective analysis was to determine the magnitude of postoperative skeletal relapse of a maxillary LeFort I osteotomy procedure performed with fixation plates and screws composed of a biodegradable copolymer (poly-L lactic and poly-L glycolic acid). METHODS: Twenty-three consecutively treated subjects, aged 19 to 39, were diagnosed with excess vertical maxillary height or anteroposterior maxillary deficiency and treated with LeFort I impaction or advancement osteotomies. Lateral cephalometric radiographs were measured and compared for the absolute magnitude of skeletal relapse from pretreatment to immediately postoperative to 1 year after surgery. RESULTS: Correlation analysis determined that a positive relationship existed between the magnitude of the surgical movement and the magnitude of postoperative relapse. The greatest relapse for any subject in any direction was 0.940 mm (anterior nasal spine to nasion-perpendicular). The greatest average relapses were 0.249 mm horizontally (anterior nasal spine to Frankfort horizontal) and 0.141 mm vertically (M-point Frankfort horizontal). CONCLUSIONS: The most significant contribution of this study to surgical stability literature is reporting the absolute magnitudes of postoperative relapse over a 1-year period of observation. Consistent with previously published reports on postoperative stability, greater magnitudes of relapse were noted for larger surgical movements, yet the absolute values of postoperative relapse with biodegradable copolymers was clinically negligible. Biodegradable copolymers can provide excellent postoperative stability for superior and anterior maxillary surgical repositioning that appears to rival published stability measurements for rigid internal metallic fixation.

Absorbable Implants↗
PubMed2003

Biomechanical testing of hamstring graft tibial tunnel fixation with bioabsorbable interference screws.

PURPOSE: This study evaluated the failure mode, maximum load at failure, displacement at failure, and stiffness differences of quadrupled hamstring graft-tibial tunnel fixation using 28-mm, tapered 35-mm, or bicortical 17- and 20-mm bioabsorbable interference screws (Arthrex, Naples, FL). TYPE OF STUDY: Biomechanical study. METHODS: Nine matched pairs (18 specimens) of young cadaver tibias (mean bone mineral density [BMD] = 0.847 g/cm2, range, 0.689 to 1.11 g/cm2) were divided into 3 groups of 6 specimens. Kruskal Wallis analysis of variance and Mann-Whitney U tests post hoc comparisons were used to assess group differences (P <.05). RESULTS: Maximum load at failure for the 28-mm screw was 488.2 +/- 197 N, with a displacement of 18.4 +/- 7.5 mm and a stiffness modulus of 38.9 +/- 7.0 N/mm. Maximum load at failure for the tapered 35-mm screw was 844.8 +/- 121.4 N, with a displacement of 15.3 +/- 1.6 mm and a stiffness modulus of 70.5 +/- 21.1 N/mm. Maximum load at failure for bicortical screw fixation was 543.7 +/- 266.5 N, with a displacement of 17.7 +/- 6.6 mm and a stiffness modulus of 57.7 +/- 14.9 N/mm. Fixation using the tapered 35-mm screw displayed greater maximum load at failure than either 28-mm screw fixation (P =.015) or bicortical screw fixation (P =.037). Significant differences were not evident for displacement. Both tapered 35-mm (P =.016) and bicortical screw (P =.026) fixation displayed greater stiffness than 28-mm screw fixation. All constructs failed by pullout. CONCLUSIONS: Fixation using a single tapered 35-mm screw displayed increased maximum load at failure compared with the 28-mm screw or bicortical fixation. Both the tapered 35-mm screw and bicortical fixation showed greater stiffness than fixation using a 28-mm screw. Use of a single 35-mm screw for quadrupled hamstring graft-tibial tunnel fixation may be preferred for patients with poor tibial BMD.

Absorbable Implants↗
PubMed2003

Transcutaneous migration of a tibial bioabsorbable interference screw after anterior cruciate ligament reconstruction.

We present a case of a poly-L-lactic acid (PLLA) tibial bioabsorbable interference screw disengaging and migrating transcutaneously 12 months after successful anterior cruciate ligament reconstruction with quadrupled hamstrings autograft. No graft insufficiency or joint inflammatory reaction was present. The screw was removed surgically with no evidence of resorption. The graft was well incorporated into the tibial tunnel. The patient recovered without difficulties and returned to her preinjury level of activity. To our knowledge, this is the first case reported of disengagement and extrusion of a PLLA bioabsorbable interference screw.

Absorbable Implants↗
PubMed2003

Primary stability of bone-patellar tendon-bone graft fixation with biodegradable pins.

PURPOSE: We evaluated the initial bone-patellar tendon-bone (BPTB) graft fixation strength of biodegradable pins compared with interference screws in anterior cruciate ligament reconstruction using bovine knees. TYPE OF STUDY: Biomechanical in vitro study. METHODS: Ten BPTB grafts from human donors fixed with 2 biodegradable 2.7-mm pins (Rigid Fix; Ethicon, Mitek Division, Norderstedt, Germany) crossing the bone block perpendicular and 10 BPTB grafts fixed with conventional biodegradable interference screws (Absolute Absorbable Interference Screw; Innovasive Devices, Marlborough, MA) underwent ultimate single-cycle failure loading at a rate of 200 mm/min. The grafts were fixed to bovine tibia to simulate young human femoral bone density. Failure mode, displacement before failure, and ultimate failure load were tested with a testing machine. The pullout force was in line with the bone tunnel to simulate a worst case scenario. RESULTS: The failure mode for cross pins was either fracture of the bone block (5 specimens) or fracture of the articular pin (5 specimens). The failure mode for interference screws was slippage past the screw in all specimens. In the single cycle loading test, the mean yield load for the biodegradable pins was 400.2 (+/- 122.4) N, maximum load, 524.6 (+/- 136.6) N, with a mean stiffness of 155.2 (+/- 32.4) N/mm. The yield load at failure for the interference screw was 402.7 (+/- 143.9) N, maximum load 515.7 (+/- 168.5) N with a mean stiffness of 168 (+/- 42) N/mm. CONCLUSIONS: Fixation of a BPTB graft with 2 biodegradable 2.7-mm pins (Rigid Fix) leads to primary stability that is comparable to fixation with biodegradable interference screws.

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PubMed2003

Mosaicplasty for the treatment of femoral head defect after incorrect resorbable screw insertion.

Articular cartilage lesions and osteochondral defects remain a difficult problem for the patient and physician. A variety of procedures and treatments have been proposed to lessen symptoms and restore the articular surface. The knee joint has been the focus of the vast majority of these cartilage restoration procedures. Osteochondral defects of the proximal femur are significantly less common, and their management remains poorly defined. This article reports the case of a young man with a deep osteochondral defect of the femoral head caused by penetrated resorbable screw after internal fixation of a displaced large single fragment of the posterior acetabular rim and subsequent treatment using mosaicplasty.

Absorbable Implants↗
PubMed2004

Hamstring anterior cruciate ligament reconstruction: a comparison of bioabsorbable interference screw and endobutton-post fixation.

PURPOSE: The purpose of this study was to evaluate hamstring anterior cruciate ligament (ACL) reconstruction using aperture fixation with bioabsorbable interference screw (BIS) and distant fixation using EndoButton (Smith & Nephew, Andover, MA) and screw-post (ENDO). TYPE OF STUDY: Prospective nonrandomized clinical outcome study. METHODS: Two groups of 15 patients who underwent autogenous hamstring ACL reconstruction with a minimum of 2 years' follow-up evaluation (mean 35 months) were included in the study. The BIS group underwent poly-L-lactic acid interference screw fixation at both femoral and tibial tunnels and the ENDO group underwent EndoButton fixation on the femoral side and screw-post fixation on the tibial side. Clinical evaluation included International Knee Documentation Committee (IKDC) and arthrometer measurements. Tunnel enlargement, screw integrity, graft integrity, and graft-tunnel interface were evaluated using radiographs and magnetic resonance imaging. Statistical analyses were performed using the Student t test, with significance set at 0.05. RESULTS: All patients in both groups had functionally normal or near-normal IKDC scores. The average IKDC subjective knee form scores were 85 +/- 11 versus 81 +/- 17 (BIS v ENDO) and side-to-side KT differences were 3.2 +/- 2.6 mm versus 2.4 +/- 1.8 mm (P >.05). For both groups, tunnel enlargement was present on radiographs at both femoral and tibial sides (36% to 77%). Tunnel enlargement was more significant at the femoral tunnels (53% to 77%) than the tibial tunnels (36% to 42%). In the BIS group, magnetic resonance imaging revealed 9 partially degraded screws and 2 intact screws on the femoral side. On the tibial side, 4 partially degraded and 10 intact screws were seen. For both groups, the grafts have partial or complete incorporation at all tunnels. Tunnel enlargement measured on radiographs correlate well with measurements on magnetic resonance images. CONCLUSIONS: Our results showed that rigid aperture fixation using BIS did not lead to significant differences in clinical outcome when compared with distant fixation using ENDO at 24 to 40 months follow-up evaluation. Significant tunnel enlargement was present in both groups, more pronounced on the femoral side. Magnetic resonance imaging findings showed that BIS were not degraded even at 2 to 4 years after surgery. LEVEL OF EVIDENCE: Level II.

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PubMed2004

Arthroscopic biceps tenodesis using a bioabsorbable interference screw.

Arthroscopic biceps tenodesis has rarely been reported. The purpose of this study is to present our technique of arthroscopic biceps tenodesis using the Bio-Tenodesis (Arthrex, Naples, FL) screw system. This system uses a uniquely designed screwdriver that allows manipulation of the biceps tendon subacromially and intra-articularly, facilitates placement and maintenance of the biceps tendon at the base of the bone socket during interference screw insertion, and assures an adequate bone-tendon-screw interface.

Absorbable Implants↗
PubMed2004

Arthroscopic biceps tenodesis.

Arthroscopic biceps tenodesis is indicated for the treatment of severe biceps tendonopathy, partial- or full-thickness tendon tears, or biceps instability typically associated with rotator cuff tear, although there has been considerable debate on tenotomy versus tenodesis. We advocate tenodesis, for the following reasons: to re-establish the resting muscle length so as to avoid scaring and spasm, to allow biceps use for complex elbow motion, and to avoid cosmetic defects in cases in which deformity can sometimes equal disability. This technical note provides illustrations and detailed descriptions of our arthroscopic tenodesis technique using a Arthrex (Naples, FL) biotenodesis system.

Absorbable Implants↗
PubMed2004

Meniscal repair devices: a clinical and biomechanical literature review.

PURPOSE: The development of new approaches to arthroscopic meniscal repair has spurred the concomitant publication of studies reviewing their use and biomechanical properties. The purpose of this article is to review both the devices and the literature surrounding their clinical and biomechanical properties. TYPE OF STUDY: Literature review. METHODS: Studies were initially gathered using a MEDLINE search, and additional information was found through cross references. We evaluate a series of studies comparing sutures, suture anchors, screws, staples, and a variety of other devices in terms of initial fixation strength, degradation profile, performance under cyclical loading, and clinical success. RESULTS: In the traditional suture studies, vertical sutures are clearly superior to both horizontal sutures and knot-end techniques in terms of initial fixation strength and performance under cyclical loading. Unfortunately, multidevice studies have been less consistent and less conclusive. the Linvatec Biostinger, Smith & Nephew T-fix, and Bionx Meniscus Arrow have separately been shown to have superior initial fixation strength on par with suture techniques. After cyclical loading, horizontal sutures, vertical sutures, 16-mm Arrows, 13-mm Arrows, and the Smith & Nephew T-fix generally show higher fixation strengths. Only the Bionx Arrow, Linvatec Biostinger, and Clearfix Screw have been shown to retain their initial fixation strengths through four months of hydrolysis time. CONCLUSIONS: Data suggest that the biomechanical performance of some devices is nearly equivalent to current suture techniques. Ultimately, the combination of a simplified surgical technique, high clinical healing rates (75%-92%), and relatively minor complications makes these devices attractive for properly indicated meniscal tears.

Absorbable Implants↗
PubMed2004

Surgical treatment of anterior cruciate ligament injuries in adolescents using double-looped semitendinosus and gracilis tendons: supraepiphysary femoral and tibial fixation.

Surgical treatment of anterior cruciate ligament injuries in adolescents continues to be controversial even though the advocates of surgical treatment are growing relative to those who prefer conservative treatment. Those using surgical techniques must respect the epiphysary cartilages and try to reproduce the same results that are achieved in adults. We report on a technique analogous to that applied to adults, using doubled hamstring tendons that are fixed with 2 transverse femoral and tibial bioabsorbable cross pins without interfering with the growth cartilage.

Absorbable Implants↗
PubMed2004

Insertion torque pullout strength relationship of soft tissue tendon graft tibia tunnel fixation with a bioabsorbable interference screw.

PURPOSE: The purpose of this study was to evaluate the relationship between insertion torque and the biomechanical characteristics of soft tissue tendon graft tibia fixation with a bioabsorbable interference screw. TYPE OF STUDY: Biomechanical study. METHODS: Doubled tibialis anterior allografts (n = 20, length = 100 mm, diameter = 9 mm) prepared for anterior cruciate ligament (ACL) reconstructions were divided into 3 groups. Maximum insertion torque was measured as grafts were fixed by the same surgeon with a 10-mm diameter, 35-mm long screw in a 7-mm diameter tunnel (dilated to 9 mm) created in either 0.16 or 0.32 g/cm3 dense synthetic bone or cadaveric tibiae (0.84 +/- 0.15 g/cm2). Tensile testing to construct failure was then performed. RESULTS: All constructs failed by tunnel pullout. Higher density synthetic bone had greater load at failure than lower density synthetic bone (486.6 +/- 83.8 v 271.6 +/- 52.6 N, P <.0001) and a slightly greater proportion of variance could be explained in synthetic bone (R2 = 0.74, P <.0001) than in cadaveric tibiae (R2 = 0.64, P =.017). Higher density synthetic bone displayed greater stiffness than lower density synthetic bone (68.1 +/- 21.6 v 37.7 +/- 11.2 N/mm, P =.012) and a higher proportion of variance could be explained in cadaveric tibiae (R2 = 0.72, P =.008) than in synthetic bone (R2 = 0.48, P =.012). Greater insertion torque levels were seen in higher density synthetic bone (2.97 +/- 0.35 v 1.24 +/- 0.06 Nm, P <.0001) than in lower density synthetic bone, and a higher proportion of variance could be explained in synthetic bone (R2 = 0.94, P <.0001) than in cadaveric tibiae (R2 = 0.74, P =.006). CONCLUSIONS: Strong relationships were evident between insertion torque, bone mineral density (BMD) and load to failure across constructs. Differences between the synthetic bone groups and cadaveric tibiae, however, suggest the influence of mixed cortical and cancellous bone, nonuniform structural patterning, and differing BMD levels and distributions in the cadaveric tibiae. CLINICAL RELEVANCE: Soft tissue graft tibial tunnel fixation is directly related to insertion torque and BMD. Synthetic models with mixed bone characteristics are needed to more accurately depict human tibiae during fixation testing.

Absorbable Implants↗
PubMed2004

Failure of anterior shoulder instability repair caused by eyelet cutout of absorbable suture anchors.

Repair of soft tissue to bone is increasingly frequently performed using absorbable suture anchors. If a repair fails clinically, it is often impossible to identify the cause of failure at repeat surgery. We report on 2 cases of recurrence of instability after arthroscopic Bankart repair. In reoperation in these cases, all sutures were correctly knotted around the labrum but were intact and torn out of the anchor eyelets. No sign of anchor displacement (3 anchors in each patient) was seen. This is the first clinical report of unambiguous structural suture anchor failure. These observations emphasize the sensitivity of Bankart repair to weak links in the repair chain, which must be avoided.

Absorbable Implants↗
PubMed2004

Arthroscopic repair of SLAP lesions with a bioknotless suture anchor.

The diagnosis and treatment of SLAP tears have improved with the development of arthroscopic shoulder surgery techniques. With types 2 and 4 tears, the goal is to restore stability to the labrum and biceps anchor and achieve healing to the glenoid. Suture repair with anchors is currently the repair technique of choice. The purpose of this article is to report a fast and simple method for arthroscopic SLAP repair that uses knotless suture anchors and obviates complex suture management and arthroscopic knot tying.

Absorbable Implants↗
PubMed2004

Posterolateral corner reconstruction using a hamstring allograft and a bioabsorbable tenodesis screw: description of a new surgical technique.

Capsuloligamentous posterolateral corner knee joint deficiencies cause increased anterior cruciate ligament forces during internal knee rotation and increased posterior cruciate ligament forces during external knee rotation. Undiagnosed posterolateral corner knee joint injury in combination with anterior cruciate ligament or posterior cruciate ligament injury can lead to failure of anterior cruciate ligament or posterior cruciate ligament reconstruction. The purpose of this technical note is to present a new posterolateral corner reconstruction technique for treating patients with chronic capsuloligamentous posterolateral corner deficiency. The technique uses a bioabsorbable tenodesis screw and a hamstring allograft to reconstruct the popliteofibular and lateral collateral ligaments.

Absorbable Implants↗
PubMed2004

New technique for chronic posterolateral instability of the knee: posterolateral reconstruction using the tibialis posterior tendon allograft.

Posterolateral instability of the knee is known as one of the most challenging injuries. Although several procedures have been designed for the posterolateral instability, there is no gold standard management as yet. We present a technique for posterolateral instability of the knee using a tibialis posterior tendon allograft, which reconstructs the lateral collateral ligament and popliteal tendon with its attachment to the tibia. This can correct not only varus, but also external rotary instability.

Absorbable Implants↗
PubMed2004

Arthroscopic-assisted biceps tenodesis for ruptures of the long head of biceps brachii: The cobra procedure.

A number of open procedures have been presented in the literature that described the repair of the ruptured long head of biceps brachii (LHBB). Although arthroscopic biceps tenodesis techniques have been used to address partial tears or subluxation of the biceps, no arthroscopic technique to assist in the treatment of complete retracted ruptures of the LHBB has been described. This article describes an arthroscopic-assisted biceps tenodesis, using interference screw fixation, in the treatment of acute or chronic LHBB ruptures. An arthroscopic-assisted biceps tenodesis with interference screw fixation provides an alternative to open LHBB tenodesis. The ability to tenodese the retracted LHBB arthroscopically is a technologic advance that could reduce morbidity in comparison to open tenodesis, thus resulting in a better functional outcome.

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