Naples FL Research Articles

No difference in prevalence of postoperative iliopsoas tendinitis in patients undergoing arthroscopic hip surgery when using absorbable versus non-absorbable suture for capsular closure.

The volume of arthroscopic hip surgery has increased dramatically in recent years with iliopsoas tendinitis (IPT) being one of the most common complications of this procedure. The purpose of this study is to investigate the prevalence of post-operative IPT in patients who undergo arthroscopic hip surgery with capsular closure using absorbable versus non-absorbable suture. This is a single center, single surgeon, retrospective analysis performed between August 2007 and May 2023 comparing two cohorts who underwent hip arthroscopy. Patients were divided into those who underwent surgery with capsular closure using absorbable (Vicryl®, Johnson and Johnson, New Brunswick, NJ) suture and those who underwent capsular closure with non-absorbable suture (Suturetape, Arthrex, Naples FL). All patients who underwent primary or revision hip arthroscopy and were at least 2 months post-operation were initially included in the study. Between August 2007 and May 2023 a total of 1513 hip arthroscopy surgeries were performed. Within this cohort, 1421 hips underwent hip arthroscopy with non-absorbable suture and 64 hips underwent surgery with absorbable suture. There was no significant difference between the proportion of IPT in the non-absorbable cohort (2.3%) versus the absorbable cohort (1.6%) (P = 0.669). Capsular closure with Absorbable sutures was non-inferior to capsular closure with non-absorbable sutures with respect to the proportion of post-operative IPT following hip arthroscopy for FAI. Additionally, the proportion of post-operative IPT was found to be significantly higher in patients undergoing revision versus primary hip arthroscopy, regardless of capsular closure suture type. IV.

Peroneus brevis as source of instability in Jones fracture fixation

PurposeIntramedullary screw fixation is currently considered the gold standard treatment for Jones fractures in the athlete. Besides biological factors (i.e., poor vascularization), mechanical instability induced by the pull of the peroneus brevis tendon (PBT) contributes to deficient Jones fracture healing. This biomechanical study aimed to simulate loads induced by the PBT at the fifth metatarsal and to compare the stability of two intramedullary screw constructs in a Jones fracture fixation model.MethodsJones fractures were created in 24 human paired specimens, and fixation was achieved with either a solid Jones fracture specific screw (JFXS) (Jones Screw; Arthrex Inc., Naples FL, USA) or a cannulated headless compression screw (HCS) (HCS; DePuySynthes, Solothurn, Switzerland). The PBT was fixed to a mechanical load frame by the use of a cryoclamp. Constructs were loaded in tension for 1000 cycles, followed by an ultimate load test. Construct failure was defined by exceeding 10° of dorsal angulation.ResultsPreliminary failure occurred more often in HCS constructs (33%) compared to JFXS constructs (0%) (P = 0.044). Mean tensile load to failure reached 123.8 ± 91.4 N in the JFXS group and 91.5 ± 62.2 N in the HCS group (P = 0.337). The mean slope of the load-displacement curve was 24.2 ± 10.4 N/mm for JFXS constructs and 24.7 ± 5.5 N/mm for HCS constructs, respectively (P = 0.887).ConclusionThis is the first study evaluating the effect of PBT pull on the mechanical stability of Jones fracture fixation. Higher preliminary failure rates of HCS were found under cyclic loading conditions compared to JFXS.

Chronic Deltoid Ligament Insufficiency Repair with Internal Brace™ Augmentation

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Patients with chronic deltoid ligament insufficiency (CDLI) present a challenging situation in foot and ankle surgery. Although numerous surgical procedures have been described, optimal treatment is still a matter of debate. While the treatment armamentarium ranges from simple ligament repair to complex deltoid reconstructions with or without realignment osteotomies, direct repair augmented with an Internal Brace™ (Arthrex, Inc., Naples FL, USA) device appears to be an attractive intermediate option. We investigated functional outcomes and complications in patients with CDLI operated on using Internal Brace™ augmentation. Methods: After IRB approval, a prospective study was conducted. Patients were included if they were older than 18 years, presented medial ankle pain and/or giving way, exhibited asymmetric flexible hindfoot valgus, failed conservative treatment, and had a positive MRI evaluated by an independent radiologist. Patients with less than six months of follow-up, stage IV flatfoot deformity, neuropathy and/or inflammatory arthritis were excluded from the study. CDLI diagnosis was confirmed intraoperatively with the arthroscopic ankle drive-through sign. Patients were evaluated preoperatively and postoperatively using foot and ankle ability measure (FAAM) score, 36-item short form survey (SF-36), and grade of satisfaction. Paired t-tests were used to assess the pre- and postoperative FAAM and SF-36 scores. Results: Eleven patients met inclusion criteria. Nine patients were male and two female, with a mean age of 32 (18-61). Six ankles were right and five left. 88% presented with medial ankle pain, 67% medial drawer, 88% asymmetric hindfoot valgus, and 44% multidirectional ankle instability. No patient was lost to follow-up, with a mean follow-up time of 13.5 months (6-21). Preoperative FAAM and SF-36 scores improved from 58.7 to 75.3 and from 60.2 to 84.4 postoperatively, respectively (p<0.05). Two implant failures were observed, with no apparent compromise of construct stability. No patient was re-operated. Conclusion: Our results suggest that deltoid ligament repair with Internal Brace™ augmentation in patients with CDLI is a reliable option with good functional outcomes and high satisfaction grade in short term follow-up.

Est-ce que la formation sur simulateur permet d’améliorer la triangulation et la précision en arthroscopie d’épaule ? Essai contrôlé randomisé

Introduction The dexterity skills required to perform safe, effective and efficient arthroscopic operations are demanding. A variety of arthroscopic surgical simulation models are available, however, the cost of nearly all available models makes them prohibitive for incorporation into the vast majority of orthopaedic training programs. The purpose of this study was to determine the effectiveness of simulator training on basic triangulation and probing skills utilizing a novel, low-cost arthroscopic triangulation training system (ArthroBox, Arthrex Inc., Naples FL). Methods A randomized controlled trial of subjects without prior arthroscopic skills training was conducted. All participants received a demonstration of how to use the arthroscopic triangulation training system and then were randomized to receive either no training or a fixed protocol of simulation training on the simulation model, including 30 minutes of training for 4 consecutive days. On day 1 and day 5, all participants were evaluated on 3 simulated arthroscopic tasks and were assessed by an independent observer. Variables analyzed included which hand the camera was held, which portals the participant initially used, how many times portals were changed, the time it took to complete the tasks and the task completion rate. Statistical analysis was conducted utilizing Student's t -tests, with P > 0.05 denoting statistical significance (OriginPro 9 software, Northampton MA, USA). Results Thirty-six participants (92% male, average age 28 ± 5 years) were randomized into two groups with 17 in the training group (T) and 19 in the no-training group (NT). On day 1, 7/17 participants (41%) in the T group completed all tasks, while 10/19 participants (53%) in the NT group completed all tasks ( P = 0.52). On day 5, significantly more participants in the T group completed all tasks on day 5 compared to the NT group (17/17 (100%) versus 12/19 (63%), P = 0.008). Participants in the T group had significantly improved task completion times for all 3 tasks on day 5 versus day 1. Participants in the NT group had a significantly improved task completion time for task 1 on day 5 versus day 1; no differences were found for tasks 2 and 3. On day 5, participants in the T group required significantly fewer portal changes compared to the NT group (2.35 ± 2.29 versus 6.95 ± 8.55, P = 0.039). Conclusions Simulation training on a simple, low-cost arthroscopic triangulation training system resulted in an overall improvement in arthroscopic probing and triangulation skills within 1 week of training, with significantly decreased task completion times and significantly increased efficiency of movement.

Calcium phosphate cement enhances the torsional strength and stiffness of high tibial osteotomies.

There has been a resurgence in the use of opening wedge high tibial osteotomy (owHTO). Calcium phosphate cement has been shown to improve strength in compression for augmentation of tibial plateau and owHTO fixation. However, knee kinematics includes a torsional load during ambulation, which is as yet unstudied in this model. The purpose of this paper is to investigate the effect of injectable calcium phosphate cement on the biomechanical stability of standard high tibial osteotomy defect with applied torsional load and ultimate stiffness of the supporting construct. Testing was performed on 22 bone mineral density-matched and age-matched cadaver specimens. Intact specimens were treated with 10° opening wedge osteotomies, identical surgical techniques as clinically used and fixation provided by iBalance© PEEK implant (Arthrex, Naples FL). Nine specimens were augmented with calcium phosphate injectable cement, Quickset (Arthrex Inc., Naples Fl). Constructs were for construct stiffness, torsional loads to failure, and mechanisms of failure. As a gold-standard comparison group, four samples were tested with a titanium, fixed angle device alone: Contourlock plate (Arthrex Inc., Naples Fl). Peak torque to failure was significantly greater in samples augmented with calcium phosphate bone cement (23.0±9.6Nm) compared with specimens fixed with PEEK implant alone (18.1±7.3). Construct stiffness in torsion was also significantly improved with bone cement application (349.0±126.8Nm/°) compared with PEEK implant alone (202.2±153.4Nm/°) and fixed angle implant system (142.9±74.7Nm/°). Injectable calcium phosphate cement improves the initial maximal torsional strength and stiffness of high tibial osteotomy construct.

Abrasive Properties of Braided Polyblend Sutures in Cuff Tendon Repair: An in Vitro Biomechanical Study Exploring Regular and Tape Sutures

This study aimed to evaluate the abrasive properties of different suture materials (tape or regular) on the infraspinatus tendon of sheep. Four types of sutures were compared: FiberWire (Arthex, Naples FL), FiberTape (Arthrex), Orthocord (DePuy Mitek, Raynham, MA) and ForceFiber (Tornier, Bloomington, MN). Each suture (n= 10) was cycled with a filxed load of 10N and an alternating motion of the suture through sheep infraspinatus tendon, with an excursion of 30mm. The migration of the suture as it cut through the tissue was measured at intervals of 5 cycles, up to failure or a total of 50 cycles, or a tendon tear greater than 13mm. ForceFiber and Orthocord sutures showed a significantly (P < .05) lower amount of abrasion compared with FiberWire and FiberTape: The mean cutting rate (defined as the size of the defect at theend of the test divided by 50 when this number of cycles was reached, or as 13mm divided by the number of cycles toreach this value when the test was stopped before 50 cycles) was, respectively, 0.04mm/cycle, 0.12mm/cycle, 0.11mm/cycle, 0.32mm/cycle, and 0.25mm/cycle. The defect size at 15 cycles was, respectively, 5.7mm, 5.6mm, 9.4mm, 7.7mm, and 7.4mm. Although no statistical significance was found, sutures shaped in a tape form (FiberTape) were less aggressive on the tendon than the corresponding sutures in regular form (FiberWire). This study found increased abrasive effects of FiberWire and FiberTape compared with ForceFiber and Orthocord sutures. Currently, surgeons have a large choice of suture materials. Knowledge of biomechanical characteristics ofdifferent braided polyblend suture materials could help surgeons decide which suture to use for rotator cuff tears.

Early failures with single clavicular transosseous coracoclavicular ligament reconstruction

Coracoclavicular (CC) ligament reconstruction remains a challenging procedure. The ideal reconstruction is biomechanically strong, allows direct visualization of passage around the coracoid, and is minimally invasive. Few published reports have evaluated arthroscopic techniques with a single clavicular tunnel and transcoracoid reconstruction. One such report noted early excellent results, but without specific outcome measures. This study reports the clinical and radiographic results of a minimally invasive, arthroscopically assisted technique of CC ligament reconstruction using a transcoracoid and single clavicular tunnel technique. A retrospective review was performed of 10 consecutive repairs in 9 active duty patients who underwent CC ligament reconstruction with the GraftRope (Arthrex, Naples FL, USA). All reconstructions were performed according to the manufacturer's technique by a single, fellowship-trained surgeon. Medical records and radiographs were evaluated for demographics, operative details, loss of reduction, and return to duty. In 8 of 10 repairs (80%) intraoperative reduction was lost at an average of 7.0 weeks (range, 3-12 weeks). Four patients (40%) required revision. Subjective patient outcomes included 5 excellent/good results, 1 fair result, and 4 poor results. Tunnel widening was universally noted, and the failure mode in most patients appeared to be at the holding suture. This transcoracoid, single clavicular tunnel technique was not a reliable approach to CC ligament reconstruction. We noted a high percentage of radiographic redisplacement and clinical failure. This technique, in its current form, cannot be recommended to treat AC joint injuries in our population.

More Than a Pretty Space: Stormwater Treatment Wetlands with Multiple Benefits at Freedom Park, Naples FL

Freedom Park is a 20 ha (50 ac) stormwater runoff quality improvement project in the Gordon River watershed in Naples FL. Constructed ponds and wetlands and restored wetland habitats are integrated into a passive park setting of trails, boardwalks, educational facilities, and natural landscaping. Operated by the Collier County Growth Management Division and the Parks and Recreation Department, the system uses wetlands to reduce nitrogen and phosphorus in water pumped from ditches draining the watershed. Water pumped from the Gordon River supplements the system during dry, low flow seasons and helps reduce river phosphorus and nitrogen loads. Restored natural forested wetlands enhance site biodiversity and enrich the visitor experience. A versatile educational facility supports multiple civic functions that complement and reinforce the steady increase in visitor use since the park opened. Freedom Park demonstrates with excellence how a regional stormwater facility can be designed as a beautiful yet functional community asset.

Osteochondral autograft transfer for the treatment of osteochondritis dissecans of the medial femoral condyle in dogs

To describe the clinical application of osteochondral autograft transfer procedure for the treatment of osteochondritis dissecans (OCD) of the canine medial femoral condyle and to report clinical and force plate outcomes. Osteochondral autograft transfer (OATS™ Arthrex, Naples FL, USA) instrumentation was employed in six stifle joints of five dogs. Clinical examination was performed preoperatively and at two to three weeks, six to eight weeks, 12-18 weeks and at >22 months postoperatively. Radiography and arthroscopy were performed preoperatively and 12-18 weeks postoperatively. The follow-up examinations performed at 22 to 56 months included radiography, questionnaire completion with the owner, and force plate gait evaluation. Articular surface reconstruction was radiographically (for 6 stifle joints) and arthroscopically (for 5 stifle joints) maintained at 12-18 weeks. Subjectively-assessed lameness resolved in five out of six stifles by the 12 to 18 week reassessment. Morbidity included lateral patellar luxation at seven weeks and cranial cruciate ligament rupture at 11 months postoperatively. At the >22 month re-evaluation examination, subjectively-assessed lameness and signs of discomfort were minimal. Owner perceptions of outcome were positive; force plate assessment of gait indicated that weight bearing on three out of six OAT implanted limbs was less than the contralateral limb, but these comparisons were not evaluated statistically. A progression in the development of osteophytes was radiographically evident. The OAT procedure can reconstruct medial femoral condyle OCD defects in dogs. Long-term lameness and progressive osteophytosis may occur but can be associated with other pathology such as cruciate ligament insufficiency.

Comparative Testing by Cyclic Loading of Rotator Cuff Suture Anchors Containing Multiple High-Strength Sutures

To compare isolated medial-row with isolated lateral-row anchor performance by use of cyclic loading followed by destructive testing in an in vitro cadaveric model. Using 16 human cadaveric humeri without tendons, we rotated 4 medial-row (Bio-Corkscrew FT [Arthrex, Naples FL], CrossFT PK [ConMed Linvatec, Largo, FL], TwinFix PK FT [Smith & Nephew Endoscopy, Andover, MA], and Healix PK [DePuy Mitek, Raynham, MA]) and 4 lateral-row (PopLok PK [ConMed Linvatec], PEEK [polyetheretherketone] PushLock [Arthrex], Footprint PEEK [Smith & Nephew Endoscopy], and Versalok [DePuy Mitek]) anchors among different medial (articular cartilage edge) and lateral greater tuberosity sites (anterior, central, posterior). All medial anchors were inserted into the humeral head at an angle no greater than 45 degrees . All lateral anchors were inserted "over the top," nearly planar to the superior humeral surface. After preloading, the constructs were cycled 500 times from 10 to 60 N at 1 Hz with the loads applied to the accompanying sutures. Those constructs surviving cycling were destructively tested. Cyclic displacement, ultimate load, and failure mode were recorded. In this laboratory setting, most displacement occurred in the first 100 cycles except for the Footprint anchor. Lateral-row anchors had greater mean displacements (2.6 mm) than medial-row anchors (1.2 mm) at 100 cycles and between 100 and 500 cycles (1.8 mm v 0.75 mm). Lateral-row anchors also had more total displacement (4.4 mm) than medial-row anchors (1.9 mm). A 5-mm displacement gap, defined as failure, was not seen in the Bio-Corkscrew FT, TwinFix PK FT, and Versalok anchors. Ultimate failure loads ranged from 163 N (Footprint) to 308 N (Versalok) (P < .05). The principal failure mode was anchor pullout, followed by eyelet breakage. Medial-row eyelet failures only occurred after 500 cycles at loads higher than each anchor's mean failure load. Eyelet failure for lateral-row anchors occurred before 500 cycles and at failure loads lower than each anchor's mean. Lateral row anchors benefit from medial row anchors for their security, and because of design differences demonstrate more displacement. When lateral-row anchors fail at the eyelet, it is at lower failure loads, while if medial-row anchors fail at the eyelet, it is at higher loads. Anchors designed to function as lateral-row fixation provide fixation strength inferior to that of medial-row anchors and are more likely to be subject to suture slippage.

Deification and Grace by Daniel A. Keating (Sapientia Press: Naples FL, 2007). Pp. 124, £16.94.

Deification and Grace by Daniel A. Keating (Sapientia Press: Naples FL, 2007). Pp. 124, £16.94.

Grace Lutheran Church, Naples FL

Abstract

The Embryo as Person

The Embryo as Person

Full posterior cruciate ligament arthroscopic inlay reconstruction technical notes and early results (SS-86)

Treatment of posterior cruciate ligament (PCL) injury remains controversial. Despite the relative good outcome reported with conservative treatment, surgery has achieved invaluable results due to the advance of the techniques and to the better understanding of PCL anatomy and biomechanics. Recently, tibial inlay reconstruction has been proposed over the traditional transtibial reconstruction. Rather than using a tunnel for tibial attachment, the inlay technique uses a bone trough at the tibial site of PCL insertion to which the bone block of the graft is directly fixed. This type of reconstruction has the specific aim of achieving a more anatomical fixation, avoiding the so-called “killer turn.” Disadvantages of this technique include the need of a large incision in the posterior aspect of the knee, operative position and longer surgical time. Therefore, a full arthroscopic inlay procedure has been developed in order to combine the benefits of a more anatomical tibial fixation with the advantage of an arthroscopic procedure. Preliminary cadaver reconstructions have been carried out at the Laboratory of Arthroscopic and Surgical Anatomy of Barcelona. The surgery is performed using the traditional arthroscopic anterior portals and two additional postero-medial and postero-lateral portals with transeptal technique. The quadriceps tendon is the ideal graft for this surgery for the presence of a bone block on one side, which can sit nicely in the trough prepared on the tibia, while the soft tissue on the other side facilitates the passage of the graft though the portals and in the joint. Tibial side is fixed first using two Fiberwire (Arthrex, Naples FL) No. 2 sutures, passed either through the bone block or the tibia and finally secured on its anterior face. Femoral side fixation is achieved according to surgeon’s preference. Five patients have been treated using this technique. All complains with a severe posterior insufficiency isolated or combined with a posterolateral insufficiency. Stress x-ray preoperatively revealed an average posterior laxity of 12.5 ± 2.5. Four patients out of five underwent an isolated arthro-inlay reconstruction, whereas one patient underwent a combined PCL/PLC reconstruction. No surgical-related complications have been observed in these five cases. At an average follow-up of 9 months, the average posterior laxity showed at stress-x-rays was 4.5 ± 3.1. All patients regained full range of motion and do not complain with any specific complications, such as loss of motion or anterior knee pain. Despite these early satisfactory results, we do believe that further studies are needed to evaluate the ability of this technique to maintain long-term stability and improve function in the PCL-deficient knee.

Neoplasm at the head of the pancreas: a case study.

1. Kristina Marie Griffin, CLS(NCA)[⇑][1] 1. is a recent graduate from Florida Gulf Coast University, Ft Myers FL. This case study was originally developed when she was a clinical laboratory science student 1. Address for correspondence: Kristina Marie Griffin, 5115 Cobble Creek Court #103, Naples FL 34110, (239) 598-5022, KMGHerbalScience{at}aol.com. CASE PRESENTATION A 68-year-old male was seen by his anticoagulation clinic doctor for a scheduled warfarin check up. He had been diagnosed with deep vein thrombosis (DVT) about two years ago. The patient's international normalized ratio (INR) was 6.31; his target range is 2.0 to 3.0. The patient was referred to the evaluation clinic, where he was administered 2.5 mg of vitamin K. Consideration was given to his initial complaints of stomach ailments at the start of fluctuating INRs in the following weeks (Table 1). In addition to unintentional weight loss, physician examination revealed that the patient claimed episodes of hematuria. He also complained of recent lower back and stomach pain, and for the past four weeks, blood-tinged sputum in the mornings. The patient has a history of smoking. A urinalysis was performed and was negative for blood. Upon palpitation, his abdomen was non-tender and without masses. A 48-hour follow-up appointment was made with the anticoagulation clinic. On the second day, the patient's prothrombin time (PT) was redrawn, and demonstrated an INR of 4.29. He maintained his directed warfarin dosage and was scheduled to return in 12 days. At 14 days he displayed a critical INR of 6.58 and was administered another 2.5 mg of vitamin K. However, at this appointment, the patient confessed missing a warfarin dose within the last ten days. Plans were documented to decrease his warfarin dosage when the patient's INR fell to within his target range. His next appointment was scheduled for two days later. ABBREVIATIONS: DVT = deep vein thrombosis; ERCP = endoscopic retrograde cholangiopancreatography; INR = international normalized ratio; PTCA = percutaneous transhepatic cholangiogram. [1]: #corresp-1