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Sample records for bucket-handle meniscal tears

  1. Bucket handle tears of the medial meniscus: meniscal intrusion rather than meniscal extrusion

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    Schlossberg, S. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Umans, H. [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Flusser, G. [Tel Aviv Sourasky Medical Center, Department of Radiology, Tel Aviv (Israel); DiFelice, G.S. [Jacobi Medical Center, Department of Surgery Division of Orthopedic Surgery, Bronx, NY (United States); Lerer, D.B. [Montefiore Medical Center, Department of Radiology, Bronx, NY (United States)

    2007-01-15

    To determine the frequency of medial meniscal extrusion (MME) versus ''medial meniscal intrusion'' in the setting of bucket handle tears. Images were evaluated for previously reported risk factors for MME, including: medial meniscal root tear, radial tear, degenerative joint disease and joint effusion. Forty-one consecutive cases of bucket handle tear of the medial meniscus were reviewed by consensus by two musculoskeletal radiologists. Imaging was performed using a 1.5 GE Signa MR unit. Patient age, gender, medial meniscal root integrity, MME, medial meniscal intrusion, degenerative joint disease, effusion and anterior cruciate ligament (ACL) tear were recorded. Thirteen females and 27 males (age 12-62 years, median=30 years) were affected; one had bucket handle tear of each knee. Effusion was small in 13, moderate in 9 and large in 18. Degenerative joint disease was mild in three, moderate in two and severe in one. 26 ACL tears included three partial and three chronic. Medial meniscal root tear was complete in one case and partial thickness in two. None of the 40 cases with an intact or partially torn medial meniscal root demonstrated MME. MME of 3.1 mm was seen in the only full-thickness medial meniscal root tear, along with chronic ACL tear, moderate degenerative joint disease and large effusion. Medial meniscal intrusion of the central bucket handle fragment into the intercondylar notch was present in all 41 cases. Given an intact medial meniscal root in the setting of a ''pure'' bucket handle tear, there is no MME. (orig.)

  2. The quadruple cruciate sign of simultaneous bicompartmental medial and lateral bucket-handle meniscal tears

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    Bugnone, Alejandro N. [University of Miami School of Medicine/Jackson Memorial Hospital, Department of Radiology, Miami, FL (United States); Ramnath, R.R. [Neuroskeletal Imaging, Merritt Island, FL (United States); Davis, S.B. [Orthopedic Center, Huntsville, Alabama (United States); Sedaros, R. [Space Coast Orthopedics, Merritt Island, FL (United States)

    2005-11-01

    We report the second known case of bicompartmental bucket-handle tears of the medial and lateral menisci and the first documented case of the bucket-handle tears occurring simultaneously following trauma, which occurred after a motorcycle accident. Both bucket-handle fragments were displaced into the intercondylar notch. An anterior cruciate ligament tear was also present. Coronal images demonstrated four structures in the intercondylar notch: the anterior and posterior cruciate ligaments and the medial and lateral bucket-handle meniscal fragments. (orig.)

  3. MR imaging of meniscal bucket-handle tears: a review of signs and their relation to arthroscopic classification

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    Aydingoez, Uestuen; Firat, Ahmet K. [Department of Radiology, Hacettepe University Medical Center, 06100 Ankara (Turkey); Atay, Ahmet Oe.; Doral, Nedim M. [Department of Orthopaedics and Traumatology, Hacettepe University Medical Center, 06100 Ankara (Turkey)

    2003-03-01

    Our objective was to review the MR imaging signs of meniscal bucket-handle tears and assess the relevance of these signs to the arthroscopic classification of displaced meniscal tears. Forty-five menisci in 42 patients who had a diagnosis of bucket-handle tear either on MR imaging or on subsequent arthroscopy (in which Dandy's classification of meniscal tears was used) were retrospectively analyzed for MR imaging findings of double posterior cruciate ligament (PCL), fragment within the intercondylar notch, absent bow tie, flipped meniscus, double-anterior horn, and disproportional posterior horn signs. Arthroscopy, which was considered as the gold standard, revealed 41 bucket-handle tears (either diagnosed or not diagnosed by MR imaging) in 38 patients (33 males, 5 females). There was a stastistically significant male preponderance for the occurrence of meniscal bucket-handle tears. Overall, sensitivity and positive predictive value of MR imaging for the detection of meniscal bucket-handle tears were calculated as 90%. Common MR imaging signs of meniscal bucket-handle tears in arthroscopically proven cases of such tears were the fragment in the notch and absent bow tie signs (98% frequency for each). Double-PCL, flipped meniscus, double-anterior horn, and disproportional posterior horn signs, however, were less common (32, 29, 29, and 27%, respectively). An arthroscopically proven bucket-handle tear was found in all patients who displayed at least three of the six MR imaging signs of meniscal bucket-handle tears. The presence of three or more MR imaging signs of meniscal bucket-handle tears is highly suggestive of this condition. (orig.)

  4. Bucket-handle meniscal tears of the knee: sensitivity and specificity of MRI signs

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    Dorsay, Theodore A.; Helms, Clyde A. [Department of Radiology, Duke University Medical Center, Erwin Road, Room 1504, NC 27710, Durham (United States)

    2003-05-01

    To determine the sensitivity and specificity of reported MRI signs in the evaluation of bucket-handle tears of the knee.Design and patients A retrospective analysis of 71 knee MR examinations that were read as displaying evidence of a bucket-handle or ''bucket-handle type'' tear was performed. We evaluated for the presence or absence of the absent bow tie sign, the coronal truncation sign, the double posterior cruciate ligament (PCL) sign, the anterior flipped fragment sign, and a fragment displaced into the intercondylar notch. Sensitivity and specificity were calculated relative to the gold standard of arthroscopy. Forty-three of 71 cases were surgically proven as bucket-handle tears. The absent bow tie sign demonstrated a sensitivity of 88.4%. The presence of at least one of the displaced fragment signs had a sensitivity of 90.7%. A finding of both the absent bow tie sign and one of the displaced fragment signs demonstrated a specificity of 85.7%. The double PCL sign demonstrated a specificity of 100%. The anterior flipped meniscus sign had a specificity of 89.7%. Bucket-handle tears of the menisci, reported in about 10% of most large series, have been described by several signs with MRI. This report gives the sensitivity and specificity of MRI for bucket-handle tears using each of these signs independently and in combination. MRI is shown to be very accurate for diagnosing bucket-handle tears when two or more of these signs coexist. (orig.)

  5. Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report

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    Beris Alexandros E

    2010-02-01

    Full Text Available Abstract Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation.

  6. Self-Reduction of Displaced Bucket-Handle Medial Meniscal Tear in a 71-Year-Old Patient: A Case Report.

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    Ciminero, Matthew L; Huntley, Samuel R; Ghasem, Alexander D; Pitcher, John D

    2015-12-01

    Bucket-handle meniscal tears are rare in geriatric patients. Displaced bucket-handle meniscal tears are usually treated operatively. Due to the rarity of these tears in elderly patients and conflicting evidence regarding the use of arthroscopy versus conservative treatment, it is valuable to report the clinical presentation, treatment, and outcome of these injuries in elderly patients. We describe a 71-year-old man who presented with an acute, displaced, magnetic resonance imaging (MRI)-confirmed right medial meniscal bucket-handle tear with mild effusion and no signs of degenerative joint disease. On physical examination, the patient was unable to fully extend the right leg due to locking of the knee. At 2-month follow-up, MRI showed mild degenerative changes and an anatomically reduced tear. At 6-month follow-up, the patient reported normal, pain-free knee function, and MRI showed the tear healing in anatomic position with minimal inferior surface changes and no effusion. He returned to his pain-free baseline level of physical activity. Upon review of the English literature, this 71-year-old patient is an exceptional case and one of the oldest patients reported to have sustained a displaced medial meniscal bucket-handle tear treated successfully with nonoperative means. Two reported cases of spontaneously reduced meniscal bucket-handle tears were found in the English literature, although both cases were seen in much younger males and involved the lateral meniscus. This case suggests that in elderly patients with displaced medial meniscus bucket-handle tears that reduce spontaneously, the physician can safely and efficaciously use conservative, nonoperative management to achieve restoration of baseline knee function and anatomic meniscal healing while avoiding the risks of arthroscopic surgery. Surgical intervention for reduction without repair may be an available option, but no literature is present to direct care; however, complete documentation as in the

  7. Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear

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    Rabelo,Neiffer Nunes; Rabelo,Nícollas Nunes; Cunha,Aluísio Augusto Gonçalves; Correia,Francisco

    2013-01-01

    We report a case of injury of the medial bucket handle meniscal tears (BH), which resolved spontaneously, in association with anterior cruciate ligament (ACL) injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treat...

  8. COMBINED INSIDE-OUT AND ALL-INSIDE TECHNIQUE IN BUCKET-HANDLE MENISCUS TEARS.

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    Yılmaz, Serdar; Cankaya, Deniz; Fırat, Ahmet; Devecı, Alper; Ozkurt, Bulent; Bozkurt, Murat

    2016-01-01

    To determine the outcomes after combined inside-out and all-inside repair technique of bucket-handle meniscus tears. A retrospective review was made of patients with bucket-handle meniscus tears repaired with combined techniques, using the all-inside technique in posterior meniscal tears and the inside-out technique in the middle part of the meniscal tears. Meniscal healing was assessed clinically using Barrett's criteria and MRI. The study comprised 52 patients with a mean age of 28.4 years old (range, 19-52 years old). The mean follow-up period was 31.3 months (range, 24-59 months). Two patients had ACL re-rupture, and complete meniscal healing was achieved in all but one patient. Although improved from preoperative status, Tegner and Lysholm scores were lower in the ACL reconstructed patients than in the intact ACL patients. Combined inside-out and all-inside meniscal repair technique is a successful and cost-effective treatment method in bucket-handle meniscus tears. Level of Evidence IV, Therapeutic Study.

  9. The displaced bucket-handle tear of the meniscus: MRI findings

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    Park, Gyung Hi; Juhng, Seon Kwan; Kim, Gang Deuk; Kwon, Young Mi; Won, Jong Jin [Wonkwang University School of Medicine, Iri (Korea, Republic of)

    1994-07-15

    To describe the features of displaced bucket-handle tears of the menisci on magnetic resonance(MR) images and to assess associated knee injuries. We retrospectively reviewed coronal and sagittal MR images in 21 bucket-handle tears. The subjects were patients who had underwent preoperative MR evaluations of the knee and were identified from the arthroscopic surgical records as bucket-handle tear. We also described patterns of associated injuries. On coronal MR images, (a) in all cases, peripheral portion of the meniscus(bucket) had the appearance of a truncated or altered wedge; (b) central fragments(handle) were observed to be sitting in the intercondylar notch (16 cases) or located between the femoral condyle and tibial plateau (5 cases). On sequential sagittal MR images, (c) the bow-tie appearance of the body of the meniscus was not seen (13 cases); (d) the bow-tie appearance of the displaced inner fragment was seen at the intercondylar notch level (9 cases); (e) 'double posterior cruciate ligament' sign was presented (7 cases). Associated joint abnormalities included anterior cruciate ligament tears(11), contralateral meniscal tears(11), posterior cruciate ligament tears(3), medial collateral ligament tears(3), osteoarthritis(1), and Baker's cyst(1). Awareness of these characteristic MR images(a-e) may increase the sensitivity of MR imaging in the diagnosis of displaced bucket-handle tears, and the MRI may be helpful to correctly characterize the displaced fragment and patterns of associated injury, providing arthroscopists a guide to appropriate surgical plans.

  10. A novel technique for modified all-inside repair of bucket-handle meniscus tears using standard arthroscopic portals.

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    Yik, Jing Hui; Koh, Bryan Thean Howe; Wang, Wilson

    2017-12-04

    Bucket-handle meniscus tears (BHMT) are often displaced and unstable. The inside-out technique of repairing such tears is currently the gold standard. All-inside repair with meniscal fixators is getting increasingly popular. Shortcomings of the inside-out technique include neurovascular complications, especially saphenous nerve palsy, and retention of a non-resorbable suture which can result in discomfort to patient, granuloma formation, and a foci of infection. Hence, the purpose of this project was to innovate a novel all-inside technique to precisely reduce and fix BHMT while avoiding neurovascular complications and retention of a non-resorbable suture. Routine arthroscopic portals were created on a patient's left knee with a displaced BHMT. Through the anteromedial portal, a conjoint pseudo double lumen cannula was inserted. Two limbs of a reduction suture were passed through the cannula, one over the "femoral" surface of the meniscus, one over the "tibial" surface of the meniscus anterior to the biceps femoris tendon, with the knee flexed at 20° to avoid injury to the saphenous nerve. Suture limbs were passed out percutaneously and tensioned. Anatomic reduction was ensured under arthroscopic visualization with ease. All inside repair was performed using the vertical mattress suture configuration. Reduction sutures were subsequently removed by cutting flush to the skin and pulling on one suture limb. The patient was back to full activities with minimal discomfort 8 months post-operatively. The technique described is superior to existing techniques for the following reasons: (1) Reduction of the displaced meniscal tear is "extra-meniscal," avoiding further trauma to a damaged meniscus. (2) Tensioning of the two suture limbs created promotes better control of reduction through tensioning. (3) Risk of discomfort, infection, and neurovascular damage caused by a retained suture is reduced. (4) No additional portals/equipment is required. We encourage this novel

  11. Articular cartilage scores in cranial cruciate ligament-deficient dogs with or without bucket handle tears of the medial meniscus.

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    Kaufman, Kathryn; Beale, Brian S; Thames, Howard D; Saunders, W Brian

    2017-01-01

    To compare articular cartilage scores in cranial cruciate ligament (CCL)-deficient dogs with or without concurrent bucket handle tears (BHT) of the medial meniscus. Retrospective case series. Client-owned dogs treated with arthroscopy and tibial plateau leveling osteotomy or extracapsular repair for complete CCL rupture (290 stifles from 264 dogs). Medical records and arthroscopic images were reviewed. Medial femoral condyle (MFC) and medial tibial plateau (MTP) cartilage was scored using the modified Outerbridge scale. Periarticular osteophytosis (PAO) and injury to the medial meniscus were recorded. Data were analyzed using Student's t-tests, Wilcoxon rank-sum test, and Fisher's exact test for changes in the stifle based on meniscal condition, body weight, and duration of lameness. PAO, MFC, and MTP articular cartilage scores were not significantly different in dogs with or without BHT. There were no significant differences in MFC or MTP scores when dogs were evaluated based on bodyweight and the presence or absence of a BHT. However, PAO formation was significantly increased in dogs weighing >13.6 kg and concurrent meniscal injury vs. dogs weighing <13.6 kg and concurrent meniscal injury (P < .001). Significantly more stifles with chronic lameness (40 of 89; 44.9%) had the highest PAO score of 2 reported compared to only 42 of 182 stifles (23.1%) with acute lameness (P < .001). The presence of a BHT of the medial meniscus was not associated with more severe arthroscopic articular cartilage lesions in the medial joint compartment at the time of surgery. © 2016 The American College of Veterinary Surgeons.

  12. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears.

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    Marchetti, Daniel Cole; Phelps, Brian M; Dahl, Kimi D; Slette, Erik L; Mikula, Jacob D; Dornan, Grant J; Bucci, Gabriella; Turnbull, Travis Lee; Singleton, Steven B

    2017-10-01

    To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P inside-out technique at angles ≥45° (all P inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level. An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  13. Role of MRI in predicting meniscal tear reparability

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    Felisaz, Paolo Florent [Universita degli Studi di Pavia, Pavia (Italy); Fondazione IRCCS Policlinico San Matteo, Istituto di Radiologia, Pavia (Italy); Alessandrino, Francesco; Perelli, Simone [Universita degli Studi di Pavia, Pavia (Italy); Zanon, Giacomo; Benazzo, Francesco [Fondazione IRCCS Policlinico San Matteo, Clinica Ortopedica e Traumatologica, Pavia (Italy); Calliada, Fabrizio; Sammarchi, Luigi [Fondazione IRCCS Policlinico San Matteo Radiologia, Diagnostica per Immagini-Istituto di Radiologia, Pavia (Italy)

    2017-10-15

    To elucidate the role of MRI in predicting meniscal tear reparability according to tear type and location in relation to vascular zones. In this retrospective study, two readers evaluated 79 pre-surgical MRIs of meniscal tears arthroscopically treated with meniscectomy or meniscal repair. Tears were classified according to type into vertical, horizontal, radial, complex, flaps and bucket handle and were considered reparable if the distance measured from the tear to the menisco-capsular junction was less than or equal to 5 mm. Predictions were compared with the surgical procedure performed in arthroscopy. We assessed the diagnostic performance of MRI, agreement between MRI and arthroscopy, and interrater agreement. Then, we conducted an ROC analysis on the distances measured by the first reader and built a multivariate logistic regression model. MRI had a sensitivity, specificity, PPV, NPV and accuracy, respectively, of 85%, 79%, 86%, 76% and 83% in predicting meniscal tear reparability. Correct predictions for the specific tear pattern were 76% for vertical, 84% for horizontal, 88% for radial, 86% for complex, 84% for flaps and 86% for bucket handle. Agreement between the two readers' predictions and arthroscopy was good (k = 0.65 and 0.61, respectively). Inter-rater agreement was almost excellent (k = 0.79). The ROC analysis revealed sensitivity and specificity of 73% and 83% with a cutoff value of <4 mm (p < 0.001). Anterior cruciate ligament injury and medial meniscal tear increased the likelihood of meniscal tear reparability. MRI can be a reliable and accurate tool to predict the reparability of meniscal tears, with higher prediction rates for bucket-handle tears. (orig.)

  14. Arthroscopic Inside-Out Repair of a Meniscus Bucket-Handle Tear Augmented With Bone Marrow Aspirate Concentrate.

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    Muckenhirn, Kyle J; Kruckeberg, Bradley M; Cinque, Mark E; Chahla, Jorge; DePhillipo, Nicholas N; Godin, Jonathan A; LaPrade, Robert F

    2017-08-01

    Bucket-handle tears of the meniscus comprise nearly 10% of all meniscus tears and commonly affect the young male population. Displacement of the free segment can lead to significant pain and disability, necessitating reduction and surgical treatment. General contraindications include malalignment, severe arthritis, significant comorbidities, or chronic asymptomatic tears, but otherwise repair should almost always be performed. Options for surgical treatment include partial meniscectomy and arthroscopic repair using an all-inside, outside-in, or inside-out technique. The purpose of this Technical Note is to detail our arthroscopic inside-out repair technique augmented with bone marrow aspirate concentrate.

  15. Meniscal tears associated with anterior cruciate ligament injury.

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    Hagino, Tetsuo; Ochiai, Satoshi; Senga, Shinya; Yamashita, Takashi; Wako, Masanori; Ando, Takashi; Haro, Hirotaka

    2015-12-01

    To investigate the frequency of meniscal tear and the location of tear associated with anterior cruciate ligament (ACL) injury. We studied 549 patients (552 knees) who were diagnosed with ACL injury by arthroscopy at our center between January 2006 and March 2014 (8 years and 3 months). The subjects comprised 289 males and 263 females ranging in age from 13 to 66 (mean 26.1) years. The cause of injury was sports-related in 89.1 %, and the mean interval from injury to initial arthroscopy was 23 months. The patients were divided into two groups: arthroscopy performed within 8 weeks after injury (acute group; 256 knees) and more than 8 weeks after injury (chronic group; 296 knees). Frequency of meniscal tear and location of tear were compared between two groups. The incidence of meniscal tear diagnosed by arthroscopic examination was 79.2 % (437 of 552 knees) in all subjects; 72.7 % (186 of 256 knees) in acute group and 84.8 % (251 of 296 knees) in chronic group, and was significantly higher in chronic group. Regarding the locations of meniscal tears, in acute group (186 knees), medial meniscal tear only was found in 20 knees (10.8 %), lateral meniscal tear only in 129 knees (69.4 %), and bilateral (including medial and lateral) meniscal tears in 37 knees (19.9 %). In chronic group (251 knees), medial meniscal tear only was found in 62 knees (24.7 %), lateral meniscal tear only in 85 knees (33.9 %), and bilateral meniscal tears in 104 knees (41.4 %). Lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear with chronic ACL injury. Bucket handle tear was observed in 25 knees (medial: 17 knees, lateral: 8 knees) in acute group, and 81 knees (medial: 69 knees, lateral: 12 knees) in chronic group, and was more common in the chronic group. The incidence of meniscal tear associated with ACL injury is higher in chronic cases; the number of medial meniscal tears is particularly high, many of which require meniscectomy. Early ACL

  16. Structural knee joint pathology in patients aged 40 years or older with meniscal tears

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L S

    2017-01-01

    three meniscal sub regions (n=13), of which 7 were large bucket-handle tears, and partial ACL rupture (n=14) were rare pathologies. Conclusions: In this explorative study, we found that only 2 of 14 intra-articular knee joint pathologies were associated with mechanical symptoms in patients aged 40 years......Purpose: Recent studies have challenged the tenet that mechanical symptoms of the knee (i.e. the sensation of catching or locking) are caused by degenerative meniscal tears per se and relieved by surgery. We explored the potential associations between meniscal and other knee joint pathologies...... identified at meniscal surgery with the presence of patient-reported mechanical symptoms. Methods: This study included patients aged 40 years or older undergoing surgery for a meniscal tear from the Knee Arthroscopy Cohort Southern Denmark (KACS). Patients were consecutively recruited from February 2013...

  17. Spontaneous healing of bucket handle tear of the medial meniscus associated with ACL tear Resolução espontânea da lesão alça de balde do menisco medial associado com rotura de LCA

    Directory of Open Access Journals (Sweden)

    Neiffer Nunes Rabelo

    2013-01-01

    Full Text Available We report a case of injury of the medial bucket handle meniscal tears (BH, which resolved spontaneously, in association with anterior cruciate ligament (ACL injury. The patient twisted his left knee during a fight in martial arts, progressing to pain and joint locking and a sense of distortion. In NMR it could be seen bucket-handle tear of the medial meniscus with displacement of the fragment to the intercondylar region, rupture of the lateral meniscus and ACL tear. After conservative treatment and physiotherapy, in an interval of one year, later examinations showed that there was spontaneous healing of ABNeste trabalho é relatado um caso de lesão do menisco medial do tipo em alça de balde (AB, que se resolveu espontaneamente, em associação com lesão de ligamento cruzado anterior (LCA. O paciente torceu o joelho esquerdo durante uma luta em artes maciais, evoluindo com dor e bloqueio articular e sensação de falseamento. Na RMN havia rotura em alça de balde do menisco medial com deslocamento do fragmento para a região intercondilar, rotura do menisco lateral e rotura do LCA. Após tratamento clínico e fisioterápico, em um intervalo de um ano, o exame de controle demonstrou que havia ocorrido resolução espontânea da AB.

  18. Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair.

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    Palisch, Andrew R; Winters, Ronald R; Willis, Marc H; Bray, Collin D; Shybut, Theodore B

    2016-10-01

    The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. ©RSNA, 2016.

  19. Rotura em "alça de balde" simultânea dos meniscos no mesmo joelho Simultaneous "bucket-handle" tear of both menisci on the same knee

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    Andre Francisco Gomes

    2009-01-01

    Full Text Available Rotura em "alça de balde" de ambos os meniscos do mesmo joelho é um fenômeno raro. Apresentamos o caso de um paciente em que a ressonância magnética demonstrou rotura em "alça de balde" dos meniscos medial e lateral do mesmo joelho, associada a rotura do ligamento cruzado anterior, confirmado por videoartroscopia. A ressonância magnética demonstra sinais que permitem o diagnóstico preciso.Simultaneous "bucket-handle" tear of menisci on the same knee is a rare phenomenon. We describe a case of a bucket-handle tear of menisci and tear of anterior cruciate ligament of the same knee showed on magnetic resonance imaging and confirmed by arthroscopy. The magnetic resonance imaging can provide accurate diagnosis of this type of injury.

  20. Meniscal root tears: significance, diagnosis, and treatment.

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    Bhatia, Sanjeev; LaPrade, Christopher M; Ellman, Michael B; LaPrade, Robert F

    2014-12-01

    Meniscal root tears, less common than meniscal body tears and frequently unrecognized, are a subset of meniscal injuries that often result in significant knee joint disorders. The meniscus root attachment aids meniscal function by securing the meniscus in place and allowing for optimal shock-absorbing function in the knee. With root tears, meniscal extrusion often occurs, and the transmission of circumferential hoop stresses is impaired. This alters knee biomechanics and kinematics and significantly increases tibiofemoral contact pressure. In recent years, meniscal root tears, which by definition include direct avulsions off the tibial plateau or radial tears adjacent to the root itself, have attracted attention because of concerns that significant meniscal extrusion dramatically inhibits normal meniscal function, leading to a condition biomechanically similar to a total meniscectomy. Recent literature has highlighted the importance of early diagnosis and treatment; fortunately, these processes have been vastly improved by advances in magnetic resonance imaging and arthroscopy. This article presents a review of the clinically relevant anatomic, biomechanical, and functional descriptions of the meniscus root attachments, as well as current strategies for accurate diagnosis and treatment of common injuries to these meniscus root attachments. © 2014 The Author(s).

  1. Association of peripheral vertical meniscal tears with anterior cruciate ligament tears

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    Vinson, Emily N.; Gage, Jeffrey A.; Lacy, Joe N. [Duke University Medical Center, Department of Radiology, Durham, NC (United States)

    2008-07-15

    The purpose of this article is to describe a type of meniscal tear seen on magnetic resonance (MR) imaging, the peripheral vertical tear, and to determine the prevalence of anterior cruciate ligament (ACL) tears in knees with this type of meniscal tear compared to knees with other types of meniscal tears. Following Institutional Review Board approval, a retrospective review of 200 knee MR examinations with imaging diagnoses of 'meniscal tear' was performed to assess the location and morphology of the meniscal tear, and to assess the status of the ACL. Nineteen peripheral vertical meniscal tears were identified in 17 patients, 14 of whom had acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. Three peripheral vertical tears were seen in the setting of a normal ACL. Of the 183 examinations with other types of meniscal tears, there were 17 cases with acute ACL tears, prior ACL reconstruction, or chronic ACL deficiency. The difference in the prevalence of ACL tear, reconstruction, or deficiency in knees with meniscal tears of the peripheral vertical type (82.4%) compared with the prevalence of ACL tear, reconstruction, or deficiency in knees with other types of meniscal tears (9.3%) was statistically significant (P < 0.001). The calculated specificity of the presence of peripheral vertical tear morphology in detecting an ACL injury in patients with meniscal tears was 98.2%. Peripheral vertical meniscal tears, particularly when involving the posterior horn, are highly associated with ACL tear, deficiency, or reconstruction. The finding of this type of tear on knee MR imaging should prompt close inspection of the ACL for evidence of acute or chronic injury, and its presence may help make the diagnosis of ACL tear in equivocal cases. (orig.)

  2. The potential of optical coherence tomography in meniscal tear characterization

    Science.gov (United States)

    Ling, Hang-yin; Guo, Shuguang; Thieman, Kelley M.; Wise, Brent T.; Pozzi, Antonio; Xie, Huikai; Horodyski, MaryBeth

    2009-02-01

    Meniscal tear is one of the most common knee injuries leading to pain and discomfort. Partial and total meniscectomies have been widely used to treat the avascular meniscal injuries in which tears do not heal spontaneously. However, the meniscectomies would cause an alteration of the tibiofemoral contact mechanics resulting in progressive osteoarthritis (OA). To mitigate the progression of OA, maximal preservation of meniscal tissue is recommended. The clinical challenge is deciding which meniscal tears are amenable to repair and which part of damaged tissues should be removed. Current diagnosis techniques such as arthroscopy and magnetic resonance imaging can provide macrostructural information of menisci, but the microstructural changes that occur prior to the observable meniscal tears cannot be identified by these techniques. Serving as a nondestructive optical biopsy, optical coherence tomography (OCT), a newly developed imaging modality, can provide high resolution, cross-sectional images of tissues and has been shown its capabilty in arthroscopic evaulation of articular cartilage. Our research was to demonstrate the potential of using OCT for nondestructive characterization of the histopathology of different types of meniscal tears from clinical cases in dogs, providing a fundamental understanding of the failure mechanism of meniscal tears. First, cross-sectional images of torn canine menisci obtained from the OCT and scanning electronic microscopy (SEM) were be compared. By studying the organization of collegan fibrils in torn menisci from the SEM images, the feasibility of using OCT to characterize the organization of collegan fibrils was elucidated. Moreover, the crack size of meniscal tears was quantatitively measured from the OCT images. Changes in the crack size of the tear may be useful for understanding the failure mechanism of meniscal tears.

  3. Evaluation of meniscal click for detecting meniscal tears in stifles with cranial cruciate ligament disease.

    Science.gov (United States)

    Neal, Brittany A; Ting, Dennis; Bonczynski, Jennifer J; Yasuda, Koji

    2015-02-01

    To assess the diagnostic efficacy of palpable meniscal click by evaluating the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of preoperative palpable meniscal click compared with examination during surgery. Prospective case series. Dogs (n = 56) with cranial cruciate ligament (CCL) injury. Stifles were examined before anesthesia (EBA) and during anesthesia (EDA) before surgery for palpable meniscal click. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy were calculated for EBA and EDA using examination during surgery as the gold standard. EBA was 45.8% sensitive and 94.4% specific for meniscal tear. EDA was 58.3% sensitive and 94.4% specific for meniscal tear. Positive predictive value for palpable meniscal click during EBA was 84.6%, negative predictive value was 72.3%, and diagnostic accuracy was 75.0%. Positive predictive value for palpable meniscal click during EDA was 87.5%, negative predictive value was 77.3%, and diagnostic accuracy was 80.0%. EBA and EDA were significantly associated with the presence of intra-operative meniscal injury (P = .0002 and P click during physical examination is strongly indicative of a meniscal tear diagnosed at surgery. The meniscus should always be carefully examined at surgery despite preoperative findings, because the absence of a palpable meniscal click is not a strong indicator for a normal meniscus. © Copyright 2014 by The American College of Veterinary Surgeons.

  4. Meniscal root tear repair: why, when and how?

    Directory of Open Access Journals (Sweden)

    Davide Edoardo Bonasia

    2015-06-01

    Full Text Available The integrity of the meniscal root insertions is fundamental to preserve correct knee kinematics and avoid degenerative changes of the knee. Injuries to the meniscal attachments can lead to meniscal extrusion, decreased contact surface, increased cartilage stress, and ultimately articular degeneration. Recent and well designed studies have clarified the anatomy and biomechanics of the medial and lateral meniscal roots. Although the treatment of meniscal root tears is still controversial, many different techniques have been described for root repair. The goal of this review is to summarize the existing knowledge regarding meniscal root tears, including anatomy, biomechanics and imaging. In addition, the most common surgical techniques, together with the clinical outcomes, are described.

  5. Anatomical Knee Variants in Discoid Lateral Meniscal Tears

    Directory of Open Access Journals (Sweden)

    Xu-Xu Chen

    2017-01-01

    Conclusions: The condylar cutoff sign observed on the tunnel view of the radiograph is helpful in predicting meniscal tear in adult patients with discoid lateral meniscus. As for these patients, further MRI test is recommended.

  6. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review.

    Science.gov (United States)

    Grant, John A; Wilde, Jeff; Miller, Bruce S; Bedi, Asheesh

    2012-02-01

    Arthroscopic meniscal repair techniques are continuing to evolve. Most studies to date comparing the healing rate of inside-out to all-inside meniscal repair techniques are confounded by associated anterior cruciate ligament reconstruction or deficiency. This review was conducted to compare the effectiveness and complications of the inside-out repair technique to that of the all-inside repair technique in isolated unstable peripheral longitudinal ("bucket-handle") meniscal tears. Systematic review. Computerized keyword searches of MEDLINE, EMBASE, CINAHL, ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were performed. Two reviewers independently performed searches and article reduction. Studies that included stratified data for isolated unstable longitudinal meniscal tears in stable knees, repaired with either an inside-out or all-inside repair technique, were selected. Data on clinical failure, subjective outcome measures, and complications were summarized. Nineteen studies included data specific to isolated meniscal tears. The rate of clinical failure was 17% for inside-out repairs and 19% for all-inside repairs. Lysholm scores and Tegner activity scores were similar between the 2 repair methods (87.8 vs 90.2 and 5.6 vs 5.5, respectively). The prevalence of nerve injury/irritation was higher with the inside-out technique (9% vs 2%). All-inside techniques had a higher rate of local soft tissue irritation, swelling, and implant migration or breakage. The use of older generation, rigid, all-inside implants is associated with chondral injury. There are no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Complications are associated with both techniques. More nerve symptoms are associated with the inside-out repair and more implant-related complications are associated with the all-inside technique. Rates of structural healing

  7. Posterior horn medial meniscal root tear: the prequel

    Energy Technology Data Exchange (ETDEWEB)

    Umans, H. [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Morrison, W. [Thomas Jefferson University Hospital, Philadelphia, PA (United States); DiFelice, G.S. [Hospital for Special Surgery, New York, NY (United States); Vaidya, N. [Crystal Run Healthcare, Middletown, NY (United States); Winalski, C.S. [Cleveland Clinic, Imaging Institute, Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH (United States)

    2014-06-15

    To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging centers over a 7-year period. The pre- and post-tear MR images were evaluated for marrow signal changes deep to the root anchor, meniscal root signal intensity, medial compartment articular cartilage thinning, and meniscal body extrusion. Images of 29 age- and gender-matched individuals with two MRIs of the same knee were reviewed as a control group. MRI in 11 of 15 (73 %) cases with subsequent PHMMR tear demonstrated linear subcortical marrow edema deep to the meniscal root anchor on the antecedent MRI compared to only 1 of 29 (3 %) non-tear controls (p < 0.0001). The abnormal signal resolved on post-tear MRI in all but two patients. Cyst-like changes deep to the PHMMR were present on initial MRI in three of 15 (23 %) cases and three of 29 (10 %) controls, persisting in all but one case on follow-up imaging. The PHMMR was gray on the initial MRI in seven of 15 (47 %) of cases that developed tears compared to four of 29 (14 %) controls (p < 0.0001). There was medial meniscal extrusion (MME) prior to tear in two of 15 (13 %) patients and in ten of 15 (67 %) patients after PHMMR failure. In the control group, MME was present in one (3 %) and three (10 %) of 29 subjects on the initial and follow-up MRIs, respectively. Articular cartilage loss was noted in two of 15 (15 %) cases before tear and nine of 15 (69 %) on follow-up imaging, as compared to one (3 %) and four (14 %) of 29 subjects in the control group. Subcortical marrow edema deep to the PHMMR may result from abnormal stresses and thus be a harbinger of meniscal root failure. This hypothesis is supported by resolution of these marrow signal changes after root tear. Following tear, extrusion of the

  8. Management of traumatic meniscal tear and degenerative meniscal lesions. Save the meniscus.

    Science.gov (United States)

    Beaufils, P; Pujol, N

    2017-12-01

    Meniscectomy remains one of the most frequent orthopedic procedures, despite meniscal sparing having been advocated for several decades now. Incidence is excessive in the light of scientifically robust studies demonstrating the interest of meniscal repair or of nonoperative treatment for traumatic tear and of nonoperative treatment for degenerative meniscal lesions. It is high time that the paradigm shifted, in favor of meniscal preservation. In traumatic tear, and most particularly longitudinal vertical tear in vascularized zones, repair shows a high success rates in terms of recovery time, functional outcome and cartilage protection. Leaving the meniscus alone may be an option in asymptomatic lesions of the lateral meniscus during anterior cruciate ligament (ACL) reconstruction. Posterior ramp lesions (in associated ACL tear), traumatic root tears and radial lesions are also excellent indications for repair, although it has to be borne in mind that the natural history of these lesions is not completely understood and nonoperative treatment also may be considered. Degenerative meniscal lesions are frequently revealed by MRI in middle-aged or elderly subjects. They are closely related to tissue aging and thus probably to osteoarthritic processes. Meniscectomy was long considered the treatment of choice. All but 1 of the 8 recent randomized studies reported non-superiority of arthroscopy over nonoperative treatment, which should thus be the first-line choice, with arthroscopic meniscectomy reserved for cases of failure, or earlier in case of "considerable" mechanical symptoms. Horizontal cleavage in young athletes is a particular case, requiring meniscal repair, to avoid a meniscectomy, which would inevitably be extensive in a young active patient. More than ever, the take-home message is: save the meniscus! Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  9. The role of biomaterials in the treatment of meniscal tears

    Directory of Open Access Journals (Sweden)

    Crystal O. Kean

    2017-11-01

    Full Text Available Extensive investigations over the recent decades have established the anatomical, biomechanical and functional importance of the meniscus in the knee joint. As a functioning part of the joint, it serves to prevent the deterioration of articular cartilage and subsequent osteoarthritis. To this end, meniscus repair and regeneration is of particular interest from the biomaterial, bioengineering and orthopaedic research community. Even though meniscal research is previously of a considerable volume, the research community with evolving material science, biology and medical advances are all pushing toward emerging novel solutions and approaches to the successful treatment of meniscal difficulties. This review presents a tactical evaluation of the latest biomaterials, experiments to simulate meniscal tears and the state-of-the-art materials and strategies currently used to treat tears.

  10. Meniscal root tears: from basic science to ultimate surgery.

    Science.gov (United States)

    Papalia, Rocco; Vasta, Sebastiano; Franceschi, Francesco; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    In meniscal root tears (MRTs), the disruption of collagen fibers that provide hoop strength results in extrusion of the menisci, altering their biomechanical properties. Clinical diagnosis is difficult, but magnetic resonance imaging usually allows to identify the lesion. Located into the vascularized zone of the meniscus, management is preferentially arthroscopic, aimed at repairing the lesions with arthroscopic transosseous sutures or suture anchors. PubMed, Cochrane Library, Google Scholar and Ovid Medline were searched in July 2012 to find literature on MRT tears. We reviewed the literature on biomechanics, imaging features and current treatments of these tears. Twenty-seven appropriate articles were identified and included in the study: 6 biomechanical studies, 11 imaging-based investigations for diagnosis, 1 study on clinical diagnosis and 9 studies about treatment. MRTs are infrequent, accounting for 10.1% of all arthroscopic meniscectomies. When the damage occurs to the roots, the transmission of the circumferential hoop tension is impaired and, consequently, the menisci tend to be displaced anteriorly and posteriorly, altering the biomechanics and possibly the kinematics of the knee. Although the importance of the integrity of the meniscal roots is well established, their diagnosis and treatment are still controversial. Biomechanical and clinical studies demonstrate that surgical repair of acute, traumatic meniscal root injuries fully restores the biomechanical features of the menisci, leading to pain relief and functional improvement. The current available surgical techniques for the meniscal root repair (suture anchors and pullout repair) are comparable. Level of evidence IV.

  11. Marginal fractures of the medial tibial plateau: possible association with medial meniscal root tear

    Energy Technology Data Exchange (ETDEWEB)

    Engelsohn, Eliyahu [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Umans, Hilary [Jacobi Medical Center, Department of Radiology, Bronx, NY (United States); Jacobi Medical Center, Department of Orthopedic Surgery, Ardsley, NY (United States); DiFelice, Gregory S. [Jacobi Medical Center, Department of Orthopedic Surgery, Ardsley, NY (United States)

    2007-01-15

    We report two cases of marginal fractures of the medial tibial plateau associated with medial meniscal root tears. Both patients sustained knee dislocations, with complete tears of the posterior horn medial meniscal root. One sustained a ''reverse Segond fracture''; the other sustained an ''anteromedial impingement fracture'' of the tibial plateau. The meniscal root tears were arthroscopically confirmed and repaired. In the first patient, the integrity of the meniscal root repair was confirmed at a 6-month follow-up arthroscopy for lysis of adhesions. In the second patient, follow-up MRI at 10 months demonstrated a healed meniscal root. The association of medial meniscal root tear with marginal fractures of the medial tibial plateau has not been previously reported. (orig.)

  12. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis

    DEFF Research Database (Denmark)

    Englund, M; Roos, Ewa M.; Lohmander, L S

    2003-01-01

    To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection.......To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection....

  13. Patient reported outcomes in patients undergoing arthroscopic partial meniscectomy for traumatic or degenerative meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Englund, Martin; Christensen, Robin

    2017-01-01

    OBJECTIVES: To compare patient reported outcomes from before surgery to 52 weeks after surgery between individuals undergoing arthroscopic partial meniscectomy for traumatic meniscal tears and those for degenerative meniscal tears. DESIGN: Comparative prospective cohort study. SETTING: Four public......-55, and undergoing arthroscopic partial meniscectomy for a traumatic or degenerative meniscal tear (defined by a combination of age and symptom onset). INTERVENTIONS: Both participant groups underwent arthroscopic partial meniscectomy for a meniscal tear, with operating surgeons recording relevant information......% women) with a traumatic or degenerative meniscal tear (n=141, mean age 38.7 years (standard deviation 10.9); n=256, 46.6 years (6.4); respectively) were included in the main analysis. At 52 weeks after arthroscopic partial meniscectomy, 55 (14%) patients were lost to follow-up. Statistically...

  14. Risk factors, diagnosis and non-surgical treatment for meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Juhl, Carsten Bogh; Ingelsrud, Lina Holm

    2018-01-01

    This statement aimed at summarising and appraising the available evidence for risk factors, diagnostic tools and non-surgical treatments for patients with meniscal tears. We systematically searched electronic databases using a pragmatic search strategy approach. Included studies were synthesised ...

  15. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis

    Directory of Open Access Journals (Sweden)

    Resorlu Mustafa

    2017-11-01

    Full Text Available This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa in osteoarthritis, chondromalacia patella and medial meniscal tears.

  16. Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Hyun Pyo; Lee, Jae Gue; Park, Ji Seon; Ryu, Kyung Nam [Kyunghee Univ., Seoul (Korea, Republic of)

    2004-02-01

    Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion.

  17. Reversed double PCL sign: unusual location of a meniscal fragment of the knee observed by MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Niitsu, M.; Itai, Y. [Dept. of Radiology, Inst. of Clinical Medicine, Univ. of Tsukuba, Ibaraki (Japan); Ikeda, K. [Inst. of Clinical Medicine, Univ. of Tsukuba, Ibaraki (Japan)

    2003-12-01

    A 36-year-old woman with tears of the anterior cruciate ligament and medial meniscus received a meniscectomy. The MR images obtained prior to the partial meniscectomy showed a bucket-handle meniscal tear with centrally displaced fragment lying anterior to the posterior cruciate ligament (PCL), representing a ''double PCL sign''; however, after the meniscectomy, MR images demonstrated a fragment in the space posterior to the PCL where no structure is generally recognized except for the ligament of wrisberg. This article reports a ''reversed'' double PCL sign, caused by inadequate surgical clearance of a bucket-handle tear of the medial meniscus. (orig.)

  18. Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy.

    Science.gov (United States)

    De Smet, Arthur A; Graf, Ben K; del Rio, Alejandro Munoz

    2011-02-01

    Although patients with parameniscal cysts usually have underlying meniscal tears, we noted that this association was less common with anterior lateral cysts. We wished to determine whether the frequency of a meniscal tear underlying a parameniscal cyst varied with cyst location. We reviewed a database of 7,771 knee MR examinations and identified 134 patients with an MR diagnosis of 138 parameniscal cysts and correlative arthroscopy in 78 patients. We reviewed their medical records and MR studies to determine the location of the cysts and presence of an underlying meniscal tear as determined by MRI or arthroscopy. There were 50 lateral and 88 medial parameniscal cysts. Medial meniscal tears were found underlying a cyst in 96% of arthroscopy patients and 86% of patients who had only MR examinations without a location difference in tears (p = 0.68). Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Anterior lateral cysts extended medially either into the root or into Hoffa fat-pad, but the type of extension did not correlate with the presence of an underlying meniscal tear. In contrast to medial parameniscal cysts or cysts at other locations adjacent to the lateral meniscus, anteriorly located lateral parameniscal cysts are less likely to have underlying meniscal tears.

  19. The accuracy of joint line tenderness by physical examination in the diagnosis of meniscal tears.

    Science.gov (United States)

    Eren, Osman Tuğrul

    2003-10-01

    The purpose of this study was to document the accuracy of joint line tenderness in the diagnosis of meniscal tears. Prospective cohort study. There were 104 male recruits (age range, 18 to 20 years; mean, 19.2 years) with suspected meniscal lesions who underwent arthroscopy. A thorough history and physical examination was performed on each patient by a physician with 4 years' experience on arthroscopic knee surgery. Twenty-six (25%) patients sustained injuries while in the Turkish Army, and 78 patients (75%) sustained injuries before they came to the army. On physical examination, assessment of joint line tenderness at the lateral and medial joint lines was performed with the patient's knee flexed 90 degrees. The accuracy, sensitivity, specificity, and positive and negative predictive values of joint line tenderness for medial and lateral sides were calculated based on arthroscopic findings. In 104 knees, the diagnosis was correct in 71 (68%) and incorrect in 33 (32%) knees. A total of 37 medial meniscal tears and 27 lateral meniscal tears were identified at arthroscopy. Other pathology included 11 anterior cruciate ligament (ACL) tears, 5 medial femoral chondral lesions, 4 chondromalacia patellae, and 1 medial plica. No discernable abnormalities were seen in 21 knees. A preoperative diagnosis of a medial meniscal tear was made in 54 knees and 32 were confirmed at arthroscopy. A lateral meniscus tear was suspected in 27 knees and confirmed in 25. Five medial meniscus and 2 lateral meniscus tears were seen at arthroscopy. These had not been suspected with tenderness over the joint line. The accuracy of the test was lower with the presence of ACL lesions and condromalacia patella. I concluded that joint line tenderness as a test for lateral meniscal tears is accurate (96%), sensitive (89%), and specific (97%). However, for medial meniscal tears, rates are lower.

  20. Is Anterior Cruciate Ligament Reconstruction Effective in Preventing Secondary Meniscal Tears and Osteoarthritis?

    Science.gov (United States)

    Sanders, Thomas L; Kremers, Hilal Maradit; Bryan, Andrew J; Fruth, Kristin M; Larson, Dirk R; Pareek, Ayoosh; Levy, Bruce A; Stuart, Michael J; Dahm, Diane L; Krych, Aaron J

    2016-07-01

    Reconstruction of anterior cruciate ligament (ACL) tears may potentially prevent the development of secondary meniscal injuries and arthritis. The purpose of this study was to (1) evaluate the protective benefit of ACL reconstruction (ACLR) in preventing subsequent meniscal tears or arthritis, (2) determine if earlier ACLR (tears, arthritis, and total knee arthroplasty (TKA) would be higher in patients treated nonoperatively after ACL tears than patients treated with surgical reconstruction. Cohort study; Level of evidence, 3. This retrospective study included a population-based incidence cohort of 964 patients with new-onset, isolated ACL tears between 1990 and 2000 as well as an age- and sex-matched cohort of 964 patients without ACL tears. A chart review was performed to collect information related to the initial injury, treatment, and outcomes. A total of 509 patients were treated with early ACLR, 91 with delayed ACLR, and 364 nonoperatively. All patients were retrospectively followed (range, 2 months to 25 years) to determine the development of subsequent meniscal tears, arthritis, or TKA. At a mean follow-up of 13.7 years, patients treated nonoperatively after ACL tears had a significantly higher likelihood of developing a secondary meniscal tear (hazard ratio [HR], 5.4; 95% CI, 3.8-7.6), being diagnosed with arthritis (HR, 6.0; 95% CI, 4.3-8.4), and undergoing TKA (HR, 16.7; 95% CI, 5.0-55.2) compared with patients treated with ACLR. Similarly, patients treated with delayed ACLR had a higher likelihood of developing a secondary meniscal tear (HR, 3.9; 95% CI, 2.2-6.9) and being diagnosed with arthritis (HR, 6.2; 95% CI, 3.4-11.4) compared with patients treated with early ACLR. Age >21 years at the time of injury, articular cartilage damage, and medial/lateral meniscal tears were predictive of arthritis after ACLR. Patients treated with ACLR have a significantly lower risk of secondary meniscal tears, symptomatic arthritis, and TKA when compared with patients

  1. Strategies for repair of radial tears close to the meniscal rim--biomechanical analysis with a cyclic loading protocol.

    Science.gov (United States)

    Herbort, Mirco; Siam, Sami; Lenschow, Simon; Petersen, Wolf; Zantop, Thore

    2010-11-01

    Lateral meniscectomy contributes to early-onset osteoarthritis. Biomechanical properties of sutures repairs for complete radial meniscal tears remain unknown. Double horizontal suture techniques for repair of radial meniscal tears with a shorter distance from the meniscal rim provide significantly higher structural properties than do comparable single-suture techniques with a wider distance from the meniscal rim. Controlled laboratory study. In 55 fresh-frozen porcine menisci, standardized complete radial meniscal tears were repaired with different distances from the meniscal rim and tear edges and with different numbers of sutures. In group A, the suture was 4 mm from the tear and 8 mm from the meniscal rim; group B, 2 mm from tear; group C, 2 mm from tear, 12 mm from rim; group D, double-loop technique, 2 mm from tear, 5 mm and 10 mm from rim; group E, longitudinal tear sutured with 1 loop, 8 mm from rim, and 4 mm between stitches. The specimens were cyclically loaded 1000 times between 5 and 20 N and loaded to failure. All repaired constructs survived the cyclic loading protocol. Compared with the single-loop techniques, the double-loop technique (group D) showed a significantly higher maximum load and yield load and significantly lower displacement after 1000 cycles. Compared with group B, group C had a higher displacement after 1000 cycles (P cycling testing in group C was higher than in groups B and D (P < .05). Repair of radial meniscal tears with a second suture and shorter distance from the meniscal rim has a positive influence on primary stability. Different distances from tear edges apparently have no influence on structural properties. Horizontal sutures for repair of radial meniscal tears provide high stability and can be enhanced with a second horizontal suture and shorter distance from the meniscal rim.

  2. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L. Stefan

    2017-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA...... and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18...

  3. Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

    Energy Technology Data Exchange (ETDEWEB)

    Park, Lawrence S.; Jacobson, Jon A.; Jamadar, David A.; Caoili, Elaine; Kalume-Brigido, Monica [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Wojtys, Edward [University of Michigan, Department of Orthopaedic Surgery, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States); University of Michigan Sports Medicine Program, Department of MedSport, 24 Frank Lloyd Wright Drive, Box 391, Ann Arbor, MI (United States)

    2007-05-15

    We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear. (orig.)

  4. Relationship between meniscal tears and tibial slope on the tibial plateau.

    Science.gov (United States)

    Alici, Tugrul; Esenyel, Cem Zeki; Esenyel, Meltem; Imren, Yunus; Ayanoglu, Semih; Cubuk, Rahmi

    2011-12-01

    The geometry of the tibial plateau has a direct influence on the translation and the screw home biomechanics of the tibiofemoral joint. Little information on the relationship between the tibial slope and meniscal lesions is available. The objective of this retrospective study was to examine the effect of the tibial slope on the medial and lateral meniscus lesions in patients with intact ACLs. The MRIs and lat roentgenograms of 212 patients with meniscus lesions were examined to determine the possible effect of the tibial slope on meniscal tears. First, the anatomic axis of the proximal tibia was established. Then, the angle between the line drawn to show the tibial slopes (medial and lateral) and the line drawn perpendicular to the proximal tibial anatomic axis was established on MRI. The patients with previously detected meniscus lesions were classified into three categories: patients with only medial meniscal tear (Group 1, 90 patients); patients with only lateral meniscal tear (Group 2, 15 patients); and patients with both medial and lateral meniscal tear (Group 3, 19 patients). Group 4 had no meniscal tear (88 patients). The MRIs of the patients who had applied to the Orthopedic Outpatient Clinic with patellofemoral pain and no meniscal tear were included as the control group. The average tibial slope of the medial tibial plateau was 3.18° in group 1, 3.64° in group 2, 3° in group 3, and 3.27° in group 4. The average tibial slope of the lateral tibial plateau was 2.88° in group 1, 3.6° in group 2, 2.68 in group 3, and 2.91 in group 4. The tibial slope on the medial tibial plateau was significantly larger than the lateral tibial plateaus in group 1 and group 4 (p0.05). In addition, the tibial slope on the lateral side of group 2 was significantly larger than that of groups 1, 3, and 4 (p<0.05). An increase in the tibial slopes, especially on the lateral tibial plateau, seems to increase the risk of meniscal tear.

  5. The Relationship between Chondromalacia Patella, Medial Meniscal Tear and Medial Periarticular Bursitis in Patients with Osteoarthritis.

    Science.gov (United States)

    Resorlu, Mustafa; Doner, Davut; Karatag, Ozan; Toprak, Canan Akgun

    2017-12-01

    This study investigated the presence of bursitis in the medial compartment of the knee (pes anserine, semimembranosus-tibial collateral ligament, and medial collateral ligament bursa) in osteoarthritis, chondromalacia patella and medial meniscal tears. Radiological findings of 100 patients undergoing magnetic resonance imaging with a preliminary diagnosis of knee pain were retrospectively evaluated by two radiologists. The first radiologist assessed all patients in terms of osteoarthritis, chondromalacia patella and medial meniscal tear. The second radiologist was blinded to these results and assessed the presence of bursitis in all patients. Mild osteoarthritis (grade I and II) was determined in 55 patients and severe osteoarthritis (grade III and IV) in 45 cases. At retropatellar cartilage evaluation, 25 patients were assessed as normal, while 29 patients were diagnosed with mild chondromalacia patella (grade I and II) and 46 with severe chondromalacia patella (grade III and IV). Medial meniscus tear was determined in 51 patients. Severe osteoarthritis and chondromalacia patella were positively correlated with meniscal tear (p chondromalacia patella (p = 0.023 and p = 0.479, respectively). Evaluation of lateral compartment bursae revealed lateral collateral ligament bursitis in 2 patients and iliotibial bursitis in 5 patients. We observed a greater prevalence of bursitis in the medial compartment of the knee in patients with severe osteoarthritis and medial meniscus tear.

  6. Arthroscopic partial meniscectomy is superior to physical rehabilitation in the management of symptomatic unstable meniscal tears.

    Science.gov (United States)

    El Ghazaly, Sherif A; Rahman, Amr A Abdul; Yusry, Ahmed H; Fathalla, Mahmoud M

    2015-04-01

    Meniscus injuries are the most commonly reported in athletes. Meniscectomy is the most common treatment. Stable peripheral tears may heal, while degenerative tears do well with physical therapy. However, the exact role of physical therapy in treating symptomatic unstable meniscal tears is not known. We aimed to identify the role of physical therapy in treating such patients and clarify the role of arthroscopic partial meniscectomy in treating unstable meniscal tears. Seventy patients with unstable meniscal tear met the inclusion criteria according to Vande Berg and co-workers. Clinical examination, McMurray test and magnetic resonance imaging were done. Age ranged from 18-67 years (average 39.87). Mild osteoarthritis was seen in 20 cases. Physical therapy thrice a week for eight weeks was offered (faradic quadriceps stimulation and neuromuscular strengthening exercises). After physical therapy, patients still complaining or unsatisfied were offered arthroscopic partial menisectomy (APM). Outcomes were evaluated using the VAS pain score and the Lysholm knee score. Mean VAS before interventions was 7.4, significantly improved to 5.16 after rehabilitation and to 1.9 after APM (p = 0.001). Mean Lysholm score before rehabilitation was 65.1 and improved to 69.6 after rehabilitation, the difference was non-significant. However, Lysholm score difference before and after APM showed a highly significant difference (p = 0.001). Pain and swelling improved after physical therapy. However, patients were not satisfied as limited range of knee motion persisted. APM was superior to physical therapy in treating symptomatic unstable meniscal tears, with high patient satisfaction and restored knee function.

  7. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Lind, Martin; Hölmich, Per

    2017-01-01

    adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears. METHODS AND ANALYSIS......: This is a protocol for a multicentre, parallel-group RCT conducted at six hospitals across all five healthcare regions in Denmark. 140 patients aged 18-40 years with a clinical history and symptoms consistent with a meniscal tear, verified on MRI, found eligible for meniscal surgery by an orthopaedic surgeon...... will be randomly allocated to one of two groups (1:1 ratio). Participants randomised to surgery will undergo either arthroscopic partial meniscectomy or meniscal repair followed by standard postsurgical care, while participants allocated to exercise and education will undergo a 12-week individualised, supervised...

  8. Study protocol for a randomised controlled trial of meniscal surgery compared with exercise and patient education for treatment of meniscal tears in young adults

    DEFF Research Database (Denmark)

    Skou, Søren Thorgaard; Lind, Martin; Hölmich, Per

    2017-01-01

    adults. The aim of this randomised controlled trial (RCT) is to investigate if early arthroscopic surgery is superior to exercise therapy and education, with the option of later surgery if needed, in improving pain, function and quality of life in younger adults with meniscal tears. METHODS AND ANALYSIS......INTRODUCTION: Arthroscopic surgery is a very common orthopaedic procedure. While several trials have investigated the effect of knee arthroscopy for middle-aged and older patients with meniscal tears, there is a paucity of trials comparing meniscal surgery with non-surgical treatment for younger...... will be randomly allocated to one of two groups (1:1 ratio). Participants randomised to surgery will undergo either arthroscopic partial meniscectomy or meniscal repair followed by standard postsurgical care, while participants allocated to exercise and education will undergo a 12-week individualised, supervised...

  9. A clinical prediction rule for meniscal tears in primary care: development and internal validation using a multicentre study

    NARCIS (Netherlands)

    Snoeker, Barbara A. M.; Zwinderman, Aeilko H.; Lucas, Cees; Lindeboom, Robert

    2015-01-01

    In primary care, meniscal tears are difficult to detect. A quick and easy clinical prediction rule based on patient history and a single meniscal test may help physicians to identify high-risk patients for referral for magnetic resonance imaging (MRI). The study objective was to develop and

  10. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje

    2016-01-01

    OBJECTIVE: To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. DESIGN: Randomised controlled superiority trial. SETTING: Orthopaedic departments at two public hospitals and two physiotherapy...... clinics in Norway. PARTICIPANTS: 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. INTERVENTIONS: 12 week supervised exercise therapy alone or arthroscopic partial...... meniscectomy alone. MAIN OUTCOME MEASURES: Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee...

  11. Exercise therapy versus arthroscopic partial meniscectomy for degenerative meniscal tear in middle aged patients

    DEFF Research Database (Denmark)

    Kise, Nina Jullum; Risberg, May Arna; Stensrud, Silje

    2016-01-01

    Objective To determine if exercise therapy is superior to arthroscopic partial meniscectomy for knee function in middle aged patients with degenerative meniscal tears. Design Randomised controlled superiority trial. Setting Orthopaedic departments at two public hospitals and two physiotherapy...... clinics in Norway. Participants 140 adults, mean age 49.5 years (range 35.7-59.9), with degenerative medial meniscal tear verified by magnetic resonance imaging. 96% had no definitive radiographic evidence of osteoarthritis. Interventions 12 week supervised exercise therapy alone or arthroscopic partial...... meniscectomy alone. Main outcome measures Intention to treat analysis of between group difference in change in knee injury and osteoarthritis outcome score (KOOS 4), defined a priori as the mean score for four of five KOOS subscale scores (pain, other symptoms, function in sport and recreation, and knee...

  12. Meniscal Tear Film Fluid Dynamics Near Marx’s Line

    KAUST Repository

    Zubkov, V. S.

    2013-07-03

    Extensive studies have explored the dynamics of the ocular surface fluid, though theoretical investigations are typically limited to the use of the lubrication approximation, which is not guaranteed to be uniformly valid a-priori throughout the tear meniscus. However, resolving tear film behaviour within the meniscus and especially its apices is required to characterise the flow dynamics where the tear film is especially thin, and thus most susceptible to evaporatively induced hyperosmolarity and subsequent epithelial damage. Hence, we have explored the accuracy of the standard lubrication approximation for the tear film by explicit comparisons with the 2D Navier-Stokes model, considering both stationary and moving eyelids. Our results demonstrate that the lubrication model is qualitatively accurate except in the vicinity of the eyelids. In particular, and in contrast to lubrication theory, the solution of the full Navier-Stokes equations predict a distinct absence of fluid flow, and thus convective mixing in the region adjacent to the tear film contact line. These observations not only support emergent hypotheses concerning the formation of Marx\\'s line, a region of epithelial cell staining adjacent to the contact line on the eyelid, but also enhance our understanding of the pathophysiological consequences of the flow profile near the tear film contact line. © 2013 Society for Mathematical Biology.

  13. The relationship between prevalent medial meniscal intrasubstance signal changes and incident medial meniscal tears in women over a 1-year period assessed with 3.0 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Crema, Michel D. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, and Department of Internal Medicine, Radiology Division, Ribeirao Preto (Brazil); Institute of Diagnostic Imaging (IDI), Ribeirao Preto (Brazil); Hunter, David J. [The University of Sydney, Sydney School of Medicine, Sydney (Australia); Roemer, Frank W. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Li, Ling [New England Baptist Hospital, Division of Research, Boston, MA (United States); Marra, Monica D. [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States); Institute of Diagnostic Imaging (IDI), Ribeirao Preto (Brazil); Nogueira-Barbosa, Marcello H. [Ribeirao Preto School of Medicine, University of Sao Paulo (USP), Department of Biomechanics, Medicine and Rehabilitation of the Locomotor Apparatus, and Department of Internal Medicine, Radiology Division, Ribeirao Preto (Brazil); Hellio Le Graverand, Marie-Pierre; Wyman, Bradley T. [Pfizer Global Research and Development, New London, CT (United States); Guermazi, Ali [Boston University School of Medicine, Department of Radiology, Quantitative Imaging Center, Boston, MA (United States)

    2011-08-15

    Intrasubstance meniscal signal changes not reaching the articular surface on fast spin echo (FSE) sequences are considered to represent mucoid degeneration on MRI. The aim of this study was to evaluate the association of prevalent intrasubstance signal changes with incident tears of the medial meniscus detected on 3.0 T MRI over a 1-year period. A total of 161 women aged {>=}40 years participated in a longitudinal 1-year observational study of knee osteoarthritis. MRI (3.0 T) was performed at baseline and 12-month follow-up. The anterior horn, body, and posterior horn of the medial meniscus were scored by two experienced musculoskeletal radiologists using the Boston-Leeds Osteoarthritis Knee Score (BLOKS) system. Four grades were used to describe the meniscal morphology: grade 0 (normal), grade 1 (intrasubstance signal changes not reaching the articular surface), grade 2 (single tears), and grade 3 (complex tears and maceration). Fisher's exact test and the Cochran-Armitage trend test were performed to evaluate whether baseline intrasubstance signal changes (grade 1) predict incident meniscal tears/maceration (grades 2 and/or 3) in the same subregion of the medial meniscus, when compared to subregions without pathology as the reference group (grade 0). Medial meniscal intrasubstance signal changes at baseline did not predict tears at follow-up when evaluating the anterior and posterior horns (left-sided p-values 0.06 and 0.59, respectively). No incident tears were detected in the body. We could not demonstrate an association between prevalent medial meniscal intrasubstance signal changes with incident tears over a 1-year period. (orig.)

  14. Occupational kneeling and meniscal tears: a magnetic resonance imaging study in floor layers

    DEFF Research Database (Denmark)

    Rytter, Søren; Jensen, Lilli Kirkeskov; Bonde, Jens Peter

    2009-01-01

    OBJECTIVE: To evaluate the association between occupational kneeling and degenerative meniscal tears. METHODS: Magnetic resonance imaging (MRI) of both knees was conducted in 92 male floor layers and 49 male graphic designers (referents), with a mean age of 55.6 years (range 42-70 yrs...... logistic regression, models were adjusted for age, body mass index, and knee-straining sports. RESULTS: Degenerative tears were significantly more prevalent in the medial meniscus among floor layers than among graphic designers [OR 2.28, 95% confidence interval (CI) 1.10-4.98] and significantly more floor...

  15. Comparison of CT and MRI in patients with tibial plateau fracture: can CT findings predict ligament tear or meniscal injury?

    Energy Technology Data Exchange (ETDEWEB)

    Mui, Leonora W.; Engelsohn, Eliyahu; Umans, Hilary [Jacobi Medical Center, Albert Einstein College of Medicine, Department of Radiology, Bronx, NY (United States)

    2007-02-15

    (1) To determine the accuracy of computed tomography (CT) in the evaluation of ligament tear and avulsion in patients with tibial plateau fracture. (2) To evaluate whether the presence or severity of fracture gap and articular depression can predict meniscal injury. A fellowship-trained musculoskeletal radiologist retrospectively reviewed knee CT and MRI examinations of 41 consecutive patients presenting to a level 1 trauma center with tibial plateau fractures. Fracture gap, articular depression, ligament tear and footprint avulsions were assessed on CT examinations. The MRI studies were examined for osseous and soft tissue injuries, including meniscal tear, meniscal displacement, ligament tear, and ligament avulsion. CT demonstrated torn ligaments with 80% sensitivity and 98% specificity. Only 2% of ligaments deemed intact on careful CT evaluation had partial or complete tears on MRI. Although the degree of fracture gap and articular depression was significantly greater in patients with meniscal injury compared with those without meniscal injury, ROC analysis demonstrated no clear threshold for gap or depression that yielded a combination of high sensitivity and specificity. In the acute setting, CT offers high sensitivity and specificity for depicting osseous avulsions, as well as high negative predictive value for excluding ligament injury. However, MRI remains necessary for the preoperative detection of meniscal injury. (orig.)

  16. Biomechanical Effects of a Horizontal Medial Meniscal Tear and Subsequent Leaflet Resection.

    Science.gov (United States)

    Brown, Matthew J; Farrell, James P; Kluczynski, Melissa A; Marzo, John M

    2016-04-01

    Horizontal, degenerative tears of the medial meniscus and subsequent meniscectomy can compromise the biomechanical function of the meniscus in load transmission and weightbearing, leading to the development of radiographic and symptomatic tibiofemoral arthritis. Resection of both leaflets of a horizontal medial meniscal tear will increase peak contact pressures and decrease contact areas in comparison with resection of only the inferior leaflet. Controlled laboratory study. Twelve fresh-frozen human cadaveric knees had tibiofemoral peak contact pressures and contact areas under an 1800-N axial load measured by Tekscan in the control state. A horizontal tear was created in the posterior horn of the medial meniscus, and the knees were retested. The knees were tested a third time after resection of the inferior leaflet (single leaflet) and a final time after resection of the superior leaflet (both leaflets). The Friedman test was used to test for group differences in peak pressure (psi) and contact area (mm(2)) between test conditions (native, tear, inferior leaflet resection, and resection of both leaflets). For the medial compartment, there was a statistically significant difference in peak pressure (P = .03) but not in contact area (P = .70) between testing conditions. Median peak pressure in the medial compartment was significantly greater for resection of both leaflets compared with the tear (406.5 vs 294.7 psi, respectively; P = .002). Median contact area in the medial compartment was greatest for resection of both leaflets (602.7 mm(2)), but there were no statistically significant differences between test conditions (P = .70). For the lateral compartment, there were no statistically significant differences in peak pressure (P = .99) or contact area (P = .77) between test conditions. Resection of a single inferior leaflet after a horizontal medial meniscal tear preserves much of the original biomechanical function of the meniscus. Resection of both leaflets

  17. MR imaging characteristics and clinical symptoms related to displaced meniscal flap tears

    Energy Technology Data Exchange (ETDEWEB)

    Lance, Valentin; Heilmeier, Ursula R.; Joseph, Gabby B.; Steinbach, Lynne; Link, Thomas M. [University of California, Department of Radiology and Biomedical Imaging, San Francisco, CA (United States); Ma, Benjamin [University of California, Department of Orthopedic Surgery and Sports Medicine, San Francisco (United States)

    2014-11-16

    The purpose of our study was (1) to analyze the flap tear location, direction of displacement and size on magnetic resonance (MR) imaging, (2) to describe associated knee abnormalities including presence of effusion, synovitis, bone marrow edema pattern or ligamentous tear, and (3) to assess clinical findings found with flap tears, including the pain score, and determine differences between operative and nonoperative groups. A retrospective radiology database search over the last 3 years identified 238 patients with flap tears, of which ultimately 58 with isolated flap tears were included after exclusion of patients with other significant knee internal derangement, severe degenerative change or prior surgery. MR studies of the knee were analyzed by two radiologists. Imaging characteristics were correlated with associated knee abnormalities and clinical findings. Statistical analysis employed linear and logistic regression models. Inter- and intrareader reliability was calculated. The medial meniscus was the most common site of flap tears (52/60, 87 %), with inferior displacement (47/60, 78 %). The degree of tibial cartilage loss had a positive correlation with the visual analog pain scale (p = 0.03). Patients who underwent arthroscopy were younger than those who did not (p = 0.01) and more likely to have a positive clinical McMurray test (p = 0.01). Medially and inferiorly displaced flap tears are the most common tear pattern. Those undergoing arthroscopy are more likely to have positive meniscal signs on clinical examination. A greater degree of cartilage loss involving the tibia on MR imaging was associated with increasing visual analog pain scores. (orig.)

  18. Knee complaints and prognosis of osteoarthritis at 10 years : impact of ACL ruptures, meniscal tears, genetic predisposition and surgery

    NARCIS (Netherlands)

    Huetink, Kasper

    2015-01-01

    In this thesis we demonstrated that several known risk factors for knee OA development i.e. ACL ruptures, meniscal tears, the presence of hand OA and increased BMI, are already associated with knee OA development as demonstrated on radiographs and MR images early in life. Identifying these factors

  19. Evaluation of medial meniscus tears and meniscal stability: weight-bearing MRI vs arthroscopy.

    Science.gov (United States)

    Barile, Antonio; Conti, Laura; Lanni, Giuseppe; Calvisi, Vittorio; Masciocchi, Carlo

    2013-04-01

    To assess the role of dedicated low-field standard and weight-bearing MRI in the evaluation of stable or unstable tears of medial meniscus in comparison with arthroscopy. Our series included 1750 knee MRI scans performed with a high-field MRI scanner from July 2010 to August 2011. We retrospectively reviewed and analyzed 20 MRI exams of normal knee and 57 MRI exams of knee with clinical evidence of tears of the medial meniscus. In the same session, after conventional 1.5T and "dedicated" 0.25T supine MRI exam, the patients underwent weight-bearing examination with the same dedicated MRI unit. In all cases sagittal and coronal PD-W were used. All patients underwent arthroscopy 18-25 days after the weight-bearing MRI. In the first group, no statistically significant anatomical modifications of shape, intensity and position of the medial meniscus between standard 1.5T, dedicated supine and upright MRI were observed. In group A, the images acquired in the supine position (dedicated and 1.5T MRI) documented in 21 cases a traumatic tear (group 2A) and in 36 cases a degenerative tear (group 2B). In group 2A, weight-bearing MRI showed presence of unstable tear a degenerative unstable meniscal tear only in 19 out of 36 cases. In group 2B, weight-bearing MRI showed only in 9 out 21 cases. Arthroscopy confirmed weight-bearing MRI diagnosis in all cases. This new approach to meniscus pathology gives an important contribution to a better management of a diagnostic-therapeutic approach in which standard MRI has not played a key role, so far. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Diagnostic value of history-taking and physical examination for assessing meniscal tears of the knee in general practice.

    Science.gov (United States)

    Wagemakers, Harry Pa; Heintjes, Edith M; Boks, Simone S; Berger, Marjolein Y; Verhaar, Jan An; Koes, Bart W; Bierma-Zeinstra, Sita Ma

    2008-01-01

    To assess the diagnostic value of history-taking and physical examination of meniscal tears in general practice. An observational study determining diagnostic values (sensitivity, specificity, predictive value, and likelihood ratios). General practice. Consecutive patients aged 18 to 65 years with a traumatic knee injury who consulted their general practitioner within 5 weeks after trauma. Participating patients filled out a questionnaire (history-taking) followed by a standardized physical examination. Assessment of meniscal tears was determined by means of magnetic resonance imaging (MRI) and was performed blinded for the results of physical examination and history-taking. Of the 134 patients included in this study, 47 had a meniscal tear. From history-taking, the determinants "age over 40 years," "continuation of activity impossible," and "weight-bearing during trauma" indicated an association with a meniscal tear after multivariate logistic regression analysis, whereas from physical examination only "pain at passive flexion" indicated an association. These associated determinants from history-taking showed some diagnostic value; the positive likelihood ratio (LR+) reached up to 2.0 for age over 40 years, whereas the isolated test pain at passive flexion from physical examination has less diagnostic value, with an LR+ of 1.3. Combining determinants from history-taking and physical examination improved the diagnostic value with a maximum LR+ of 5.8; however, this combination only applied to a limited number of patients. History-taking has some diagnostic value, whereas physical examination did not add any diagnostic value for detecting meniscal tears in general practice.

  1. Changes in rates of arthroscopy due to degenerative knee disease and traumatic meniscal tears in Finland and Sweden.

    Science.gov (United States)

    Mattila, Ville M; Sihvonen, Raine; Paloneva, Juha; Felländer-Tsai, Li

    2016-02-01

    Knee arthroscopy is commonly performed to treat degenerative knee disease symptoms and traumatic meniscal tears. We evaluated whether the recent high-quality randomized control trials not favoring arthroscopic surgery for degenerative knee disease affected the procedure incidence and trends in Finland and Sweden. We conducted a bi-national registry-based study including all adult (aged ≥18 years) inpatient and outpatient arthroscopic surgeries performed for degenerative knee disease (osteoarthritis (OA) and degenerative meniscal tears) and traumatic meniscal tears in Finland between 1997 and 2012, and in Sweden between 2001 and 2012. In Finland, the annual number of operations was 16,389 in 1997, reached 20,432 in 2007, and declined to 15,018 in 2012. In Sweden, the number of operations was 9,944 in 2001, reached 11,711 in 2008, and declined to 8,114 in 2012. The knee arthroscopy incidence for OA was 124 per 10(5) person-years in 2012 in Finland and it was 51 in Sweden. The incidence of knee arthroscopies for meniscal tears coded as traumatic steadily increased in Finland from 64 per 10(5) person-years in 1997 to 97 per 10(5) person-years in 2012, but not in Sweden. The incidence of arthroscopies for degenerative knee disease declined after 2008 in both countries. Remarkably, the incidence of arthroscopy for degenerative knee disease and traumatic meniscal tears is 2 to 4 times higher in Finland than in Sweden. Efficient implementation of new high-quality evidence in clinical practice could reduce the number of ineffective surgeries.

  2. Middle-aged patients with an MRI-verified medial meniscal tear report symptoms commonly associated with knee osteoarthritis

    DEFF Research Database (Denmark)

    Hare, Kristoffer B.; Stefan Lohmander, L.; Kise, Nina Jullum

    2017-01-01

    with early radiographic signs of knee osteoarthritis. Patients and methods — We included individual baseline items from the Knee injury and Osteoarthritis Outcome Score collected in 2 randomized controlled trials evaluating treatment for an MRI-verified degenerative medial meniscal tears in 199 patients aged...... 35–65 years. Each item was scored as no, mild, moderate, severe, extreme, and at least “mild” considering the symptoms present. Early radiographic signs of osteoarthritis, defined as a Kellgren and Lawrence grade of at least 1, were seen in 70 patients. Results — At least monthly knee pain, pain...... with a degenerative medial meniscus tear reported symptoms commonly associated with knee osteoarthritis. Frequent knee pain, presence of lack of confidence in the knee, and clicking did not distinguish those with a meniscal tear alone from those with early radiographic knee OA. Our findings support the notion...

  3. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee.

    Science.gov (United States)

    Shybut, Theodore B; Vega, Charles E; Haddad, Jebran; Alexander, Jerry W; Gold, Jonathon E; Noble, Philip C; Lowe, Walter R

    2015-04-01

    Meniscal root tears are an increasingly recognized subset of meniscal injury. The menisci are critical secondary stabilizers of the anterior cruciate ligament (ACL). The kinematic effect of lateral meniscus posterior root tear in the setting of ACL injury is not known. The purpose of this study was to determine the effect of tear of the lateral meniscal root on stability of the ACL-deficient knee. The hypothesis was that disruption of the lateral meniscal root will further destabilize the ACL-deficient knee during a simulated pivot shift. Controlled laboratory study. Pivot-shift testing of 8 fresh-frozen cadaveric knees was performed after attachment of photoreflective flags and preparation of CT scans. Each knee was mounted in a custom activity simulator and dynamically loaded from 15° to 90° of flexion with all the permutations of the following: iliotibial band force (50, 75, 100, 125, 150, and 175 N), internal rotation moments (1, 2, and 3 N·m), and valgus moments (5 and 7 N·m). In addition, anterior stability tests were performed by applying a 90-N anterior force to the tibia at flexion angles of 15°, 30°, 45°, 60°, and 90°. During each test, the anterior tibial translation and rotation of the tibia were measured with a high-resolution multiple infrared camera motion analysis system for the following 3 conditions: ACL-intact (ACL-I), ACL-deficient (ACL-D), and ACL-deficient/lateral meniscal posterior root avulsion (ACL-D/LMR-A). A pivot-shift phenomenon was observed in the ACL-D and ACL-D/LMR-A conditions. The mean tibial translation of the lateral tibial condyle during the pivot-shift maneuver was 2.62 ± 0.53 mm for the ACL-I knees, 6.01 ± 0.51 mm for the ACL-D knees (P value vs. intact: .0005), and 8.13 ± 0.75 mm for the ACL-D/LMR-A knees (P value vs intact: stability of the ACL-deficient knee during rotational loading. This study shows that lateral meniscal root injury further destabilizes the ACL-deficient knee and thus advances the concept that

  4. Finite element analysis of the effect of meniscal tears and meniscectomies on human knee biomechanics.

    Science.gov (United States)

    Peña, E; Calvo, B; Martínez, M A; Palanca, D; Doblaré, M

    2005-06-01

    Many authors have suggested that the high levels of shear and tensile stresses that appear in the articular cartilage after meniscectomy are partly responsible for cartilage pathologies, such as osteoarthrosis. In this paper, we investigate the effect of meniscal tears and meniscectomies on the human knee joint. Solid models of the tibia, femur, menisci and cartilage were generated from MRI images. A three-dimensional finite element model was developed that included the femur, tibia, cartilage layers, menisci and ligaments. The femur and tibia were considered to be rigid, the articular cartilage and menisci to be linearly elastic, isotropic and homogeneous and the ligaments were modelled as hyperelastic. Three different situations were compared: a healthy tibio-femoral joint, a tibio-femoral joint with tears in one meniscus and a tibio-femoral joint after meniscectomy. The minimal principal stresses corresponding to a compressive load at 0 degrees flexion were obtained for the posterior zone of the medial meniscus and the corresponding region of the articular cartilage. Under an axial femoral compressive load, the maximal contact stress in the articular cartilage after meniscectomy was about twice that of a healthy joint. This fact could partially explain the cartilage damage and degeneration that have been observed after meniscectomy.

  5. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management.

    LENUS (Irish Health Repository)

    2012-02-01

    Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.

  6. Radiographic joint space narrowing in osteoarthritis of the knee: relationship to meniscal tears and duration of pain

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Wing P. [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); Taipei Medical University-Wan Fang Hospital, Department of Radiology, Taipei (China); Huang, Guo-Shu [Tri-Service General Hospital, National Defense Medical Center, Department of Radiology, Taipei (China); Hsu, Shu-Mei [Taipei Medical University, Department of Radiology, School of Medicine, Taipei (China); National Taiwan University, Department of Public Health, Taipei (China); Chang, Yue-Cune [Tamkang University, Department of Mathematics, Taipei County (China); Ho, Wei-Pin [Taipei Medical University-Wan Fang Hospital, Department of Orthopedic Surgery, Taipei (China)

    2008-10-15

    The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis. A total of 140 patients who had knee osteoarthritis and underwent primary total knee replacement (TKR) surgery, with unicompartmental medial tibiofemoral JSN (grade 1 or greater) and normal lateral compartments, were recruited. Polytomous logistic regression was used to assess the relationship between JSN and risk factors. All patients with JSN were categorized as grade 1 (n=14, 10.0%), grade 2 (n=64, 45.7%), or grade 3 (n=62, 44.3%). Women presented with indications for a TKR at a younger age than men (mean age, 69 vs 73 years, P<0.05). There were 123 (87.9%) meniscal tears and 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures; 115 of 134 (85.8%) patients had moderate to severe cartilage erosion. A higher grade of JSN was correlated with a higher frequency of meniscal tears [odds ratio (OR) 6.00, 95% CI 1.29-27.96 for grade 2 vs grade 1 JSN] and duration of knee pain (OR 1.25, 95% CI 1.01-1.53 for grade 3 vs grade 1 JSN). A higher grade of JSN was not correlated with a higher frequency of ACL rupture or articular cartilage erosion. A higher grade of JSN is associated with a higher frequency of meniscal tears and long duration of knee pain in patients with knee osteoarthritis. (orig.)

  7. Inside-Out Versus All-Inside Repair of Isolated Meniscal Tears: An Updated Systematic Review.

    Science.gov (United States)

    Fillingham, Yale A; Riboh, Jonathan C; Erickson, Brandon J; Bach, Bernard R; Yanke, Adam B

    2017-01-01

    Meniscal tears are common in the young, active population. In this group of patients, repair is advised when possible. While inside-out repair remains the standard technique, recent advances in all-inside repair devices have led to a growth in their popularity. Previous reviews on the topic have focused on outdated implants of limited clinical relevance. To determine the difference in failure rates, functional outcomes, and complications between inside-out and modern all-inside repairs. Systematic review. A systematic review was registered with PROSPERO and performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and Cochrane databases. Inclusion criteria were (1) clinical study reporting on all-inside or inside-out repair, (2) evidence levels 1 to 4, and (3) use of modern all-inside implants for all-inside repairs. Exclusion criteria were (1) use of meniscal arrows or screws and (2) concomitant surgical procedures. Study characteristics, subjects, surgical technique, clinical outcomes, and complications were collected and analyzed. A total of 481 studies were screened and assessed for eligibility, which identified 27 studies for review. Studies defined clinical failure as persistent mechanical symptoms, effusion, or joint line tenderness, while anatomic failure was incomplete or no healing on MRI or second-look arthroscopy. There were no significant differences in clinical or anatomic failure rates between inside-out and all-inside repairs (clinical failure: 11% vs 10%, respectively, P = .58; anatomic failure: 13% vs 16%, respectively, P = .63). Mean ± SD Lysholm and Tegner scores for inside-out repair were 88.0 ± 3.5 and 5.3 ± 1.2, while the respective scores for all-inside repair were 90.4 ± 3.7 and 6.3 ± 1.3. Complications occurred at a rate of 5.1% for inside-out repairs and 4.6% for all-inside repairs. The quality of the evidence comparing inside-out and all-inside meniscal

  8. Computed tomographic arthrography of the stifle for detection of cranial and caudal cruciate ligament and meniscal tears in dogs.

    Science.gov (United States)

    Samii, Valerie F; Dyce, Jonathan; Pozzi, Antonio; Drost, Wm Tod; Mattoon, John S; Green, Eric M; Kowaleski, Michael P; Lehman, Amy M

    2009-01-01

    The purpose of this study was to evaluate the utility of single-detector computed tomographic arthrography (CT arthrography) for the diagnosis of cranial and caudal cruciate ligament and meniscal lesions in the dog stifle. Four normal and 25 abnormal stifle joints, determined to have lesions related to intra-articular ligamentous insufficiency based on clinical history, orthopedic examination, and survey orthogonal radiographs, were imaged using a previously developed CT arthrography protocol. Surgery was performed immediately following the CT procedure. Three board-certified radiologists inexperienced at interpreting CT stifle arthrograms reviewed all CT studies independently, and then as a group, without knowledge of surgical or necropsy findings. Sensitivity, specificity, positive predictive value, and negative predictive value for determination of cranial and caudal cruciate and meniscal tears were calculated for each individual reviewer and based on group consensus. All reviewers identified the normal canine stifle joints imaged correctly. Reviewers did well in discriminating normal from torn cranial cruciate ligaments, with sensitivities of 96-100% and specificities of 75-100%. No reviewer correctly identified the solitary caudal cruciate ligament tear and specificity ranged from 89.3% to 100%. Reviewers were less adept at discriminating normal from torn meniscal fibrocartilage, with sensitivities of 13.3-73.3% and specificities of 57.1-100%. Interpretive accuracy improved slightly when consensus scores were compared with surgical findings. Single-detector CT arthrography may be useful for identifying pathology of the canine cruciate ligaments but is of limited value for assessing the menisci.

  9. Knee function and knee muscle strength in middle-aged patients with degenerative meniscal tears eligible for arthroscopic partial meniscectomy.

    Science.gov (United States)

    Stensrud, Silje; Risberg, May Arna; Roos, Ewa M

    2014-05-01

    Functional limitations exist postmeniscectomy, but preoperative data are scarce. To examine knee function, knee muscle strength and performance in middle-aged patients with degenerative meniscal tears, eligible for arthroscopic partial meniscectomy. Cross-sectional study. Eighty-two participants with MRI verified degenerative meniscal tear (35% women, mean age 49 years) answered the Knee injury and Osteoarthritis Outcome Score (KOOS) and were tested for isokinetic knee muscle strength and lower extremity performance (one-leg hop for distance, 6 m timed hop and maximum number of knee-bends in 30 s). Limb Symmetry Index (LSI) was used to express side-to-side differences in per cent using the non-injured leg as the control. An LSI ≥90% was considered normal. Mean scores of the five subscales of the KOOS were from 13 to 36 points lower compared with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (pstrength and between 8% and 13% in lower-extremity performance. Between 41% and 52% of the participants had abnormal LSI values in quadriceps muscle strength and lower-extremity performance. Middle-aged patients with a symptomatic degenerative meniscal tear experience functional knee problems when eligible for meniscectomy. Included participants reported difficulty with knee pain, symptoms, function and quality of life and quadriceps strength and lower-extremity performance were impaired. Approximately 50% of the study group had clinically relevant impairments in quadriceps strength and lower-extremity performance, defined as >10% differences between the injured and the non-injured leg.

  10. Medial meniscal posterior root/horn radial tears correlate with cartilage degeneration detected by T1ρ relaxation mapping

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Kenji, E-mail: Kenji-am@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Hashimoto, Sanshiro, E-mail: info@msorc.jp [Minami-Shinjuku Orthopaedic Rehabilitation Clinic, 2-16-7 Yoyogi, Shibuya-ku, Tokyo 151-0053 (Japan); Nakamura, Hiroshi, E-mail: nakamura@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Mori, Atsushi, E-mail: atsu@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Sato, Akiko, E-mail: akiko-sato@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan); Majima, Tokifumi, E-mail: tkmajima@iuhw.ac.jp [Department of Orthopaedic Surgery, International University of Health and Welfare Hospital, 537-3 Iguchi, Nasu-shiobara, Tochigi 329-2763 (Japan); Takai, Shinro, E-mail: takai-snr@nms.ac.jp [Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 (Japan)

    2015-06-15

    Highlights: • Posterior radial tears in medial meniscus associate T1ρ values of cartilage. • Posterior radial tears relate to cartilage degeneration even in early-stage osteoarthritis. • Abnormalities in meniscus on MRI are useful for screening early-stage osteoarthritis. - Abstract: Objective: This study aimed to identify factors on routine pulse sequence MRI associated with cartilage degeneration observed on T1ρ relaxation mapping. Materials and methods: This study included 137 subjects with knee pain. T1ρ values were measured in the regions of interest on the surface layer of the cartilage on mid-coronal images of the femorotibial joint. Assessment of cartilage, subchondral bone, meniscus and ligaments was performed using routine pulse sequence MRI. Radiographic evaluation for osteoarthritis was also performed. Results: Multiple regression analysis revealed posterior root/horn tears to be independent factors increasing the T1ρ values of the cartilage in the medial compartment of the femorotibial joint. Even when adjusted for radiographically defined early-stage osteoarthritis, medial posterior meniscal radial tears significantly increased the T1ρ values. Conclusions: This study showed that posterior root/horn radial tears in the medial meniscus are particularly important MRI findings associated with cartilage degeneration observed on T1ρ relaxation mapping. Morphological factors of the medial meniscus on MRI provide findings useful for screening early-stage osteoarthritis.

  11. Return to play after all-inside meniscal repair in competitive football players: a minimum 5-year follow-up.

    Science.gov (United States)

    Alvarez-Diaz, Pedro; Alentorn-Geli, Eduard; Llobet, Federico; Granados, Nelson; Steinbacher, Gilbert; Cugat, Ramón

    2016-06-01

    The purpose of this study was to report the mid-to-long-term return to sports after all-inside meniscal repair in competitive football players. All football players undergoing all-inside meniscal repair with a minimum Tegner activity score of 9 and minimum follow-up of 5 years were eligible for inclusion. Patients were excluded if: (a) they had ipsilateral or contralateral: meniscectomy, posterior cruciate ligament tear, multi-ligament knee injuries, osteotomies, or meniscal transplant (b) they had meniscal tears in the anterior horn, and (c) they had bucket-handle tears. All patients included were contacted by phone and asked for current sport status or Tegner score. Preoperative Tegner scores were collected from the medical charts. All patients (n = 29) were men with a median (range) age of 27 (18-37) years and a follow-up of 6 (5-8) years. All meniscal injuries were complete and longitudinal tears. The median preinjury Tegner activity score was 9 (range 9-10). Two patients required revision arthroscopy (6.7 %) with partial meniscectomy before being able to return to competitive football due to suture failure. Twenty-six patients (89.6 %) returned to the same level of competition after recovering from surgery. At the last follow-up, 13 patients (45 %) were able to continue playing football at any level, and 8 (28 %) of them were able to return to the same pre-injury competitive level. The main reasons for the decreased level of activity (from competitive to recreational) or to give up football were job-related or changes in their personal life situation, but were not related to knee or meniscal disorders. Fourteen patients underwent meniscal repair alone, whereas 15 patients had an associated ACL reconstruction procedure. There were no significant differences in the collected variables between both subgroups. All-inside meniscal repair allows for excellent results with regard to return-to-play rates in competitive football. However, only half of the

  12. Arthroscopic Partial Meniscectomy or Conservative Treatment for Nonobstructive Meniscal Tears : A Systematic Review and Meta-analysis of Randomized Controlled Trials

    NARCIS (Netherlands)

    van de Graaf, Victor A; Wolterbeek, Nienke; Mutsaerts, Eduard L A R; Scholtes, Vanessa A B; Saris, Daniel B F; de Gast, Arthur; Poolman, Rudolf W

    PURPOSE: To conduct a meta-analysis of randomized controlled trials comparing the outcome of arthroscopic partial meniscectomy (APM) with conservative treatment in adults with nonobstructive meniscal tears and to recommend a treatment of choice. METHODS: We systematically searched the databases of

  13. Autologous mesenchymal stem cells or meniscal cells: what is the best cell source for regenerative meniscus treatment in an early osteoarthritis situation?

    Science.gov (United States)

    Zellner, Johannes; Pattappa, Girish; Koch, Matthias; Lang, Siegmund; Weber, Johannes; Pfeifer, Christian G; Mueller, Michael B; Kujat, Richard; Nerlich, Michael; Angele, Peter

    2017-10-10

    Treatment of meniscus tears within the avascular region represents a significant challenge, particularly in a situation of early osteoarthritis. Cell-based tissue engineering approaches have shown promising results. However, studies have not found a consensus on the appropriate autologous cell source in a clinical situation, specifically in a challenging degenerative environment. The present study sought to evaluate the appropriate cell source for autologous meniscal repair in a demanding setting of early osteoarthritis. A rabbit model was used to test autologous meniscal repair. Bone marrow and medial menisci were harvested 4 weeks prior to surgery. Bone marrow-derived mesenchymal stem cells (MSCs) and meniscal cells were isolated, expanded, and seeded onto collagen-hyaluronan scaffolds before implantation. A punch defect model was performed on the lateral meniscus and then a cell-seeded scaffold was press-fit into the defect. Following 6 or 12 weeks, gross joint morphology and OARSI grade were assessed, and menisci were harvested for macroscopic, histological, and immunohistochemical evaluation using a validated meniscus scoring system. In conjunction, human meniscal cells isolated from non-repairable bucket handle tears and human MSCs were expanded and, using the pellet culture model, assessed for their meniscus-like potential in a translational setting through collagen type I and II immunostaining, collagen type II enzyme-linked immunosorbent assay (ELISA), and gene expression analysis. After resections of the medial menisci, all knees showed early osteoarthritic changes (average OARSI grade 3.1). However, successful repair of meniscus punch defects was performed using either meniscal cells or MSCs. Gross joint assessment demonstrated donor site morbidity for meniscal cell treatment. Furthermore, human MSCs had significantly increased collagen type II gene expression and production compared to meniscal cells (p cell-based tissue engineering approach was shown

  14. Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears.

    Science.gov (United States)

    Beamer, Brandon S; Masoudi, Aidin; Walley, Kempland C; Harlow, Ethan R; Manoukian, Ohan S; Hertz, Ben; Haeussler, Claudia; Olson, Jeffrey J; Deangelis, Joseph P; Nazarian, Ara; Ramappa, Arun J

    2015-02-01

    The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  15. Trajectory of self-reported pain and function and knee extensor muscle strength in young patients undergoing arthroscopic surgery for meniscal tears

    DEFF Research Database (Denmark)

    Thorlund, Jonas Bloch; Østengaard, Lasse; Cardy, Nathan

    2017-01-01

    OBJECTIVES: To investigate the trajectory of patient reported pain and function and knee extensor muscle strength over time in young individuals undergoing arthroscopic meniscal surgery. DESIGN: Systematic review and meta-analysis METHODS: Six databases were searched up to October 13th, 2016...... extensor muscle strength was impaired in the injured leg prior to surgery and was still reduced compared with control data up to 12 months after surgery (SMD: -1.16) (95% CI: -1.83; -0.49). All included studies were assessed to have a high risk of bias. CONCLUSIONS: No studies were found comparing....... PATIENTS AND INTERVENTION: People aged 30 years or younger undergoing surgery for a meniscal tear. OUTCOMES: and comparator: (1) Self-reported pain and function in patients undergoing meniscal surgery compared to a non-operative control group (2). Knee extensor strength in the leg undergoing surgery...

  16. Comparison of all-inside meniscal repair devices with matched inside-out suture repair.

    Science.gov (United States)

    Rosso, Claudio; Kovtun, Konstantin; Dow, William; McKenzie, Brett; Nazarian, Ara; DeAngelis, Joseph P; Ramappa, Arun J

    2011-12-01

    All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair. All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing. Controlled laboratory study. Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated. The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested (P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure. An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch. Inside-out sutures and all-inside devices have similar responses to cyclic loading.

  17. Comparison of spin echo T1-weighted sequences versus fast spin-echo proton density-weighted sequences for evaluation of meniscal tears at 1.5 T

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Andrew B.; Pesce, Lorenzo L.; Wu, Jim S.; Smart, L.R.; Medvecky, Michael J.; Haims, Andrew H. [Yale University School of Medicine, Department of Diagnostic Radiology, P.O. Box 208042, New Haven, CT (United States)

    2009-01-15

    At our institution, fast spin-echo (FSE) proton density (PD) imaging is used to evaluate articular cartilage, while conventional spin-echo (CSE) T1-weighted sequences have been traditionally used to characterize meniscal pathology. We sought to determine if FSE PD-weighted sequences are equivalent to CSE T1-weighted sequences in the detection of meniscal tears, obviating the need to perform both sequences. We retrospectively reviewed the records of knee arthroscopies performed by two arthroscopy-focused surgeons from an academic medical center over a 2-year period. The preoperative MRI images were interpreted independently by two fellowship-trained musculoskeletal radiologists who graded the sagittal CSE T1 and FSE PD sequences at different sittings with grades 1-5, where 1 = normal meniscus, 2 = probable normal meniscus, 3 = indeterminate, 4 = probable torn meniscus, and 5 = torn meniscus. Each meniscus was divided into an anterior and posterior half, and these halves were graded separately. Operative findings provided the gold standard. Receiver operating characteristic (ROC) analysis was performed to compare the two sequences. There were 131 tears in 504 meniscal halves. Using ROC analysis, the reader 1 area under curve for FSE PD was significantly better than CSE T1 (0.939 vs. 0.902, >95% confidence). For reader 2, the difference met good criteria for statistical non-inferiority but not superiority (0.913 for FSE PD and 0.908 for CSE T1; >95% non-inferiority for difference at most of -0.027). FSE PD-weighted sequences, using our institutional protocol, are not inferior to CSE T1-weighted sequences for the detection of meniscal tears and may be superior. (orig.)

  18. The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor.

    Science.gov (United States)

    Resorlu, Hatice; Zateri, Coskun; Nusran, Gurdal; Goksel, Ferdi; Aylanc, Nilufer

    2017-01-01

    To investigate the relation between chondromalacia patella and the sulcus angle/trochlear depth ratio as a marker of trochlear morphology. In addition, we also planned to show the relationship between meniscus damage, subcutaneous adipose tissue thickness as a marker of obesity, patellar tilt angle and chondromalacia patella. Patients with trauma, rheumatologic disease, a history of knee surgery and patellar variations such as patella alba and patella baja were excluded. Magnetic resonance images of the knees of 200 patients were evaluated. Trochlear morphology from standardized levels, patellar tilt angle, lateral/medial facet ratio, subcutaneous adipose tissue thickness from 3 locations and meniscus injury were assessed by two specialist radiologists. Retropatellar cartilage was normal in 108 patients (54%) at radiological evaluation, while chondromalacia patella was determined in 92 (46%) cases. Trochlear sulcus angle and prepatellar subcutaneous adipose tissue thickness were significantly high in patients with chondromalacia patella, while trochlear depth and lateral patellar tilt angle were low. The trochlear sulcus angle/trochlear depth ratio was also high in chondromalacia patella and was identified as an independent risk factor at regression analysis. Additionally, medial meniscal tear was observed in 35 patients (38%) in the chondromalacia patella group and in 27 patients (25%) in the normal group, the difference being statistically significant (P = 0.033). An increased trochlear sulcus angle/trochlear depth ratio is a significant predictor of chondromalacia patella. Medial meniscus injury is more prevalent in patients with chondromalacia patella in association with impairment in knee biomechanics and the degenerative process.

  19. Correlation of histological examination of meniscus with MR images; Focused on high signal intensity of the meniscus not caused by definite meniscal tear and impact on MR diagnosis of tears

    Energy Technology Data Exchange (ETDEWEB)

    Li, Chun Ai; Kim, Min Ki; Kim, In Hwan; Lee, Ju Hong; Jang, Kyu Yun; Lee, Sang Yong [Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju (Korea, Republic of)

    2013-12-15

    To document the causes of high signal intensity of the meniscus which is not caused by definite meniscal tears on MR imaging, through correlation with histological examination. For the correlation between the MR image and histology, we obtained prospectively 31 meniscal specimens from 21 patients. Proton density-weighted turbo spin-echo MR images were used. Minimal tear, thinning of the lamellar layer, degeneration of the central layer, and radial tie fibers were detected upon histological examination, and were correlated with the corresponding MR images. Minimal tear of the lamellar layer was seen in 60 zones out of 100 slides. On MR images, 29 (48.3%) of these 60 zones had high signal intensity. Thinning of the lamellar layer was seen in 24 zones, with 7 (29.2%) having high signal intensity. 57 central zones showed degenerative change in the central layer and high signal intensity on all corresponding MR images. Radial tie fibers in the central layer appeared as high signal intensity areas. Minimal tear and thinning of the lamellar layer, degeneration and radial tie fibers of the central layer of the meniscus cause high signal intensity on MR images.

  20. Dynamic Alterations in Microarchitecture, Mineralization and Mechanical Property of Subchondral Bone in Rat Medial Meniscal Tear Model of Osteoarthritis

    Directory of Open Access Journals (Sweden)

    De-Gang Yu

    2015-01-01

    Full Text Available Background: The properties of subchondral bone influence the integrity of articular cartilage in the pathogenesis of osteoarthritis (OA. However, the characteristics of subchondral bone alterations remain unresolved. The present study aimed to observe the dynamic alterations in the microarchitecture, mineralization, and mechanical properties of subchondral bone during the progression of OA. Methods: A medial meniscal tear (MMT operation was performed in 128 adult Sprague Dawley rats to induce OA. At 2, 4, 8, and 12 weeks following the MMT operation, cartilage degeneration was evaluated using toluidine blue O staining, whereas changes in the microarchitecture indices and tissue mineral density (TMD, mineral-to-collagen ratio, and intrinsic mechanical properties of subchondral bone plates (BPs and trabecular bones (Tbs were measured using micro-computed tomography scanning, confocal Raman microspectroscopy and nanoindentation testing, respectively. Results: Cartilage degeneration occurred and worsened progressively from 2 to 12 weeks after OA induction. Microarchitecture analysis revealed that the subchondral bone shifted from bone resorption early (reduced trabecular BV/TV, trabecular number, connectivity density and trabecular thickness [Tb.Th], and increased trabecular spacing (Tb.Sp at 2 and 4 weeks to bone accretion late (increased BV/TV, Tb.Th and thickness of subchondral bone plate, and reduced Tb.Sp at 8 and 12 weeks. The TMD of both the BP and Tb displayed no significant changes at 2 and 4 weeks but decreased at 8 and 12 weeks. The mineral-to-collagen ratio showed a significant decrease from 4 weeks for the Tb and from 8 weeks for the BP after OA induction. Both the elastic modulus and hardness of the Tb showed a significant decrease from 4 weeks after OA induction. The BP showed a significant decrease in its elastic modulus from 8 weeks and its hardness from 4 weeks. Conclusion: The microarchitecture, mineralization and mechanical

  1. Chronic anterior cruciate ligament tears and associated meniscal and traumatic cartilage lesions: evaluation with morphological sequences at 3.0 T

    Energy Technology Data Exchange (ETDEWEB)

    Vlychou, Marianna; Fezoulidis, Ioannis V. [University Hospital of Larissa, Department of Radiology, Medical School of Thessaly, Larissa (Greece); Hantes, Michalis; Michalitsis, Sotirios; Malizos, Konstantinos [University Hospital of Larissa, Department of Orthopaedic Surgery, Medical School of Thessaly, Larissa (Greece); Tsezou, Aspasia [University Hospital of Larissa, Department of Molecular Genetics and Cytogenetics, Medical School of Thessaly, Larissa (Greece)

    2011-06-15

    To investigate the diagnostic efficacy of morphological sequences at 3.0 T MR imaging in detecting anterior cruciate ligament (ACL), meniscal pathology and traumatic cartilage legions in young patients with chronic deficient anterior cruciate ligament knees. This prospective study included 43 patients (39 male) between the age of 15 and 37 years (mean age 22.6 years) with a history of knee injury sustained at least 3 months prior to the decision to repair a torn ACL. All patients underwent a 3.0 T MR scan with the same standard protocol, including intermediate-weighted and three-dimensional spoiled gradient-recalled T1-weighted sequences with fat saturation and subsequently surgical reconstruction of the ACL, along with meniscal and cartilage repair, when necessary. All ACL tears were correctly interpreted by 3.0 T MR images. The sensitivity of the MR scans regarding tears of the medial meniscus was 93.7%, the specificity 92.6%, the positive predictive value 88.2% and the negative predictive value 95.8%. The sensitivity of the MR scans regarding tears of lateral meniscus was 85.7%, the specificity was 93.1%, the positive predictive value 85.7% and the negative predictive value 93.1%. With regard to the grading of the cartilage lesions, Cohen's kappa coefficient indicated moderate agreement for grade I and II cartilage lesions (0.5), substantial agreement for grade III and IV cartilage lesions (0.70 and 0.66) and substantial agreement for normal regions (0.75). Regarding location of the cartilage lesions, Cohen's kappa coefficient varied between almost perfect agreement in the lateral femoral condyle and no agreement in the trochlea. In the setting of chronic ACL deficiency, MR imaging at 3.0 T achieves satisfactory diagnostic performance regarding meniscal and ligamentous pathology. In the detection of cartilage lesions MRI is less successful. (orig.)

  2. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears

    Directory of Open Access Journals (Sweden)

    Francisco Abaeté Chagas-Neto

    2016-04-01

    Full Text Available Abstract Objective: To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE magnetic resonance imaging (MRI technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods: Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results: For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively and specificity (80% and 85%, respectively. For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively and specificity (68% and 71%, respectively. In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively and specificity (82% and 92%, respectively. There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion: The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

  3. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears*

    Science.gov (United States)

    Chagas-Neto, Francisco Abaeté; Nogueira-Barbosa, Marcello Henrique; Lorenzato, Mário Müller; Salim, Rodrigo; Kfuri-Junior, Maurício; Crema, Michel Daoud

    2016-01-01

    Objective To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. Materials and Methods Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. Results For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. Conclusion The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition. PMID:27141127

  4. Diagnostic performance of 3D TSE MRI versus 2D TSE MRI of the knee at 1.5 T, with prompt arthroscopic correlation, in the detection of meniscal and cruciate ligament tears.

    Science.gov (United States)

    Chagas-Neto, Francisco Abaeté; Nogueira-Barbosa, Marcello Henrique; Lorenzato, Mário Müller; Salim, Rodrigo; Kfuri-Junior, Maurício; Crema, Michel Daoud

    2016-01-01

    To compare the diagnostic performance of the three-dimensional turbo spin-echo (3D TSE) magnetic resonance imaging (MRI) technique with the performance of the standard two-dimensional turbo spin-echo (2D TSE) protocol at 1.5 T, in the detection of meniscal and ligament tears. Thirty-eight patients were imaged twice, first with a standard multiplanar 2D TSE MR technique, and then with a 3D TSE technique, both in the same 1.5 T MRI scanner. The patients underwent knee arthroscopy within the first three days after the MRI. Using arthroscopy as the reference standard, we determined the diagnostic performance and agreement. For detecting anterior cruciate ligament tears, the 3D TSE and routine 2D TSE techniques showed similar values for sensitivity (93% and 93%, respectively) and specificity (80% and 85%, respectively). For detecting medial meniscal tears, the two techniques also had similar sensitivity (85% and 83%, respectively) and specificity (68% and 71%, respectively). In addition, for detecting lateral meniscal tears, the two techniques had similar sensitivity (58% and 54%, respectively) and specificity (82% and 92%, respectively). There was a substantial to almost perfect intraobserver and interobserver agreement when comparing the readings for both techniques. The 3D TSE technique has a diagnostic performance similar to that of the routine 2D TSE protocol for detecting meniscal and anterior cruciate ligament tears at 1.5 T, with the advantage of faster acquisition.

  5. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair.

    Science.gov (United States)

    Ramappa, Arun J; Chen, Alvin; Hertz, Benjamin; Wexler, Michael; Grimaldi Bournissaint, Leandro; DeAngelis, Joseph P; Nazarian, Ara

    2014-01-01

    Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. Controlled laboratory study. Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.

  6. Defining the Value of Future Research to Identify the Preferred Treatment of Meniscal Tear in the Presence of Knee Osteoarthritis.

    Directory of Open Access Journals (Sweden)

    Elena Losina

    Full Text Available Arthroscopic partial meniscectomy (APM is extensively used to relieve pain in patients with symptomatic meniscal tear (MT and knee osteoarthritis (OA. Recent studies have failed to show the superiority of APM compared to other treatments. We aim to examine whether existing evidence is sufficient to reject use of APM as a cost-effective treatment for MT+OA.We built a patient-level microsimulation using Monte Carlo methods and evaluated three strategies: Physical therapy ('PT' alone; PT followed by APM if subjects continued to experience pain ('Delayed APM'; and 'Immediate APM'. Our subject population was US adults with symptomatic MT and knee OA over a 10 year time horizon. We assessed treatment outcomes using societal costs, quality-adjusted life years (QALYs, and calculated incremental cost-effectiveness ratios (ICERs, incorporating productivity costs as a sensitivity analysis. We also conducted a value-of-information analysis using probabilistic sensitivity analyses.Calculated ICERs were estimated to be $12,900/QALY for Delayed APM as compared to PT and $103,200/QALY for Immediate APM as compared to Delayed APM. In sensitivity analyses, inclusion of time costs made Delayed APM cost-saving as compared to PT. Improving efficacy of Delayed APM led to higher incremental costs and lower incremental effectiveness of Immediate APM in comparison to Delayed APM. Probabilistic sensitivity analyses indicated that PT had 3.0% probability of being cost-effective at a willingness-to-pay (WTP threshold of $50,000/QALY. Delayed APM was cost effective 57.7% of the time at WTP = $50,000/QALY and 50.2% at WTP = $100,000/QALY. The probability of Immediate APM being cost-effective did not exceed 50% unless WTP exceeded $103,000/QALY.We conclude that current cost-effectiveness evidence does not support unqualified rejection of either Immediate or Delayed APM for the treatment of MT+OA. The amount to which society would be willing to pay for additional information

  7. Relationship between years in the trade and the development of radiographic knee osteoarthritis and MRI-detected meniscal tears and bursitis in floor layers. A cross-sectional study of a historical cohort

    DEFF Research Database (Denmark)

    Jensen, Lilli Kirkeskov; Rytter, Søren; Marott, Jacob Louis

    2012-01-01

    An increased risk of developing knee disorders including radiographic knee osteoarthritis (OA) have been shown among workers with kneeling working demands. There may also be a dose-related association between duration of employment in occupations with kneeling work and development of radiographic...... knee OA and magnetic resonance imaging (MRI)-detected meniscal tears and bursitis....

  8. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study): protocol of a randomised controlled trial

    NARCIS (Netherlands)

    van de Graaf, Victor A.; Scholtes, Vanessa A.B.; Wolterbeek, Nienke; Noorduyn, Julia C.A.; Neeter, Camille; van Tulder, Maurits W.; Saris, Daniël B.F.; de Gast, Arthur; Poolman, Rudolf W.

    2016-01-01

    Introduction Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard

  9. Cost-effectiveness of Early Surgery versus Conservative Treatment with Optional Delayed Meniscectomy for Patients over 45 years with non-obstructive meniscal tears (ESCAPE study) : Protocol of a randomised controlled trial

    NARCIS (Netherlands)

    Van De Graaf, Victor A.; Scholtes, Vanessa A B; Wolterbeek, Nienke; Noorduyn, Julia C A; Neeter, Camille; Van Tulder, Maurits W.; Saris, Daniël B F; De Gast, Arthur; Poolman, Rudolf W.

    2016-01-01

    Introduction Recent studies show similar outcome between surgery and conservative treatment in patients with non-obstructive meniscal tears. However, surgery is still often preferred over conservative treatment. When conservative treatment is non-inferior to surgery, shifting the current standard

  10. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs

    NARCIS (Netherlands)

    van Tienen, TG; Heijkants, RGJC; de Groot, JH; Pennings, AJ; Poole, AR; Veth, RPH; Buma, P

    Objective: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce

  11. Presence and mechanism of knee articular cartilage degeneration after meniscal reconstruction in dogs.

    NARCIS (Netherlands)

    Tienen, Tony van; Heijkants, R.G.J.C.; Groot, J.H. de; Pennings, A.J.; Poole, A.R.; Veth, R.P.H.; Buma, P.

    2003-01-01

    OBJECTIVE: Partial meniscectomy is the golden standard for treating a bucket-handle tear in the meniscus of the knee, but it inevitably leads to articular cartilage degeneration. Surgical creation of an access channel between the lesion and the vascularized synovial lining is intended to induce

  12. Isolated lateral meniscectomy. A study of twenty-six patients with isolated tears.

    Science.gov (United States)

    Yocum, L A; Kerlan, R K; Jobe, F W; Carter, V S; Shields, C L; Lombardo, S J; Collins, H R

    1979-04-01

    To better define the role that the lateral meniscus plays in stabilizing the knee, a study was made of twenty-six patients who had an uncomplicated lateral meniscectomy between 1972 and 1977. Patients with any degree of ligament instability, cruciate or collateral, prior to lateral meniscectomy were eliminated from the study. Also eliminated were any patients with roentgenographic evidence of degenerative arthrits, osteochondritis dissecans, or loose bodies. Only patients whose operative reports stated that the articular cartilage of the lateral compartment was either grossly normal or showed Grade-1 chondromalacia (less than one centimeter in diameter and only softening of the cartilage) at the time of surgery were included in the review. The meniscal lesions included bucket-handle tears, horizontal cleavage tears, and multiple linear defects. No grossly cystic menisci were included in the study. Two menisci demonstrated cystic degenerative changes on histological section. In sixteen patients some degree of ligament instability developed. The longer the interval between injury to the meniscus and its excision, the less satisfactory the result. Only fifteen (54 per cent) of the patients reported satisfactory results, and twenty lost some motion of the knee. We concluded that stability of the knee joint is a multifactorial problem, in which the lateral meniscus certainly plays an important part.

  13. All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles.

    Science.gov (United States)

    Rosso, Claudio; Müller, Sebastian; Buckland, Daniel M; Schwenk, Tanja; Zimmermann, Simon; de Wild, Michael; Valderrabano, Victor

    2014-09-01

    All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing. All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls. Controlled laboratory study. Bucket-handle tears in 72 porcine menisci were repaired using the Omnispan and Fast-Fix 360 (all-inside devices) and Orthocord 2-0 and Ultrabraid 2-0 sutures (matched controls). Initial displacement, displacement after cyclic loading (100, 500, 1000, 2000, 5000, 10,000, and 100,000 cycles) between 5 and 20 N, ultimate load to failure, and mode of failure were recorded, as well as stiffness. Initial displacement and displacement after cyclic loading were not different between the groups. The Omnispan repair demonstrated the highest load-to-failure force (mean ± SD, 151.3 ± 21.5 N) and was significantly stronger than all the other constructs (Orthocord 2-0, 105.5 ± 20.4 N; Ultrabraid 2-0, 93.4 ± 22.5 N; Fast-Fix 360, 76.6 ± 14.2 N) (P inside-out mattress repair was significantly stronger than the Fast-Fix 360 repair (P = .003). The Omnispan (30.8 ± 3.5 N/mm) showed significantly higher stiffness compared with the Ultrabraid 2-0 (22.9 ± 6.9 N/mm, P inside meniscal devices show comparable biomechanical properties compared with inside-out suture repair in cyclic loading, even after 100,000 cycles. Eight to 10 weeks of rehabilitation might not pose a problem for all repairs in this worst-case scenario. © 2014 The Author(s).

  14. New observations on meniscal cysts

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Jada Jean; Connor, Gregory F.; Helms, Clyde A. [Duke University Medical Center, Durham, NC (United States)

    2010-12-15

    The purpose of this study was to determine the incidence of meniscal cysts, assess the frequency of various magnetic resonance (MR) imaging characteristics, and emphasize radiographic observations not commonly reported. A total of 2,095 consecutive knee MR imaging reports from a 22 month period were retrospectively reviewed for the presence of meniscal cysts. Two musculoskeletal radiologists reviewed the cases where cysts were reported. A meniscal cyst was considered present if abnormally increased signal was identified within an enlarged meniscus (i.e., intrameniscal cyst) or if a loculated fluid-intensity lesion with a clear connection to the adjacent meniscus was identified (i.e., parameniscal cyst). Presence or absence of a meniscal tear, intrameniscal and parameniscal signal intensity, patient age, sex, location of meniscal cyst, presence of discoid meniscus, and size of the parameniscal cyst component were recorded. All knee imaging examinations were performed on a 1.5T MR unit. Imaging findings were correlated with arthroscopic reports when available. A total of 167 cases (8.0%) of meniscal cysts were diagnosed in 161 patients. Of the 167 cysts, 69 (41.3%) were located in the lateral meniscus and 98 (58.7%) in the medial meniscus. In 6 patients (3.7%), meniscal cysts were present in both menisci of the same knee. Twelve (7.2%) meniscal cysts were associated with discoid menisci. Ninety-seven (57.8%) meniscal cysts were associated with meniscal tears. Of the total number of meniscal cysts, 104 (62.3%) had a parameniscal cyst. An isolated intrameniscal cyst was present in 63 (37.7%) cases. One hundred (96%) of the parameniscal cyst components were isointense to fluid on T2-weighted FSE images. All cysts exhibited abnormal intrameniscal signal. Only 14 (8.4%) of the intrameniscal components were isointense to fluid on T2-weighted FSE images. The arthroscopic reports of 88 of the 161 (54.7%) patients were available for review and correlation. A tear extending to

  15. New observations on meniscal cysts.

    Science.gov (United States)

    Anderson, Jada Jean; Connor, Gregory F; Helms, Clyde A

    2010-12-01

    The purpose of this study was to determine the incidence of meniscal cysts, assess the frequency of various magnetic resonance (MR) imaging characteristics, and emphasize radiographic observations not commonly reported. A total of 2,095 consecutive knee MR imaging reports from a 22 month period were retrospectively reviewed for the presence of meniscal cysts. Two musculoskeletal radiologists reviewed the cases where cysts were reported. A meniscal cyst was considered present if abnormally increased signal was identified within an enlarged meniscus (i.e., intrameniscal cyst) or if a loculated fluid-intensity lesion with a clear connection to the adjacent meniscus was identified (i.e., parameniscal cyst). Presence or absence of a meniscal tear, intrameniscal and parameniscal signal intensity, patient age, sex, location of meniscal cyst, presence of discoid meniscus, and size of the parameniscal cyst component were recorded. All knee imaging examinations were performed on a 1.5T MR unit. Imaging findings were correlated with arthroscopic reports when available. A total of 167 cases (8.0%) of meniscal cysts were diagnosed in 161 patients. Of the 167 cysts, 69 (41.3%) were located in the lateral meniscus and 98 (58.7%) in the medial meniscus. In 6 patients (3.7%), meniscal cysts were present in both menisci of the same knee. Twelve (7.2%) meniscal cysts were associated with discoid menisci. Ninety-seven (57.8%) meniscal cysts were associated with meniscal tears. Of the total number of meniscal cysts, 104 (62.3%) had a parameniscal cyst. An isolated intrameniscal cyst was present in 63 (37.7%) cases. One hundred (96%) of the parameniscal cyst components were isointense to fluid on T2-weighted FSE images. All cysts exhibited abnormal intrameniscal signal. Only 14 (8.4%) of the intrameniscal components were isointense to fluid on T2-weighted FSE images. The arthroscopic reports of 88 of the 161 (54.7%) patients were available for review and correlation. A tear extending to

  16. A 12-week supervised exercise therapy program for young adults with a meniscal tear: Program development and feasibility study

    DEFF Research Database (Denmark)

    Skou, Søren T.; Thorlund, Jonas B.

    2018-01-01

    interview. Feedback from patients was included to finalize the exercise therapy program. Median improvements (Range) in KOOS subscales were 15 (0–33) for Pain, 11 (−11 to 50) for Symptoms, 16 (3–37) for Function in daily living, 23 (10–45) for Function in sport and recreation, and 9 (−6 to 31) for Quality...... on clinical expertise and available evidence. Six patients (age range 22–39 years) considered eligible for meniscal surgery by an orthopedic surgeon underwent the program. Patients completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) and evaluated the program during a semi-structured qualitative...... of life. The patients found the program relevant and effective with only a few short-lasting adverse events and important clinical improvements after four to ten weeks. Physical therapist supervision was considered important. No patients wanted surgery up to 6 month after the exercise therapy program...

  17. Meniscal Ramp Lesions

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S.; Moatshe, Gilbert; Mitchell, Justin J.; Cram, Tyler R.; Yacuzzi, Carlos; LaPrade, Robert F.

    2016-01-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn of the medial meniscus should be performed. Several treatment options have been reported, including nonsurgical management, inside-out meniscal repair, or all-inside meniscal repair. In cases of isolated ramp lesions, a standard meniscal repair rehabilitation protocol should be followed. However, when a concomitant ACL reconstruction (ACLR) is performed, the rehabilitation should follow the designated ACLR postoperative protocol. The purpose of this article was to review the current literature regarding meniscal ramp lesions and summarize the pertinent anatomy, biomechanics, diagnostic strategies, recommended treatment options, and postoperative protocol. PMID:27504467

  18. Meniscal Ramp Lesions

    OpenAIRE

    Chahla, Jorge; Dean, Chase S.; Moatshe, Gilbert; Mitchell, Justin J.; Cram, Tyler R.; Yacuzzi, Carlos; LAPRADE, ROBERT F.

    2016-01-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and conse...

  19. Meniscal pullout repair following meniscal ossicle resection: a case report.

    Science.gov (United States)

    Ohishi, Tsuyoshi; Suzuki, Daisuke; Yamamoto, Kazufumi; Banno, Tomohiro; Shimizu, Yuta; Ohmura, Akihiro; Matsuyama, Yukihiro

    2013-01-01

    We present this case of a meniscal ossicle of the posterior horn of the medial meniscus that was treated by an arthroscopic ossicle resection followed by a pullout repair of the remaining meniscus. A 49-year-old businessman complained of catching and left knee pain. Radiographic and arthroscopic findings revealed a meniscal ossicle embedded in the posterior horn of the medial meniscus and posterior horn tear. After resection of the posterior horn with the ossicle, a pullout suture repair for the posterior segment of the meniscus was done to minimize the further extrusion of the meniscus. A histologic appearance supported the vestigial development of the meniscal ossicle as the etiology. This is the first report describing a repair of the meniscus after ossicle resection. Copyright © 2012 Elsevier B.V. All rights reserved.

  20. Meniscal pathology in children: differences and similarities with the adult meniscus

    Energy Technology Data Exchange (ETDEWEB)

    Francavilla, Michael L.; Restrepo, Ricardo; Zamora, Kathryn W.; Sarode, Vijaya [Department of Radiology, Miami Children' s Hospital, Miami, FL (United States); Swirsky, Stephen M. [Department of Orthopedics, Miami Children' s Hospital, Miami, FL (United States); Mintz, Douglas [Hospital for Special Surgery, New York, NY (United States)

    2014-08-15

    The normal meniscus undergoes typical developmental changes during childhood, reaching a mature adult appearance by approximately 10 years of age. In addition to recognizing normal meniscal appearances in children, identifying abnormalities - such as tears and the different types of discoid meniscus and meniscal cysts, as well as the surgical implications of these abnormalities - is vital in pediatric imaging. The reported incidence of meniscal tears in adolescents and young adults has increased because of increased sports participation and more widespread use of MRI. This review discusses the normal appearance of the pediatric meniscus, meniscal abnormalities, associated injuries, and prognostic indicators for repair. (orig.)

  1. The Efficacy of Meniscal Treatment Associated with Lateral Tibial Plateau Fractures.

    Science.gov (United States)

    Park, Hyun-Joo; Lee, Hui-Du; Cho, Jin Ho

    2017-06-01

    The purpose of this study was to examine the incidence of lateral meniscal tears associated with lateral tibial plateau fractures and report the clinical outcomes of meniscal treatment with internal fixation of fractures. All lateral tibial plateau fractures (Schatzker types II and III) in skeletally mature patients treated operatively at our institution between January 2010 and February 2016 were included. All patients underwent open reduction and internal fixation using a buttress plate or cancellous screws. All meniscal tears were initially considered for repair using an all-inside technique. The incidence of lateral meniscal tears with lateral tibial plateau fractures was 64%. Ten patients underwent meniscal repair. In second-look arthroscopy, normal healing was observed in all of the repaired lateral menisci. At the last follow-up, none of the 10 patients had clinical symptoms related to meniscal injuries. One of the 4 patients who had not undergone meniscal treatment although a lateral tear was suspected based on magnetic resonance imaging achieved stable bony union; however, due to the complaint of persisting knee pain, lateral meniscectomy was performed. Treatment of meniscal lesions associated with lateral tibial plateau fractures showed good clinical and second-look arthroscopic results. Therefore, we believe that recognition and treatment of a meniscal injury at the time of surgical fixation can improve clinical outcome.

  2. Inside-Out Meniscal Repair: Medial and Lateral Approach.

    Science.gov (United States)

    Chahla, Jorge; Serra Cruz, Raphael; Cram, Tyler R; Dean, Chase S; LaPrade, Robert F

    2016-02-01

    Preservation of meniscal tissue has been proven to be the best approach in most cases of meniscal tears. Currently available techniques for treating a peripheral meniscal tear include inside-out, outside-in, and all-inside techniques. Each of these techniques present potential advantages and disadvantages. Despite technologic advances in all-inside devices, because of implant-related complications, cost concerns, and device availability, the inside-out technique is still the preferred method among many surgeons. Although the inside-out repair technique is considered more technically demanding and requires additional incisions, it has several advantages such as the possibility for an increased number of sutures, creating a stronger construct, and greater versatility in their placement. This article describes the inside-out meniscal repair technique with its corresponding posterolateral and posteromedial surgical approaches.

  3. The effects of ACL deficiency on meniscal deformation and kinematics

    OpenAIRE

    Irvine, James N.; Thorhauer, Eric; Zheng, Liying; Baidoo, Kevin; Abebe, Ermias; Tashman, Scott; Zhang, Xudong; Vyas, Dharmesh; Harner, Christopher D.; Arner, Justin W.

    2015-01-01

    Objectives: The meniscus plays a vital role in knee load transmission by increasing the tibiofemoral joint contact area and distributing the joint forces within the medial and lateral compartments. Clinically, anterior cruciate ligament (ACL) injuries are commonly concomitant with tears of the lateral meniscus. In isolated ACL tears, it is likely that meniscal behavior is affected as a result of altered tibiofemoral kinematics. However, little is known regarding the effects of acute ACL injur...

  4. Concomitant ligamentous and meniscal injuries in floating knee.

    Science.gov (United States)

    Liu, Ya; Zhang, Jun; Zhang, Shu; Li, Rui; Yue, Xianhu

    2015-01-01

    To identify and characterize the concomitant ligamentous and meniscal injuries in floating knee. A total of 37 cases of floating knee were enrolled. Arthroscopic or open surgical examination of the knee, Lachman test, posterior drawer's test, and varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. Through arthroscopic and open surgical examinations, a medial meniscal tear was detected in 14 (37.8%) cases and a lateral meniscal tear in 11 (29.7%). Twenty-one (56.8%) patients had anterior cruciate ligament (ACL) injury including complete injury in 6 and incomplete injury in 15 cases. Three (8.1%) patients had posterior cruciate ligament (PCL) tear, including complete injury in 1 and incomplete injury in 2. Varus and valgus stress tests revealed that 10 (27.0%) and 7 (18.9%) patients had medial and lateral collateral ligament (MCL and LCL) laxity, respectively. Lachman test showed positive in 8 (21.6%) cases. Posterior drawer test showed positive in 3 (8.1%) cases. Twenty-six (70.3%) patients had knee ligamentous injuries. ACL injury was the most common ligamentous injury. ACL injury in 15 (71.4%) cases was associated with meniscal injury, including medial meniscal injury in 9 (42.9%) and lateral meniscal injury in 6 (28.6%). Physicians should pay attention to the concomitant ligamentous and meniscal injuries in floating knee. Careful clinical examination with aid of arthroscopic examination is helpful for the early diagnosis and treatment of these injuries.

  5. Predicted probability of meniscus tears: comparing history and physical examination with MRI.

    Science.gov (United States)

    Yan, R; Wang, H; Yang, Z; Ji, Z H; Guo, Y M

    2011-12-14

    The indication for surgical treatment of a meniscal lesion should not only rely on magnetic resonance imaging (MRI) findings, but also on a detailed history and a thorough clinical examination. However, various intra-articular lesions may often produce similar symptoms. So, what kinds of symptoms are more associated with a meniscal tear? Is MRI worth doing? The aims of this study were to identify sensitive and specific clinical tests and elements of patients' history with a high predictive value, and to assess the combined diagnostic accuracy of sensitive and specific clinical tests and elements of patients' history with MRI. Data from 281 consecutive knee arthroscopies to investigate and treat suspected internal knee pathologies were retrospectively collected between March 2009 and April 2010. The study group consisted of 262 knees. Statistically significant factors in the clinical diagnosis of meniscal tears were screened by a chi-square test. Logistic regression analysis was used to determine which factors associated with meniscal tears found during arthroscopy. The diagnostic values of MRI and the sensitive and specific clinical tests and elements of patients' history with high predictive value for meniscal tears were calculated. The overall diagnostic value of MRI for meniscal tears was: accuracy, 88.8%; sensitivity, 95.7%; specificity, 75.8%; positive predictive value (PPV), 88.2%; and negative predictive value (NPV), 90.4%. Giving way, locking and McMurray's test were independent diagnostic factors with a predicted correct percentage of 80.0% (p predicted correct percentage of meniscal tears found during arthroscopy to 91.6% (p factors for the diagnosis of meniscal tears. MRI has higher accuracy, sensitivity and NPV for the diagnosis of meniscal tears than giving way, locking and McMurray's test. The combination of giving way, locking, McMurray's test and MRI for confirmation is typical for a meniscal lesion diagnosis. Based on these findings, MRI should be

  6. AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT "SQUEEZE" TECHNIQUE

    National Research Council Canada - National Science Library

    Hudson, Robinetta; Richmond, Amy; Sanchez, Belinda; Stevenson, Valerie; Baker, Russell T; May, James; Nasypany, Alan; Reordan, Don

    2016-01-01

    .... The purpose of this case series was to examine the effect of the Mulligan Concept (MC) "Squeeze" technique in physically active participants who presented with clinical symptoms of meniscal tears...

  7. Mechanical properties and morphological analysis of the transitional zone between meniscal body and ligamentous meniscal attachments.

    Science.gov (United States)

    Freutel, M; Scholz, N B; Seitz, A M; Ignatius, A; Dürselen, L

    2015-06-01

    In recent years, an increasing number of studies reporting on meniscal root tears have been published. While the meniscus and its ligamentous meniscal attachments have been studied before, little is known about the transitional zone between these two structures. Therefore, the aim of this study was to mechanically and morphologically characterize the transitional zone between meniscus and its meniscal attachments. Dumbbell-shaped specimens were obtained from the transitional zone between meniscus and its meniscal attachments of 6 knee joints. Samples were divided into tibial and central layers of the anterior lateral (AL), anterior medial (AM), posterior lateral (PL) and posterior medial (PM) transitional region. Testing was performed to obtain the dissipated energy during hysteresis as well as the linear modulus (Elin), the maximum strain (εmax), the maximum engineering stress (σmax,eng) and location of rupture during tensile test to failure. Two additional knee joints were used to investigate morphological differences between meniscus, transitional zone and meniscal attachments in 8µm transverse slices. The central layer of the AL, AM and PL dissipated up to 48% less energy than the tibial layer. Elin was highest in the tibial layer of the PM with 107.4±61.1MPa and lowest in the central layer of the PL with 56.0±20.5MPa. The maximum strain was higher in the central layer than in the tibial layer at the AL, AM, and PL locations. The average σmax,eng was 12.7±9.9MPa over all location and layers. 78% of the samples ruptured during tensile test to failure in the transitional zone. The morphological evaluation showed a smooth transitional zone with a transitional curve which was either linear or bell-shaped. The strength found in the transitional zone was lower than in the meniscus and the meniscal attachments, which corresponds well to clinical findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Integrity of articular cartilage on T2 mapping associated with meniscal signal change

    Energy Technology Data Exchange (ETDEWEB)

    Kai, Brian [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada); Mann, Sumeer A. [Department of Radiology, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, AB, T6G 2B7 (Canada); King, Chris [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada); Forster, Bruce B., E-mail: bruce.forster@vch.ca [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada)

    2011-09-15

    Objective: The purpose of this study was to investigate the relationship between T2 relaxation values (T2 RVs) within the superficial zone of articular cartilage and different types of meniscal degeneration/tear. Materials and methods: A review of 310 consecutive knee MRIs which included an 8 echo T2 relaxation sequence, in patients referred for standard clinical indications, was performed independently and in blinded fashion by 2 observers. The posterior horns of the medial and lateral menisci were each evaluated and divided into 4 subgroups: Normal (control), Grade I/II meniscal signal, Grade III meniscal signal-simple tear (Grade III-S), and Grade III meniscal signal-complex tear (Grade III-C). After exclusion criteria were applied, the medial meniscal group consisted of 65 controls and 133 patients, while the lateral meniscal group consisted of 143 controls and 55 patients. T2 RVs were measured by an observer blinded to the clinical history and MRI grading. Measurements were obtained over the superficial zone of femoral and tibial articular cartilage adjacent to the center of the posterior horn of each meniscus to ensure consistency between measurements. Analysis of covariance adjusting for age and gender was used to compare T2 RVs between patients and controls. Results: T2 RVs were significantly increased in patients with Grade III-C meniscal tears compared to controls over the medial tibial plateau (MTP; p = 0.0001) and lateral tibial plateau (LTP; p = 0.0008). T2 RVs were not increased in patients with Grade III-C meniscal tears over the medial femoral condyle (MFC; p = 0.11) or lateral femoral condyle (LFC; p = 0.99). Grade I/II meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.15), LFC (p = 0.69), MTP (p = 0.42), or LTP (p = 0.50). Grade III-S meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.54), LFC (p = 0.43), MTP (p = 0.30), or LTP (p = 0.38). Conclusion: Grade III-C meniscal tears are associated with

  9. Outcomes of Inside-out Meniscal Repair in the Setting of Multiligament Reconstruction in the Knee.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Matheny, Lauren M; Mitchell, Justin J; Cinque, Mark E; LaPrade, Robert F

    2017-07-01

    Limited evidence exists for meniscal repair outcomes in a multiligament reconstruction setting. Purpose/Hypothesis: The purpose of this study was to assess outcomes and failure rates of meniscal repair in patients who underwent multiligament reconstruction compared with patients who underwent multiligament reconstruction but lacked meniscal tears. The authors hypothesized that the outcomes of meniscal repair associated with concomitant multiligament reconstruction would significantly improve from preoperatively to postoperatively at a minimum of 2 years after the index surgery. Secondarily, they hypothesized that this cohort would demonstrate similar outcomes and failure rates compared with the cohort that did not have meniscal lesions at the time of multiligament reconstruction. Cohort study; Level of evidence, 3. Inclusion criteria for the study included radiographically confirmed skeletally mature patients of at least 16 years of age who underwent multiligamentous reconstruction of the knee without previous ipsilateral osteotomy, intra-articular infections, or intra-articular fractures. Patients were included in the experimental group if they underwent inside-out meniscal suture repair with concurrent multiligament reconstruction. Those included in the control group (multiligament reconstruction without a meniscal tear) underwent multiligament reconstruction but did not undergo any type of meniscal surgery. Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index, Short Form-12 physical component summary and mental component summary, Tegner activity scale, and patient satisfaction scores were recorded preoperatively and postoperatively. The failure of meniscal repair was defined as a retear of the meniscus that was confirmed arthroscopically. There were 43 patients (16 female, 27 male) in the meniscal repair group and 62 patients (25 female, 37 male) in the control group. Follow-up was obtained in 93% of patients with a mean of 3.0 years (range, 2

  10. Analysis of meniscal degeneration and meniscal gene expression

    Directory of Open Access Journals (Sweden)

    Norton James H

    2010-01-01

    Full Text Available Abstract Background Menisci play a vital role in load transmission, shock absorption and joint stability. There is increasing evidence suggesting that OA menisci may not merely be bystanders in the disease process of OA. This study sought: 1 to determine the prevalence of meniscal degeneration in OA patients, and 2 to examine gene expression in OA meniscal cells compared to normal meniscal cells. Methods Studies were approved by our human subjects Institutional Review Board. Menisci and articular cartilage were collected during joint replacement surgery for OA patients and lower limb amputation surgery for osteosarcoma patients (normal control specimens, and graded. Meniscal cells were prepared from these meniscal tissues and expanded in monolayer culture. Differential gene expression in OA meniscal cells and normal meniscal cells was examined using Affymetrix microarray and real time RT-PCR. Results The grades of meniscal degeneration correlated with the grades of articular cartilage degeneration (r = 0.672; P HLA-DPA1, integrin, beta 2 (ITGB2, ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1, ankylosis, progressive homolog (ANKH and fibroblast growth factor 7 (FGF7, were expressed at significantly higher levels in OA meniscal cells compared to normal meniscal cells. Importantly, many of the genes that have been shown to be differentially expressed in other OA cell types/tissues, including ADAM metallopeptidase with thrombospondin type 1 motif 5 (ADAMTS5 and prostaglandin E synthase (PTGES, were found to be expressed at significantly higher levels in OA meniscal cells. This consistency suggests that many of the genes detected in our study are disease-specific. Conclusion Our findings suggest that OA is a whole joint disease. Meniscal cells may play an active role in the development of OA. Investigation of the gene expression profiles of OA meniscal cells may reveal new therapeutic targets for OA therapy and also may uncover novel

  11. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment.

    Science.gov (United States)

    Chahla, Jorge; Dean, Chase S; Moatshe, Gilbert; Mitchell, Justin J; Cram, Tyler R; Yacuzzi, Carlos; LaPrade, Robert F

    2016-07-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed. Therefore, to rule out a ramp lesion, an arthroscopic evaluation with probing of the posterior horn of the medial meniscus should be performed. Several treatment options have been reported, including nonsurgical management, inside-out meniscal repair, or all-inside meniscal repair. In cases of isolated ramp lesions, a standard meniscal repair rehabilitation protocol should be followed. However, when a concomitant ACL reconstruction (ACLR) is performed, the rehabilitation should follow the designated ACLR postoperative protocol. The purpose of this article was to review the current literature regarding meniscal ramp lesions and summarize the pertinent anatomy, biomechanics, diagnostic strategies, recommended treatment options, and postoperative protocol.

  12. Meniscal ramp lesions : anatomy, incidence, diagnosis, and treatment

    OpenAIRE

    Chahla, Jorge; Dean, Chase S.; Moatshe, Gilbert; Mitchell, Justin J.; Cram, Tyler R.; Yacuzzi, Carlos; LaPrade, Robert F.

    2016-01-01

    © 2016 The Author(s). This is an Open Access article. Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (...

  13. Meniscal ramp lesions : anatomy, incidence, diagnosis, and treatment

    OpenAIRE

    Chahla, Jorge; Dean, Chase S.; Moatshe, Gilbert; Mitchell, Justin J.; Cram, Tyler R.; Yacuzzi, Carlos; LAPRADE, ROBERT F.

    2016-01-01

    Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, ...

  14. Inside-Out Repair for Radial Meniscus Tears.

    Science.gov (United States)

    Pareek, Ayoosh; O'Malley, Michael P; Levy, Bruce A; Stuart, Michael J; Krych, Aaron J

    2016-08-01

    Understanding of meniscal function through basic science, natural history, and biomechanics has highlighted the importance of preserving the meniscus to maintain normal knee biomechanics. Tears that may alter these biomechanics can contribute to the progressive nature of degenerative joint disease in the knee. Radial tears result in the disruption of the circumferential fibers causing inability of the native meniscus to resist normal hoop stresses, thereby leading to increased focal areas of pressure that cause complications such as early onset arthrosis. In this technical note, we describe our preferred operative technique to repair radial meniscal tears using an arthroscopic inside-out approach with satisfactory clinical outcomes and healing response.

  15. Medial Meniscus Root Tear in the Middle Aged Patient: A Case Based Review

    Science.gov (United States)

    Carreau, Joseph H.

    2017-01-01

    Abstract Biomechanical studies have shown that medial meniscal root tears result in meniscal extrusion and increased tibiofemoral joint contact pressures, which can accelerate the progression of arthritis. Repair is generally recommended for acute injuries in the young, active patient population. The far more common presentation however, is a subacute root tear with medial meniscal extrusion in a middle aged patient. Coexisting arthritis is common in this population and complicates decision making. Treatment should be based on the severity of the underlying arthritis. In cases of early or minimal arthritis, root repair is ideal to improve symptoms and restore meniscal function. In patients with moderate or severe medial compartment arthritis, medial unloader bracing or injections can be tried initially. When non-operative treatment fails, high tibial osteotomy or arthroplasty is recommended. Long term clinical studies are needed to determine the natural history of medial meniscal root tears in middle aged patients and the best surgical option. PMID:28852346

  16. Rehabilitation following meniscal repair

    OpenAIRE

    Cavanaugh, John T.; Killian, Sarah E.

    2012-01-01

    It has become increasingly more evident that the meniscus plays an important role in contributing to knee joint longevity. Advances in surgical techniques by orthopaedic surgeons to repair traumatized menisci have led to better long term outcomes, decreasing the incidence of articular cartilage degeneration. Advances have also been made in rehabilitative techniques following meniscal repair. These techniques along with sound rehabilitation principles to include a criteria based progression ha...

  17. Value of modern sonography in the assessment of meniscal lesions

    Energy Technology Data Exchange (ETDEWEB)

    Wareluk, Pawel, E-mail: pwareluk@wum.edu.pl [Department of Diagnostic Imaging, Second Faculty of Medicine, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw (Poland); Szopinski, Kazimierz T., E-mail: kszopinski@wum.edu.pl [Department of Dental and Maxillofacial Radiology, First Faculty of Medicine, Medical University of Warsaw, ul. Nowogrodzka 59, 02-006 Warsaw (Poland)

    2012-09-15

    The aim of this prospective study was to assess the accuracy of modern ultrasonography in diagnostic imaging of meniscal tears. One hundred and sixty menisci were evaluated in 80 patients (42 females, 38 males, mean age = 36.2 years, range = 16–70 years). Inclusion criteria for the study were twofold: clinical suspicion of meniscal injury and clinical indication for arthroscopy. Knee examination was performed with the Voluson 730 Expert ultrasound system (General Electric). After sonographic examination, all patients underwent arthroscopic procedures within 1–4 days. The final diagnosis of meniscal tears was taken from surgical reports. The overall sensitivity, specificity, positive predictive value and negative predictive value of sonographic examination in the assessment of meniscal tears amounted to 85.4%, 85.7%, 67.3% and 94.4%, respectively. The statistical parameters were not statistically different in medial and lateral menisci. Age, sex, body mass index (BMI), weight, physical activity, mechanism on injury, and time lapse from injury did not have a statistically significant impact on the usefulness of ultrasonography. The highest sensitivity (>90%) was obtained in medial menisci and in patients with a BMI > 25. The highest specificity (>90%) was obtained in lateral menisci, in patients after twisting injuries, in sports injuries, and in recent injuries (time lapse from the injury <1 month). The positive predictive value (PPV) of sonographic examination was higher than 90% only in recent injuries (<1 month), however, the negative predictive value of ultrasound is high, being less than 90% in males with lesions of lateral menisci and in sequelae of sports injuries.

  18. Early results of all-inside meniscal repairs using a pre-loaded suture anchor.

    Science.gov (United States)

    Fok, August W M; Yau, W P

    2013-04-01

    To report the clinical and radiological results of all-inside meniscal repairs using a pre-loaded suture anchor. Case series. Regional hospital, Hong Kong. From January 2008 to June 2010, 51 patients with a mean age of 26 (range, 15-48) years with 57 meniscal tears underwent meniscal repair utilising the all-inside meniscal repair technique entailing a pre-loaded suture anchor. All tears were located at red-red or red-white zones. Concurrent anterior cruciate ligament reconstruction was performed in 37 (73%) of the patients. Patients were evaluated postoperatively based on the International Knee Documentation Committee score, clinical examination, and magnetic resonance imaging. Presence of locking, joint-line tenderness, effusion, and positive McMurray test were considered to indicate clinical failure. The mean follow-up was 19 (range, 12-39) months. An average of 2 (range, 1 to 4) suture devices was used per patient. The mean tear size was 20 (range, 10-40) mm. In all, 10 (18%) of the tears had failed clinically and 11 (19%) appeared unhealed on postoperative imaging. The mean International Knee Documentation Committee score improved significantly from 62 preoperatively to 81 postoperatively (Psuture anchor is safe and effective, and yielded an 83% clinical and 81% radiological success rate.

  19. AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT "SQUEEZE" TECHNIQUE.

    Science.gov (United States)

    Hudson, Robinetta; Richmond, Amy; Sanchez, Belinda; Stevenson, Valerie; Baker, Russell T; May, James; Nasypany, Alan; Reordan, Don

    2016-08-01

    Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) "Squeeze" technique in physically active participants who presented with clinical symptoms of meniscal tears. The MC "Squeeze" technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population. The Numeric Pain Rating Scale (NRS), the Patient Specific Functional Scale (PSFS), the Disability in the Physically Active (DPA) Scale, and the Knee injury and Osteoarthritis Outcomes Score (KOOS) were administered to assess participant pain level and function. Statistically significant improvements were found on cumulative NRS (p ≤ 0.001), current NRS (p ≤ 0.002), PSFS (p ≤ 0.003), DPA (p ≤ 0.019), and KOOS (p ≤ 0.002) scores across all five participants. All participants exceeded the minimal clinically important difference (MCID) on the first treatment and reported an NRS score and current pain score of one point or less at discharge. The MC "Squeeze" technique produced statistically and clinically significant changes across all outcome measures in all five participants. The use of the MC "Squeeze" technique in this case series indicated positive outcomes in five participants who presented with meniscal tear symptoms. Of importance to the athletic population, each of the participants continued to engage in sport activity as tolerated unless otherwise required during the treatment period. The outcomes reported in this case series exceed those reported when using traditional conservative therapy and the return to play timelines for meniscal tears treated with partial meniscectomies. Level 4.

  20. Incidence and Detection of Meniscal Ramp Lesions on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Reconstruction.

    Science.gov (United States)

    DePhillipo, Nicholas N; Cinque, Mark E; Chahla, Jorge; Geeslin, Andrew G; Engebretsen, Lars; LaPrade, Robert F

    2017-08-01

    Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament (ACL) reconstruction. Detection at the time of arthroscopy can be accomplished based on clinical suspicion and careful evaluation. Preoperative assessment via magnetic resonance imaging (MRI) has been reported to have a low sensitivity in identifying meniscal ramp lesions. To investigate the incidence of meniscal ramp lesions in patients with ACL tears and the sensitivity of preoperative MRI for the detection of ramp lesions. Case series; Level of evidence, 4. All patients who underwent ACL reconstruction by a single surgeon between 2010 and 2016 were included in this study, and patients with medial meniscal ramp lesions found at the time of arthroscopy were identified. The sensitivity of MRI compared with the gold standard of arthroscopic evaluation was determined by review of the preoperative MRI musculoskeletal radiologist report, mimicking the clinical scenario. The incidence was calculated based on arthroscopic findings, and the potential secondary signs of meniscal ramp tears were evaluated on MRI. In a consecutive series of 301 ACL reconstructions, 50 patients (33 male, 17 female) with a mean age of 29.6 years (range, 14-61 years) were diagnosed with a medial meniscal ramp lesion at arthroscopic evaluation (16.6% incidence). The sensitivity of MRI for ramp lesions was 48% based on the preoperative MRI report. A secondary finding of a posteromedial tibial bone bruise was identified on preoperative MRI in 36 of the 50 patients with ramp lesions in a retrospective MRI review by 2 orthopaedic surgeons. Medial meniscal ramp lesions were present in approximately 17% of 301 patients undergoing ACL reconstruction, and less than one-half were diagnosed on the preoperative MRI. A posteromedial tibial bone bruise was found to be a secondary sign of a ramp lesion in 72% of patients. Increased awareness of this potentially combined injury pattern is

  1. The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study.

    Science.gov (United States)

    Stärke, Christian; Kopf, Sebastian; Gröbel, Karl-Heinz; Becker, Roland

    2010-03-01

    The purpose of this biomechanical study was to investigate the potential effect of a nonanatomic repair of the meniscal horn attachment on the resultant circumferential tension in a large animal model and to show that the circumferential tension of the meniscus affects the local stress of the cartilage. All investigations were done in the medial compartment of porcine knees. First, the anterior horn attachment of the meniscus was mechanically separated from the surrounding tibial bone and fitted with a force transducer (n = 8). The femorotibial joint was loaded in compression at different flexion angles, and the resultant tension at the horn attachment was recorded. The measurements were done with the horn attachment at its anatomic position and repeated with the horn attachment being displaced medially or laterally by 3 mm. In the second part the local deformation of the cartilage under a femorotibial compressive load was measured at different levels of meniscal hoop tension (n = 5). A nonanatomic position of the horn attachment had a significant effect on the resultant tension (P horn attachment 3 mm medially decreased the tension at the horn attachment by 49% to 73%, depending on flexion angle and femorotibial load. The opposite placement resulted in a relative increase in the tension by 28% to 68%. Lower levels of meniscal hoop tension caused increased deformation of the cartilage (P horn attachment strongly affects conversion of femorotibial loads into circumferential tension. There is a narrow window for a functionally sufficient repair of meniscal root tears. Although clinical inferences are limited because the specimens used were from a different species, there seems to be only a narrow window for a mechanically sufficient repair of root tears. Copyright 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair.

    Science.gov (United States)

    Choi, Nam-Hong; Kim, Tae-Hyung; Victoroff, Brian N

    2009-11-01

    There are no reports comparing meniscal healing between inside-out and all-inside repairs using sutures. No difference in healing rate exists between meniscal repairs with inside-out and all-inside suture repair in conjunction with anterior cruciate ligament reconstruction with hamstring tendon. Cohort study; Level of evidence, 2. Forty-eight consecutive patients underwent meniscal repairs of longitudinal tears of the posterior horn of the medial meniscus combined with anterior cruciate ligament reconstructions. All-inside repair was attempted when the tears were located in the red-red zone or the ramp area of the meniscus. If a tear that was in the ramp area or red-red zone extended to the midbody of the meniscus, or if there was a tear in red-white zone, the inside-out repair technique was used. Fourteen patients had all-inside meniscal repairs, and 34 patients had inside-out meniscal repairs with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients. Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm scores, and Tegner activity scales. There was a significant difference in

  3. Comparison of Medial and Lateral Meniscus Root Tears.

    Directory of Open Access Journals (Sweden)

    Ji Hyun Koo

    Full Text Available The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs and twenty patients had lateral meniscus root tears (LMRTs. Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8 in the MMRT group and 0.9mm (range, -1.9 to 3.4 in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years and 30 years (range: 14-62 years in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001, and between an ACL tear and LMRT (p<0.0001. A history of trauma was significantly common in LMRT (p<0.0001. LMRT patients were significantly younger than MMRT patients (p<0.0001. Kellgren-Lawrence (K-L grade differed significantly between MMRT and LMRT group (p<0.0001. Meniscal extrusion is

  4. Arthroscopic meniscectomy for degenerative meniscal tears reduces knee pain but is not cost-effective in a routine health care setting: a multi-center longitudinal observational study using data from the osteoarthritis initiative.

    Science.gov (United States)

    Rongen, J J; Govers, T M; Buma, P; Rovers, M M; Hannink, G

    2017-09-10

    It is disputed whether arthroscopic meniscectomy is an (cost-) effective treatment for degenerative meniscus tears in day-to-day clinical practice. The objective of this study was to assess the cost-effectiveness of arthroscopic meniscectomy in subjects with knee osteoarthritis, in routine clinical practice, while taking into account the increased risk for future knee replacement surgery. We compared cost-effectiveness of arthroscopic meniscectomy compared to no surgery. We used a state transition (Markov) simulation model to evaluate the cost-effectiveness of arthroscopic meniscectomy compared to no surgery in subjects with knee osteoarthritis (age range 45-79 years). Data used in the preparation of the current study were obtained from the Osteoarthritis Initiative (AOI) database. We applied a 9 years' time horizon (which is equal to the current OAI study follow up period), and evaluated cost-effectiveness from a societal perspective. The main outcome measure was the incremental cost-effectiveness ratio (Euros per quality adjusted life-year (QALY) gained). Arthroscopic meniscectomy was associated with 8.09 (SD ± 0.07) QALYs at a cost of € 21,345 (SD ± 841), whereas the no surgery was associated with 8.05 (SD ± 0.07) QALYs at a cost of € 16,284 (SD ± 855). For arthroscopic meniscectomy, the incremental cost per QALY gained was € 150,754. In day-to-day clinical practice, arthroscopic meniscectomy in subjects with knee osteoarthritis is associated with € 150,754 per QALY gained, which exceeds the generally accepted willingness to pay (WTP) (range € 20,000-€ 80,000). Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  5. Repairing Posteromedial Meniscocapsular Separation: A Technique Using Inside-Out Meniscal Repair Needles.

    Science.gov (United States)

    Joshi, Anant; Usman, Sajeer; Sabnis, Bhushan; Kini, Abhishek

    2016-02-01

    Posteromedial meniscocapsular separation of the knee has received renewed interest, with many articles describing a high incidence in association with anterior cruciate ligament injury. Various techniques have been described to address these lesions using all-inside meniscal repair sutures or using rotator cuff repair instruments through the posteromedial portal. Most orthopaedic surgeons are accustomed to using the "inside-out" meniscal repair technique with a double-armed suture. This technique is cost-effective and, in our opinion, more efficient in repairing such tears. We present our technique of repairing peripheral meniscocapsular lesions using an inside-out meniscal repair system. We believe that this technique is easily reproducible, is less time-consuming, and ensures a good "bite" of the capsular tissue, producing a robust repair.

  6. MRI can accurately detect meniscal ramp lesions of the knee.

    Science.gov (United States)

    Arner, Justin W; Herbst, Elmar; Burnham, Jeremy M; Soni, Ashish; Naendrup, Jan-Hendrik; Popchak, Adam; Fu, Freddie H; Musahl, Volker

    2017-12-01

    Posterior horn meniscal tears are commonly found in conjunction with anterior cruciate ligament (ACL) injury. Some believe tears in the posterior meniscocapsular zone, coined ramp lesions, are important to knee stability. The purpose of this study was to determine whether pre-operative MRI evaluation was able to accurately and reproducibly identify ramp lesions. Three blinded reviewers assessed MRIs twice for the presence of ramp lesions in patients undergoing ACL reconstruction. Sensitivity, specificity, negative predictive value, and positive predictive value for MRI were calculated based on arthroscopic diagnosis of a ramp lesion. Intra-class correlation coefficient was calculated to assess intra- and interobserver reliability of the MRI assessment between the three examiners. Significance was set at p ramp lesions, while the other 77 had other meniscal pathology. Sensitivity of detecting a ramp lesion on MRI ranged from 53.9 to 84.6%, while specificity was 92.3-98.7%. Negative predictive value was 91.1-97.4%, while positive predictive value was 50.0-90.0%. Inter-rater reliability between three reviewers was moderate at 0.56. The observers had excellent intra-rater reliability ranging from 0.75 to 0.81. This study demonstrates high sensitivity and excellent specificity in detecting meniscal ramp lesions on MRI. Ramp lesions are likely more common and may have greater clinical implications than previously appreciated; the outcomes of untreated lesions must be investigated. Pre-operative identification of ramp lesions may aid clinicians in surgical planning and patient education to improve outcomes by addressing pathology which may have otherwise been missed. III.

  7. Meniscal shear stress for punching

    NARCIS (Netherlands)

    Tuijthof, Gabrielle J. M.; Meulman, Hubert N.; Herder, Just L.; van Dijk, C. Niek

    2009-01-01

    Aim: Experimental determination of the shear stress for punching meniscal tissue. Methods: Meniscectomy (surgical treatment of a lesion of one of the menisci) is the most frequently performed arthroscopic procedure. The performance of a meniscectomy is not optimal with the currently available

  8. AN ALTERNATIVE APPROACH TO THE TREATMENT OF MENISCAL PATHOLOGIES: A CASE SERIES ANALYSIS OF THE MULLIGAN CONCEPT “SQUEEZE” TECHNIQUE

    Science.gov (United States)

    Richmond, Amy; Sanchez, Belinda; Stevenson, Valerie; Baker, Russell T.; May, James; Nasypany, Alan; Reordan, Don

    2016-01-01

    ABSTRACT Background Partial meniscectomy does not consistently produce the desired positive outcomes intended for meniscal tears lesions; therefore, a need exists for research into alternatives for treating symptoms of meniscal tears. The purpose of this case series was to examine the effect of the Mulligan Concept (MC) “Squeeze” technique in physically active participants who presented with clinical symptoms of meniscal tears. Description of Cases The MC “Squeeze” technique was applied in five cases of clinically diagnosed meniscal tears in a physically active population. The Numeric Pain Rating Scale (NRS), the Patient Specific Functional Scale (PSFS), the Disability in the Physically Active (DPA) Scale, and the Knee injury and Osteoarthritis Outcomes Score (KOOS) were administered to assess participant pain level and function. Outcomes Statistically significant improvements were found on cumulative NRS (p ≤ 0.001), current NRS (p ≤ 0.002), PSFS (p ≤ 0.003), DPA (p ≤ 0.019), and KOOS (p ≤ 0.002) scores across all five participants. All participants exceeded the minimal clinically important difference (MCID) on the first treatment and reported an NRS score and current pain score of one point or less at discharge. The MC “Squeeze” technique produced statistically and clinically significant changes across all outcome measures in all five participants. Discussion The use of the MC “Squeeze” technique in this case series indicated positive outcomes in five participants who presented with meniscal tear symptoms. Of importance to the athletic population, each of the participants continued to engage in sport activity as tolerated unless otherwise required during the treatment period. The outcomes reported in this case series exceed those reported when using traditional conservative therapy and the return to play timelines for meniscal tears treated with partial meniscectomies. Levels of Evidence Level 4 PMID:27525181

  9. Effect of unstable meniscal injury on three-dimensional knee kinematics during gait in anterior cruciate ligament-deficient patients.

    Science.gov (United States)

    Harato, Kengo; Niki, Yasuo; Kudo, Yutaka; Sakurai, Aiko; Nagura, Takeo; Hasegawa, Takayuki; Masumoto, Ko; Otani, Toshiro

    2015-10-01

    Our purpose was to clarify the differences of three-dimensional knee kinematics in anterior cruciate ligament (ACL)-deficient patients between with and without meniscal injury using gait analysis. A total of 72 knees in 36 young athletes with primary and unilateral ACL injury, with a mean age of 22 years, participated. Gait analysis was done before surgery. According to the arthroscopic findings, patients were divided into two groups. The patients with an unstable meniscal tear were allocated to the meniscal injury group (ACL+M group), and the patients without a meniscal tear were allocated to the no meniscal injury group (ACL group). In the gait analysis, three-dimensional knee kinematics was evaluated and compared. The patients in both groups exhibited lower sagittal plane knee excursions and peak knee extension angles on the affected limb than on the unaffected limb during the mid-stance. In terms of the axial plane, a rotation angle was significantly smaller in the affected knees than in the unaffected knees in the ACL group. On the other hand, an opposite phenomenon was observed in the ACL+M group. Moreover, a significantly larger rotation angle in the affected knees during the stance phase and the whole gait cycle was observed in the ACL+M group than in the ACL group. Increased rotational motion during the gait was observed in the ACL-deficient knees combined with unstable meniscal injuries. Meniscal condition may be a key factor for compensatory gait mechanics to prevent rotatory instability in ACL-deficient patients patients. III. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Tissue adhesives for meniscus tear repair: an overview of current advances and prospects for future clinical solutions

    NARCIS (Netherlands)

    Bochynska, Agnieszka; Hannink, G.; Grijpma, Dirk W.; Buma, P.

    2016-01-01

    Menisci are crucial structures in the knee joint as they play important functions in load transfer, maintaining joint stability and in homeostasis of articular cartilage. Unfortunately, ones of the most frequently occurring knee injuries are meniscal tears. Particularly tears in the avascular zone

  11. Dynamically tensioned ACL functional knee braces reduce ACL and meniscal strain.

    Science.gov (United States)

    Tomescu, Sebastian; Bakker, Ryan; Wasserstein, David; Kalra, Mayank; Nicholls, Micah; Whyne, Cari; Chandrashekar, Naveen

    2017-11-29

    The effectiveness of ACL functional knee braces to reduce meniscal and ACL strain after ACL injury or reconstruction is not well understood. A new dynamic knee tensioning brace system has been designed to apply an active stabilizing force to the knee. The ability of this system to reduce tissue strains is unknown. The purpose of this study was to test the ability of the dynamically tensioned brace to reduce strain in both the ACL and meniscus during rehabilitation activities. A combined in vivo/in silico/in vitro method was used to study three activities: gait, double leg squat, and single leg squat. Muscle forces and kinematics for each activity were derived through in vivo motion capture and applied to seven cadaveric knee specimens fitted with custom braces. Medial meniscal strain and ACL strain were measured in ACL intact, deficient and reconstructed conditions. The brace lowered peak and average meniscal strain in ACL deficient knees (P < 0.05) by an average of 1.7%. The brace was also found to lower meniscal strain in reconstructed knees (1.1%) and lower ACL strain in ACL intact (1.3%) and reconstructed knees (1.4%) (P < 0.05). This study supports the use of a brace equipped with a dynamic tensioning system to lower meniscal strain in ACL-deficient knees. Its use may help decrease the risk of subsequent meniscal tears in chronic ACL deficiency or delayed reconstruction. In ACL-intact and reconstructed knees, the brace may be beneficial in injury prophylaxis or in protecting the ACL graft following reconstruction. These results will aid clinicians make informed recommendations for functional brace use in patients with unstable knees. II.

  12. The relationship between meniscal pathology and osteoarthritis depends on the type of meniscal damage visible on magnetic resonance images: data from the Osteoarthritis Initiative.

    Science.gov (United States)

    Antony, B; Driban, J B; Price, L L; Lo, G H; Ward, R J; Nevitt, M; Lynch, J; Eaton, C B; Ding, C; McAlindon, T E

    2017-01-01

    To determine the association of different types of meniscal pathology with knee pain, bone marrow lesion (BML) volume, and end-stage knee osteoarthritis (esKOA). Participants were selected from an ancillary project to the Osteoarthritis Initiative (OAI) who had at least one knee with symptomatic osteoarthritis. Baseline magnetic resonance images (MRI) were evaluated for meniscal pathology using a modified International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) classification system. We collapsed 10 types of meniscal pathology into five categories: normal, intrameniscal signal, morphological deformity/extrusion (altered meniscal shape and/or extrusion but no apparent substance loss), tear, and maceration. Outcomes included Western Ontario and McMaster Universities osteoarthritis index (WOMAC) knee pain and BML volume at baseline and after 2 years. We defined the prevalence of esKOA based on a validated algorithm. We performed logistic regression and adjusted for age, sex, and body mass index (BMI). The 463 participants (53% male) included in the analysis had mean age 63 (9.2) years, BMI 29.6 (4.6) kg/m2, and 71% had Kellgren-Lawrence grade ≥2. Morphological deformity/extrusion and maceration, but no other types of meniscal pathology, were associated with BML volume (morphological deformity/extrusion odds ratio [OR] = 2.47, 95% CI: 1.49, 4.09, maceration OR = 5.85, 95% CI: 3.40, 10.06) and change in BML volume (morphological deformity/extrusion OR = 2.17, 95% CI: 1.37, 3.45, maceration OR = 3.12, 95% CI: 1.87, 5.19). Only maceration was associated with baseline WOMAC knee pain (OR = 2.82, 95% CI: 1.79, 4.43) and prevalence of esKOA (OR = 7.53, 95% CI: 4.25, 13.31). Based on MRI, morphologic deformity/extrusion and maceration rather than intrameniscal signal or tear were associated with osteoarthritis severity and progression, which highlights the importance of differentiating distinct types of meniscal pathology

  13. Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery

    DEFF Research Database (Denmark)

    Christensen, Simon Tornbjerg; Nissen, Nis; Englund, Martin

    2017-01-01

    BACKGROUND: The relationship between meniscal tears and other joint pathologies with patient-reported symptoms is not clear. We investigated associations between structural knee pathologies identified at surgery with preoperative knee pain and function in patients undergoing arthroscopic meniscal...... surgery. METHODS: This study included 443 patients from the Knee Arthroscopy Cohort Southern Denmark (KACS), a prospective cohort following patients 18 years or older undergoing arthroscopic meniscal surgery at 4 hospitals between 1 February 2013 and 31 January 2014. Patient-reported outcomes, including...... the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification...

  14. Potential use of mesenchymal stem cells in human meniscal repair: current insights

    Directory of Open Access Journals (Sweden)

    Pak J

    2017-03-01

    Full Text Available Jaewoo Pak,1–3* Jung Hun Lee,1,4* Kwang Seung Park,4 Jeong Ho Jeon,4 Sang Hee Lee4 1Stems Medical Clinic, Gangnamgu, Seoul, Republic of Korea; 2TEDA‑Puhua International Hospital, Tianjin, People’s Republic of China; 3Life Science Institute, Komplek Permata Senayan, Jalan Tentara Pelajar, Jakarta Selatan, Indonesia; 4National Leading Research Laboratory, Department of Biological Sciences, Myongji University, Yongin, Gyeonggido, Republic of Korea *These authors contributed equally to this work Abstract: The menisci of the human knee play an important role in maintaining normal functions to provide stability and nutrition to the articular cartilage, and to absorb shock. Once injured, these important structures have very limited natural healing potential. Unfortunately, the traditional arthroscopic meniscectomy performed on these damaged menisci may predispose the joint toward early development of osteoarthritis. Although a very limited number of studies are available, mesenchymal stem cells (MSCs have been investigated as an alternative therapeutic modality to repair human knee meniscal tears. This review summarizes the results of published applications of MSCs in human patients, which showed that the patients who received MSCs (autologous adipose tissue-derived stem cells or culture-expanded bone marrow-derived stem cells presented symptomatic improvements, along with magnetic resonance imaging evidences of the meniscal repair. Keywords: adipose tissue-derived stem cells, bone marrow-derived stem cells, human knee, meniscal tear, articular cartilage, therapeutic modality

  15. Repair of Avascular Meniscus Tears with Electrospun Collagen Scaffolds Seeded with Human Cells

    Science.gov (United States)

    Baek, Jihye; Sovani, Sujata; Glembotski, Nicholas E.; Du, Jiang; Jin, Sungho; Grogan, Shawn P.

    2016-01-01

    The self-healing capacity of an injured meniscus is limited to the vascularized regions and is especially challenging in the inner avascular regions. As such, we investigated the use of human meniscus cell-seeded electrospun (ES) collagen type I scaffolds to produce meniscal tissue and explored whether these cell-seeded scaffolds can be implanted to repair defects created in meniscal avascular tissue explants. Human meniscal cells (derived from vascular and avascular meniscal tissue) were seeded on ES scaffolds and cultured. Constructs were evaluated for cell viability, gene expression, and mechanical properties. To determine potential for repair of meniscal defects, human meniscus avascular cells were seeded and cultured on aligned ES collagen scaffolds for 4 weeks before implantation. Surgical defects resembling “longitudinal tears” were created in the avascular zone of bovine meniscus and implanted with cell-seeded collagen scaffolds and cultured for 3 weeks. Tissue regeneration and integration were evaluated by histology, immunohistochemistry, mechanical testing, and magentic resonance imaging. Ex vivo implantation with cell-seeded collagen scaffolds resulted in neotissue that was significantly better integrated with the native tissue than acellular collagen scaffolds or untreated defects. Human meniscal cell-seeded ES collagen scaffolds may therefore be useful in facilitating meniscal repair of avascular meniscus tears. PMID:26842062

  16. Three Tesla MRI for the diagnosis of meniscal and anterior cruciate ligament pathology: a comparison to arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Sampson, M.J. [Department of Radiology Sports Surgery Clinic, Santry Demesne, Dublin (Ireland)], E-mail: allymattsampson@hotmail.com; Jackson, M.P.; Moran, C.J.; Moran, R. [Department of Orthopaedics, Sports Surgery Clinic, Santry Demesne, Dublin (Ireland); Eustace, S.J. [Department of Radiology Sports Surgery Clinic, Santry Demesne, Dublin (Ireland); Shine, S. [Department of Radiology, Cappagh Hospital, Finglas, Dublin (Ireland)

    2008-10-15

    Aim: To assess the accuracy of 3 T magnetic resonance imaging (MRI) in the evaluation of meniscal and anterior cruciate ligament (ACL) injury. Materials and methods: Sixty-one consecutive patients were identified who were referred for evaluation of suspected intra-articular pathology with a 3 T MRI and who, subsequently, underwent an arthroscopic procedure of the knee were included for the study. Two musculoskeletal radiologists interpreted the images. The sensitivity, specificity, positive predictive value, and negative predictive value were then calculated for the MRI versus the arthroscopic findings as a reference standard. Results: The sensitivity and specificity for the overall detection of meniscal tears in this study was 84 and 93%, respectively. The results for the medial meniscus separately were 91 and 93% and for the lateral 77 and 93%. The evaluation of ACL integrity was 100% sensitive and specific. The meniscal tear type was correctly identified in 75% of cases and its location in 94%. Conclusion: This study demonstrates good results of 3 T MRI in the evaluation of the injured knee. Caution should still be given to the interpretation on MRI of a lateral meniscus tear, and it is suggested that the standard diagnostic criteria of high signal reaching the articular surface on two consecutive image sections be adhered to even at these higher field strengths.

  17. A Computer-Aided Type-II Fuzzy Image Processing for Diagnosis of Meniscus Tear.

    Science.gov (United States)

    Zarandi, M H Fazel; Khadangi, A; Karimi, F; Turksen, I B

    2016-12-01

    Meniscal tear is one of the prevalent knee disorders among young athletes and the aging population, and requires correct diagnosis and surgical intervention, if necessary. Not only the errors followed by human intervention but also the obstacles of manual meniscal tear detection highlight the need for automatic detection techniques. This paper presents a type-2 fuzzy expert system for meniscal tear diagnosis using PD magnetic resonance images (MRI). The scheme of the proposed type-2 fuzzy image processing model is composed of three distinct modules: Pre-processing, Segmentation, and Classification. λ-nhancement algorithm is used to perform the pre-processing step. For the segmentation step, first, Interval Type-2 Fuzzy C-Means (IT2FCM) is applied to the images, outputs of which are then employed by Interval Type-2 Possibilistic C-Means (IT2PCM) to perform post-processes. Second stage concludes with re-estimation of "η" value to enhance IT2PCM. Finally, a Perceptron neural network with two hidden layers is used for Classification stage. The results of the proposed type-2 expert system have been compared with a well-known segmentation algorithm, approving the superiority of the proposed system in meniscal tear recognition.

  18. MR imaging of the combined anterior and posterior cruciate ligament tears: focussing on the ratterns of injuries and associated findings

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Seon Young; Choi, Chang Lak; Park, Dal Soo; Park, Eun Hee; Lee, Sang Ho; Song, Mun Kab; Lee, Kwang Won [Eulji Medical College, Taejon (Korea, Republic of); Kwon, Soon Tae [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1997-09-01

    To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL)tears;to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. Ten patients with compbined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eitht complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament jnjuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. Associated findings in patients with combined ACL and PCL tears are more frequent than in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined.

  19. Arthroscopic all-inside meniscal repair - Does the meniscus heal? A clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Hoffelner, Thomas; Resch, Herbert; Mayer, Michael; Tauber, Mark [Department of Traumatology and Sports Injuries, Salzburg (Austria); Forstner, Rosemarie [University Hospital of Salzburg, Department of Radiology, Salzburg (Austria); Minnich, Bernd [University of Salzburg, Department of Organismic Biology, Salzburg (Austria)

    2011-02-15

    The purpose of this study was to correlate clinical and radiological results using a 3-T MRI to verify meniscal healing after arthroscopic all-inside meniscus repair. We selected 27 patients (14 men and 13 women) with an average age of 31 {+-} 9 years and retrospective clinical examinations and radiological assessments using a 3-T MRI after all-inside arthroscopic meniscal repair were conducted. Repair of the medial meniscus was performed in 19 patients and of the lateral meniscus in eight. In 17 patients (63%), we performed concomitant anterior cruciate ligament reconstruction. The mean follow-up period was 4.5 {+-} 1.7 years. The Lysholm score and Tegner activity index were used for clinical evaluation. Four grades were used to classify the radiological signal alterations within the meniscus: central globular (grade 1); linear horizontal or band-like (grade 2); intrameniscal alterations and linear signal alterations communicating with the articular surface (grade 3); and complex tears (grade 4). At follow-up, the average Lysholm score was 76 {+-} 15 points, with ten of the patients placed in group 6 based on the Tegner activity index. MRI examinations revealed no signal alteration in three patients, grade 1 in 0, grade 2 in five, grade 3 in 13, and grade 4 in six. The MRI findings correlated positively with the clinical scores in 21 patients (78%). Correlation of clinical and radiological examination was performed using 3-T MRI. In spite of satisfactory clinical outcomes at follow-up, a radiological signal alteration may still be visible on MRI, which was believed to be scar tissue, but could not be proven definitively. Imaging with a 3-Tesla MRI after meniscal suture surgery provides good but no definitive reliability on meniscus healing and therefore gives no advantage compared to 1.5-T MRI, with good clinical outcome using an all-inside arthroscopic meniscal repair. 3T-MRI can not substitute diagnostic arthroscopy in patients with persistent complaints after

  20. MR imaging of anterior cruciate ligament tears: is there a gender gap?

    Energy Technology Data Exchange (ETDEWEB)

    Fayad, Laura M. [Morgan Department of Radiology and Radiological Science, John Hopkins Medical Institutions, Baltimore, MD (United States); Parellada, J.Antoni; Parker, Laurence; Schweitzer, Mark E. [Department of Radiology, Thomas Jefferson University Hospital, Gibbon Building Suite 3390, 111 South 11th St., 19107-5098, Philadelphia, PA (United States)

    2003-11-01

    Clinically, females receive anterior cruciate ligament (ACL) tears more commonly than males. We explored whether gender differences exist in MR imaging patterns of ACL tears. At 1.5T, two observers evaluated MR examinations of 84 consecutive age-matched patients (42 males, 42 females, aged 16-39) with ACL tears, for mechanism of injury, extent and type of tear, the presence of secondary signs and associated osseous, meniscal and ligamentous injuries. The most common mechanism of injury for both females and males was the pivot shift mechanism (67 and 60%, respectively). Females were more commonly imaged in the acute stage of tear than males (98 and 67%, respectively, p=0.001) and more commonly possessed the typical posterolateral tibial bone contusion pattern (88 and 62%, respectively, p=0.0131). Males exhibited a deeper femoral notch sign (2.7 and 2.0 mm, p=0.007) and medial meniscal, lateral collateral ligament and posterior cruciate ligament injuries more commonly than females (48 and 24%, p=0.009, 30 and 7%, p=0.035, 17 and 0%, p=0.035). There was no significant difference between genders for the presence of other secondary signs and contusion patterns, associated lateral meniscal tears, presence of O'Donoghue's triad or associated medial collateral ligament injuries. Gender differences in MR imaging patterns of ACL tears exist: females are more commonly imaged in the acute stage and more commonly possess posterolateral tibial bone contusions; males have a more severe presentation than females, associated with more severe lateral femoral condyle and soft tissue injuries. (orig.)

  1. MRI diagnosis of ACL bundle tears: value of oblique axial imaging

    Energy Technology Data Exchange (ETDEWEB)

    Ng, Alex W.H.; Griffith, James F.; Hung, Esther H.Y. [Chinese University of Hong Kong, Department of Imaging and Interventional Radiology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China); Law, Kan Yip; Yung, Patrick S.H. [Chinese University of Hong Kong, Department of Orthopedics and Traumatology, Prince of Wales Hospital, Shatin, NT, Hong Kong SAR (China)

    2013-02-15

    To investigate the diagnostic accuracy of oblique axial intermediate weighting MR imaging in detecting partial thickness anterior cruciate ligament (ACL) bundle tears. The study protocol was approved by the institutional ethics committee. Sixty-one subjects (43 male, 18 female; mean age 27.4 years; range 9 to 57 years) with clinically suspected ACL tear or meniscal tear between September 2009 and January 2011 were studied with MRI and arthroscopy. Detection of partial tear for the ACL as a whole and for each ACL bundle by protocol A (standard orthogonal sequences) and protocol B (standard orthogonal sequences plus oblique axial intermediate weighted imaging) was compared in a blinded fashion. Performance characteristics for protocol A and protocol B were compared using sensitivity, specificity, accuracy and ROC curves. A two-tailed p value of <0.05 indicated statistical significance. Fifteen (24.6%) normal, 15 (24.6%) partial and 31 complete tears were diagnosed by arthroscopy. Sensitivity, specificity and accuracy of protocol A for the diagnosis of partial tear of the ACL was 33%, 87% and 74%, while for protocol B the values were 87%, 87% and 87% respectively. The area under the curve (AUC) for the diagnosis of partial ACL tear and individual bundle tear was higher for protocol B, although this difference did not reach statistical significance (p > 0.05). The addition of oblique axial imaging to standard MR imaging improves diagnostic accuracy for detecting partial tears of the ACL as well as individual bundle tears of the ACL. (orig.)

  2. Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.

    Science.gov (United States)

    Hein, Christopher N; Deperio, Jennifer Gurske; Ehrensberger, Mark T; Marzo, John M

    2011-06-01

    Medial meniscal posterior root avulsion (MMRA) leads to deleterious alteration of medial joint compartment loading profiles and increased risk of medial degenerative changes. Surgical repair restores more normal biomechanics to the knee. Our hypothesis is that MMRA will cause medial meniscal (MM) extrusion and gap formation between the root attachment site and MM. Meniscal root repair will restore the ability of the meniscus to resist extrusion, and reduce gap formation at the defect. Seven fresh frozen human cadaveric knees were dissected and mechanically loaded using a servo-hydraulic load frame (MTS ®) with 0 and 1800 N. The knees were tested under three conditions: native, avulsed, and repaired. Four measurements were obtained: meniscal displacement anteriorly, medially, posteriorly, and gap distance between the root attachment site and MM after transection and repair. The medial displacement of the avulsed MM (3.28 mm) was significantly greater (p < 0.001) than the native knee (1.60mm) and repaired knee (1.46 mm). Gap formation is significantly larger in the avulsed compared to repaired state at 0 (p < 0.02) and 1800N (p < 0.02) and also larger with loading in both avulsed (p < 0.05) and repaired (p < 0.02) conditions. Therefore, MMRA results in MM extrusion from the joint and gap formation between the MM root and the MM. Subsequent surgical repair reduces meniscal displacement and gap formation at the defect. Copyright © 2010 Elsevier B.V. All rights reserved.

  3. MR imaging of the knee following cruciate ligament reconstruction and meniscal surgery; MRT des Kniegelenks nach Kreuzband- und Meniskusoperationen

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, K. [Technische Univ. Muenchen, Klinikum rechts der Isar (Germany). Inst. fuer Roentgendiagnostik

    2009-03-15

    Due to the increasing number of surgical procedures performed on the knee, MR imaging of the postoperative knee has gained more and more importance. For the evaluation of anterior cruciate ligament grafts and postoperative menisci, basic knowledge of surgical techniques is essential in order to differentiate normal postoperative findings from transplant failure, retears, and complications. This article reviews technical aspects of MR imaging following knee surgery, basic principles of operative techniques for anterior cruciate ligament reconstruction and therapy of meniscal tears, normal postoperative findings, MR imaging criteria for recurrent lesions, and findings with typical complications. (orig.)

  4. Repair of Meniscal Ramp Lesions Through a Posteromedial Portal During Anterior Cruciate Ligament Reconstruction: Outcome Study With a Minimum 2-Year Follow-up.

    Science.gov (United States)

    Thaunat, Mathieu; Jan, Nicolas; Fayard, Jean Marie; Kajetanek, Charles; Murphy, Colin G; Pupim, Barbara; Gardon, Roland; Sonnery-Cottet, Bertrand

    2016-11-01

    To evaluate the results of arthroscopic all-inside suture repair of medial meniscal ramp lesions through a posteromedial portal during anterior cruciate ligament (ACL) reconstruction. All patients who underwent a suture of the posterior segment of the medial meniscus using a suture hook device through a posteromedial portal during ACL reconstruction with minimum 2 year-follow-up were included in the study. Repair was performed for longitudinal tears within the rim of less than 3 mm (capsulomeniscal junction or red-red zone) or 3 to 5 mm (red-white zone) of an unstable torn meniscus. Patients were assessed pre- and postoperatively with IKDC score and Tegner activity scale. Instrumented knee testing was performed with the Rolimeter arthrometer. Complications including reoperation for failed meniscal repair were also recorded. One hundred thirty-two patients met the inclusion criteria. The mean follow-up time was 27 months (range, 24 to 29 months). The average subjective IKDC rose from 63.8 ± 13.5 (range, 27 to 92) preoperatively to 85.7 ± 12 (range, 43 to 100) at last follow-up (P tears were related to a newly formed tear located anterior to the initial tear. Our results show that arthroscopic meniscal repair of ramp lesions during ACL reconstruction through a posteromedial portal provided a high rate of meniscus healing at the level of the tear and appeared to be safe and effective in this group of patients. Level IV, therapeutic study, case series (no control group). Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  5. Evolution of Intrameniscal Signal-Intensity Alterations Detected on MRI Over 24 Months in Patients With Traumatic Anterior Cruciate Ligament Tear.

    Science.gov (United States)

    Guimaraes, Julio Brandao; Facchetti, Luca; Schwaiger, Benedikt J; Gersing, Alexandra S; Majumdar, Sharmila; Ma, Benjamin C; Li, Xiaojuan; Link, Thomas M

    2017-02-01

    The objective of our study was to assess the prevalence and evolution of intrameniscal signal-intensity alteration in subjects with an anterior cruciate ligament (ACL) tear over 24 months and compare clinical outcome and changes of cartilage between subjects with and those without this meniscal abnormality. Fifty-seven subjects with an ACL tear were screened for intrameniscal signal-intensity alteration. Morphologic and compositional MRI was performed before ACL reconstruction and 12 and 24 months after ACL reconstruction. Twelve subjects with an intrameniscal signal-intensity alteration and 12 subjects without any meniscal abnormality on MRI were identified. Clinical outcome was measured using the Knee Injury and Osteoarthritis Outcome Score (KOOS), and T1ρ and T2 maps of the cartilage were obtained. In 10 of 12 subjects (83%) the meniscal signal-intensity abnormality identified on baseline MRI was located at the posterior horn of the medial meniscus. None of these subjects presented with a meniscal tear over 24 months of follow-up. At 12 months after the ACL tear, the intrameniscal signal-intensity alteration detected on baseline MRI had completely resolved in seven of 12 subjects (58%), showed a signal-intensity decrease in four (33%), and remained stable in one subject (8%). Of the 10 subjects who underwent MRI at 24 months, the meniscal signal-intensity alteration had completely resolved in eight (80%), and the signal intensity had decreased in the other two subjects. Changes in the KOOS and cartilage T1ρ and T2 values from baseline and 24 months did not differ significantly between subjects with and those without intrameniscal signal-intensity alteration (p > 0.05). High intrameniscal signal-intensity alterations are a common finding in subjects with an ACL tear and have a benign course over 24 months after surgical repair of the ACL tear.

  6. Lesão meniscal por fadiga Meniscal injury due to fatigue

    Directory of Open Access Journals (Sweden)

    Gilberto Luis Camanho

    2009-01-01

    Full Text Available OBJETIVO: O intuito do presente estudo é de analisar um grupo de pacientes portadores de lesão meniscal decorrente da falência estrutural sem relação com trauma ou problemas degenerativos, optando por chamá-la de lesão meniscal por fadiga. MATERIAL E MÉTODO: Foram avaliados 140 pacientes com lesão meniscal sem causa aparente e, portanto, considerados portadores da lesão meniscal por fadiga. Dentre eles, 85 pacientes eram do sexo masculino e 55 do sexo feminino. O menisco medial foi o mais acometido (92% dos casos. RESULTADOS: Todas as lesões foram diagnosticadas através de exame clínico e ressonância magnética. Os pacientes foram submetidos a meniscectomia por via artroscópica e os resultados foram divididos em dois tipos: bons e maus. Foram encontrados 27% de maus resultados dos quais nove pacientes evoluíram para osteonecrose idiopática. CONCLUSÃO: Concluímos que as lesões por fadiga devem ser analisadas como lesões provocadas por falência, portanto uma patologia sindrômica que pode evoluir para uma osteonecrose idiopática..OBJECTIVE: The purpose of the present study was to review a group of patients with meniscal injuries resulting from structural failure unrelated to trauma or degenerative problems to which was given the name "meniscal injury due to fatigue". MATERIAL AND METHOD: Evaluations were made on 140 patients with meniscal injuries without any apparent cause, who were therefore considered to have meniscal injuries due to fatigue. Among these, 85 patients were male and 55 were female. The medial meniscus was the most affected site (92% of the cases. RESULTS: All these injuries were diagnosed by means of clinical examination and magnetic resonance imaging. The patients underwent meniscectomy by means of arthroscopy and the results were divided into two types: good and poor. Poor results were found in 27% of the cases, among which nine patients progressed to idiopathic osteonecrosis. CONCLUSION: We conclude that

  7. Meniscal allograft transplantation: a meta-analysis

    Directory of Open Access Journals (Sweden)

    De Bruycker Manolito

    2017-01-01

    Full Text Available Purpose: This meta-analysis evaluates the mid- to long-term survival outcome of MAT (meniscal allograft transplantation. Potential prognosticators, with particular focus on chondral status and age of the patient at the time of transplantation, were also analysed. Study design: Meta-analysis. Methods: An online database search was performed using following search string: “meniscal allograft transplantation” and “outcome”. A total of 65 articles were analysed for a total of 3157 performed MAT with a mean follow-up of 5.4 years. Subjective and clinical data was analysed. Results: The subjective and objective results of 2977 patients (3157 allografts were analysed; 70% were male, 30% were female. Thirty-eight percent received an isolated MAT. All other patients underwent at least one concomitant procedure. Lysholm, Knee injury and Osteoarthritis Outcome (KOOS, International Knee Documentation Committee (IKDC and Visual Analogue Scale (VAS scores were analysed. All scores showed a good patient satisfaction at long-term follow-up. The mean overall survival rate was 80.9%. Complication rates were comparable to standard meniscal repair surgery. There was a degenerative evolution in osteoarthritis with at least one grade in 1760 radiographically analysed patients. Concomitant procedures seem to have no effect on the outcome. Age at transplantation is a negative prognosticator. The body mass index (BMI of the patient shows a slightly negative correlation with the outcome of MAT. Conclusions: MAT is a viable solution for the younger patient with chronic pain in the meniscectomised knee joint. The complications are not severe and comparable to meniscal repair. The overall failure rate at final follow-up is acceptable and the allograft heals well in most cases, but MAT cannot be seen as a definitive solution for post-meniscectomy pain. The correct approach to the chronic painful total meniscectomised knee joint thus requires consideration of all

  8. Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees.

    Science.gov (United States)

    Seitz, Andreas Martin; Lubomierski, Anja; Friemert, Benedikt; Ignatius, Anita; Dürselen, Lutz

    2012-06-01

    We examined the influence of partial meniscectomy of 10 mm width on 10 human cadaveric knee joints, as it is performed during the treatment of radial tears in the posterior horn of the medial meniscus, on maximum contact pressure, contact area (CA), and meniscal hoop strain in the lateral and medial knee compartments. In case of 0° and 30° flexion angle, 20% and 50% partial meniscectomy did not influence maximum contact pressure and area. Only in case of 60° knee flexion, 50% partial resection increased medial maximum contact pressure and decreased the medial CA statistically significant. However, 100% partial resection increased maximum contact pressure and decreased CA significantly in the meniscectomized medial knee compartment in all tested knee positions. No significant differences were noted for meniscal hoop strain. From a biomechanical point of view, our in vitro study suggests that the medial joint compartment is not in danger of accelerated cartilage degeneration up to a resection limit of 20% meniscal depth and 10 mm width. Contact mechanics are likely to be more sensitive to partial meniscectomy at higher flexion angles, which has to be further investigated. Copyright © 2011 Orthopaedic Research Society.

  9. Fibrochondrogenic potential of synoviocytes from osteoarthritic and normal joints cultured as tensioned bioscaffolds for meniscal tissue engineering in dogs

    Directory of Open Access Journals (Sweden)

    Jennifer J. Warnock

    2014-09-01

    Full Text Available Meniscal tears are a common cause of stifle lameness in dogs. Use of autologous synoviocytes from the affected stifle is an attractive cell source for tissue engineering replacement fibrocartilage. However, the diseased state of these cells may impede in vitro fibrocartilage formation. Synoviocytes from 12 osteoarthritic (“oaTSB” and 6 normal joints (“nTSB” were cultured as tensioned bioscaffolds and compared for their ability to synthesize fibrocartilage sheets. Gene expression of collagens type I and II were higher and expression of interleukin-6 was lower in oaTSB versus nTSB. Compared with nTSB, oaTSB had more glycosaminoglycan and alpha smooth muscle staining and less collagen I and II staining on histologic analysis, whereas collagen and glycosaminoglycan quantities were similar. In conclusion, osteoarthritic joint—origin synoviocytes can produce extracellular matrix components of meniscal fibrocartilage at similar levels to normal joint—origin synoviocytes, which makes them a potential cell source for canine meniscal tissue engineering.

  10. Clinical Results of Arthroscopic Repair of Isolated Longitudinal Tear of Medial Meniscus by Vertical Cruciate Double Mattress Sutures with Outside-in Technique

    Directory of Open Access Journals (Sweden)

    Seyied Hamid Barzgar

    2013-09-01

    Full Text Available Introduction : Meniscal tears are one of the most common injuries treated by arthroscopic techniques. Arthroscopic meniscal repair is an accepted way of treatment for meniscal tears. Different arthroscopic techniques for meniscal repair are: inside-out, outside-in and all inside. In the first 2 techniques, meniscus is repaired by sutures and in the later by suture or by commercial ready implants . The goal of current study is assessing clinical results of arthroscopic repair of longitudinal meniscal tears with vertical cruciate double mattress sutures by outside-in technique after 9 months.   Methods: In this case series study, in 13 patients having criteria for engaging the study with longitudinal isolated meniscus tear, arthroscopic meniscal repair was done with vertical cruciate double mattress sutures by outside-in technique and patients were followed for 9 months.   Results: Of 13 patients, there were 12 males (92.3% and one female (7.7% aged 15-38 (average 28.3 years. In follow up period, there was one case (7.7% of irritation by subcutaneous knot. There was not any failure of repair. Average Lysholm score increased from 55.23 to 91.23 after 9 months of follow up, which was statistically significant (p<0.001. At the end of follow up period, there was not any medial joint line tenderness of knee, giving way or significant effusion or pain.   Conclusion: This study shows that this technique has a good short term outcome with no failure and low complications but it is necessary to do more long term studies to prove it.

  11. Cell-based meniscal tissue engineering: a case for synoviocytes.

    Science.gov (United States)

    Fox, Derek B; Warnock, Jennifer J

    2011-10-01

    Avascular meniscal injuries are largely incapable of healing; the most common treatment remains partial meniscectomy despite the risk of subsequent osteoarthritis. Meniscal responses to injury are partially mediated through synovial activity and strategies have been investigated to encourage healing through stimulating or transplanting adjacent synovial lining. However, with their potential for chondrogenesis, synovial fibroblast-like stem cells hold promise for meniscal cartilage tissue engineering. Thus, specific purposes of this review were to (1) examine how the synovial intima and synoviomeniscal junction affect current meniscal treatment modalities; and (2) examine the components of tissue engineering (cells, scaffolds, bioactive agents, and bioreactors) in the specific context of how cells of synovial origin may be used for meniscal healing or regeneration. An online bibliographic search through PubMed was performed in March 2010. Studies were subjectively evaluated and reviewed if they addressed the question posed. Fifty-four resources were initially retrieved, which offered information on the chondrogenic potential of synovial-based cells that could prove valuable for meniscal fibrocartilage engineering. Based on the positive effects of adjoining synovium on meniscal healing as used in some current treatment modalities, the chondrogenic potential of fibroblast-like stem cells of synovial origin make this cell source a promising candidate for cell-based tissue engineering strategies. The abundance of autologous synovial lining, its ability to regenerate, and the potential of synovial-derived stem cells to produce a wide spectrum of chondral matrix components make it an ideal candidate for future meniscal engineering investigations.

  12. Arthroscopic characteristics of meniscal injuries in osteoarthritic knees.

    Science.gov (United States)

    Li, Jinglong; Lu, Liangyu; Zhu, Wenhui; Shi, Dongliang; Zhan, Ke; Wang, Yubin

    2014-01-01

    The aim of this study was to investigate the arthroscopic characteristics of meniscal injuries in osteoarthritic knees and explore their significance in the selection of surgical approach. Four original types of meniscal injuries were defined. The study included 87 cases; 12 Type 1, 26 Type 2, 35 Type 3 and 14 in Type 4 meniscal injuries. For Type 1 injuries, 5 cases underwent meniscal suture repair and 7 cases partial meniscal resection. Partial meniscal resection was performed in 22 cases and subtotal resection in 4 cases of Type 2 injury. For Type 3 injury, meniscal debridement was performed in 2, partial resection in 8, subtotal resection in 19 and total resection in 6 cases. For Type 4 injury, 3 cases underwent subtotal resection and 11 underwent total resection. Patients were evaluated with the Lysholm, visual analog scale, and Kellgren-Lawrence scale scores and cartilage lesions stages. Mean follow-up period was 26 (range: 8 to 51) months. Joint swelling or pain was present in 13 cases after fatigue. Twist lock symptom was observed in one Type 3 injury and one Type 4 injury. Joint flexion was limited to 20° in one Type 3 injury and two Type 4 injuries. Total knee joint replacement was performed in two Type 2 and two Type 4 injuries 2 to 3 years and 2 months after surgery. The classification of meniscal injuries in osteoarthritic knees was designed to guide arthroscopic surgery and improve the therapeutic efficacy of minimally invasive surgery for knee osteoarthritis.

  13. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers

    DEFF Research Database (Denmark)

    Mikkelsen, Sigurd; Brauer, Charlotte; Pedersen, Ellen Bøtker

    2016-01-01

    hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84) after five years as a baggage handler...

  14. All-Inside Versus Inside-Out Meniscal Repair With Concurrent Anterior Cruciate Ligament Reconstruction: A Meta-regression Analysis .

    Science.gov (United States)

    Westermann, Robert W; Duchman, Kyle R; Amendola, Annunziato; Glass, Natalie; Wolf, Brian R

    2017-03-01

    Meniscal tears are frequently repaired during anterior cruciate ligament reconstruction (ACLR). To systematically evaluate differences in clinical failures between all-inside and inside-out meniscal repairs performed during ACLR. Meta-analysis; Level of evidence, 4. A systematic review was perfomed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases queried included MEDLINE, CINAHL, EMBASE, and Cochrane Central Register of Controlled Trials. All English-language studies reporting failure rates after meniscal repair with either the all-inside or inside-out technique performed in conjunction with ACLR were identified between 1980 and 2015. Studies with a minimum 2-year follow-up were included. Reported outcomes, clinical meniscal repair failures, and complications were assessed. Studies were weighted according to the size of the clinical series and mean follow-up length. Inverse-variance-weighted mixed models were used to evaluate whether there was a significant difference in pooled reoperation rates between repair techniques. In total, 21 studies met inclusion criteria. Of these, 13 studies reported outcomes after all-inside repair, and 10 studies reported outcomes after inside-out repair (2 studies reported both). A total of 1126 patients were included in the analysis. The mean (±SD) follow-up for all-inside repair was 58.64 ± 22.24 months versus 76.25 ± 31.69 months for inside-out repair ( P = .13). The clinical failure rate for all-inside meniscal repair performed concurrently with ACLR was 16% (121/744) compared with 10% (39/382) for inside-out repair, and this was found to be significant ( P = .016). Implant irritation and device migration were the most common complications reported for all-inside repair; complication rates did not differ between the groups. There may be fewer early clinical failures when the inside-out technique is utilized for meniscal repair at the time of concomitant ACLR

  15. Macroscopic and Histological Evaluations of Meniscal Allograft Transplantation Using Gamma Irradiated Meniscus: A Comparative in Vivo Animal Study

    Directory of Open Access Journals (Sweden)

    Jin Zhang

    2015-01-01

    Full Text Available Background: Many studies suggest that the gamma irradiation decreases allograft strength in a dose-dependent manner. However, no study has demonstrated that this decrease in strength translates into higher failure rate in meniscal allograft transplantation (MAT. The aim of this study was to investigate the effects of gamma irradiation on macroscopic and histological alterations of transplanted meniscal tissue and joint cartilage after MAT. Methods: Medial total meniscectomies were performed on the right knees of 60 New Zealand white rabbits. All meniscal allografts were divided into three groups (20 in each group and then sterilized with 0 Mrad, 1.5 Mrad, or 2.5 Mrad of gamma irradiation. For each group, 5 menisci were randomly chosen for scanning electron microscopic (SEM analysis and the remaining 15 were prepared for MAT surgeries. Forty-five right knees received MAT surgeries (0 Mrad group, 1.5 Mrad group, 2.5 Mrad group, 15 in each group, whereas the remaining 15 only received medial meniscectomy (Meni group. The left knees of the Meni group were chosen as the Sham group (n = 15. All the rabbits were sacrificed at week 24 postoperatively. Cartilage of the medial compartment of each group was evaluated macroscopically using the International Cartilage Repair Society (ICRS score and then histologically using the Mankin score based on the Masson Trichrome staining. Results: The SEM analysis confirmed that the meniscal collagen fibers would be significantly damaged as the dose of gamma irradiation increased. At week 24, the overall scores of macroscopic evaluations of the transplanted meniscal tissue showed no significant differences among the three groups receiving MAT surgeries, except for 2 in the 2.5 Mrad group presented partial radial tears at midbody. The ICRS scores and the Mankin scores showed the lowest in the Sham group and the highest in the Meni group (P < 0.05. For the three groups receiving MAT surgeries, the 2.5 Mrad group showed

  16. BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

    OpenAIRE

    Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi,Marco Martins; Caetano, Edie Benedito

    2010-01-01

    Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in on...

  17. Streaming tearing mode

    Science.gov (United States)

    Shigeta, M.; Sato, T.; Dasgupta, B.

    1985-01-01

    The magnetohydrodynamic stability of streaming tearing mode is investigated numerically. A bulk plasma flow parallel to the antiparallel magnetic field lines and localized in the neutral sheet excites a streaming tearing mode more strongly than the usual tearing mode, particularly for the wavelength of the order of the neutral sheet width (or smaller), which is stable for the usual tearing mode. Interestingly, examination of the eigenfunctions of the velocity perturbation and the magnetic field perturbation indicates that the streaming tearing mode carries more energy in terms of the kinetic energy rather than the magnetic energy. This suggests that the streaming tearing mode instability can be a more feasible mechanism of plasma acceleration than the usual tearing mode instability.

  18. BIORESORBABLE POLYMERIC MENISCAL PROSTHESIS: STUDY IN RABBITS

    Science.gov (United States)

    Cardoso, Tulio Pereira; de Rezende Duek, Eliana Aparecida; Amatuzzi, Marco Martins; Caetano, Edie Benedito

    2015-01-01

    Objective: To induce growth of a neomeniscus into the pores of a prosthesis in order to protect the knee joint cartilage. Methods: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms, and 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during a single operation. A bioabsorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer was implanted in one side. The animals were sacrificed after different postoperative time intervals. The femoral condyles and neomeniscus were subjected to histological analysis. Histograms were used to measure the degradation and absorption of the prosthesis, the growth of meniscal tissue in the prosthesis and the degree of degradation of the femoral condyle joint cartilage. Results: The data obtained showed that tissue growth histologically resembling a normal meniscus occurred, with gradual absorption of the prosthesis, and the percentages of chondrocytes on the control side and prosthesis side. Conclusion: Tissue growth into the prosthesis pores that histologically resembled the normal rabbit meniscus was observed. The joint cartilage of the femoral condyles on the prosthesis side presented greater numbers of chondrocytes in all its layers. PMID:27022549

  19. Meniscal transplantation: procedures, outcomes, and rehabilitation

    Directory of Open Access Journals (Sweden)

    Young J

    2017-05-01

    Full Text Available James Young, Francois Tudor, Ahmed Mahmoud, Peter Myers Brisbane Orthopaedic & Sports Medicine Centre, Brisbane Private Hospital, Spring Hill, Brisbane, Queensland, Australia Abstract: Meniscal allograft transplantation (MAT is a possible treatment option for patients with joint pain after meniscectomy. It is necessary that the joint be aligned and stable. Current evidence shows that MAT improves pain and mechanical function in the mid to long term with patients reporting significantly improved outcomes at up to 15 years following surgery. Studies on survivorship showed up to 76% graft survival at 10 years. Recent studies have suggested a chondroprotective effect, but there is, at present, no evidence to support MAT in the prevention of osteoarthritis. This review article reported the current evidence for MAT showing support for fresh frozen, nonirradiated allografts. However, further research is required to determine the ideal indications for MAT, the optimal graft fixation method, and the safest rehabilitation protocol. Keywords: meniscus, meniscectomy, meniscal allograft transplantation

  20. Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences.

    Science.gov (United States)

    Piasecki, Dana P; Spindler, Kurt P; Warren, Todd A; Andrish, Jack T; Parker, Richard D

    2003-01-01

    Despite research on the increased risk of anterior cruciate ligament tears in female athletes, few studies have addressed sex differences in the incidence of associated intraarticular injuries. When patients are stratified by sport and competition level, no sex differences exist in either the mechanism of injury or pattern of intraarticular injuries observed at anterior cruciate ligament reconstruction. Prospective cohort study. Two hundred twenty-one athletes undergoing anterior cruciate ligament reconstruction met our inclusion criteria of anterior cruciate ligament tear as a singular event without reinjury or history of prior injury or surgery in either knee. Data were collected on competition level (high school, amateur), sport (basketball, soccer, skiing), mechanism of injury, articular cartilage injuries, and meniscal tears. Data were statistically analyzed by sex with the chi-square test and Student's t-test. High school athletes had no significant sex differences in mechanism of injury. Female soccer athletes had fewer medial meniscal tears than did male athletes, and female basketball players had fewer medial femoral condyle injuries. At the amateur level, female basketball players had more contact injuries, an earlier onset of swelling, and fewer lateral meniscal tears than did male players. At the high school level, male and female athletes shared a common mechanism of injury, and yet the female athletes had fewer intraarticular injuries in basketball and soccer. If such intraarticular injuries prove to be a significant risk factor for poor long-term outcome, women may enjoy a better prognosis after reconstruction.

  1. Magnetic resonance diagnosis of posterior horn tears of the lateral meniscus using a thin axial plane: the zip sign - a preliminary study

    Energy Technology Data Exchange (ETDEWEB)

    Savoye, P.Y.; Ravey, J.N.; Dubois, C.; Barbier, L.P.; Ferretti, G. [CHU Grenoble, Clinique Universitaire de Radiologie et d' Imagerie Medicale, B.P 217, Grenoble Cedex 09 (France); Courvoisier, A.; Saragaglia, D. [CHU Grenoble, Clinique Universitaire de Chirurgie Orthopedique et Traumatologique, Grenoble (France)

    2011-01-15

    The ''zip'' sign is a newly described form of meniscal tear progressing from the distal insertion of menisco-femoral ligaments (MFLs) through the lateral meniscal wall; the tear occurs during anterior cruciate ligament (ACL) rupture. The purpose of this study was to evaluate the zip sign on knee MRI within the context of ACL injuries. From a series of 261 MR examinations for acute knee injury, we selected 97 patients with both MR and arthroscopic data for a retrospective blinded review. The zip sign was defined on axial thin MR sections as a straight line from the distal insertion of MFLs in association with five sagittal images lateral to the posterior cruciate ligament (PCL) where the MFLs were identified. Sensitivity and specificity in detecting lateral meniscal tears before and after having defined the zip sign were calculated. Sensitivity in detecting the tears of the posterior horn of the lateral meniscus (PHLM) reached 87.5% (CI 0.68-0.97) after zip sign criteria were defined. The zip sign has excellent inter-observer agreement, K > 0.90. The zip sign indicates a lesion at the insertion site of MFLs into the PHLM on thin axial images associated with sagittal MR sections that may improve MR sensitivity in detecting PHLM tears. (orig.)

  2. Magnetic resonance diagnosis of posterior horn tears of the lateral meniscus using a thin axial plane: the zip sign--a preliminary study.

    Science.gov (United States)

    Savoye, P Y; Ravey, J N; Dubois, C; Barbier, L Pittet; Courvoisier, A; Saragaglia, D; Ferretti, G

    2011-01-01

    The "zip" sign is a newly described form of meniscal tear progressing from the distal insertion of menisco-femoral ligaments (MFLs) through the lateral meniscal wall; the tear occurs during anterior cruciate ligament (ACL) rupture. The purpose of this study was to evaluate the zip sign on knee MRI within the context of ACL injuries. From a series of 261 MR examinations for acute knee injury, we selected 97 patients with both MR and arthroscopic data for a retrospective blinded review. The zip sign was defined on axial thin MR sections as a straight line from the distal insertion of MFLs in association with five sagittal images lateral to the posterior cruciate ligament (PCL) where the MFLs were identified. Sensitivity and specificity in detecting lateral meniscal tears before and after having defined the zip sign were calculated. Sensitivity in detecting the tears of the posterior horn of the lateral meniscus (PHLM) reached 87.5% (CI 0.68-0.97) after zip sign criteria were defined. The zip sign has excellent inter-observer agreement, К>0.90. The zip sign indicates a lesion at the insertion site of MFLs into the PHLM on thin axial images associated with sagittal MR sections that may improve MR sensitivity in detecting PHLM tears.

  3. Factors Predicting Meniscal Allograft Transplantation Failure.

    Science.gov (United States)

    Parkinson, Ben; Smith, Nicholas; Asplin, Laura; Thompson, Peter; Spalding, Tim

    2016-08-01

    Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined. To determine predictors of MAT failure in a large series to refine the indications for surgery and better inform future patients. Cohort study; Level of evidence, 3. All patients undergoing MAT at a single institution between May 2005 and May 2014 with a minimum of 1-year follow-up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation, or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of the index surgery: group 1, intact or partial-thickness chondral loss; group 2, full-thickness chondral loss 1 condyle; and group 3, full-thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure, independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model. There were 125 consecutive MATs performed, with 1 patient lost to follow-up. The median follow-up was 3 years (range, 1-10 years). The 5-year graft survival for the entire cohort was 82% (group 1, 97%; group 2, 82%; group 3, 62%). The probability of failure in group 1 was 85% lower (95% CI, 13%-97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% CI, 16%-89%) than medial allografts at any time. This study showed that the presence of severe

  4. Factors Predicting Meniscal Allograft Transplantation Failure

    Science.gov (United States)

    Parkinson, Ben; Smith, Nicholas; Asplin, Laura; Thompson, Peter; Spalding, Tim

    2016-01-01

    Background: Meniscal allograft transplantation (MAT) is performed to improve symptoms and function in patients with a meniscal-deficient compartment of the knee. Numerous studies have shown a consistent improvement in patient-reported outcomes, but high failure rates have been reported by some studies. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery. The factors that predict failure of a meniscal allograft within this complex patient group are not clearly defined. Purpose: To determine predictors of MAT failure in a large series to refine the indications for surgery and better inform future patients. Study Design: Cohort study; Level of evidence, 3. Methods: All patients undergoing MAT at a single institution between May 2005 and May 2014 with a minimum of 1-year follow-up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation, or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of the index surgery: group 1, intact or partial-thickness chondral loss; group 2, full-thickness chondral loss 1 condyle; and group 3, full-thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure, independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model. Results: There were 125 consecutive MATs performed, with 1 patient lost to follow-up. The median follow-up was 3 years (range, 1-10 years). The 5-year graft survival for the entire cohort was 82% (group 1, 97%; group 2, 82%; group 3, 62%). The probability of failure in group 1 was 85% lower (95% CI, 13%-97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% CI, 16%-89%) than medial allografts at

  5. Development of a fast curing tissue adhesive for meniscus tear repair.

    Science.gov (United States)

    Bochyńska, Agnieszka Izabela; Hannink, Gerjon; Janssen, Dennis; Buma, Pieter; Grijpma, Dirk W

    2017-01-01

    Isocyanate-terminated adhesive amphiphilic block copolymers are attractive materials to treat meniscus tears due to their tuneable mechanical properties and good adhesive characteristics. However, a drawback of this class of materials is their relatively long curing time. In this study, we evaluate the use of an amine cross-linker and addition of catalysts as two strategies to accelerate the curing rates of a recently developed biodegradable reactive isocyanate-terminated hyper-branched adhesive block copolymer prepared from polyethylene glycol (PEG), trimethylene carbonate, citric acid and hexamethylene diisocyanate. The curing kinetics of the hyper-branched adhesive alone and in combination with different concentrations of spermidine solutions, and after addition of 2,2-dimorpholinodiethylether (DMDEE) or 1,4-diazabicyclo [2.2.2] octane (DABCO) were determined using FTIR. Additionally, lap-shear adhesion tests using all compositions at various time points were performed. The two most promising compositions of the fast curing adhesives were evaluated in a meniscus bucket handle lesion model and their performance was compared with that of fibrin glue. The results showed that addition of both spermidine and catalysts to the adhesive copolymer can accelerate the curing rate and that firm adhesion can already be achieved after 2 h. The adhesive strength to meniscus tissue of 3.2-3.7 N was considerably higher for the newly developed compositions than for fibrin glue (0.3 N). The proposed combination of an adhesive component and a cross-linking component or catalyst is a promising way to accelerate curing rates of isocyanate-terminated tissue adhesives.

  6. Inside-Out Repair of Meniscal Ramp Lesions.

    Science.gov (United States)

    DePhillipo, Nicholas N; Cinque, Mark E; Kennedy, Nicholas I; Chahla, Jorge; Geeslin, Andrew G; Moatshe, Gilbert; Engebretsen, Lars; LaPrade, Robert F

    2017-08-01

    Meniscal ramp lesions have been reported to be present in 9% to 17% of patients undergoing anterior cruciate ligament reconstruction. Detection at the time of arthroscopy can be accomplished based upon clinical suspicion and careful evaluation without the use of an accessory posteromedial portal. Options for surgical treatment include arthroscopic repair using an all-inside or inside-out technique. The purpose of this Technical Note is to detail our arthroscopic inside-out repair technique for meniscal ramp lesions.

  7. Biological Activities of Phosphocitrate: A Potential Meniscal Protective Agent

    Directory of Open Access Journals (Sweden)

    Yubo Sun

    2013-01-01

    Full Text Available Phosphocitrate (PC inhibited meniscal calcification and the development of calcium crystal-associated osteoarthritis (OA in Hartley guinea pigs. However, the mechanisms remain elusive. This study sought to examine the biological activities of PC in the absence of calcium crystals and test the hypothesis that PC is potentially a meniscal protective agent. We found that PC downregulated the expression of many genes classified in cell proliferation, ossification, prostaglandin metabolic process, and wound healing, including bloom syndrome RecQ helicase-like, cell division cycle 7 homolog, cell division cycle 25 homolog C, ankylosis progressive homolog, prostaglandin-endoperoxide synthases-1/cyclooxygenase-1, and plasminogen activator urokinase receptor. In contrast, PC stimulated the expression of many genes classified in fibroblast growth factor receptor signaling pathway, collagen fibril organization, and extracellular structure organization, including fibroblast growth factor 7, collagen type I, alpha 1, and collagen type XI, alpha 1. Consistent with its effect on the expression of genes classified in cell proliferation, collagen fibril organization, and ossification, PC inhibited the proliferation of OA meniscal cells and meniscal cell-mediated calcification while stimulating the production of collagens. These findings indicate that PC is potentially a meniscal-protective agent and a disease-modifying drug for arthritis associated with severe meniscal degeneration.

  8. Femorotibial contact mechanics and meniscal strain after serial meniscectomy.

    Science.gov (United States)

    Pozzi, Antonio; Tonks, Catherine A; Ling, Hang-Yin

    2010-06-01

    To evaluate changes in femorotibial contact areas (CA) and pressures and meniscal strain after serial meniscectomies of the caudal pole of the medial meniscus. Ex vivo biomechanical study. Unpaired pelvic limbs from 8 adult dogs weighing 28-35 kg. All specimens underwent sequentially, a 30% radial width partial meniscectomy, a 75% radial width partial meniscectomy, and a segmental caudal pole hemi-meniscectomy. Digital pressure sensors were used to measure lateral and medial peak and mean contact pressures and areas before and after serial meniscectomies. Meniscal strain was measured under load in the intact meniscus and after 30% and 75% radial width meniscectomy. Repeated measures analysis of variance with a post hoc Bonferroni's test (PMedial CA decreased by 34.7% after 75% radial width meniscectomy and 47.2% after hemi-meniscectomy. A 30% radial width meniscectomy resulted in 38.5%, and a 75% radial width meniscectomy a 69.2%, decrease in medial meniscal strain compared with control, but these differences were not statistically significant. In this cadaveric model, smaller (30%) partial meniscectomies had minimal effect on the biomechanics of meniscal function, whereas larger partial (75%) and segmental meniscectomies resulted in significant changes in meniscal and femorotibial contact mechanics. This ex vivo data should be considered in clinical decision making for treatment of meniscal problems in dogs.

  9. Arthroscopic Treatment of Discoid Lateral Meniscus Tears in Children With Achondroplasia.

    Science.gov (United States)

    Atanda, Alfred; Wallace, Maegen; Bober, Michael B; Mackenzie, William

    2016-01-01

    Achondroplasia is the most common form of skeletal dysplasia that presents to the pediatric orthopaedist. More than half of achondroplasia patients are affected with knee pain. It is thought that the majority of this pain may be due to spinal stenosis, hip pathology, or knee malalignment. Discoid menisci can be a source of lateral knee joint pain in skeletally immature patients in general. We present the first case series of patients with achondroplasia who had symptomatic discoid lateral menisci treated with arthroscopic knee surgery. The charts of 6 patients (8 knees) with achondroplasia who underwent arthroscopic knee surgery for symptomatic discoid lateral menisci were collected. History and physical examination data, magnetic resonance imaging findings, and operative reports were reviewed. Meniscal tear configuration and treatment type (meniscectomy vs. repair) were noted. Each patient was found to have a tear of the discoid meniscus. All menisci were treated with saucerization. In addition, meniscal repair was performed in 2 cases, partial meniscectomy in 3 cases, and subtotal meniscectomy in 3 cases. Two patients had bilateral discoid meniscal tears which were treated. Average follow-up was 2.4 years (range, 1 to 4.5 y) and the average pediatric International Knee Documentation Committee (pedi-IKDC) score was 85.3% (range, 75% to 95.4%). At final follow-up, all patients were pain free and able to return to full activities. Discoid meniscus tears may be a source of lateral joint line pain in patients with achondroplasia. These injuries can be successfully treated with arthroscopic surgery in this patient population. Future studies need to be done to determine the exact incidence of discoid menisci in achondroplasia patients and also to determine whether there is a genetic relationship between the 2 conditions. Level IV-case series.

  10. Iatrogenic tracheal tear.

    LENUS (Irish Health Repository)

    Dias, A

    2010-10-01

    Large post intubation tracheal tears are usually detected intra-operatively due to unstable signs namely impaired ventilation and mediastinal emphysema and often require surgical management. Smaller tracheal tears are often missed during anaesthesia and recognized during the postoperative period. Conservative management should be considered in these latter cases.

  11. Hip Labral Tear

    Science.gov (United States)

    ... sports as ice hockey, soccer, football, golf and ballet are at higher risk of developing a hip labral tear. Structural abnormalities of the hip also ... of a hip labral tear may be: Trauma. Injury to or dislocation of the hip joint — which can occur during car accidents or ...

  12. Meniscus Tears (For Teens)

    Science.gov (United States)

    ... surgery. A torn meniscus is a common sports injury, particularly in contact sports like football and hockey. Meniscus tears can range from minor ... knee while playing a contact sport, such as football, hockey, or rugby, where ... along with other knee injuries such as ligament tears. Can I Prevent a ...

  13. Idiopathic Bilateral Bloody Tearing

    Directory of Open Access Journals (Sweden)

    Emrullah Beyazyıldız

    2015-01-01

    Full Text Available Bloody tear is a rare and distinct clinic phenomenon. We report a case presenting with the complaint of recurrent episodes of bilateral bloody tearing. A 16-year-old girl presented to our clinic with complaint of bloody tearing in both eyes for 3 months. Bloody tearing was not associated with her menses. A blood-stained discharge from the punctum was not observed during the compression of both nasolacrimal ducts. Nasolacrimal passage was not obstructed. Imaging studies such as dacryocystography and gradient-echo magnetic resonance imaging (MRI of nasolacrimal canal were normal. Intranasal endoscopic evaluation was normal. We collected samples from bloody tears two times and pathological examination was performed. Pathological analysis showed lots of squamous cells and no endometrial cells; dysplastic cells were found. Further evaluations for underlying causes were unremarkable. No abnormalities were found in ophthalmologic, radiologic, and pathologic investigations. This condition is likely a rare abnormality and the least recognized aetiology for the idiopathic phenomenon.

  14. Antimicrobial compounds in tears.

    Science.gov (United States)

    McDermott, Alison M

    2013-12-01

    The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Platelet-rich plasma in meniscal repair: does augmentation improve surgical outcomes?

    Science.gov (United States)

    Griffin, Justin W; Hadeed, Michael M; Werner, Brian C; Diduch, David R; Carson, Eric W; Miller, Mark D

    2015-05-01

    Increased contact stresses after meniscectomy have led to an increased focus on meniscal preservation strategies to prevent articular cartilage degeneration. Platelet-rich plasma (PRP) has received attention as a promising strategy to help induce healing and has been shown to do so both in vitro and in vivo. Although PRP has been used in clinical practice for some time, to date, few clinical studies support its use in meniscal repair. We sought to (1) evaluate whether PRP augmentation at the time of index meniscal repair decreases the likelihood that subsequent meniscectomy will be performed; (2) determine if PRP augmentation in arthroscopic meniscus repair influenced functional outcome measures; and (3) examine whether PRP augmentation altered clinical and patient-reported outcomes. Between 2008 and 2011, three surgeons performed 35 isolated arthroscopic meniscus repairs. Of those, 15 (43%) were augmented with PRP, and 20 (57%) were performed without PRP augmentation. During the study period, PRP was used for patients with meniscus tears in the setting of no ACL reconstruction. Complete followup at a minimum of 2 years (mean, 4 years; range, 2-6 years) was available on 11 (73%) of the PRP-augmented knees and 15 (75%) of the nonaugmented knees. Clinical outcome measures including the International Knee Documentation Committee (IKDC) score, Tegner Lysholm Knee Scoring Scale, and return to work and sports/activities survey tools were completed in person, over the phone, or through the mail. Range of motion data were collected from electronic patient charts in chart review. With the numbers available, a post hoc power calculation demonstrated that we would have expected to be able to discern a difference using IKDC if we treated 153 patients with PRP and 219 without PRP assuming an alpha rate of 5% and power exceeding 80%. Using the Lysholm score as an outcome measure, post hoc power estimate was 0.523 and effect size was -1.1 (-2.1 to -0.05) requiring 12 patients

  16. A Cohort Study on Meniscal Lesions among Airport Baggage Handlers.

    Directory of Open Access Journals (Sweden)

    Sigurd Mikkelsen

    Full Text Available Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort. The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84 after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of

  17. Meniscal Allograft Transplantation: Factors Predicting Failure

    Science.gov (United States)

    Parkinson, Ben; Smith, Nicholas; Thompson, Peter; Spalding, Tim

    2017-01-01

    Background: Meniscal allograft transplantation (MAT) has been shown to provide a significant improvement in patient reported outcomes for individuals with post-menisectomy syndrome. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery and it is difficult to ascertain which factors influence the outcome. Hypothesis / Purpose: The aim of this study was to determine the predictors of meniscal allograft transplantation failure in a large series in order to refine the indications for surgery and better inform future patients. Study Design: Prospective case series. Methods: All patients undergoing MAT at a single institution between May 2005 and May 2014, with a minimum of one year follow up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of surgery; Group 1 – intact or partial thickness chondral loss; Group 2 - full thickness chondral loss one condyle; Group 3 - full thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure (cartilage grade at the time of MAT, IKDC score, lateral or medial allografts, gender, additional procedures and tissue bank source), independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model. Results: There were 125 consecutive MATs performed, with one patient lost to follow up. The median follow up was 3 years (range 1 – 10 years). The 5 year graft survival for the entire cohort was 82% (97% group 1, 82% group 2, 62% group 3). The probability of failure in group 1 was 85% lower (95% confidence interval 13 – 97%) than in group 3 at any time. The probability of failure with lateral allografts was 76

  18. A statistically-augmented computational platform for evaluating meniscal function.

    Science.gov (United States)

    Guo, Hongqiang; Santner, Thomas J; Chen, Tony; Wang, Hongsheng; Brial, Caroline; Gilbert, Susannah L; Koff, Matthew F; Lerner, Amy L; Maher, Suzanne A

    2015-06-01

    Meniscal implants have been developed in an attempt to provide pain relief and prevent pathological degeneration of articular cartilage. However, as yet there has been no systematic and comprehensive analysis of the effects of the meniscal design variables on meniscal function across a wide patient population, and there are no clear design criteria to ensure the functional performance of candidate meniscal implants. Our aim was to develop a statistically-augmented, experimentally-validated, computational platform to assess the effect of meniscal properties and patient variables on knee joint contact mechanics during the activity of walking. Our analysis used Finite Element Models (FEMs) that represented the geometry, kinematics as based on simulated gait and contact mechanics of three laboratory tested human cadaveric knees. The FEMs were subsequently programmed to represent prescribed meniscal variables (circumferential and radial/axial moduli-Ecm, Erm, stiffness of the meniscal attachments-Slpma, Slamp) and patient variables (varus/valgus alignment-VVA, and articular cartilage modulus-Ec). The contact mechanics data generated from the FEM runs were used as training data to a statistical interpolator which estimated joint contact data for untested configurations of input variables. Our data suggested that while Ecm and Erm of a meniscus are critical in determining knee joint mechanics in early and late stance (peak 1 and peak 3 of the gait cycle), for some knees that have greater laxity in the mid-stance phase of gait, the stiffness of the articular cartilage, Ec, can influence force distribution across the tibial plateau. We found that the medial meniscus plays a dominant load-carrying role in the early stance phase and less so in late stance, while the lateral meniscus distributes load throughout gait. Joint contact mechanics in the medial compartment are more sensitive to Ecm than those in the lateral compartment. Finally, throughout stance, varus

  19. Creatinine and nonprotein nitrogen plasma levels: possible etiopathogenetic factors in rotator cuff tears.

    Science.gov (United States)

    Papalia, Rocco; Del Buono, Angelo; Leonardi, Francesco; Osti, Leonardo; Maffulli, Nicola; Denaro, Vincenzo

    2011-05-01

    To determine the plasma levels of nonprotein nitrogen (NPN) and creatinine in healthy patients with rotator cuff tears. The study included 400 subjects. The study group included 200 patients (93 men and 107 women; mean age, 56.8 years; range, 23-81 years) who underwent arthroscopic repair of a rotator cuff tear from 2004 to 2007. The control group included 200 patients (93 men and 107 women; mean age, 53.9 years; range, 20-81 years) who underwent arthroscopy for management of a meniscal tear, with or without articular cartilage damage, in the same period. The 2 groups were frequency-matched by age and sex. Measurement of plasma levels of NPN and creatinine were performed in all patients. Patients with rotator cuff tears showed higher plasma NPN levels within the normal range (P = 0.035) than patients with knee disorders (control group). Creatinine levels were comparable (P = 0.66) in both groups. There appears to be an association between plasma NPN levels and rotator cuff tears. On the basis of our findings, plasma NPN could be involved in the pathogenesis of rotator cuff tears, although we advocate further research to draw more definitive conclusions.

  20. New Complication Associated With All-Inside Meniscal Repair Device

    Science.gov (United States)

    Warth, Lucian C.; Bollier, Matthew J.; Hoffman, Douglas F.; Cummins, Justin S.; Hall, Mederic M.

    2016-01-01

    Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair. PMID:27635413

  1. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries

    Energy Technology Data Exchange (ETDEWEB)

    Dyck, Pieter van; Smet, Eline de; Gielen, Jan L.; Parizel, Paul M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Clockaerts, Stefan [University College Hospitals, Department of Orthopaedics, London (United Kingdom); Vanhoenacker, Filip M. [Antwerp University Hospital and University of Antwerp, Department of Radiology, Antwerp (Belgium); Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); AZ St-Maarten, Department of Radiology, Antwerp (Belgium); Lambrecht, Valerie [Ghent University Hospital and University of Ghent, Department of Radiology, Ghent (Belgium); Wouters, Kristien [Antwerp University Hospital and University of Antwerp, Department of Biostatistics, Antwerp (Belgium)

    2016-10-15

    To determine the frequency of anterolateral ligament (ALL) injury in patients with acute anterior cruciate ligament (ACL) rupture and to analyse its associated injury patterns. Ninety patients with acute ACL rupture for which MRI was obtained within 8 weeks after the initial trauma were retrospectively identified. Two radiologists assessed the status of the ALL on MRI by consensus. The presence or absence of an ALL abnormality was compared with the existence of medial and lateral meniscal tears diagnosed during arthroscopy. Associated collateral ligament and osseous injuries were documented with MRI. Forty-one of 90 knees (46 %) demonstrated ALL abnormalities on MRI. Of 49 knees with intact ALL, 15 (31 %) had a torn lateral meniscus as compared to 25 torn lateral menisci in 41 knees (61 %) with abnormal ALL (p = 0.008). Collateral ligament (p ≤ 0.05) and osseous injuries (p = 0.0037) were more frequent and severe in ALL-injured as compared with ALL-intact knees. ALL injuries are fairly common in patients with acute ACL rupture and are statistically significantly associated with lateral meniscal, collateral ligament and osseous injuries. (orig.)

  2. Advances and Prospects in Tissue-Engineered Meniscal Scaffolds for Meniscus Regeneration

    Directory of Open Access Journals (Sweden)

    Weimin Guo

    2015-01-01

    Full Text Available The meniscus plays a crucial role in maintaining knee joint homoeostasis. Meniscal lesions are relatively common in the knee joint and are typically categorized into various types. However, it is difficult for inner avascular meniscal lesions to self-heal. Untreated meniscal lesions lead to meniscal extrusions in the long-term and gradually trigger the development of knee osteoarthritis (OA. The relationship between meniscal lesions and knee OA is complex. Partial meniscectomy, which is the primary method to treat a meniscal injury, only relieves short-term pain; however, it does not prevent the development of knee OA. Similarly, other current therapeutic strategies have intrinsic limitations in clinical practice. Tissue engineering technology will probably address this challenge by reconstructing a meniscus possessing an integrated configuration with competent biomechanical capacity. This review describes normal structure and biomechanical characteristics of the meniscus, discusses the relationship between meniscal lesions and knee OA, and summarizes the classifications and corresponding treatment strategies for meniscal lesions to understand meniscal regeneration from physiological and pathological perspectives. Last, we present current advances in meniscal scaffolds and provide a number of prospects that will potentially benefit the development of meniscal regeneration methods.

  3. Visibility of Anterolateral Ligament Tears in Anterior Cruciate Ligament-Deficient Knees With Standard 1.5-Tesla Magnetic Resonance Imaging.

    Science.gov (United States)

    Hartigan, David E; Carroll, Kevin W; Kosarek, Frank J; Piasecki, Dana P; Fleischli, James F; D'Alessandro, Donald F

    2016-10-01

    To attempt to visualize the ligament with standard 1.5-tesla magnetic resonance imaging (MRI) in the acute anterior cruciate ligament (ACL)-torn knee, and if it is visible, attempt to characterize it as torn or intact at its femoral, meniscal, and tibial attachment sites. This was a retrospective MRI study based on arthroscopic findings of a known ACL tear in 72 patients between the years 2006 and 2010. Patients all had hamstring ACL reconstructions, no concomitant lateral collateral ligament, or posterolateral corner injury based on imaging and physical examination, and had a preoperative 1.5-tesla MRI scan with standard sequences performed within 3 weeks of the injury. Two fellowship-trained musculoskeletal radiologists retrospectively reviewed the preoperative MRI for visualization of the anterolateral ligament (ALL) for concomitant tears. Inter- and intraobserver reliability was calculated. Learning effect was analyzed to determine if radiologists' agreement improved as reads progressed. Both radiologists were able to visualize the ALL in 100% of the scans. Overall, ALL tears were noted in 26% by radiologist 1 and in 62% by radiologist 2. The agreement between the ligament being torn or not had a kappa of 0.54 between radiologists. The agreements in torn or not torn between radiologists in the femoral, meniscal, and tibial sites were 0.14, 0.15, and 0.31. The intraobserver reliability by radiologist 1 for femoral, meniscal, and tibial tears was 0.04, 0.57, and 0.54 respectively. For radiologist 2, they were 0.75, 0.61, and 0.55. There was no learning effect noted. ALL tears are currently unable to be reliably identified as torn or intact on standard 1.5-tesla MRI sequences. Proper imaging sequences are of crucial importance to reliably follow these tears to determine their clinical significance. Level IV, therapeutic case series study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. Studies on lipid artificial tears

    OpenAIRE

    Torrent Burgués, Juan

    2017-01-01

    Report-review sobre llàgrima artificial, llàgrima lipídica. The use of artificial tears is related with dry eye problems or ocular irritations. It exist different types of artificial tears. One type of them is the lipid artificial tears which tray to repair or improve the lipid layer present in the outermostpart of the tear film. Several lipid artificial tears are present in the market and commercialised by several companies. In the composition of some of these lipid tears occurs as a prin...

  5. Effect of medial meniscal release on tibial translation after tibial plateau leveling osteotomy.

    Science.gov (United States)

    Pozzi, Antonio; Kowaleski, Michael P; Apelt, Detlef; Meadows, Cheyney; Andrews, Chad M; Johnson, Kenneth A

    2006-07-01

    To evaluate the biomechanical effects of medial meniscal release (MMR) and medial, caudal pole hemimeniscectomy (MCH) on joint stability in the cranial cruciate ligament (CCL)-deficient canine stifle before and after tibial plateau leveling osteotomy (TPLO). Experimental study. Thirty-one dogs. In experiment 1, 16 pairs of normal hindlimbs randomly assigned to an intact or transected CCL group were studied to determine the magnitude of tibial translation after MMR and MCH under 20% body weight load using radiographic imaging of radio-opaque markers. In experiment 2, 15 pairs of CCL-deficient hindlimbs were randomly assigned to a TPLO or sham TPLO group. The remainder of the experiment was performed as described for experiment 1. The effect of CCL transection, MMR, MCH and TPLO were analyzed using 2-way repeated measures ANOVA; P.05). We found a greater effect of MMR in sham TPLO than TPLO stifles (P=.0013) but no further effect of MCH after MMR (P>.05). By resisting tibial translation the medial meniscus might be at greater risk of tearing in CCL-deficient stifles. TPLO may spare the medial meniscus by neutralizing the tibial thrust and eliminating the wedge effect of the medial meniscus. MMR may not be indicated in the CCL-deficient stifle stabilized by TPLO.

  6. Arthroscopic all-inside repair of tears of the anterior horn of the lateral meniscus.

    Science.gov (United States)

    Kim, Sung-Jae; Jung, Kwang-Am; Kim, Jong-Min; Kwun, Jun-Dae; Baek, Seung-hee; Han, Jeung-Nam

    2005-11-01

    Presently, the outside-in or inside-out meniscal repair techniques are recommended for the repair of tears of the anterior horn of the lateral meniscus. However, an incision about 1 to 2 cm or more in length is needed, and the biomechanics of the lateral meniscus may be altered during motion. We have developed a new alternative repair technique to prevent this skin incision and preserve the normal biomechanics of the lateral meniscus during motion. We use 3 portals: a lateral patellofemoral axillary portal, a standard anterolateral portal, and an extreme far medial portal. We perform all-inside repair for tears of the anterior horn of the lateral meniscus using suture hooks.

  7. A giraffe neck sign of the medial meniscus: A characteristic finding of the medial meniscus posterior root tear on magnetic resonance imaging.

    Science.gov (United States)

    Furumatsu, Takayuki; Fujii, Masataka; Kodama, Yuya; Ozaki, Toshifumi

    2017-07-01

    The posterior root ligament of the medial meniscus (MM) has a critical role in regulating the MM movement. An accurate diagnosis of the MM posterior root tear (MMPRT) using magnetic resonance imaging (MRI) is important for preventing sequential osteoarthritis following the MMPRT. However, diagnosis of the MMPRT is relatively difficult even after using several characteristic MRI findings. The aim of this study was to identify a useful meniscal body sign of the MMPRT for improving diagnostic MRI reading. Eighty-five patients who underwent surgical treatments for the MMPRT (39 knees) and other types of MM tears (49 knees) were included. The presence of characteristic MRI findings such as cleft sign, ghost sign, radial tear sign, medial extrusion sign, and new meniscal body shape-oriented "giraffe neck sign" was evaluated in 120 MRI examinations. Giraffe neck signs were observed in 81.7% of the MMPRTs and in 3.3% of other MM tears. Cleft, ghost, and radial tear signs were highly positive in the MMPRTs compared with other MM tears. Medial extrusion signs were frequently observed in both groups. Coexistence rates of any 2 MRI signs, except for medial extrusion sign, were 91.7% in the MMPRT group and 5% in other MM tears. This study demonstrated that a new characteristic MRI finding "giraffe neck sign" was observed in 81.7% of the MMPRT. Our results suggest that the combination of giraffe neck, cleft, ghost, and radial tear signs may be important for an accurate diagnostic MRI reading of the MMPRT. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  8. Probability Theory Without Tears!

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 1; Issue 2. Probability Theory Without Tears! S Ramasubramanian. Book Review Volume 1 Issue 2 February 1996 pp 115-116. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/001/02/0115-0116 ...

  9. Tears of Wine

    Science.gov (United States)

    Rathore, Prerana; Sharma, Vivek

    `Tears of wine' refer to the rows of wine-drops that spontaneously emerge within a glass of strong wine. Evaporation-driven Marangoni flows near the meniscus of water-alcohol mixtures drive liquid upward forming a thin liquid film, and a rim or ridge forms near the moving contact line. Eventually the rim undergoes an instability forming drops, that roll back into bulk reservoir forming so called tears or legs of wine. Most studies in literature argue the evaporation of more volatile, lower surface tension component (alcohol) results in a concentration-dependent surface tension gradient that drives the climbing flow within the thin film. Though it is well-known that evaporative cooling can create temperature gradients that could provide additional contribution to the climbing flows, the role of thermocapillary flows is less well-understood. Furthermore, the patterns, flows and instabilities that occur near the rim, and determine the size and periodicity of tears, are not well-studied. Using experiments and theory, we visualize and analyze the formation and growth of tears of wine. The sliding drops, released from the rim towards the bulk reservoir, show oscillations and a cascade of fascinating flows that are analyzed for the first time.

  10. Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels.

    Science.gov (United States)

    LaPrade, Christopher M; LaPrade, Matthew D; Turnbull, Travis Lee; Wijdicks, Coen A; LaPrade, Robert F

    2015-04-01

    that a newly proposed iteration of the transtibial pull-out repair technique using a second transtibial tunnel, which theoretically restores more of the posterior medial meniscal root, was almost identical to the current clinical standard involving a single transtibial tunnel. As the importance of repairing meniscal root tears is increasingly recognized, further studies on new iterations of both techniques are warranted to minimize the risk of displacement caused by early motion in the initial postoperative rehabilitation period. © 2015 The Author(s).

  11. Meniscal ossification. II. The normal pattern in the tiger knee.

    Science.gov (United States)

    Ganey, T M; Ogden, J A; Abou-Madi, N; Colville, B; Zdyziarski, J M; Olsen, J H

    1994-04-01

    Examination of knee menisci of Bengal tigers revealed ossicles within the cartilaginous anterior horn of each medial meniscus. This ossification was not evident in the neonatal animal, but was present in animals aged 20 months or older. The ossicle appeared prior to the completion of skeletal maturation at the knee, and was composed of normal remodeling trabecular bone. While most animals had a single, variably sized ossicle, multiple ossicles also occurred. The meniscal cartilage apposed to the femoral articulation exhibited a distinct columnar pattern in the region of the ossicle, in contrast to the non-columnar pattern throughout the bulk of the meniscus, including the ossicle side apposed to the tibial plateau. In this particular large mammalian species medial meniscal ossification appears to be a normal anatomical variation that progressively develops following birth, and may serve as a model for the phylogenetic (developmental) theory of etiology.

  12. Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells

    Science.gov (United States)

    2015-09-01

    cells, stem cells, progenitor cells, meniscus healing , meniscus repair, osteoarthritis 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...2. Keywords meniscus, meniscal cells, stem cells, progenitor cells, meniscus healing , meniscus repair, osteoarthritis 3. Overall Project Summary...Colonies will be compared for frequency and size. For colony forming assays, meniscus cells (P1) from 8wk old mice were seeded a density of 1000/25cm2

  13. Meniscal ossicles in large non-domestic cats.

    Science.gov (United States)

    Walker, Michael; Phalan, David; Jensen, James; Johnson, James; Drew, Mark; Samii, Valerie; Henry, George; McCauley, Jessica

    2002-01-01

    Radiographs of the stifles of 6 species of 34 large, non-domestic cats were reviewed foremost for the presence of meniscal ossicles and then for the presence of the other potential four sesamoids. The animals in the review included 12 lions, 7 tigers, 7 cougars, 3 leopards, 3 bobcats, and 2 jaguars. Fluoroscopy, arthrography, computed tomography, necropsy, and histology were also used to evaluate the stifles of one tiger after euthanasia. Ossicles were found in the region of the cranial horn of the medial meniscus in most of the lions, tigers, leopards, and jaguars. These ossicles were found in half of the cougars but in none of the bobcats. Among the large, non-domestic cats, meniscal ossicles had been reported previously only in Bengal tigers. The lions, tigers, and leopards having meniscal ossicles appeared to have a lateral but often not a medial fabella of the gastrocnemius muscle, an observation previously unreported. Popliteal sesamoids and patellas were present in all the skeletally mature cats.

  14. Sonographic Imaging of Meniscal Subluxation in Patients with Radiographic Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Chun-Hung Ko

    2007-09-01

    Conclusion: Meniscal subluxation is a prominent feature on weight-bearing sonographic imaging in patients with radiographic osteoarthritis and could be considered as a risk factor for the development of knee osteoarthritis. By using musculoskeletal ultrasonography, one can detect this occult meniscal derangement early before the appearance of radiographic signs of osteoarthritis.

  15. Tear Film Lipids

    Science.gov (United States)

    Butovich, Igor A.

    2013-01-01

    Human meibomian gland secretions (MGS, or meibum) are formed from a complex mixture of lipids of different classes such as wax esters, cholesteryl esters, (O-acyl)-ω-hydroxy fatty acids (OAHFA) and their esters, acylglycerols, diacylated diols, free fatty acids, cholesterol, and a smaller amount of other polar and nonpolar lipids, whose chemical nature and the very presence in MGS have been a matter of intense debates. The purpose of this review is to discuss recent results that were obtained using different experimental techniques, estimate limitations of their usability, and discuss their biochemical, biophysical, and physiological implications. To create a lipid map of MGS and tears, the results obtained in the author’s laboratory were integrated with available information on chemical composition of MGS and tears. The most informative approaches that are available today to researchers, such as HPLC-MS, GC-MS, and proton NMR, are discussed in details. A map of the meibomian lipidome (as it is seen in reverse phase liquid chromatography/mass spectrometry experiments) is presented. Directions of future efforts in the area are outlined. PMID:23769846

  16. Meniscal Ramp Lesions: Anatomy, Incidence, Diagnosis, and Treatment

    National Research Council Canada - National Science Library

    Chahla, Jorge; Dean, Chase S; Moatshe, Gilbert; Mitchell, Justin J; Cram, Tyler R; Yacuzzi, Carlos; LaPrade, Robert F

    2016-01-01

    ...) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear...

  17. Understanding posterior meniscal roots lesions: from basic science to treatment

    Directory of Open Access Journals (Sweden)

    Raphael Serra Cruz

    Full Text Available ABSTRACT The variability of symptoms and the fact that they are not easily recognized in imaging studies make the diagnosis and treatment of posterior meniscal roots lesions a challenging task to the orthopedist. In recent years, a more precise understanding of the anatomy and biomechanical impair of the knee joint in these cases has enabled great advances in therapeutic approaches. Well-documented studies have shown that the repair of these lesions presents superior functional and clinical improvement when compared with meniscectomy. However, the progression of degenerative joint changes in the long-term still exhibits conflicting results.

  18. Tearing: Breakthrough in Human Emotional Signaling

    Directory of Open Access Journals (Sweden)

    Robert R. Provine

    2009-01-01

    Full Text Available Tearing is not a benign secretory correlate of sadness or other emotional state, but a potent visual cue that adds meaning to human facial expression, the tear effect. Although tearing (lacrimation provides ocular lubrication and is a response to irritation in many animals, emotional tearing may be unique to humans and does not develop until several months after birth. This study provides the first experimental demonstration that tears are a visual signal of sadness by contrasting the perceived sadness of human facial images with tears against copies of those images that had the tears digitally removed. Tear removal produced faces rated as less sad. Anecdotal findings suggest further that tear-removal often produced faces of uncertain emotional valence, perhaps awe, concern, or puzzlement, not just less sad. Tearing signaled sadness and resolved ambiguity. The evolution and development of emotional tearing in humans provide a novel, potent and neglected channel of affective communication.

  19. Are Articular Cartilage Lesions and Meniscus Tears Predictive of IKDC, KOOS, and Marx Activity Level Outcomes after ACL Reconstruction? A 6-Year Multicenter Cohort Study

    Science.gov (United States)

    Cox, Charles L.; Huston, Laura J.; Dunn, Warren R.; Reinke, Emily K.; Nwosu, Samuel K.; Parker, Richard D.; Wright, Rick W.; Kaeding, Christopher C.; Marx, Robert G.; Amendola, Annunziata; McCarty, Eric C.; Wolf, Brian R.; Harrell, Frank E.; Spindler, Kurt P.

    2014-01-01

    Background Identifying risk factors for inferior outcomes after ACL reconstruction (ACLR) is important for prognosis and future treatment. The goal of this study was to determine whether articular cartilage and meniscal variables are predictive of 3 validated sports outcome instruments after ACLR. Hypothesis/Purpose We hypothesized that articular cartilage lesions and meniscus tears/treatment would be predictors of the IKDC, KOOS (all 5 subscales), and Marx activity level at 6 years following ACLR. Study Design Prospective cohort, Level 1 Methods Between 2002 and 2004, 1512 ACLR subjects were prospectively enrolled and followed longitudinally with the IKDC, KOOS, and Marx activity score completed at entry, 2, and 6 years. A logistic regression model was built incorporating variables from patient demographics, surgical technique, articular cartilage injuries, and meniscus tears/treatment to determine the predictors (risk factors) of IKDC, KOOS, and Marx at 6 years. Results We completed a minimum follow-up on 86% (1307/1512) of our cohort at 6 years. The cohort was 56% male, had a median age of 23 years at the time of enrollment, with 76% reporting a non-contact injury mechanism. Incidence of concomitant pathology at the time of surgery consisted of the following: articular cartilage (medial femoral condyle [MFC]-25%, lateral femoral condyle [LFC]-20%, medial tibial plateau [MTP]-6%, lateral tibial plateau [LTP]-12%, patella-20%, trochlear-9%) and meniscal (medial-38%, lateral-46%). Both articular cartilage lesions and meniscal tears were significant predictors of 6-year outcomes on IKDC and KOOS. Grade 3 or 4 articular cartilage lesions (excluding patella) significantly reduced IKDC and KOOS scores at 6 years. IKDC demonstrated worse outcomes with the presence of a grade 3-4 chondral lesion on the MFC, MTP, and LFC. Likewise, KOOS was negatively affected by cartilage injury. The sole significant predictor of reduced Marx activity was the presence of a grade 4 lesion

  20. Biomechanical and immunohistochemical properties of meniscal cartilage after high hydrostatic pressure treatment.

    Science.gov (United States)

    Naal, Florian D; Schauwecker, Johannes; Steinhauser, Erwin; Milz, Stefan; von Knoch, Fabian; Mittelmeier, Wolfram; Diehl, Peter

    2008-10-01

    Meniscal allograft processing procedures, in particular gamma irradiation, deteriorate the biomechanical and biological properties of the transplanted tissue. High hydrostatic pressure (HHP) treatment, widely used in food technology to inactivate microorganisms while preserving natural compounds, might serve as a gentle alternative to gamma irradiation in the processing of meniscal allografts. We therefore investigated the effects of HHP treatment on the biomechanical and immunohistochemical properties of meniscal cartilage. Specimens of bovine menisci were treated with HHP for 10 min (20 degrees C) at 300 MPa and 600 MPa. Untreated control samples were left at room temperature and ambient pressure. We performed repetitive cycling indentation-tests to assess the biomechanical properties-in particular the viscoelastic behavior-of HHP treated and untreated meniscal specimens. Immunohistochemical analysis for collagens type I, II, and III and for the proteoglycans versican, aggrecan and for link-protein was performed by immunolabeling cross-sections of untreated and at 600 MPa HHP treated specimens. Comparing untreated and HHP treated meniscal specimens there were no significant differences for all tested biomechanical parameters. All cross-sections of untreated and HHP treated specimens stained positive for the collagens and proteoglycans. We demonstrated that meniscal cartilage can be treated by HHP at levels as high as 600 MPa without affection of the biomechanical and immunochistochemical properties. Therefore, HHP treatment might serve as a gentle alternative to gamma irradiation in the processing of meniscal allografts. Further research is necessary to verificate the present results in vivo. (c) 2008 Wiley Periodicals, Inc.

  1. MRI follow-up of conservatively treated meniscal knee lesions in general practice

    Energy Technology Data Exchange (ETDEWEB)

    Oei, Edwin H.G.; Hunink, M.G.M. [University Medical Center Rotterdam, Program for the Assessment of Radiological Technology (ART Program), Erasmus MC, Rotterdam (Netherlands); University Medical Center Rotterdam, Department of Radiology, Erasmus MC, Rotterdam (Netherlands); University Medical Center Rotterdam, Department of Epidemiology, Erasmus MC, Rotterdam (Netherlands); Koster, Ingrid M. [University Medical Center Rotterdam, Department of Radiology, Erasmus MC, Rotterdam (Netherlands); Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Hensen, Jan-Hein J.; Vroegindeweij, Dammis [Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Boks, Simone S. [University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Rotterdam (Netherlands); Maasstad Ziekenhuis, Department of Radiology, Rotterdam (Netherlands); Diaconessenhuis Meppel, Department of Radiology, Meppel (Netherlands); Wagemakers, Harry P.A.; Koes, Bart W.; Bierma-Zeinstra, Sita M.A. [University Medical Center Rotterdam, Department of General Practice, Erasmus MC, Rotterdam (Netherlands)

    2010-05-15

    To evaluate meniscal status change on follow-up MRI after 1 year, prognostic factors and association with clinical outcome in patients with conservatively treated knee injury. We analysed 403 meniscal horns in 101 conservatively treated patients (59 male; mean age 40 years) in general practice who underwent initial knee MRI within 5 weeks of trauma. We performed ordinal logistic regression analysis to analyse prognostic factors for meniscal change on follow-up MRI after 1 year, and we assessed the association with clinical outcome. On follow-up MRI 49 meniscal horns had deteriorated and 18 had improved. Age (odds ratio [OR] 1.3/decade), body weight (OR 1.2/10 kg), total anterior cruciate ligament (ACL) rupture on initial MRI (OR 2.4), location in the posterior horn of the medial meniscus (OR 3.0) and an initial meniscal lesion (OR 0.3) were statistically significant predictors of meniscal MRI appearance change after 1 year, which was not associated with clinical outcome. In conservatively treated patients, meniscal deterioration on follow-up MRI 1 year after trauma is predicted by higher age and body weight, initial total ACL rupture, and location in the medial posterior horn. Change in MRI appearance is not associated with clinical outcome. (orig.)

  2. Scaffolds for partial meniscal replacement: an updated systematic review.

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Diaz Balzani, Lorenzo; D'Adamio, Stefano; Maffulli, Nicola; Denaro, Vincenzo

    2013-01-01

    Meniscectomy, a most common orthopaedic procedure, results in increased contact area of the articular surfaces of tibia and femur leading to early osteoarthritis. We systematically review the literature on clinical outcomes following partial meniscal replacement using different scaffolds. We performed a comprehensive search of Medline, CINAHL, Embase and the Cochrane Central Registry of Controlled Trials. The reference lists of the selected articles were then examined by hand. Only studies focusing on investigation of clinical outcomes on patients undergoing a partial meniscal replacement using a scaffold were selected. We then evaluated the methodological quality of each article using the Coleman methodology score (CMS), a 10 criteria scoring list assessing the methodological quality of the selected studies (CMS). Fifteen studies were included, all prospective studies, but only 2 were randomized controlled trials. Biological scaffolds were involved in 12 studies, 2 studies investigated synthetic scaffolds, whereas 1 remaining article presented data from the use of both classes of device. The mean modified CMS was 64.6. Several demographic and biomechanical factors could influence the outcomes of this treatment modality. Partial replacement using both classes of scaffolds achieves significant and encouraging improved clinical results when compared with baseline values or with controls when present, without no adverse reaction related to the device. There is a need for more and better designed randomized trials, to confirm with a stronger level of evidence the promising preliminary results achieved by the current research.

  3. The effect of medial meniscectomy and meniscal allograft transplantation on knee and anterior cruciate ligament biomechanics.

    Science.gov (United States)

    Spang, Jeffrey T; Dang, Alan B C; Mazzocca, Augustus; Rincon, Lina; Obopilwe, Elifho; Beynnon, Bruce; Arciero, Robert A

    2010-02-01

    Our purpose was to evaluate the effect of meniscectomy and meniscal allograft transplant on anterior cruciate ligament (ACL) and knee biomechanics. A differential variable reluctance transducer was placed in the ACL of 10 human cadaveric knees to record strain. Tibial displacement from a neutral reference was recorded relative to the position of the femur. Testing was performed at 30 degrees, 60 degrees, and 90 degrees of knee flexion. Six cycles of anterior-posterior loads were applied to the limit of 150 N. After a testing cycle, a medial meniscectomy was performed and the testing cycle was repeated. A meniscal allograft transplant was performed, and a final testing cycle was conducted. ACL strain and tibial displacement in the meniscectomy and meniscal allograft states were compared with the intact-knee state. Tibial displacement after meniscectomy significantly increased at all angles. The meniscal allograft transplant restored tibial displacement to normal values at 30 degrees and 90 degrees. ACL strain increased significantly after meniscectomy at 60 degrees and 90 degrees of flexion, and meniscal allograft transplant returned the strain values to normal at 60 degrees and 90 degrees. In most cases medial meniscectomy produced a significant increase in tibial displacement relative to the femur, and meniscal allograft transplantation restored displacement values to normal. Meniscectomy increased ACL strain and meniscal allograft transplant restored strain values to normal in 2 of 3 tested flexion angles. The absence of the medial meniscus exposes the ACL to increased strain, whereas meniscal allograft lowered the strain on the native ACL. This could have implications for those patients undergoing ACL reconstruction who have concomitant removal of the medial meniscus. (c) 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. The effect of medial meniscal horn injury on knee stability.

    Science.gov (United States)

    Chen, Lianxu; Linde-Rosen, Monica; Hwang, Sun Chul; Zhou, Jingbin; Xie, Qiang; Smolinski, Patrick; Fu, Freddie H

    2015-01-01

    This study investigated the effect of damage of the posterior and anterior horns of the medial meniscus on knee stability. Twenty fresh-frozen porcine knees were divided into two groups (anterior horn and posterior horn injury). Each group was tested in three states: intact medial meniscus, posterior or anterior horn of medial meniscus resection and total medial meniscectomy. A robotic testing system was used to test anterior tibial translation (ATT) at 30° (full extension), 60° and 90° of knee flexion with an external anterior tibial load of 89 N, internal rotation (IR) and external rotation (ER) at 30° and 60° of knee flexion under a 4 N m tibial rotation torque. In response to an IR torque, there was a significant difference between the state of intact medial meniscus and anterior and posterior horn damage, except for anterior horn resection at 60° of knee flexion. In response to an ER torque, there were no significant differences between the state of intact meniscus and horn damage except for anterior horn resection at 30° of knee flexion. Meniscal damage had no significant effect on ATT. The results indicated that the posterior horn was more important in controlling the IR stability than the anterior horn with knee flexion, and the anterior horn was more important in controlling the ER stability than the posterior horn at full knee extension in the anterior cruciate ligament-intact knee. These findings further the understanding of the mechanisms, the prevention of injuries and rehabilitation of meniscal horn injury in clinical practice.

  5. Cartilage Degeneration, Subchondral Mineral and Meniscal Mineral Densities in Hartley and Strain 13 Guinea Pigs.

    Science.gov (United States)

    Sun, Yubo; Scannell, Brian P; Honeycutt, Patrick R; Mauerhan, David R; H, James Norton; Hanley, Edward N

    2015-01-01

    Osteoarthritis is a joint disease involved in articular cartilage, subchondral bone, meniscus and synovial membrane. This study sought to examine cartilage degeneration, subchondral bone mineral density (BMD) and meniscal mineral density (MD) in male Hartley, female Hartley and female strain 13 guinea pigs to determine the association of cartilage degeneration with subchondral BMD and meniscal MD. Cartilage degeneration, subchondral BMD and meniscal MD in 12 months old guinea pigs were examined with histochemistry, X-ray densitometry and calcium analysis. We found that male Hartley guinea pigs had more severe cartilage degeneration, subchondral BMD and meniscal MD than female Hartley guinea pigs, but not female strain 13 guinea pigs. Female strain 13 guinea pigs had more severe cartilage degeneration and higher subchondral BMD, but not meniscal MD, than female Hartley guinea pigs. These findings indicate that higher subchondral BMD, not meniscal MD, is associated with more severe cartilage degeneration in the guinea pigs and suggest that abnormal subchondral BMD may be a therapeutic target for OA treatment. These findings also indicate that the pathogenesis of OA in the male guinea pigs and female guinea pigs are different. Female strain 13 guinea pig may be used to study female gender-specific pathogenesis of OA.

  6. A matched-cohort population study of reoperation after meniscal repair with and without concomitant anterior cruciate ligament reconstruction.

    Science.gov (United States)

    Wasserstein, David; Dwyer, Tim; Gandhi, Rajiv; Austin, Peter C; Mahomed, Nizar; Ogilvie-Harris, Darrell

    2013-02-01

    Evidence for the success of a meniscal repair performed alone versus combined with anterior cruciate ligament reconstruction (ACLR) is equivocal. No large-scale comparative studies exist regarding this issue. In the general population, meniscal repair in a presumed stable knee has the same rate of reoperation as meniscal repair performed with ACLR. Cohort study; Level of evidence, 3. All meniscal repairs performed with ACLR in Ontario, Canada, between July 2003 and March 2008 in patients aged 15 to 60 years were identified using administrative billing, diagnostics, and procedural coding. This cohort was matched 1:1 for sex, age, and calendar year of surgery with a cohort of patients who underwent meniscal repair alone. The McNemar test of matched pairs was used to compare reoperation rates (debridement or repair) within 2 years of the index procedure. Conditional logistic regression analysis was used to identify potential risk factors for reoperation among unmatched patient (socioeconomic status surrogate, comorbidity) and provider (surgeon volume, academic hospital status) factors. Of 1332 patients who underwent meniscal repair and ACLR, 1239 (93%) were matched with patients who underwent meniscal repair alone. The rate of meniscal reoperation was 9.7% in the combined cohort compared with 16.7% in the repair alone cohort (P < .0001). In the regression analysis, only ACLR was protective against meniscal reoperation (odds ratio, 0.57; P < .0001). Surgeon volume of meniscal repair did not influence outcome. A meniscal repair performed in conjunction with ACLR carries a 7% absolute and 42% relative risk reduction of reoperation after 2 years compared with isolated meniscal repair.

  7. Development and Characterization of UHMWPE Fiber-Reinforced Hydrogels For Meniscal Replacement

    Science.gov (United States)

    Holloway, Julianne Leigh

    Meniscal tears are the most common orthopedic injuries to the human body. The current treatment of choice, however, is a partial meniscectomy that leads to osteoarthritis proportional to the amount of tissue removed. As a result, there is a significant clinical need to develop materials capable of restoring the biomechanical contact stress distribution to the knee after meniscectomy and preventing the onset of osteoarthritis. In this work, a fiber-reinforced hydrogel-based synthetic meniscus was developed that allows for tailoring of the mechanical properties and molding of the implant to match the size, shape, and property distribution of the native tissue. Physically cross-linked poly(vinyl alcohol) (PVA) hydrogels were reinforced with ultrahigh molecular weight polyethylene (UHMWPE) fibers and characterized in compression (0.1-0.8 MPa) and tension (0.1-250 MPa) showing fine control over mechanical properties within the range of the human meniscus. Morphology and crystallinity analysis of PVA hydrogels showed increases in crystallinity and PVA densification, or phase separation, with freeze-thaw cycles. A comparison of freeze-thawed and aged, physically cross-linked hydrogels provided insight on both crystallinity and phase separation as mechanisms for PVA gelation. Results indicated both mechanisms independently contributed to hydrogel modulus for freeze-thawed hydrogels. In vitro swelling studies were performed using osmotic solutions to replicate the swelling pressure present in the knee. Minimal swelling was observed for hydrogels with a PVA concentration of 30-35 wt%, independently of hydrogel freeze-thaw cycles. This allows for independent tailoring of hydrogel modulus and pore structure using freeze-thaw cycles and swelling behavior using polymer concentration to match a wide range of properties needed for various soft tissue applications. The UHMWPE-PVA interface was identified as a significant weakness. To improve interfacial adhesion, a novel

  8. Tears of popliteomeniscal fascicles, diagnostic and clinical implications. A review of the evidence.

    Science.gov (United States)

    Papalia, R; Simonetta, R; Di Vico, G; Torre, G; Saccone, L; Espregueira-Mendes, J; Denaro, V

    2016-01-01

    Postero-lateral corner of the knee is composed of several structures including the popliteo-meniscal fascicles (PMFs). These fibrous structures form a stable ligamentous complex around the popliteus tendon, which stabilize the lateral meniscus, increasing the strength of postero-lateral corner. Studies were retrieved through an electronic search of CINAHL, EMBASE, and Pub-Med, until May 2016. Studies in English, Italian, French, and Spanish were considered for inclusion. Randomized controlled trials, prospective and retrospective comparative studies, case series, and case reports were included. Studies eligible for inclusion concerned PMFs anatomy, biomechanics, diagnostic assessment of PMFs tears and clinical options for tears management. Thirteen studies were included in this review. There were: 7 case series, 4 case reports and 3 anatomical studies. Through anatomic dissection, two or three PMFs (antero-inferior fascicle, aiPMF; postero-superior fascicle, psPMF; postero-inferior fascicle, piPMF) can be indentified and isolated. Evaluation through MRI can be a useful diagnostic tool in detecting PMFs tears, especially using proton density (PD) sequences. The biomechanical analysis assessed that lateral meniscus (LM) motion is directly related with PMFs integrity and increased with section of one or both the fascicles. The clinical studies clearly state that a snapping syndrome, associated with lateral knee pain, can develop when one or both PMFs are torn. The three PMFs described are considered as relevant components of the popliteal hiatus, in the posterolateral aspect of the knee. MRI evaluation can detect these fibrous fascicles with good sensitivity. More studies with larger samples would be needed for a clear comprehension of PMFs function and clinical management of PMFs tears, especially with large case series and modern biomechanical testing.

  9. Software Simulation of Hot Tearing

    DEFF Research Database (Denmark)

    Andersen, S.; Hansen, P.N.; Hattel, Jesper Henri

    1999-01-01

    . With this additional information, the criteria can, for the first time, be used to their full potential.The purpose of this paper is to first give an introduction to a stress/strain simulation procedure that can be used in any foundry. Then, some results how to predict the hot cracking tendency in a casting are shown......The brittleness of a solidifying alloy in a temperature range near the solidus temperature has been recognised since the fifties as the mechanism responsible for hot tearing. Due to this brittlenes, the metal will crack under even small amounts of strain in that temperature range. We see these hot...... the solidification rate and the strain rate of the hot tear prone areas. But, until recently it was only possible to simulate the solidification rate, so that the criteria could not be used effectively.Today, with new software developments, it is possible to also simulate the strain rate in the hot tear prone areas...

  10. Knee function and knee muscle strength in middle-aged patients with degenerative meniscal tears eligible for arthroscopic partial meniscectomy

    DEFF Research Database (Denmark)

    Stensrud, Silje; Risberg, May Arna; Roos, Ewa M.

    2014-01-01

    with a population-based reference group and similar to patients prior to anterior cruciate ligament reconstruction. Quadriceps strength and lower-extremity performance were impaired for the injured leg compared with the non-injured leg (p10% differences between the injured and the non-injured leg....

  11. Tear gas: an epidemiological and mechanistic reassessment

    National Research Council Canada - National Science Library

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R; Jordt, Sven‐Eric

    2016-01-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong...

  12. Acute Medial Plantar Fascia Tear.

    Science.gov (United States)

    Pascoe, Stephanie C; Mazzola, Timothy J

    2016-06-01

    A 32-year-old man who participated in competitive soccer came to physical therapy via direct access for a chief complaint of plantar foot pain. The clinical examination findings and mechanism of injury raised a concern for a plantar fascia tear, so the patient was referred to the physician and magnetic resonance imaging was obtained. The magnetic resonance image confirmed a high-grade, partial-thickness, proximal plantar fascia tear with localized edema at the location of the medial band. J Orthop Sports Phys Ther 2016;46(6):495. doi:10.2519/jospt.2016.0409.

  13. Autophagy protects meniscal cells from glucocorticoids-induced apoptosis via inositol trisphosphate receptor signaling.

    Science.gov (United States)

    Shen, Chao; Gu, Wen; Cai, Gui-Quan; Peng, Jian-Ping; Chen, Xiao-Dong

    2015-09-01

    Intra-articular injection of glucocorticoids (GCs) has been widely used in the management of osteoarthritis and rheumatoid arthritis. Nevertheless, several studies showed that GCs had toxic effects on chondrocytes as well as synovial cells. Previously we reported the protective role of autophagy in the degeneration of meniscal tissues. However, the effects of GCs on autophagy in the meniscal cells have not been fully elucidated. To investigate whether GCs can regulate autophagy in human meniscal cells, the meniscal cells were cultured in vitro and exposed in the presence of dexamethasone. The levels of apoptosis and autophagy were investigated via flow cytometry as well as western blotting analysis. The changes of the aggrecanases were measured using real-time PCR. The role of autophagy in dexamethasone-induced apoptosis was investigated using pharmacological agents and RNA interference technique. An agonist of inositol 1,4,5-trisphosphate receptor (IP3R) was used to investigate the mechanism of dexamethasone-induced autophagy. The results showed that dexamethasone induced autophagy as well as apoptosis in normal human meniscal cells. Using RNA interference technique and pharmacological agents, our results showed that autophagy protected the meniscal cells from dexamethasone-induced apoptosis. Our results also indicated that dexamethasone increased the mRNA levels of aggrecanases. This catabolic effect of dexamethasone was enhanced by 3-MA, the autophagy inhibitor. Furthermore, our results showed that dexamethasone induced autophagy via suppressing the phosphorylation of IP3R. In summary, our results indicated that autophagy protected meniscal cells from GCs-induced apoptosis via inositol trisphosphate receptor signaling.

  14. Effects of radial tears and partial meniscectomy of lateral meniscus on the knee joint mechanics during the stance phase of the gait cycle--A 3D finite element study.

    Science.gov (United States)

    Mononen, Mika E; Jurvelin, Jukka S; Korhonen, Rami K

    2013-08-01

    The purpose of the current study was to evaluate influences of radial tears and partial meniscectomy of lateral meniscus on the knee joint mechanics during normal walking by using computational modeling. A 3D geometry of a knee joint of a healthy patient was obtained from our previous study, whereas the data of normal walking were taken from the literature. Cartilage tissue was modeled as a fibril reinforced poroviscoelastic material, whereas meniscal tissue was modeled as a transverse isotropic elastic material. The realistic gait cycle data were implemented into the computational model and the effects of radial tears and partial meniscectemy of lateral meniscus on the knee joint mechanics were simulated. Middle, posterior, and anterior radial tears in lateral meniscus increased stresses by 300%, 430%, and 1530%, respectively, at the ends of tears compared to corresponding areas in the model with intact lateral meniscus. Meniscus tears did not alter stresses and strains at the tibial cartilage surface, whereas partial meniscectomy increased contact pressures, stresses, strains and pore pressures in the tibial cartilage by 50%, 44%, 21%, and 43%, respectively. Increased stresses and strains were observed primarily during the first ∼50% of the stance phase of the gait cycle. The present study suggests that anterior radial tear causes the highest risk for the development of total meniscal rupture, whereas partial meniscectomy increases the risk for the development of OA in lateral tibial cartilage. Highest risks for meniscus and cartilage failures are suggested to occur during the loading response and mid-stance of the gait cycle. In the future, the present modeling may be further developed to offer a clinical tool for aid in decision making of clinical interventions for patients with knee joint injuries. Copyright © 2013 Orthopaedic Research Society.

  15. Identification, Characterization, and Utilization of Adult Meniscal Progenitor Cells

    Science.gov (United States)

    2015-09-01

    the joint capsule immediately medial to the patellar tendon was incised and opened with a #15 blade . Without cutting the ligaments, the medial...of the meniscus was made, the knees were fixed and processed for histological analysis. Figure 5. Histological analysis of surgical tears of medial...We therefore tested either left or right knee menisci from one mouse, or pooled the data on the menisci of the same mouse. Histology images were taken

  16. Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy.

    Science.gov (United States)

    Zhang, Alan L; Miller, Stephanie L; Coughlin, Dezba G; Lotz, Jeffrey C; Feeley, Brian T

    2015-10-01

    To test contact pressures in the knee after treatment of a radial meniscus tear with an all-inside meniscal repair technique and compare the results with inside-out repair and partial meniscectomy. Six non-paired cadaveric knees were analyzed with intra-compartment pressures measured at loads of 250 N, 500 N and 1000 N at 0°, eight degrees, 15°, and 30° of knee flexion. Compartmental contact pressures were measured for the intact medial meniscus, radial tear in the posterior horn, all-inside repair using the NovoStitch suture passer device (Ceterix Orthopaedics Inc., Menlo Park, CA), inside-out repair method, and partial meniscectomy. One-way ANOVA was used for statistical analysis. The greatest differences in peak pressures between treatments were observed under 1000 N load at 30° flexion (0.8± (SD) 0.1 MPa (intact meniscus), 0.8± (SD) 0.1 MPa (all-inside), 0.9± (SD) 0.1 MPa (inside-out) and 1.6± (SD) 0.2 MPa (partial meniscectomy)). Treatment with partial meniscectomy resulted in the highest peak pressures compared to all other states (pinside technique as well as the inside-out technique resulted in significantly decreased compartment pressures compared to partial meniscectomies (pinside or inside-out techniques. An all-inside repair technique using the NovoStitch suture passer can decrease contact pressures for a radial meniscus tear similarly to the inside-out repair technique when compared to partial meniscectomy. This novel arthroscopic suture passer warrants further analysis in the clinical setting as it may be a reliable method for repair of radial meniscal tears through an arthroscopic all-inside technique. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. Meniscal repair by all-inside technique with Fast-Fix device

    Directory of Open Access Journals (Sweden)

    Leonardo Jose Bernardes Albertoni

    2013-09-01

    Full Text Available OBJECTIVE: The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device. METHODS: A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Student's t test. RESULTS: The mean follow-up was 59 months (16-84. The Lysholm score showed 72% (16 patients of excellent and good results (84-100 points, 27% (6 patients fair (65-83 points and no cases classified as poor (<64 points. According to the IKDC: 81% (18 patients of excellent and good results (75-100 points, 18% of cases regular (50-75 points and no patient had poor results (<50 points. There were no failures or complications. CONCLUSION: The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.

  18. Isolation, Characterization, and Multipotent Differentiation of Mesenchymal Stem Cells Derived from Meniscal Debris

    Directory of Open Access Journals (Sweden)

    Weili Fu

    2016-01-01

    Full Text Available This study aimed to culture and characterize mesenchymal stem cells derived from meniscal debris. Cells in meniscal debris from patients with meniscal injury were isolated by enzymatic digestion, cultured in vitro to the third passage, and analyzed by light microscopy to observe morphology and growth. Third-passage cultures were also analyzed for immunophenotype and ability to differentiate into osteogenic, adipogenic, and chondrogenic lineages. After 4-5 days in culture, cells showed a long fusiform shape and adhered to the plastic walls. After 10–12 days, cell clusters and colonies were observed. Third-passage cells showed uniform morphology and good proliferation. They expressed CD44, CD90, and CD105 but were negative for CD34 and CD45. Cultures induced to differentiate via osteogenesis became positive for Alizarin Red staining as well as alkaline phosphatase activity. Cultures induced to undergo adipogenesis were positive for Oil Red O staining. Cultures induced to undergo chondrogenesis were positive for staining with Toluidine Blue, Alcian Blue, and type II collagen immunohistochemistry, indicating cartilage-specific matrix. These results indicate that the cells we cultured from meniscal debris are mesenchymal stem cells capable of differentiating along three lineages. These stem cells may be valuable source for meniscal regeneration.

  19. Ultrasound-guided percutaneous drainage of meniscal cysts: preliminary clinical experience

    Energy Technology Data Exchange (ETDEWEB)

    MacMahon, P.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)]. E-mail: petermacmahon@yahoo.com; Brennan, D.D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Duke, D. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Forde, S. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland); Eustace, S.J. [Department of Radiology, Cappagh National Orthopaedic Hospital, Finglas, Dublin (Ireland)

    2007-07-15

    Aim: To evaluate the efficacy of ultrasound-guided percutaneous drainage of symptomatic meniscal cysts. Materials and methods: Patients with lateral knee joint tenderness and swelling and confirmed meniscal cyst on magnetic resonance imaging (MRI) were consecutively enrolled for ultrasound-guided percutaneous cyst aspiration. Cysts were injected with local anaesthetic and steroid before completion of procedure. All 18 patients (all male, average age 33 years) were subsequently followed up (average time 10 months) and meniscal cyst symptoms assessed by questionnaire. Fischer's exact test used to analyse the data. Results: In every case the procedure was well tolerated, and each patient indicated that they would be willing to have a repeat procedure in the future. Ten patients reported complete resolution of symptoms secondary to therapeutic cyst aspiration and had resumed participation in high-performance sport. Two patients reported a satisfactory sustained response, reporting only occasional 'twinges of pain'. In the remaining six patients, symptoms returned after an initial pain-free period. The pain-free period ranged from 1-8 weeks. In this study, patient outcome did not significantly correlate with any meniscal cyst characteristic. Conclusion: Ultrasound-guided percutaneous aspiration of meniscal cysts is a well-tolerated, simple, and safe procedure. In this small patient series, it was associated with positive early results with favourable outcomes in the mid to long-term. It should be considered in patients unsuitable for surgical debridement or as an interim therapy if surgery is delayed or postponed.

  20. Inappropriate use of arthroscopic meniscal surgery in degenerative knee disease

    Science.gov (United States)

    Muheim, Leander L S; Senn, Oliver; Früh, Mathias; Reich, Oliver; Rosemann, Thomas; Neuner-Jehle, Stefan M

    2017-01-01

    Background and purpose Current evidence suggests that arthroscopic knee surgery has no added benefit compared with non-surgical management in degenerative meniscal disease. Yet in many countries, arthroscopic partial meniscectomy (APM) remains among the most frequently performed surgeries. This study quantifies and characterizes the dynamics of the current use of knee arthroscopies in Switzerland in a distinctively non-traumatic patient group. Methods We assessed a non-accident insurance plan of a major Swiss health insurance company for surgery rates of APM, arthroscopic debridement and lavage in patients over the age of 40, comparing the years 2012 and 2015. Claims were analyzed for prevalence of osteoarthritis, related interventions and the association of surgery with insurance status. Results 648,708 and 647,808 people were examined in 2012 and 2015, respectively. The incidence of APM, debridement, and lavage was 388 per 105 person-years in 2012 and 352 per 105 person-years in 2015 in non-traumatic patients over the age of 40, consisting mostly of APM (96%). Between years, APM surgery rates changed in patients over the age of 65 (p arthroscopic knee surgery. Interpretation APM is widely used in non-traumatic patients in Switzerland, which contrasts with current evidence. Many procedures take place in patients with degenerative knee disease. Surgery rates were similar in non-traumatic middle-aged patients between 2012 and 2015. Accordingly, the potential of inappropriate use of APM in non-traumatic patients in Switzerland is high. PMID:28665174

  1. In vivo assessment of weight-bearing knee flexion reveals compartment-specific alterations in meniscal slope.

    Science.gov (United States)

    Lustig, Sebastien; Scholes, Corey J; Balestro, Jean-Christian; Parker, David A

    2013-10-01

    The purpose of this study was to determine the effects of flexion angle on meniscal slope during partial weight-bearing knee flexion. Forty-eight sagittal sequences were performed on 12 patients (6 male patients, 6 female patients; 25.7 ± 10.5 years) during partial weight bearing in an open magnetic resonance imaging (MRI) scanner at full extension, 60°, 90°, and maximum knee flexion. A previously published method was used to measure the meniscal slope for each compartment using manual digitalization. A general linear model was used to test for effects of compartment and flexion angle on meniscal slope. The mean maximum flexion angle achieved was 125° ± 10.5°. A significant main effect of compartment (P knee flexion (P = .031). The results showed that meniscal slope in healthy knees increased significantly with knee flexion for both menisci, with significantly greater changes in the lateral meniscus. Furthermore, a lack of correlation was observed between the meniscal slope in extension and the meniscal slope at increasing flexion angles, questioning the efficacy of measuring the meniscal slope only in extension as commonly described. Overall, this study has provided valuable insight into how meniscal slope changes with knee motion. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  2. Effects of tear size and location on predictions of supraspinatus tear propagation.

    Science.gov (United States)

    Miller, R Matthew; Thunes, James; Musahl, Volker; Maiti, Spandan; Debski, Richard E

    2018-02-08

    Rotator cuff tears remain a significant clinical problem with a high incidence rate and severe clinical burden. Previous computational models developed to study rotator cuff tears have not modeled tissue damage and tear propagation. The objective of this study was to predict tear propagation for various combinations of tear size and location using an experimentally validated finite element model of supraspinatus tendon. It was hypothesized that larger rotator cuff tears propagate at lower loads than smaller tears, and that posterior tears require higher loads to propagate than anterior tears. Using a previously validated computational model of supraspinatus tendon, tears of size 0.5-1.5 cm were introduced to the tendon geometry in the anterior, middle, and posterior tendon thirds. Cohesive elements were assigned subject-specific failure properties and used to model tissue damage and tear propagation. A displacement of 5 mm was applied to the medial tendon edge to induce tear propagation. Model outputs included critical load required to propagate the tear, and principal stress and maximum principal strain at the anterior and posterior tear tips. For all tear sizes, posterior tears required the highest loads to propagate (247-567 N). Anterior tears generally required the least load to propagate (171-280 N). Stress and strain were larger on the articular side (maximum 33.9% articular strain vs 27.8% bursal strain). Overall, larger tears located in the anterior supraspinatus tendon that interrupt the rotator cable are most at risk for tear propagation, and should be carefully followed by clinicians when considering treatment options. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Comparison of tear lipid profile among basal, reflex, and flush tear samples.

    Science.gov (United States)

    Rohit, Athira; Stapleton, Fiona; Brown, Simon H J; Mitchell, Todd W; Willcox, Mark D P

    2014-12-01

    To determine whether tear collection by flushing the ocular surface with saline (flush tears) or collection by stimulation (reflex tears) can be used as an alternative to basal tear collection for the identification and quantification of lipids in the tear film. Tear samples were collected from 10 participants with no history of ocular surface disease or contact lens wear. Up to 10 μl of basal, reflex, and flush tear samples were collected from each eye using a microcapillary tube on three occasions with the order of methods randomized and allowing at least 24 hours between each collection method. Lipids were quantified from each tear sample using nano-electrospray ionization tandem mass spectrometry. Total lipids significantly differed in their concentration (pmol/μl) and mole % with each collection technique. Cholesterol esters [mean % (SE)] formed the major component of the total lipidome in basal [54.8% (3.1)], reflex [35.7% (6.4)], and flush [33.0% (3.1)] tear samples. However, the mole % of each lipid class substantially varied with each tear collection method. Nonpolar lipids, including cholesterol, wax esters, and triacylglycerols, dominated the tear lipidome in basal [92.8% (1.9)], reflex [71.8% (7.9)], and flush [83.6% (3.8)] tear samples. However, the mole % of phospholipids in reflex [27.5% (8.1)] and flush [15.8% (3.8)] tear samples was higher (p = 0.005) than that in basal tears [5.4% (2.0)]. Flush or reflex tears did not have similar lipid profiles in either concentration or in mole % to basal tears. It is recommended that basal tears are used for tear lipid analysis as the reflex or flush tears contain very low levels of most lipid components.

  4. MRI of the knee: how do field strength and radiologist's experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament?

    Energy Technology Data Exchange (ETDEWEB)

    Krampla, W.; Roesel, M.; Svoboda, K.; Nachbagauer, A.; Gschwantler, M.; Hruby, W. [Donauspital, Radiology Department, Vienna (Austria)

    2009-06-15

    Accuracy of MRI reports is taken for granted. In this paper the inter-observer reliability in the interpretation of meniscal lesions, degree of chondropathy, and integrity of the ACL was analyzed while taking the radiologist's experience and field strength into account. Fifty-two MRI studies of knees were interpreted by 11 radiologists independently. Twenty-two were acquired on 1.0-T, 20 on 1.5-T, and 10 on 3.0-T systems. Four of the radiologists had more than 5 years and seven had 3 to 5 years of experience in interpreting MRI studies. The findings were compared with the intra-operative findings. Inter-observer variance, specificity, and sensitivity were evaluated for each field strength. Inter-observer correlation ranged between 0.370 for cartilage lesions and 0.597 for meniscal tears. Correlation values did not increase with experience or field strength. The number of false reports was dependent on the observer, but not on field strength. The rate of false interpretations was significantly higher for most criteria in the less experienced group. In conclusion, inter-observer correlation was low, although the diagnostic criteria were defined. The use of the classification scheme should be standardized by uniform training. Radiologist experience seems to be more important than field strength. (orig.)

  5. Reduced tear meniscus dynamics in dry eye patients with aqueous tear deficiency.

    Science.gov (United States)

    Yuan, Yimin; Wang, Jianhua; Chen, Qi; Tao, Aizhu; Shen, Meixiao; Shousha, Mohamed Abou

    2010-06-01

    To measure the tear meniscus dynamics in aqueous tear deficiency dry eye patients using optical coherence tomography. Clinical research study of a laboratory technique. Twenty-five aqueous tear deficiency dry eye patients and 30 healthy subjects were recruited. Upper and lower tear menisci of 1 randomly selected eye of each participant were imaged during normal and delayed blinking using optical coherence tomography. Measured parameters included upper tear meniscus height and volume, lower tear meniscus height and volume, the blink outcome defined as the meniscus volume change during blink action, and open eye outcome defined as the meniscus volume change during the open eye period. During normal blinking, both tear meniscus height and volume before blink in dry eye patients were significantly smaller than those in healthy subjects, except for the upper tear meniscus volume. During normal blinking, the blink outcome and open eye outcome of lower tear meniscus were significantly smaller in dry eye patients compared with healthy subjects. During delayed blinking, the upper and lower tear menisci heights and volumes significantly increased in both groups. However, dry eye patients had smaller increases than healthy subjects. During delayed blinking, the open eye outcomes of upper and lower tear menisci were smaller in dry eye patients than healthy subjects. Dry eye patients seem to have reduced tear meniscus dynamics during normal blinking and smaller increases of meniscus volume during delayed blinking. Analysis of tear meniscus dynamics may provide more insight in the altered tear system in dry eye patients. Copyright 2010 Elsevier Inc. All rights reserved.

  6. FasT-Fix versus inside-out suture meniscal repair in the goat model.

    Science.gov (United States)

    Hospodar, Steven J; Schmitz, Matthew R; Golish, S Raymond; Ruder, Craig R; Miller, Mark D

    2009-02-01

    Recent all-inside meniscal repair devices are available, but in vivo studies with these devices are sparse. The FasT-Fix has inferior meniscal healing compared with the inside-out suture technique in the goat model. Controlled laboratory study. After Institutional Review Board approval, 73 male castrated goats (Capra hircus) underwent a 2-cm meniscal incision and subsequent repair with the FasT-Fix device on one knee and inside-out meniscal repair on the contralateral knee. Both repairs used a vertical mattress suture technique. Access to the menisci was via an open technique with an extra-articular osteotomy of the medial collateral ligament origin on the femur. The animals were then allowed to ambulate unrestricted in a pasture after a 7-day stay in cages. Necropsy was carried out 6 months postoperatively, and the menisci and articular cartilage were studied with gross and microscopic inspection. Nine of the 73 animals were excluded before necropsy. A total of 64 animals underwent necropsy, gross measurement of residual lesions, gross evaluation for chondral damage, histologic evaluation of meniscal repair, histologic evaluation of any adjacent inflammatory reaction to implants, and data analysis. Compared with the inside-out group, the FasT-Fix group had longer residual full-thickness defects (1.2 +/- 2.9 mm vs 0.2 +/- 1.1 mm; P = .011) and longer residual partial-thickness defects (8.4 +/- 6.3 mm vs 3.6 +/- 5.5 mm; P inside-out meniscal repair technique in the goat model. The clinical significance of this finding is not known. Further clinical study of the FasT-Fix implant is warranted.

  7. Actifit synthetic meniscal substitute: experience with 18 patients in Brest, France.

    Science.gov (United States)

    Baynat, C; Andro, C; Vincent, J P; Schiele, P; Buisson, P; Dubrana, F; Gunepin, F X

    2014-12-01

    The management of post-meniscectomy pain is poorly standardised. Allogeneic transplantation may be appropriate in some patients after total meniscectomy. After partial meniscectomy, the synthetic meniscal substitute Actifit may constitute a valid option if the knee is stable or stabilised and aligned or re-aligned. The interconnected pore structure of Actifit promotes tissue regeneration from the meniscal wall. Arthroscopy is used to position the implant, which is then sutured to the remaining native meniscus using horizontal stitches and to the meniscal wall using vertical stitches. However, a burdensome programme of rigorous rehabilitation is required after Actifit implantation. We hypothesised that implantation of a meniscal substitute effectively alleviated pain without adversely affecting the knee. To assess the intra-articular behaviour of Actifit and the outcomes of Actifit implantation in a prospective case-series of patients monitored using arthroscopy, pathology, and imaging studies, as well as the Lysholm score to assess clinical benefits on daily activities. Between October 2009 and April 2012, 18 patients underwent Actifit implantation at the military hospital in Brest, France. All procedures were performed by the same surgeon, who had extensive experience with meniscal suturing. There were 13 males and 5 females aged 20 to 46 years. The medial meniscus was involved in 13 patients and the lateral meniscus in 5 patients. Actifit implantation was used alone in 6 patients and in combination with anterior cruciate ligament reconstruction and/or realignment osteotomy in 12 patients. All patients were followed-up for at least 2 years. The mean Lysholm score after 1 year was 92%, indicating excellent outcomes. Magnetic resonance imaging showed no damage to the implant or degeneration of the neighbouring cartilage. Histological examination of meniscal substitute biopsies taken 1 year after implantation showed polymer ingrowth by normal chondrocytes and

  8. TFOS DEWS II Tear Film Report.

    Science.gov (United States)

    Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

    2017-07-01

    The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Posterior root tears of the lateral meniscus.

    Science.gov (United States)

    Feucht, Matthias J; Salzmann, Gian M; Bode, Gerrit; Pestka, Jan M; Kühle, Jan; Südkamp, Norbert P; Niemeyer, Philipp

    2015-01-01

    To summarize and discuss the current knowledge on posterior lateral meniscus root tears. A comprehensive review of the MEDLINE database was carried out to identify relevant articles using different keywords (e.g. "meniscus root", "root tear", "meniscus avulsion", "radial tear" and "lateral meniscus"). The reference lists of the reviewed articles were searched for additional relevant articles. Posterior lateral meniscus root tears are found in 7-12% of patients with a tear of the anterior cruciate ligament (ACL). Biomechanical studies have found an increase in lateral compartment contact pressure of approximately 50% after creation of a posterior lateral meniscus root tear. There is some evidence that the biomechanical consequences of these injuries are significantly influenced by the presence and integrity of the meniscofemoral ligaments. Clinical studies have found encouraging results after repair of posterior lateral meniscus root tears. Whether root repair can prevent the development of osteoarthritis is currently unknown. A posterior lateral meniscus root tear is a clinical relevant but most likely underrecognized concomitant injury in patients with a tear of the ACL. This article may support clinicians in diagnosing and treating this unique type of meniscus tear. V.

  10. Artificial tears potpourri: a literature review

    Directory of Open Access Journals (Sweden)

    Moshirfar M

    2014-07-01

    Full Text Available Majid Moshirfar,1 Kasey Pierson,2,* Kamalani Hanamaikai,3,* Luis Santiago-Caban,1 Valliammai Muthappan,1 Samuel F Passi11Department of Ophthalmology, John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA; 2University of Arizona College of Medicine, Phoenix, Phoenix, AZ, USA; 3A T Still University, School of Osteopathic Medicine in Arizona, Mesa, AZ, USA *These authors contributed equally to this work Abstract: Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. Keywords: dry eye, tear film, dysfunctional tear syndrome, ophthalmic lubricant, artificial tears, lipid layer, tear osmolarity, TBUT, Systane®, Refresh®, Blink®, GenTeal®, Soothe®, Lacrisert®, ocular surface inflammatory disease, Sjogren

  11. Repeated measurements of dynamic tear distribution on the ocular surface after instillation of artificial tears.

    Science.gov (United States)

    Wang, Jianhua; Aquavella, James; Palakuru, Jayachandra; Chung, Suk

    2006-08-01

    To determine the repeatability of real-time optical coherence tomography (OCT) measurements of tear film thickness (TFT) and variables of tear film menisci. Forty eyes were imaged with a custom-built, real-time OCT to obtain heights, curvatures, and cross-sectional areas of upper and lower tear menisci simultaneously. The central TFT was indirectly determined as the difference between the combined thickness of the central cornea and tear film and the true corneal thickness obtained after instillation of artificial tears. Dynamic tear distribution was determined by OCT imaging immediately and 5, 20, 40, and 60 minutes after tear instillation. Measurements taken after two blinks of one eye at each visit were repeated on the next day. Measurements from the companion eye were made on separate days. There were no significant differences between the two measurements of each variable made on consecutive days. At baseline, upper tear meniscus variables were strongly correlated with the comparable lower meniscus variables. However, there were no significant correlations between TFT and any tear meniscus variable. Immediately after instillation of artificial tears, all measured variables increased significantly. TFT, upper and lower menisci heights, and upper meniscus area remained elevated for at least 5 minutes. In addition there were significant correlations between TFT and the lower tear meniscus height and area. The custom-built OCT showed good repeatability and holds promise in measuring the dynamic distribution of artificial tears on the ocular surface.

  12. Meniscal tissue regeneration in porous 50/50 copoly(L-lactide/epsilon-caprolactone) implants

    NARCIS (Netherlands)

    de Groot, J. H.; Zijlstra, F. M.; Kuipers, HW; Pennings, A. J.; Veth, RPH; Jansen, HWB

    Porous materials of a high-molecular-weight 50/50 copolymer of L-lactide and epsilon-caprolactone with different compression moduli were used for meniscal repair. In contrast to the previously used 4,4'-diphenylmethane and 1,6-trans-cyclohexane diisocyanates containing polyurethanes, degradation

  13. Biomechanics of the meniscus-meniscal ligament construct of the knee.

    Science.gov (United States)

    Masouros, S D; McDermott, I D; Amis, A A; Bull, A M J

    2008-12-01

    The menisci of the knee act primarily to redistribute contact force across the tibio-femoral articulation. This meniscal function is achieved through a combination of the material, geometry and attachments of the menisci. The main ligaments that attach the menisci to the tibia (insertional ligaments, deep medial collateral ligament), the femur (meniscofemoral ligaments, deep medial collateral ligament) and each other (the anterior intermeniscal ligament) are the means by which the contact force between tibia and femur is distributed into hoop stresses in the menisci to reduce contact pressure at the joint. This means that the functional biomechanics of the menisci cannot be considered in isolation and should be considered as the functional biomechanics of the meniscus-meniscal ligament construct. This article presents the current knowledge on the anatomy and functional biomechanics of the meniscus and its associated ligaments. Much is known about the function of the meniscus-meniscal ligament construct; however, there still remain significant gaps in the literature in terms of the properties of the anterior intermeniscal ligament and its function, the properties of the insertional ligaments, and the most appropriate ways to reconstruct meniscal function surgically.

  14. Effects of suture site or penetration depth on anchor location in all-inside meniscal repair.

    Science.gov (United States)

    Uchida, Ryohei; Mae, Tatsuo; Hiramatsu, Kunihiko; Iuchi, Ryo; Kinugasa, Kazutaka; Shino, Konsei; Yoshikawa, Hideki; Nakata, Ken

    2016-12-01

    To evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair. Eight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection. Of 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups. Secure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location. Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation. Copyright © 2016 Elsevier B.V. All rights reserved.

  15. A review on hot tearing of magnesium alloys

    Directory of Open Access Journals (Sweden)

    Jiangfeng Song

    2016-09-01

    Full Text Available Hot tearing is often a major casting defect in magnesium alloys and has a significant impact on the quality of their casting products. Hot tearing of magnesium alloys is a complex solidification phenomenon which is still not fully understood, it is of great importance to investigate the hot tearing behaviour of magnesium alloys. This review attempts to summarize the investigations on hot tearing of magnesium alloys over the past decades. The hot tearing criteria including recently developed Kou's criterion are summarized and compared. The numeric simulation and assessing methods of hot tearing, factors influencing hot tearing, and hot tearing susceptibility (HTS of magnesium alloys are discussed.

  16. Tear gas: an epidemiological and mechanistic reassessment.

    Science.gov (United States)

    Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R; Jordt, Sven-Eric

    2016-08-01

    Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved-with aerial drone systems tested and requested by law enforcement-epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain-sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals, Inc. on behalf of New York Academy of Sciences.

  17. Interferometric characterization of tear film dynamics

    Science.gov (United States)

    Primeau, Brian Christopher

    The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

  18. Tear exchange and contact lenses: a review.

    Science.gov (United States)

    Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

    2015-01-01

    Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

  19. Effect of Ramadan Fasting on Tear Proteins

    Directory of Open Access Journals (Sweden)

    Reyhaneh Sariri

    2010-01-01

    Full Text Available Muslims abstain from eating, drinking and smoking from dawn to sunset during the holy month of Ramadan. Prolonged fasting is thought to be among risk factors for many diseases, e.g., cardiovascular, gastrointestinal and various infectious diseases. It could also play a part in several eye diseases, including dry eye syndrome, glaucoma, and cataract. Toxic and oxidative effects due to increased concentrations of some biochemicals as a result of reduction in tear volume thought to play an important role in damaging ocular tissue. Human tear is an important biological fluid similar to blood in many aspects. Tear film is composed of three basic layers i.e. lipid, aqueous and mucin. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier, and endures an optical refractive surface. The aim of this study was to analyze and compare tear protein of volunteers during fasting. Using two reliable analytical methods, i.e. electrophoresis and high performance liquid chromatography (HPLC, we compared tear protein content of sixty volunteers (35 males and 25 females, 23–27 years old during fasting in holly month of Ramadan (FAST: n=62 and one month before Ramadan (CTRL: n=60. The results showed that some identified tear proteins decreased during fasting. On the other hand, the activity of some enzymes such as lysozyme, lactoferrin and alpha amylase also decreased in fasting samples. Electrophoresis results showed that tear protein patterns in FAST (PP<0.005 than in CTRL.

  20. Identification of lactoferrin in bovine tears.

    Science.gov (United States)

    Brown, M H; Brightman, A H; Fenwick, B W; Rider, M A

    1996-09-01

    To determine whether bovine tear film contains the iron-binding glycoprotein, lactoferrin. 40 Adult Hereford, Angus, and Simmental cattle. Protein analysis: pooled bovine tears were used for protein analysis (size exclusion high-performance liquid chromatography [HPLC] fractionation). HPLC was used for tear analysis. A diode array detector was used (215 and 280 microns) for chromatogram analysis and comparisons. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE): protein electrophoresis was performed, using 7.5% running gels with 4% stacking gels. Molecular weight of proteins in the unknown samples was determined as recommended by the manufacturer of the standards. Protein sequencing: amino acid sequencing, using automated Edman degradation of HPLC purified protein, was performed. The sequence obtained was compared with the known protein sequence of bovine lactoferrin. HPLC analysis of whole bovine tears resulted in a consistent chromatogram. Peak collection was performed to recover a protein from the bovine tear film with chromatogram characteristics nearly identical to purified bovine lactoferrin. Silver-stained SDS-PAGE of this peak revealed a band with molecular mass consistent with bovine lactoferrin (estimated mass of 78 kd). The first 13 amino acid residues of this protein were identical to the amino acid sequence of bovine lactoferrin. Analysis of whole bovine tears, using size exclusion HPLC, SDS-PAGE, and amino acid sequencing, provided evidence that bovine tears contain lactoferrin. Lactoferrin probably exerts a bacteriostatic effect in bovine tear film. Locally produced lactoferrin may bathe the ocular surface and sequester iron from potential pathogens.

  1. Tear Osmolarity and Tear Film Parameters in Patients With Ocular Rosacea.

    Science.gov (United States)

    Karaman Erdur, Sevil; Eliacik, Mustafa; Kocabora, Mehmet Selim; Balevi, Ali; Demirci, Goktug; Ozsutcu, Mustafa; Gulkilik, Gokhan; Aras, Cengiz

    2016-11-01

    The aim of this study was to evaluate tear osmolarity and tear film parameters in patients with ocular rosacea. In a single center, 25 eyes of 25 patients with ocular rosacea (group 1), 25 eyes of 25 patients with rosacea without ocular involvement (group 2), and 20 eyes of 20 healthy individuals (group 3) were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), scoring of ocular surface fluorescein staining using modified Oxford scale, and tear osmolarity. Tear osmolarity values, OSDI and Oxford scale scores were significantly higher in group 1 than in groups 2 and 3 (Ptear osmolarity between groups 2 and 3 (P=0.629, P=0.175, P=0.713, P=865, and P=0.388, respectively). This study showed that ocular rosacea is associated with tear hyperosmolarity and tear film dysfunction.

  2. Importance of meniscal injury diagnosis and surgical management in dogs during reconstruction of cranial cruciate ligament rupture: A retrospective study

    Directory of Open Access Journals (Sweden)

    Seok-Beom Seo

    2017-09-01

    Conclusion: Finally based on the clinical superiority, it is recommended that meniscal injury should be checked and corrected during RCCL reconstruction for getting better clinical outcomes. [J Adv Vet Anim Res 2017; 4(3.000: 311-318

  3. Deltoid muscle and tendon tears in patients with chronic rotator cuff tears

    Energy Technology Data Exchange (ETDEWEB)

    Ilaslan, Hakan; Recht, Michael P. [Cleveland Clinic, Musculoskeletal Radiology/A21, Division of Radiology, Cleveland, OH (United States); Iannotti, Joseph P. [Cleveland Clinic, Department of Orthopedic Surgery, Cleveland, OH (United States)

    2007-06-15

    To describe the magnetic resonance imaging (MRI) appearances of tears of the deltoid muscle and tendon in patients with rotator cuff tears and without a prior history of shoulder surgery. Deltoid tears diagnosed on MR examinations were prospectively recorded between February 2003 through June 2004. The images of these patients were then retrospectively reviewed to determine the location of the deltoid tear, the presence of rotator cuff tears, tendon retraction, muscle atrophy, degree of humeral head subluxation, bony erosive changes involving the undersurface of the acromion, and the presence of edema or fluid-like signal intensity in the deltoid muscle and overlying subcutaneous tissues. There were 24 (0.3%) patients with deltoid tears; nine men and 15 women. The age range was 54 to 87 (average 73) years. The right side was involved in 20 cases, and the left in four cases. Fifteen patients had full thickness and nine had partial thickness tears of the deltoid. Shoulder pain was the most common presenting symptom. The physical examination revealed a defect in the region of the deltoid in two patients. Nineteen patients had tears in the muscle belly near the musculotendinous junction, and five had avulsion of the tendon from the acromial origin. Full thickness rotator cuff tears were present in all of the patients, and 22 patients had associated muscle atrophy. Subcutaneous edema and fluid-like signal was present in 15 patients. Tears of the deltoid muscle or tendon is an unusual finding, but they can be seen in patients with chronic massive rotator cuff tears. Partial thickness tears tend to involve the undersurface of the deltoid muscle and tendon. Associated findings such as intramuscular cyst or ganglion in the deltoid muscle belly and subcutaneous edema or fluid-like signal overlying the deltoid in a patient with a rotator cuff tear should raise the suspicion of a deltoid tear. (orig.)

  4. Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark.

    Science.gov (United States)

    Hare, Kristoffer Borbjerg; Vinther, Jesper Høeg; Lohmander, L Stefan; Thorlund, Jonas Bloch

    2015-02-24

    A recent study reported a large increase in the number of meniscal procedures from 2000 to 2011 in Denmark. We examined the nation-wide distribution of meniscal procedures performed in the private and public sector in Denmark since different incentives may be present and the use of these procedures may differ from region to region. We included data on all patients who underwent an arthroscopic meniscal procedure performed in the public or private sector in Denmark. Data were retrieved from the Danish National Patient Register on patients who underwent arthroscopic meniscus surgery as a primary or secondary procedure in the years 2000 to 2011. Hospital identification codes enabled linkage of performed procedures to specific hospitals. Yearly incidence of meniscal procedures per 100,000 inhabitants was calculated with 95% CIs for public and private procedures for each region. Incidence of meniscal procedures increased at private and at public hospitals. The private sector accounted for the largest relative and absolute increase, rising from an incidence of 1 in 2000 to 98 in 2011. In 2011, the incidence of meniscal procedures was three times higher in the Capital Region than in Region Zealand. Our study identified a large increase in the use of meniscal procedures in the public and private sector in Denmark. The increase was particularly conspicuous in the private sector as its proportion of procedures performed increased from 1% to 32%. Substantial regional differences were present in the incidence and trend over time of meniscal procedures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Arthroscopic partial medial meniscectomy

    Directory of Open Access Journals (Sweden)

    Dašić Žarko

    2011-01-01

    Full Text Available Background/Aim. Meniscal injuries are common in professional or recreational sports as well as in daily activities. If meniscal lesions lead to physical impairment they usually require surgical treatment. Arthroscopic treatment of meniscal injuries is one of the most often performed orthopedic operative procedures. Methods. The study analyzed the results of arthroscopic partial medial meniscectomy in 213 patients in a 24-month period, from 2006, to 2008. Results. In our series of arthroscopically treated medial meniscus tears we noted 78 (36.62% vertical complete bucket handle lesions, 19 (8.92% vertical incomplete lesions, 18 (8.45% longitudinal tears, 35 (16.43% oblique tears, 18 (8.45% complex degenerative lesions, 17 (7.98% radial lesions and 28 (13.14% horisontal lesions. Mean preoperative International Knee Documentation Committee (IKDC score was 49.81%, 1 month after the arthroscopic partial medial meniscectomy the mean IKDC score was 84.08%, and 6 months after mean IKDC score was 90.36%. Six months after the procedure 197 (92.49% of patients had good or excellent subjective postoperative clinical outcomes, while 14 (6.57% patients subjectively did not notice a significant improvement after the intervention, and 2 (0.93% patients had no subjective improvement after the partial medial meniscectomy at all. Conclusion. Arthroscopic partial medial meniscetomy is minimally invasive diagnostic and therapeutic procedure and in well selected cases is a method of choice for treatment of medial meniscus injuries when repair techniques are not a viable option. It has small rate of complications, low morbidity and fast rehabilitation.

  6. Selenium Reduces Early Signs of Tumor Necrosis Factor Alpha-Induced Meniscal Tissue Degradation.

    Science.gov (United States)

    Häfelein, Klaus; Preuße-Prange, Andrea; Behrendt, Peter; Kurz, Bodo

    2017-05-01

    Meniscal integrity is a prerequisite for sustained knee joint health and prevention of meniscal degeneration is a main research goal. Cartilage-protective effects of selenium have been described, but little is known about the impact on the meniscus. We therefore investigated the influence of sodium selenite on meniscal explants under tumor necrosis factor-alpha (TNFα)-stimulated proinflammatory conditions. Meniscal explant disks (3 mm diameter × 1 mm thickness) were isolated from 2-year-old cattle and incubated with TNFα (10 ng/ml) and sodium selenite (low dose, LoD 6.7 ng/ml as being found in Insulin-Transferrin-Selenium medium supplements, ITS; medium-dose, MeD 40 ng/ml described as physiological synovial concentration; high dose, HiD 100 ng/ml described as optimal serum concentration). After 3 days of culture glycosaminoglycan (GAG) release (DMMB assay), nitric oxide (NO) production (Griess assay), gene expression of matrix-degrading enzymes (quantitative RT-PCR), and apoptosis rate were determined. TNFα led to a significant raise of GAG release and NO production. LoD and MeD selenite significantly reduced the TNFα-induced GAG release (by 83, 55 %, respectively), NO production (by 59, 40 %, respectively), and apoptosis (by 68, 39 %, respectively). LoD and MeD selenite showed a tendency to reduce the TNFα-mediated increase of inducible NO-synthase (iNOS) levels, LoD selenite furthermore matrix metalloproteinase (MMP)-3 transcription levels and a disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS)-4 levels. LoD and less pronounced MeD selenite show a substantial impact on the early meniscal inflammatory response. To our knowledge this is the first study showing the protective influence of selenium on meniscal tissue maintenance. To understand the superior potency of low-dose selenium on molecular level future studies are needed.

  7. Arthroscopic all-inside treatment of popliteomeniscal fascicles tears: surgical technique and results from the first 6 consecutive patients.

    Science.gov (United States)

    Simonetta, R; Di Vico, G; Papalia, R; Vasta, S; Denaro, V

    2016-01-01

    Athletes whose knees are subjected to sudden changes of direction and high jumps such as martial arts athletes, dancers, wrestlers and football players are at higher risk of injuring popliteomeniscal fascicles. Painful squatting and mechanical symptoms such as locking sensation are common. Current available treatments includes open or arthroscopic in repair. Arthroscopic repair with all-inside device can relieve symptoms and restore knee function. Six patients from two surgical centers with isolated popliteomeniscal fascicles tears were treated with arthroscopic all-inside repair. The surgical technique is thoroughly described. All patients showed consistent symptoms and MRI findings, as well as meniscal hypermobility during arthroscopic probing. Moreover, four out of six showed a chondral lesion of the lateral femoral condyle. All of them had their lateral meniscus sutured with one or more sutures. Symptoms were relieved and all but one were able to return to play at the pre-injury level. No postoperative complications were encountered. The diagnosis of the disruption of popliteomeniscal fascicles is challenging and often seen in athletes that play sports which involve repetitive twisting. However, patients’ complaints are consistent. Arthroscopic repair with an all-inside device showed to be a reliable and easy technique for addressing the condition, although some issues still need to be investigated, such as how much constraint the repair should provide. Arthroscopic all-inside repair of popliteomeniscal tears prove to be safe and effective in the short-term follow-up, allowing for sport activity resumption.

  8. Tear ferning in normal dogs and dogs with keratoconjunctivitis sicca ...

    African Journals Online (AJOL)

    This study evaluates tear ferning as an ancillary technique for the evaluation of the canine tear film in normal eyes and eyes affected by keratoconjunctivitis sicca (KCS). Thirty dogs with KCS and 50 control dogs with normal tear film were evaluated with a full ophthalmoscopic examination and a Schirmer tear test type 1 ...

  9. Tear Movement through a Contact Lens of Variable Thickness

    Science.gov (United States)

    Gerhart, Matthew; Anderson, Daniel

    2013-11-01

    This work is on a two-dimensional tear film with a movable porous contact lens. The inclusion of a contact lens into a tear film results in three layers: Pre-Lens Tear Film, Contact Lens, and the Post-Lens Tear Film layers. The interfaces between the contact lens and the tear films are modeled as planar interfaces. There is a free surface interface between the tear film and the outside air. The goal is analyze the effects of the spatial variability of thickness on the Post-Lens Tear Film thickness and on the fluid flow through the Contact Lens layer.

  10. Isolated tear of the plantaris tendon: ultrasound and MRI appearance

    Energy Technology Data Exchange (ETDEWEB)

    Bianchi, Stefano [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Sailly, Matthieu [CIM, Cabinet Imagerie Medicale, Geneva (Switzerland); Health Center, ASPIRE, Doha (Qatar); Molini, Lucio [Ospedale Galliera, Struttura complessa di Radiodiagnostica, Genova (Italy)

    2011-07-15

    We report a retrospective analysis of the ultrasound and magnetic resonance imaging appearance of five patients with isolated plantaris tendon tears. Both imaging techniques allowed detection of the tear, assessment of its severity and of its location. Compared with magnetic resonance imaging, ultrasound resulted in a less expensive and time-consuming evaluation. Isolated plantaris tendon tears can clinically mimic Achilles tendon tears or thrombophlebitis. Unlike these conditions, plantaris tear has a benign outcome and does not need surgical treatment or anticoagulation. (orig.)

  11. Influence of toroidal rotation on tearing modes

    Science.gov (United States)

    Cai, Huishan; Cao, Jintao; Li, Ding

    2017-10-01

    Tearing modes stability analysis including toroidal rotation is studied. It is found that rotation affects the stability of tearing modes mainly through the interaction with resistive inner region of tearing mode. The coupling of magnetic curvature with centrifugal force and Coriolis force provides a perturbed perpendicular current, and a return parallel current is induced to affect the stability of tearing modes. Toroidal rotation plays a stable role, which depends on the magnitude of Mach number and adiabatic index Γ, and is independent on the direction of toroidal rotation. For Γ >1, the scaling of growth rate is changed for typical Mach number in present tokamaks. For Γ = 1 , the scaling keeps unchanged, and the effect of toroidal rotation is much less significant, compared with that for Γ >1. National Magnetic Confinement Fusion Science Program and National Science Foundation of China under Grants No. 2014GB106004, No. 2013GB111000, No. 11375189, No. 11075161 and No. 11275260, and Youth Innovation Promotion Association CAS.

  12. Human tears reveal insights into corneal neovascularization.

    Science.gov (United States)

    Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

    2012-01-01

    Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

  13. Tear film MMP accumulation and corneal disease

    OpenAIRE

    Smith, V; Rishmawi, H; Hussein, H; Easty, D

    2001-01-01

    BACKGROUND/AIMS—Matrix metalloproteinases (MMPs) accumulate in the tears of patients with active peripheral ulcerative keratitis (PUK) but it is unknown whether these enzymes have a central role in disease progression. The aims of the present investigation were to determine the source of these enzymes and to ascertain whether their accumulation in tears is a phenomenon specific to PUK or a general feature of other anterior segment diseases.
METHODS—The experimental samples were obtained from ...

  14. Mallory-Weiss Tear during Esophagogastroduodenoscopy

    Directory of Open Access Journals (Sweden)

    Ji Wan Kim

    2015-02-01

    Full Text Available Mallory-Weiss tears (MWTs are mucosal lacerations caused by forceful retching and are typically located at the gastroesophageal junction. Reported cases of MWT with serious complications seen in esophagogastroduodenoscopy are limited. We report MWT in an 81-year-old woman who presented with gastric perforation by esophagogastroduodenoscopy. We discuss and indicate that hiatal hernia, atrophic gastritis and old age may be associated with the gastric perforation in comparison to typical tears occurring at the gastroesophageal junction.

  15. Effect of Ramadan fasting on tear proteins.

    Science.gov (United States)

    Sariri, Reyhaneh; Varasteh, Abdolali; Sajedi, Reza Hassan

    2010-01-01

    Muslims abstain from eating, drinking and smoking from dawn to sunset during the holy month of Ramadan. Prolonged fasting is thought to be among risk factors for many diseases, e.g., cardiovascular, gastrointestinal and various infectious diseases. It could also play a part in several eye diseases, including dry eye syndrome, glaucoma, and cataract. Toxic and oxidative effects due to increased concentrations of some biochemicals as a result of reduction in tear volume thought to play an important role in damaging ocular tissue. Human tear is an important biological fluid similar to blood in many aspects. Tear film is composed of three basic layers i.e. lipid, aqueous and mucin. The tear film covering the ocular surface presents a mechanical and antimicrobial barrier, and endures an optical refractive surface. The aim of this study was to analyze and compare tear protein of volunteers during fasting. Using two reliable analytical methods, i.e. electrophoresis and high performance liquid chromatography (HPLC), we compared tear protein content of sixty volunteers (35 males and 25 females, 23-27 years old) during fasting in holly month of Ramadan (FAST: n = 62) and one month before Ramadan (CTRL: n = 60). The results showed that some identified tear proteins decreased during fasting. On the other hand, the activity of some enzymes such as lysozyme, lactoferrin and alpha amylase also decreased in fasting samples. Electrophoresis results showed that tear protein patterns in FAST (P < 0.05) were different from those of CTRL. There were a few more protein peaks in the FAST group (P < 0.005) than in CTRL.

  16. Tear film measurement by optical reflectometry technique

    Science.gov (United States)

    Lu, Hui; Wang, Michael R.; Wang, Jianhua; Shen, Meixiao

    2014-01-01

    Abstract. Evaluation of tear film is performed by an optical reflectometer system with alignment guided by a galvanometer scanner. The reflectometer system utilizes optical fibers to deliver illumination light to the tear film and collect the film reflectance as a function of wavelength. Film thickness is determined by best fitting the reflectance-wavelength curve. The spectral reflectance acquisition time is 15 ms, fast enough for detecting film thickness changes. Fast beam alignment of 1 s is achieved by the galvanometer scanner. The reflectometer was first used to evaluate artificial tear film on a model eye with and without a contact lens. The film thickness and thinning rate have been successfully quantified with the minimum measured thickness of about 0.3 μm. Tear films in human eyes, with and without a contact lens, have also been evaluated. A high-contrast spectral reflectance signal from the precontact lens tear film is clearly observed, and the thinning dynamics have been easily recorded from 3.69 to 1.31 μm with lipid layer thickness variation in the range of 41 to 67 nm. The accuracy of the measurement is better than ±0.58% of the film thickness at an estimated tear film refractive index error of ±0.001. The fiber-based reflectometer system is compact and easy to handle. PMID:24500519

  17. Rotator cuff tear: A detailed update

    Directory of Open Access Journals (Sweden)

    Vivek Pandey

    2015-01-01

    Full Text Available Rotator cuff tear has been a known entity for orthopaedic surgeons for more than two hundred years. Although the exact pathogenesis is controversial, a combination of intrinsic factors proposed by Codman and extrinsic factors theorized by Neer is likely responsible for most rotator cuff tears. Magnetic resonance imaging remains the gold standard for the diagnosis of rotator cuff tears, but the emergence of ultrasound has revolutionized the diagnostic capability. Even though mini-open rotator cuff repair is still commonly performed, and results are comparable to arthroscopic repair, all-arthroscopic repair of rotator cuff tear is now fast becoming a standard care for rotator cuff repair. Appropriate knowledge of pathology and healing pattern of cuff, strong and biological repair techniques, better suture anchors, and gradual rehabilitation of postcuff repair have led to good to excellent outcome after repair. As the healing of degenerative cuff tear remains unpredictable, the role of biological agents such as platelet-rich plasma and stem cells for postcuff repair augmentation is still under evaluation. The role of scaffolds in massive cuff tear is also being probed.

  18. Diet, nutraceuticals and the tear film.

    Science.gov (United States)

    Jalbert, Isabelle

    2013-12-01

    Nutrition disorders and their correlates such as obesity are increasingly prevalent worldwide. A number of studies to date have suggested numerous potential associations between diet and tear film health; this paper will provide a summary of the available literature. The tear film is characterized through its protein and lipid content and through clinical measurements of characteristics such as osmolarity, volume and stability. Malnutrition, protein and vitamin-A deficiencies are extremely deleterious to tear film health and supplementation with oral vitamin A in this setting is of clear benefit. The relative impact of diet on tear film within what would be considered normal ranges of consumption is less clear. A number of population studies have suggested that hyperlipidemia and a diet low in omega-3 fatty acids are risks factor for dry eye disease. Numerous studies have investigated the effectiveness of oral supplementation with antioxidants, omega-3 (e.g. fish oil and linseed oil) and omega-6 (e.g. evening primrose oil) fatty acids in the last 10 years. Taken together, these suggest a small benefit of oral supplementation on tear film volume, stability and decreased ocular symptoms in patients previously diagnosed with diseases involving the ocular surface (e.g. Sjögren's syndrome, meibomian gland dysfunction, dry eye disease) and contact lens wearers suffering from dry eye. More research is required to determine the exact composition, dosage and indications for their use and to fully characterize how these nutraceuticals modulate the tear film. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. Impact of Smoking on the Ocular Surface, Tear Function, and Tear Osmolarity.

    Science.gov (United States)

    Aktaş, Serdar; Tetikoğlu, Mehmet; Koçak, Ahmet; Kocacan, Metin; Aktaş, Hatice; Sağdık, Hacı Murat; Özcura, Fatih

    2017-12-01

    This study evaluated the effects of cigarette smoking on the ocular surface, tear function, and tear osmolarity. A total of 50 smokers with at least 5 years of heavy smoking (defined as 1 pack/day) and 51 nonsmoking, healthy individuals were enrolled. Tear osmolarity was measured with an osmometer (TearLab™ Osmolarity System). Ocular surface examinations involved corneal fluorescein staining, measurement of the tear film breakup time (TBUT), the Schirmer 1 test, measurement of corneal sensitivity with a Cochet-Bonnet esthesiometer, and conjunctival impression cytology. Dry eye symptoms were scored using the Ocular Surface Disease Index (OSDI) questionnaire. The results were compared with those from an age and sex-matched control group. The Chi-squared and independent sample t-tests were used for statistical analyses. The smokers had significantly higher tear osmolarity values (305.38 ± 9.81 vs. 301.14 ± 7.04 mOsm/L; p = 0.014) and OSDI scores (34.13 ± 16.58 vs. 18.09 ± 9.61; p tear film, which can damage the ocular surface and tear function.

  20. Contact lens interactions with the tear film.

    Science.gov (United States)

    Mann, Aisling; Tighe, Brian

    2013-12-01

    Biochemical changes brought about by the influence of the contact lens on the tear film are conveniently split into two categories. Firstly, the lens can remove or reduce the levels of specific components in the tear film, and secondly, the lens can augment the tear film, by stimulating the influx of new components or increasing the level of existing components. The most obvious tear film components for study in this context are lipids, proteins, mucins and electrolytes. The interactions are affected by the properties of the lens, the characteristics of the individual wearer and the wear schedule. An additional complicating factor is the fact that the lens is many times thicker than the tear film and any immobilised tear components will be more extensively exposed to oxygen and UV radiation than is the case in the absence of a lens. It is arguably the lipoidal components that are most markedly affected by lens wear, since their immobilisation on the lens surface markedly increases their susceptibility to autoxidative degradation. The limited information that is available highlights the importance of subject specificity and suggests that lipid oxidation phenomena are potentially important in contributing to the 'end of day' discomfort of symptomatic contact lens patients. It is clear that tear lipids, although regarded as relatively inert for many years, are now seen as a reactive and potentially important family of compounds in the search for understanding of contact lens-induced discomfort. The influence of the lens on tear proteins shows the greatest range of complexity. Deposition and denaturation can stimulate immune response, lower molecular weight proteins can be extensively absorbed into the lens matrix and the lens can stimulate cascade or upregulation processes leading either to the generation of additional proteins and peptides or an increase in concentration of existing components. Added to this is the stimulating influence of the lens on vascular

  1. The sensitivity of cartilage contact pressures in the knee joint to the size and shape of an anatomically shaped meniscal implant

    NARCIS (Netherlands)

    Khoshgoftar, M.; Vrancken, A.C.T.; Tienen, T.G. van; Buma, P.; Janssen, D.W.; Verdonschot, N.J.

    2015-01-01

    Since meniscal geometry affects the cartilage contact pressures, it is essential to carefully define the geometry of the synthetic meniscal implant that we developed. Recently, six independent modes of size- and shape-related geometry variation were identified through 3D statistical shape modeling

  2. Results of meniscectomy for treatment of isolated meniscal injuries: Correlation between results and etiology of injury Resultado da meniscectomia no tratamento da lesão meniscal isolada: Correlação entre os resultados obtidos e a etiologia da lesão

    Directory of Open Access Journals (Sweden)

    Gilberto Luis Camanho

    2006-04-01

    Full Text Available PURPOSE: To evaluate the results of the treatment of patients with isolated meniscal injuries of different etiologies. MATERIALS AND METHODS: 435 patients of both sexes and different age groups underwent meniscectomy after their isolated meniscal injuries were clinically diagnosed and confirmed by nuclear magnetic resonance imaging. RESULTS: Most patients achieved good results and were able to return to the activities they had practiced prior to surgery without major limitations. CONCLUSIONS: Meniscectomy for the treatment of traumatic meniscal injury provides better results than meniscectomy for the treatment of degenerative meniscal injury. The results of meniscectomy for the treatment of meniscal injury due to fatigue are similar to those of meniscectomy for the treatment of traumatic meniscal injury, although the risk of osteonecrosis development is higher.OBJETIVO: Avaliar os resultados do tratamento de pacientes com lesão meniscal isolada de diversas etiologias. MATERIAIS E MÉTODOS: 435 pacientes de ambos os sexos, de diferentes faixas etárias, foram submetidos a meniscectomia depois que a lesão meniscal isolada foi diagnosticada clinicamente e confirmada por ressonância nuclear magnética. RESULTADOS: A maioria dos pacientes obteve bom resultado, retornando às atividades que exerciam antes da cirurgia, sem limitações relevantes. CONCLUSÕES: No tratamento da lesão meniscal traumática, a meniscectomia dá melhores resultados do que no tratamento da lesão meniscal degenerativa. No tratamento da lesão meniscal por fadiga, a meniscectomia dá resultados semelhantes aos obtidos no tratamento da lesão meniscal traumática, apesar de haver maior risco de ocorrência de osteonecrose.

  3. Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System.

    Science.gov (United States)

    Skiveren, J; Bermark, S; LeBlanc, K; Baranoski, S

    2015-08-01

    The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN) and social and health-care assistants (non-RN) from both primary health care and a Danish university hospital in Copenhagen. Thirty photographs, with equal representation of the three types of skin tears, were selected to test validity. The photographs chosen were those originally used for internal and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists. The ISTAP classification system was validated by 241 RNs, and 29 non-RN. The results indicated a moderate level of agreement on classification of skin tears by type (Fleiss' Kappa=0.460). A moderate level of agreement was demonstrated for both the RN group and the non-RN group (Fleiss' Kappa=0.464 and 0.443, respectively). The ISTAP Skin Tear Classification System was developed with the goal of establishing a global language for describing and documenting skin tears and to raise the health-care community's awareness of skin tears. The Danish translation of the ISTAP classification system supports the earlier ISTAP study and further validates the classification system. The Danish translation of the classification system is vital to the promotion of skin tears in both research and the clinical settings in Denmark.

  4. Rotator cuff tears: An evidence based approach

    Science.gov (United States)

    Sambandam, Senthil Nathan; Khanna, Vishesh; Gul, Arif; Mounasamy, Varatharaj

    2015-01-01

    Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and

  5. Joint degeneration following meniscal allograft transplantation in a canine model: mechanical properties and semiquantitative histology of articular cartilage.

    Science.gov (United States)

    Elliott, Dawn M; Jones, Relief; Setton, Lori A; Scully, Sean P; Vail, T Parker; Guilak, Farshid

    2002-03-01

    This study examined the hypothesis that meniscal allograft transplantation serves a "chondroprotective" role and prevents the histological and biomechanical changes of the articular cartilage following meniscectomy. Skeletally mature mongrel dogs underwent total medial meniscectomy and received either a fresh meniscal allograft ( n=10) or no further treatment ( n=10). Semiquantitative histology and biomechanical analysis of the femoral articular cartilage was used to assess cartilage pathology 12 weeks following surgery. Histological analysis showed significant changes in cartilage structure that did not differ between the meniscectomy and allograft transplantation groups. Similarly, the tensile modulus of the surface zone cartilage was significantly lower than that in unoperated controls following either meniscectomy or allograft transplantation. A significant correlation was observed between the biomechanical and histological changes, suggesting that degenerative changes in cartilage structure and mechanical function are interrelated. Our findings do not support the hypothesis that meniscal allograft transplantation provides chondroprotection of the femoral condyle and also suggest that it does not lead to increased degenerative changes.

  6. Allergy and allergic mediators in tears.

    Science.gov (United States)

    Leonardi, Andrea

    2013-12-01

    The identification of inflammatory mediators in the tear fluid have been extensively used in ocular allergy to find either a 'disease marker', to better understand the immune mechanisms involved in the ocular surface inflammation, or to identify potential targets for therapeutic interventions. While the clinical characteristics allow a relatively convincing diagnosis of ocular allergic diseases, in the initial, non active phases, or in the chronic stages, the diagnosis may not be clear. Although not highly specific, total tear IgE can be measured with local tests by inserting a paper strip in the lower meniscus. The measurement of tear specific inflammatory markers, such as histamine, tryptase, ECP, IL-4, IL-5 and eotaxin, may be useful for the diagnosis or monitoring ocular allergy. New technologies such as multiplex bead assays, membrane-bound antibody array and proteomic techniques can characterize the distribution of a wide range of bioactive trace proteins in tears. Dozens of mediators, cytokines, chemokines, growth factors, angiogenic modulators, enzymes and inhibitors were thus identified in small tear samples using these techniques, providing the possible identification of specific biomarker for either specific disease or disease activity. However, to date, there is no a single specific laboratory test suitable for the diagnosis and monitoring of allergic conjunctivitis. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. A case of recurrent bloody tears

    Directory of Open Access Journals (Sweden)

    Karslıoğlu Ş

    2011-07-01

    Full Text Available Şafak Karslioğlu1, Ilke Bahçeci Şimşek2, Müslime Akbaba11Ìstanbul Oculoplastic and Orbital Surgery and Ocular Oncology Center, 2Ophthalmology Department, Medicine Hospital, Ìstanbul, TurkeyAbstract: Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an erythema multiforme-like drug eruption. He experienced chronic conjunctivitis which resulted in a few minor symblephara. One year later, the patient developed attacks of bloody tearing. All clinical, radiologic, and laboratory investigations related to bloody epiphora were within normal limits except for a mild, nonspecific chronic inflammatory reaction in the perivascular tissues of the lacrimal gland and orbital soft tissues. Also, an increase in vascular permeability and contrast extravasation on carotid angiography was detected. High-dose vitamin C was administered. The patient continued to have unilateral bloody tears intermittently for two years, but the episodes became much less frequent and had resolved by three years. It is conceivable that increased vascular permeability following the systemic inflammatory process could have played a role in the etiology of recurrent bloody tears in this atypical patient.Keywords: bloody tears, erythema multiforme, drug eruption, vitamin C

  8. Role of lactoferrin in the tear film.

    Science.gov (United States)

    Flanagan, J L; Willcox, M D P

    2009-01-01

    The surface of the eye provides an inert barrier against infection. Through its unique combination of antimicrobial action and anti-inflammatory activities lactoferrin (Lf) in the tear film plays an important role in the maintenance of ocular health. In order to maintain clarity the eye must provide immunological defense without immunopathology. Along with physical barriers, soluble plasma factors and other proteins such as lysozyme, Lf produced by the acinar cells of the lacrimal gland serves a number of roles in defense for this purpose. Lf in tears provides antimicrobial efficacy by binding free iron thus reducing the availability of iron necessary for microbial growth and survival as well as pathogenesis. Lf has been shown to inhibit biofilm formation and thus may play a role in protecting contact lens surfaces from colonization. Virus particles' entry into epithelial cells is inhibited by Lf while an excess of Lf in tear film is thought to limit the opportunistic Lf-mediated bridging of adenovirus and host cell that occurs in other tissues. Lf dampens the classical complement activation pathway by binding to markers of inflammation and immune activation while pathogen-associated molecular patterns such as lipopolysaccharide (LPS) are targeted by Lf for removal through tears and hydrodynamic flushing. This review focuses on the role of Lf in human tear film and its contribution to ocular health during contact lens wear.

  9. Arthroscopic Transtibial Pullout Repair for Posterior Medial Meniscus Root Tears: A Systematic Review of Clinical, Radiographic, and Second-Look Arthroscopic Results.

    Science.gov (United States)

    Feucht, Matthias J; Kühle, Jan; Bode, Gerrit; Mehl, Julian; Schmal, Hagen; Südkamp, Norbert P; Niemeyer, Philipp

    2015-09-01

    To systematically review the results of arthroscopic transtibial pullout repair (ATPR) for posterior medial meniscus root tears. A systematic electronic search of the PubMed database and the Cochrane Library was performed in September 2014 to identify studies that reported clinical, radiographic, or second-look arthroscopic outcomes of ATPR for posterior medial meniscus root tears. Included studies were abstracted regarding study characteristics, patient demographic characteristics, surgical technique, rehabilitation, and outcome measures. The methodologic quality of the included studies was assessed with the modified Coleman Methodology Score. Seven studies with a total of 172 patients met the inclusion criteria. The mean patient age was 55.3 years, and 83% of patients were female patients. Preoperative and postoperative Lysholm scores were reported for all patients. After a mean follow-up period of 30.2 months, the Lysholm score increased from 52.4 preoperatively to 85.9 postoperatively. On conventional radiographs, 64 of 76 patients (84%) showed no progression of Kellgren-Lawrence grading. Magnetic resonance imaging showed no progression of cartilage degeneration in 84 of 103 patients (82%) and showed reduced medial meniscal extrusion in 34 of 61 patients (56%). On the basis of second-look arthroscopy and magnetic resonance imaging in 137 patients, the healing status was rated as complete in 62%, partial in 34%, and failed in 3%. Overall, the methodologic quality of the included studies was fair, with a mean modified Coleman Methodology Score of 63. ATPR significantly improves functional outcome scores and seems to prevent the progression of osteoarthritis in most patients, at least during a short-term follow-up. Complete healing of the repaired root and reduction of meniscal extrusion seem to be less predictable, being observed in only about 60% of patients. Conclusions about the progression of osteoarthritis and reduction of meniscal extrusion are limited by

  10. Anterior cruciate ligament and meniscal injuries in sports: incidence, time of practice until injury, and limitations caused after trauma

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    Full Text Available ABSTRACT OBJECTIVE: To analyze the incidence of ACL and meniscal injuries in a population of recreational and elite athletes from Brazil and the relation of these injuries with their sports activities. METHODS: This was a prospective observational study of 240 patients with ACL and/or meniscal injuries submitted to surgical treatment. Data of patients and sport modality, as well as Tegner score were registered in the first clinical evaluation. The patients were divided into three groups: (1 isolated rupture of the ACL; (2 ACL injury associated with meniscal injury; (3 isolated menisci injury. RESULTS: The majority of the patients belonged to group 1 (44.58%, followed by group 2 (30.2% and 3 (25%. Most patients were soccer players. The mean time from sport practice to injury in group 1 was 17.81 years. In group 2, it was 17.3 years, and in group 3, 26.91 years. Soccer athletes presented ACL injury in 0.523/1000 h of practice and meniscal injury in 0.448/1000 h of practice. Before the injury, the mean Tegner score obtained for groups 1, 2, and 3 were 7.18, 7.34, and 6.53, respectively. After knee injury, those values were 3.07, 3.18, and 2.87, respectively. CONCLUSION: Soccer was the sport that caused the majority of lesions, regardless the group. Furthermore, patients from groups 1 and 2 had less time of practice prior to the injury (17.81 and 17.3 years than the patients of group 3 (26.91 years. Women presented a higher risk to develop ACL and meniscal injuries in 1000 h of game/practice. Running, volleyball, and weightlifting are in ascending order of risk for ACL and/or meniscal injury. Regarding the return to sport practice, the efficiency of all athletes was impaired because of the injury.

  11. Tear film break-up time in rabbits.

    Science.gov (United States)

    Wei, Xiaojia E; Markoulli, Maria; Zhao, Zhenjun; Willcox, Mark D P

    2013-01-01

    Rabbits have a longer inter-blink time (approximately 10 minutes) compared with humans (five to eight seconds), suggesting that rabbits have a much more stable tear film. Using fluorescein, the tear break-up time of rabbits has been reported to be similar to that of humans. This study set out to measure the tear break-up time in rabbits using non-invasive methods and to establish the pattern of tear break-up compared to humans. The tear break-up time was measured and the pattern of tear break-up was observed in six New Zealand White rabbits on two separate occasions using both the Keeler Tearscope-plus(TM) and a slitlamp biomicroscope. The mean rabbit tear break-up time was 29.8 ± 3.4 (SD) minutes. This contrasts with the reports of human tear break-up time of eight to 30 seconds. The tear breaking spread very slowly and was often restricted to the area of the initial break. Rabbit tears have a significantly higher tear break-up time than humans and this aligns with previously demonstrated differences in inter-blink time between rabbits and humans. Understanding the underlying mechanisms of tear stability may lead to novel ways of increasing human tear film stability. © 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia.

  12. HPLC analysis of closed, open, and reflex eye tear proteins

    Directory of Open Access Journals (Sweden)

    Sitaramamma T

    1998-01-01

    Full Text Available Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC utilising both gel filtration (P-300 SW and reverse-phase (C-18 columns and the HPLC fractions were further analysed by sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53% in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.

  13. HPLC analysis of closed, open, and reflex eye tear proteins.

    Science.gov (United States)

    Sitaramamma, T; Shivaji, S; Rao, G N

    1998-12-01

    Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA) was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53%) in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.

  14. Projecting Lifetime Risk of Symptomatic Knee Osteoarthritis and Total Knee Replacement in Individuals Sustaining a Complete Anterior Cruciate Ligament Tear in Early Adulthood.

    Science.gov (United States)

    Suter, Lisa G; Smith, Savannah R; Katz, Jeffrey N; Englund, Martin; Hunter, David J; Frobell, Richard; Losina, Elena

    2017-02-01

    To estimate the lifetime risk of knee osteoarthritis (OA) and total knee replacement (TKR) in persons sustaining anterior cruciate ligament (ACL) tear by age 25 years. We used the Osteoarthritis Policy Model to project the cumulative incidence of symptomatic knee OA requiring TKR in varying situations: no prevalent or incident injury; isolated ACL tear, surgically treated; isolated ACL tear, nonoperatively treated; or a prevalent history or surgically treated ACL and meniscal tear (MT). We estimated MT prevalence and incidence and increased risk of knee OA associated with ACL injury and MT from published literature. We conducted a range of sensitivity analyses to examine the impact of uncertainty in input parameters. Estimated lifetime risk of symptomatic knee OA was 34% for the cohort with ACL injury and MT, compared to 14% for the no-injury cohort. ACL injury without MT was associated with a lifetime risk of knee OA between 16% and 17%, depending on ACL treatment modality. Estimated lifetime risk of TKR ranged from 6% in the no-injury cohort to 22% for the ACL injury and MT cohort. Subjects in the ACL injury and MT cohort developed OA approximately 1.5 years earlier (55.7 versus 57.1) and underwent TKR approximately 2 years earlier (66 versus 68) than the cohort without knee injuries. Sustaining ACL injury early in adulthood leads to greater lifetime risk and earlier onset of knee OA and TKR; concomitant MTs compound this risk. These data provide insight into the impact of sustainable injury prevention interventions in young adults. © 2016, American College of Rheumatology.

  15. Growth factor treated tensioned synoviocyte neotissues: towards meniscal bioscaffold tissue engineering.

    Science.gov (United States)

    Warnock, J J; Bobe, G; Duesterdieck-Zellmer, K F; Spina, J; Ott, J; Baltzer, W I; Bay, B K

    2014-04-01

    Meniscal injury is a common cause of osteoarthritis, pain, and disability in dogs and humans, but tissue-engineered bioscaffolds could be a treatment option for meniscal deficiency. The objective of this study was to compare meniscus-like matrix histology, composition, and biomechanical properties of autologous tensioned synoviocyte neotissues (TSN) treated with fetal bovine serum (TSNfbs) or three chondrogenic growth factors (TSNgf). Fourth passage canine synoviocytes from 10 dogs were grown in hyperconfluent monolayer culture, formed into TSN, and then cultured for 3 weeks with 17.7% FBS or three human recombinant TSNgf (bFGF, TGF-β1, and IGF-1). Cell viability was determined with laser microscopy. Histological architecture and the composition of fibrocartilage matrix were evaluated in TSN by staining tissues for glycosaminoglycan (GAG), α-smooth muscle actin, and collagen 1 and 2; quantifying the content of GAG, DNA, and hydroxyproline; and measuring the gene expression of collagens type 1α and 2α, the GAG aggrecan, and transcription factor Sry-type Homeobox Protein-9 (SOX9). Biomechanical properties were determined by materials testing force-deformation curves. The TSN contained components and histological features of mensical fibrocartilage extracellular matrix. Growth factor-treated TSN had higher DNA content but lower cell viability than TSNfbs. TSNgf had greater fibrocartilage-like matrix content (collagen 2 and GAG content with increased collagen 2α and SOX9 gene expression). Additionally, TSNgf collagen was more organized histologically and so had greater tensile biomechanical properties. The results indicate the potential of TSN when cultured with growth factors as implantable bioscaffolds for the treatment of canine meniscal deficiency. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. ¿El síndrome meniscal, consecuencia de la retracción miosfacial de los isquiotibiales?

    OpenAIRE

    Tristan, Roberto

    2014-01-01

    Objetivo: Evaluar la incidencia de la retracción miofascial de los isquiotibiales sobre el síndrome meniscal de rodilla. Material y Métodos: En el presente trabajo se ha realizado un tipo de investigación descriptiva, el diseño es de tipo no experimental transversal y la muestra fue no probabilística, realizando un relevamiento de datos a 51 pacientes de 18 a 45 años con síndrome meniscal de rodilla que se encuentran en el periodo de rehabilitación de esta afección en una Cl...

  17. [Tears' immunology in acute eye diseases].

    Science.gov (United States)

    Ignat, F; Godeanu, L; Davidescu, L; Voiculescu, M

    2001-01-01

    The aim of the study is to research the immunoglobulins' concentration into the tears liquid and into the blood serum at the patients with acute affections of the anterior ocular pole. The study was accomplished on two groups of patients: one group with herpetic Keratitis, the other with anterior uveitis, the second having a different etiology--that the viral one. Another group of patients with senile cataract was used like witness-group. The immunoglobulins concentration were detected into the serum and into the tears by the Mancini method of the radial immunodiffusion. The results indicate a general immunodefficiency signed by the decrease of IgG and IgM into the serum on the one hand, and the increase of local defense mechanisms reflected on the growing of IgA and IgG level into the tears, on the other hand.

  18. Slab tears and intermediate-depth seismicity

    Science.gov (United States)

    Meighan, Hallie E.; ten Brink, Uri S.; Pulliam, Jay

    2013-01-01

    Active tectonic regions where plate boundaries transition from subduction to strike slip can take several forms, such as triple junctions, acute, and obtuse corners. Well-documented slab tears that are associated with high rates of intermediate-depth seismicity are considered here: Gibraltar arc, the southern and northern ends of the Lesser Antilles arc, and the northern end of Tonga trench. Seismicity at each of these locations occurs, at times, in the form of swarms or clusters, and various authors have proposed that each marks an active locus of tear propagation. The swarms and clusters start at the top of the slab below the asthenospheric wedge and extend 30–60 km vertically downward within the slab. We propose that these swarms and clusters are generated by fluid-related embrittlement of mantle rocks. Focal mechanisms of these swarms generally fit the shear motion that is thought to be associated with the tearing process.

  19. Tear osmolarity and tear function assessment in patients with polycystic ovary syndrome

    Directory of Open Access Journals (Sweden)

    Derya Alp Guliyev

    Full Text Available ABSTRACT Purpose: Polycystic ovary syndrome (PCOS is an endocrine disease characterized by chronic anovulation and hyperandrogenism. Hormonal changes can affect tear function. This study evaluates tear function and impact of hyperandrogenism on it in PCOS patients. Methods: Fifty patients with PCOS and thirty control volunteers were examined for tear break-up time, Schirmer-I and tear osmolarity. Also, serum levels of total testosterone, FSH, LH and AMH were determined in venous blood samples in the early follicular phase. PCOS patients were divided into two groups by plasma total testosterone level: Group A with normal (≤0.513 ng/ml;n=27, Group B with higher hormone level (>0.513 ng/ml;n=23. Healthy control group indicated as Group C (n=30. Results: LH, total testosterone levels were higher in the PCOS group than in the control group (p=0.012; p=0.025. Mean values of tear break-up time and Schirmer-I were different between groups and especially Group A and C were near to each other differing from B (p>0.05. Tear osmolarity results were higher in Group B, compared to A and C (p=0.049; p=0.033. No significant difference detected in tear osmolarity value means of Group A and C (p=0.107. AMH levels were higher in Group B, compared to A and C (p=0.002; p=0.001. AMH levels in Group A were higher than that of C (p=0.002. Positive correlation between levels of total testosterone and AMH was detected in all PCOS patients (n=50;Pearson's r=0.579; p<0.001. Conclusion: Tear function can be affected in PCOS patients with hyperandrogenism. Tear osmolarity is the most sensitive and objective assessment method for ocular surface changes in PCOS.

  20. Superior labrum anterior-to-posterior tear.

    Science.gov (United States)

    Sum, Jonathan C; Omid, Reza

    2012-12-01

    The patient was a 25-year-old male college student with a chief complaint of right shoulder pain. The patient was initially diagnosed with bicipital tendinitis by his physician and had been treated for 4 weeks by a physical therapist. However, his symptoms did not improve and he was unable to return to his preinjury activity levels, so he sought the services of another physical therapist for a second opinion. Due to concern for a labrum tear, the physical therapist referred the patient to an orthopaedic surgeon. Magnetic resonance arthrography revealed findings consistent with a superior labrum anterior-to-posterior tear.

  1. Is rehabilitation effective in massive rotator cuff tears?

    Science.gov (United States)

    Collin, P G; Gain, S; Nguyen Huu, F; Lädermann, A

    2015-06-01

    Irreparable massive rotator cuff tears are challenging to treat. Our objective here was to evaluate the efficacy of a specifically designed rehabilitation programme. We hypothesised that outcomes of the rehabilitation programme would vary with the site of the tears. Patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis were included prospectively. They followed a five-session specific rehabilitation programme. The outcomes were analysed according to the site of the tears. We included 45 patients with a mean age of 67 years. At last follow-up after rehabilitation, 24 patients had recovered more than 160° of anterior shoulder elevation. Treatment failure was common in patients with massive anterior rotator cuff tears or tears involving three or more tendons. Patients with massive posterior tears, in contrast, often experienced substantial improvements, even in the medium term. Outcomes of rehabilitation therapy in patients with irreparable massive rotator cuff tears and shoulder pseudoparalysis vary according to the site and number of the tears. Failure of rehabilitation therapy is common in patients with massive anterior tears or tears involving at least three tendons. In contrast, in patients with isolated massive posterior tears, substantial benefits from rehabilitation therapy can be expected. III. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. The contact lens environment: tear proteins in perspective.

    Science.gov (United States)

    Carney, L G; Hill, R M

    1985-03-01

    Tear protein deposition on contact lenses can lead to interruption or even cessation of lens wear. Yet, there are positive roles that tear proteins play in the maintenance of ocular integrity, with and without contact lenses present. One of these roles, that of tear buffering, is explored here.

  3. Danish translation and validation of the International Skin Tear Advisory Panel Skin Tear Classification System

    DEFF Research Database (Denmark)

    Skiveren, J; Bermark, S; LeBlanc, K

    2015-01-01

    OBJECTIVE: The aim of this study was to translate, validate and establish reliability of the International Skin Tear Classification System in Danish. METHOD: Phase 1 of the project involved the translation of the International Skin Tear Advisory Panel (ISTAP) Skin Tear Classification System...... and external validation by the ISTAP group. The subjects were approached in their place of work and invited to participate in the study and to attend an educational session related to skin tears. RESULTS: The Danish translation of the ISTAP classification system was tested on 270 non-wound specialists...... into Danish, using the forward-back translation method described by the principles of good practice for the translation process for patient-reported outcomes. In Phase 2, the Danish group sought to replicate the ISTAP validation study and validate the classification system with registered nurses (RN...

  4. An Athlete's Nightmare: Tearing the ACL

    Science.gov (United States)

    ... on the balls of their feet. "If the calf muscles are not absorbing the force, and if ... A stretch and/or tear of a ligament. Strain An injury to either a muscle or a tendon. Photo courtesy of NIAMS Summer ...

  5. Massive rotator cuff tears: definition and treatment.

    Science.gov (United States)

    Lädermann, Alexandre; Denard, Patrick J; Collin, Philippe

    2015-12-01

    The aim of this review is to summarise tear pattern classification and management options for massive rotator cuff tears (MRCT), as well as to propose a treatment paradigm for patients with a MRCT. Data from 70 significant papers were reviewed in order to define the character of reparability and the possibility of alternative techniques in the management of MRCT. Massive rotator cuff tears (MRCT) include a wide panoply of lesions in terms of tear pattern, functional impairment, and reparability. Pre-operative evaluation is critical to successful treatment. With the advancement of medical technology, arthroscopy has become a frequently used method of treatment, even in cases of pseudoparalytic shoulders. Tendon transfer is limited to young patients with an irreparable MRCT and loss of active rotation. Arthroplasty can be considered for the treatment of a MRCT with associated arthritis. There is insufficient evidence to establish an evidence-based treatment algorithm for MRCTs. Treatment is based on patient factors and associated pathology, and includes personal experience and data from case series.

  6. Treatment for acute anterior cruciate ligament tear

    DEFF Research Database (Denmark)

    Frobell, Richard B; Roos, Harald P; Roos, Ewa M

    2013-01-01

    To compare, in young active adults with an acute anterior cruciate ligament (ACL) tear, the mid-term (five year) patient reported and radiographic outcomes between those treated with rehabilitation plus early ACL reconstruction and those treated with rehabilitation and optional delayed ACL...

  7. Ion Landau Damping on Drift Tearing Modes

    CERN Document Server

    Connor, J W; Zocco, A

    2012-01-01

    The equations governing the ion Landau damping (ILD) layers for a drift tearing mode are derived and solved to provide a matching to ideal MHD solutions at large $x$ and to the drift tearing solution emerging from the ion kinetic region, $k\\rho_{i}\\sim1$, at small $x,$ the distance from the rational surface. The ILD layers lie on either side of the mode rational surface at locations defined by $k_{y}xV_{Ti}/L_{s}=\\omega_{*e}(1+0.73\\eta_{e})$ and have been ignored in many previous analyses of linear drift tearing stability. The effect of the ILD layer on the drift tearing mode is to introduce an additional stabilizing contribution, requiring even larger values of the stability index, $\\Delta^{\\prime}$ for instability, than predicted by Connor Hastie and Zocco [PPCF,54, 035003, (2012)] and Cowley, Kulsrud and Hahm [Phys. Fluids,29, 3230, (1986)]. The magnitude and scaling of the new stabilizing effect in slab geometry is discussed.

  8. Correlations among upper and lower tear menisci, noninvasive tear break-up time, and the Schirmer test.

    Science.gov (United States)

    Wang, Jianhua; Palakuru, Jayachandra R; Aquavella, James V

    2008-05-01

    To determine the relationships among tear meniscus parameters, noninvasive tear break-up time (NITBUT), and the Schirmer test. Experimental study. Thirty-six subjects were tested on one randomly selected eye. Real-time corneal optical coherence tomography (OCT) was used to image the upper and lower tear menisci during normal and delayed blinking followed by measurement of NITBUT and the Schirmer test. Digital images of the eye were taken for measuring the lid lengths to estimate tear volume in the menisci. Compared with normal blinking, significant increases of tear menisci occurred during delayed blinking (post hoc, P < .01). NITBUT was weakly but significantly correlated with the height (r = 0.36; P = .03) and area (r = 0.37; P = .03) of the lower tear meniscus during normal blinks. NITBUT was also correlated with the lower tear meniscus volume (r = 0.45; P < .05) and total tear meniscus volume (r = 0.43; P < .05) during normal blinking. The Schirmer test was not significantly related to any parameters of the tear menisci, volumes, or NITBUT; however, it was negatively correlated with the age of the subjects (r = -0.47; P = .004). The age was negatively correlated with the upper tear meniscus (r ranged from 0.36 to 0.37 for the radius, height, and area, P < .05) measured during delayed blinking. NITBUT appears correlated with the lower tear meniscus during normal blinking, and the Schirmer test appears not correlated with the noninvasively measured tear meniscus.

  9. The accuracy of physical diagnostic tests for assessing meniscal lesions of the knee: a meta-analysis.

    NARCIS (Netherlands)

    Scholten, R.J.P.M.; Devillé, W.L.J.M.; Opstelten, W.; Bijl, D.; Plas, C.G. van der; Bouter, L.M.

    2001-01-01

    OBJECTIVE. Our systematic review summarizes the evidence about the accuracy of physical diagnostic tests for assessing meniscal lesions of the knee. SEARCH STRATEGY. We performed a literature search of MEDLINE (1966-1999) and EMBASE 1988- 1999) with additional reference tracking. SELECTION

  10. Large regional differences in incidence of arthroscopic meniscal procedures in the public and private sector in Denmark

    DEFF Research Database (Denmark)

    Hare, Kristoffer Borbjerg; Vinther, Jesper Høeg; Lohmander, L Stefan

    2015-01-01

    of these procedures may differ from region to region. SETTING: We included data on all patients who underwent an arthroscopic meniscal procedure performed in the public or private sector in Denmark. PARTICIPANTS: Data were retrieved from the Danish National Patient Register on patients who underwent arthroscopic...

  11. Prótese meniscal de polímero bioabsorvível: estudo em coelhos Bioresorbable polymeric meniscal prosthesis: study in rabbits

    Directory of Open Access Journals (Sweden)

    Tulio Pereira Cardoso

    2010-06-01

    Full Text Available OBJETIVO: Obter o crescimento de um neomenisco por entre as porosidades da prótese com objetivo de proteger a cartilagem articular do joelho. MÉTODOS: Foram operados 70 joelhos de 35 coelhos Nova Zelândia com idades entre cinco e sete meses, pesando entre dois e 3,8 quilogramas, sendo 22 machos e 13 fêmeas. Submetidos no mesmo tempo cirúrgico à meniscectomia medial nos dois joelhos, em um lado foi implantada prótese meniscal de polímero bioabsorvível composta por 70% de poli (dioxanona e 30% de poli (L-ácido láctico. Realizada eutanásia com diferentes tempos pós-implante. Os côndilos femorais mediais e o neomenisco foram submetidos à análise histológica, observando-se a degradação e absorção da prótese, o crescimento de tecido meniscal na mesma, e o grau de degradação da cartilagem articular dos côndilos femorais, medido pelo histograma. RESULTADOS: Os dados obtidos avaliaram o crescimento de tecido histologicamente semelhante ao menisco normal, com absorção gradual da prótese e a porcentagem de condrócitos no lado controle e no lado com implante da prótese. CONCLUSÕES: Ocorreu crescimento de tecido por entre os poros da prótese com características histológicas semelhantes a do menisco normal de coelho. A cartilagem articular dos côndilos femorais no lado com implante da prótese apresenta maior número de condrócitos em todas as suas camadas.OBJECTIVE: To induce the ingrowth of a neomeniscus between the pores of the prosthesis in order to protect the articular cartilage of the knee. METHODS: 70 knees of 35 New Zealand rabbits were operated. The rabbits were five to seven months old, weighed 2 to 3.8 kilograms. 22 were male and 13 were female. Each animal underwent medial meniscectomy in both knees during the same time of surgery, having a bioresorbable polymeric meniscal prosthesis composed of 70% polydioxanone and 30% L-lactic acid polymer implanted in one side. They were submitted to euthanasia after

  12. Effect degree of crosslinking on the tearing energy

    Science.gov (United States)

    Fedors, R. F.

    1974-01-01

    Much recent work has been carried out on the tear behavior of elastomers, both filled and unfilled. By use of a criterion for tearing involving the concept of the tearing energy, the effects of variables such as test temperature, test rate, specimen geometry, and chemical nature of the elastomer have been investigated. The one variable which has not yet been studied is the specific effect of changes in the degree of crosslinking on tear behavior. By use of data published in the literature on the smooth tear behavior of unfilled vulcanizates, it is shown that these data can all be superposed onto a common response curve when the proper normalizations are applied.

  13. Epidemiology of Meniscal Injuries in U.S. High School Athletes from 2007/08 – 2012/13

    Science.gov (United States)

    Mitchell, Joshua; Graham, William; Best, Thomas M.; Collins, Christy; Currie, Dustin W.; Comstock, R. Dawn; Flanigan, David C.

    2016-01-01

    Purpose Knowledge of epidemiologic trends of meniscal injuries in young active populations is limited. Better awareness of injury patterns is a first step to lowering injury rates. Our hypothesis was that meniscal injuries in high school athletes would vary by gender, sport, and type of exposure. Methods During 2007–2013, a large nationally disperse sample of US high schools reported athlete exposure and injury data for 22 sports by having certified athletic trainers complete an internet-based data collection tool. Results 1,082 meniscal injuries were reported during 21,088,365 athlete-exposures for an overall injury rate of 5.1 per 100,000 athlete exposures. The overall rate of injury was higher in competition (11.9) than practice (2.7) (RR = 4.4; 95% CI, 3.9–5.0), and 12/19 sports showed significantly higher injury rates in competition compared to practice. Of all injuries, 68.0% occurred in boys, yet among the gender-comparable sports of soccer, basketball, track and field, lacrosse, and baseball/softball injury rates were higher for girls than boys (5.5 and 2.5, respectively, RR = 2.2; 95% CI, 1.8–2.7). Contact injury represented the most common mechanism (55.9%). Surgery was performed for the majority of injuries (63.8%), and 54.0% of athletes had associated intra-articular knee pathology. Conclusions Meniscal injury patterns among high school athletes vary by gender, sport, and type of exposure. Overall rates are higher for boys, but this is driven by football; however in gender-comparable sports girls may be at higher risk for meniscal injury. Our study is clinically relevant because recognition of distinct differences in these injury patterns will help drive evidence-based, targeted injury prevention strategies and efforts. Level of Evidence Level III PMID:26506845

  14. Combined Subscapularis Tears in Massive Posterosuperior Rotator Cuff Tears: Do They Affect Postoperative Shoulder Function and Rotator Cuff Integrity?

    Science.gov (United States)

    Park, Jin-Young; Chung, Seok Won; Lee, Seoung-Joon; Cho, Hyoung-Weon; Lee, Jae Hyung; Lee, Jun-Hee; Oh, Kyung-Soo

    2016-01-01

    Previous studies on massive rotator cuff tears have not addressed the outcomes of tears extending to the subscapularis tendon. The retear rate in patients with a massive posterosuperior rotator cuff tear combined with a subscapularis tear is higher than that in patients with a massive posterosuperior rotator cuff tear with an intact subscapularis tendon. Cohort study; Level of evidence, 3. Data were collected and analyzed from 92 consecutive patients who underwent arthroscopic repair of a massive posterosuperior rotator cuff tear. Patients were divided into 3 groups according to the status of the subscapularis tendon: intact subscapularis tendon (I-massive tear; n = 42), tear involving half or less than half of the subscapularis tendon (S-massive tear; n = 22), and tear involving more than half of the subscapularis tendon (L-massive tear; n = 28). The integrity of the rotator cuff was determined by ultrasonography at 4.5 and 12 months or later after surgery. Clinical evaluations were performed using the visual analog scale (VAS) pain score, the American Shoulder and Elbow Surgeons (ASES) score, the Constant score, and active shoulder range of motion. Data were collected on the day before surgery and at final follow-up (at least 24 months postoperatively). A total of 25 retears (27%) were identified based on an ultrasonographic evaluation. Although statistical significance was not found, there was a trend toward a higher retear rate in patients with an L-massive tear (43%) compared with those with an S-massive tear (18%; P = .050) or I-massive tear (21%; P = .059) at final follow-up. The subclassification of retears according to the involved tendons revealed that subsequent retears of the subscapularis tendon were noted only in patients with an L-massive tear. In patients with an L-massive tear, postoperative data comparison between patients with intact subscapularis tendons and those with failed subscapularis tendons revealed that a significant difference was noted

  15. Antioxidant content and ultraviolet absorption characteristics of human tears.

    Science.gov (United States)

    Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

    2011-04-01

    Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the tear film of the aging eye may help prevent or improve dry eye symptoms and promote ocular health.

  16. Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies.

    Science.gov (United States)

    Alentorn-Geli, Eduard; Choi, J H James; Stuart, Joseph J; Toth, Alison P; Garrett, William E; Taylor, Dean C; Moorman, Claude T

    2016-10-01

    The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included. After appropriate screening, a total of 54 studies were reviewed in detail (full text), and 6 met inclusion criteria. The most common cause of exclusion was the investigation of longitudinal tears. Only two studies could be meta-analyzed. Stiffness was significantly higher for all-inside compared with inside-out repair techniques (p = 0.0009). No significant differences were observed between both suture methods for load to failure (p = 0.45). However, both studies used different all-inside devices and suture constructs. No clear conclusions can be drawn from the comparison of both types of repairs for displacement, site of failure, or contact pressure changes. Overall, there are no conclusive data to suggest that inside-out or outside-in suture repair has better load to failure or stiffness, less displacement, or different site of failure compared with all-inside repair. According to biomechanical data, it is under surgeon's preference to elect one repair technique over the other. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  17. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative

    NARCIS (Netherlands)

    Rongen, J.J.; Rovers, M.M.; Tienen, T.G. van; Buma, P; Hannink, G.J.

    2017-01-01

    OBJECTIVE: The primary objective was to assess whether patients with knee osteoarthritis and whom undergo arthroscopic meniscectomy have an increased risk for future knee replacement surgery. DESIGN: Data used were obtained from the Osteoarthritis Initiative (OAI) study. SETTING: Participants were

  18. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative.

    Science.gov (United States)

    Rongen, J J; Rovers, M M; van Tienen, T G; Buma, P; Hannink, G

    2017-01-01

    The primary objective was to assess whether patients with knee osteoarthritis and whom undergo arthroscopic meniscectomy have an increased risk for future knee replacement surgery. Data used were obtained from the Osteoarthritis Initiative (OAI) study. Participants were enrolled, in four clinical centers, between February 2004 and May 2006 and were followed up on an annual basis up to and including 108-months from enrollment. 4674 participants (58.4% female), aged 45-79, of all ethnic groups, who had, and those who were at high risk for developing, symptomatic knee osteoarthritis were included, of which 3337 (71.4%) were included in the final follow up visit. Hazard ratio of knee replacement surgery for participants who underwent arthroscopic meniscectomy during follow up compared to propensity score matched participants who did not undergo arthroscopic meniscectomy during follow up. 335 participants underwent arthroscopic meniscectomy during follow up, of which 63 (18.8%) underwent knee replacement surgery in the same knee. Of the 335 propensity score matched participants 38 (11.1%) underwent knee replacement surgery during follow up. Results from the Cox-proportional hazards model demonstrated that the hazard ratio of knee replacement surgery was 3.03 (95% CI (1.67-5.26)) for participants who underwent arthroscopic meniscectomy relative to the propensity score matched participants who did not undergo arthroscopic meniscectomy. In patients with knee osteoarthritis arthroscopic knee surgery with meniscectomy is associated with a three fold increase in the risk for future knee replacement surgery. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  19. Role of metalloproteinases in rotator cuff tear.

    Science.gov (United States)

    Garofalo, Raffaele; Cesari, Eugenio; Vinci, Enzo; Castagna, Alessandro

    2011-09-01

    The role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPS) in the pathophysiology of rotator cuff tears has not been established yet. Recent advances empathize about the role of MMPs and TIMPS in extracellular matrix (ECM) remodeling and degradation in rotator cuff tears pathogenesis and healing after surgical repair. An increase in MMPs synthesis and the resulting MMPs mediated alterations in the ECM of tendons have been implicated in the etiopathogenesis of tendinopathy, and there is an increase in the expression of MMPs and a decrease in TIMP messenger ribonucleic acid expression in tenocytes from degenerative or ruptured tendons. Importantly, MMPs are amenable to inhibition by cheap, safe, and widely available drugs such as the tetracycline antibiotics and bisphosphonates. A better understanding of relationship and activity of these molecules could provide better strategies to optimize outcomes of rotator cuff therapy.

  20. Plate Tearing Under Mixed Mode Loading

    DEFF Research Database (Denmark)

    Andersen, Rasmus Grau; Nielsen, Kim Lau; Felter, Christian Lotz

    2016-01-01

    Cohesive-zone finite element modeling is often the technique of choice when dealing with extensive crack growth in large-scale ductile sheet metal structures. Shell elements with in-plane dimensions much larger than the plate thickness are typically employed to discretize the structure, and thus...... that takes place in front of an advancing crack can significantly enhance the crack growth resistanceas the energy going into thinning the sheet typically dominates the total fracture energy.This has been investigated in great details for the case of pure Mode I tearing and both the energy dissipation, peak...... stress, and shape of the cohesive traction-separation law have been laid out. In a similar fashion, the present study resolves the sequence of failure details related to steady-state sheet tearing under mixed mode loading by employing the micro-mechanics based Gurson model. But, the fracture process...

  1. Tearing mode stability calculations with pressure flattening

    CERN Document Server

    Ham, C J; Cowley, S C; Hastie, R J; Hender, T C; Liu, Y Q

    2013-01-01

    Calculations of tearing mode stability in tokamaks split conveniently into an external region, where marginally stable ideal MHD is applicable, and a resonant layer around the rational surface where sophisticated kinetic physics is needed. These two regions are coupled by the stability parameter. Pressure and current perturbations localized around the rational surface alter the stability of tearing modes. Equations governing the changes in the external solution and - are derived for arbitrary perturbations in axisymmetric toroidal geometry. The relationship of - with and without pressure flattening is obtained analytically for four pressure flattening functions. Resistive MHD codes do not contain the appropriate layer physics and therefore cannot predict stability directly. They can, however, be used to calculate -. Existing methods (Ham et al. 2012 Plasma Phys. Control. Fusion 54 025009) for extracting - from resistive codes are unsatisfactory when there is a finite pressure gradient at the rational surface ...

  2. Characterization of ocular gland morphology and tear composition of pinnipeds.

    Science.gov (United States)

    Kelleher Davis, Robin; Doane, Marshall G; Knop, Erich; Knop, Nadja; Dubielzig, Richard R; Colitz, Carmen M H; Argüeso, Pablo; Sullivan, David A

    2013-07-01

    The importance of tear film integrity to ocular health in terrestrial mammals is well established, however, in marine mammals, the role of the tear film in protection of the ocular surface is not known. In an effort to better understand the function of tears in maintaining health of the marine mammal eye surface, we examined ocular glands of the California sea lion and began to characterize the biochemical nature of the tear film of pinnipeds. Glands dissected from California sea lion eyelids and adnexa were examined for gross morphology, sectioned for microscopic analysis, and stained with hematoxylin and eosin. The tear film was examined using interferometry. Tears were collected from humans and pinnipeds for the analysis of protein and carbohydrate content. The sea lion has sebaceous glands in the lid, but these glands are different in size and orientation compared with typical meibomian glands of terrestrial mammals. Two other accessory ocular glands located dorsotemporally and medially appeared to be identical in morphology, with tubulo-acinar morphology. An outer lipid layer on the ocular surface of the sea lion was not detected using interferometry, consistent with the absence of typical meibomian glands. Similar to human tears, the tears of pinnipeds contain several proteins but the ratio of carbohydrate to protein was greater than that in human tears. Our findings indicate that the ocular gland architecture and biochemical nature of the tear film of pinnipeds have evolved to adapt to the challenges of an aquatic environment. © 2012 American College of Veterinary Ophthalmologists.

  3. The sensitivity of cartilage contact pressures in the knee joint to the size and shape of an anatomically shaped meniscal implant

    OpenAIRE

    Khoshgoftar, M.; Vrancken, A.C.T.; Tienen, T.G. van; Buma, P.; D. Janssen; Verdonschot, N.

    2015-01-01

    Since meniscal geometry affects the cartilage contact pressures, it is essential to carefully define the geometry of the synthetic meniscal implant that we developed. Recently, six independent modes of size- and shape-related geometry variation were identified through 3D statistical shape modeling (SSM) of the medial meniscus. However, this model did not provide information on the functional importance of these geometry characteristics. Therefore, in this study finite element simulations were...

  4. Transplantation of Achilles Tendon Treated With Bone Morphogenetic Protein 7 Promotes Meniscus Regeneration in a Rat Model of Massive Meniscal Defect

    Science.gov (United States)

    Ozeki, Nobutake; Muneta, Takeshi; Koga, Hideyuki; Katagiri, Hiroki; Otabe, Koji; Okuno, Makiko; Tsuji, Kunikazu; Kobayashi, Eiji; Matsumoto, Kenji; Saito, Hirohisa; Saito, Tomoyuki; Sekiya, Ichiro

    2013-01-01

    Objective This study was undertaken to examine whether bone morphogenetic protein 7 (BMP-7) induces ectopic cartilage formation in the rat tendon, and whether transplantation of tendon treated with BMP-7 promotes meniscal regeneration. Additionally, we analyzed the relative contributions of host and donor cells on the healing process after tendon transplantation in a rat model. Methods BMP-7 was injected in situ into the Achilles tendon of rats, and the histologic findings and gene profile were evaluated. Achilles tendon injected with 1 μg of BMP-7 was transplanted into a meniscal defect in rats. The regenerated meniscus and articular cartilage were evaluated at 4, 8, and 12 weeks. Achilles tendon from LacZ-transgenic rats was transplanted into the meniscal defect in wild-type rats, and vice versa. Results Injection of BMP-7 into the rat Achilles tendon induced the fibrochondrocyte differentiation of tendon cells and changed the collagen gene profile of tendon tissue to more closely approximate meniscal tissue. Transplantation of the rat Achilles tendon into a meniscal defect increased meniscal size. The rats that received the tendon treated with BMP-7 had a meniscus matrix that exhibited increased Safranin O and type II collagen staining, and showed a delay in articular cartilage degradation. Using LacZ-transgenic rats, we determined that the regeneration of the meniscus resulted from contribution from both donor and host cells. Conclusion Our findings indicate that BMP-7 induces ectopic cartilage formation in rat tendons. Transplantation of Achilles tendon treated with BMP-7 promotes meniscus regeneration and prevents cartilage degeneration in a rat model of massive meniscal defect. Native cells in the rat Achilles tendon contribute to meniscal regeneration. PMID:23897174

  5. Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions.

    Science.gov (United States)

    Verdonk, René; Verdonk, Peter; Huysse, Wouter; Forsyth, Ramses; Heinrichs, Eva-Lisa

    2011-04-01

    A novel, biodegradable, aliphatic polyurethane scaffold was designed to fulfill an unmet clinical need in the treatment of patients with irreparable partial meniscal lesions. Treatment of irreparable partial meniscal lesions with an acellular polyurethane scaffold supports new tissue ingrowth. Case series; Level of evidence, 4. Fifty-two patients (with 34 medial and 18 lateral lesions) were recruited into a prospective, single-arm, multicenter, proof-of-principle study and treated with the polyurethane scaffold. The scaffold was implanted after partial meniscectomy using standard surgeon-preferred techniques for suturing. Tissue ingrowth was assessed at 3 months by dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and at 12 months by gross examination during second-look arthroscopy, in the course of which a biopsy sample from the inner free edge of the scaffold meniscus was taken for qualitative histologic analysis. Tissue ingrowth at 3 months was demonstrated on DCE-MRI in 35 of 43 (81.4%) patients. All but one 12-month second-look (43 of 44 [97.7%]) showed integration of the scaffold with the native meniscus and all biopsy specimens (44) showed fully vital material, with no signs of cell death or necrosis. Three distinct layers were observed based on morphologic structure, vessel structure presence or absence, and extracellular matrix composition. The DCE-MRI demonstrated successful early tissue ingrowth into the scaffold. The biopsy findings demonstrated the biocompatibility of the scaffold and ingrowth of tissue with particular histologic characteristics suggestive of meniscus-like tissue. In conclusion, these data show for the first time consistent regeneration of tissue when using an acellular polyurethane scaffold to treat irreparable partial meniscus tissue lesions.

  6. Dynamic compression of human and ovine meniscal tissue compared with a potential thermoplastic elastomer hydrogel replacement.

    Science.gov (United States)

    Fischenich, Kristine M; Boncella, Katie; Lewis, Jackson T; Bailey, Travis S; Haut Donahue, Tammy L

    2017-10-01

    Understanding how human meniscal tissue responds to loading regimes mimetic of daily life as well as how it compares to larger animal models is critical in the development of a functionally accurate synthetic surrogate. Seven human and eight ovine cadaveric meniscal specimens were regionally sectioned into cylinders 5 mm in diameter and 3 mm thick along with 10 polystyrene-b-polyethylene oxide block copolymer-based thermoplastic elastomer (TPE) hydrogels. Samples were compressed to 12% strain at 1 Hz for 5000 cycles, unloaded for 24 h, and then retested. No differences were found within each group between test one and test two. Human and ovine tissue exhibited no regional dependency (p < 0.05). Human samples relaxed quicker than ovine tissue or the TPE hydrogel with modulus values at cycle 50 not significantly different from cycle 5000. Ovine menisci were found to be similar to human menisci in relaxation profile but had significantly higher modulus values (3.44 MPa instantaneous and 0.61 MPa after 5000 cycles compared with 1.97 and 0.11 MPa found for human tissue) and significantly different power law fit coefficients. The TPE hydrogel had an initial modulus of 0.58 MPa and experienced less than a 20% total relaxation over the 5000. Significant differences in the magnitude of compressive modulus between human and ovine menisci were observed, however the relaxation profiles were similar. Although statistically different than the native tissues, modulus values of the TPE hydrogel material were similar to those of the human and ovine menisci, making it a material worth further investigation for use as a synthetic replacement. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 2722-2728, 2017. © 2017 Wiley Periodicals, Inc.

  7. ¿El transplante meniscal, mejora la función articular de la rodilla a mediano plazo? [Does meniscal transplantation improve the knee articular function at medium term?

    Directory of Open Access Journals (Sweden)

    Ruben Edilio Paoletta

    2012-08-01

    Full Text Available Introducción Existen pocas alternativas terapéuticas que logren mejorias clínicas a mediano plazo para tratar a pacientes jóvenes posmeniscectomizados. El objetivo de este estudio es evaluar los resultados clínicos de una serie de pacientes tratados con transplante meniscal a mediano plazo. Material y métodos Desde 1998 al 2008, 28 pacientes recibieron un transplante meniscal como consecuencia de presentar una rodilla degenerativa por meniscetomías previas. El menisco externo estuvo comprometido en 17 oportunidades y el interno en 11. La edad promedio fue de 33 años (rango de 24 a 47. Veintiún pacientes fueron tratados con procedimientos quirúrgicos concomitantes: osteotomías, ligamentoplastias, injertos osteocondrales autólogos, aloinjertos osteocondrales y transplante de condrocitos. El promedio de seguimiento fue de 47 meses. Los pacientes fueron evaluados clínicamente mediante los escores de Lysholm e IKDC preoperatoriamente y luego anualmente. Resultados Al seguimiento final, los escores de Lysholm y de IKDC mostraron mejorías clínicas significativas (p<0.05. El 86 % de los pacientes refirió estar completamente o bastante satisfecho con el resultado final y 25 de 28 pacientes (89% elegirían la misma cirugía si tuviesen el mismo problema en la rodilla contralateral. Ocho pacientes presentaron complicaciones relacionadas con la ruptura del menisco transplantado que fueron tratadas con meniscectomía parcial o sutura meniscal en forma artroscópica. Conclusiones El transplante meniscal en combinación con procedimientos concomitantes permite mejorar la función y los síntomas en pacientes sintomáticos postmenisectomizados a mediano plazo.

  8. Cytokine changes in tears and relationship to contact lens discomfort

    OpenAIRE

    Willcox, Mark D.P.; Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    Purpose To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Methods Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected the...

  9. HPLC analysis of closed, open, and reflex eye tear proteins

    OpenAIRE

    Sitaramamma T; Shivaji S; Rao Gullapalli

    1998-01-01

    Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate - polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different fro...

  10. Hall effect on tearing mode instabilities in tokamak

    Science.gov (United States)

    Zhang, W.; Ma, Z. W.; Wang, S.

    2017-10-01

    The tearing mode instability is one of the most important dynamic processes in space and laboratory plasmas. Hall effects, resulting from the decoupling of electron and ion motions, can cause fast development and rotation of the perturbation structure of the tearing mode. A high-accuracy nonlinear magnetohydrodynamics code is developed to study Hall effects on the evolution of tearing modes in the Tokamak geometry. It is found that the linear growth rate increases with the increase in the ion skin depth and the self-consistently generated rotation can greatly alter the dynamic behavior of the double tearing mode.

  11. Oral alcohol administration disturbs tear film and ocular surface.

    Science.gov (United States)

    Kim, Joo Hyun; Kim, Jung Ha; Nam, Woo Ho; Yi, Kayoung; Choi, Dong Gyu; Hyon, Joon Young; Wee, Won Ryang; Shin, Young Joo

    2012-05-01

    To investigate whether ethanol administration disturbs the tear film and ocular surface. Case-control study. Twenty healthy male subjects were recruited. Ethanol was administered to 10 subjects and another 10 subjects served as controls. Twenty healthy male subjects with no ocular disease were recruited. Ethanol (0.75 g/kg) was administered orally at 8 pm for 2 hours to 10 subjects. The tear film and ocular surface were evaluated at 6 pm before drinking, at midnight, and immediately (6 am) and 2 hours (8 am) after waking the next morning. Tear osmolarity, ethanol concentration in tears and serum, Schirmer's test results, tear film break-up time (TBUT), corneal punctuate erosion, and corneal sensitivity were measured. Ethanol was detected in tears and serum at midnight, but it was not detected the next morning. The mean tear osmolarity level increased in the alcohol group at midnight compared with that in the control group (Ptears. Ethanol in tears induced tear hyperosmolarity and shortened TBUT and triggered the development of ocular surface diseases. Similar changes could exacerbate signs and symptoms in patients with ocular surface disease. Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

  12. Integrated multimodal metrology for objective and noninvasive tear evaluation.

    Science.gov (United States)

    Kottaiyan, Ranjini; Yoon, Geunyoung; Wang, Qi; Yadav, Rahul; Zavislan, James M; Aquavella, James V

    2012-01-01

    The clinical tests used to assess tear film and diagnose dry eye are invasive and produce results that are different from natural tear characteristics. There is a need to objectively and noninvasively assess tear parameters under controlled environmental circumstances to refine dry eye diagnosis and therapy. We have developed multimodal tear imaging systems integrated in a chamber in which individual environmental factors can be precisely varied to investigate their impacts on tear parameters. With the custom-built high-resolution wavefront sensor combined with placido disc, it is possible to objectively detect two-dimensional tear breakups in real time and evaluate its impact on visual quality. Micrometer ultra-high resolution optical coherence tomography (OCT) enables us to quantify thickness and volume of the tear over the cornea and tear menisci. The ocular surface imaging ellipsometer uses polarized illumination from which both the lipid refractive index and thickness can be measured at a very high resolution. Using an enhanced thermal camera, we measure the ocular surface temperature noninvasively, which makes it possible to study spatial and temporal changes in tear evaporation. The multimodal deployment of these four components in the controlled chamber will assist in better differentiating the various clinical dry eye entities and will lead to the development of specific dry eye treatments. Copyright © 2012 Elsevier Inc. All rights reserved.

  13. Immunoglobulin Concentration in Tears of Contact Lens Wearers

    OpenAIRE

    Maurya, Rajendra P.; Bhushan, Prashant; Singh, Virendra P.; Singh, Mahendra K.; Kumar, Prakash; Bhatia, Ravindra P.S.; Singh, Usha

    2014-01-01

    Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear I...

  14. Changes of tear film after trabeculectomy in glaucoma

    Directory of Open Access Journals (Sweden)

    Xue-Jun Li

    2015-07-01

    Full Text Available AIM: To learn the changes of the tear film before and after the trabeculectomy of glaucoma and explore the incidence of dry eye and the prevention and control measures.METHODS: The 36 patients(60 eyesof glaucoma were examined in detail before 3d of trabeculectomy and after the surgery at 3, 7, 14 and 30d. The examinations include lower eyelid central river of tears, break-up time(BUT, Schirmer Ⅰ test(SⅠtand staining scores of corneal fluorescein under slit lamp microscope.RESULTS:The tear meniscus height of central lower eyelid was increased and the tear film BUT was shortened at the same time, the scores of SⅠt was reduced and corneal fluorescein staining score was increased at postoperative 3 and 7d compared with that of preoperation. The tear meniscus height of central lower eyelid, tear film BUT and SIt and score of corneal fluorescein staining began to recover in most of the affected eyes after surgery 14d. At 30d after surgery, 22% of patients tear film failed to recover to the preoperative level; dry eye occured in 18% preoperative eyes with normal tear film.CONCLUSION:Trabeculectomy of glaucoma may affect the stability of the tear film and some patients showeing obvious dry eye and should be intervened and treatmented timely.

  15. Relationship between Corneal Sensation, Blinking, and Tear Film Quality

    National Research Council Canada - National Science Library

    Nosch, Daniela Sonja; Pult, Heiko; Albon, Julie; Purslow, Christine; Murphy, Paul John

    2016-01-01

    PURPOSETo examine the possible role of corneal sensitivity and tear film quality in triggering a blink by investigating the relationship between blink rate, central corneal sensitivity threshold (CST...

  16. Tear lipocalins bind a broad array of lipid ligands.

    Science.gov (United States)

    Glasgow, B J; Abduragimov, A R; Farahbakhsh, Z T; Faull, K F; Hubbell, W L

    1995-05-01

    To identify the native ligands of tear lipocalins, tear proteins were separated by size exclusion chromatography and the lipid content in the major protein fractions identified. Lipids extracted from native tears and purified tear lipocalins comigrated with fatty acids, fatty alcohols, phospholipids, glycolipids, and cholesterol on thin layer chromatograms. Abundant stearic and palmitic acids as well as cholesterol, and lesser amounts of lauric acid were specifically identified in extracts of purified lipocalins by gas chromatography-mass spectroscopy. A preliminary study of the ligand-protein interaction was carried out using nitroxide spin-labeled lipids.

  17. Platelet-Rich Fibrin Facilitates Rabbit Meniscal Repair by Promoting Meniscocytes Proliferation, Migration, and Extracellular Matrix Synthesis

    OpenAIRE

    Wong, Chin-Chean; Kuo, Tzong-Fu; Yang, Tsung-Lin; Tsuang, Yang-Hwei; Lin, Ming-Fang; Chang, Chung-Hsun; Lin, Yun-Ho; Chan, Wing P.

    2017-01-01

    Although platelet-rich fibrin (PRF) has been used in clinical practice for some time, to date, few studies reveal its role as a bioactive scaffold in facilitating meniscal repair. Here, the positive anabolic effects of PRF on meniscocytes harvested from the primary culture of a rabbit meniscus were revealed. The rabbit meniscocytes were cultured with different concentrations of PRF-conditioned medium, and were evaluated for their ability to stimulate cell migration, proliferation, and extrace...

  18. One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the Meniscal Viper Repair System

    Directory of Open Access Journals (Sweden)

    Ochiai Satoshi

    2011-08-01

    Full Text Available Abstract Background Principles for the treatment of tibial intercondylar eminence fracture are early reduction and stable fixation. Numerous ways to treatment of this fracture have been invented. We designed a simple, low-invasive, and arthroscopic surgical strategy for tibial intercondylar eminence fracture utilizing the Meniscal Viper Repair System used for arthroscopic meniscal suture. Methods We studied 5 patients, who underwent arthroscopic suture fixation that we modified. The present technique utilized the Meniscal Viper Repair System for arthroscopic suture of the meniscus. With one handling, a high-strength ultra-high molecular weight polyethylene(UHMWPE suture can be passed through the anterior cruciate ligament (ACL and the loops for suture retrieval placed at both sides of ACL. Surgical results were evaluated by the presence or absence of bone union on plain radiographs, postoperative range of motion of the knee joint, the side-to-side differences measured by Telos SE, and Lysholm scores. Results The reduced position achieved after surgery was maintained and good function was obtained in all cases. The mean distance of tibia anterior displacement and assessment by Lysholm score showed good surgical results. Conclusion This method simplified the conventional arthroscopic suture fixation and increased its precision, and was applicable to Type II fractures that could be reduced, as well as surgically indicated Types III and IV. The present series suggested that our surgical approach was a useful surgical intervention for tibial intercondylar eminence fracture.

  19. Polymorphonuclear leukocyte cells and elastase in tears.

    Science.gov (United States)

    Sakata, M; Sack, R A; Sathe, S; Holden, B; Beaton, A R

    1997-08-01

    To characterize the effects that mode of sampling and overnight eye closure have on the nature of caseinolytic activity recovered in tear fluid. Reflex, open and closed (R, O and C) eye tear fluids were collected by microcapillary tubes or from the inferior formix by Schirmer strip. Microcapillary collected samples were centrifuged and recovered cells cytochemically characterized and probed by immunofluorescence microscopy, or alternatively extracted in acidic PBS. Tear supernatants, pellets and Schirmer strip extracts were subjected to casein zymography or SDS-PAGE and immunoprobed for plasmin/plasminogen. To identify caseinolytic activity, samples were immunoprecipitated with antibodies to plasmin/plasminogen or to elastase, and the immunoprecipitated materials were subjected to zymographic analysis. Immunoblot assays revealed R and O samples contained low levels of plasminogen (approximately 1.1 micrograms/ml) and only trace levels of plasmin (leukocyte (PMN) cell elastase based on size and antigenicity. This is derived from PMNs recovered from the C pellet. Elastase could also be recovered from Schirmer strips from 90% of donors, provided that the strips were extracted in sample loading buffer. The activity was restricted to the portion of the strip that had been in contact with the ocular tissue. The main source of caseinolytic activity in C fluid is elastase. This arises from PMNs that undergo recruitment, activation and degranulation in the C environment. In contrast, the elastase recovered in Schirmer strip extracts is derived from intact PMNs that adhere to the strip during sample collection. This would suggest that PMN cells undergo a low level of recruitment into the open eye environment.

  20. A case of recurrent bloody tears

    OpenAIRE

    Karslıoğlu, Şafak; Şimşek, İlke Bahçeci; Akbaba, Müslime

    2011-01-01

    Şafak Karslioğlu1, Ilke Bahçeci Şimşek2, Müslime Akbaba11Ìstanbul Oculoplastic and Orbital Surgery and Ocular Oncology Center, 2Ophthalmology Department, Medicine Hospital, Ìstanbul, TurkeyAbstract: Well-known causes of blood-tinged epiphora are conjunctival lesions, tumors of the lacrimal apparatus, and systemic bleeding disorders. We describe an unusual patient who presented with recurrent episodes of bloody tearing which began following an eryt...

  1. Apomictic maternal diploids in tetraploid Job's tears.

    Science.gov (United States)

    Venkateswarlu, J; Rao, P N

    1975-06-01

    Two cases of reversion to diploidy were observed in autotetraploid Job's tears (Coix lacryma-jobi L. 4n = 40) out of a total of 1,112 plants examined over a period of 7 years. One of these was a trisomie (2n = 21) and the other a disomic (2n = 20), derived from apomictic development ofn+1 andn maternal gametes of the tetraploid, respectively. In some respects both these derivatives differed from the original diploid that gave rise to the tetraploid through colchicine treatment. The potentialities of such reversions in the evolution of new diploid races are discussed.

  2. Long-Term MRI Findings in Operated Rotator Cuff Tear

    Energy Technology Data Exchange (ETDEWEB)

    Kyroelae, K.; Niemitukia, L.; Jaroma, H.; Vaeaetaeinen, U. [Kuopio Univ. Hospital (Finland). Dept. of Orthopaedics and Traumatology

    2004-08-01

    Purpose: To describe magnetic resonance imaging (MRI) findings at long-term follow-up after rotator cuff (RC) tear using standard MRI sequences without fat saturation. Material and Methods: Twenty-eight patients aged 55.8{+-}7.6 underwent MRI examination 4.6{+-}2.1 years after surgery for RC tear. Standard sequences in oblique coronal, oblique sagittal, and axial planes were obtained. The RC, including re-tears and tendon degeneration, was independently evaluated by two observers. Thickness of the supraspinatus tendon and narrowing of the subacromial space were measured. The clinical outcome was evaluated with the Constant score and compared with the MRI findings. Results: The RC tear was traumatic in 18 (64%) patients and degenerative in 10 (36%). At follow-up, 11 (39%) had normal RC tendons with good clinical outcome. Four (14%) patients had painful tendinosis without RC tear. A full-thickness RC tear was found in 7 (25%) patients and a partial tear in 6 (21%). In one patient with a full-thickness tear, and in two with partial tear, tendinosis was found in another of the RC tendons. The subacromial space was narrowed in 13 (46%) of the patients. A narrowing of the subacromial space correlated with re-tear (P<0.05). Conclusions: The RC may be evaluated with standard MRI sequences without fat saturation at long-term follow-up. A normal appearance of the RC is correlated with good clinical outcome, while re-tear and tendinosis are associated with pain.

  3. Effect of ingested raw ginger (zingerber officinale ) on tear production

    African Journals Online (AJOL)

    4.36years to chew and swallow as a bolus. Its effect on tear production was then monitored using Schirmer's test. The initial rate of tear production was measured before administration of ginger for each subject. Subsequent measurements were ...

  4. Measurement of Tear Production in English Angora and Dutch Rabbits.

    Science.gov (United States)

    Rajaei, Seyed Mehdi; Rafiee, Siamak Mashhady; Ghaffari, Masoud Selk; Masouleh, Mohammad N; Jamshidian, Mahmoud

    2016-03-01

    The purpose of this study was to establish normal values for tear production tests in different breeds of domestic rabbits. Healthy adult rabbits (n = 60; 120 eyes) of 2 different breeds (English angora and Dutch; n = 15 of each sex and breed) were used in this study. Tear production was measured by using the 1-min Schirmer tear test (STT), phenol red thread test (PRTT), and endodontic absorbent paper point tear test (EAPTT). In addition, horizontal palpebral fissure length was evaluated as a measure of ocular adnexal dimensions. Tear production (mean ± 1 SD) in English angora rabbits was 5.4 ± 1.6 mm/min according to the STT, 25.0 ± 2.7 mm in 15 s for the PRTT, and 18.8 ± 2.1 mm/min by the EAPTT; in Dutch rabbits, these values were 4.6 ± 1.2 mm/min, 23.6 ± 2.3 mm in 15 s, and 16.9 ± 1.7 mm/min, respectively. Only the EAPTT revealed a significant difference in tear production between English Angora and Dutch rabbits. These results provide reference values for tear production in English Angora and Dutch rabbits according to 3 different quantitative tear film assessment methods.

  5. State Secret: North Carolina and the Cherokee Trail of Tears

    Science.gov (United States)

    Bryant, James

    2008-01-01

    This paper is an analytic essay that examines the treatment of the Cherokee Trail of Tears in a North Carolina fourth grade textbook. I begin by offering a satiric look at an imaginary textbook's treatment of the Holocaust that is based closely on the actual narrative of the Trail of Tears written in the fourth grade text. Following this, close…

  6. Rotator cuff tears in the throwing athlete.

    Science.gov (United States)

    Shaffer, Benjamin; Huttman, Daniel

    2014-06-01

    Tears of the rotator cuff, both partial, and less commonly, full thickness, are relatively common in the throwing athlete. The rotator cuff is subjected to enormous stresses during repetitive overhead activity. The supraphysiological strains, especially when combined with pathology elsewhere in the kinetic chain, can lead to compromise of the cuff fabric, most commonly on the undersurface where tensile overload occurs. Exacerbation by a tight posterior capsular, anterior instability, and internal impingement render the cuff progressively compromised, with intrinsic shear stresses and undersurface fiber failure. Advances in imaging technology, including contrast magnetic resonance imaging, dynamic ultrasound, and arthroscopic visualization have enhanced our understanding of cuff pathology in this athletic population. Unfortunately, this has not yet translated into how to best approach these athletes to return them to their previous level of activity. Nonoperative management remains the mainstay for most throwers, with arthroscopic debridement an effective surgical option for those with refractory symptoms. Despite technological advances in cuff repair in the general population, comparable outcomes have not been achieved in high-level throwers. Widespread appreciation that securing the cuff operatively will likely end an athletes' throwing career has led to adopting a surgical approach that emphasizes debridement over repair for nearly all partial and full-thickness tears. Whether advances in surgical technique will ultimately permit definitive and lasting repairs that allow overhead throwers to return to their previous level of sports remains unknown at this time.

  7. Visual Quality Metrics Resulting from Dynamic Corneal Tear Film Topography

    Science.gov (United States)

    Solem, Cameron Cole

    The visual quality effects from the dynamic behavior of the tear film have been determined through measurements acquired with a high resolution Twyman-Green interferometer. The base shape of the eye has been removed to isolate the aberrations induced by the tear film. The measured tear film was then combined with a typical human eye model to simulate visual performance. Fourier theory has been implemented to calculate the incoherent point spread function, the modulation transfer function, and the subjective quality factor for this system. Analysis software has been developed for ease of automation for large data sets, and outputs movies have been made that display these visual quality metrics alongside the tear film. Post processing software was written to identify and eliminate bad frames. As a whole, this software creates the potential for increased intuition about the connection between blinks, tear film dynamics and visual quality.

  8. Tear levels of macrophage migration inhibitory factor in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-06-01

    Full Text Available Objective: The pathogenesis of vernal keratoconjunctivitis(VKC is not fully understood and cannot be explainedonly with type I hypersensitivity reaction. The aim of thisstudy was to determine the Macrophage migration inhibitoryfactor (MIF levels in tear fluids of patients with VKC.Methods: Tear fluid samples were collected with microcapillarytubes for hematocrit at the lateral canthus ofpatients in the supine position without any anesthesia.Tear levels of MIF were measured by ELISA kit. Tear fluidsamples were collected from 10 healthy subjects and 20patients with VKC.Results: Tear levels of MIF in patients with VKC weresignificantly higher than those in controls (p<0,001.Conclusion: These results suggested that MIF may havesignificant effect on the pathogenetic process of VKC. JClin Exp Invest 2013; 4 (2: 195-198Key words: Macrophage migration inhibitory factor, vernalkeratoconjunctivitis, ELISA

  9. Separation of human tear proteins by high performance liquid chromatography.

    Science.gov (United States)

    Boonstra, A; Kijlstra, A

    1984-12-01

    The optimal conditions for separating human tear proteins by high performance liquid chromatography (HPLC) using a Waters I-125 gel filtration column were investigated. Several elution buffers were tested including phosphate buffer alone and phosphate buffer to which varying amounts of NaCl or 0.1% Tween was added. The combination of phosphate buffer (pH 5.28), 0.5 M NaCl and 0.1% Tween gave the best resolution and a recovery of 90% of the proteins applied. Tear lactoferrin was shown to adhere to the column packing when the molarity of the elution buffer was not high enough. Using optimal conditions, the tear proteins IgA, lactoferrin and lysozyme were identified in distinct peaks after a preparative HPLC run. When used in combination with Schirmer strips as a tear sampling method, HPLC was shown to be a rapid, simple and reproducible way of investigating the composition of tear proteins.

  10. Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

    Science.gov (United States)

    Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

    2011-09-01

    The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (Ptears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

  11. Idiopathic horseshoe-like macular tear: a case report

    Directory of Open Access Journals (Sweden)

    Kubota M

    2016-07-01

    Full Text Available Masaomi Kubota,1 Tomohiro Shibata,1 Hisato Gunji,1 Hiroshi Tsuneoka2 1Department of Ophthalmology, The Jikei University School of Medicine Kashiwa Hospital, Chiba, 2Department of Ophthalmology, The Jikei University School of Medicine, Tokyo, Japan Background: Although a few cases with idiopathic horseshoe-like macular tear have been reported, the mechanism remains unknown and a standard treatment has yet to be determined. Objective: To report the outcome for a patient with idiopathic horseshoe-like macular tear who underwent vitreous surgery. Case report: A 65-year-old man with no previous injury or ophthalmic disease presented with abnormal vision in his left eye. Best-corrected visual acuity was 0.8 in the right and 0.3 in the left, and the relative afferent pupillary defect was negative. Ophthalmoscopy revealed a horseshoe-like tear on the temporal side of the macula in the left eye. The tear size was 0.75 disc diameters (DD. Optical coherence tomography showed that the focal retinal detachment reached the fovea. A few days after the first visit, there was no longer adhesion of the flap of the tear to the retina and the tear size had increased to 1.5 DD. The patient underwent vitreous surgery similar to large macular hole surgery, with the tear closure repaired using the inverted internal limiting membrane flap technique with 20% SF6 gas tamponade. Although the tear decreased to 0.5 DD after the surgery, complete closure of the tear was not achieved. Conclusion: While cases with horseshoe-like macular tear following trauma and branch retinal vein occlusion have been reported, to the best of our knowledge, this is the first reported idiopathic case. In the present case, there was expansion of the tear until the patient actually underwent surgery. If vertical vitreous traction indeed plays a role in horseshoe-like macular tears, this will need to be taken into consideration at the time of the vitreous surgery in these types of cases. Keywords

  12. Tear film physiology and contact lens wear. II. Contact lens-tear film interaction.

    Science.gov (United States)

    Holly, F J

    1981-04-01

    The successful fitting of contact lenses requires the practitioner to take into account many properties of the specific lens type used but the practitioner must also understand patient factors including tear properties, use of appropriate solutions, procedures for lens cleaning, and efficiency of blinking. Selection of appropriate patients, selection of lens type, proper fitting, good maintenance, and training and monitoring of patients increase the probability of achieving success.

  13. Tear Mediators in Corneal Ectatic Disorders.

    Directory of Open Access Journals (Sweden)

    Dorottya Pásztor

    Full Text Available To compare the concentrations of 11 tear mediators in order to reveal the biochemical difference between pellucid marginal degeneration (PMD and keratoconus (KC.We have designed a cross-sectional study in which patients with corneal ectasia based on slit-lamp biomicroscopy and Pentacam HR (keratometry values (K1, K2, Kmax, astigmatism, minimal radius of curvature (Rmin, corneal thickness (Apex and Min, indices (surface variation, vertical asymmetry, keratoconus, central keratoconus, height asymmetry and decentration were enrolled. Eyes of keratoconic patients were similar to the PMD patients in age and severity (K2, Kmax and Rmin. Non-stimulated tear samples were collected from nine eyes of seven PMD patients, 55 eyes of 55 KC patients and 24 eyes of 24 healthy controls. The mediators' (interleukin -6, -10, chemokine ligand 5, -8, -10, matrix metalloproteinase (MMP -9, -13, tissue inhibitor of metalloproteinases (TIMP-1, tissue plasminogen activator, plasminogen activator inhibitor, nerve growth factor concentrations were measured using Cytometric Bead Array.MMP-9 was the only mediator which presented relevant variances between the two patient groups (p = 0.005. The ratios of MMP-9 and TIMP-1 were 2.45, 0.40 and 0.23 in PMD, KC and the controls, respectively.As far as we are aware, this is the first study that aims to reveal the biochemical differences between PMD and KC. Further studies of biomarkers to investigate the precise role of these mediators need to be defined, and it is important to confirm the observed changes in a larger study to gain further insights into the molecular alterations in PMD.

  14. Correlation between Rotator Cuff Tears and Systemic Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Andrea Donovan

    2011-01-01

    Full Text Available The purpose of this study was to investigate the association of aortic arch calcification, a surrogate marker of atherosclerosis, with rotator cuff tendinosis and tears given the hypothesis that decreased tendon vascularity is a contributing factor in the etiology of tendon degeneration. A retrospective review was performed to identify patients ages 50 to 90 years who had a shoulder MRI and a chest radiograph performed within 6 months of each other. Chest radiographs and shoulder MRIs from 120 patients were reviewed by two sets of observers blinded to the others' conclusions. Rotator cuff disease was classified as tendinosis, partial thickness tear, and full thickness tear. The presence or absence of aortic arch calcification was graded and compared with the MRI appearance of the rotator cuff. The tendon tear grading was positively correlated with patient age. However, the tendon tear grading on MRI was not significantly correlated with the aorta calcification scores on chest radiographs. Furthermore, there was no significant correlation between aorta calcification severity and tendon tear grading. In conclusion, rotator cuff tears did not significantly correlate with aortic calcification severity. This suggests that tendon ischemia may not be associated with the degree of macrovascular disease.

  15. Cytokine changes in tears and relationship to contact lens discomfort.

    Science.gov (United States)

    Willcox, Mark D P; Zhao, Zhenjun; Naduvilath, Thomas; Lazon de la Jara, Percy

    2015-01-01

    To determine the reproducibility of a multiplex bead assay for measuring cytokines in tears and correlations between ocular discomfort with or without contact lens wear and the concentration of cytokines in tears. Ninety participants (divided into two groups) were enrolled in this prospective study. They were asked to rate their ocular comfort and collect their tears in the morning and just before sleep for 10 days with or without contact lenses. The participants collected their tears using a glass microcapillary tube for both stages. Galyfilcon A lenses were worn on a daily disposable basis during the contact lens stage, and comfort scores and tears were collected before lens insertion and prior to lens removal at the end of the day. Tears were analyzed for cytokine concentrations using a 27-plex multibead assay. Correlations were sought between cytokine concentrations and comfort. There was a significant (pocular comfort over the day with or without lens wear. The magnitude of ocular discomfort was significantly greater (p-0.5 Log pg/ml, p-0.2 Log pg/ml, ptears was correlated to ocular comfort, but this was not changed by contact lens wear. Ocular comfort during the day is magnified by contact lens wear. However, the increase in the change in comfort during lens wear was not associated with changes in 15 cytokines in the tear film.

  16. Tear osmolarity and ocular surface parameters in patients with psoriasis

    Directory of Open Access Journals (Sweden)

    Goktug Demirci

    Full Text Available ABSTRACT Purpose: The aim of this study was to evaluate tear osmolarity, tear film function, and ocular surface changes in patients with psoriasis. Methods: At a single center, 30 eyes of 30 patients with psoriasis (group 1 and 30 eyes of 30 healthy individuals (group 2 were evaluated using the Ocular Surface Disease Index (OSDI questionnaire, Schirmer I test, tear film break-up time (TBUT test, scoring of ocular surface fluorescein staining using a modified Oxford scale, and tear osmolarity measurement. Results: Tear osmolarity values, OSDI, and Oxford scale scores were significantly higher in group 1 (309.8 ± 9.4 mOsm, 38.9 ± 1.1, and 0.7 ± 1.1, respectively than in group 2 (292.7 ± 7.7 mOsm, 4.2 ± 0.3, and 0.1 ± 0.3, respectively; p<0.01 for all. TBUT was significantly lower in group 1 (8.7 ± 3.6 s than in group 2 (18.1 ± 2.8 s; p<0.001. No significant differences were detected in Schirmer I test values between the groups (16.2 ± 2.5 mm in group 1 and 16.6 ± 2.3 mm in group 2; p=0.629. Conclusions: The results of this study showed that psoriasis may influence tear osmolarity and tear film function. Patients with psoriasis showed tear hyperosmolarity and tear film dysfunction.

  17. Investigation of Tear Biomarkers as an Indicator of Human Health

    Science.gov (United States)

    Morton, Stephen; Tucker, Bethany; Crucian, Brian; Steinberg, Susan; Hagan, Suzanne

    2017-01-01

    Scientific literature suggests that tear biomarkers can be used as a guide towards clinical diagnosis of human health (Hagan et al., 2016). This study will investigate whether tear biomarkers represents a research and clinical opportunity to assess human health prior to, during, and after exposure to the spaceflight environment. The focus of this study is to compare biomarkers previously identified as potentially relevant to both ocular and brain health against unique physiological outcomes of exposure to the space flight environment. Study subjects suffering from terrestrial conditions thought to be similar to Spaceflight Associated Neuro-ocular Syndrome (SANS: formerly VIIP), e.g. patients with idiopathic intracranial hypertension (IIH) and optic neuritis may be relevant to conditions associated with spaceflight. This study will review methodologies, tear biomarkers related to state of ocular and brain health, the strengths and weakness of using tear fluid biomarkers versus other body fluid samples, and will survey current tear fluid biomarker knowledge in research and clinical practice. A strength of using tear biomarkers is that sampling is non-invasive and used as a guide in understanding pathologies, including ocular and systemic inflammatory conditions (Cocho et al., 2016)., Salvisberg et al., 2014). Moreover, tear biomarkers may reflect diseases affecting the central nervous system (CNS) (Salvisberg et al., 2014). For example, in multiple sclerosis (MS), the concordance rate between tear biomarkers versus cerebrospinal fluid (CSF) is approximately 83%, indicating that, in the majority of cases, tears are at least as effective as CSF in potentially identifying novel MS biomarkers (Devos et al., 2001).

  18. Immunoglobulin concentration in tears of contact lens wearers.

    Science.gov (United States)

    Maurya, Rajendra P; Bhushan, Prashant; Singh, Virendra P; Singh, Mahendra K; Kumar, Prakash; Bhatia, Ravindra P S; Singh, Usha

    2014-01-01

    To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation.

  19. Evaluation of Tear Function Tests and Lower Tear Meniscus Height in Keratoconus Patients

    Directory of Open Access Journals (Sweden)

    Özge Saraç

    2012-07-01

    Full Text Available Pur po se: To assess the tear function tests and the lower tear meniscus height (LTMH in keratoconus patients and to evaluate the relationship of these parameters with the progression of keratoconus. Ma te ri al and Met hod: Thirty-eight eyes (group 1 of 21 keratoconus patients and 36 eyes (group 2 of 18 healthy subjects were included in this prospective study. Both groups underwent corneal topographic and keratometric measurements, tear break-up time (T-BUT and Schirmer tests as well as measurement of the LTMH with anterior segment optic coherence tomography (OCT after the ophthalmologic examination. The values obtained from both groups were compared and evaluated for statistical significance and reliability. Re sults: There was no statistically significant difference between the two groups in terms of age and gender (p>0.05. The mean Schirmer test values were 14.87±8.9 mm and 16.77±8.1 mm in group 1 and group 2, respectively (p=0.367. There was not any correlation between the keratometric power and the Schirmer test in group 1 and group 2 (group 1: r=0.114, p=0.548, group 2: r=0.151, p=0.972. The mean TBUT value was 12.83±7.3 sec in group 1, and 18.25±8.5 sec in group 2 (p=0.018. There was a negative correlation between keratometric power and TBUT in group 1, while there was no correlation in group 2 (group 1: r=0.717, p=0.001, group 2: r=0.235, p=0.212. The mean LTMH was 265.30±112 µm in group 1 and 313.29±167 µm in group 2 (p=0.151. There was no correlation between keratometric power and LTMH in both groups (group 1: r=0.001, p=0.997, group 2: r=0.318, p=0.130. Dis cus si on: In this study, it was shown that keratoconus patients have normal tear volume but reduced tear film stability compared to healthy individuals and this reduction is relate to the progression of keratoconus. (Turk J Ophthalmol 2012; 42: 249-52

  20. Automatic assessment of tear film break-up dynamics.

    Science.gov (United States)

    Ramos, L; Barreira, N; Pena-Verdeal, H; Giráldez, M J

    2014-01-01

    Dry eye syndrome is a common disorder of the tear film which affects a remarkable percentage of the population. The Break-Up Time (BUT) is a clinical test used for the diagnosis of this disease, which computes the time the first tear film break-up appears. This work describes a fully automatic methodology to compute the BUT measurement and evaluate the break-up dynamics until the final blink. This analysis provides useful additional information for the assessment of tear film stability.

  1. The Role of Thermal Conduction in Tearing Mode Theory

    CERN Document Server

    Connor, J W; Hastie, R J; Liu, Y Q

    2014-01-01

    The role of anisotropic thermal diffusivity on tearing mode stability is analysed in general toroidal geometry. A dispersion relation linking the growth rate to the tearing mode stability parameter, Delta, is derived. By using a resistive MHD code, modified to include such thermal transport, to calculate tearing mode growth rates, the dispersion relation is employed to determine Delta in situations with finite plasma pressure that are stabilised by favourable average curvature in a simple resistive MHD model. We also demonstrate that the same code can also be used to calculate the basis-functions [C J Ham, et al, Plasma Phys. Control. Fusion 54 (2012) 105014] needed to construct Delta.

  2. Development of Job’s-tears ice cream recipe

    Directory of Open Access Journals (Sweden)

    Wiwat Wangcharoen

    2009-10-01

    Full Text Available Job’s tears ice cream recipe was developed by varying proportions of Job’s tears, sucrose, salt and coconut milk. Product positioning mapping was used to identify the sensory attributes that were drivers of preference, which appeared to be sweetness, smoothness, richness, and coconut milk and Job's-tears flavours of the product. Cluster analysis was used to differentiate consumers by their preference direction. Nutritional composition, antioxidant capacity and total phenolic content of the final product were also determined.

  3. Comparison of Schirmer's test and tear film breakup time test to detect tear film abnormalities in patients with pterygium.

    Science.gov (United States)

    Rahman, Atiya; Yahya, Kamran; Fasih, Uzma; Waqar-ul-Huda; Shaikh, Arshad

    2012-11-01

    To compare tear film breakup time test with Schirmer's test in patients with pterygium. The case-control study, involving 86 patients with unilateral primary pterygium aged between 30 and 70 years, was conducted at the Department of Ophthalmology, Karachi Medical and Dental College, Abbasi Shaheed Hospital, from May 2009 to December 2010. The eye with pterygium was taken as the case, and was compared with the other eye without pterygium which was taken as the control in these patients. All patients underwent routine ophthalmic examination. Tear film tests such as Schirmer's test and tear film breakup time test were performed on all these eyes. Results of tear function test between the eyes with pterygium (cases) and the eye without pterygium (control) were compared. SPSS 17 was used for statistical analysis. Chi square test was used for comparing the results of the cases and the controls. Of the 86 patients, 63 (73.3%) were men, while 23 (26.7%) were women. The median age was 41 years. There were 62 (72.1%) patients with pterygium in the right eye, while 24 (27.9%) had it in the left. Among the involved eyes, decreased tear breakup time (10 seconds. On the other hand, 8 (9.3 %) eyes with pterygium had Schirmer's test positive and 78 (90.7 %) eyes had it negative. Tear film breakup time test has better diagnostic value compared to Schirmer's test in detecting tear film abnormality in patients with pterygium.

  4. Serial measurement of tear meniscus by FD-OCT after instillation of artificial tears in patients with dry eyes.

    Science.gov (United States)

    Bujak, Matthew C; Yiu, Samuel; Zhang, Xinbo; Li, Yan; Huang, David

    2011-01-01

    To use Fourier-domain optical coherence tomography (FD-OCT) to study the effect of artificial tears on the tear meniscus in patients with dry eyes. The lower tear meniscus of 16 consecutive patients with dry eyes was imaged by an FD-OCT system (RTVue; Optovue, Inc., Fremont, CA). Baseline and five serial pairs of measurements were taken after the instillation of artificial tears (Optive; Allergan, Irvine, CA) at 1, 2, 5, 10, and 15 minutes. The lower meniscus height, depth, and area were measured with a computer caliper. Baseline meniscus measurements were 235.5 ± 150.0 μm, 138.1 ± 78.7 μm, and 0.020 ± 0.022 mm(2) for height, depth, and area, respectively. After instillation of artificial tears, all lower tear meniscus parameters remained significantly elevated for 5 minutes and returned to baseline by 10 minutes. FD-OCT is able to quantify a dramatic initial increase in tear meniscus, followed by a decay back to baseline values after approximately 5 minutes. FD-OCT may be useful in objectively quantifying the dynamic efficacy of dry eye treatments. Copyright 2011, SLACK Incorporated.

  5. Severity of medial meniscus damage in the canine knee after anterior cruciate ligament transection.

    Science.gov (United States)

    Smith, G N; Mickler, E A; Albrecht, M E; Myers, S L; Brandt, K D

    2002-04-01

    To examine the relationship between the severity of cartilage damage and the severity of meniscus damage after transection of the anterior cruciate ligament (ACLT) in adult dogs. Data were obtained from 40 dogs which underwent ACLT and from three additional sham-operated dogs that were subjected to arthrotomy but not ligament transection. Joint pathology was analysed 12, 24 or 32 weeks after surgery. The severity of damage to the articular cartilage on the femoral condyle and tibial plateau was graded with a scoring system based on that of the Sociètè Française d'Arthroscopie and meniscus damage was graded on a 0-4 scale. No damage to the meniscus or articular cartilage was observed 12 weeks after surgery in the dogs subjected only to arthrotomy. In contrast, tears of the medial meniscus were observed in two of 10 (20%) dogs examined 12 weeks after ACLT. The incidence of severe tears increased to 86% and 84% after 24 weeks and 32 weeks, respectively. Damage to the lateral meniscus was mild, with only 7.5% of all dogs with a cruciate-deficient knee having a bucket handle or complete tear. Most of the unstable knees exhibited ulceration of the articular cartilage of the femoral condyles and tibial plateaus 12 weeks (mean chondropathy score+/-standard deviation 11.9+/-8.5, N=10), 24 weeks (7.9+/-5.0, N=7), and 32 weeks (7.1+/-5.5, N=23) after ACLT. The mean chondropathy scores for the tibial plateaus were similar to those for the femoral condyles. No correlation was apparent between the severity of cartilage damage and of meniscus damage for either joint surface. Damage to the medial meniscus is a consistent feature of the pathology which develops in the canine knee after ACLT, but the severity of cartilage damage is not correlated with the severity of meniscal damage. Copyright 2002 OsteoArthritis Research Society International.

  6. Trasplante meniscal. Efecto de los métodos de preservación y resultados a medio plazo

    OpenAIRE

    González Lucena, Gemma

    2012-01-01

    El tratamiento de las lesiones meniscales ha evolucionado en las últimas décadas, debido a múltiples estudios que han puesto de relieve las importantes funciones de los meniscos y las consecuencias negativas de su extirpación a medio y largo plazo. Dada la limitada capacidad de regeneración del tejido meniscal, hasta hace unos años se disponía de pocas opciones para el tratamiento del dolor persistente y la consiguiente degeneración articular precoz que presentaban los pacientes sometidos a u...

  7. Effectiveness of electrical stimulation on rehabilitation after ligament and meniscal injuries: a systematic review

    Directory of Open Access Journals (Sweden)

    Aline Mizusaki Imoto

    Full Text Available CONTEXT AND OBJECTIVE: Electrical stimulation (ES is widely used to strengthen muscles following ligament and meniscal injuries. The aim of this study was to evaluate the effectiveness of ES for rehabilitation after soft tissue injuries of the knee treated surgically or conservatively. DESIGN AND SETTING: Systematic review at the Brazilian Cochrane Center. METHODS: We searched the Cochrane Central Register of Controlled Trials (2010, Issue 12, Medline (Medical Analysis and Retrieval System Online via PubMed (1966 to December 2010, Embase (Excerpta Medica database, 1980 to December 2010, Lilacs (Literatura Latino-Americana e do Caribe em Ciências da Saúde, 1982 to December 2010, and PEDro (Physiotherapy Evidence Database, 1929 to December 2010. The studies included were randomized controlled trials using ES to increase muscle strength for rehabilitation of patients with soft tissue injuries of the knee. Two authors independently evaluated studies for inclusion and performed data extraction and methodological quality assessment. RESULTS: Seventeen studies evaluating ES after anterior cruciate ligament reconstruction and two studies evaluating ES after meniscectomy were included. There was a statistically significant improvement in quadriceps strength through ES (mean difference, MD: -32.7; 95% confidence interval, CI: -39.92 to -25.48; n = 56 and in functional outcomes (MD -7; -12.78 to -1.22; n = 43 six to eight weeks after surgical reconstruction of the anterior cruciate ligament. CONCLUSION: There is evidence that ES coupled with conventional rehabilitation exercises may be effective in improving muscle strength and function two months after surgery

  8. The 50 Most-Cited Articles in Meniscal Allograft Transplantation Research: A Bibliometric Analysis.

    Science.gov (United States)

    Chaudhry, Zaira S; Fram, Brianna; Henn, R Frank; Sherman, Seth L; Hammoud, Sommer

    2017-12-01

    Objective To identify the 50 most-cited articles in meniscal allograft transplantation (MAT) research and analyze their characteristics. Design In September 2017, the Scopus database was queried to identify the 50 most-cited articles in MAT research. Variables analyzed include number of citations, publication year, journal, institution, country of origin, article type, study design, and level of evidence. Citation density was calculated for each article. The correlation between citation density and publication year and the correlation between level of evidence and number of citations, citation density, and publication year were computed. Results The 50 most-cited articles were published in 12 journals between 1986 and 2011. The number of citations ranged from 59 to 290 (109.3 ± 48.6). Citation density ranged from 2.7 to 17.6 citations per year (7.0 ± 3.3). There was a positive correlation between citation density and publication year ( r = +0.489, P articles were clinical and 44% were basic science. Of the 28 clinical articles, 61% were level IV or V evidence. Level of evidence was not significantly correlated with number of citations ( r = -0.059, P = 0.766), citation density ( r = +0.030, P = 0.880), or publication year ( r = -0.0009, P = 0.996). Conclusion This analysis provides the orthopedic community with a readily accessible list of the classic citations in MAT research and provides insight into the historical development of this procedure. Although there was a moderate positive correlation between citation density and publication year, articles with stronger levels of evidence were not more frequently cited despite the increasing trend toward evidence-based practice.

  9. Contact lens and tear film dynamics during blinking

    Science.gov (United States)

    Reid, Timothy; Anderson, Daniel

    2016-11-01

    We develop a mathematical model that couples the dynamics of the tear film and contact lens during blinking. We derive an ordinary differential equation for the motion of the contact lens (parallel to the cornea) driven and retarded by viscous forces in the thin fluid films separating the contact lens from the eyelids and the corneal surface. Using the contact lens motion and tear film dynamics models we calculate a numerical solution of tear film thickness, showing that the lens and lid motion influence the tear film dynamics. The numerical solution uses a mapped Chebyshev spectral method for the spatial derivatives to reduce the model to a system of differential algebraic equations. National Science Foundation Grants (DMS-1407087) and (DMS-1107848).

  10. Surgery for ACL Tear Often Successful Over Long Term

    Science.gov (United States)

    ... fullstory_167352.html Surgery for ACL Tear Often Successful Over Long Term Even 10 years after procedure, ... were scheduled for presentation Friday at the annual meeting of the AOSSM in Toronto. Findings presented at ...

  11. The influence of nonpolar lipids on tear film dynamics

    Science.gov (United States)

    Breward, Chris

    2013-11-01

    We will examine the effects of the presence of nonpolar lipids on the evolution of a tear film during a blink. We will track the thickness of the aqueous tear layer, the thickness of the nonpolar lipid layer, and the concentration of the polar lipids that reside between the two. Our model can be reduced in various limits to previous models for tear dynamics studied. We present numerical solutions for the evolution of the tear film and show how the key parameters play a role in determining how the nonpolar lipid spreads. This work was partially supported by Award No. KUK-C1-013-04 made by King Abdullah University of Science and Technology (KAUST).

  12. Tearing mode dynamics and sawtooth oscillation in Hall-MHD

    Science.gov (United States)

    Ma, Zhiwei; Zhang, Wei; Wang, Sheng

    2017-10-01

    Tearing mode instability is one of the most important dynamic processes in space and laboratory plasmas. Hall effects, resulted from the decoupling of electron and ion motions, could cause the fast development and perturbation structure rotation of the tearing mode and become non-negligible. We independently developed high accuracy nonlinear MHD code (CLT) to study Hall effects on the dynamic evolution of tearing modes with Tokamak geometries. It is found that the rotation frequency of the mode in the electron diamagnetic direction is in a good agreement with analytical prediction. The linear growth rate increases with increase of the ion inertial length, which is contradictory to analytical solution in the slab geometry. We further find that the self-consistently generated rotation largely alters the dynamic behavior of the double tearing mode and the sawtooth oscillation. National Magnetic Confinement Fusion Science Program of China under Grant No. 2013GB104004 and 2013GB111004.

  13. The Effect of Polar Lipids on Tear Film Dynamics

    KAUST Repository

    Aydemir, E.

    2010-06-17

    In this paper, we present a mathematical model describing the effect of polar lipids, excreted by glands in the eyelid and present on the surface of the tear film, on the evolution of a pre-corneal tear film. We aim to explain the interesting experimentally observed phenomenon that the tear film continues to move upward even after the upper eyelid has become stationary. The polar lipid is an insoluble surface species that locally alters the surface tension of the tear film. In the lubrication limit, the model reduces to two coupled non-linear partial differential equations for the film thickness and the concentration of lipid. We solve the system numerically and observe that increasing the concentration of the lipid increases the flow of liquid up the eye. We further exploit the size of the parameters in the problem to explain the initial evolution of the system. © 2010 Society for Mathematical Biology.

  14. Tear levels of IL-16 in vernal keratoconjunctivitis

    Directory of Open Access Journals (Sweden)

    Onur Çatak

    2013-09-01

    Full Text Available Objective: Vernal keratoconjunctivitis is more common inchildren and young adults having an atopic background.The aim of the present study was to determine the interleukin-16 (IL-16 levels in tear fluids of patients withvernal keratoconjunctivitis (VKC.Methods: Tear fluid samples were collected from 20patients with VKC and 10 healthy subjects. Tear fluidsamples were collected with microcapillary tubes for hematocritat the lateral canthus of patients in the supineposition without any anesthesia. Tear levels of IL-16 weremeasured by ELISA kit.Results: The mean levels of IL-16 among the patients(514±135 pg/ml was significantly higher than amongcontrols (358±139 pg/ml (p=0.04.Conclusions: These results considered that IL-16 havesignificant effect on the pathogenetic process of vernalkeratoconjunctivitis.Key words: Interleukin-16, vernal keratoconjunctivitis,enzyme-linked immunosorbent assay

  15. Progression from calcifying tendinitis to rotator cuff tear

    Energy Technology Data Exchange (ETDEWEB)

    Gotoh, Masafumi; Higuchi, Fujio; Suzuki, Ritsu; Yamanaka, Kensuke [Department of Orthopaedic Surgery, Medical Center of Kurume University, 155-1 Kokubu-machi, Kurume City, Fukuoka 839-0862 (Japan)

    2003-02-01

    This report documents the clinical, radiographic and histologic findings in a 46-year-old man with calcifying tendinitis in his left shoulder which progressed to rotator cuff tear. The patient had a 1-year history of repeated calcifying tendinitis before being referred to our hospital. On the initial visit, radiographs and magnetic resonance imaging (MRI) revealed calcium deposition localized in the supraspinatus tendon without apparent tear. Three months after the first visit, MRI revealed a partial-thickness rotator cuff tear at the site of calcium deposition. Surgical and histologic findings demonstrated that calcium deposition was the cause of cuff rupture. To our knowledge, based on a review of the English literature, this is the first case report in which the progression from calcifying tendinitis to rotator cuff tear has been serially observed. (orig.)

  16. Tear fluid electrolytes and albumin in persons under environmental stress

    Energy Technology Data Exchange (ETDEWEB)

    Thygesen, J.E.; Bach, B.; Molhave, L.; Pedersen, O.F.; Prause, J.U.; Skov, P.

    1987-06-01

    Sixty-two subjects selected among 287 persons with indoor air complaints were exposed to a standard mixture of 22 different organic gases and vapors normally found in Danish houses. Persons were randomly assigned to one of four exposure groups, and each subject stayed during the test day from 10:00 AM to 4:00 PM under standardized conditions in a climate chamber. During exposure the blink frequency was recorded, and after exposure the tear fluid contents of serum albumin, potassium, and sodium were measured. It was found that the persons had an increased concentration of serum albumin in the tear fluid, and that exposure to high concentrations of organic gases and vapors induced a tear reflex-mediated dilution of the tears.

  17. Tear osmolarity and dry eye symptoms in diabetics

    Science.gov (United States)

    Fuerst, Nicole; Langelier, Nicole; Massaro-Giordano, Mina; Pistilli, Maxwell; Stasi, Kalliopi; Burns, Carrie; Cardillo, Serena; Bunya, Vatinee Y

    2014-01-01

    Purpose To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI). Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results The majority of the subjects were female (76%), African American (56%), and/or had a diagnosis of type 2 diabetes (82%). The mean ± standard deviation (SD) for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE) 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02). Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe) OSDI scores (r=−0.35, P=0.01). Higher tear osmolarity was associated with lower (less severe) OSDI scores (r=−0.29, P=0.04). Conclusion Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with long-standing diabetes, may not experience symptoms and seek care in a timely manner. PMID:24648714

  18. The eyelids and tear film in contact lens discomfort.

    Science.gov (United States)

    Siddireddy, Jaya Sowjanya; Vijay, Ajay Kumar; Tan, Jacqueline; Willcox, Mark

    2017-10-17

    To investigate characteristics of the eyelid margins, meibomian glands and the tear film of contact lens wearers, and to determine whether these characteristics were related to symptoms of contact lens discomfort. A cross sectional study was performed on thirty existing daily wear soft contact lens wearers (6 male; 24 female) with median age of 23 years (range 18-41). Eyelid signs and tear film characteristics were evaluated during a single visit and subjects completed the contact lens and dry eye questionnaire (CLDEQ-8) to evaluate ocular discomfort. Based on the CLDEQ-8 responses, subjects were classified as symptomatic (n=17) or asymptomatic (n=13). Grades of foam at meibomian gland orifices (3±1), expressibility (2±1) and quality of secretions (2±1), tear evaporation rate with (112±54g/m(2)/h) or without (88±45g/m(2)/h) contact lens wear, fluorescein tear breakup time (8±2 seconds) and tear lipid layer thickness (45±17nm) were significantly associated with symptoms of discomfort in symptomatic lens wearers only (r(2)>0.45; p value<0.05). Upper lid-wiper epitheliopathy, meibomian gland acini reflectivity and tear meniscus height showed significant correlations with comfort scores in both symptomatic and asymptomatic contact lens wearers (p<0.05). A greater number of Demodex mites was also observed in the upper eyelid of symptomatic lens wearers (2±1) compared to asymptomatic lens wearers (0±0; p value=0.042). Morphological irregularities of the meibomian glands and alterations to tear film secretions that affect tear evaporative dynamics were associated with symptoms of discomfort amongst the symptomatic lens wearers. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  19. The severe acute respiratory syndrome coronavirus in tears.

    Science.gov (United States)

    Loon, S-C; Teoh, S C B; Oon, L L E; Se-Thoe, S-Y; Ling, A-E; Leo, Y-S; Leong, H-N

    2004-07-01

    Severe acute respiratory syndrome (SARS) is a new infectious disease that caused a global outbreak in 2003. Research has shown that it is caused by a novel coronavirus. A series of cases is reported where polymerase chain reaction (PCR) testing on tears had demonstrated the presence of the virus. Detection of ocular infection from tears using the PCR technique has been widely used by ophthalmologists to diagnose infections for other viruses. This is a case series report from cases classified as probable or suspect SARS cases. Tear samples were collected from 36 consecutive patients who were suspected of having SARS in Singapore over a period of 12 days (7-18 April 2003), and analysed by PCR using protocols developed by the WHO network of laboratories. Three patients with probable SARS (one female and two male patients) had positive results from their tear samples. Tear samples were used to confirm SARS in the female patient, who was positive only from her tears. The positive specimens were found in cases sampled early in their course of infection. This is the first case series reported with the detection of the SARS coronavirus from tears, and has important implications for the practice of ophthalmology and medicine. The ability to detect and isolate the virus in the early phase of the disease may be an important diagnostic tool for future patients and tear sampling is both simple and easily repeatable. Many healthcare workers are in close proximity to the eyes of patients and this may be a source of spread among healthcare workers and inoculating patients. Ophthalmic practices may need to change as more stringent barrier methods, appropriate quarantine, and isolation measures are vital when managing patients with SARS.

  20. Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear

    Energy Technology Data Exchange (ETDEWEB)

    Umans, Rachel L. [Cornell University Medical College, New York, NY (United States); Umans, Benjamin D. [Harvard University, Cambridge, MA (United States); Umans, Hilary [Albert Einstein College of Medicine, Bronx, NY (United States); Lenox Hill Radiology and Imaging Associates, New York, NY (United States); Elsinger, Elisabeth [Albert Einstein College of Medicine, Bronx, NY (United States); Montefiore Medical Center, Bronx, NY (United States)

    2016-07-15

    To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear. We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements. Consistency and concordance were assessed. Pearson's Chi-square test was used to test the correlation between qualitative findings and PP tear status. Correlation between measurements and PP status was assessed using t tests and Wilcoxon's rank-sum test (p values < 0.05 considered significant). Classification and regression trees were utilized to identify attributes that, taken together, would consistently distinguish PP tear from controls. Quantitative measurements were highly reproducible (concordance 0.88-0.99). Elevated 2nd MT protrusion, lesser MT supination and rotational divergence of >45 between the 1st-2nd MT axis correlated with PP tear. Pericapsular soft tissue thickening correlated most strongly with PP tear, correctly classifying 95 % of cases and controls. Excluding pericapsular soft tissue thickening, sequential assessment of 2nd toe enthesitis, 2nd flexor tendon subluxation, and splaying of the second and third toes accurately classified PP status in 92 %. Pericapsular soft tissue thickening most strongly correlated with PP tear. For cases in which it might be difficult to distinguish pericapsular fibrosis from neuroma, sequential assessment of 2nd toe enthesitis, flexor tendon subluxation and splaying of the 2nd and 3rd toe is most helpful for optimizing accurate diagnosis of PP tear. (orig.)

  1. Human Tear Lipocalin Exhibits Antimicrobial Activity by Scavenging Microbial Siderophores

    OpenAIRE

    Fluckinger, Maria; Haas, Hubertus; Merschak, Petra; Glasgow, Ben J.; Redl, Bernhard

    2004-01-01

    Human tear lipocalin (TL; also known as Lcn1) is a secretory protein present in large amounts in fluids that cover epithelial surfaces such as tears and respiratory secretions. It is supposed to act as a physiological scavenger of hydrophobic, potentially harmful molecules, but there is evidence that it also inhibits bacterial growth. In the present study, we reconsidered the possibility that TL might interfere with microbial growth by scavenging of siderophores, as described for human neutro...

  2. ANAL INCONTINENCE AFTER UNRECOGNISED ANAL SPHINCTER TEAR AT VAGINAL DELIVERY

    Directory of Open Access Journals (Sweden)

    Mija Blaganje

    2018-02-01

    Full Text Available Background: Anal sphincter tears during vaginal delivery may result in serious sequel. Anal sphincter tears occur in approximately 2–19 % of all vaginal deliveries and are the most common precursor for faecal incontinence,1 however »occult« anal sphincter injury has been defined in 33 % of primiparous women following vaginal delivery.2 Methods: 31-year old primiparous woman received transfusion due to atony after delivery. Episiotomy, second degree perineal tear and vaginal tear were surgically corrected immediately after delivery. In the following days inability to control passing of liquid stools and flatulence together with stress urinary incontinence appeared. The complaint persisted. Ultrasound and EMG examination confirmed rupture of the external anal sphincter, which had been missed at delivery. Over a year after delivery the patient had a posterior colporraphy with surgical correction of external anal sphincter, which did not result in any clinical improve- ment. On follow-up ultrasound examination a hypoechoegenic area between the external sphincter and vaginal wall was detected. The patient was referred to The University Hos- pital in Graz, where the tear will be treated with autologous myoblast transplantation in a clinical trial. Conclusions: Treatment of a missed anal sphincter tear is complicated, expensive and unpleasant for the patient. Early detection with immediate appropriate surgical correction after delivery is most efficient, but it takes experience.

  3. Comparison of non-invasive tear film stability measurement techniques.

    Science.gov (United States)

    Wang, Michael Tm; Murphy, Paul J; Blades, Kenneth J; Craig, Jennifer P

    2018-01-01

    Measurement of tear film stability is commonly used to give an indication of tear film quality but a number of non-invasive techniques exists within the clinical setting. This study sought to compare three non-invasive tear film stability measurement techniques: instrument-mounted wide-field white light clinical interferometry, instrument-mounted keratoscopy and hand-held keratoscopy. Twenty-two subjects were recruited in a prospective, randomised, masked, cross-over study. Tear film break-up or thinning time was measured non-invasively by independent experienced examiners, with each of the three devices, in a randomised order, within an hour. Significant correlation was observed between instrument-mounted interferometric and keratoscopic measurements (p 0.05). Tear film stability values obtained from the hand-held device were significantly shorter and demonstrated narrower spread than the other two instruments (all p 0.05). Good clinical agreement exists between the instrument-mounted interferometric and keratoscopic measurements but not between the hand-held device and either of the instrument-mounted techniques. The results highlight the importance of specifying the instrument employed to record non-invasive tear film stability. © 2017 Optometry Australia.

  4. Fewer rotator cuff tears fifteen years after arthroscopic subacromial decompression.

    Science.gov (United States)

    Björnsson, Hanna; Norlin, Rolf; Knutsson, Anders; Adolfsson, Lars

    2010-01-01

    A successful clinical result is reported in 75% to 85% of impingement patients after arthroscopic subacromial decompression. The result is maintained over time, but few studies have investigated the integrity of the rotator cuff in these patients. Using ultrasonography, we examined the integrity of the rotator cuff in 70 patients 15 years after arthroscopic subacromial decompression. All patients had an intact rotator cuff at the index procedure. Tendons were still intact in 57 patients (82%), 10 (14%) had partial-thickness tears, and 3 (4%) had full-thickness tears. The total number of 18% tears (partial and full thickness) in this study, including patients clinically diagnosed with subacromial impingement at a mean age of 60 years, is unexpectedly low compared with 40% degenerative tears reported in asymptomatic adults of the same age. Arthroscopic subacromial decompression seems to reduce the prevalence of rotator cuff tears in impingement patients. This appears attributable to elimination of extrinsic factors such as mechanical wear and bursitis. The potential effect of surgery on intrinsic cuff degeneration is unknown, but intrinsic factors may explain tears still developing despite decompression. Level III, therapeutic study.

  5. Artificially modified collagen fibril orientation affects leather tear strength.

    Science.gov (United States)

    Kelly, Susyn J; Wells, Hannah C; Sizeland, Katie H; Kirby, Nigel; Edmonds, Richard L; Ryan, Tim; Hawley, Adrian; Mudie, Stephen; Haverkamp, Richard G

    2017-12-30

    Ovine leather has around half the tear strength of bovine leather and is therefore not suitable for high value applications such as shoes. Tear strength has been correlated with the natural collagen fibril alignment (orientation index, OI). It is hypothesized that it could be possible to artificially increase the OI of the collagen fibrils and that an artificial increase in OI could increase tear strength. Ovine skins, after the pickling and bating, were strained bi-axially during chrome tanning. The strain ranged from 2% to 15% of the initial sample length, either uniformly in both directions by 10% or with 3% in one direction and 15% in the other. Once tanned the leather tear strengths were measured and the collagen fibril orientation measured using synchrotron based small angle X-ray scattering. The OI increased as a result of strain during tanning, from 0.48 to 0.79 (P = 0.001), measured edge-on and the thickness normalized tear strength increased from 27 N/mm to 43 N/mm (P leather was strained 10% in two orthogonal directions. This is evidence to support a causal relationship between high OI (measured edge-on), highly influenced by thickness, and tear strength. It also provides a method to produce stronger leather. This article is protected by copyright. All rights reserved.

  6. Towards Multiscale Interactions Between Tearing Modes and Microturbulence

    Science.gov (United States)

    Williams, Z. R.; Pueschel, M. J.; Terry, P. W.

    2017-10-01

    Work on the Madison Symmetric Torus Reversed-Field Pinch (RFP) has shown that large-scale tearing modes present in standard operation are highly detrimental to confinement. These tearing modes, even when reduced in improved confinement regimes of operation, significantly affect zonal flow activity and play a large role in setting microturbulent-induced transport levels. Previous gyrokinetic work has shown that a small but finite tearing fluctuation amplitude is necessary to produce transport values in agreement with experimental observation. This has previously been implemented via an ad-hoc, constant-in-time A∥ perturbation. This work details self-consistent modeling of tearing fluctuations in the RFP using the Gene code via the inclusion of a current gradient drive incorporated into the background distribution function. Tearing mode growth rates calculated from gyrokinetic simulations are benchmarked with results from fluid theory. Additionally, first results from multiscale Gene simulations describing tearing mode interactions with RFP microturbulence are presented. This work is supported by the U.S. Department of Energy, Grant No. DE-FG02-85ER-53121.

  7. Effectiveness of Combined Tear Film Therapy in Patients with Evaporative Dry Eye with Short Tear Film Breakup Time.

    Science.gov (United States)

    Kim, Yung Hui; Kang, Yeon Soo; Lee, Hyo Seok; Choi, Won; You, In Cheon; Yoon, Kyung Chul

    2017-10-01

    The aim of this study was to evaluate the effectiveness of combined tear film therapy targeted to aqueous, mucin, and lipid layers in patients with refractory evaporative dry eye (EDE) with short tear film breakup time (TBUT). The patients who had EDE with short TBUT and severe symptoms refractory to artificial tears were treated with hyaluronic acid (HA) 0.15% and diquafosol tetrasodium (DQS) 3% (Group 1), HA and carbomer-based lipid-containing eyedrops (Liposic EDO Gel, LPO) (Group 2), or HA, DQS, and LPO (Group 3). Ocular Surface Disease Index (OSDI) score, visual analog scale (VAS) symptom score, TBUT, Schirmer score, and corneal and conjunctival staining scores were evaluated, and noninvasive tear film breakup time (NIBUT) and tear meniscus height were measured using Keratograph ® 5 M before and 1 and 3 months after treatment. OSDI scores, VAS scores, TBUT, and NIBUT were improved at 1 and 3 months after treatment in all groups (all P film layers was most effective in improving ocular symptoms and tear film quality.

  8. Comparative study of lubricating properties of tear substitutes Systane® Ultra and Visine® Clear Tears

    Directory of Open Access Journals (Sweden)

    Yu. A. Pavlova

    2014-07-01

    Full Text Available Purpose: To compare tear substitutive properties of Systane® Ultra and Visine® Clear Tears in dry eye therapy.Methods: 20 patients with dry eye due to chronic blepharoconjunctivitis and 20 patients with neurotrophic dry eye following corneal refractive surgery were examined. Treatment schedule was the following: in the first 7 days, Systane® Ultra was instilled in the right eye and Visine® Clear Tears was instilled in the left eye, while from day 8 to day 30, only one medicine selected by the patient was applied. Their efficacy was measured by tear film stability and patients’ subjective sensations.Results: Norn test results improved to day 7 in patients with dry eye following corneal refractive surgery and to day 30 in patients with dry eye due to blepharoconjunctivitis regardless of eye drops used. As to patients’ comfort, Systane® Ultra is preferable to Visine® Clear Tears.Conclusion: Systane® Ultra is therapeutically similar to but preferable to Visine® Clear Tears due to good tolerability.

  9. Cost-effectiveness analysis of the diagnosis of meniscus tears.

    Science.gov (United States)

    Mather, Richard C; Garrett, William E; Cole, Brian J; Hussey, Kristen; Bolognesi, Michael P; Lassiter, Tally; Orlando, Lori A

    2015-01-01

    Diagnostic imaging represents the fastest growing segment of costs in the US health system. This study investigated the cost-effectiveness of alternative diagnostic approaches to meniscus tears of the knee, a highly prevalent disease that traditionally relies on MRI as part of the diagnostic strategy. To identify the most efficient strategy for the diagnosis of meniscus tears. Economic and decision analysis; Level of evidence, 1. A simple-decision model run as a cost-utility analysis was constructed to assess the value added by MRI in various combinations with patient history and physical examination (H&P). The model examined traumatic and degenerative tears in 2 distinct settings: primary care and orthopaedic sports medicine clinic. Strategies were compared using the incremental cost-effectiveness ratio (ICER). In both practice settings, H&P alone was widely preferred for degenerative meniscus tears. Performing MRI to confirm a positive H&P was preferred for traumatic tears in both practice settings, with a willingness to pay of less than US$50,000 per quality-adjusted life-year. Performing an MRI for all patients was not preferred in any reasonable clinical scenario. The prevalence of a meniscus tear in a clinician's patient population was influential. For traumatic tears, MRI to confirm a positive H&P was preferred when prevalence was less than 46.7%, with H&P preferred above that. For degenerative tears, H&P was preferred until the prevalence reaches 74.2%, and then MRI to confirm a negative was the preferred strategy. In both settings, MRI to confirm positive physical examination led to more than a 10-fold lower rate of unnecessary surgeries than did any other strategy, while MRI to confirm negative physical examination led to a 2.08 and 2.26 higher rate than H&P alone in primary care and orthopaedic clinics, respectively. For all practitioners, H&P is the preferred strategy for the suspected degenerative meniscus tear. An MRI to confirm a positive H&P is

  10. A Porcine Animal Model for Early Meniscal Degeneration - Analysis of Histology, Gene Expression and Magnetic Resonance Imaging Six Months after Resection of the Anterior Cruciate Ligament.

    Science.gov (United States)

    Kreinest, Michael; Reisig, Gregor; Ströbel, Philipp; Dinter, Dietmar; Attenberger, Ulrike; Lipp, Peter; Schwarz, Markus

    2016-01-01

    The menisci of the mammalian knee joint balance the incongruence between femoral condyle and tibial plateau and thus menisci absorb and distribute high loads. Degeneration processes of the menisci lead to pain syndromes in the knee joint. The origin of such degenerative processes on meniscal tissue is rarely understood and may be described best as an imbalance of anabolic and catabolic metabolism. A standardized animal model of meniscal degeneration is needed for further studies. The aim of the current study was to develop a porcine animal model with early meniscal degeneration. Resection of the anterior cruciate ligament (ACLR) was performed on the left knee joints of eight Göttingen minipigs. A sham operation was carried out on the right knee joint. The grade of degeneration was determined 26 weeks after the operation using histology and magnetic resonance imaging (MRI). Furthermore, the expression of 14 genes which code for extracellular matrix proteins, catabolic matrix metalloproteinases and inflammation mediators were analyzed. Degenerative changes were detected by a histological analysis of the medial meniscus after ACLR. These changes were not detected by MRI. In terms of their gene expression profile, these degenerated medial menisci showed a significantly increased expression of COL1A1. This paper describes a new animal model for early secondary meniscal degeneration in the Göttingen minipig. Histopathological evidence of the degenerative changes could be described. This early degenerative changes could not be seen by NMR imaging.

  11. Efecto de la sutura y adición de células troncales mesenquimales adultas en la regeneración meniscal. Estudio de la expresión de factores de crecimiento en conejos

    OpenAIRE

    Comellas Melero, Nerea

    2012-01-01

    Conservar la mayor parte posible de tejido meniscal funcional en la cirugía de las lesiones meniscales es una regla esencial de este tipo de intervenciones sobre todo cuando se trata de pacientes jóvenes. La resección meniscal tiene efectos deletéreos evidentes en la función a largo plazo de la rodilla; 10 4, 341 . Pese a esto, las técnicas actuales de sutura meniscal tienen limitaciones relacionadas con las características mecánicas y bioquímicas del menisco; de manera que las lesiones que s...

  12. Glycan involvement in the adhesion of Pseudomonas aeruginosa to tears.

    Science.gov (United States)

    Kautto, Liisa; Nguyen-Khuong, Terry; Everest-Dass, Arun; Leong, Andrea; Zhao, Zhenjun; Willcox, Mark D P; Packer, Nicolle H; Peterson, Robyn

    2016-04-01

    The human eye is constantly bathed by tears, which protect the ocular surface via a variety of mechanisms. The O-linked glycans of tear mucins have long been considered to play a role in binding to pathogens and facilitating their removal in the tear flow. Other conjugated glycans in tears could similarly contribute to pathogen binding and removal but have received less attention. In the work presented here we assessed the contribution of glycan moieties, in particular the protein attached N-glycans, presented by the broad complement of tear proteins to the adhesion of the opportunistic pathogen Pseudomonas aeruginosa, a leading cause of microbial keratitis and ulceration of the cornea. Our adhesion assay involved immobilising the macromolecular components of tears into the wells of a polyvinyl difluoride (PVDF) microtitre filter plate and probing the binding of fluorescently labelled bacteria. Three P. aeruginosa strains were studied: a cytotoxic strain (6206) and an invasive strain (6294) from eye infections, and an invasive strain (320) from a urinary tract infection (UTI). The ocular isolates adhered two to three times more to human tears than to human saliva or porcine gastric mucin, suggesting ocular niche-specific adaptation. Support for the role of the N-glycans carried by human tear proteins in the binding and removal of P. aeruginosa from the eye was shown by: 1) pre-incubation of the bacteria with free component sugars, galactose, mannose, fucose and sialyl lactose (or combination thereof) inhibiting adhesion of all the P. aeruginosa strains to the immobilised tear proteins, with the greatest inhibition of binding of the ocular cytotoxic 6206 and least for the invasive 6294 strain; 2) pre-incubation of the bacteria with N-glycans released from the commercially available human milk lactoferrin, an abundant protein that carries N-linked glycans in tears, inhibiting the adhesion to tears of the ocular bacteria by up to 70%, which was significantly more

  13. Lacritin Level in Tear Film of Rheumatoid Arthritis Patients

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    Rana Sorkhabi

    2013-12-01

    Full Text Available Purpose: The main ocular manifestation of rheumatoid arthritis is dry eye. Lacritin is a secreted glycoprotein of tear and when applied topically in rabbits, it increased the volume of basal tear secretion. So the aim of this study was to compare Lacritin level in rheumatoid arthritis (RA and control group. Methods: This cross-sectional study was done on 40 patients with RA and 48 healthy subjects as a control group. In all participants, tear break-up time (TBUT and Schirmer test with anesthesia were accomplished. Tear samples were collected directly from the inferior lateral tear meniscus and were immediately stored at -80° C until use. Lacritin level of tears were assessed by enzyme- linked immunosorbent assay. Results: The mean age of participants was 44.7±16.3 and 43.3±18 years, respectively (p=0.70. Lacritin level in RA group (19.6±23.1 ng/ml was significantly lower (31.9±23.3 ng/ml than control (p=0.008. Pearson correlation between Lacritin level and TBUT, Schirmer value, ESR, and high-sensitivity C-creative protein (hs-CRP in RA patients were not significant with p=0.27, 0.67, 0.09 and 0.07 accordingly. Conclusion: In early stages of RA in spite of normal tear production, Lacritin level decreased, however there is not any correlation between Lacritin level and TBUT, Schirmer value, ESR, and hs-CRP in these patients.

  14. Nonlinear Stability and Evolution of Drift-Tearing Modes

    Science.gov (United States)

    Scott, Bruce Douglas

    The question of the nonlinear stability and subsequent evolution of drift-tearing modes in tokamak-like environments is considered. The tearing mode and the drift physics are introduced, and a brief review of previous work given. A set of reduced equations for the drift-tearing mode is derived from two-fluid magnetohydrodynamics. The equations are specialised for small, nonlinear magnetic islands in slab geometry. These are used to scrutinise the results of linear stability theory in light of nonlinear physics arising from the effect of the mode on the equilibrium density and temperature profiles. It is shown that linearly growing drift-tearing modes are rendered stable at a very small island width by quasilinear thermal effects. However, both linearly and quasilinearly stabilised modes grow to large amplitude if the initial island width is larger than the linear tearing layer, demonstrating the importance of nonlinear considerations in predictions of stability. Having concluded that drift-tearing modes will in fact be seen in present and near-future thermal regimes, their evolution is addressed. Observations of rotating m = 2 magnetic fluctuations in tokamak discharges are often attributed to diamagnetically propagating drift-tearing modes. It is shown, however, that this propagation ceases at small island width as the local density profile is flattened by sound waves. The critical width for density flattening is small compared to island widths typically inferred from the observed fluctuations. The rotation of these fluctuations must therefore result from radial electric fields, implying that observed rotation rates can be used as a local diagnostic for these fields.

  15. Subnormal Cytokine Profile in the Tear Fluid of Keratoconus Patients

    Science.gov (United States)

    Jun, Albert S.; Cope, Leslie; Speck, Caroline; Feng, Xiaojun; Lee, Seakwoo; Meng, Huan; Hamad, Abdel; Chakravarti, Shukti

    2011-01-01

    Keratoconus, historically viewed as a non-inflammatory disease, is an ectatic corneal disorder associated with progressive thinning of the corneal stroma. Recently, a few inflammatory mediators have been reported to be elevated in the tear fluid of keratoconus patients. Consequently, we investigated a wide range of inflammation regulating cytokines in the tears and sera of keratoconus and control subjects. Interleukin (IL)-1β, IL-4, IL-6, IL-10, IL-12, IL-13, IL-17, interferon (IFN)-γ, chemokine C-C motif ligand 5 (CCL5) and tumor necrosis factor (TNF)-α were tested in tear samples and sera of keratoconus and control individuals by multiplex immuno-bead assays. Selected cytokines were further tested by standard ELISA on pooled tear samples. All cytokines in the sera were generally low, with no significant changes between keratoconus and control subjects. However, in tear fluids, clear differences were detected between the two groups. These differences include increased IL-6, and decreased IL-12, TNF-α, IFN-γ, IL-4, IL-13 and CCL5 in keratoconus compared to control tear fluids. The decreases in IL-12, TNF-α and CCL5 were statistically significant, while the IL-13 decrease was statistically significant in the severe keratoconus group only. IL-17 could not be detected by multiplex immuno-bead assay, but showed an increase in keratoconus by conventional ELISA on a limited number of pooled tear samples. Our findings confirm increased IL-6, but dispute earlier reports of increased TNF-α, and suggest a cytokine imbalance in keratoconus disrupting corneal homeostasis. Moreover, an increase in IL-17 suggests tissue degenerative processes at work, contributing to the thinning and weakening of the corneal connective tissue in keratoconus. PMID:21298010

  16. Tears at the myotendinous junction of the infraspinatus: ultrasound findings.

    Science.gov (United States)

    Guerini, H; Pluot, E; Pessis, E; Thevenin, F; Campagna, R; Feydy, A; Gaudin, P; Drapé, J L

    2015-04-01

    Tears involving the myotendinous junction (MTJ) of the infraspinatus (IS) have been recently described on MRI. These occur centrally in the muscle belly, and are not associated with full thickness tears of the distal infraspinatus tendon. They also induce a rapidly progressive fatty infiltration of the muscles and amyotrophy. The purpose of this study is to assess the accuracy of ultrasonography in diagnosing MTJ tears of the infraspinatus and to describe the usual ultrasonographic appearance compared with MRI. Retrospective study of 2403 US examinations of the shoulder (over 5 years). Fifteen patients with a reported suspicion of infraspinatus MTJ tears were included. MRI examination was available in all cases, CT arthrography in 13 cases, and one patient underwent surgical confirmation. All patients were sent for an ultrasound for suspect lesion of the tendons of the rotator cuff, with posterior pain in the infraspinatus fossa. All cases seen on ultrasonography were confirmed on MRI. CT arthrography confirmed the absence of tear of the IS tendon in all cases and did not reveal the MTJ tears. Two signs appeared to us as being of special interest: the "tadpole sign" on longitudinal views, and the "black eye sign" on sagittal views. The proximal retraction of the tendon at the MTJ is the anatomical explanation of both signs. Tears at the myotendinous junction of the infraspinatus are rare but can be diagnosed on US examination, provided that the sonographer pays attention to the infraspinatus fossa especially in cases of normality of the distal tendinous cuff. Copyright © 2015 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  17. Blinking and tear break-up during four visual tasks.

    Science.gov (United States)

    Himebaugh, Nikole L; Begley, Carolyn G; Bradley, Arthur; Wilkinson, Jenni A

    2009-02-01

    This study investigates the relationship between blinking, tear film break-up, and ocular symptoms for normal and dry eye subjects performing four different visual tasks. Sixteen control and sixteen dry eye subjects performed four visual tasks (looking straight ahead, watching a movie, identifying rapidly changing letters, and playing a computer game) while blink patterns and fluorescein images of the tear film were videotaped. Pre and posttesting symptom questionnaires, querying the intensity of nine symptoms of ocular irritation, were completed by all subjects. Blink rate and blink amplitude were computed from digitized videos. The percentage of tear film break-up before the blink was calculated. Dry eye subjects had a significantly higher blink rate (p = 0.017, t-test). Both groups blinked significantly less during the game and letter tasks (p break-up in normal subjects was typically inferior; whereas dry eye subjects showed more tear break-up centrally and superiorly. Real-time video recording of tear break-up and blink behavior pointed to complex interaction between the two. Dry eye subjects shifted more toward intense ocular symptoms at posttesting (p break-up during normal visual tasks may explain the increased level of ocular discomfort symptoms reported at the end of the day, particularly in dry eye patients.

  18. Abdominal breathing increases tear secretion in healthy women.

    Science.gov (United States)

    Sano, Kokoro; Kawashima, Motoko; Ikeura, Kazuhiro; Arita, Reiko; Tsubota, Kazuo

    2015-01-01

    To determine the relationship between abdominal breathing and tear meniscus volume in healthy women, we investigated the change in tear meniscus volume in two groups: normal breathing and abdominal breathing. We used a crossover experimental model and examined 20 healthy women aged 20-54 years (mean ± SD, 32.7 ± 11.1 years). The participants were randomly assigned to one of two groups. During the first visit, the normal breathing group was subjected to normal breathing for 3 min, whereas the abdominal breathing group was subjected to abdominal breathing (4-second inhalation and 6-second exhalation) for 3 min. During the second visit, the protocols were swapped between the two groups. We estimated the R wave to R wave (R-R) interval, tear meniscus volume, salivary amylase activity, pulse, and blood pressure before and immediately after, 15 min after, and 30 min after completion of the breathing activity. After abdominal breathing, compared to that before breathing, the tear meniscus volume increased significantly 15 min after breathing (Pabdominal breathing (PAbdominal breathing for 3 minutes increases the tear meniscus volume in healthy women. Consequently, abdominal breathing may be considered in the treatment of dry eye disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. Preference direction study of Job’s-tears ice cream

    Directory of Open Access Journals (Sweden)

    Wiwat Wangcharoen

    2007-09-01

    Full Text Available Job's-tears (Coix lachryma-jobi L. is a kind of cereal commonly used in Asia as food and medicine, but it is still not widely consumed in Thailand. Four prototype products of Job’s-tears ice cream were developed by varying 2 levels of glucose syrup (16 and 32% of Job's-tears used and coconut milk (50 and 100 % of Job's-tears used. Their sensory attribute profiles were evaluated by 3 groups of 10 selected panelists using Ratio profile test (RPT, and their acceptances, hedonic scores, were evaluated by 100 consumers. Results showed that there were significant effects of coconut milk quantity on several attributes, such as appearance (whiteness, texture (hardness, smoothness, and flavour (coconut milk aroma, sweetness, saltiness, but the effect of glucose syrup quantity was significant on hardness only. Acceptance data were analyzed by cluster analysis to find out the difference of preference directions and 3 clusters (n1 = 39, n2 = 25, n3 = 36 were found. The first cluster preferred Job's tears ice cream containing high glucose syrup and low coconut milk, whilst the second preferred high level of only one of these two ingredients, and the third preferred high level of both ingredients. External preference maps were created from RPT and acceptance data to express the preference direction of each cluster.

  20. Tear film evaporation--effect of age and gender.

    Science.gov (United States)

    Guillon, Michel; Maïssa, Cécile

    2010-08-01

    Dry eye is more prevalent in older patients and among them more marked in women than men. The increase in dry eye with aging is traditionally thought to be associated with a decrease in tear production enhanced by hormonal changes. Clinical evidence of an abnormal lipid production system in older patients, in particular women is established. It is therefore postulated that the greater prevalence of dry eye problems in an older population has an evaporative component. Tear film evaporation was measured with the Oregon Health Sciences University Evaporimeter at 30% and 40% humidity. 160 subjects less than 45 years old and 57 subjects aged 45 years or more formed the study population. The results revealed a significant effect of age (p women; and (iii) the synergic effect of age and gender was very marked: the rate of evaporation of older women was 34-80% higher than that of older men and 36-69% than younger women. Aging of the tear film includes a significant evaporative component characterised by higher tear film evaporation for the over 45 compared to younger people. Further, in the over 45 years of age, a significantly greater tear film evaporation was recorded in women than men. The findings have significant implications for the management of presbyopic dry eye sufferers. 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  1. Dog Tear Film Proteome In-Depth Analysis.

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    Mateusz Winiarczyk

    Full Text Available In this study, mass spectrometry was used to explore the canine tear proteome. Tear samples were obtained from six healthy dogs, and one-dimensional sodium dodecyl sulphate polyacrylamide gel electrophoresis (1D SDS-PAGE was used as a first step to separate intact proteins into 17 bands. Each fraction was then trypsin digested and analysed by matrix-assisted laser desorption/ionization time-of-flight tandem mass spectrometry (MALDI-TOF-MS/MS to characterize the protein components in each fraction. In total, 125 tear proteins were identified, with MCA (Major Canine Allergen, Serum albumin, UPF0557 protein C10orf119 homolog, Collagen alpha-2(I chain, Tyrosine -protein kinase Fer, Keratine type II cytoskeletal, Beta-crystallin B2, Interleukin-6 and Desmin occurring as the most confident ones with the highest scores. The results showed that the proteomic strategy used in this study was successful in the analysis of the dog tear proteome. To the best of our knowledge, this study is the first to report the comprehensive proteome profile of tears from healthy dogs by 1D SDS PAGE and MALDI-TOF. Data are available via ProteomeXchange with identifier PXD003124.

  2. Rotator cuff tears in children and adolescents: experience at a large pediatric hospital

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    Zbojniewicz, Andrew M.; Emery, Kathleen H. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Maeder, Matthew E. [University of Cincinnati College of Medicine, Department of Radiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States); Lenox Hill Hospital, Department of Radiology, New York, NY (United States); Salisbury, Shelia R. [University of Cincinnati College of Medicine, Division of Biostatistics and Epidemiology, Cincinnati Children' s Hospital Medical Center, Cincinnati, OH (United States)

    2014-06-15

    Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between

  3. Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis

    Directory of Open Access Journals (Sweden)

    Adriana Falcão Veloso Lyra

    2014-04-01

    Full Text Available Purpose: To evaluate the effects of preservativefree 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose compared with those of preservativefree artificial tears alone on the symptoms and signs of acute viral conjunctivitis. Methods: This was a randomized, doublemasked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose. The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Results: Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05. The frequency of side effects during treatment was similar between groups (p>0.05. Conclusions: Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis.

  4. Tear film dynamics: modeling the glycocalyx as a porous medium

    Science.gov (United States)

    Siddique, Javed; Mastroberardinob, , Antonio; Braun, Richard; Anderson, Daniel

    2015-11-01

    The human tear film is a complex fluid structure composed of multiple layers: an aqueous layer that comprises most of the film and an outermost thinner lipid layer coat a forest of large transmembrane mucins at the epithelial surface. The glycocalyx helps provide stability to the ocular surface by assisting the tear film to wet it. It is also permeable to water, but less so to ions. We formulate a thin film model based on lubrication theory in order to understand the dynamics between the aqueous layer and the glycocalyx, which we treat as a rigid porous medium. We present numerical solutions for the evolution of the tear film and discuss the roles played by the key parameters of the system. This work was supported by the Simons Foundation Grant No. 281839.

  5. Tear Break-up Time in High Altitude Areas.

    Science.gov (United States)

    Jha, K N

    2009-01-01

    In high altitude areas, patients report with irritation, redness and foreign body sensation in their eyes suggesting tear film abnormality due to low humidity and windy environmental conditions. Tear Break- up Time (TBUT) was studied in 100 subjects consisting of local population and those originally from plains residing in high altitude areas in Ladakh. There were 24% individuals with TBUT of 10 seconds. In symptomatic patients with TBUT of <5 seconds, eight cases had irritation of eyes, six foreign body sensation and two cases had pain, watering, irritation and redness of eyes. Pterygium was seen in 12 individuals and inter palpebral congestion in 4 cases. A total of 24% cases showed abnormal (<5 seconds) TBUT. Abnormality of tear film in the presence of low humidity and windy condition with high ultraviolet radiation may lead to ocular discomfort and pterygium in these areas.

  6. Skin tear prevalence and associated factors: a systematic review

    Directory of Open Access Journals (Sweden)

    Kelly Cristina Strazzieri-Pulido

    2015-08-01

    Full Text Available OBJECTIVETo identify and analyse skin tear prevalence and factors associated with its occurrence.METHODSystematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem.RESULTSThe analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors.CONCLUSIONSkin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

  7. [Skin tear prevalence and associated factors: a systematic review].

    Science.gov (United States)

    Strazzieri-Pulido, Kelly Cristina; Peres, Giovana Ribau Picolo; Campanili, Ticiane Carolina Gonçalves Faustino; Santos, Vera Lúcia Conceição de Gouveia

    2015-08-01

    To identify and analyse skin tear prevalence and factors associated with its occurrence. Systematic review of literature of studies published until June 2014 including studies published in full in English, Spanish or Portuguese. The studies were analysed according to the Strengthening the Reporting of Observational Studies in Epidemiology and the Guidelines for Critically Appraising Studies of Prevalence or Incidence of a Health Problem. The analysis of eight studies showed skin tear prevalence of 3.3% to 22% in the hospital setting and 5.5% to 19.5% in homecare. Advanced age, dependence on basic activities of daily life, frail elderly, level of mobility, agitated behavior, non-responsiveness, greater risk for concurrent development of pressure ulcers, cognitive impairment, spasticity and photoaging were cited as risk factors. Skin tear prevalence ranged from 3.3% to 22% and is mainly associated with advanced age and dependence on basic activities of daily life.

  8. Tear fluid-eye drops compatibility assessment using surface tension.

    Science.gov (United States)

    Hotujac Grgurević, Martina; Juretić, Marina; Hafner, Anita; Lovrić, Jasmina; Pepić, Ivan

    2017-02-01

    To evaluate the compatibility of commercially available eye drop surface tension with the tear film physiological range and to characterize commonly used ophthalmic excipients in terms of their surface activity under eye-biorelevant conditions. There are a number of quality requirements for the eye drops (e.g. tonicity, pH, viscosity, refractive index) that needs to comply with the physiological parameters of the eye surface. However, the adjustment of surface tension properties of the eye drops to the normal range of surface tension at the air/tear fluid interface (40-46 mN/m) has received rather less attention thus far. Yet, the surface tension at the air/tear fluid interface is of vital importance for the normal function of the eye surface. The surface tension compatibility of the isotonic aqueous solutions of commonly used ophthalmic excipients as well as 18 approved eye drops with the tear fluid have been evaluated using surface tension method. Each ophthalmic ingredient including the preservatives, solubilizing agents and thickening agents can influence the surface tension of the final formulation. In case of complex ophthalmic formulations one should also consider the possible interactions among excipients and consequent impact on overall surface activity. Out of 18 evaluated eye drops, three samples were within, 12 samples were below and three samples were above the physiological range of the tear fluid surface tension. Our results provide a rationale for clinical studies aiming to assess the correlation between the eye drops surface tension and the tear film (in)stability.

  9. Cytokine and chemokine levels in tears from healthy subjects.

    Science.gov (United States)

    Carreño, Ester; Enríquez-de-Salamanca, Amalia; Tesón, Marisa; García-Vázquez, Carmen; Stern, Michael E; Whitcup, Scott M; Calonge, Margarita

    2010-11-01

    There is growing evidence for the existence of an 'immune tone' in normal tears. The aim of this study was to determine the levels of a large panel of cytokines and chemokines in tears obtained from healthy subjects. These levels can then serve as baseline values for comparison with patients suffering from ocular surface diseases. Nine healthy subjects participated in this study, and normal ocular surface health was documented by the results of a dry eye questionnaire, Schirmer strip wetting, and vital staining of the cornea. Four microliters of tears were collected from each eye and analysed separately with multiplex bead-based assays for the concentration of 30 cytokines and chemokines. Twenty-five cytokines/chemokines were detected. CCL11/Eotaxin1, GM-CSF, G-CSF, IFN-γ, IL-2, IL-3, IL-4, IL-5, IL-10, IL-13, IL-12p70, IL-15, CX3CL1/Fractalkine, TNF-α, epidermal growth factor, and CCL4/MIP-1β were present at 5-100 pg/ml. IL-1β, IL-6, IL-7A, CXCL8/IL-8, and CCL2/MCP-1 were present at 100-400 pg/ml. IL-1Ra, CXCL10/IP-10 and vascular endothelial growth factor were present at more than 1000 pg/ml. Multiplex bead-based assays are convenient for cytokine/chemokine detection in tears. Fracktalkine has been detected in human healthy tears for the first time. The knowledge of cytokine/chemokine concentrations in tears from normal subjects is an important reference for further comparison with patients suffering from ocular surface diseases. Variability in their levels can reflect a phenomenon of potential importance for the understanding of the ocular surface cytokine pattern. © 2010 The Authors. Journal compilation © 2010 Acta Ophthalmol.

  10. Assessment of Tear Film Using Videokeratoscopy Based on Fractal Dimension.

    Science.gov (United States)

    Llorens-Quintana, Clara; Iskander, D Robert

    2018-01-01

    The proposed automated approach for estimating the quality of the tear film closes the gap between the manual and automated assessment, translating the high-speed videokeratoscopy technology from scientific laboratories to a clinical practice. To develop and test a new method for characterizing Tear Film Surface Quality with high-speed videokeratoscopy utilizing a fractal dimension approach. The regularity of the reflected pattern in high-speed videokeratoscopy (E300; Medmont) depends on tear film stability. Thus, determining tear film stability can be addressed by estimating the fractal dimension of the reflected pattern. The method is tested on 39 normal subjects. The results of the fractal dimension approach are compared with those obtained using previously proposed automated method, based on a gray-level co-occurrence matrix approach, and with subjective results obtained by two operators that were assessing the video recordings in ideal conditions. Fractal dimension method was less affected by eye movements and changes in the videokeratoscopic image background than gray-level co-occurrence matrix method. Median difference of the noninvasive break-up time between manual and automated methods was 0.03 s (IQR = 4.47 s) and 0.0 s (IQR = 2.22 s) for gray-level co-occurrence matrix and fractal dimension approaches, respectively. Correlation coefficient with manual noninvasive break-up time was r = 0.86 (P dimension approach. Significant statistical difference was found between noninvasive break-up measurements of manual and gray-level co-occurrence matrix method (P = 0.008). The proposed method has the potential to characterize tear film dynamics in more detail compared to previous methods based on high-speed videokeratoscopy. It showed good correlation with manual assessment of tear film.

  11. Rotator cuff tears noncontrast MRI compared to MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Department of Radiology, Chungang University Hospital, Seoul (Korea, Republic of); Yoo, Jae Chul [Sungkyunkwan University, School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2015-12-15

    To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

  12. Tear film osmolarity in ocular mucous membrane pemphigoid.

    Science.gov (United States)

    Miserocchi, Elisabetta; Iuliano, Lorenzo; Berchicci, Luigi; Bandello, Francesco; Modorati, Giulio

    2014-07-01

    The aim of this study was to evaluate tear film osmolarity in patients with ocular mucous membrane pemphigoid (MMP). This observational cross-sectional study included 40 patients with biopsy-proven ocular MMP at Foster stage III referred to the tertiary-care Ocular Immunology and Uveitis Service at the San Raffaele Scientific Institute in Milan from June 2010 to August 2013. We evaluated the following clinical parameters: tear film osmolarity, ocular surface disease symptoms (OSDI) questionnaire, Schirmer test, tear film break-up time (TFBUT), and corneal and conjunctival staining. Forty patients (27 women and 13 men) were enrolled. All patients were undergoing systemic immunosuppressive therapy: 19 patients (47.5%) were on methotrexate, 9 (22.5%) were on mycophenolate mofetil, 9 (22.5%) were on low-dose corticosteroids, and 3 (7.5%) were on azathioprine. The mean osmolarity was 322.90 ± 33.39 mOsm/L, the mean OSDI score was 73.2 ± 17.9, the mean TFBUT was 6.60 ± 3.13 seconds, and the mean Schirmer test value was 4.07 ± 3.58 seconds. Tear film osmolarity significantly correlated with the TFBUT (r = 0.80; P < 0.0001), whereas no clinical correlation was found with the Schirmer test value (r = 0.01; P = 0.40) or with the OSDI score (r = 0.02; P = 0.29). Osmolarity did not turn out to be statistically different in the subgroups according to the Oxford corneal staining scale (P = 0.71) and to the Van Bijsterveld conjunctival staining score (P = 0.31). Tear osmolarity increased in patients with ocular MMP and correlated with the TFBUT. This result emphasizes the role of evaporative dry-eye condition in patients with ocular MMP. Tear osmolarity may be considered as a useful test in the diagnostic assessment of dry eye associated with MMP and for targeting therapeutic decisions.

  13. Tear lipocalin, lysozyme and lactoferrin concentrations in postmenopausal women.

    Science.gov (United States)

    Careba, I; Chiva, A; Totir, M; Ungureanu, E; Gradinaru, Sinziana

    2015-01-01

    Among the most frequently encountered pathologies examined by the ophthalmologist is dry eye syndrome (DE), which can be discovered particularly in the elderly. The initial diagnosis of DE is of high importance, but also challenging. This is because the biochemical changes in the tear film often develop before any detectable signs. In this study, the possible relationship between ocular symptomatology, tear volume and tear break-up time (TBUT) and lipocalin, lactoferrin and lysozyme concentrations in the tear film were explored in a group of symptomatic dry-eyed postmenopausal (PM) women compared to age-matched controls. Sixty-six healthy PM females with ages of at least 50 years were grouped in two homogeneous lots (by age, post-menopause, co-morbidities) of 33 females each, one lot presenting mild or moderate dry eye syndrome (DE) and one asymptomatic non-dry eye (NDE), based on their feedback to the Ocular Surface Disease Index (OSDI) questionnaire and noninvasive TBUT and Schirmer test results. Tears were collected via capillary tubes and an eye wash method. Tear lysozyme, lactoferrin and lipocalin concentrations were determined via electrophoresis. OSDI responses revealed 3 mild DE, 30 moderate DE and 33 NDE. The OSDI total score and sub scores for the DE group were significantly greater than for the NDE group (p lactoferrin concentration (plactoferrin concentrations. In a PM population, lipocalin and lysozyme are invariable, irrespective of the presence and severity of DE symptoms. However, lactoferrin shows a significant decrease. This is a comprehensive study of lipocalin, lactoferrin and lysozyme in dry-eyed PM women and our results suggested that lactoferrin could be used as a biomarker of DE in postmenopausal women. PM = postmenopausal; DE = dry eye disease; NDE = non-dry eye; ELISA = Enzyme-linked immunosorbent assay.

  14. Anterior medial meniscal root avulsions due to malposition of the tibial tunnel during anterior cruciate ligament reconstruction: two case reports.

    Science.gov (United States)

    Laprade, Christopher M; James, Evan W; Engebretsen, Lars; Laprade, Robert F

    2014-05-01

    The meniscal roots are essential for preserving the native biomechanical and structural properties of the tibiofemoral joint. Meniscus root avulsions, which disrupt the normal meniscus anchoring points, have been reported to result in deleterious biomechanics and clinical outcomes. In this series, two cases of iatrogenic medial meniscus anterior root avulsions after anterior cruciate ligament (ACL) reconstruction are reported. Iatrogenic medial meniscus anterior root avulsions after malpositioning of the tibial tunnels during ACL reconstruction have not been previously reported in the literature and may account for poor long-term outcomes seen in some patients after ACL reconstruction. Therefore, careful attention must be paid to correct tibial tunnel placement during ACL reconstruction. Case series, Level IV.

  15. The Strength of Transosseous Medial Meniscal Root Repair Using a Simple Suture Technique Is Dependent on Suture Material and Position.

    Science.gov (United States)

    Robinson, James R; Frank, Evelyn G; Hunter, Alan J; Jermin, Paul J; Gill, Harinderjit S

    2018-01-01

    A simple suture technique in transosseous meniscal root repair can provide equivalent resistance to cyclic load and is less technically demanding to perform compared with more complex suture configurations, yet maximum yield loads are lower. Various suture materials have been investigated for repair, but it is currently not clear which material is optimal in terms of repair strength. Meniscal root anatomy is also complex; consisting of the ligamentous mid-substance (root ligament), the transition zone between the meniscal body and root ligament; the relationship between suture location and maximum failure load has not been investigated in a simulated surgical repair. (A) Using a knottable, 2-mm-wide, ultra-high-molecular-weight polyethylene (UHMWPE) braided tape for transosseous meniscal root repair with a simple suture technique will give rise to a higher maximum failure load than a repair made using No. 2 UHMWPE standard suture material for simple suture repair. (B) Suture position is an important factor in determining the maximum failure load. Controlled laboratory study. In part A, the posterior root attachment of the medial meniscus was divided in 19 porcine knees. The tibias were potted, and repair of the medial meniscus posterior root was performed. A suture-passing device was used to place 2 simple sutures into the posterior root of the medial meniscus during a repair procedure that closely replicated single-tunnel, transosseous surgical repair commonly used in clinical practice. Ten tibias were randomized to repair with No. 2 suture (Suture group) and 9 tibias to repair with 2-mm-wide knottable braided tape (Tape group). The repair strength was assessed by maximum failure load measured by use of a materials testing machine. Micro-computed tomography (CT) scans were obtained to assess suture positions within the meniscus. The wide range of maximum failure load appeared related to suture position. In part B, 10 additional porcine knees were prepared. Five

  16. Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Ferrari, Francesco S.; Governi, Simone; Burresi, Francesca; Vigni, Francesco; Stefani, Paolo [Department of Radiologic and Orthopaedic-Rehabilitative Sciences, University Hospital Siena (Italy)

    2002-05-01

    The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions. (orig.)

  17. Risk factors for multiple retinal tears in patients with acute posterior vitreous detachment.

    Science.gov (United States)

    Karahan, Eyyup; Karti, Omer; Er, Duygu; Cam, Duygu; Aydın, Rukiye; Zengin, Mehmet Ozgur; Kaynak, Suleyman

    2017-02-03

    To evaluate possible risk factors for multiple retinal tears in patients with acute posterior vitreous detachment. Three hundred and seventy-six consecutive patients presenting with symptoms of floaters and/or flashes were examined. The associations of retinal tears with the duration of symptoms, multiple floaters, flashing, a family history of retinal detachment, peripheral retinal degeneration, lens status, myopia, tobacco dust, and retinal or vitreous hemorrhage were analyzed. Fifty-four (14.4%) of the 376 patients had 71 initial retinal tears. Forty of the 54 eyes had one retinal tear, and 14 eyes had multiple retinal tears. The presence of retinal or vitreous hemorrhage increased the risk of multiple retinal tears 6.1 times using univariate analysis and 7.0 times using multivariate analysis. Unrecognized retinal tears in patients with acute posterior vitreous detachment can cause subsequent retinal detachment. It is therefore important to consider multiple retinal tears, especially in patients with retinal or vitreous hemorrhage.

  18. Clinical Severity and Tear Biomarkers, Eosinophil Cationic Protein and CCL23, in Chronic Allergic Conjunctival Diseases.

    Science.gov (United States)

    Shoji, Maki; Shoji, Jun; Inada, Noriko

    2016-12-08

    To evaluate the relationship between clinical severity and tear levels of eosinophil cationic protein (ECP) and CC chemokine ligand 23 (CCL23) in patients with chronic allergic conjunctival disease (cACD). This clinical study included 21 patients with cACD, including atopic keratoconjunctivitis and vernal keratoconjunctivitis, and 14 subjects as controls. The clinical severity score was determined by objective findings. Tear ECP grade was evaluated using tear ECP levels determined by enzyme immunoassay. CCL23 expression in tears was also determined by enzyme immunoassay. In the cACD group, tear ECP grade was significantly correlated with the clinical severity score. Clinical severity scores and tear ECP grades in the CCL23-positive subgroup were significantly higher than those in the CCL23-negative subgroup. We have confirmed the value of tear ECP grade and CCL23 expression in tears as a severity grading system in patients with cACD.

  19. Hot tearing of aluminum-copper B206 alloys with iron and silicon additions

    National Research Council Canada - National Science Library

    Kamguo Kamga, H; Larouche, D; Bournane, M; Rahem, A

    2010-01-01

    ...) to investigate the combined effect of these additions on hot tear resistance. Susceptibility to hot tearing was found to increase gradually with iron content when the conditions were favorable to the formation of the β(FeCu) phase...

  20. Tear osmolarity and dry eye symptoms in diabetics

    Directory of Open Access Journals (Sweden)

    Fuerst N

    2014-03-01

    Full Text Available Nicole Fuerst,1 Nicole Langelier,1 Mina Massaro-Giordano,1 Maxwell Pistilli,1 Kalliopi Stasi,1 Carrie Burns,2 Serena Cardillo,2 Vatinee Y Bunya1 1Department of Ophthalmology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 2Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA Purpose: To assess the relationship between tear osmolarity and dry eye symptoms in patients with diabetes. Patients and methods: Fifty patients with diabetes were enrolled. Demographic information and past medical history were recorded. Symptoms were assessed using the ocular surface disease index (OSDI. Tear osmolarity of each eye was measured with the TearLab® Osmolarity System. Results: The majority of the subjects were female (76%, African American (56%, and/or had a diagnosis of type 2 diabetes (82%. The mean ± standard deviation (SD for age was 54.6±13.4, and maximum tear osmolarity was 304.6±12.7 mOsm/L. Men had higher osmolarity than women (mean ± standard error (SE 311.8±4.0 mOsm/L versus 302.3±1.9 mOsm/L, P=0.02. Age, race, use of artificial tears, years of diabetes, and hemoglobin A1c did not have a statistically significant association with tear osmolarity. Longer duration of diabetes was associated with lower (less severe OSDI scores (r=-0.35, P=0.01. Higher tear osmolarity was associated with lower (less severe OSDI scores (r=-0.29, P=0.04. Conclusion: Approximately half of the diabetic subjects in our study had elevated tear osmolarity, and half of our population also reported symptoms consistent with dry eye disease. However, the two were slightly inversely related in that those with higher osmolarity reported fewer symptoms. Subjects with a longer duration of diabetes also reported fewer dry eye symptoms. Therefore, health care providers should be aware that patients who are most likely to have ocular surface disease, including those with

  1. Winging of scapula due to serratus anterior tear

    Directory of Open Access Journals (Sweden)

    Varun Singh Kumar

    2014-10-01

    Full Text Available 【Abstract】Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle. Traumatic injury to serratus anterior muscle itself is very rare. We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male. Winging was present in neutral position and in extension of right shoulder joint but not on "push on wall" test. Patient was managed conservatively and achieved satisfactory result. Key words: Serratus anterior tear; Scapula; Wounds and injuries

  2. Mode coupling trigger of neoclassical magnetohydrodynamic tearing modes in tokamaks

    Energy Technology Data Exchange (ETDEWEB)

    Gianakon, T.A.; Hegna, C.C.; Callen, J.D.

    1997-05-01

    Numerical studies of the nonlinear evolution of coupled magnetohydrodynamic - type tearing modes in three-dimensional toroidal geometry with neoclassical effects are presented. The inclusion of neoclassical physics introduces an additional free-energy source for the nonlinear formation of magnetic islands through the effects of a bootstrap current in Ohm`s law. The neoclassical tearing mode is demonstrated to be destabilized in plasmas which are otherwise {Delta}{prime} stable, albeit once a threshold island width is exceeded. A possible mechanism for exceeding or eliminating this threshold condition is demonstrated based on mode coupling due to toroidicity with a pre-existing instability at the q = 1 surface.

  3. Patellar taping alters knee kinematics during step descent in individuals with a meniscal injury: An exploratory study.

    Science.gov (United States)

    Roy, Nicolas; Gaudreault, Nathaly; Tousignant, Michel; Vézina, François; Boudreau, Nicolas

    2016-01-01

    Meniscus lesions are common musculoskeletal knee injuries which often lead to pain, limitation and compensations during functional tasks, such as descending stairs. This study investigated the effect of patellar taping with tension and without tension on three-dimensional (3D) kinematics of the knee during a slow step descent task in patients with meniscal lesions. Ten patients diagnosed with a meniscal lesion, confirmed by magnetic resonance imaging, underwent five, step descent movements at slow speed under three different conditions: 1) no taping; 2) tension-free taping; and 3) patellar taping with medial tension. 3D kinematic data were recorded from the injured knee using an eight-camera infrared Vicon motion analysis system. Maximum and minimum angle values and total range of motion (maximum/minimum value) in three movement planes during single-limb stance were compared using a repeated measure ANOVA. Results showed a significant increase in the maximum and minimum angle value in the sagittal plane (mean differences=2.4° and 4.2°, respectively) and a decrease in the transverse plane (-6.3° and -2.2°, respectively) for the patellar taping condition compared to the no taping condition. A decreased rotational angle range when comparing the patellar taping to the no taping (-4.1°) and tension-free taping (-3.1°) conditions was also observed. These changes remained significant when pain was considered as a covariate in the analysis. The tension applied to the patellar tape played a role in controlling the sagittal and transverse plane step-down movement among patients in our study. These results support the use of patellar taping with a medially oriented tension to help to reduce the transversal plane movement of the knee in this population and they bring new light to the taping effect. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Meniscal repair in vivo using human chondrocyte-seeded PLGA mesh scaffold pretreated with platelet-rich plasma.

    Science.gov (United States)

    Kwak, Hong Suk; Nam, Jinwoo; Lee, Ji-Hye; Kim, Hee Joong; Yoo, Jeong Joon

    2017-02-01

    The objective of this study was to test the hypothesis that platelet-rich plasma (PRP) pretreatment on a poly-lactic-co-glycolic acid (PLGA) mesh scaffold enhances the healing capacity of the meniscus with human chondrocyte-seeded scaffolds in vivo, even when the seeded number of cells was reduced from 10 million to one million. A flexible PLGA mesh scaffold was pretreated with PRP using a centrifugal technique. One million human articular chondrocytes were seeded onto the scaffold by dynamic oscillation. After 7 days, scaffolds were placed between human meniscal discs and were implanted subcutaneously in nude mice for 6 weeks (n = 16/group). Fluorescence microscopy demonstrated uniform attachment of the chondrocytes throughout the scaffolds 24 h following seeding. Cell attachment analysis revealed a significantly increased number of chondrocytes on PRP-pretreated than non-treated scaffolds (p < 0.05). Field emission scanning electron microscopy revealed chondrocytes attached to the PRP-pretreated scaffolds interconnecting their cellular processes with the fibrin network at 24 h and day 7 of culture. Of the 16 constructs containing PRP-pretreated scaffolds implanted in mice, six menisci healed completely, nine healed incompletely and one did not heal. Histological results from the 16 control constructs containing non-treated scaffolds revealed that none had healed completely, four healed incompletely and 12 did not heal. The histological outcome between the groups was significantly different (p < 0.05). These findings suggest that human articular chondrocytes on PRP-pretreated PLGA mesh scaffolds demonstrate increased cell attachment and enhance the healing capacity of meniscus with a reduced number of seeding cells in a meniscal repair mouse model. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  5. Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0T MR imaging.

    Science.gov (United States)

    Michalitsis, S; Hantes, M; Thriskos, P; Tsezou, A; Malizos, K N; Fezoulidis, I; Vlychou, M

    2017-02-01

    To assess articular cartilage changes in the knee joint as detected on 3.0T MR imaging after 2-year follow-up in patients who underwent arthroscopic anterior cruciate ligament reconstruction (ACLR) with or without concomitant meniscal surgery. A total of twenty-nine patients (mean age 30.3 ± 10 years), who underwent arthroscopic ACLR, received clinical and imaging follow-up at an average of 27.8 ± 4.8 months after surgery. Our patients were divided into two subgroups: eighteen patients with additional meniscal injuries at the time of arthroscopic ACLR who underwent meniscal surgery and eleven patients with intact menisci. The cartilage status of all knees at the time of arthroscopic ACLR was recorded. All patients underwent an MRI scan preoperatively and at follow-up with the same imaging protocol. Cartilage status of all knee compartments was evaluated at the time of follow-up by MR imaging and the ICRS classification. Deterioration of the cartilage status was found at all knee compartments of our study group, with respect to the number of cartilage defects. The cartilage of the lateral femoral condyle (LFC) was most severely affected, followed by patellar and medial femoral condyle (MFC) cartilage. A statistically significant relation was found between surgery of the medial meniscus and the development of new cartilage defects in LFC (p = 0.01) and MFC (p = 0.03) after adjusting for the site of meniscal surgery. The cartilage of LFC and the status of the medial meniscus were also found to be significantly related (p = 0.04). Partial meniscectomy was found to be associated with an increased incidence of new cartilage defects when compared to either meniscal repair or absence of meniscal surgery, although it was not statistically significant. Development of new cartilage lesions was evident after 2-year follow-up in patients with arthroscopic ACLR as detected by MR imaging. There was a multicompartmental pattern of cartilage involvement, and the

  6. Spectral-domain optical coherence tomography study on dynamic changes of human tears after instillation of artificial tears.

    Science.gov (United States)

    Napoli, Pietro Emanuele; Satta, Giovanni Maria; Coronella, Franco; Fossarello, Maurizio

    2014-07-01

    To analyze in vivo the dynamic changes induced by different artificial tears (ATs) in the precorneal tear film (PCTF) and lower tear meniscus (LTM) by using spectral-domain (SD) anterior segment optical coherence tomography (OCT). We prospectively examined 42 normal human eyes by using SD-OCT imaging. On the day before OCT imaging, all enrolled subjects were evaluated for abnormalities of ocular surface. All tear film images were obtained before and after instillation of three different types of ATs (mucomimetic, lipid-based, and saline) in five serial scans: immediately (within 30 seconds), at the first, fifth, 10th, and 20th minute. Subjects received a drop of 35 μL in one randomly selected eye. All examinations were conducted in the same conditions of temperature, brightness, humidity, and time of day. Changes in the morphological pattern of both LTM and PCTF were associated with the type of artificial tear instilled on the ocular surface. Similarly, the radius of curvature (rc), the height (h), and the depth (d) showed dynamic variations depending on treatment. Although by the 20th minute, both h and d returned to baseline values in all groups, a significant difference in rc (compared with baseline) was detected for mucomimetic ATs (P = 0.04) and lipid ATs (P = 0.02). Spectral-domain OCT imaging has preliminarily proved to be a noninvasive tool to evaluate, in real time, the different changes induced by ATs instillation. An important stride in understanding the clinical response to various tear substitutes can be achieved by this objective and quantitative approach. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

  7. Magnetic resonance imaging for the diagnosis of chondral, meniscal and cruciate ligaments injuries of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Karam, Francisco Consoli; Fridmann, Marcos William; Arbo, Rodrigo Di Mare; Vieira, Jose Francisco [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine]. E-mail: franciscokaram@terra.com.br; Silva, Jefferson Luis Braga da; Pires, Luiz Antonio Simoes [Pontificia Univ. Catolica do Rio Grande do Sul (PUCRS), Porto Alegre, RS (Brazil). Faculty of Medicine. Hospital Sao Lucas; Abreu, Armando; Abreu, Marcelo [Hospital Mae de Deus, Porto Alegre, RS (Brazil). Servico de Radiologia

    2007-05-15

    Objective: To evaluate the diagnostic accuracy of magnetic resonance imaging (MRI) of the knee. Materials and methods: Seventy-two patients have been submitted to MRI previously to arthroscopy of the knee performed by a single surgeon and utilized as a comparative standard method. Sensitivity, specificity, values of likelihood and rate of interobserver agreement have been evaluated. Results: The kappa agreement coefficient between MRI and arthroscopy was very good for lesions in the anterior cruciate ligament (0.84), good for lateral meniscus (0.75), reasonable for medial meniscus (0.50) and poor for chondral lesions (< 0.50). MRI has demonstrated high sensitivity for tears in the anterior cruciate ligament (94%) and in the medial meniscus (92%), good sensitivity for lesions in the lateral meniscus (80%), and low sensitivity for lesions in all of the chondral zones (< 50%), while the specificity has been excellent for all the chondral, and ligamentous structures, besides the lateral menisci analyzed (more than 97%), and reasonable (65%) for the medial meniscus. Conclusion: MRI is an useful tool in the clinical diagnosis of intra-articular knee lesions, as already demonstrated by similar results reported both in the Brazilian and international literature. (author)

  8. Detection of endogenous cortisol in equine tears and blood at rest and after simulated stress.

    Science.gov (United States)

    Monk, Caroline S; Hart, Kelsey A; Berghaus, Roy D; Norton, Natalie A; Moore, Phillip A; Myrna, Kathern E

    2014-07-01

    To determine whether cortisol is present in equine tears at rest and during simulated stress and compare tear cortisol to serum free and total cortisol. Fourteen healthy adult horses were included. Paired tear total cortisol and serum total and free cortisol concentrations were measured with ELISA, chemiluminescent immunoassay, and ultrafiltration methodology, respectively, in 10 horses at rest once daily for five consecutive days. In an additional four horses, paired tear and serum samples were collected for cortisol measurement before and after adrenocorticotropic hormone (ACTH) stimulation (cosyntropin, 1 μg/kg IV). Cortisol was detectable in equine tears at rest. Following ACTH stimulation, tear cortisol increased significantly from baseline at 60-120 min (P ≤ 0.001). Serum total and free cortisol also increased significantly at 30-180 min after ACTH stimulation (P ≤ 0.001). Both serum and tear cortisol returned to baseline concentrations by 360 min. Changes in tear cortisol were similarly associated with changes in serum total and free cortisol, although high tear cortisol concentrations suggest a portion of tear cortisol may be protein-bound. Cortisol is present in equine tears and increases in concert with serum cortisol following ACTH stimulation. Further study is needed to determine whether endogenous cortisol in tears contributes to ocular pathology. © 2013 American College of Veterinary Ophthalmologists.

  9. The relation between invasive and non-invasive tear break-up time ...

    African Journals Online (AJOL)

    Tear stability normal to Nigerians with consideration of gender and age has not been reported. Tear stability in young adults was measured using invasive and non-invasive tear break-up time (TBUT and NIBUT). Forty –five subjects aged 20 to 30 years were selected from among the students of University of. Benin, Edo ...

  10. A Prospective Evaluation of Survivorship of Asymptomatic Degenerative Rotator Cuff Tears

    Science.gov (United States)

    Keener, Jay D.; Galatz, Leesa M.; Teefey, Sharlene A.; Middleton, William D.; Steger-May, Karen; Stobbs-Cucchi, Georgia; Patton, Rebecca; Yamaguchi, Ken

    2015-01-01

    Background: The purpose of this prospective study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears. Methods: Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospective longitudinal study. Two hundred and twenty-four subjects (118 initial full-thickness tears, fifty-six initial partial-thickness tears, and fifty controls) were followed for a median of 5.1 years. Validated functional shoulder scores were calculated (visual analog pain scale, American Shoulder and Elbow Surgeons [ASES], and simple shoulder test [SST] scores). Subjects were followed annually with shoulder ultrasonography and clinical evaluations. Results: Tear enlargement was seen in 49% of the shoulders, and the median time to enlargement was 2.8 years. The occurrence of tear-enlargement events was influenced by the severity of the final tear type, with enlargement of 61% of the full-thickness tears, 44% of the partial-thickness tears, and 14% of the controls (p pain. The final tear type was associated with a greater risk of pain development, with the new pain developing in 28% of the controls, 46% of the shoulders with a partial-thickness tear, and 50% of those with a full-thickness tear (p pain (p shoulders with a stable tear compared with 30% of the shoulders with tear enlargement (p shoulders with a stable tear showed increased infraspinatus muscle degeneration compared with 28% of those in which the tear had enlarged (p = 0.07). Conclusions: This study demonstrates the progressive nature of degenerative rotator cuff disease. The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear, and tear enlargement is associated with a greater risk of pain development across all tear types. Level of Evidence: Prognostic Level II. See Instructions for

  11. An investigation of non-invasive tear break up time and tear meniscus height of keratoconic versus non-keratoconic individuals

    Directory of Open Access Journals (Sweden)

    Deanne L. Nicholas

    2016-03-01

    Full Text Available Keratoconus is a debilitating condition where the cornea develops a conical shape rather than the characteristic round shape due to various physiological and structural changes taking place within the layers of the cornea. As a result of the pathogenesis of keratoconus, there are numerous changes that may occur within the tears of these patients. Research has shown changes in the tear metabolome, the presence of degradation products as well as loss of goblet cells into the tears. Could the changes occurring within the tear structure of these patients affect the results of various tear quantity and quality tests? Non-invasive tear break up time (NTBUT is a diagnostic test used to determine the quality of the tear film and has been used extensively when diagnosing dry eye disease. This test is utilised in order to determine the time taken for the tear film to begin breaking apart, signalling thinning of the tears. Shorter break up times are therefore indicative of instability or changes occurring within the tear film which could be diagnostic of dry eye disease. Tear meniscus height (TMH measurements have also been utilised in clinical practice, where these measurements provide an indication of the volume of tears contained within the upper and lower menisci. Lower tear volumes have been shown to be present in cases of dry eye disease where either tear production or tear drainage may be affected. Changes in the quality and quantity of the tear film in subjects with dry eye disease have been thoroughly investigated; however, the same cannot be said for subjects with keratoconus. Could the same findings be possible in subjects with keratoconus? Is it possible that the changes occurring within the tears of keratoconic subjects could lead to abnormal NTBUT and TMH measurements when compared to those of control subjects? Could the results of the NTBUT and TMH tests be related to one another? This study compares the NTBUT and TMH measurements of both

  12. Localized tearing modes in the magnetotail driven by curvature effects

    Science.gov (United States)

    Sundaram, A. K.; Fairfield, D. H.

    1995-01-01

    The stability of collisionless tearing modes is examined in the presence of curvature drift resonances and the trapped particle effects. A kinetic description for both electrons and ions is employed to investigate the stability of a two-dimensional equilibrium model. The main features of the study are to treat the ion dynamics properly by incorporating effects associated with particle trajectories in the tail fields and to include the linear coupling of trapped particle modes. Generalized dispersion relations are derived in several parameter regimes by considering two important sublayers of the reconnecting region. For a typical choice of parameters appropriate to the current sheet region, we demonstrate that localized tearing modes driven by ion curvature drift resonance effects are excited in the current sheet region with growth time of the order of a few seconds. Also, we examine nonlocal characteristics of tearing modes driven by curvature effects and show that modes growing in a fraction of a second arise when mode widths are larger than the current sheet width. Further, we show that trapped particle effects, in an interesting frequency regime, significantly enhance the growth rate of the tearing mode. The relevance of this theory for substorm onset phase and other features of the substorms is briefly discussed.

  13. Study of Perineal Tears During Delivery of Singletons in Cephalic ...

    African Journals Online (AJOL)

    degree perineal tears were nulliparity especially if maternal age was 27 and above, foetal weight = 3500 rd g, instrumental deliveries and deliveries of adolescents while that of 3 degree were forceps delivery (1 case) and macrosomic babies (2) in patients of 27 and 29 years. Conclusion: In the above mentioned conditions, ...

  14. Tear production and intraocular pressure in canine eyes with ...

    African Journals Online (AJOL)

    ... and intraocular pressure (IOP) in dogs with unilateral corneal ulceration using the Schirmer tear test (STT) and rebound (TonoVet®) tonometry. IOP and STT values were recorded in both ulcerated and non-ulcerated (control) eyes of 100 dogs diagnosed with unilateral corneal ulceration. Dogs presented with other ocular ...

  15. Heat transfer and tear film dynamics over multiple blink cycles

    Science.gov (United States)

    Deng, Quan; Braun, R. J.; Driscoll, Tobin A.

    2014-07-01

    We consider model problems for the tear film over multiple blink cycles with heat transfer from the posterior side of the tear film. A nonlinear partial differential equation governs the film thickness on a moving domain in one space dimension and time. One end of the tear film moves in order to mimic blinking in the eye. The film thickness is coupled with the diffusion of heat from the posterior of the film, where the underlying cornea and aqueous humor are modeled as a rectangular domain. The domain of the tear film is located on one edge of the rectangle. The resulting problem is solved using the method of lines with a Chebyshev spectral method in space. Evaporation is included in the model, with end fluxes specified to compensate for the evaporation from the film. The numerical results reveal a similarity to quantitative in vivo observations of the film dynamics and measured ocular surface temperature. Periodicity in the film and temperature dynamics is explored with different flux conditions and end motions, and a transition between periodic and non-periodic solutions is analyzed.

  16. Aortic bifurcation tear following blunt trauma in childhood

    Directory of Open Access Journals (Sweden)

    Shlomo Yellinek

    2015-07-01

    Full Text Available Rupture of the abdominal aorta from blunt trauma is rare and aortic biforcation tear is extremely rare. We will present the management of a 2 year old boy who suffered blunt abdominal trauma and was operated in urgent fashion in our institution.

  17. Aortic bifurcation tear following blunt trauma in childhood

    OpenAIRE

    Yellinek, Shlomo; Gimelrich, Dimitri; Merin, Ofer; Reissman, Petachia; Arkovitz, Marc

    2015-01-01

    Rupture of the abdominal aorta from blunt trauma is rare and aortic biforcation tear is extremely rare. We will present the management of a 2 year old boy who suffered blunt abdominal trauma and was operated in urgent fashion in our institution.

  18. Reverse Fosbury Flop Tear of the Rotator Cuff

    Directory of Open Access Journals (Sweden)

    Jérôme Tirefort

    2017-01-01

    Full Text Available Introduction. “Fosbury flop” tear is an avulsion of the posterosuperior rotator cuff from the bone with reversal healing on its medial bursal-side. This case report describes a unique variant of Fosbury flop tear with a lesion of the musculotendinous junction that healed, for its tendon part, on the anterior humerus and coracoid process. Case Presentation. A 62-year-old man developed a posttraumatic painful shoulder with active loss of range of motion. Magnetic resonance arthrography demonstrated a lesion of the musculotendinous junction of the supraspinatus with healing of the tendon on the above-mentioned structures (reverse Fosbury flop. During arthroscopic evaluation, tendon repair was not possible and a debridement to avoid subacromial and anterior impingement associated with a tenotomy of the long head of the biceps were carried out. One year postoperatively, the patient had complete range of motion and was satisfied with the clinical results. Discussion and Conclusion. Different Fosbury flop tears exist. Radiologists and orthopedic surgeons should be aware of these tear patterns as failure to recognize them may lead to inadequate treatment.

  19. Immunoglobulin Concentration in Tears of Contact Lens Wearers

    Directory of Open Access Journals (Sweden)

    Rajendra P Maurya

    2014-01-01

    Conclusion: The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation.

  20. The effect of Acetaminophen (Paracetamol ) on Tear Production ...

    African Journals Online (AJOL)

    The effect of acetaminophen (paracetamol ) on the tear production of 100 young healthy subjects was studied using their right eyes. These subjects with the mean age of 22.5±3.24 years consisted of 40 men and 60 women selected after a thorough case history, IOP measurement and TBUT determination to rule out ...

  1. Stop the Tears of Drug and Alcohol Abuse

    Science.gov (United States)

    Shimon, Jane; Gibson, Terry-Ann; Spear, Caile

    2009-01-01

    Objectives: By participating in this Stop the Tears teaching strategy, students will be able to: (1) analyze how alcohol and drug abuse could affect their lives as well as the lives of their friends and family and, (2) create a media message, such as a poster, pamphlet, poem, or song, in which alcohol and drug prevention is advocated specific to…

  2. Compensatory muscle activation in patients with glenohumeral cuff tears

    NARCIS (Netherlands)

    Steenbrink, Franciscus

    2010-01-01

    Patients suffering tendon tears in the glenohumeral cuff muscles show activation of muscles which pull the arm downwards during arm elevation tasks. This so-called co-activation deviates from healthy controls and is triggered by pain. Goal of this thesis was to demonstrate that deviating muscle

  3. Surgical management of partial tears of the anterior cruciate ligament.

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Zampogna, Biagio; Tecame, Andrea; Maffulli, Nicola; Denaro, Vincenzo

    2014-01-01

    Partial anterior cruciate ligament (ACL) tears involving the posterolateral (PL) bundle can lead to rotatory laxity of the knee, while tears involving the anteromedial (AM) bundle result in abnormal anteroposterior laxity of the knee. In this systematic review, we examine the best evidence on the management of partial tears of the ACL. A comprehensive search of several databases was performed from the inception of the database to December 2011, using various combinations of keywords focusing on clinical outcomes of human patients who had partial tears of ACL and who had undergone ACL augmentation. We evaluated the methodological quality of each article using the Coleman Methodology Score. Ten articles published in peer-reviewed journals were identified (392 males and 242 females), with a mean modified Coleman methodology of 66.1 ± 10.2. Only two studies compared standard ACL reconstruction and augmentation techniques. No study has a sample large enough to allow establishing guidelines. Validated and standardized proprioception assessment methods should be used to report outcomes. Imaging outcomes should be compared to functional outcomes, and a control group consisting of traditional complete ACL reconstruction should be present. There is a need to perform appropriately powered randomized controlled trials presenting clinical outcome with homogeneous score systems to allow accurate statistical analysis. ACL augmentation technique, preserving the intact AM or PL bundle of the ACL, is encouraging but currently available evidences are too weak to support his routine use in clinical practice.

  4. Haemolacria (bloody tears): A perplexing symptom: A report of two ...

    African Journals Online (AJOL)

    He was given intramuscular vitamin K and high dose vitamin C. Other relevant investigations to determine the cause could not be done due to financial constraints, however the bloody tearing stopped after two months and has not recurred after being followed up for two years. The second patient, presented with redness of ...

  5. Micromethods for the analysis of tear proteins in pharmacological studies.

    Science.gov (United States)

    Saso, L; Tommasino, P; Grippa, E; Leone, M G; Silvestrini, B

    1999-02-01

    Although it is well established that ocular mucins and other proteins are essential for tear film stability, whether certain drugs, like non steroidal antiinflammatory drugs (NSAIDs), could cause ocular dryness by inhibiting their secretion is not known. To perform these and other studies of pharmacological interest, we evaluated several micromethods for the analysis of tear samples. The major proteins of the tear fluid collected in capillaries, i.e. IgA, lactoferrin, tear specific prealbumin and lysozyme, were analyzed by SDS-PAGE and gel permeation HPLC, using 2.5-5 microliters of sample. Gastric mucin (PGM), examined as a standard, was analyzed by solid phase assays based on previously described histochemical staining methods: dot blot assays were performed using small disks of polyvinylidene difluoride or nylon membranes, prepared by an ordinary paper punch, which were coated with PGM and stained by Alcian blue or the periodic acid Schiff's reagent. The densitometric analysis was carried out using an ordinary flat scanner controlled by a personal computer equipped with an inexpensive software. The sensitivity of these simple assays was low (100-500 micrograms) but considered sufficient for certain studies. A more sensitive assay (5-20 micrograms) was developed by immobilizing PGM in small agarose gels (100 microliters), prepared in the wells of 96-well microplates, which could by stained by stains-all and analyzed by an automatic plate reader at 595 nm.

  6. Anterior shoulder capsular tears in professional baseball players.

    Science.gov (United States)

    Gulotta, Lawrence V; Lobatto, Daniel; Delos, Demetris; Coleman, Struan H; Altchek, David W

    2014-08-01

    Tearing of the anterior capsule of the shoulder is a rare but debilitating injury for throwing athletes. However, there is very little in the literature to guide its diagnosis and treatment. In this case series, we outline our experience with anterior capsular tears of the shoulder in professional baseball players. Five professional baseball players were diagnosed with midsubstance tears of their anterior capsule. A trial of rest and rehabilitation failed in all patients, and they eventually underwent surgery. These patients were retrospectively reviewed. The presenting symptoms and findings were documented, and outcomes were assessed by the player's ability to return to play. The mean age was 33.5 years (range, 31-37 years), and all patients presented with anterior shoulder pain and the inability to throw. No patient had an acute traumatic injury. Magnetic resonance imaging provided the correct diagnosis in 4 patients, and the diagnosis was made with diagnostic arthroscopy in the fifth. Three underwent arthroscopic repair, and 2 underwent open repair of the anterior capsule. Of the 5 players, 4 (80%) returned to their preinjury level by a mean of 13.3 months (range, 8-18 months). Anterior capsular tears can occur in older throwing athletes. Surgical repair, whether arthroscopic or open, can yield good results in most patients. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  7. Analysis and comparison of proteomic profiles of tear fluid from human, cow, sheep, and camel eyes.

    Science.gov (United States)

    Shamsi, Farrukh A; Chen, Ziyan; Liang, Jingwen; Li, Kaijun; Al-Rajhi, Ali A; Chaudhry, Imtiaz A; Li, Mingtao; Wu, Kaili

    2011-11-25

    To investigate the tear proteome profiles of human, cow, sheep, and camel comparatively and to explore the difference of tear protein profiles among different species. Tears were collected from both eyes of 25 clinically healthy volunteers, 50 cows, 25 sheep, and 50 camels. Pooled tear protein samples were separated by SDS-PAGE and two-dimensional electrophoresis. Protein spots of differential expression were excised and subjected to in-gel digestion and identification by matrix assisted laser desorption/ionization-time-of-flight/time-of-flight mass spectrum analysis. Because of the incomplete genomic data of cow, sheep, and camel, a combined strategy of de novo sequencing and BLAST (Best Local Alignment Search Tool) homology searching was also used for protein identification. The differentially expressed proteins were validated by Western blot analysis. On comparison with human tears (182 ± 6 spots), 223 ± 8, 217 ± 11, and 241 ± 3 well-resolved protein spots were detected in triphenylmethane dye-stained gels of cow, sheep, and camel tears, respectively. Similar high-abundant proteins (lactoferrin, lysozyme, etc.) were found in all tear fluids. Tear lipocalins have been identified in cow and sheep tears. BLAST searching revealed a 21-kDa protein, identical with human vitelline membrane outer layer protein 1 (VMO1) homolog, in camel tears. The Western blot confirmed that VMO1 homolog was present in both camel and sheep tears but not in human and cow tears. The comparative proteomic analyses of tears from healthy humans, cows, sheep, and camels were first reported. Differential protein expression existed in the tear among species, offering useful information for further study on tear proteins and the related ocular diseases.

  8. Tear trough – Anatomy and treatment by autologous fat grafting

    Directory of Open Access Journals (Sweden)

    Chang Yung Chia

    2016-07-01

    Full Text Available Tear trough is the main irregularity at midface, of which treatment is difficult. There is no agreement in literature about its anatomy and best treatment. The author presented an anatomical study and personal autologous fat grafting technique for tear trough treatment. Anatomical dissections were done on two fresh cadavers to examine the skin, subcutaneous, muscle and bone layers, spaces, and attachments. Safety and efficacy were evaluated via retrospective analysis of the last 200 consecutive procedures performed by the author. Tear trough is caused by the abrupt transition of the palpebral orbicular oculi muscle (OOM (i.e., thin skin without subcutaneous fat compartment to the orbital OOM (i.e., thicker skin with malar fat compartment. The tear trough region is located at the OOM bony origin at the medial canthus where no specific ligament was found. The grafted fat volume stabilized at two or three months after the procedure, instead of six months as stated in literature, with excellent results and no severe complications. Tear trough is a personal characteristic, a natural anatomical depression caused by subcutaneous irregularity and can worsen with age. The lack of volume is not effectively corrected by surgeries and thus it must be filled. Fat grafting has several advantages over alloplastic fillers, although it may be more difficult. Fat graft is autologous and abundant, and tissue transplantation could enhance skin quality. Fat grafting is a simple, safe, and effective solution for adding extra volume to correct the deflation phenomenon of the midface aging process. There is no specific anatomical plane for volume injection; the fat graft must be evenly distributed in the deep and superficial plane for uniformity.

  9. Knee Arthroscopic Surgery in Middle-Aged Patients With Meniscal Symptoms: A 3-Year Follow-up of a Prospective, Randomized Study.

    Science.gov (United States)

    Gauffin, Håkan; Sonesson, Sofi; Meunier, Andreas; Magnusson, Henrik; Kvist, Joanna

    2017-07-01

    The optimal treatment for middle-aged patients with knee pain and meniscal lesions has been extensively debated. Most previous studies have revealed only short-term beneficial results of knee arthroscopic surgery. The authors have previously shown a positive benefit of knee arthroscopic surgery and an exercise program after 1 year when compared with an exercise program alone. To evaluate if knee arthroscopic surgery combined with an exercise program provided an additional long-term benefit after 3 years compared with an exercise program alone in middle-aged patients with meniscal symptoms. Randomized controlled trial; Level of evidence, 1. Of 179 eligible patients, aged 45 to 64 years, 150 were randomized to (1) a 3-month exercise program (nonsurgery group) or (2) the same as group 1 plus knee arthroscopic surgery within 4 weeks (surgery group). The primary outcome was the change in the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscore of pain between baseline and the 3-year follow-up. Results from the 1-year follow-up have been published previously. Both treatment groups improved significantly in the KOOS pain subscore at 3 years' follow-up in the intention-to-treat and as-treated analyses ( P arthroscopic surgery, seen at 1 year in middle-aged patients with meniscal symptoms, was diminished at 3 years and was no longer statistically significant. Knee arthroscopic surgery may be beneficial for middle-aged patients with meniscal symptoms in addition to an exercise program. Older age and absence of mechanical symptoms should not be contraindications to surgery. Registration: NCT01288768 ( ClinicalTrials.gov identifier).

  10. Quantification of tear proteins and sPLA2-IIa alteration in patients with allergic conjunctivitis

    Science.gov (United States)

    Li, Kaijun; Liu, Xialin; Chen, Ziyan; Huang, Qiang

    2010-01-01

    Purpose Allergic conjunctivitis (AC) has been reported to induce the instability of the tear film. The tear protein and the lipid layer play important roles in maintaining the tear film. The aim of this study was to quantify the alteration of the major tear protein components and a lipid related protein secretory type IIa phospholipase A2 (sPLA2-IIa) in tears of seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) patients. Methods Twenty-one SAC and PAC patients and thirteen normal controls completed a symptom questionnaire and underwent regular ocular examination. SAC and PAC patients were diagnosed based on the clinical presentation and elevated serum IgE levels. Schirmer test paper was used to collect tear samples from SAC and PAC patients and normal controls. Soybean trypsin inhibitor (SBTI) was used as an internal standard to analyze tear samples in 15% SDS–PAGE gel. Total tear protein and its major components from the SAC and PAC patients and normal controls were quantified by band densitometry. The major tear protein bands were determined by MALDI-TOF/TOF spectrum analysis. Western blot was used to detect the content of sPLA2-IIa in tears of allergic conjunctivitis patients and normal controls. Results Schirmer test scores were more than 10 mm in all the SAC and PAC patients and control subjects. The tear film breakup time of SAC and PAC patients was much shorter than that of the normal controls. We obtained 15 bands of tear protein by one dimensional SDS–PAGE, in which 14 bands were determined by mass-spectrum analysis. The band densitometry analysis revealed that the total tear protein concentration was much higher in SAC and PAC patients than in normal controls (p<0.05). The quantity of tear protein band 4 (serum albumin precursor), band 6 (Ig gamma-2), band 9 (leukocyte elastase inhibitor) were also significantly higher in AC patients (p<0.05). Content of sPLA2-IIa, as shown by western blot, was much higher in AC

  11. Tear break-up time for tear film evaluation: Are moistening solutions interchangeable?

    Science.gov (United States)

    Serés, Carme; Quevedo, Lluïsa; Cardona, Genís; Blanch, Estel la; Augé, Montserrat

    2015-08-01

    It was the main purpose of this study to investigate the influence of the moistening solution on TBUT measurements in an asymptomatic population. An online survey was employed to determine the compliance of Spanish eye care practitioners with the recommended normalized procedure to administer TBUT. For the purpose of examining the clinical relevance of discrepancies from the recommended procedure, a randomized, double-masked, bilateral study was designed in which a micropipette was used to moisten fluorescein strips with a controlled volume of six different solutions, commonly available in the contact lens office, and TBUT was measured in 58 non-dry eye (OSDI<15) subjects (age from 19 to 32 years). Results from the online survey revealed that 64% of Spanish practitioners frequently use (or have used) different solutions to moisten fluorescein strips during TBUT assessment. Statistically significant differences in TBUT values were found between the various solutions as a whole (χ(2)=198.384, p<0.001), as well as between all solutions when explored pair-wise (all p<0.001), except for the two saline solutions. The present findings support the relevance of selecting the appropriate solution when conducting TBUT for the evaluation of the tear film. Deviations from the recommended procedure may result in misdiagnosis of dry eye and unnecessary patient referral. Copyright © 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  12. The effect of meniscus compression on the biomechanical properties of repaired meniscal lesions. Winner of the AGA-DonJoy Award 2003.

    Science.gov (United States)

    Staerke, Christian; Bochwitz, Carsten; Groebel, Karl-Heinz; Unterhauser, Frank; Becker, Roland

    2004-05-01

    The objective of the present study was to investigate the influence of meniscus compression, as it occurs with weight-bearing, on the biomechanical behavior of different repair types. Young human meniscal tissue specimens were fitted with a single Bionx Arrow, a Innovasive Meniscal Screw, or a vertical suture (Ethibond 2-0) according to standard clinical practice. Test specimens then underwent repetitive loading with 10 N under 1 N pretension up to a maximum of 1182 cycles and were finally loaded to failure. Half of the cases in each group were additionally subjected to synchronized intermittent compression during the test. The main variables investigated were the number of cycles survived and ultimate failure load. To reduce the complexity, investigations were limited to the peripheral repair site. The number of cycles survived was significantly affected by compression and the type of repair. Arrows and Screws survived 311 and 52 cycles, respectively, without compression, while 983 and 1182 cycles were survived with added compression. In the suture group, no premature failure occurred either with or without compression. Both compression and the type of repair had a significant effect on the ultimate failure load. It increased about twofold in the Arrow and Screw group, while the suture group was not affected. Compression of the meniscus can substantially increase the pullout resistance of meniscal repair implants and thus seems not to be a factor negatively influencing the stability of the repair.

  13. Comparison of ultrasonography and magnetic resonance imaging to arthroscopy for diagnosing medial meniscal lesions in dogs with cranial cruciate ligament deficiency.

    Science.gov (United States)

    Franklin, Samuel P; Cook, James L; Cook, Cristi R; Shaikh, Layla S; Clarke, Kevin M; Holmes, Shannon P

    2017-07-01

    OBJECTIVE To compare the accuracy of ultrasonography and MRI for diagnosing medial meniscal lesions in dogs with cranial cruciate ligament (CCL) deficiency. DESIGN Diagnostic test evaluation. ANIMALS 26 dogs (31 stifle joints) with CCL deficiency. PROCEDURES A single surgeon physically examined each dog and performed ultrasonography and arthroscopy of affected stifle joints to identify medial meniscal lesions. Video recordings of the arthroscopic procedure were saved and subsequently reviewed by the same surgeon and by a second surgeon working independently and blinded to results of all examinations. A radiologist blinded to results of all examinations evaluated MRI scans of the affected joints. Correct classification rate (CCR), sensitivity, and specificity of ultrasonography and MRI were calculated twice, with each of the 2 surgeons' arthroscopic assessments used as the reference standard. RESULTS Compared with arthroscopic examination by the unblinded surgeon, ultrasonography had a CCR of 90%, sensitivity of 95% (95% confidence interval [CI], 73% to 100%), and specificity of 82% (95% CI, 48% to 97%). For MRI, these values were 84%, 75% (51% to 90%), and 100% (68% to 100%), respectively. Compared with arthroscopic assessment by the blinded surgeon, ultrasonography had a CCR of 84%, sensitivity of 86% (95% CI, 64% to 96%), and specificity of 78% (95% CI, 40% to 96%). For MRI, these values were 77%, 68% (45% to 82%), and 100% (63% to 100%), respectively. CONCLUSIONS AND CLINICAL RELEVANCE These data suggested imperfect performance but clinical usefulness of both ultrasonography and MRI for diagnosing medial meniscal lesions in dogs.

  14. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Koplas, Monica C. [University of Mississippi Medical Center, Section of Musculoskeletal Radiology, Department of Radiology, Jackson, MS (United States); Schneider, Erika [Cleveland Clinic, Imaging Institute, Cleveland, OH (United States); Sundaram, Murali [Cleveland Clinic, Section of Musculoskeletal Radiology, Imaging Institute, Cleveland, OH (United States)

    2011-05-15

    Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed. (orig.)

  15. Structural Characteristics Are Not Associated With Pain and Function in Rotator Cuff Tears

    Science.gov (United States)

    Curry, Emily J.; Matzkin, Elizabeth E.; Dong, Yan; Higgins, Laurence D.; Katz, Jeffrey N.; Jain, Nitin B.

    2015-01-01

    Background: Structural characteristics of rotator cuff tears are used in surgical decision making. However, data on the association of tear size with patient-reported pain and function are sparse. Purpose: To assess the association of tear size, fatty infiltration, and muscle atrophy with shoulder pain/function in patients with cuff tears undergoing operative and nonoperative treatment. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 67 patients with rotator cuff tears were recruited for this longitudinal cohort study. Patients were determined to have a cuff tear using clinical assessment and blinded magnetic resonance imaging review. The Shoulder Pain and Disability Index (SPADI) was used as a measure of shoulder pain and function. Results: Tear size and thickness were not significantly associated with pain (SPADI pain score, 60.6 [95% CI, 49.8-71.5] for partial-thickness tear; 56.8 [95% CI, 42.8-70.7] for rotator cuff tears undergoing operative and nonoperative treatment, pain and functional status were not associated with tear size and thickness, fatty infiltration, and muscle atrophy. Conversely, factors unrelated to cuff anatomy such as mental health, comorbidities, age, and sex were associated with pain/function. These findings have clinical implications during surgical decision making and suggest that pain and functional disability in patients with rotator cuff tears is multifactorial and should not solely be attributed to structural characteristics. PMID:26675985

  16. In situ visualization of tears on contact lens using ultra high resolution optical coherence tomography.

    Science.gov (United States)

    Wang, Jianhua; Jiao, Shuliang; Ruggeri, Marco; Shousha, Mohamed Abou; Shousha, Mohammed Abou; Chen, Qi

    2009-03-01

    To demonstrate the capability of directly visualizing the tear film on contact lenses using optical coherence tomography (OCT). Six eyes of three healthy subjects wearing PureVision and ACUVUE Advance soft and Boston RGP hard contact lenses were imaged with a custom built, high speed, ultra-high resolution spectral domain optical coherence tomograph. Refresh Liquigel was used to demonstrate the effect of artificial tears on the tear film. Ultra high resolution images of the pre- and post-lens films were directly visualized when each lens was inserted onto the eye. After the instillation of artificial tears during lens wear, the tear film was thicker. The post-lens tear film underneath the lens edge was clearly shown. Interactions between the lens edges and the ocular surface were obtained for each of the lens types and base curves. With a contrast enhancement agent, tear menisci on the contact lenses around the upper and lower eyelids were highlighted. With hard contact lenses, the tear film was visualized clearly and changed after a blink when the lens was pulled up by the lid. Ultra-high resolution OCT is a potentially promising technique for imaging tears around contact lenses. This successful demonstration of in situ post-lens tear film imaging suggests that OCT could open a new era in studying tear dynamics during contact lens wear. The novel method may lead to new ways of evaluating contact lens fitting.

  17. [Gelatinous tear substitutes and nonspecific eye ointments in the critical care unit and in perioperative use].

    Science.gov (United States)

    Marquardt, R; Christ, T; Bonfils, P

    1987-10-01

    The effect of Vidisic (a new jelly artificial tear solution) and an ointment basing on Dexpanthenol on the tear production and the tear film stability was studied both on patients in the intensive care units (ICU) and during operations. In 10 relaxed and ventilated patients of the ICU there was no significant change in the tear production after application of either therapy. In 30 patients, undergoing surgery in endotracheal anaesthesia, the break-up-time and the test according to Schirmer were measured pre- and postoperatively. Like in the ICU-patients no difference in tear production could be found. Regarding the stability of the precorneal tear film however Vidisic was more effective than ointment basing on Dexpanthenol. Especially this clear jelly artificial tear solution allowed in contrast to the ointment a permanent and reliable judgement of the pupillary reaction. In addition the patients felt more comfortable with Vidisic.

  18. Effect of topical 1% tropicamide on Schirmer tear test results in clinically normal horses.

    Science.gov (United States)

    Selk Ghaffari, Masoud; Sabzevari, Amin; Radmehr, Behrad

    2009-01-01

    To observe the effect of topical 1% tropicamide on equine tear production as measured by Schirmer I tear test. Fourteen adult horses received one drop of 1% tropicamide ophthalmic solution in one eye and the opposite eye served as the control. The tear production in both eyes was tested at 1, 2, 4, 6, and 24 h after 1% tropicamide administration. Measurements made 1 h after treatment revealed a significant reduction in Schirmer tear test values in tropicamide treated eyes (P = 0.002). The observed decrease in tear production was maintained up to 4 h after treatment (P = 0.002). Although tropicamide-induced decrease in STT values was observed in the treated eyes, the contralateral eyes did not show significant changes in Schirmer tear test results. Single dose of topical 1% tropicamide resulted in statistically significant reduction in Schirmer tear test values in clinically normal horses.

  19. ProTec Tear-Offs: A Preliminary Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Peeler, D

    2005-09-01

    The Savannah River National Laboratory (SRNL) has conducted a series of ''scoping'' tests (referred to as Phase 1) to assess the potential use of a Mylar{reg_sign} tear-off system as a primary or secondary protective barrier to minimize acid etching (''frosting''), accidental scratching, and/or radiation damage for shielded cells windows. Conceptually, thin, multi-layered sheets of Mylar (referred to as a ''tear-off'' system) could be directly applied to the Lexan{reg_sign} sheet or glovebox/hood sash window to serve as a secondary (or primary) barrier. Upon degradation of visual clarity due to accidental scratching, spills/splatters, and/or radiation damage, the outer layer (or sheet) of Mylar could be removed ''refreshing'' or restoring the view. Due to the multi-layer aspect, the remaining Mylar layers would provide continued protection for the window from potential reoccurrences (which could be immediate or after some extended time period). Although the concept of using a tear-off system as a protective barrier was conceptually enticing, potential technical issues were identified and addressed as part of this Phase 1 feasibility study. These included resistance to: (1) acid(s) (concentrated (28.9 M) HF, concentrated (15.9M) HNO{sub 3}, 6M HCl, and 0.6M H{sub 3}BO{sub 3}), (2) base (a simulated sludge with pH of 12.9), (3) gamma radiation (cumulative dose of {approx}200,000 rad), and (4) scratch resistance (simulating accidental scratching with the manipulators). Not only can these four factors play a significant role in determining the visual clarity of the integrated system, they can also contribute to the mechanical integrity issues which could dictate the ability to remove the outer layer when visual clarity has degraded. The results of the Phase 1 study clearly indicate that the Mylar tear-off concept (as a primary or secondary protective barrier) is a potential technical

  20. Goldmann tonometry tear film error and partial correction with a shaped applanation surface.

    Science.gov (United States)

    McCafferty, Sean J; Enikov, Eniko T; Schwiegerling, Jim; Ashley, Sean M

    2018-01-01

    The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT) prism and in a correcting applanation tonometry surface (CATS) prism. The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius) used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms. The CATS prism tear film adhesion error (2.74±0.21 mmHg) was significantly less than the GAT prism (4.57±0.18 mmHg, p film adhesion error was independent of applanation mire thickness ( R 2 =0.09, p =0.04). Fluorescein produces more tear film error than artificial tears (+0.51±0.04 mmHg; p film adhesion error (1.40±0.51 mmHg) was significantly less than that of the GAT prism (3.30±0.38 mmHg; p =0.002). Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error bŷ41%. Fluorescein solution increases the tear film adhesion compared to artificial tears, while mire thickness has a negligible effect.

  1. Predicting rotator cuff tears using data mining and Bayesian likelihood ratios.

    Directory of Open Access Journals (Sweden)

    Hsueh-Yi Lu

    Full Text Available Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone.In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree and a statistical method (logistic regression to classify the rotator cuff diagnosis into "tear" and "no tear" groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models.Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear.Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears.

  2. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

    2007-02-15

    We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

  3. Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ro Woon; Choi, Soo-Jung; Ahn, Jae Hong; Shin, Dong Rock; Kang, Chae Hoon [University of Ulsan, College of Medicine, Department of Radiology, Asan Foundation, Gangneung Asan Hospital, Gangneung-si, Gangwon-do (Korea, Republic of); Lee, Man Ho [Andong Medical Center, Department of Radiology, Andong-si, Gyeongsangbuk-do (Korea, Republic of); Lee, Ki Won [University of Ulsan, College of Medicine, Department of Orthopedic Surgery, Asan Foundation, Gangneung Asan Hospital, Gangneung-si, Gangwon-do (Korea, Republic of)

    2016-12-15

    To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears. This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears. Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively). Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears. (orig.)

  4. I.S.Mu.L.T - Rotator Cuff Tears Guidelines

    Science.gov (United States)

    Oliva, Francesco; Piccirilli, Eleonora; Bossa, Michela; Via, Alessio Giai; Colombo, Alessandra; Chillemi, Claudio; Gasparre, Giuseppe; Pellicciari, Leonardo; Franceschetti, Edoardo; Rugiero, Clelia; Scialdoni, Alessandro; Vittadini, Filippo; Brancaccio, Paola; Creta, Domenico; Buono, Angelo Del; Garofalo, Raffaele; Franceschi, Francesco; Frizziero, Antonio; Mahmoud, Asmaa; Merolla, Giovanni; Nicoletti, Simone; Spoliti, Marco; Osti, Leonardo; Padulo, Johnny; Portinaro, Nicola; Tajana, Gianfranco; Castagna, Alex; Foti, Calogero; Masiero, Stefano; Porcellini, Giuseppe; Tarantino, Umberto; Maffulli, Nicola

    2015-01-01

    Despite the high level achieved in the field of shoulder surgery, a global consensus on rotator cuff tears management is lacking. This work is divided into two main sessions: in the first, we set questions about hot topics involved in the rotator cuff tears, from the etiopathogenesis to the surgical treatment. In the second, we answered these questions by mentioning Evidence Based Medicine. The aim of the present work is to provide easily accessible guidelines: they could be considered as recommendations for a good clinical practice developed through a process of systematic review of the literature and expert opinion, in order to improve the quality of care and rationalize the use of resources. PMID:26958532

  5. Modeling Tear Film Evaporation and Breakup with Duplex Films

    Science.gov (United States)

    Stapf, Michael; Braun, Richard; Begley, Carolyn; Driscoll, Tobin; King-Smith, Peter Ewen

    2015-11-01

    Tear film thinning, hyperosmolarity, and breakup can irritate and damage the ocular surface. Recent research hypothesizes deficiencies in the lipid layer may cause locally increased evaporation, inducing conditions for breakup. We consider a model for team film evolution incorporating two mobile fluid layers, the aqueous and lipid layers. In addition, we include the effects of salt concentration, osmosis, evaporation as modified by the lipid layer, and the polar portion of the lipid layer. Numerically solving the resulting model, we explore the conditions for tear film breakup and analyze the response of the system to changes in our parameters. Our studies indicate sufficiently fast peak values or sufficiently wide areas of evaporation promote TBU, as does diffusion of solutes. In addition, the Marangoni effect representing polar lipids dominates viscous dissipation from the non-polar lipid layer in the model. This work was supported in part by NSF grant 1412085 and NIH grant 1R01EY021794.

  6. The growth of the tearing mode - Boundary and scaling effects

    Science.gov (United States)

    Steinolfson, R. S.; Van Hoven, G.

    1983-01-01

    A numerical model of resistive magnetic tearing is developed in order to verify and relate the results of the principal approximations used in analytic analyses and to investigate the solutions and their growth-rate scalings over a large range of primary parameters which include parametric values applicable to the solar atmosphere. The computations cover the linear behavior for a variety of boundary conditions, emphasizing effects which differentiate magnetic tearing in astrophysical situations from that in laboratory devices. Eigenfunction profiles for long and short wavelengths are computed and the applicability of the 'constant psi' approximation is investigated. The growth rate is computed for values of the magnetic Reynolds number up to a trillion and of the dimensionless wavelength parameter down to 0.001. The analysis predicts significant effects due to differing values of the magnetic Reynolds number.

  7. Influence of toroidal rotation on resistive tearing modes in tokamaks

    Energy Technology Data Exchange (ETDEWEB)

    Wang, S.; Ma, Z. W., E-mail: zwma@zju.edu.cn [Institute for Fusion Theory and Simulation, Zhejiang University, Hangzhou 310027 (China)

    2015-12-15

    Influence of toroidal equilibrium plasma rotation on m/n = 2/1 resistive tearing modes is studied numerically using a 3D toroidal MHD code (CLT). It is found that the toroidal rotation with or without shear can suppress the tearing instability and the Coriolis effect in the toroidal geometry plays a dominant role on the rotation induced stabilization. For a high viscosity plasma (τ{sub R}/τ{sub V} ≫ 1, where τ{sub R} and τ{sub V} represent resistive and viscous diffusion time, respectively), the effect of the rotation shear combined with the viscosity appears to be stabilizing. For a low viscosity plasmas (τ{sub R}/τ{sub V} ≪ 1), the rotation shear shows a destabilizing effect when the rotation is large.

  8. Micro-tearing modes in the Mega Ampere Spherical Tokamak

    CERN Document Server

    Applegate, D J; Connor, J W; Cowley, S C; Dorland, W; Hastie, R J; Joiner, N; 10.1088/0741-3335/49/8/001

    2011-01-01

    Recent gyrokinetic stability calculations have revealed that the spherical tokamak is susceptible to tearing parity instabilities with length scales of a few ion Larmor radii perpendicular to the magnetic field lines. Here we investigate this 'micro-tearing' mode in greater detail to uncover its key characteristics, and compare it with existing theoretical models of the phenomenon. This has been accomplished using a full numerical solution of the linear gyrokinetic-Maxwell equations. Importantly, the instability is found to be driven by the free energy in the electron temperature gradient as described in the literature. However, our calculations suggest it is not substantially affected by either of the destabilising mechanisms proposed in previous theoretical models. Instead the instability is destabilised by interactions with magnetic drifts, and the electrostatic potential. Further calculations reveal that the mode is not significantly destabilised by the flux surface shaping or the large trapped particle f...

  9. Effect of topical tropicamide on tear production as measured by Schirmer's tear test in normal dogs and cats.

    Science.gov (United States)

    Margadant, D L; Kirkby, K; Andrew, S E; Gelatt, K N

    2003-12-01

    To evaluate the effect of a single dose of topical 1% tropicamide on tear production as measured by the Schirmer tear test (STT) in the normal dog and cat. Twenty-eight dogs and 32 cats received 50 micro l : l of 1% tropicamide in one eye and the opposite eye served as the control. STTs were performed immediately before instillation of tropicamide and then at 1, 4, 8 and 24 h post drug instillation. STT results were compared between the control and treated eyes at the different times. Aqueous tear production in dogs, measured by STT, was not significantly reduced. The mean +/- SEM STTs for the baseline time for control and tropicamide-treated eyes were 19.9 +/- 0.8 and 20.3 +/- 0.8 mm wetting/min, respectively. For the control eyes, the subsequent mean +/- SEM STT levels were 20.3 +/- 0.9 (1 h), 21.1 +/- 0.8 (4 h), 20.1 +/- 0.9 (8 h), and 18.7 +/- 0.7 (24 h). For the tropicamide-treated eyes, the subsequent mean +/- SEM STT levels were 19.4 +/- 0.9 (1 h), 19.3 +/- 0.9 (4 h), 20.0 +/- 0.9 (8 h), and 18.4 +/- 0.8 (24 h). Aqueous tear production of both eyes was significantly reduced in cats at 1 h but returned to baseline by 4 h post tropicamide instillation. The mean +/- SEM STT levels for the baseline time in cats for control and tropicamide-treated eyes were 14.9 +/- 0.8 and 14.7 +/- 0.8 mm wetting/min, respectively. Subsequent mean +/- SEM STT levels for the control eyes were 6.4 +/- 1.1 (1 h), 11.9 +/- 1.0 (4 h), 13.9 +/- 0.8 (8 h), and 16.4 +/- 1.0 (24 h). For the tropicamide-treated eyes, the subsequent mean +/- SEM STT levels were 5.3 +/- 0.8 (1 h), 10.2 +/- 0.8 (4 h), 14.7 +/- 1.0 (8 h), and 16.6 +/- 1.0 (24 h). Single dose 1% tropicamide does not significantly lower tear production rates, as measured by the STT, in normal dogs. However, in normal cats single doses of 1% tropicamide in one eye cause significant reductions in tear production of both eyes at 1 h that recovered to baseline levels by 4 h.

  10. Schirmer tear test, phenol red thread tear test, eye blink frequency and corneal sensitivity in the guinea pig.

    Science.gov (United States)

    Trost, Katrin; Skalicky, M; Nell, Barbara

    2007-01-01

    To establish reference values for Schirmer tear tests (STT) I and II, phenol red thread (PRT) tear test and eye blink frequency, and to determine corneal sensitivity for normal guinea pigs. One hundred and eight eyes of 54 adult Duncan-Hartley guinea pigs. Schirmer tear test (STT) I and then STT II were performed in 36 guinea pigs. PRT and STT I were compared in 18 adult Duncan-Hartley guinea pigs. Corneal sensitivity was determined in 23 guinea pigs by evaluating the corneal touch threshold (CTT) of five different regions using a Cochet-Bonnet esthesiometer. Eye blink frequency was measured in 10 guinea pigs over a period of 20 min and in 17 guinea pigs over a period of 10 min. Mean STT I was 0.36 mm +/- 1.09 mm (wetting/min) and mean STT II was 0.43 mm +/- 1.29 mm (wetting/min). There was no significant difference between mean STT I and mean STT II (P = 0.79). The mean PRT-value was 16 +/- 4.7 mm (wetting/15 s), and the mean STT I-value in the same guinea pigs was 0.6 +/- 1.83 mm (wetting/min). Corneal sensitivity was significantly higher in the center than in the four limbal regions. The mean CTT for central, ventral, nasal, temporal and dorsal regions was 2, 1.7, 1.7, 1.7 and 1.6 cm or 3.7, 5.2, 5.6, 5.7 and 6.4 g/mm(2), respectively. Eye blink frequency was between two to five (mean 3.4 +/- 1.04) blinks per eye over 20 min in guinea pigs in their home environment, while in handheld and restrained guinea pigs eye blink frequency showed a variation between 0 and 17 blinks per eye (mean 3.24 +/- 3.64 blinks per eye) over 10 min. As there were no significant differences between STT I and STT II results, reflex tear secretion in the guinea pig may not exist. The most likely explanation is a lower corneal sensitivity in the guinea pig than in other species, such as cats, dogs and horses. Because of the small amount of tears, PRT is the preferred test for tear measurement in the guinea pig.

  11. Two types of peak emotional responses to music: The psychophysiology of chills and tears.

    Science.gov (United States)

    Mori, Kazuma; Iwanaga, Makoto

    2017-04-07

    People sometimes experience a strong emotional response to artworks. Previous studies have demonstrated that the peak emotional experience of chills (goose bumps or shivers) when listening to music involves psychophysiological arousal and a rewarding effect. However, many aspects of peak emotion are still not understood. The current research takes a new perspective of peak emotional response of tears (weeping, lump in the throat). A psychophysiological experiment showed that self-reported chills increased electrodermal activity and subjective arousal whereas tears produced slow respiration during heartbeat acceleration, although both chills and tears induced pleasure and deep breathing. A song that induced chills was perceived as being both happy and sad whereas a song that induced tears was perceived as sad. A tear-eliciting song was perceived as calmer than a chill-eliciting song. These results show that tears involve pleasure from sadness and that they are psychophysiologically calming; thus, psychophysiological responses permit the distinction between chills and tears. Because tears may have a cathartic effect, the functional significance of chills and tears seems to be different. We believe that the distinction of two types of peak emotions is theoretically relevant and further study of tears would contribute to more understanding of human peak emotional response.

  12. Behavioral and neural responses to infant and adult tears: The impact of maternal love withdrawal.

    Science.gov (United States)

    Riem, Madelon M E; van IJzendoorn, Marinus H; De Carli, Pietro; Vingerhoets, Ad J J M; Bakermans-Kranenburg, Marian J

    2017-09-01

    The current study examined behavioral and neural responses to infant and adult tears, taking into account childhood experiences with parental love-withdrawal. With functional MRI (fMRI), we measured neural reactivity to pictures of infants and adults with and without tears on their faces in nulliparous women with varying childhood experiences of maternal use of love withdrawal. Behavioral responses to infant and adult tears were measured with an approach-avoidance task. We found that individuals with experiences of love withdrawal showed less amygdala and insula reactivity to adult tears, but love withdrawal did not affect amygdala and insula reactivity to infant tears. During the approach-avoidance task, individuals responded faster to adult tears in the approach condition compared with the avoidance condition, indicating that adult tears facilitate approach behavior. Individuals responded faster to infant tears than to adult tears, regardless of approach or avoidance condition. Our findings suggest that infant tears are highly salient and may, therefore, overrule the effects of contextual and personal characteristics that influence the perception of adult crying. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  13. Dynamics and function of the tear film in relation to the blink cycle

    Science.gov (United States)

    Braun, R.J.; King-Smith, P.E.; Begley, C.G.; Li, Longfei; Gewecke, N.R.

    2014-01-01

    Great strides have recently been made in quantitative measurements of tear film thickness and thinning, mathematical modeling thereof and linking these to sensory perception. This paper summarizes recent progress in these areas and reports on new results. The complete blink cycle is used as a framework that attempts to unify the results that are currently available. Understanding of tear film dynamics is aided by combining information from different imaging methods, including fluorescence, retroillumination and a new high-speed stroboscopic imaging system developed for studying the tear film during the blink cycle. During the downstroke of the blink, lipid is compressed as a thick layer just under the upper lid which is often released as a narrow thick band of lipid at the beginning of the upstroke. “Rippling” of the tear film/air interface due to motion of the tear film over the corneal surface, somewhat like the flow of water in a shallow stream over a rocky streambed, was observed during lid motion and treated theoretically here. New mathematical predictions of tear film osmolarity over the exposed ocular surface and in tear breakup are presented; the latter is closely linked to new in vivo observations. Models include the effects of evaporation, osmotic flow through the cornea and conjunctiva, quenching of fluorescence, tangential flow of aqueous tears and diffusion of tear solutes and fluorescein. These and other combinations of experiment and theory increase our understanding of the fluid dynamics of the tear film and its potential impact on the ocular surface. PMID:25479602

  14. Comparison of two methods of tear sampling for protein quantification by Bradford method

    Directory of Open Access Journals (Sweden)

    Eliana Farias

    2013-02-01

    Full Text Available The aim of this study was to compare two methods of tear sampling for protein quantification. Tear samples were collected from 29 healthy dogs (58 eyes using Schirmer tear test (STT strip and microcapillary tubes. The samples were frozen at -80ºC and analyzed by the Bradford method. Results were analyzed by Student's t test. The average protein concentration and standard deviation from tears collected with microcapillary tube were 4.45mg/mL ±0.35 and 4,52mg/mL ±0.29 for right and left eyes respectively. The average protein concentration and standard deviation from tears collected with Schirmer Tear Test (STT strip were and 54.5mg/mL ±0.63 and 54.15mg/mL ±0.65 to right and left eyes respectively. Statistically significant differences (p<0.001 were found between the methods. In the conditions in which this study was conducted, the average protein concentration obtained with the Bradford test from tear samples obtained by Schirmer Tear Test (STT strip showed values higher than those obtained with microcapillary tube. It is important that concentration of tear protein pattern values should be analyzed according the method used to collect tear samples.

  15. Hot tearing susceptibility of aluminum alloys using CRCM-Horizontal mold

    Directory of Open Access Journals (Sweden)

    H. Akhyar

    Full Text Available Hot tearing is one of the common defects in casting products. Hot tearing susceptibility (HTS is evaluated using three casting temperatures: 710, 760 and 810 °C. Four aluminum alloys were obtained from the melting of two ingots and casted into constrained rod casting modified-horizontal (CRCM-H molds. The HTS equation was developed to evaluate the hot tearing tendency of metal by the length of bars, tear categories, and tear position. This experiment investigated the effect of various casting temperatures on hot tearing tendency. Hot tearing frequently occurred on the sprue end while only a few tears were found on the ball end and mid bar. The HTS index maximum was 55 at a casting temperature of 760 °C in Alloy 2 and the HTS index minimum was 3 at a casting temperature of 760 °C in Alloy 1. Footprint charts were used with axis values that represent the hot tear susceptibility index on cast-samples. Keywords: Hot tearing, Casting temperature, Footprint chart, CRCM-H

  16. The influence of humidity, temperature, and oral contraceptive in tear

    Science.gov (United States)

    Sousa, Raul A. R. C.; Ribeiro, Tânia L. C.; Moreira, Sandra M. B.; Baptista, António M. G.

    2013-11-01

    The aim of this study is to ascertain whether the quantity and quality of tear and eye subjective comfort are influenced by the temperature, humidity and oral Contraceptives Taking or Non-taking (CTNT). Forty-one students, females, from the University of Minho, Braga, Portugal, aged (mean+/-1standard deviation) of 21.51+/-1.85 years, ranging from 20 to 30 years, participated in this study. The McMonnies Questionnaire (MMQ), Break Up Time (BUT) and Phenol Red Test (PRT) were accessed between 14-17 hours in four sets of visits throughout the year: Visit 1, Visit 2, Visit 3 and Visit 4. The PRT and BUT values (mean+/-1standard deviation) for Visit 1, Visit 2, Visit 3 and Visit 4 were respectively 23.88+/-6.50mm, 22.29+/-8.00mm, 23.61+/-6.75mm, 22.88+/-7.00mm and 6.02+/-1.58s, 5.62+/-1.22s, 5.23+/-0.88s, 5.53+/-1. 42s. The MMQ scores for Visit 1, Visit 2, Visit 3 and Visit 4 ranged from 2-13, 2-15, 1-14 and 2-14 with medians of 6, 7, 6 and 6, respectively. The influence of temperature, humidity and CTNT on PRT, BUT and MMQ were evaluated using generalized linear mixed model. For BUT and MMQ statistical significant effects were found regarding temperature and humidity. The temperature and humidity influenced the tear quality and subjective comfort bu