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Biomedical subjects

F A Barber

Publications and source records attributed to F A Barber.

At least 37 records · Page 2Linked to original sources
PubMed1997

Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction.

Meniscal repair is preferable to meniscectomy because of the recognized benefits of the meniscus and the consequences of its loss. The most appropriate rehabilitation program after meniscus repair is unclear. Many meniscus repairs occur in association with anterior cruciate ligament (ACL) reconstructions. An accelerated program permitting early full weight bearing, unrestricted motion, and no limitations on pivoting sports after the resolution of the postoperative effusion and full motion is established encourages patients and surgeon acceptance of the meniscus repair. To evaluate the success of meniscus repair in this accelerated rehabilitation program, a consecutive series of 63 patients with 65 meniscus tears undergoing arthroscopic meniscus repair were followed for a minimum of 2 years. There were seven failures (11%) at an average follow up of 38 months. The average patient age was 26 (range, 13 to 44). Arthroscopic relooks were done in 26%. Successful meniscal healing occurred in 92% of repairs done with ACL reconstructions, but only 67% of meniscus repairs performed in ACL-deficient knees, and 67% of meniscus repairs done in stable knees with no ACL injury. There was no statistical difference in the failures for acute and chronic meniscus tears, nor in the age of the patient undergoing the meniscal repair. Published rehabilitation protocols differ considerably on the three main issues of immobilization, weight bearing, and return to pivoting sports. These data show a meniscus repair success rate consistent with other published series. No modification of an ACL reconstruction accelerated rehabilitation program is needed for meniscus repairs performed in conjunction with the reconstruction.

Adult↗
PubMed1996

Meniscal impingement syndrome.

The meniscal impingement syndrome consists of three elements: impaction on the anterior medial femoral condyle by the leading edge of the medial meniscus, articular cartilage damage of at least Outerbridge grade 3, and knee hyperextension of at least 5 degrees. This report reviews this condition in a series of seven knees with an average follow-up of 39 months. The time from the onset of symptoms until surgery averaged 45 months. Treatment consisted of a thorough arthroscopic knee evaluation and debridement of the articular cartilage fragmentation and any impinging synovitis. Postoperative rehabilitation includes extension block bracing, hamstring strengthening, and closed-chain exercise. With this regimen, there was improvement in the Tegner scores and a reduction in postoperative knee hyperextension. Identification of this uncommon condition requires a complete evaluation of the medial femoral condyle in patients with knee hyperextension.

Adolescent↗
PubMed1996

Tissue fixation security in transosseous rotator cuff repairs: a mechanical comparison of simple versus mattress sutures.

The primary purpose of this investigation was to compare tissue fixation security by simple sutures versus mattress sutures in transosseous rotator cuff repair. These two repair techniques were each performed in 17 human cadaver shoulders, with two bone tunnels being used for the repair by two simple sutures and two other bone tunnels being used for the repair by one mattress suture. The repairs were loaded to failure in a servohydraulic materials test system. Rotator cuff repair by simple sutures was found to be significantly stronger than repair by mattress sutures (P = .0007). The average ultimate load to failure for the simple suture construct (189.62 N) was 39.72% greater than that for the mattress suture construct (135.71 N). Most of the failures occurred by suture breakage at the knot. Load-sharing by multiple suture tails and multiple knots in the simple suture configuration likely contributed to its superior strength characteristics compared with the mattress suture configuration.

Biomechanical Phenomena↗
PubMed1996

Is an anterior cruciate ligament reconstruction outcome age dependent?

Treatment of a torn anterior cruciate ligament (ACL) in older patients must be considered in relation to healing delays, rehabilitation difficulties, stiffness, arthritis, and actual athletic demands. This study compares ACL reconstructions in patients 40-years old and older with those under 40-years old and contrasts these to published nonoperative data in the 40 and older patient. Patients undergoing ACL reconstruction between 1992 and 1994 were preoperatively and postoperatively assessed with Lysholm, Tegner, KT, radiographic, and clinical examinations. They were divided into two groups: those 40 years and older (group 1) and those 39 years and younger (group 2). Group 1 had 33 patients with an average age of 44 years (range, 40 to 52 years). Radiographic Fairbank changes were absent. Group 2 had 170 patients with an average age of 27 years (range, 16 to 39 years). Group 1 preoperative instability and intake data were not statistically different from those of group 2. Average follow-up was 21 months for both groups. Both groups showed significant improvement in all parameters at 12- and 24-month follow-up examinations. Lysholm scores, Tegner scores, average KT manual maximum side-to-side differences, Lachman tests, and pivot shift testing were not statistically different in either group. Using Lysholm criteria, in group 1, 89% had excellent/good results, and 11% fair/poor results. This was not statistically different from group 2, which showed 91% excellent/good results and 9% fair/poor results at 24-month follow-up examination. For this age group, nonoperative treatment reports indicate 57% excellent/good results and 43% fair/poor results. The outcomes between these groups are the same and fail to establish the age of 40 years as a barrier to successful ACL reconstruction.

Achilles Tendon↗
PubMed1996

Suture anchor strength revisited.

The rapid proliferation of suture anchors continues. Our prior report on the pullout strength of 14 different anchors is supplemented by a similar test conducted on 8 additional anchors. Comparative data on modes of failure and failure strengths (ultimate loads to failure) for these new devices are compared statistically with the previously tested anchors. In a fresh never-frozen porcine femur model, 10 samples of each of the additional anchors tested were threaded with stainless steel sutures and inserted into three different test areas (diaphyseal cortex, metaphyseal cortex, and a cancellous trough). Tensile stress parallel to the axis of insertion was applied at a rate of 12.5 mm/s by an Instron 1321 testing machine (Instron Corp, Canton, MA) until failure and mean anchor failure strengths calculated. The anchors tested were the Mitek G2 as a control, miniMitek, Mitek Superanchor, Mitek Rotator Cuff anchor (Mitek Products, Westwood, MA), Innovasive Devices Radial Osteal Compression device (Innovasive Devices, Hopkinton, MA), Arthrex Fastak (Arthrex Inc, Naples, FL), Arthrotek miniHarpoon (Arthrotek, Warsaw, IN), Orthopedic Biosystems PeBA 3 and PeBA 5 (Orthopedic Biosystems, Scottsdale, AZ), and AME 5.5 screw (American Medical Electronics, Richardson, TX). Failure mode (anchor pullout, suture eyelet cut out, or wire breakage) was generally consistent for each anchor type. The size of insertion hole is clinically important and each anchor's performance was evaluated as a function of its minor diameter or drill hole. For screw anchors, the larger the minor diameter of the screw, the higher the mean failure strengths in all three test areas (P = .001). However, larger drill holes for non-screw anchors resulted in lower mean failure strengths in cancellous bone (P = .03) and diaphyseal cortex (P < .005).

Animals↗
PubMed1995

The ultimate strength of suture anchors.

Suture anchors of various designs are gaining acceptance for open and arthroscopic procedures. The rapid proliferation of these devices challenges those using them to apply objective criteria for device selection. Comparative data on implant security in different settings, modes of failure, and ultimate failure strengths is lacking. This study was undertaken to independently develop such data for an objective comparison of the suture anchors currently available. Using a fresh never-frozen porcine femur model, 10 samples of each of the 14 different anchors tested were inserted into each of the three different test areas; diaphyseal cortex (usually 3- to 4-mm thick), metaphyseal cortex (usually 1- to 2-mm thick), and a cancellous bone "trough". The suture anchors were threaded with 0.018-inch stainless steel wire or, for anchors requiring a more flexible suture, 0.018-inch stainless steel 1 x 7 wire braid. Tensile stress parallel to the axis of insertion was applied at a rate of 12.5 mm/second by an Instron 1321 (Instron Corp, City, State) until failure. Average failure strength was calculated for each anchor at each test area. The anchors tested were the Mitek G2, Mitek G3, Mitek G4 (Mitek Surgical Products, Norwood, MA), Linvatec Revo screw (Linvatec, Largo, FL), Acufex TAG Wedge, Acufex TAG Rod 2 (Acufex Microsurgical, Mansfield, MA), Statak models 1.5, 2.5, 3.5, 5.0, and 5.2 (Zimmer, Warsaw, IN), Arthrex ESP (Arthrex Inc., Naples, FL), Arthrotek Harpoon, and Arthrotek LactoSorb (Arthrotek, Warsaw, IN). The average failure strength of each of these anchors in the diaphyseal cortex, metaphyseal cortex, and cancellous bone is reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1995

The in vivo histology of an absorbable suture anchor: a preliminary report.

Suture anchors are playing an increasingly important role in attaching tendons or ligaments to bone. Anchors are usually made of metallic or other nonbioabsorbable materials. The development of an absorbable suture anchor would provide a valuable tool for the surgeon; this characteristic would minimize the problems of anchor loosening, migration, interference with imaging studies, and the potential requirement for later implant removal. This study evaluated the in vivo histological response over time of the first generation Arthrex Expanding Suture Plug (ESP) (Arthrex Inc, Naples, FL). Suture anchors threaded with nonabsorbable No. 2 braided polyester sutures were implanted into ram femurs and removed at various intervals over a period of 12 weeks. After preparation, histological study showed a gradual healing response in the bone tract. There was no evidence of an inflammatory infiltrate or foreign-body reaction during the 12 weeks of implantation. A normal bone callus appeared at the insertion tunnel site consistent with a fracture-healing response. Later, a fibrous membrane appeared at the junction of the implant and the bone tunnel. Over the 12 week interval, there was a decrease in osteoblastic activity and the appearance of cavernous vascular spaces in the superficial portions of the membrane near the periosteum. The ESP anchor composed of poly-L-lactic acid was well tolerated in the in vivo setting. Throughout the study, no substantial acute, chronic, or foreign-body reaction was observed. These observations are consistent with the expected in vivo behavior of poly-L-lactic acid. There is no reason to believe that the ESP composed of poly-L-lactic acid should cause a foreign body reaction.

Animals↗
PubMed1995

Preliminary results of an absorbable interference screw.

A randomized, prospective multicenter comparison was done of a bioabsorbable interference screw (Bioscrew; Linvatec Corp, Largo, FL) made from poly L-lactic acid and a metal interference screw produced by the same company. Assignment was randomized by sealed envelopes. A total of 110 patients underwent arthroscopic patellar tendon autografts. A minimum 12 months follow-up is available on 85 patients (mean 19 months, range 12 to 33) including 42 with Bioscrews and 43 with metal screws. There were 56 male and 29 female patients. The average age was 29 years (16 to 50 years). Tourniquet times and associated surgical findings were similar for the two groups. Postoperative Tegner and Lysholm scores were not statistically different between the two groups. KT tests at 1 year showed an average 20-lb laxity of 1.8 mm for the Bioscrew and 1.2 mm for the metal screw groups. The average 1-year KT maximum manual side-to-side difference was 1.6 mm for Bioscrews and 1.6 mm for metal screws. A pivot shift was absent in 83% of Bioscrews and 90% of metal screws at follow-up. Six of 85 Bioscrews inserted (7%) broke on insertion (all were 7-mm diameter screws at the femoral site). No additional fixation was required in four cases. In two, the broken screw was replaced. No lytic bone changes or tunnel widening were found with any Bioscrew. One metal screw had tibial tunnel widening. No statistical difference was found between the Bioscrew and the metal screw groups. Short-term data support the conclusion that the Bioscrew is a reasonable alternative to metal interference screws.

Absorption↗
PubMed1994

Accelerated rehabilitation for meniscus repairs.

Although meniscus tears suitable for repair are infrequent, meniscal repair is preferable to meniscectomy. Unfortunately, the postoperative restrictions commonly recommended preclude the athlete's rapid return to sports and can lead to the selection of meniscectomy over meniscus repair. Wide variations presently exist in the published postmeniscus repair rehabilitation programs. No objective assessment of these variables has been made to date. To assess the value of postoperative limits to motion, weight bearing, and agility activities, a comparison was made of our previously published "standard" rehabilitation program with an "accelerated" program permitting unlimited weight bearing, full motion, and no restrictions on pivoting sports. Group 1 (58 repairs), treated conventionally, had 11 failures (19%) at an average of 38 months postsurgery. The average age in group 1 was 23 years (range 14-45). Group 2, which included 40 repairs treated with the "accelerated" program, had four failures (10%) at an average follow-up of 20 months. The average age in group 2 was 26 years (range 15-40). Arthroscopic second looks were performed in 35% of group 1 and 25% of group 2. These data fail to show any statistical difference and do not support the need for activity restrictions after a meniscus repair.

Adult↗
PubMed1994

Snow skiing combined anterior cruciate ligament/medial collateral ligament disruptions.

Recent reports indicate that combined anterior cruciate ligament/medial collateral ligament (ACL/MCL) knee injuries are usually associated with a lateral meniscus tear. In our center, snow skiing is the athletic activity most frequently associated with this double-ligament injury complex. A sports-specific analysis was undertaken to evaluate the hypothesis that the snow skiing ligament injury is different from similar injuries caused by other athletic activities. Of a total of 64 acute arthroscopically confirmed tears of both the MCL and ACL, 23 were caused by snow skiing and 41 by nonskiing activities. There were fewer lateral meniscus tears in skiers (43%) when compared with the nonskiers (88%). Skiers also had fewer medial meniscus tears (13%) than did nonskiers (37%). No medial meniscus tears occurred in the absence of a lateral meniscus tear. Although 78% of the skiers were women, only 12% of the nonskiers were women. Skiers were older (average age 35 years) than the nonskiers (average age 28 years). The right knee was injured almost twice as frequently as the left. These data suggest that the double (ACL/MCL) ligament injury in skiers might be distinctly different from that in nonskiers.

Adolescent↗
PubMed1993

Acute traumatic knee hemarthrosis.

A rapidly developing hemarthrosis in an acutely injured knee is reported to be associated with "surgically significant" lesions, such as anterior cruciate ligament tears, meniscus tears, and osteochondral fractures, in < or = 90% of cases. We report two cases of adult men who showed signs of such acute hemarthroses in stable knees after significant trauma. Neither had significant intraarticular pathology, such as meniscal, articular, or ligamentous injury, at arthroscopy. Persistent postarthroscopic bleeding led to additional diagnostic testing that found mild factor VIII deficiency. Hemophilia A and other clotting disorders should be considered by arthroscopic surgeons as a possible cause of a posttraumatic hemarthrosis.

Accidental Falls↗
PubMed1993

Suture anchor failure strength--an in vivo study.

Suture anchors are increasingly used to secure tendons or ligaments to bone. These devices are applicable for arthroscopic shoulder stabilization and rotator cuff repair. This study reports the in vivo characteristics of four anchors, including one absorbable anchor composed of poly-L-lactic acid. Failure strength and method of failure were recorded for these anchors as a function of time. Samples of four anchors [Mitek G2, Zimmer Statak, Acufex TAG wedge, and the absorbable Arthrex expanding suture plug (ESP)] were implanted into ram femurs and harvested at intervals. Each bone-anchor-suture system was stressed to failure. The failure force and failure method was recorded. Mitek G2 and Statak suture anchors failed consistently at 30 pounds by suture breakage. They had no implantation difficulties. The TAG wedge exhibited suture pull-out and implant flipping at insertion. The TAG wedge failed by suture cut-out, anchor pull-out, and suture breakage. Its average failure strength was initially 16 pounds, but increased to 28 pounds at 2 weeks and reached the 30-pound level by 4 weeks. The ESP poly-L-lactic acid anchors experienced implantation breakage in 20% because of their greater length and composition. At pull-out testing, the ESP failed by suture cut-out, anchor pull-out, and suture breakage. Failure strength was initially 27 pounds, was 17 pounds at 2 weeks, and increased to 30 pounds by 6 weeks. The absorbable ESP does not have initial pull-out strength comparable with the Mitek and Statak suture anchors but does achieve this strength by 6 weeks.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1992

The effect of inflammatory synovial fluid on the breaking strength of new "long lasting" absorbable sutures.

The effect of inflammatory synovial fluid upon several absorbable sutures potentially useful for arthroscopic procedures, e.g., meniscus repair and shoulder stabilization, was studied by implanting lengths of these sutures into unstable, arthritic rabbit knees and testing their breaking strength after varying time periods (up to 18 weeks). Polyglyconate (Maxon) sutures retained no significant strength at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 3 weeks, retained only 40% of their original strength 6 weeks after implantation, and had no measurable strength at 9 weeks. Polycaprolactone (LTS) sutures showed a slow reduction in strength and retained approximately 90% of their original breaking strength after 18 weeks of implantation. Green braided polyester (Mersiline) sutures showed no loss of breaking strength over the testing period. Measurements of inherent viscosity were made to give an indirect indication of the decline in molecular weight of these sutures. These data paralleled the breaking strength decline in every case. The surgeon selecting an absorbable suture must consider the length of time the suture will hold the target tissue. This information should be helpful to surgeons considering an absorbable suture for procedures such as meniscus repair and shoulder stabilization.

Absorption↗
PubMed1992

What is the terrible triad?

In 1936 Campbell asserted that "impairment of the anterior crucial and mesial ligaments is associated with injuries of the internal cartilage." O'Donoghue in 1950 called attention to "that unhappy triad (1) rupture of the medial collateral ligament, (2) damage to the medial meniscus, and (3) rupture of the anterior cruciate ligament" and recommended early surgical intervention. In 1955 he reported 33 cases with both medial collateral (MCL) and anterior cruciate ligament (ACL) tears, but there were only three lateral meniscus tears reported. Based on a recent report by Shelbourne and Nitz that questions the validity of this unhappy triad, a review of all arthroscopically confirmed acute injuries of second degree or worse to the ACL and MCL was undertaken. Of a total of 52 knees reviewed, 50 knees had third-degree ACL tears and two had second-degree ACL tears. One of the second-degree tears was associated with a second-degree MCL and one with a third-degree ACL tear. Neither had an associated meniscus tear. Forty-five third-degree ACL tears were associated with third-degree MCL tears (group 1) and five with second-degree MCL tears (group 2). Eighty percent (36 knees) of group 1 had lateral meniscus tears. Only 29% of group 1 (13 knees) had associated medial meniscus tears. None of these medial meniscus tears was isolated. Eighty percent (four knees) of group 2 had lateral meniscus tears with only one associated medial meniscus tear. Again, there were no medial meniscus tears in the absence of a lateral meniscus tear. We did not find the combination of injury originally described as the unhappy triad.

Adult↗
PubMed1992

Iliotibial band syndrome.

The iliotibial band syndrome is most often diagnosed in runners but can be found in athletes who participate in other sports. From our experience most patients are high mileage runners with shoes either worn out or with insufficient cushioning. A total of 19 athletes with this condition have been seen in the past 3 years. Treatment consisted of rest or decreased distance, shoe changes, modification in exercise technique, anti-inflammatory medication, steroid injections and stretching. Surgery was not required.

Adolescent↗