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Biomedical subjects

R W Wright

Publications and source records attributed to R W Wright.

95 records · Page 6Linked to original sources
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Anterior cruciate ligament reconstruction as an outpatient procedure.

During a 27-month period, 222 patients with 227 anterior cruciate ligament-deficient knees underwent arthroscopically assisted reconstructions as outpatient procedures. Bone-tendon-bone autografts were used for 169 of these reconstructions; the other 58 were done with bone-tendon-bone allografts. Additional procedures were performed on 180 of the patients. The interval from injury to reconstruction averaged 29 months. The protocol developed at our clinic employs a general anesthetic administered with the intent of same-day discharge, infiltration of the skin and joint with bupivacaine, a cold compressive dressing, and the use of both ketorolac tromethamine and a Schedule III narcotic (acetaminophen with codeine or with propoxyphene) for postoperative pain control. At an average followup of 10 months, no readmissions in the immediate postoperative period had been required and no short- or long-term postoperative complications could be attributed to the protocol. This safe and effective technique offers the patient the advantage of anterior cruciate ligament reconstruction as a same-day procedure and allows the surgeon to implement its use in any outpatient setting without additional discharge planning.

Acetaminophen↗
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The effect of knee effusions on KT-1000 arthrometry. A cadaver study.

We studied five fresh-frozen lower extremity cadaveric specimens to assess the effect of knee effusions on KT-1000 arthrometry. Part 1 consisted of serial 10-ml injections (up to 100 ml) of saline into each knee and measurements of midpatellar knee circumference and anterior displacement using the KT-1000 arthrometer at 67, 89, and 134 N after each 10-ml increment. Part 2 consisted of evacuation of the saline and transection of the anterior cruciate ligament through a 2-cm medial parapatellar arthrotomy. Each knee again underwent the part 1 protocol. Sequential injections in parts 1 and 2 showed incremental increases in knee circumference and KT-1000 arthrometer measurements for all three force levels. A 3-mm increase in anterior translation compared with the value at 0-ml injection was obtained by the 70-ml injection point in both groups. At the 70-ml injection point, the patella was ballottable, thereby affecting anterior measurements-despite posterior force on the patella sensor pad-because of the KT-1000 arthrometer reference level at midpatella. This increase in KT-1000 arthrometer readings could erroneously imply anterior cruciate ligament disruption in the clinical situation of right-to-left comparison. We conclude that clinicians using the KT-1000 arthrometer should aspirate knees that have effusions and a ballottable patella to minimize false-positive readings.

Aged↗
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Magnetic resonance imaging as a tool to predict meniscal reparability.

One hundred six patients who underwent high field strength magnetic resonance imaging and subsequent arthroscopy of the knee were evaluated to determine the accuracy of magnetic resonance imaging in predicting meniscal tear reparability. Each scan was independently read by three examiners with varying degrees of expertise: a musculoskeletal radiologist, a senior orthopaedic surgeon, and a general radiologist. Each suspected tear was characterized by its morphologic type, maximum length, and minimum distance from the meniscosynovial junction. A prediction was then made of whether the tear was reparable. There were 115 meniscal tears noted in the 106 patients studied. The examiners' ability to correctly estimate tear type was only fair, with correct estimates made only 14% to 67% of the time. The overall correlation of the three examiners to correctly predict the method of treatment was fair. The average accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of magnetic resonance imaging in predicting meniscal reparability were 74%, 29%, 89%, 50%, and 80%, respectively; for predicting meniscectomy, these values were 69%, 68%, 75%, 90%, and 43%, respectively. There were no significant differences between the three examiners in the accuracy of their treatment predictions. The results of this study suggest that magnetic resonance imaging is only moderately reliable for the prediction of meniscus reparability. In addition, the training of the reader does not appear to significantly influence the results.

Adolescent↗
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Comparison of fresh and cryopreserved human sperm attachment to bovine oviduct (uterine tube) epithelial cells in vitro.

Formation of a prefertilization sperm reservoir in mammals is thought to occur via sperm cell attachment to fallopian tube or oviduct epithelial cells (OEC). Recent data suggests that such an interaction also occurs for human sperm in the fallopian tube. We have previously validated an in vitro sperm-OEC coculture system utilizing bovine OEC monolayers to study postejaculatory human sperm physiology. This study was done to evaluate aspects of human sperm attachment to OEC in coculture and to determine if such attachment and subsequent sperm survival differ between fresh and cryopreserved human sperm. In experiment 1, aliquots of fresh (n = 4) or cryopreserved sperm (n = 3) from normospermic donors were placed into coculture with OEC monolayers at dilutions ranging from 2 x 10(5) to 15 x 10(6) sperm per well. Numbers of each type of sperm attaching to OEC at each concentration were determined. In experiment 2, fresh and cryopreserved sperm from the same donors (n = 4) were put into OEC coculture to observe numbers attaching and subsequent survival time for each sperm type. Sperm attachment to OEC occurred in a linear, dose-dependent manner for fresh and cryopreserved sperm in experiment 1, both as a function of total sperm numbers and as a function of numbers of motile sperm applied (R2 > or = 0.79). However, cryopreserved sperm attached to the OEC at a slower rate than fresh (as a function of the average increase in the number of sperm attaching per unit increase in the number of sperm applied; P < 0.05), with an overall lower percentage of the total and motile sperm applied attaching to OEC (P < 0.01) for cryopreserved versus fresh sperm. Fewer cryopreserved sperm also attached to the OEC, as compared with fresh sperm, in experiment 2 (P < 0.05), even after correcting for motility differences between the sperm types. Sperm survival time in coculture was also decreased for cryopreserved sperm as compared with fresh sperm (P = 0.005). Understanding the kinetics of sperm and OEC interactions may be useful for developing improved cryopreservation protocols or bioassays of sperm function.

Animals↗