The Experts below are selected from a list of 1653 Experts worldwide ranked by ideXlab platform

Michelle H. Mcgarry - One of the best experts on this subject based on the ideXlab platform.

  • ulnar collateral Ligament reconstruction using bisuspensory fixation a biomechanical comparison with the docking technique
    American Journal of Sports Medicine, 2013
    Co-Authors: Timothy J Jackson, Gregory J Adamson, Alexander B Peterson, John Patton, Michelle H. Mcgarry
    Abstract:

    Background:Many ulnar collateral Ligament (UCL) reconstruction techniques have been created and biomechanically tested. Single-bundle reconstructions aim to re-create the important anterior bundle of the UCL. To date, no technique has utilized suspensory fixation on the ulnar and humeral sides to create a single-bundle reconstruction.Hypothesis:The bisuspensory technique will restore valgus laxity to its Native state, with comparable load-to-failure characteristics to the docking technique.Study Design:Controlled laboratory study.Methods:Six matched pairs of fresh-frozen cadaveric elbows were randomized to undergo UCL reconstruction using either the docking technique or a novel single-bundle bisuspensory technique. Valgus laxity and rotation measurements were quantified using a MicroScribe 3DLX digitizer at various flexion angles for the Native Ligament, transected Ligament, and 1 of the 2 tested reconstructed Ligaments. Laxity testing was performed from maximum extension to 120° of flexion. Each reconstr...

  • Biomechanical evaluation of a new reconstruction technique of the ulnar collateral Ligament in the elbow with modified bone tunnel placement and interference screw fixation.
    Clinical Biomechanics, 2009
    Co-Authors: Kenneth Seiber, Felix H Savoie, Michelle H. Mcgarry, Ranjan Gupta
    Abstract:

    Abstract Background A new method for reconstruction of the anterior bundle of the ulnar collateral Ligament using modified bone tunnel placement and interference screw fixation was developed to minimize operative dissection, improve graft tensioning, and reduce associated operative morbidities. The objective of this study was to compare varus–valgus laxity and failure properties of this new ulnar collateral Ligament reconstruction to the intact ulnar collateral Ligament. Methods Nine matched pairs of cadaveric upper extremities were used, the intact ulnar collateral Ligament as the control for the load to failure properties and the contralateral arm for ulnar collateral Ligament reconstruction. Varus–valgus laxity was measured at 30°, 50°, 70°, and 90° of elbow flexion for intact, ulnar collateral Ligament transected, and ulnar collateral Ligament reconstruction. Ulnar collateral Ligament reconstruction was performed using a tendon graft passed through a bone tunnel and looped around the medial column of the humerus without dissection of the ulnar nerve. Distally, the graft was looped through a bone tunnel in the proximal ulna. Both ends were secured with interference screws. The specimens were loaded to failure at 50° of flexion at a rate of 30 deg/s. Repeated measures analysis of variance with a P value of 0.05 was used. Findings Elbow laxity significantly increased with ulnar collateral Ligament transection. Following reconstruction, varus–valgus laxity at 30° and 50° of elbow flexion was completely restored to the intact state, only partially restored at 70°, and not changed at 90°. There was no significant difference between the yield and ultimate torques for the intact vs. reconstructed elbows. The angular displacement at yield and failure was significantly greater for the reconstructed elbows compared to the intact. Interpretation This reconstruction technique provides comparable strength to that of the Native Ligament. While stability was improved, failure occurred at greater angular displacement for the reconstructed limbs.

P. Chistolini - One of the best experts on this subject based on the ideXlab platform.

  • ACL reconstruction by bone-patellar tendon-bone graft: mechanical evaluation of the elastic modulus and failure modes
    Journal of Orthopaedics and Traumatology, 2003
    Co-Authors: M. Torre, F. Feo, G. Angelis, I. Ruspantini, G. Frustagli, P. Chistolini
    Abstract:

    The aim of this study was to apply an engineering approach to study the biomechanical behaviour of both Native and reconstructed anterior cruciate Ligaments (ACL) under tensile test, simulating the primary stability of the reconstructed ACL in the immediate postoperative period, when the bone callus has not formed yet. We used the bovine bone-patellar tendon-bone grafts to reconstruct ACL in bovine knees. The grafts were fixed by means of titanium interference screws and titanium transverse compressive screws. We tested 18 Native and 18 reconstructed Ligaments (7 with interference screws and 11 with transverse compressive screws). We applied mechanical tension at a 500 mm/min strain rate, and observed the mode of failure. The data analysis confirmed the different behaviour recorded in load elongation curves, a difference enhanced in stress-strain curves for both fixation methods. The stressstrain patterns for the interference screw and for the Native Ligament were quite similar.

  • ACL reconstruction by bone-patellar tendon-bone graft: mechanical evaluation of the elastic modulus and failure modes
    Journal of Orthopaedics and Traumatology, 2003
    Co-Authors: M. Torre, F. Feo, G. Angelis, I. Ruspantini, G. Frustagli, P. Chistolini
    Abstract:

    The aim of this study was to apply an engineering approach to study the biomechanical behaviour of both Native and reconstructed anterior cruciate Ligaments (ACL) under tensile test, simulating the primary stability of the reconstructed ACL in the immediate postoperative period, when the bone callus has not formed yet. We used the bovine bone-patellar tendon-bone grafts to reconstruct ACL in bovine knees. The grafts were fixed by means of titanium interference screws and titanium transverse compressive screws. We tested 18 Native and 18 reconstructed Ligaments (7 with interference screws and 11 with transverse compressive screws). We applied mechanical tension at a 500 mm/min strain rate, and observed the mode of failure. The data analysis confirmed the different behaviour recorded in load elongation curves, a difference enhanced in stress-strain curves for both fixation methods. The stress-strain patterns for the interference screw and for the Native Ligament were quite similar.

Vicente Sanchis-alfonso - One of the best experts on this subject based on the ideXlab platform.

  • Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model.
    Journal of clinical medicine, 2019
    Co-Authors: Vicente Sanchis-alfonso, Gerard Ginovart, Diego Alastruey-lópez, Erik Montesinos-berry, Joan Carles Monllau, Angel Alberich-bayarri, María Angeles Pérez
    Abstract:

    Objectives: To evaluate the effect of various medial patellofemoral Ligament (MPFL) fixation techniques on patellar pressure compared with the Native knee. Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral Ligament (MQTFL) reconstruction). Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the Native knee. As in a Native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a Native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a Native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a Native Ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a Native Ligament. After 30° of flexion, the MPFL graft loosened, similarly to a Native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a Native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the Native knee. Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the Native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

  • Guidelines for Medial Patellofemoral Ligament Reconstruction in Chronic Lateral Patellar Instability
    The Journal of the American Academy of Orthopaedic Surgeons, 2014
    Co-Authors: Vicente Sanchis-alfonso
    Abstract:

    The standard surgical approach for chronic lateral patellar instability with at least two documented patellar dislocations is to stabilize the patella by using an anatomic medial patellofemoral Ligament reconstruction with a mini-open technique and a graft that is stronger than the Native Ligament t

Gregory S Difelice - One of the best experts on this subject based on the ideXlab platform.

  • Primary Repair of the Lateral Collateral Ligament Using Additional Suture Augmentation.
    Arthroscopy techniques, 2020
    Co-Authors: Harmen D. Vermeijden, Jelle P. Van Der List, Gregory S Difelice
    Abstract:

    Abstract Injuries to the lateral collateral Ligament (LCL) most commonly occur with concomitant cruciate Ligament tears. Over the past decade, there has been increased interest in anatomic reconstruction of the posterolateral corner (PLC). Not much attention has been paid to anatomic primary LCL repair given the historically high failure rates of primary repair of lateral sided knee Ligaments, but better outcomes can now be expected because of recent developments in additional suture augmentation. The purpose of this Technical Note is to describe the surgical technique of primary distal LCL repair using suture augmentation. Using this procedure, the Native Ligament is preserved while allowing early mobilization as suture augmentation is protective of the repaired Ligament.

  • biomechanical evaluation of 2 techniques for ulnar collateral Ligament reconstruction of the elbow
    American Journal of Sports Medicine, 2006
    Co-Authors: George A Paletta, Steven Klepps, Gregory S Difelice, Tracy Allen, Michael D Brodt, Meghan E Burns, Matthew J Silva, Rick W Wright
    Abstract:

    BACKGROUND: Elbow medial ulnar collateral Ligament tears often result in pain and instability that may be career threatening in overhead-throwing athletes. Surgical reconstruction is frequently chosen to treat this injury. Ulnar collateral Ligament reconstruction as described by Jobe is the most commonly used technique. Testing of this construct has not demonstrated that the biomechanical parameters of the Native Ligament are restored. A more recent construct, the docking technique, may more reliably reproduce these factors. HYPOTHESIS: Increasing the number of strands of palmaris longus tendon graft used in ulnar collateral Ligament reconstruction and tensioning them using the docking technique result in a construct with improved biomechanical parameters as compared with the Jobe technique. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty-three fresh-frozen human cadaveric elbows were randomized into 3 subgroups: Jobe (11), docking (12), and Native (10). The Jobe and docking groups underwent reconstruction using their described palmaris tendon graft constructs. The ulnar collateral Ligament was left intact in the Native group. Elbows were potted and tested using a servohydraulic materials testing machine to apply a valgus moment at 30 degrees of elbow flexion. Maximal moments to failure, stiffness, and strain at maximal moment and with a 3 N.m force applied were determined using a 2-camera motion analysis system to track reflective markers spanning the site. RESULTS: The docking (14.3 N.m) and Native (18.8 N.m) subgroups resulted in higher maximal moment to failure than did the Jobe (8.9 N.m) subgroup (P .05). Native Ligaments were stiffer (301.4 N.m) than were Jobe (74.3 N.m) or docking (80.8 N.m; P .05). CONCLUSION: Neither technique reproduced the biomechanical profile of the Native ulnar collateral Ligament; the findings of this study suggest that the docking construct may offer initial biomechanical advantage over the Jobe construct.

Neal S. Elattrache - One of the best experts on this subject based on the ideXlab platform.

  • Ulnar Collateral Ligament Repair With Suture Bridge Augmentation.
    Arthroscopy techniques, 2018
    Co-Authors: Ekaterina Urch, Anthony Degiacomo, Christos D. Photopoulos, Orr Limpisvasti, Neal S. Elattrache
    Abstract:

    The gold standard for management of elbow ulnar collateral Ligament (UCL) injuries in elite athletes is reconstruction of the UCL with a tendon graft. Over the past several years, UCL repair for acute tears, as well as partial tears, in young athletes has gained increasing popularity, with studies reporting good outcomes and high rates of return to sports. Additionally, there is increased interest in Ligament augmentation using the InternalBrace concept. A recent technique paper describes a direct repair of the UCL augmented with a spanning suture bridge. Although clinical outcomes for this method are promising, one possible concern when using this technique is bone loss at the ulnar origin of the UCL should revision reconstruction be required. We propose an alterNative augmentation method that allows for stress shielding of the healing Native Ligament while minimizing bone compromise in the face of UCL reconstruction at a later time point.