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Biomedical subjects

F A Barber

Publications and source records attributed to F A Barber.

At least 55 records · Page 3Linked to original sources
PubMed1990

Complications of ankle arthroscopy.

Of over 4500 ankle arthroscopies recently surveyed by the Arthroscopy Association of North America, only one complication (an infection) was reported. Nerve injury, vascular injury, or reflex sympathetic dystrophy were not reported. The ankle's anatomy is complex and there are many structures that can be damaged by imprecise portal placement. A review of our experience with 53 consecutive ankle arthroscopies found nine complications for a rate of 17%. There were three permanent dorsal sensory nerve injuries, two synovial fistulas, three wound infections, and one reflex sympathetic dystrophy. A literature review found other reported complications to include instrument breakage, synovitis, painful scars and nodules, and fibula fracture. Complications occur with ankle arthroscopy more frequently than previously reported, and the average or beginning ankle arthroscopist should expect a higher rate of surgical complication than has been previously reported.

Adolescent↗
PubMed1989

Penetrating knee injuries: the nail gun.

Since the development of the nail gun in the 1950s, various reports cite injuries to the head, chest, abdomen, and extremities. Few of these reports mention any nail gun injuries to the knee joint. A total of 33 patients with penetrating injuries to the knee was identified. Of these, 13 had penetrating wounds caused by power nail guns or staplers. The average age was 25 years (range, 17-40). In 10 of the 13 patients, bone involvement (femur in 6, patella in 2, tibia in 1, and both femur and patella in 1) occurred. Treatment consisted of arthroscopy with irrigation of the knee and nail removal in 10 patients. The other 3 patients underwent arthrotomy in conjunction with nail removal and irrigation. No drains were used postoperatively. I.v. cephalosporin antibiotics were given initially in all cases and were continued orally after hospital discharge. Immediate post injury follow-up varied from a few days to 3 months. Six of the 13 patients were found for follow-up 10-33 months (average 19 months) post injury. All of these returned to full duty in the home construction industry. None developed an infection or needed additional surgery. Based on this series, power nail gun knee joint wounds should have tetanus prophylaxis, arthroscopic evaluation, and irrigation of the knee joint in conjunction with nail removal, i.v. antibiotics for 12-48 h, followed by a 10-day course of oral antibiotics. Unless cultures indicate differently, a first-generation cephalosporin is recommended.

Adult↗
PubMed1988

Inflammatory synovial fluid and absorbable suture strength.

The effect of inflammatory synovial fluid upon several absorbable sutures commonly used for meniscus repair was studied by implanting lengths of these sutures into unstable, arthritic rabbit knees and, after varying lengths of time (1-6 weeks), testing their breaking strength. Both polyglactin-910 (Vicryl) and polyglycolic-acid (Dexon) sutures retained only minimal breaking strength 3 weeks after implantation. Chromic gut sutures demonstrated a steady reduction in breaking strength until they retained only 6% of their original strength at 5 weeks and none at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 2 weeks and retained only 40% of their original strength 5 weeks after implantation. The rate of loss in polydioxanone breaking strength was faster in inflammatory synovial fluid than previously reported in the normal synovial joint. Braided polyester sutures (Mersiline) showed no loss of breaking strength over the duration of this test. While the choice of suture is only one variable influencing the outcome of a meniscus repair, this study demonstrates that only polydioxanone and green braided polyester sutures retain any strength 6 weeks after implantation (the time of immobilization commonly recommended for meniscal repairs). Complete meniscal healing can require several months. In the absence of compelling evidence to the contrary, the use of nonabsorbable suture materials for meniscal repair seems the most appropriate choice.

Absorption↗
PubMed1988

The posterior medial complex disruption.

Seventy-five patients with 86 complex tears of the medial meniscus posterior horn (posterior medial complex disruptions) treated by arthroscopic partial meniscectomy were contacted for evaluation of their functional results. Forty-five patients returned for physical and radiographic examination 1 to 6 years after surgery. Condylar chondromalacia was significantly higher in patients waiting to undergo surgery over 6 months from the onset of their symptoms (94%) than those waiting less than 6 months (40%) (P = .0001). Patients were classified into phases based on preoperative x-rays and the operative presence of condylar chondromalacia. Satisfactory results were seen in 87% of phase 0 and phase 1 patients, 50% of phase 2 patients, and 32% of phase 3 patients. Phase classification provided significant data for prognostication of satisfactory results (P = .0001). With advancing age, presence of preoperative x-ray changes, the articular cartilage damage may compromise the results. Most patients in this study exhibited clinical improvement suggesting some benefit from the mechanical washout, if not the meniscectomy.

Adult↗
PubMed1988

Arthroscopic surgery of the ankle.

Ankle arthroscopy is a useful technique, especially for intra-articular problems and osteocartilagenous lesions. Indications for this diagnostic and therapeutic technique include: ankle sprain unresponsive to the usual course of treatment, complaints of intermittent locking, pain and clicking, limitation of motion, and painful conditions with no obvious etiology (especially in a worker's compensation beneficiary). A review of arthroscopic, radiographic, and clinical data of all patients undergoing ankle arthroscopy at our center provided the following diagnoses: talar dome osteochondral fractures, loose bodies, accessory ossicles, talar dome cyst with loose bodies, and chronic synovitis. The anatomy of ankle arthroscopy is demanding; while the technique incorporates the same instrumentation as is used for knee arthroscopy, awareness of the neurovascular structures is essential to avoid complications. Although infrequent, complications can include sinus tract formation, sensory nerve damage, synovitis, infection, instrument breakage, and calf compartment syndromes due to extravasation of irrigation fluid.

Ankle Joint↗
PubMed1987

Meniscus repair: results of an arthroscopic technique.

A prospective study of arthroscopically repaired peripheral meniscal tears in 24 patients (19 men and five women) was initiated in 1983. Two patients were lost to follow-up. Seventeen medial and five lateral tears were followed an average of 29 months (15-42 months) with 17 having clinically apparent healing (77%). Sixteen had ACL tears, 10 of which were stabilized. Thirteen of 16 stable knees healed their menisci (81%), whereas only 4 of 6 unstable knees had healed menisci (67%). Fifteen were acute tears repaired within 2 weeks of injury, and 7 were chronic tears. Four acutely repaired menisci failed. One lateral meniscus tore in the previously sutured site 12 months later, whereas 1 medial meniscus tore 24 months after repair in a new area associated with significant trauma. Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. No serious complications such as peroneal nerve or popliteal vascular damage occurred. Transient saphenous neuropraxia (22%) and posterior portal adhesions (9%) were temporary problems. The procedure is recommended only for the advanced arthroscopist, who is advised first to establish the anatomical relationships clearly by cadaver dissections.

Adolescent↗
PubMed1987

Fenestrated medial patella plica.

Fenestrated medial patellar plicae are unusual. In a review of 1,000 consecutive knee arthroscopies, the incidence of this finding was 1.8%. These fenestrations may vary in size and shape from being small, circular, and only 5 mm in diameter to being lengthwise openings 3-4 cm long. There is a high prevalence of associated medial knee symptoms (80%) that are relieved by complete resection. Since the plical fenestration does not appear to abrade the articular cartilage, symptoms are probably the result of medial wall inflammation.

Adolescent↗
PubMed1987

Complete posterior acromioclavicular dislocation. A case report.

While acromioclavicular joint injury is not uncommon, a complete posterior dislocation in which the distal clavicle penetrates and is entrapped by the trapezius muscle is among the most rare. Early open reduction with reconstruction of the periosteal-muscular envelope as well as repair of the coracoclavicular ligaments permitted a rapid and full recovery. No previous report has indicated any concurrent pulmonary problems, but as this case report and literature review indicate, a careful evaluation of the pulmonary status is mandatory since pneumothorax and pulmonary contusions are possible.

Acromioclavicular Joint↗
PubMed1985

Meniscal repair. An arthroscopic technique.

Repair of a longitudinal peripheral meniscal tear permits salvage of this structure in a high percentage of cases. In previous reports an arthrotomy was used to accomplish this repair; in this paper an arthroscopic technique is presented. The potential risks are significant and include damage to the peroneal nerve and popliteal vascular structures, failure of meniscal healing and the usual complications of arthroscopy. The procedure is recommended only for the advanced arthroscopist who is advised first to establish clearly by cadaver dissections the anatomical relationships.

Arthroscopy↗
PubMedDate not supplied

Bioabsorbable interference screws for graft fixation in anterior cruciate ligament reconstruction.

The central one third of the patellar tendon autograft is popular because the bone-tendon-bone (BTB) construct provides several graft fixation options, robust graft incorporation, and a mechanically sufficient substitute. Interference screw fixation is one method used to secure the graft. Bioabsorbable interference screws may offer advantages over metal interference screws. Bioabsorbable screws are made from poly L-lactic acid (PLLA) and are absorbed by the body. This prospective, randomized study compared the safety and efficacy of the PLLA screw with that of the metal cannulated interference screw for anterior cruciate ligament reconstruction. There were 204 patients randomly assigned to the Bioscrew (Linvatec, Largo, FL) (n = 103) or the metal interference screw (n = 101) groups at four sites. The mean age was 30 years. There were 66 women and 138 men. Mean follow-up was 30 months for Bioscrews and 28 months for metal screws; the average follow-up interval was 2.4 years. The Lysholm mean scores at 4 years for the 32 patients seen at this interval were 95.0 and 97.2 for the Bioscrew and metal screw group, respectively. Ligament laxity comparisons made with an instrumented arthrometer at manual maximum force resulted in side-to-side mean score differences of B = 1.8mm and M = 1.6mm. The Tegner activity level score means were B = 6.1 and M = 5.8. Other variables examined included pain, thigh size, meniscal tests, Lachman's test, range of motion, anterior drawer, pivot shift, patellofemoral crepitus and tenderness, and joint effusion. None of these variables showed a statistically significant difference between groups. No radiographic evidence of osteolytic change or bone resorption around the Bioscrews was observed. There were no complications related to loss of fixation, toxicity, allergenicity, or other evidence of osteolytic or inflammatory reaction. In every assessment between groups there was no difference found. There were 12 PLLA screws that broke during insertion without any adverse effects. The PLLA headless cannulated interference fit screws produce equal results to similarly designed metal screws.

Adolescent↗
PubMedDate not supplied

Flipped patellar tendon autograft anterior cruciate ligament reconstruction.

To determine the efficacy of an anterior cruciate ligament (ACL) graft that customizes length and facilitates anatomic outlet fixation, a prospective study of the "flipped" patellar tendon autograft ACL reconstruction began in 1995. This technique shortens the tendon portion to match the intra-articular length by rotating 1 bone plug 180 degrees proximally onto the tendon, thus flipping the bone plug over its ligamentous insertion. Bioscrews (poly L-lactic acid; Linvatec, Largo, FL) secured the grafts. All patients undergoing this procedure with a minimum 21 months follow-up were reviewed. Preoperative and postoperative Tegner, Lysholm, and IKDC activity scores, and Lachman and pivot shift tests were obtained. Postoperative KT testing and radiographs were obtained. Fifty patients were followed-up for an average of 28 months (range, 21 to 39 months). Average patient age was 34 years (range, 16 to 52 years). Tegner scores increased from 2.0 preoperatively to 6.0 postoperatively. Lysholm scores increased from 46 preoperatively to 93 at follow-up, with 86% excellent (66%) or good (20%). IKDC activity scores increased from 3.1 preoperatively to 1.7 postoperatively. KT manual-maximum difference at follow-up averaged 0.7 mm, with 74% less than 3-mm, 18% 3- to 5-mm, and 8% greater than 5-mm difference. Postoperative Lachman results were 0 in 45 patients and 1+ in 5 patients. Postoperative pivot shift was absent in all but 1 patient. Full extension was achieved in all cases and flexion averaged 136 degrees with no patient having less than 120 degrees flexion. No lytic bone changes or tunnel widening were seen. The flipped patellar tendon autograft reduces graft length to its intra-articular portion, increasing graft stability, isometry, and stiffness, and avoiding tunnel graft mismatch with clinically excellent results.

Absorbable Implants↗