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Biomedical subjects

W A Grana

Publications and source records attributed to W A Grana.

At least 19 recordsLinked to original sources
PubMed2001

A comparison of outcomes at 2 to 6 years after acute and chronic anterior cruciate ligament reconstructions using hamstring tendon grafts.

PURPOSE: To compare short- to intermediate-term outcomes of patients in whom an acute or chronic anterior cruciate ligament (ACL) reconstruction was performed with a hamstring tendon graft. TYPE OF STUDY: A consecutive case series of patients who had 2-incision, arthroscopically assisted ACL reconstructions with a triple-strand hamstring tendon graft was retrospectively evaluated. METHODS: A total of 120 patients were evaluated at a mean of 44 months. The Tegner Activity Scale, individual components of the Cincinnati Knee Rating System, and the modified Lysholm Score were administered to all patients. A total of 93 patients (78%) returned for examination, instrumented ligament laxity testing, radiographs, isokinetic strength testing, and completion of the IKDC Standard Knee Ligament Evaluation Form. Data from patients undergoing reconstructions for acute and chronic ACL deficiencies were compared. The acute group was defined as reconstruction within 6 weeks of injury without recurrent episodes of instability. RESULTS: At surgery, significantly more (P <.05) cartilage abnormalities and partial medial menisectomies were found in the chronic group. At final follow-up, no significant differences (P >.05) were found between the acute and chronic groups for instrumented laxity, muscle strength, knee motion, or sports activity level. The acute group scored significantly higher (P <.05) on the Lysholm scale, Cincinnati Function scale, IKDC subjective assessment, and IKDC rating for pain at follow-up. The final IKDC grade resulted in significantly more (P =.039) normal knees for the acute group; however, 94.1% of acute and 92.9% of chronic knees were graded normal or nearly normal. CONCLUSIONS: Hamstring tendons are an excellent graft choice for ACL reconstruction in both acute and chronic injuries. According to the strict IKDC rating system, greater than 90% of all patients can be expected to have a normal or nearly normal knee at short- to intermediate-term follow-up; however, the chronic group will have fewer patients with a rating of normal.

Anterior Cruciate Ligament↗
PubMed2001

Anterior cruciate ligament reconstruction in the immature athlete: long-term results of intra-articular reconstruction.

From 1986-1992, a total of 21 ACL reconstructions were completed in 20 skeletally immature athletes with an average age of 13.7 years (range: 11.8-15.6 years). Fifteen patients underwent operative reconstruction with hamstring tendons with wide open physes and 6 patients with bone-patellar tendon-bone (BPTB). All grafts were anatomically placed through transphyseal bone tunnels in the femur and tibia. Nineteen of 20 patients (20 of 21 reconstructions) returned for follow-up at an average of 34 months (range: 17-89 months). All patients had reached skeletal maturity at follow-up. No patient had limb-length discrepancy >1 cm postoperatively. No change in tibiofemoral alignment was noted (average 4.5 versus 4.25, P=.69). Modified Lysholm score was 93/95, and 19 of 20 athletes returned to preinjury level sports activity. Ligament laxity side-to-side difference was <3 mm in 16 patients, 3-6 mm in 2 patients, and >6 mm in 2 patients. One patient developed recurrent symptomatic laxity and was lost to follow-up. Two late graft ruptures (1 hamstring and 1 BPTB graft) occurred after major reinjury during sports. In this group of patients, ACL reconstruction through bone tunnels successfully eliminated instability although the failure rate, including late graft ruptures, was higher than that usually reported for adults. No limb length or angular deformity developed as a result of the transphyseal tunnels.

Adolescent↗
PubMed2000

Tendon-to-bone healing of a semitendinosus tendon autograft used for ACL reconstruction in a sheep model.

Anterior cruciate ligament (ACL) reconstruction was performed in a single hind limb of 30 sheep using a doubled semitendinosus tendon graft. Three additional animals were used as controls. Histologic and biomechanical analysis was performed from 4-52 weeks postoperatively. Perpendicular collagen fibers were found connecting the tendon graft to the bone tunnels at 8 weeks. These fibers were seen circumferentially at 12 weeks. By 24 weeks, the bone tunnel was well-defined, and no further changes were observed at 52 weeks. Tendon incorporation within the femoral and tibial tunnels was similar at each interval. Although the small sample size did not permit statistical testing, the reconstruction strength was similar up to 12 weeks (15%-19% of controls). This increased at 24 (28%) and 52 (40%) weeks. The stiffness primarily increased from 4-8 weeks (18%-39%) and 24-52 weeks (52%-82%). Up to 12 weeks, failures occurred by graft pull-out from the bone tunnel. All 24- and 52-week specimens ruptured through the intra-articular portion of the graft, further indicating sufficient graft incorporation within the bone tunnels.

Animals↗
PubMed2000

Healing of articular cartilage: a review.

Currently, there is no one human technique that stands out as being better than another. The results of curettement or microfracture remain as good as anything else that is available. The healing in these defects seems to be as good as those that are achieved with osteochondral tissue graft or with chondrocyte culture techniques. The controlled prospective treatment of cartilage defects that compares these techniques to traditional methods has not been done.

Cartilage Diseases↗
PubMed1998

Strength of ACL reconstructions using semitendinosus tendon grafts.

PURPOSE: Patellar tendon autografts have been considered by many as the gold standard for intraarticular reconstruction of the anterior cruciate ligament (ACL). Hamstring tendon grafts are being used increasingly, however there are few studies focusing on their mechanical properties. The objectives of the present study are to determine the strength of a semitendinosus graft at various postoperative periods. METHODS: In Part I of the study, a looped semitendinosus graft was used to reconstruct the ACL in five frozen human cadaver knees with a simulated endoscopic technique. The immediate post-operative strength was determined by loading the knees of failure using a mechanical testing system. In Part II the effects of graft maturation and incorporation were considered. A similar graft was used to reconstruct the ACL in twelve ewe sheep. Their knees were harvested and tested at four, eight, and twelve weeks postoperatively. RESULTS: The mean maximum strength and stiffness of the cadaveric reconstructions were 352 N and 8.18 N/mm, respectively. All failures occurred at the fixation sites. The average strength of the sheep reconstructions was similar at four, eight, and twelve weeks (376 N. 415 N. and 323 N. respectively). The stiffness increased from 21.1 N/mm at four weeks to 46.7 N/mm at eight weeks and then remained the same. The failures occurred primarily by tendon pull-out of the femoral tunnel at four, eight and twelve weeks. CONCLUSIONS: Graft pull-out from the femoral tunnel implies incomplete tendon incorporation during the initial three months post-operatively. Activities which place high loads on the graft should be avoided during this period. Additionally, the mechanical properties of this hamstring graft reconstruction are similar to those reported for patellar tendon grafts in other animal models.

Animals↗
PubMed1995

Arthroscopic subacromial decompression: two- to seven-year follow-up.

Arthroscopic subacromial decompression (ASD) was performed in 88 patients (90 shoulders) with stage II or early III impingement syndrome of the shoulder unresponsive to nonoperative treatment. The purpose of this retrospective study was to evaluate the follow-up an average of 41 months (range 24 to 82 months) after surgery. We wished to compare results in (1) patients with and without rotator cuff tears, (2) in athletes and nonathletes, and (3) in throwers and nonthrowers. Patients were evaluated by (1) Neer's Criteria for Satisfactory Result, (2) the UCLA Shoulder RAting Scale, (3) the Shoulder and Elbow Surgeons Rating Scale, (4) a detailed questionnaire, and (5) patient satisfaction. In the follow-up group (n = 90), 80% met Neer's criteria for satisfactory result; 94% had satisfactory results by the UCLA Shoulder Scale; 95% had a satisfactory result by the Shoulder and Elbow Society Scale; and 93% of shoulder patients expressed satisfaction at follow-up. There were no statistically significant differences in function between the group without rotator cuff tear (n = 47) and the group with rotator cuff tear (n = 43). Satisfactory results were obtained in 68% of throwing athletes and in 90% of nonthrowing athletes (P < .05) by the Neer Rating, whereas only 50% of competitive baseball and softball pitchers had satisfactory results. Out impression is that ASD is an acceptable alternative to open anterior acromioplasty with comparable results for the treatment of the impingement lesion. There were no differences in result in patients who had a partial rotator cuff tear and those who had no tear.(ABSTRACT TRUNCATED AT 250 WORDS)

Acromion↗
PubMed1993

Ischemic claudication mimicking lumbar disk herniation in the athlete.

The rising trend in athletic activity by the older individual will cause an increase of the development of vascular ischemia as a cause of low back and leg pain. Physicians dealing with the athletic population must be familiar with the various signs and symptoms of back and leg pain and must be able to differentiate between a vascular and neurogenic etiology. The rapid distinction between the two may lead to the avoidance of a catastrophic event.

Angiography, Digital Subtraction↗
PubMed1992

The effect of anabolic steroids on the biomechanical and histological properties of rat tendon.

Twenty-four male rats were divided into four groups, with anabolic steroids and exercise as variables. Biomechanical tests and histological evaluations were performed. The results of the biomechanical tests suggested that anabolic steroids produce a stiffer tendon, which fails with less elongation. The energy at the time when the tendon failed, the toe-limit elongation, and the elongation at the time of the first failure were all affected significantly. Changes in the force at failure were not statistically significant. No alterations of structure were noted when the specimens were viewed with light microscopy. Alterations of the sizes of the collagen fibrils were noted on electron microscopy.

Anabolic Agents↗
PubMed1990

Patellofemoral pain in children.

The primary inadequacy in the treatment of patellofemoral pain in children has been the inability to translate distinct problems recognized during physical examination into a specific clinical classification. Using a classification system based on etiology rather than symptoms allows the clinician to proceed with treatment based on a specific diagnosis. The majority of patellofemoral pain in children is caused by trauma and malalignment syndromes (or a combination of both) and can usually be managed successfully with nonoperative methods. Success in a rehabilitation program depends on a precise understanding of the original or underlying cause of the child's patellofemoral pain.

Bone Diseases, Developmental↗
PubMed1988

The changes in human synovial fluid osmolality associated with traumatic or mechanical abnormalities of the knee.

Synovial fluid osmolality was determined in 22 knees at the time of arthroscopic evaluation. The arthroscopy was for traumatic or mechanical abnormality of the knee. The results indicate no significant difference in osmolality among the conditions studied, but there was a significant decrease in synovial fluid osmolality compared to the values for the normal knee. The information presented provides baseline data for various pathologic conditions and a basis for future work.

Adolescent↗
PubMed1988

The young athlete's knee: recent advances.

The understanding and treatment of the young athlete's knee has improved and continues to do so as arthroscopy and good long-term follow-up studies guide the process. In the management of epiphyseal fractures about the knee the presence of associated ligament injury and the high likelihood of a growth plate injury is now well documented. In the management of ligament injuries and internal derangements, arthroscopy has profoundly changed diagnosis and treatment. Pathology can be precisely identified and the appropriate treatment initiated to preserve an athletic career and possibly prevent degenerative arthritis in adulthood. Lastly, patellofemoral pain continues to be a difficult problem to treat, but a more scientific approach is evolving. This has been facilitated by a better understanding of the varied etiologies for anterior knee pain, and a trend away from classifying all such conditions as chondromalacia.

Adolescent↗