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PubMed1997

Complement and complement regulatory proteins in human tears.

PURPOSE: The complement system is part of the innate defense system of the body, and it contributes to inflammatory conditions. The current study examined tears for the presence of complement components, the activity of the components, and the presence of regulatory components. METHODS: The significance of a functional complement system in tears was examined in four ways. First, the presence and concentration of complement components in tear samples (open-eye, closed-eye, and reflex tears) was examined by sandwich enzyme-linked immunosorbent assay. Second, the presence of an active pathway in each tear type was established by supplementation of complement-deficient sera. Third, Western blotting of tear samples was used to determine whether complement components were activated in tears. Fourth, the presence of regulatory components was examined by enzyme-linked immunosorbent assay and by the inhibition of the ability of tears to supplement deficient sera. RESULTS: Components C1q, C3, factor B, C4, C5, and C9 were detected in closed-eye tears. Only C3, factor B, and C4 were detected in open-eye and reflex tears. Tears were able to supplement complement-deficient sera, indicating that the components were in an active state. Complement components C3, factor B, C4, and C9 were activated in closed-eye tears. The regulatory protein decay-accelerating factor was found only in closed-eye tears. Lactoferrin, another regulatory protein present in all tear types, was shown to inhibit complement-mediated red blood cell lysis, although the inhibition by closed-eye tear lactoferrin was reduced compared to that isolated from other tear types. CONCLUSIONS: This study has demonstrated that the complement system in tears was functionally active and that the concentration of all components was increased greatly in closed-eye tears. In spite of the presence of regulatory proteins, proteins of the complement cascade in tears were shown to be activated.

Blinking↗
PubMed2004

Pre-clinical investigation of the efficacy of an artificial tear solution containing hydroxypropyl-guar as a gelling agent.

PURPOSE: Pre-clinical studies of a new artificial tear product (Systane Lubricating Eye Drops Alcon Laboratories, Inc., Fort Worth, TX) containing the novel gelling agent hydroxypropyl-guar (HP-guar) and two demulcents, polyethylene glycol 400 (PEG) and propylene glycol (PG) were conducted to determine the ability of the product to protect ocular surface epithelial cells from desiccation in vivo and in vitro, and to promote recovery of the damaged corneal epithelial barrier in vivo. Other leading artificial tear products were also evaluated as comparators to determine the relative effectiveness of different polymer systems. METHODS: Damage due to desiccation was assessed by measuring corneal uptake of methylene blue compared to untreated corneas. Corneas of anesthetized rabbits were treated with the new artificial tear product and subjected to desiccation by holding the eyelids open for 2 hours with a speculum. Control eyes were subjected to desiccation without application of a tear formulation. To measure recovery of the corneal epithelium from damage, corneas of anethesthetized rabbits were exposed to 0.01% benzalkonium chloride (BAC) for 5 minutes to increase epithelial permeability. The corneas were exposed to the new artificial tear for 1.5 hours followed by measurement of uptake of 5,6 carboxyfluorescein (CF). In the desiccation and CF uptake experiments, the new tear product was also compared to a tear product formulation without HP-guar and to a commercially available artificial tear containing carboxymethyl cellulose (CMC) and Purite. In a third set of experiments, immortalized human corneal epithelial cells and Chang conjunctival cells in culture were exposed to the PEG/PG/HP-guar tear product, the control formulation without HP-guar, a tear formulation preserved with BAC, or the artificial tear containing CMC/Purite for 15min. The tear formulation was removed and the cells were exposed to desiccating conditions in a laboratory safety hood for 10 or 30min. Cell viability was determined using the MTT assay. RESULTS: The in vivo desiccation model, showed that the new tear product, Systane, offered complete protection of the cornea from desiccation (methylene blue uptake not different than naïve control). Following exposure to 0.01% BAC, the new artificial tear product also provided an environment in which the corneal epithelium recovered completely from damage (CF uptake not different than normal, untreated cornea). This level of protection was not observed when corneas were treated with other formulations. Results from the in vitro desiccation procedure indicated that viability of corneal epithelial and Chang cells treated with the PEG/PG/HP-guar product was significantly greater than viability of cells treated with the tear product without HP-guar or the tear products containing BAC or CMC/Purite. CONCLUSIONS: The tear product containing HP-guar, PEG 400 and propylene glycol satisfies several pre-clinical criteria for an appropriate artificial tear formulation. It gives long-term desiccation protection of the intact cornea and also epithelial cells in culture and has no apparent deleterious affects on cells. It also provides conditions in which a damaged corneal epithelium can recover normal barrier function. The combination of ingredients in the formulation appears to provide an effective mucomimetic artificial tear product. These pre-clinical data suggest that the product will be effective in providing superior relief for the dry eye sufferer.

Animals↗
PubMedDate not supplied

MR evaluation of subscapularis tears.

PURPOSE: The purpose of this work was to describe the MR appearance of tears of the subscapularis tendon and compare the usefulness of different imaging planes as well as note the association of subscapularis tears with other rotator cuff tears and biceps tendon dislocations. METHOD: MR studies at 1.5 T over an 8 year interval were retrospectively assessed for the presence of a rotator cuff tear and/or tear of the subscapularis tendon. Images that showed a subscapularis tear were reviewed for the presence of a visible tear separately on the axial, coronal, and sagittal images. The MR studies were also evaluated for associated tears of the supraspinatus, infraspinatus, and teres minor muscles as well as biceps tendon dislocation and the "naked humerus sign" on coronal images. Last, clinical records and surgical reports were reviewed. RESULTS: Forty-five (2%) of 2,167 rotator cuff tears involved the subscapularis; 27% were partial and 73% were complete tears. Tears were best seen in the sagittal oblique plane. Almost all subscapularis tears were an extension of typical rotator cuff tears: supraspinatus in 35 patients (79%), extending into infraspinatus tears in 25 (56%) and into teres minor tears in 2 patients (4%). Bicipital dislocations were seen in 22 patients (49%), and three complete tears of the biceps (7%) were noted as well. The naked humerus sign was demonstrated in 31 patients (69%). Surgical reports that confirmed the MR findings were available for 15 patients. CONCLUSION: About 2% of rotator cuff tears involve the subscapularis tendon. Most subscapularis tears are extensions of supraspinatus tears and frequently involve the biceps tendon.

Adult↗
PubMed2004

Medial meniscus extrusion on knee MRI: is extent associated with severity of degeneration or type of tear?

OBJECTIVE: The meniscus is considered "extruded" when it extends beyond the tibial margin. We hypothesize that severe degeneration, large radial tears, complex tears, and tears involving the meniscal root would alter meniscal stability and cause more substantial extrusion. MATERIALS AND METHODS: The knee MRI database at Thomas Jefferson University Hospital was searched for reports describing meniscal extrusion; MR images were reviewed retrospectively. On mid coronal images, extrusion of the medial meniscus was quantified in millimeters. A separate, independent review of the meniscus evaluated degeneration severity and tear (type and extent). Radial tears were divided into those involving more (large) or less (small) than 50% of the meniscal width. Tears that involved the "root" at the tibial spine were recorded. Chi-square analysis compared these findings with extrusion extent, divided into minor (</= 3 mm) and major (> 3 mm) extrusion. RESULTS: One hundred five knees were reviewed (12 men and 93 women; age range, 34-83 years; mean age, 56 years). Distribution of medial meniscus extrusion was 2 mm (n = 17), 3 mm (n = 17), 4 mm (n = 27), 5 mm (n = 14), 6 mm (n = 16), and 7-10 mm (n = 14). Mild, moderate, or marked degeneration was seen in 47%, 26%, and 27% with minor extrusion, respectively, and in 17%, 41%, and 42% with major extrusion, respectively (p = 0.003). Tears were seen in 59% (20/34) with minor extrusion versus 89% (63/71) with major extrusion (p = 0.001). Tears involved one third, two thirds, or all of the meniscus in 75%, 25%, or 0%, respectively, with minor extrusion and 46%, 40%, or 14% with major extrusion, respectively (p = 0.014). Longitudinal (nonradial) and horizontal tears were not associated with extent of extrusion (p = 1.0). Oblique tears were significantly associated with minor extrusion (minor, 26% [9/34]; major, 4% [3/71]; p = 0.003). Radial tears were seen in 9% (3/34) with minor extrusion versus 21% (15/71) with major extrusion (p = 0.20). All three radial tears with minor extrusion were small; conversely, 87% (13/15) of radial tears with major extrusion were large (p = 0.019). Complex tears were seen in 18% (6/34) with minor extrusion versus 59% (42/71) with major extrusion (p < 0.001). Tears involving the meniscal root were seen in 3% (1/34) with minor extrusion and 42% (30/71) with major extrusion (p < 0.001). CONCLUSION: Substantial medial meniscus extrusion (> 3 mm) is associated with severe meniscal degeneration, extensive tear, complex tear, large radial tear, and tear involving the meniscal root.

Databases, Factual↗
PubMed2005

The effect of rotator cuff tear size on shoulder strength and range of motion.

STUDY DESIGN: Prospective cohort study. OBJECTIVES: To determine the effect of rotator cuff tear size on shoulder strength and range of motion. BACKGROUND: Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood. METHODS AND MEASURES: Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness). RESULTS: There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90 degrees and 10 degrees of abduction, in external rotation strength at 90 degrees, and in the "full can test" (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0 degrees and 90 degrees abduction (all, P<.001) were also observed. Abduction strength deficit at 10 degrees was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size. CONCLUSIONS: Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10 degrees of abduction was indicative of a large or massive rotator cuff tear.

Adult↗
PubMed1998

Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee. Arthroscopic analysis.

Arthroscopic diagnosis was used to determine the incidence of the most frequent injuries to the knee's internal structures associated with ACL tear as well as ones without ACL tear. The most frequent finding associated with a recent ACL tear was the LM tear (72.7%). There is a statistically significant incidence of recent LM tear in knees with a recent ACL tear compared with recently injured knees without an ACL tear (P < 0.001). A statistically significant incidence of longitudinal LM tear was found in knees with a recent ACL tear compared with recently injured knees without an ACL tear (P < 0.001). Longitudinal tears were present in 63.6% of the knees with a recent ACL tear or in 87.5% of all knees with a recent LM tear. No statistically significant difference was found in the incidence of LM tear in the knees with a recent ACL tear compared to the incidence of LM tear in knees with an old ACL tear (P > 0.05). The posterior horn was most frequently injured (71.5% vs 64.0%). A significant difference between the findings in the various patient groups studied supports the hypothesis that longitudinal LM tears in an ACL-deficient knee do not involve secondary meniscal pathology but that their onset derives from a primary recent injury. Most probably, the recent LM lesion does not evolve in meniscal length and depth. This hypothesis needs thorough investigation.

Adult↗
PubMed1998

MR imaging of meniscal tears with discoid lateral meniscus.

OBJECTIVE: To study MR findings of meniscal tears with discoid lateral menisci (DLMs) and to evaluate the incidence and accuracy of MRI compared to arthroscopical surgery. MATERIAL AND METHODS: MR appearances of surgically proved torn discoid lateral menisci (DLM) were studied in 57 knees (40 patients). They were all performed with a 1.5T MR before surgery. MR sequences included T1- and T2* weighted images on both coronal and sagittal planes and 3D-axial images with a slice thickness of 0.7 mm. RESULT: Of 57 DLMs, there were 32 complete DLMs and 25 incomplete DLMs. Twenty-five of 32 complete DLMs had tears; including seven with intrasubstance tear, five with radial tear, five with other kinds of tears and eight with severe tears involving whole meniscus. On the other hand, 13 of 25 incomplete DLMs had tears; including two with intrasubstance tear, six with radial tear, four with other kinds of tears and one with severe tears. All DLMs were correctly diagnosed on MR images. Twenty-seven of 38 tears with DLM were correctly identified on conventional 2D MR images. This yielded 71.1% sensitivity, 100% specificity and 80.7% overall accuracy. When adding axial 3D MR images to 2D MR images, 36 of 38 tears were correctly diagnosed. A combination of both techniques yielded a sensitivity of 94.7% and a specificity of 100%. Ten of 11 radial tears with DLM were correctly identified on 3D axial images, where only three of them could be diagnosed on conventional 2D images. Eight of nine intrasubstance tears were correctly identified on 3D axial images, where six of them could be diagnosed on conventional 2D images. CONCLUSION: DLMs had a much higher incidence of meniscal tears than normally shaped lateral menisci and MR is the only modality of choice to evaluate them before surgery. Especially 3D axial MR images were quite useful in the detection of intrasubstance and radial tears often associated with DLMs.

Adult↗
PubMedDate not supplied

Treatment of partial meniscal tears identified during anterior cruciate ligament reconstruction with limited synovial abrasion.

SUMMARY: This is a retrospective review of the results of 40 patients with 44 partial stable meniscal tears who were treated with parameniscal synovial abrasion at the time of anterior cruciate ligament reconstruction. There were 19 medial meniscal (MM) tears and 25 lateral meniscal (LM) tears. Meniscal tear morphology included 33 single longitudinal tears (18 MM, 15 LM), 10 double longitudinal tears (1 MM, 9 LM), and 1 radial tear (LM). All 44 tears were located in the posterior horn or posterior junction of the meniscus. Rim width was </=3 mm in 29 and >3 mm in 15 tears. In this study, failure was defined as a symptomatic meniscal tear requiring subsequent surgery. The overall failure rate at an average follow-up of 3.3 years was 11% (5 of 44). Four failures occurred in the MM (21% of total MM tears) and 1 failure occurred in the LM (4% of total LM tears). The median time to failure was 12 months with 3 of 5 failures occurring secondary to a significant reinjury. We looked at the effect of 8 factors on overall failure rate. Although statistical validity was not established in this small patient population, we did observe a higher failure rate for stable MM tears. Our study supports the small amount of literature that shows a high clinical success rate with observation of stable LM tears identified at the time of anterior cruciate ligament reconstruction. However, the much higher failure rate of stable MM tears raises concern. This difference is explained by biomechanical and clinical studies showing that the MM develops higher stresses than the LM with loading. Based on this work, we believe that stable longitudinal MM tears have a higher propensity to fail over time by propagation of the tear and are better managed with meniscal repair.

Adolescent↗
PubMed2005

Tear meniscus level as an indicator of nasolacrimal obstruction.

PURPOSE: To quantitate the normal level of the tear meniscus, and to determine whether it is an accurate diagnostic indicator of nasolacrimal drainage obstruction. METHODS: We performed a retrospective, controlled, case series study on patients evaluated from 2000 to 2002 for epiphora. The height of the tear meniscus was measured using the slit lamp by one experienced observer. Nasolacrimal outflow status was assessed by probing and irrigation. Patency on the nontearing eye was also confirmed by probing and irrigation, and the corresponding tear meniscus levels comprised one control group (59 sides of 62 patients). Tear meniscus levels in patients with ptosis or dermatochalasis without epiphora comprised the second control group (78 sides of 39 patients). The 2 control groups were combined to determine the normal tear meniscus level and ratio between the two sides. The control tear meniscus levels and ratios in patients without epiphora were compared with the tear meniscus levels and ratios in patients with nasolacrimal obstruction (65 sides of 62 patients). RESULTS: The 2 control groups examined did not statistically differ with respect to tear meniscus height (P = 0.06). The control median tear meniscus level (0.2 mm) significantly differed from the obstructed median tear meniscus level (0.6 mm) (P<0.0001). The control median ratio between the two sides (1.0) significantly differed from the obstructed ratio (2.5) (P<0.0001). The absolute tear meniscus level and the tear meniscus ratio were both accurate indicators of obstruction. The percent change in absolute tear meniscus level after lacrimal surgery was -58.3%. CONCLUSIONS: To our knowledge, a quantitative analysis of the tear meniscus height has not been previously documented in the literature. Patients with nasolacrimal system stenosis or obstruction have elevated tear meniscus levels and ratios relative to control subjects. The absolute tear meniscus level and ratio tests are excellent diagnostic indicators of nasolacrimal obstruction and its resolution after successful lacrimal surgery.

Case-Control Studies↗
PubMed1998

Tear dynamics and dry eye.

Tears undergo four processes: production by the lacrimal gland, distribution by blinking, evaporation from the ocular surface and drainage through the nasolacrimal duct. Abnormalities in any of these steps can cause dry eye. There are two kinds of tear production, basic and reflex, which can be distinguished from each other by the Schirmer test with nasal stimulation. Reflex tearing is important because it supplies such essential components as EGF and vitamin A, whose deficiency may cause squamous metaplasia. There is no reflex tearing in Sjogren's syndrome because of destruction of the lacrimal gland. In cases of diminished or absent reflex tearing, topical autologous serum is the treatment of choice. Even when there is adequate tear production, insufficient distribution, such as occurs with the decreased blinking associated with the use of video display terminals (VDT), may cause dry eye. Any process or activity that suppresses blinking interferes with tear distribution. Tear evaporation increases under certain conditions and in some diseases. When the exposed ocular surface area is increased, such as in VDT work, tear evaporation increases. Meibomian gland dysfunction (MGD) also causes increased tear evaporation by altering the quality of the oily layer in tears. Tear evaporation can be suppressed by using a warm compresser or a humidifier, narrowing the palpebral fissure, or wearing protective eyeglasses. The tear clearance rate is measured by fluorescein dye dilution in the conjunctiva. When the tear clearance is low, inflammatory cytokines or preservatives accumulate in the conjunctival sac, resulting in ocular surface diseases. Frequent use of artificial tears without preservative is the key treatment. A differential diagnosis of the abnormalities of tear dynamics can give us a proper understanding of the pathogenesis of dry eye. With this knowledge, we can formulate an efficient therapeutic approach.

Blinking↗
PubMed2003

Substance P in human tears.

PURPOSE: To determine the levels and biochemical characteristics of substance P-like immunoreactivity (SPLI) in human tears and ascertain whether substance P (SP) concentrations in tears reflect the condition of the ocular surface. METHODS: Unstimulated tears were collected with a micropipette. Tear samples were partially purified using C-18 cartridges. Levels of SPLI in purified samples were measured using an enzyme immunoassay (EIA). For biochemical characterization of SPLI, tear extracts were fractionated using high-performance liquid chromatography (HPLC); each fraction was then subjected to EIA. To determine the catabolism of SP in tears, synthetic SP was incubated in medium containing pooled tears and then analyzed using HPLC. RESULTS: The concentration of SPLI in normal human tears was 306.0 +/- 96.5 pg/mL (mean +/- SD, range 148-555 pg/mL). Levels of SPLI did not vary significantly by age or gender. Concentrations of SPLI in tears from eyes with unilateral corneal hypesthesia were lower than those in tears from contralateral healthy eyes. Diclofenac sodium eye drops reduced concentrations of prostaglandin E2 and SPLI in tears. Analysis using HPLC indicated that five different substances contributed to SPLI in tears and that SP was broken down into several fragments, including SP(8-11), by enzymes present in tears. CONCLUSIONS: Substance P is a normal component of human tears. Levels of SPLI in tears might reflect the denervated status of the ocular surface. Substance P is catabolized by degradative enzymes in tears to maintain the ocular surface by exerting the trophic effects of SP while avoiding undesirable effects.

Administration, Topical↗
PubMedDate not supplied

Tear film breakup times in young healthy cats before and after anesthesia.

The objectives of this study were: (i) to determine tear film breakup times (BUTs) in young healthy cats; (ii) to determine tear film BUTs in feline eyes within 8-20 h following general anesthesia; (iii) to determine if tear film BUTs vary significantly preoperatively when compared with values obtained 8-20 h postoperatively; (iv) to determine if Schirmer tear test (STT) values correlate with tear film BUTs in young healthy cats; and (v) to determine if the isolation of particular etiologic agents from conjunctival swabs of healthy cats affects tear film BUTs. We studied eighteen healthy Domestic Short-haired (n=14) and Domestic Long-haired (n=4) cats, with normal ocular examinations, ranging in age from 0.5 to 3 years. Complete ophthalmic examinations, including tear film BUTs, were performed on all cats. Conjunctival swabs from each eye of all cats and blood samples from all cats were collected and submitted for polymerase chain reaction screening for feline herpes virus, Chlamydophila felis, Mycoplasma spp., and calicivirus. In 10 of 18 cats, STT values and tear film BUTs were measured before general anesthesia was administered and again within 8-20 h following the end of anesthesia. Mean preanesthesia tear film BUTs for all 18 cats were 17.4+/-4.6 s OD and 16.0+/-4.5 s OS. Mean postanesthesia tear film BUT results were 12.5+/-4.3 and 13.1+/-4.0 s OD and OS, respectively. Postanesthesia tear film BUTs were significantly more rapid than those measured before anesthesia (OD only). There was also a positive correlation, both before and after anesthesia, between STT values in both eyes (OU) and tear film BUTs OU. The isolation or lack of isolation of conjunctival microorganisms using PCR did not significantly affect tear film BUTs. Mean tear film BUT in young healthy domestic cats is 16.7+/-4.5 s. Tear BUT is positively correlated with STT values. Although mean tear film BUTs OD at 8-20 h following anesthesia were more rapid than preanesthesia values, this difference did not appear clinically relevant.

Anesthesia, General↗
PubMed2003

Modification of Pseudomonas aeruginosa interactions with corneal epithelial cells by human tear fluid.

Both cytotoxic and invasive strains of Pseudomonas aeruginosa can damage corneal epithelial cells in vitro, but neither can infect healthy corneas in vivo. We tested the hypothesis that whole human tear fluid can protect corneal epithelia against P. aeruginosa virulence mechanisms. Cultured corneal epithelial cells were inoculated with 10(6) CFU of one of 10 strains of P. aeruginosa (five cytotoxic, five invasive)/ml with or without reflex tear fluid collected from the conjunctival sacs of human volunteers. Cytotoxicity was assessed by observation of trypan blue staining and measurement of lactate dehydrogenase release; invasion was quantified by using gentamicin survival assays. Tear fluid retarded growth of only 50% of the P. aeruginosa strains (three of five invasive strains, two of five cytotoxic strains) yet protected corneal cells against invasion by or cytotoxicity of 9 of 10 strains. The only strain resistant to the tear cytoprotective effects was susceptible to tear bacteriostatic activity. Dilution of tear fluid threefold significantly reduced cytoprotection, while bacteriostatic activity prevailed with dilutions beyond 100-fold. Sulfacetamide (1 mg/ml) with bacteriostatic activity matching that of tear fluid was less cytoprotective than tear fluid (80% protection with tear fluid, 48% with sulfacetamide). Video microscopy revealed bacterial chain formation in both tear fluid and sulfacetamide, but tear fluid also blocked bacterial swimming motility. After prolonged tear contact, bacteria regained normal growth rates, swimming motility, and cytotoxic activity, suggesting a breakdown of protective tear factors. Boiled tear fluid lost bacteriostatic activity and effects on bacterial motility but retained cytoprotective function. These results suggest that human tear fluid can protect corneal epithelial cells against P. aeruginosa virulence mechanisms in a manner not dependent upon bacteriostatic activity or effects on bacterial motility. Whether overlapping tear film components are involved in these defense functions is to be determined.

Animals↗
PubMed2003

Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport.

The purposes of this multi-center study were: (a) to document the location and type of meniscal and chondral lesions that accompany anterior cruciate ligament (ACL) tears, and (b) to test for possible relationships between these lesions and patient age, time from initial injury (TFI), and sports level (i.e., recreation, amateur, professional, and national). The cases of 764 patients with ACL tears who underwent arthroscopy for the first time were retrospectively analyzed. The group included 684 males and 80 females of mean age 27 years (range 14-59 years). The mean TFI was 19.8 months (range 0.2-360 months). Eighty-seven percent of the group engaged in regular sporting activity. Thirty-seven percent had medial meniscal tears, 16% had lateral meniscal tears, and 20% had tears of both menisci. The most common tear types were longitudinal tears in the posterior and middle horns of both menisci. Tears of the lateral meniscus were more centrally located than those of the medial meniscus. Incomplete tears and radial tears were significantly more common in the lateral meniscus. Nineteen percent of the knees had one or more chondral lesions. Sixty percent of the chondral lesions were located in the medial tibio-femoral compartment. Patient age was statistically associated with presence of a medial meniscal tear, presence of a grade 3 or 4 chondral lesion, and presence of a complex tear of the medial meniscus. Sports level was not statistically related to any of the parameters studied. The odds of having a medial meniscal tear at 2 to 5 years TFI were 2.2 times higher than the odds in the first year post-injury, and the odds at >5 years were 5.9 times higher than at 0 to 12 months TFI. The frequency of lateral meniscal tear remained fairly constant at 2 years TFI. The odds of having a grade 3 or 4 chondral lesion were 2.7 times greater at 2 to 5 years TFI than they were at 1 year post-injury, and these odds increased to 4.7 when patients at >5 years TFI were compared to those in the 2 to 5 years category. Multivariate analysis demonstrated that TFI and age were equally important predictors of lateral meniscal tears and of grade 3 or 4 chondral lesions; however, TFI was the better predictor of medial meniscal tear.

Adolescent↗
PubMedDate not supplied

Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair.

PURPOSE: The purpose of this article is 2-fold: To report the long-term functional results of arthroscopic rotator cuff repair (average, 3.5 years in this study), and to analyze results by tear size and repair technique (margin convergence v direct tendon-to-bone repair). TYPE OF STUDY: Case series. METHODS: Between September 1993 and April 1997, 62 patients had an arthroscopic rotator cuff repair performed by the senior author (S.S.B.). Of this group, 59 patients (59 shoulders) were available for follow-up. Preoperative and postoperative function were assessed by means of a modified UCLA scoring system. Tears were categorized according to size (greatest diameter, number of tendons involved, and pattern of tear [crescent shape v U-shape]). Crescent-shaped tears were repaired in a direct tendon-to-bone fashion and U-shaped tears were repaired by a margin-convergence technique. RESULTS: Good and excellent results were achieved in 95% of the cases, regardless of tear size. The large and massive tears did as well as the small and medium-sized tears. That is, results were independent of tear size (P >.05). Results of tears repaired by margin convergence were not significantly different statistically from those repaired by direct tendon-to-bone repair (P >.05), validating the selection criteria of U-shaped tears for repair by margin convergence. There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for each tear size). Delay from injury to surgery, even of several years, did not adversely affect surgical outcome. CONCLUSIONS: (1) Arthroscopic rotator cuff repair can achieve good and excellent results in a large percentage of patients (95% in this series). (2) Results of arthroscopic rotator cuff repair are independent of tear size. (3) U-shaped tears repaired by margin convergence have results comparable to those of crescent-shaped tears repaired directly by a tendon-to-bone technique. (4) There is a rapid return to full overhead function after arthroscopic rotator cuff repair (average, 4 months for all tear sizes). (5) A delay from injury to diagnosis, even of several years, is not a contraindication to arthroscopic rotator cuff repair.

Arthroscopy↗
PubMed1995

Bucket-handle tears of the medial and lateral menisci of the knee: value of MR imaging in detecting displaced fragments.

OBJECTIVE: A bucket-handle tear of a meniscus is a longitudinal tear with an attached fragment displaced away from the meniscus. Several MR findings of bucket-handle tears have been reported previously. However, the sensitivity of MR for detecting the displaced fragment is unknown. We determined the sensitivity of MR for detecting a displaced bucket-handle tear and determined how the sensitivity varied with tears of different sizes. We also evaluated whether the three findings of a displaced fragment differed in frequency between medial and lateral tears. MATERIALS AND METHODS: We retrospectively evaluated the MR examinations of 39 patients with arthroscopically proven bucket-handle tears for signs of a displaced meniscal fragment. Thirty-two patients had medial meniscal bucket-handle tears, and seven had lateral tears. Two observers evaluated each examination independently, with discrepancies resolved by consensus of a third reader. Each observer evaluated for three findings of a bucket-handle tear: a double posterior cruciate ligament sign, a flipped meniscus sign, or a fragment in the intercondylar notch. A double posterior cruciate ligament sign is present when the meniscal fragment is displaced anterior to the posterior cruciate ligament, resembling two ligaments. A flipped meniscus sign occurs when the fragment is flipped anteriorly so the anterior horn of the meniscus appears to be enlarged. We tested for differences between menisci in the sensitivity for each sign using Pearson's chi-squared test or Fisher's exact test. We compared the sensitivity of MR for identifying fragments when the tear involved one third, two thirds, or the entire meniscus using Spearman's rank correlation. RESULTS: Overall sensitivity for a displaced fragment was only 0.64. When the bucket-handle tear involved the entire meniscus, the displaced fragment could be seen in 84% of the menisci. The double posterior cruciate ligament sign was seen in 53% of the medial and none of the lateral bucket-handle tears (p = .01). The flipped meniscus sign was noted in 44% of medial and 29% of lateral menisci (p = .68), and a fragment was identified in the intercondylar notch in 66% of medial and 43% of lateral menisci (p = .40). CONCLUSION: MR is sensitive for detecting meniscal fragments in large bucket-handle tears, but is less so in small tears. The flipped meniscus sign and presence of a fragment in the notch were comparably useful findings of a displaced fragment in both medial and lateral menisci. The double posterior cruciate ligament sign was noted only in medial bucket-handle tears.

Adult↗
PubMed1989

Non-operative treatment of meniscal tears.

In a retrospective review of the results of 3,612 arthroscopic procedures that were performed for the treatment of an acute or a chronic meniscal lesion, with or without an associated ligamentous lesion, we identified eighty meniscal tears (in seventy-five patients) that had been assumed to be stable. Seventy were vertical longitudinal tears and ten were vertical radial tears. The seventy longitudinal tears included fifty-two lateral and eighteen medial meniscal lesions. All of the radial tears were in the lateral meniscus. Of the seventy-five patients, fifty-two had been followed for two to ten years. At the time of follow-up, only six of these fifty-two patients had needed additional intervention because of symptoms that were related to the meniscal tear. Four of them had the intervention after a sports-related traumatic extension of a stable tear, and two, because persistent symptoms were caused by the original meniscal lesion. A repeat arthroscopy was performed on thirty-two patients (twenty-six of whom had a longitudinal tear and six of whom had a radial tear), at an average of twenty-six months after the original arthroscopy. Seventeen of the twenty-six longitudinal tears had completely healed. Five of the six radial tears had no evidence of healing and one had extended. Neither ligamentous laxity nor a meniscal tear that was chronic at the time when it was discovered appeared to preclude healing of the stable longitudinal tears. No localized degenerative changes in the adjacent articular cartilage were found in association with any of the stable vertical longitudinal or radial meniscal lesions. Excluding the six patients who had had additional surgical treatment, none of the fifty-two patients who filled out a questionnaire reported that they had symptoms of a meniscal lesion, and none of the forty-two patients who were re-examined two years or more after the operation had signs of a meniscal lesion. Stable vertical longitudinal tears, which tend to occur in the peripheral vascular portions of the menisci, have great potential for healing. The tear should be left alone unless it is the only abnormality that is found and it is causing symptoms that warrant treatment. Stable radial tears, which tend to occur in the avascular inner one-third of the meniscus, have little potential for healing. Whether it is best to leave these lesions alone or to fashion an intact rim by contouring the meniscus was not established by this study.

Adolescent↗
PubMed2002

Tear production during the neonatal period.

PURPOSE: To measure tear secretion in term and preterm infants to assess whether tear secretion correlates with the maturity of the infants and to evaluate the changes in tear production during the neonatal period. DESIGN: Prospective, observational case series. METHODS: Ninety-six term and 22 preterm medically stable infants were studied. Post-conceptional age and birth-weight of each infant were recorded. Tear secretion was measured by the Schirmer test before (total tear secretion) and after (basal tear secretion) the instillation of topical anesthetic agent. Both eyes were tested consecutively. The initial tear measurements were performed within the first 2 days of life, and tear measurements were repeated at 2 weeks and 4 weeks after birth. RESULTS: The mean total tear production was 16.3 (+/-3.6) mm in term and 7.4 (+/-3.2) mm in preterm infants. The mean basal tear production was 7.3 (+/-3.2) mm in term and 3.5 (+/-1.3) mm in preterm infants. Total tear secretion significantly correlated with birth-weight (r, 0.42, P =.04) and post-conceptional age (r, 0.56, P =.006) in preterm infants. For term infants, total tear secretion significantly increased at 2 weeks (18.1 +/- 3.4 mm, P <.001) and 4 weeks (19.5 +/- 4.1 mm, P <.001) after birth. For preterm infants, a significant increase in total tear production was observed at the fourth week (11.5 +/- 3 mm, P <.001). CONCLUSION: Tear production in newborns depends on the maturity of the infants and increases substantially during the neonatal period. Preterm infants have reduced tear secretion compared with term infants.

Birth Weight↗