Recurrent compartment syndrome after fracture of a tibiofibular synostosis in a National Football League player.
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Adult↗
Biomedical subjects
Anthony Miniaci
Publications and source records attributed to Anthony Miniaci.
Thermal capsulorrhaphy for the treatment of shoulder instability.
Thermal capsulorrhaphy has been used to treat many different types of shoulder instability, including multidirectional instability, unidirectional instability, and microinstability in overhead-throwing athletes. A device that delivers laser energy or radiofrequency energy to the capsule tissue causes the collagen to denature and the capsule to shrink. The optimal temperature to achieve the most shrinkage without causing necrosis of the tissue is between 65 degrees and 75 degrees centigrade. This treatment causes a significant decrease in mechanical stiffness for the first 2 weeks, and then, after the tissue undergoes active cellular repair from the surrounding uninjured tissue, the mechanical properties return to near normal by 12 weeks. If the thermal energy is applied in a grid pattern, then the tissue heals with more stiffness by 6 weeks. Clinical studies on thermal capsulorrhaphy for the treatment of multidirectional instability have shown a high rate of recurrent instability (12%-64%). The clinical studies on unidirectional instability showed much better recurrence rates (4%-25%), but because most of the patients also underwent concomitant Bankart repairs and superior labral anterior posterior lesion repairs, the efficacy of the thermal treatment cannot be ascertained. A randomized controlled trial would be needed to assess whether instability with Bankart lesions requires augmentation with thermal capsulorrhaphy. For the patients with microinstability who are overhead-throwing athletes, thermal capsulorrhaphy has shown varying results from a 97% rate of return to sports to a 62% rate of return to sports. Complications of this technique include temporary nerve injuries that usually involve the sensory branch of the axillary nerve and thermal necrosis of the capsule, which is rare.
Animals↗
Intra-articular hyaluronan following autogenous osteochondral grafting of the knee.
PURPOSE: The aim of this study was to assess whether intra-articular hyaluronan viscosupplementation after osteochondral grafting (mosaic arthroplasty) of the knee allowed better graft integration and function in a sheep model. TYPE OF STUDY: Experimental study. METHODS: Twelve adult sheep underwent a mosaic arthroplasty procedure to a standardized osteochondral defect on the medial femoral condyle. One week after surgery the animals were randomized to receive a course of weekly intra-articular injections for 5 weeks of either sodium-hyaluronate solution 25 mg/2.5 mL (HA group) or of a 2.5 mL buffer solution (control group). Synovial fluid samples were taken preoperatively, preceding each injection, and at 8 and 12 weeks. The animals were euthanized at 12 weeks, the knees dissected out, and biomechanical and histologic assessments were made. RESULTS: There was no difference in the synovial fluid leukocyte or total protein concentration between the groups, but the hyaluronan concentration was statistically higher in the HA group. Aggregate moduli of the articular surface were statistically higher in the graft articular cartilage in the HA group than in the control group, as were the sulphated glycosaminoglycan levels. Histologic assessment found more articular cartilage flow in the HA group, whereas there was more interstitial tissue present in the interstices between the grafts in the control group. CONCLUSIONS: Results from this study suggest that hyaluronan viscosupplementation following osteochondral grafting does convey some beneficial effects on graft cartilage in the early postoperative period in an ovine model. CLINICAL RELEVANCE: This study suggests that, in the early postoperative period, hyaluronan supplementation improves articular cartilage survival after osteochondral grafting.
Animals↗
Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks.
PURPOSE: The purpose of this study was to evaluate the clinical results of bioabsorbable tacks (Suretac; Smith & Nephew Endoscopy, Mansfield, MA) for the arthroscopic repair of full-thickness rotator cuff tears. TYPE OF STUDY: Prospective case series. METHODS: A prospective clinical review was performed on 53 patients (38 men, 15 women) with full-thickness rotator cuff tears repaired arthroscopically using bioabsorbable tacks. Minimum follow-up was 24 months and patients were evaluated using preoperative and postoperative American Shoulder and Elbow Society (ASES) scores and Short-Form 36 Health Surveys (SF-36). A Constant and Murley score was performed at a minimum of 2 years postoperatively. RESULTS: The average patient age was 51 years (range, 23 to 74 years) and the average time for review was 29 months (range, 24 to 60 months). The average size of rotator cuff tears measured 2.5 cm (range, 1 to 5 cm) and an average of 2 Suretacs (range, 1 to 4) were used for the repair. Ten patients had tears larger than 3 cm and 5 patients had tears that measured 5 cm or larger. The average total score according to the ASES shoulder index improved from 33 to 85 points. The average score for pain improved from 6.9 to 1.3 points. The score for function improved from 11 to 25 points. These results were statistically significant (P < 0.01). There was a significant improvement in all components of the SF-36 survey. The average postoperative Constant score was 87 with the pain component measuring 12 points, range of movement 38 points, and power 21 points. CONCLUSIONS: Arthroscopic repair of full-thickness rotator cuff tears using bioabsorbable tacks produces satisfactory outcomes with regard to objective orthopaedic criteria as well as overall patient satisfaction in terms of pain relief and function. Arthroscopic rotator cuff repairs are technically demanding procedures. The use of tacks facilitates this procedure without any apparent deterioration in clinical results. LEVEL OF EVIDENCE: Level IV, case series.
Absorbable Implants↗
Imaging evaluation of the postoperative knee ligaments.
Until the advent of magnetic resonance imaging (MRI), evaluation of ligament reconstruction of the knee was largely based on clinical examination and radiographs. MRI is the modality of choice for noninvasive evaluation of reconstructed ligaments, menisco-capsular structures and soft tissues. This article reviews the surgical techniques, normal and abnormal appearances of the ACL and PCL grafts and common complications following ligament reconstruction.
Anterior Cruciate Ligament↗
Radiologic case study. First metarsophalangeal plantar plate injury (turf toe).
Turf toe and related injuries to the first metatarsophalangeal joint are common injuries that occur in several sports. Although often a clinical diagnosis, advanced imaging can help grade severity of sprain and evaluate for associated or unsuspected injuries. Without proper rest and conservative management, a treatable injury can have chronic sequelae and morbidity. Operative management is uncommon, but successful in returning high-level competitive athletes to their sport.
Adolescent↗
Manual punch versus power harvesting of osteochondral grafts.
PURPOSE: The purpose of the study was to analyze the effect on chondrocyte viability of 2 existing methods of harvesting osteochondral grafts used for articular cartilage resurfacing. TYPE OF STUDY: Acute animal experiment. METHODS: Power (P) trephine versus manual (M) punch harvesting was tested; 2.7-mm and 4.5-mm dowels were harvested from 8 femoral trochlea from 4 sheep using the Acufex MosaicPlasty system (Andover, MA). Grafts were harvested perpendicular to the articular surface to a depth of 10 mm under constant saline irrigation. Power trephine grafts (n = 46, 2.7 P; n = 45, 4.5 P) were harvested by coupling the serrated trephine to a standard orthopaedic nitrogen powered drill. Manual punch grafts (n = 41, 2.7 M; n=33, 4.5 M) were harvested by malleting the punch to the required depth, minimizing rocking, and only slightly turning the punch on removal. Five 40-microm-thick fresh cartilage sections oriented perpendicular to the articular surface were obtained from each graft and then stained with Syto 13 and ethidium bromide vital stains, and the proportion of live cells per field and physical damage were compared between groups. Masson's trichrome stain was used on paraffin-embedded histologic sections. RESULTS: Power harvesting was technically more difficult and resulted in more gross and light microscopic damage to the osteochondral grafts. Chondrocyte viability was significantly greater for manual punch versus power harvesting of both graft sizes (P <.005). Chondrocyte viability was greater for 4.5 P versus 2.7 P grafts (P <.005), but no difference was found between the 2.7 M and 4.5 M groups (P =.357). CONCLUSIONS: Chondrocyte viability is significantly greater using manual punch versus serrated power trephines when harvesting osteochondral grafts for cartilage resurfacing procedures. Power trephines should not be used for this procedure. CLINICAL RELEVANCE: This study shows that the original method (power trephine) of harvesting osteochondral grafts results in great loss of chondrocyte viability versus manual punch harvesting and should no longer be used.
Animals↗
Cruciate and posterolateral corner injuries in the athlete: clinical and magnetic resonance imaging features.
With an increasing number of people participating in recreational and competitive sporting activities, sports-related injuries of the knee and knee ligaments have increased in incidence. The extent and severity of such injuries may have important implications with regard to potential return to athletic pursuits as well as impacting upon activities of daily life. This article discusses the MR imaging and clinical features of sports-related injuries of the cruciate ligaments and posterolateral corner of the knee, highlighting the implications of such injuries on joint function. MR imaging has the potential to accurately identify these ligamentous injuries, as well as other potential associated combined injuries of the knee, with information from MR imaging examination assisting in decision-making and planning with regard to potential clinical and/or surgical patient management.
Anterior Cruciate Ligament Injuries↗
Multidirectional instability: surgical decision making.
Although previous authors have described multidirectional instability of the shoulder, it was not until 1980 that Neer and associates solidified the current understanding and treatment of inferior and multidirectional instability. They emphasized the importance of differentiating this condition from the more common unidirectional instabilities and introduced the concept of an inferior capsular shift to globally tension the capsule anteriorly, inferiorly, and posteriorly, while thickening and reinforcing it on the side of greatest instability (i.e., anterior or posterior). Since the time of this initial description, the diagnosis and treatment of multidirectional instability has been fraught with difficulty and confusion. More recently, the advent of shoulder arthroscopy has blazed the trail for minimally invasive techniques to correct multidirectional instability, including arthroscopic thermal capsulorrhaphy and suture plication. However, despite strong opinions regarding these surgical techniques, when comparing open approaches to arthroscopic techniques for the treatment of multidirectional instability, long-term outcomes of arthroscopic techniques have yet to replicate those of open surgery.
Arthroscopy↗
MR imaging of cartilage repair procedures.
It is becoming increasingly important for the radiologist to evaluate the appearance and outcome of cartilage repair procedures. MR imaging is currently the best method for such evaluation but it is necessary to use cartilage-specific sequences and to modify those sequences when necessary to minimize artifacts from retained metal within the joint. This article reviews the surgical technique of the more commonly performed cartilage repair procedures, currently recommended techniques for the MR imaging evaluation of articular cartilage and cartilage repair procedures, and the MR imaging appearance of cartilage repair procedures and of the most frequently encountered complications following such procedures.
Arthroplasty↗
Thermal capsular shrinkage for treatment of multidirectional instability of the shoulder.
BACKGROUND: Capsular laxity is the main pathology in patients with multidirectional instability, and thermal shrinkage has been commonly employed to treat this condition. The objective of this study was to evaluate thermal capsular shrinkage as a treatment of multidirectional instability of the shoulder. METHODS: Nineteen consecutive patients with multidirectional instability were treated with thermal shrinkage. Fifteen patients had involuntary instability, and four had voluntary instability. The predominant direction of the instability was anteroinferior in ten patients and posterior in five; four patients had instability in multiple directions. Patients were followed for a minimum of two years or until surgical failure and recurrence of symptoms. Postoperatively, the patients wore a sling for three weeks, and they were evaluated regularly at three, six, and twelve months. The Western Ontario Shoulder Instability Index as well as subjective and objective evaluations of the patient's function, range of motion, pain, and instability were used as clinical outcome measures. RESULTS: Nine patients had recurrence of the instability at an average of nine months (range, seven to fourteen months) following the surgical procedure. Four patients had sensory dysesthesias in the axillary nerve distribution, and one of them had deltoid weakness. All neurological symptoms resolved within nine months. The surgical procedure failed in the five patients with predominantly posterior instability. It failed in only two of the ten patients with predominantly anteroinferior instability, and overall this group had objective improvement. CONCLUSIONS: Thermal capsular shrinkage used to treat multidirectional instability had a substantial failure rate with associated postoperative complications, including recurrence of instability (nine of the nineteen patients), stiffness (five patients), and neurological symptoms (four patients).
Adolescent↗
Update on advanced surgical techniques in the treatment of traumatic focal articular cartilage lesions in the knee.
Considerable interest has been developed over the past several years in expanding the treatment of symptomatic femoral condylar articular cartilage lesions in active patients. Multiple surgical techniques have been reported and evolving technologies, equipment and approaches continue to expand. The purpose of this paper is to review the presentation of focal articular cartilage lesions including treatment indications, current surgical options and postoperative protocols emphasizing advanced techniques used to preserve or restore hyaline cartilage tissue. The various surgical options are discussed and the advantages and disadvantages are reviewed and highlighted in a clinical practice guideline algorithm.
Adolescent↗
Management of chondral injuries of the knee by osteochondral autogenous transfer (mosaicplasty).
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Bone Transplantation↗
Magnetic resonance imaging of the shoulder in asymptomatic professional baseball pitchers.
The purpose of this study was to evaluate the magnetic resonance imaging findings in both shoulders of asymptomatic professional baseball pitchers. Fourteen pitchers who were without significant prior injury underwent a blinded clinical assessment and magnetic resonance imaging of both shoulders. All images were interpreted by two experienced musculoskeletal radiologists. The appearance of the rotator cuff tendons was graded, with additional evaluation of the biceps, labrum, and osseous structures. Ten athletes were found to have stable shoulders and painless full range of motion. Clinically, four athletes had at least a 40 degrees loss in internal rotation as compared with the nonthrowing arm. There were no significant differences in magnetic resonance imaging findings of the supraspinatus and infraspinatus tendons between the throwing and nonthrowing shoulders. The labrum was abnormal in 79% of the 28 shoulders. Enthesopathic changes of the posterior glenoid labrum were identified in the four pitchers who had loss of internal rotation. We conclude that unenhanced magnetic resonance imaging of the shoulder in asymptomatic high performance throwing athletes reveals abnormalities that may encompass a spectrum of "nonclinical" findings. These data can be useful in separating symptomatic pathologic findings from these variants. Enthesopathic changes of the posterior glenoid labrum in the throwing arm may represent an early Bennett-type lesion. The cause may be excessive traction on the posterior capsule during the pitching motion, with subclinical injury to this area.
Acromion↗