Biomedical subjects

V J DiStefano

Publications and source records attributed to V J DiStefano.

10 recordsLinked to original sources

PubMed1998

Revascularization and ligamentization of autogenous anterior cruciate ligament grafts in humans.

Forty-eight patients were enrolled in a study to determine the time interval for maturity and remodeling following arthroscopically assisted autogenous anterior cruciate ligament reconstruction (ACLR). Two biopsy specimens, one superficial and one deep, at the same level in the midsubstance of the ACL were obtained. Graft age, time from ACL reconstruction to biopsy, ranged from 3 months to 120 months. The patients were placed into four groups, (1) 3 to 6 months, (2) 7 to 12 months, (3) more than 12 months, and (4) control, in accordance with the time following ACL reconstruction. Each specimen was independently evaluated using light microscopy by two different observers in a blinded design. The biopsy specimens were evaluated for vascularity, cellularity, fiber pattern, and metaplasia when compared with the normal ACL. None of the patients was protected from activity as a result of ligament biopsy and no adverse outcomes were reported as a result of biopsy. Our study showed that fiber pattern, cellularity, vascularity, and degree of metaplasia obtained gross histological similarity with a normal ACL by 12 months after autogenous reconstruction. Unexpectedly, no significant statistical differences were noted for all grafts more than 6 months after ACLR, for two of the histological features studied, vascularity and fiber pattern, P=.05. We conclude that by 12 months after autogenous ACLR, graft maturity resembles a normal ACL. Additionally, because no statistical differences were noted in vascularity and fiber pattern after 6 months following autogenous ACLR, significant graft maturity may occur before 12 months. This may allow early postoperative return to full activity and support proponents of accelerated rehabilitation programs following autogenous ACLR.

Adult↗

PubMed1998

Tibial tunnel bone grafting: a new technique for dealing with graft-tunnel mismatch in endoscopic anterior cruciate ligament reconstruction.

A problem that is frequently encountered during endoscopic anterior cruciate ligament reconstruction bone-patellar tendon-bone autograft is that the graft is often too long and protrudes from the tibial tunnel. If less than 20 mm of the bone plug remains in the tibial tunnel, interference screw fixation cannot safely be used, and an alternate form of fixation may have to be employed. A simple technique has been developed to deal with this problem. The technique involves bone-grafting the tibial tunnel with a cancellous core of bone that is removed while creating the tibial tunnel. This not only makes it possible to safely use interference screw fixation in all cases, but it also makes it possible to place the point of graft fixation very near the anatomic anterior cruciate ligament insertion site.

Anterior Cruciate Ligament↗

PubMed1996

Femoral nerve palsy after arthroscopic surgery with an infusion pump irrigation system. A report of three cases.

One patient developed complete, and two patients, partial, femoral nerve palsy after arthroscopic surgery in which an infusion pump was used to operate an irrigation system. In one case, hip flexor and quadricep function was completely lost after the patient underwent arthroscopic partial medial meniscectomy without the use of a tourniquet. A CT scan of the pelvis demonstrated considerable fluid accumulation in the thigh and inguinal regions. The remaining two patients developed quadriceps weakness, but not complete femoral nerve palsy, after arthroscopic-assisted anterior cruciate ligament reconstructions. Although tourniquets were used in these latter two procedures, the pressures were low (300 to 325 mm Hg) and the tourniquet times not excessive, suggesting that femoral nerve palsy in these two patients resulted from fluid extravasation. In all three cases, muscle function returned within 6 to 7 months, but sensory nerve deficits were still present at that time.

Adult↗

PubMed1980

Function, post-traumatic sequelae and current concepts of management of knee meniscus injuries: a review article.

Long thought to be expendable or insignificant for function, the menisci may well be very important structures in the knee joint. Menisci are of critical importance from the standpoint of stability, shock absorption, load transmission, and lubrication, and also play a role in preventing synovial impingement, and in defining the endpoints of flexion and extension. In the wake of meniscectomy, certain predictable time-related events afflict the joint, i.e., instability and degenerative arthrosis. These eventualities are less pronounced following partial resection, and lend credence and support to the concept of subtotal meniscectomy. Meniscal surgery has taken on new dimensions with the advent of arthroscopy, which permits initial sparing and continued observation of meniscal lesions of questionable significance, as well as low morbidity partial resection in trained hands. The efficacy of meniscoplasty vis-à-vis suturing of peripheral tears is noteworthy. Present evidence suggests that traditional meniscectomy is best reserved for those lesions which do not lend themselves to partial resection, and should be combined with advancement of the corresponding capsuloligamentous complex and perhaps in some cases, even by dynamic tendon transfers.

Adolescent↗

PubMed1977