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Biomedical subjects

Gary G Poehling

Publications and source records attributed to Gary G Poehling.

10 recordsLinked to original sources
PubMed2006

Initial biomechanical properties of staple-anchor Achilles tendon allograft and interference screw bone-patellar tendon-bone autograft fixation for anterior cruciate ligament reconstruction in a cadaveric model.

PURPOSE: Anterior cruciate ligament (ACL) reconstruction is a common procedure that has a fairly high success rate. Despite such success, controversy exists with regard to fixation and graft type. The purpose of this study was to quantify the maximum load to failure for staple-anchor freeze-dried Achilles tendon allograft fixation compared with interference screw bone-pattelar tendon-bone autograft fixation at the time of insertion for ACL reconstruction. METHODS: Eleven pairs of cadaveric knees were prepared for ACL reconstruction by disarticulation before graft insertion. The tibia and femur were mounted separately onto an MTS machine and were loaded to failure in line with the tunnels. Femoral fixation for the allograft was provided by a staple anchor; tibial fixation was provided by a suture anchor. Titanium interference screws on the femoral and tibial sides provided autograft fixation. A paired t test was performed to compare mechanical testing results in the 2 groups. RESULTS: Mean maximum load to failure for the allograft was 58.7 N (range, 32.3 to 92.6 N) and 119.6 N (range, 82 to 165.9 N) for the femur and the tibia, respectively, compared with 228.2 N (range, 74.2 to 352 N) and 232.9 N (range, 65.1 to 553.1 N) for the autografts. This difference was statistically significant (P < .001) for femoral fixation, but it was not statistically significant for tibial fixation (P = .186). CONCLUSIONS: Soft tissue Achilles tendon allograft with staple fixation is a significantly weaker fixation construct when compared with autograft bone-patellar tendon-bone with interference screw fixation. CLINICAL RELEVANCE: This study shows significantly weaker fixation in the staple-alograft construct and yet this construct has had at least equivalent results over a 5-year time frame, indicating that rigid femoral fixation may not be a critical factor in long-term results.

Achilles Tendon↗
PubMed2005

Cost comparison of anterior cruciate ligament reconstruction: autograft versus allograft.

PURPOSE: To compare the economic costs associated with anterior cruciate ligament (ACL) reconstruction using either autograft or allograft. The surgical costs are reported, including charge categories, for each procedure. All operations were performed in the Southern United States of America. TYPE OF STUDY: Evaluation of cost data collected from a group of patients participating in a prospective, nonrandomized trial. METHODS: A total of 122 patients with ACL-deficient knees undergoing surgical reconstruction using either bone-patellar tendon-bone autograft (n = 86) or freeze-dried Achilles tendon allograft (n = 37) were analyzed (1 patient underwent 2 allograft reconstructions). Patient selection for groups was based on the physician performing the surgery (2 surgeons performed autografts and 1 performed allografts). Groups were compared with respect to age, sex, race, and occupation. Hospital charge data were retrieved from the billing department and divided into various categories for comparison of the 2 groups. RESULTS: The mean hospital charge for ACL reconstruction was 4,622 dollars for allograft and 5,694 dollars for autograft (P < .0001). Differences included increased operating room time and a greater likelihood of overnight hospitalization for autograft procedures. This was slightly offset by higher charges for operating room supplies for allograft reconstructions owing to the cost of the graft itself. CONCLUSIONS: Allograft reconstruction of the ACL was significantly less expensive than autograft bone-patellar tendon-bone reconstruction. Allograft ACL reconstruction is a less costly alternative to autograft reconstruction. LEVEL OF EVIDENCE: Level IV, economic analysis with no sensitivity analysis.

Adult↗
PubMed2005

Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft.

PURPOSE: To prospectively compare outcomes of primary anterior cruciate ligament (ACL) reconstruction with either Achilles tendon allograft with soft-tissue fixation or standard bone-patellar tendon-bone autograft with interference screw fixation. TYPE OF STUDY: Prospective comparative case series. METHODS: A group of 41 patients who underwent soft-tissue allograft reconstruction and a group of 118 patients who underwent autograft bone-patellar tendon-bone reconstruction were included in the final results. Patients were evaluated preoperatively and postoperatively at 1 to 2 weeks, 6 weeks, 3 months, 6 months, and then annually for 5 years. Objective measures of outcome included KT-1000 measurements, range of motion, ligamentous integrity, thigh atrophy, and International Knee Documentation Committee score. Subjective evaluations included patient completion of 5 questionnaires documenting functional status, pain, and health-related quality of life: (1) the short-form McGill Pain Questionnaire, (2) a patient subjective assessment of knee function and symptoms, (3) a patient subjective assessment follow-up, (4) a knee pain scale, and (5) the RAND 36-Item Health Survey. Mixed models analysis of variance was used to compare the outcomes of the treatment groups using baseline values of the study variables as a covariate. RESULTS: Autograft patients reported significantly more pain on the bodily pain subscale of the RAND-36 than the allograft group at 1 week (P = .0006), 6 weeks (P = .0007), and 3 months (P = .0270). Autograft patients reported more pain than allograft patients on the McGill Pain Scale visual analog scale at 1 to 2 weeks (P < .0001) and 6 weeks (P = .0147). Patient assessment of function and symptoms showed that a higher proportion of patients reported normal or nearly normal knee function in the allograft group than in the autograft group at 3 months (33% v 14%, P = .0558, respectively). Fewer activity limitations were reported by allograft patients than autograft patients at 6 weeks (P = .0501), 3 months (P = .0431), and 6 months (P = .0014). After reconstruction, the allograft group displayed significantly more laxity in KT-1000 measurements at all time points than the autograft group (P = .0520). These measurements decreased over time for both groups (P < .0001). CONCLUSIONS: Five-year follow-up of patients undergoing ACL reconstruction with allograft versus autograft were compared objectively and subjectively. Both groups of patients achieved similar long-term outcomes. Overall, the allograft patients reported less pain at 1 and 6 weeks after surgery, better function at 1 week, 3 months, and 1 year, and fewer activity limitations throughout the follow-up period. LEVEL OF EVIDENCE: Level II, prospective cohort study.

Adult↗
PubMed2004

Arthroscopic reduction versus fluoroscopic reduction in the management of intra-articular distal radius fractures.

PURPOSE: Although arthroscopy offers an unparalleled view of intra-articular pathology, its use in the treatment of intra-articular distal radius fractures remains controversial. This study was designed to compare functional and radiologic outcomes of arthroscopically assisted (AA) versus fluoroscopically assisted (FA) reduction and external fixation of distal radius fractures. TYPE OF STUDY: Retrospective, case-matched comparison of 2 different procedures. METHODS: Between January 1995 and December 1999, 15 patients with comminuted intra-articular distal radius fractures underwent AA external fixation and percutaneous pinning. Fifteen patients underwent external fixation and FA reduction and pinning. Patients in both groups were matched for fracture pattern and age. RESULTS: Follow-up evaluation consisted of an evaluation of grip strength and range of motion as well as radiographic evaluation of palmar tilt, radial shortening, stepoff, and degenerative changes. Health-related quality of life outcomes were assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Patients who underwent AA surgery had significantly improved supination compared with those who underwent FA surgery (88 degrees v 73 degrees; P =.02). AA reduction also resulted in improved wrist extension (mean, 77 degrees v 69 degrees; P =.01) and wrist flexion (mean, 78 degrees v 59 degrees; P =.02). Radial shortening, Knirk and Jupiter congruity grades, and DASH scores were similar for both groups. CONCLUSIONS: AA reduction and fixation of intra-articular distal radius fractures permits a more thorough inspection of the ulnar-sided components of the injury. At follow-up evaluation, patients who underwent AA procedures had a greater degree of supination, flexion, and extension than patients undergoing FA surgery. LEVEL OF EVIDENCE: Level II prospective cohort study.

Adult↗
PubMed2004

Allograft maturation in anterior cruciate ligament reconstruction.

This case report describes the histologic incorporation of a freeze-dried Achilles tendon allograft used for arthroscopic anterior cruciate ligament (ACL) reconstruction. The patient had regained stability from the procedure but had worsening pain over the medial compartment. The patient underwent total knee arthroplasty 2.5 years after ACL reconstruction. The surgeon was able to observe the graft in situ and examine the histology of the graft tunnel interface. This interface demonstrated Sharpey's fibers.

Achilles Tendon↗