Biomedical subjects

P A Torzilli

Publications and source records attributed to P A Torzilli.

68 records · Page 4Linked to original sources

PubMedDate not supplied

Effect of humeral head component size on hemiarthroplasty translations and rotations.

Glenohumeral translation and rotation were measured in 6 grossly normal, fresh frozen shoulder preparations while a manual load was applied to the humerus. The same tests (maximum elevation, total rotation, anterior/posterior (A/P) translation, and inferior translation) were repeated for each shoulder through 8 series: 1 with the shoulder intact, 1 with the shoulder vented, and 6 with progressively larger humeral head components after hemiarthroplasty. There was an inverse linear relation between humeral head component size and all 4 outcome variables. Replacing the native head with a component of equal diameter reduced elevation 20%, rotation 40%, A/P translation 50%, and inferior translation 60% in the vented shoulder. Replacing the native head with a component of equal effective volume decreased elevation 8%, rotation 20%, A/P translation 25%, and inferior translation 40% in the vented shoulder. Increasing humeral head component size decreased rotation, A/P translation, and inferior translation by similar percentages and elevation somewhat less. Humeral head component size is better described in terms of volume than in terms of diameter or offset.

Arthroplasty, Replacement↗

PubMedDate not supplied

Effect of joint compression on inferior stability of the glenohumeral joint.

UNLABELLED: To determine the relative importance of negative intraarticular pressure, capsular tension, and joint compression on inferior stability of the glenohumeral joint we studied 17 fresh, normal adult cadaver shoulders using a "3 degrees of freedom" shoulder test apparatus. Translations were measured in intact and vented shoulders while a 50-N superior and inferior directed force was applied to the shoulder. Three different joint compressive loads (22 N, 111 N, 222 N) were applied externally. Tests were performed in 3 positions of humeral abduction in the scapular plane (0 degree, 45 degrees, 90 degrees) and in 3 positions of rotation (neutral, maximal internal, and maximal external). After tests of the intact and vented shoulder, the glenohumeral ligaments were sectioned and tests were repeated. With minimal joint compression of 22 N, negative intraarticular pressure and capsular tension limited translation of the humeral head on the glenoid. Increasing the joint compressive load to 111 N resulted in a reduction of mean inferior translation from 11.0 mm to 2.0 mm at 0 degree abduction, from 21.5 mm to 1.4 mm at 45 degrees abduction, and from 4.5 mm to 1.2 mm at 90 degrees abduction. With a compressive load of 111 N, venting the capsule or sectioning of glenohumeral ligaments had no effect on inferior stability. CLINICAL RELEVANCE: Glenohumeral joint compression through muscle contraction provides stability against inferior translation of the humeral head, and this effect is more important than negative intraarticular pressure or ligament tension.

Adult↗

PubMedDate not supplied

Thermal modification of collagen.

Shoulder capsular shrinkage has recently been proposed as a therapeutic modality in a select group of patients with instability. Basic science research studying the mechanism of collagen shrinkage and the effect of shrinkage on the tissue's mechanical properties is essential to define the ideal process by which to achieve optimal tissue shrinkage. Tissue shrinkage is a function of both time and temperature. This relationship was studied, and a model was derived to describe the relationship mathematically. Tissue shrinkage rate was extremely sensitive to temperature changes. The purpose of this study, was to shrink collagenous tissue thermally and then to measure the mechanical property changes as a function of tissue shrinkage. Uniaxial tensile testing of normal and heat-shrunken bovine tendon was carried out, and a model was developed to express the relationship between shrinkage and mechanical properties. We found that the mechanical properties decreased with increasing shrinkage, and that the maximal allowable shrinkage before significant material property changes occurred was between 15% to 20%. Ultrastructural analysis with transmission electron microscopy showed denaturation of the collagen fibrillar structure and provided direct support for the observed material changes.

Animals↗

PubMedDate not supplied

Mechanical evaluation of three methods of plating distal radial osteotomies.

Eighteen intact canine cadaver radii underwent nondestructive axial testing, and were osteotomized, plated, and retested. Each bone was tested with and without mediolateral or craniocaudal restriction of motion. Fixation of the osteotomies was performed under static compression with a cranially applied 5-hole 3.5 mm dynamic compression plate, a cranially applied 7-hole 3.5 mm T-plate, or a medially applied 7-hole 2.7 mm dynamic compression plate. There was no loss of axial stiffness after osteotomy and fixation, and there were no differences in axial stiffness between the methods of fixation. Mediolateral stiffness (bending around the craniocaudal axis) was consistently greater than craniocaudal stiffness (bending around the mediolateral axis) before and after osteotomy and plate fixation. There was no difference in the axial stiffness of otherwise intact radii when craniocaudal or mediolateral screw holes were drilled; however, all radii with craniocaudal screw holes and one radius with mediolateral screw holes fractured at a screw hole at high axial loads.

Animals↗

PubMedDate not supplied

The effect of triple pelvic osteotomy on hip force in dysplastic dogs: a theoretical analysis.

The effect of a triple pelvic osteotomy (TPO) procedure on the forces acting about the hip joint was examined in five dysplastic canine hips using a previously described theoretical analysis. Hip reaction force (Fh) and its angle of application (theta h) were calculated from radiographic measurements made before and after TPO procedures which sequentially increased acetabular ventroversion from 0 degree to 20 degrees, 30 degrees, and 40 degrees. The results of the in vitro study showed that Fh decreased with increasing acetabular ventroversion reaching an asymptotic value between 30 degrees and 40 degrees. The decrease in Fh corresponded to an increase in theta h toward the vertical, with statistical significance found in both Fh and theta h between 0 degree and 20 degrees. The changes observed in Fh and theta h after TPO were attributed to the medialization of the femoral head resulting from the reduction of the subluxated head. The results of this study suggest that the noted reduction in the magnitude of the forces acting on the hip joint may act in concert with increased coverage of the femoral head to effect the beneficial clinical results observed with the TPO procedure.

Animals↗

PubMedDate not supplied

Fourier transform infrared imaging spectroscopy analysis of collagenase-induced cartilage degradation.

Collagenase treatment of cartilage serves as an in vitro model of the pathological collagen degradation that occurs in the disease osteoarthritis (OA). Fourier transform infrared imaging spectroscopic (FT-IRIS) analysis of collagenase-treated cartilage is performed to elucidate the molecular origin of the spectral changes previously found at the articular surface of human OA cartilage. Bovine cartilage explants are treated with 0.1% collagenase for 0, 15, or 30 min. In situ collagen cleavage is assessed using immunofluorescent staining with an antibody specific for broken type II collagen. The FT-IRIS analysis of the control and treated specimens mirrors the differences previously found between normal and OA cartilage using an infrared fiber optic probe (IFOP). With collagenase treatment, the amide II/1338 cm(-1) area ratio increases while the 1238 cm(-1)/1227 cm(-1) peak ratio decreases. In addition, polarized FT-IRIS demonstrates a more random orientation of the collagen fibrils that correlate spatially with the immunofluorescent-determined regions of broken type II collagen. We can therefore conclude that the spectral changes observed in the collagenase-treated cartilage, and similarly in OA cartilage, arise from changes in collagen structure. These findings support the use of mid-infrared spectral analysis, in particular the minimally invasive IFOP, as potential techniques for the diagnosis and management of degenerative joint diseases such as osteoarthritis.

Animals↗

PubMedDate not supplied

Biologic fixation of ligament prostheses and augmentations. An evaluation of bone ingrowth in the dog.

The biologic fixation (bone ingrowth) of three prosthetic ligament devices (bovine xenograft Xenotech Laboratories, Inc., Irvine, CA; Gore-Tex, W. L. Gore and Associates, Flagstaff, AZ; and knitted dacron, Stryker, Kalamazoo, MI) and one ligament augmentation device (LAD, braided polypropylene, 3M, St. Paul, MN) were evaluated in vivo. The devices were placed unstressed, in an extraarticular location in the cortical-cancellous bone of the proximal femur and humerus of dogs. Six months following implantation tissue ingrowth was evaluated using high resolution radiography, routine histology, scanning electron microscopy, and biomechanical tensile tests to measure the ultimate (maximum) pull-out strength of the devices. The knitted dacron and Gore-Tex prosthesis showed marked ingrowth of trabecular bone into the interstices of the device with evidence of bone growth around individual fibers of the prosthesis. The bovine xenograft demonstrated bone immediately adjacent to the material with evidence of spicular ingrowth of bone into the natural clefts of the prosthesis. The LAD showed no evidence of bone ingrowth and demonstrated a fibrous tissue interface between the prosthesis and surrounding trabecular bone. Six months following implantation the pull-out strengths of the devices were as follows: knitted dacron, 445.7 +/- 151.0N; Gore-Tex, 438.1 +/- 131.94N; bovine xenograft, 332.8 +/- 64.2N; and LAD, 78.4 +/- 47.9N. Statistical analysis revealed no significant difference between the pull-out strengths of the knitted dacron, Gore-Tex, and bovine xenograft.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Static capsuloligamentous restraints to superior-inferior translation of the glenohumeral joint.

The purpose of this study was to determine the contributions of specific capsuloligamentous structures to restraining superior-inferior translation of the glenohumeral joint. Eleven cadaveric shoulders were tested using a four degrees-of-freedom test apparatus. The humerus was free to translate in three planes and free to flex and extend when a superior and inferior force of 50 N was applied. Testing was performed in three positions of abduction (0 degree, 45 degrees, and 90 degrees) and three positions of rotation (neutral, maximum internal, and external). Shoulders were tested intact, vented, and after division of specific capsuloligamentous structures. The primary restraint to inferior translation of the adducted shoulder was the superior glenohumeral ligament. The coracohumeral ligament appeared to have no significant suspensory role. With progressive abduction, the anterior and posterior portions of the glenohumeral ligament become the main static stabilizers resisting inferior translation: the anterior portion was the primary capsular restraint at 45 degrees of abduction, while the posterior portion was the primary restraint at 90 degrees of abduction, neutral rotation. Our results indicate that clinical assessment of glenohumeral translation in the superior-inferior plane should be performed in multiple positions of abduction and rotation.

Biomechanical Phenomena↗

PubMedDate not supplied

The effect of joint-compressive load and quadriceps muscle force on knee motion in the intact and anterior cruciate ligament-sectioned knee.

To determine the effect of an externally applied joint-compressive load and a quadriceps muscle force on knee motion, we tested nine intact cadaveric knees and four knees after sectioning of the anterior cruciate ligament. Anteroposterior translation was measured at 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 90 degrees of knee flexion after the application of an anteroposterior force of 100 N, a joint-compressive load of 0, 111, 222, 333, or 444 N, and a quadriceps force of 0 or 133 N. Both a joint-compressive load and a quadriceps force significantly decreased total anteroposterior translation by as much as 50% to 66% in intact knees and 42% to 71% in anterior cruciate ligament-sectioned knees. A substantial anterior translation was also found with the application of a joint-compressive load or a quadriceps force and no anterior force. We termed this translation an anterior neutral-position shift. The anterior neutral-position shift was significantly greater in the ligament-sectioned knees compared with the intact knees, so much so that at flexion angles greater than 15 degrees, the application of a 100-N posterior force could not translate the tibia to the most anterior position achieved in the intact knee with a 100-N anterior force.

Aged↗

PubMedDate not supplied

Strategies for an anterior capsular shift of the shoulder. A biomechanical comparison.

We evaluated the effect of two different anterior capsular shift strategies on load-induced multidirectional glenohumeral motion. Nine cadaveric shoulders were tested on a special test apparatus in which three motions were constrained but which allowed simultaneous measurement of three translations: anteroposterior, mediolateral, and superoinferior. A simulated Bankart lesion was created by detaching the inferior glenohumeral ligament and labrum from the anterior glenoid from 5 mm superior to the anterior band of the inferior glenohumeral ligament to a point just posterior to the infraglenoid tubercle. The two types of medial-based anterior capsular shifts were performed sequentially using fixation via a transglenoid drill hole and No. 2 suture. One shift medialized the anterior capsule on the glenoid by 5 mm; the other one shifted the anterior capsule 5 mm superior on the anterior glenoid. Biomechanical testing was done in two positions of humeral elevation in the scapular plane, three positions of humeral rotation, and with an externally applied joint compression load of 22 N. Glenohumeral motion was measured in the intact state, after creation of the simulated Bankart lesion, and after each of the two anterior capsular shifts. Both the superior and medial shifts of the capsule decreased anterior glenohumeral translation to equivalent extents. For posterior and inferior translation at 45 degrees elevation, the superior shift significantly decreased translation to a greater extent than did the medial shift.

Aged↗

PubMedDate not supplied

The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study.

The role of the posterolateral and cruciate ligaments in restraining knee motion was studied in 11 human cadaveric knees. The posterolateral ligaments sectioned included the lateral collateral and arcuate ligaments, the popliteofibular ligament, and the popliteal tendon attachment to the tibia. Combined sectioning of the anterior cruciate and posterolateral ligaments resulted in maximal increases in primary anterior and posterior translations at 30 degrees of knee flexion. Primary varus, primary internal, and coupled external rotation also increased and were maximal at 30 degrees of knee flexion. Combined sectioning of the posterior cruciate and posterolateral ligaments resulted in increased primary posterior translation, primary varus and external rotation, and coupled external rotation at all angles of knee flexion. Examination of the knee at 30 degrees and 90 degrees of knee flexion can discriminate between combined posterior cruciate ligament and posterolateral injury and isolated posterolateral injury. The standard external rotation test performed at 30 degrees of knee flexion may not be routinely reliable for detecting combined anterior cruciate and posterolateral ligament injury. However, measurements of primary anterior-posterior translation, primary varus rotation, and coupled external rotation may be used to detect combined anterior cruciate and posterolateral ligament injury.

Aged↗

PubMedDate not supplied

The role of the popliteofibular ligament in stability of the human knee. A biomechanical study.

The popliteal tendon has a significant attachment to the fibula, the popliteofibular ligament. The role of this ligament in knee stability has not been determined. In this study we used selective cutting techniques to measure the static contribution of the popliteal tendon attachments to the tibia and the popliteofibular ligament for stability of the knee. Sectioning of all the posterolateral structures except the popliteal tendon attachments to the tibia or the popliteofibular ligament resulted in increased primary posterior translation, varus rotation, external rotation, and coupled external rotation. Although statistically significant, these increases were small. Sectioning of all the posterolateral structures resulted in larger increases in primary posterior translation, varus rotation, external rotation, and coupled external rotation. Our data indicate that the popliteal tendon attachments to the tibia and the popliteofibular ligament are important in resisting posterior translation and varus and external rotation. If an isolated injury to the posterolateral structures occurs, anatomic reconstruction of the major ligaments that restrain posterior translation and varus and external rotation may provide the best functional result. Reconstruction for isolated posterolateral instability should include anatomic attachment of the popliteal tendon to the tibia and the popliteofibular ligament.

Aged↗

PubMedDate not supplied

The combined dynamic and static contributions to subacromial impingement. A biomechanical analysis.

Ten human cadaveric shoulders were tested with a dynamic shoulder model simulating physiologic rotator cuff, deltoid, and biceps muscle forces. The combined effect of the muscle forces and acromial structure on subacromial impingement was measured with minimally invasive, miniature pressure transducers. Shoulders with large acromial spurs had significantly greater impingement pressures at the anterolateral acromion in neutral, internal, and external rotation compared with those with flatter acromia. Application of a biceps muscle force reduced anterolateral acromial pressures by 10%. Failure to simulate a supraspinatus force decreased acromial pressure 52% in shoulders with type III acromia in neutral rotation. Without rotator cuff forces applied, the maximum deltoid muscle force required to elevate the arm increased by 17%. Acromial pressures were increased when no rotator cuff forces were applied, but the increases were not significant. After an anterior acromioplasty, pressures decreased by 99% anteriorly. However, failure to achieve a flat surface posteriorly increased pressures in this location, especially with the shoulder in external rotation. Modeling the rotator cuff and deltoid muscle forces demonstrated the importance of the muscular force couple to center the humeral head during elevation of the arm. The inferior forces of the infraspinatus, teres minor, and subscapularis muscles were necessary to neutralize the superior shear force produced by the deltoid and supraspinatus muscles.

Acromioclavicular Joint↗

PubMedDate not supplied

A feasibility study for removing tissue contamination from porous implants.

Porous implants that are unpackaged in the operating room but not implanted are discarded because they must be considered potentially contaminated with tissue. To reduce this waste, a method was developed to decontaminate these implants so that they can be resterilized and implanted. This method consists of ultrasonic scrubbing, sequentially, in aqueous solutions of dishwashing detergent, 7% nitric acid, and 5.25% sodium hypochlorite. The effectiveness of the method was tested by contaminating samples of porous implants with tissue, subjecting them to the decontamination method, and then using the following techniques to determine whether any tissue remained. The weights of samples after decontamination were compared with their weights before contamination. The rate of removal of labeled protein contamination from samples was measured. The capacity of decontaminated samples to activate immune system cells was assayed. Bioburden evaluations were performed on decontaminated samples. Within the measurement capabilities of each technique, no tissue was detected in any sample after decontamination.

Animals↗