Improving alignment in total knee arthroplasty: a cadaveric assessment of a surgical navigation tool with computed tomography imaging.

PURPOSE: To investigate the accuracy of an imageless, optical surgical navigation tool to assist with femoral and tibial bone cuts performed during TKA. PATIENTS AND METHODS: Six board-certified orthopedic surgeons participated in a laboratory cadaver investigation, performing femoral and tibial bone cuts with the assistance of a computer navigation tool. Femoral and tibial varus/valgus, tibial slope, femoral flexion, and both femoral and tibial rotation measurements from the device were compared with angular measurements calculated from computed tomography (CT) images of the knees. RESULTS: Measurements with the navigation tool were highly correlated with those obtained from CT scans in all three axes. For the distal femoral cut, the absolute mean difference in varus/valgus was 0.83° (SD 0.46°, r = 0.76), femoral flexion was 1.91° (SD 1.16°, r = 0.85), and femoral rotation was 1.29° (SD 1.01°, r = 0.88) relative to Whiteside's line and 0.97° (SD 0.56°, r = 0.81) relative to the posterior condylar axis. For the tibia, the absolute mean difference in varus/valgus was 1.08° (SD 0.64°, r = 0.85), posterior slope was 2.78° (SD 1.40°, r = 0.60), and rotation relative to the anteroposterior axis (posterior cruciate ligament to the medial third of the tibial tuberosity) was 2.98° (SD 2.54°, r = 0.79). CONCLUSION: Utilization of an imageless navigation tool may aid surgeons in accurately performing and monitoring femoral and tibial bone cuts, and implant rotation in TKA and thus, more accurately align TKA components.

Computer-Assisted Navigation Accurately Delivers Preoperative Targets for Acetabular Component Orientation During Direct Anterior Approach Total Hip Arthroplasty.

Despite its success, total hip arthroplasty (THA) remains associated with potentially significant complications associated with component malposition. Preoperative planning can mitigate some of these potential concerns; however, the accurate intraoperative delivery of preoperative targets can be challenging. Computer-assisted navigation may assist with intraoperative target delivery, although the integration of these two technologies is relatively uncommon. We retrospectively reviewed cases of THA planned with a computed tomography-based preoperative planning software and performed with the use of an imageless, computer-assisted navigation system. Postoperative acetabular component orientation from radiographs was compared with preoperative targets and intraoperative navigation measurements. A total of 76 patients were included in the analysis. The mean anteversion target (20.0°±3.1°) did not differ significantly from the mean intraoperative navigation measurement (20.5°±3.3°; P=.30; mean difference, 2.2°±2.3°). The mean radiographic measurement (26.6°±6.5°) differed from the target by a mean of 7.5°±6.1° (P<.001). The mean inclination target (38.4°±1.9°) did not differ significantly from the mean intra-operative measurement (38.0°±1.5°; P=.20; mean difference, 1.3°±1.7°) but differed from the radiographic measurement by a mean of 5.2°±4.2° (41.8°±5.6°; P<.001). No adverse events were reported in the 90-day period following the index procedure. Our study demonstrated that an imageless navigation system can accurately deliver computed tomography-derived preoperative targets for acetabular component orientation. Differences noted on radiographs may be due to the difference in patient positioning for the postoperative imaging (standing) as compared with preoperative imaging or surgery itself (supine). [Orthopedics. 2023;46(4):218-223.].

Evaluation of alfaxalone total intravenous anesthesia in rabbits (Oryctolagus cuniculus) premedicated with dexmedetomidine or dexmedetomidine and buprenorphine.

OBJECTIVE: To evaluate alfaxalone for total intravenous anesthesia (TIVA) in rabbits premedicated with dexmedetomidine or dexmedetomidine and buprenorphine. STUDY DESIGN: Crossover study (part 1) with observational study (part 2). ANIMALS: A total of eight New Zealand White rabbits (Oryctolagus cuniculus), four female and four male, aged 12-16 weeks and weighing 2.8-3.5 kg in part 1. Separately, four additional rabbits in part 2. METHODS: Crossover study design with eight rabbits per treatment. Rabbits were administered treatment D, dexmedetomidine (0.2 mg kg-1), or treatment DB, dexmedetomidine (0.1 mg kg-1) and buprenorphine (0.05 mg kg-1) intramuscularly. Anesthesia was induced with alfaxalone intravenously until a supraglottic airway device was placed to deliver 100% oxygen. Anesthesia was maintained with alfaxalone (TIVA). Infusion rates were adjusted to achieve an absent pedal withdrawal reflex. Heart rate, respiratory rate, noninvasive blood pressure, end-tidal carbon dioxide partial pressure and peripheral hemoglobin oxygen saturation (SpO2) were recorded every 5 minutes. Subsequently, four rabbits underwent ovariohysterectomy using treatment DB and alfaxalone TIVA. RESULTS: The mean ± standard deviation alfaxalone infusion rate was 9.6 ± 2.6 and 4.5 ± 1.3 mg kg-1 hour-1 for treatments D and DB, respectively. In both treatments, blood pressure remained within acceptable range and SpO2 was > 95%. Postinduction apnea and respiratory depression were observed in both treatments and managed with manual positive pressure ventilation. Four separate rabbits underwent successful ovariohysterectomy with treatment DB and alfaxalone TIVA. One rabbit required supplementation with inhalant anesthesia; three rabbits were successfully maintained using alfaxalone TIVA alone. CONCLUSIONS AND CLINICAL RELEVANCE: Premedication with dexmedetomidine-buprenorphine combined with alfaxalone TIVA may be a viable alternative for performing abdominal surgery in the rabbit. The use of supplemental oxygen and ability to provide respiratory support are advised.

Validation of a Novel Software Measurement Tool for Total Hip Arthroplasty.

Background Preoperative planning and postoperative evaluation of component position in total hip arthroplasty (THA) utilize specialized software that must be able to provide measurements that are both accurate and precise. A new software program for use in THA has recently been developed. We sought to evaluate the accuracy of this new software in comparison with two current, widely used software programs. Methodology Postoperative anteroposterior (AP) pelvic radiographs from 135 THA patients were retrospectively reviewed. Reference values for acetabular anteversion, inclination, and leg length were established using validated software programs (TraumaCad® as the primary reference value [PRV] and OsiriX LiteTM as the secondary reference value [SRV]). Measurements from the new software program (Intellijoint VIEWTM) were compared with reference values using Student's t-test and chi-square test. Results For anteversion, mean values for the PRV (27.34° ± 7.27°) and the new software (27.29° ± 7.21°) were not significantly different (p = 0.49). The new software differed from the PRV by a mean of 0.05° ± 0.93°. Similar results were noted for inclination, where the new software differed from the PRV and SRV by -0.13° ± 0.65° and 0.25° ± 1.26°, respectively (mean values: PRV: 43.62° ± 6.02°; SRV: 43.99° ± 6.27°; new software: 43.74° ± 6.17°; p = 0.87), and for leg length, where the new software differed from the PRV and SRV by 0.05 mm ± 0.46 mm and 0.22 mm ± 0.52 mm, respectively (mean values: PRV: 10.61 mm ± 11.60 mm; SRV: 10.77 mm ± 11.70 mm; new software: 10.56 mm - ± 11.61 mm; p = 0.98). Measurements were highly correlated across multiple reviewers (intraclass correlation coefficient ≥0.987). Conclusions The new software measurement tool is accurate and precise for assessing the acetabular component position and leg length measurements following THA in AP pelvic radiographs compared to currently used image measurement software.

Compressed Paper as an Alternative to Corn Cob Bedding in Mouse (Mus musculus) Cages.

Bedding material is a critical component of the mouse environment and affects animal wellbeing and research integrity. Corn cob (CC) bedding has been a common bedding choice in research despite several potential negative aspects of its use. We investigated the use of compressed paper (CP) bedding as a refinement to CC bedding. CP bedding demonstrated greater total and immediate absorption, compared with CC bedding. CP-bedded cages had a reduced frequency of early cage changing prior to the Guide-recommended 2-wk interval for IVC; this reduction was proportional to room census. Intracage ammonia levels were lower in CP-bedded IVC compared with CC-bedded IVC, independent of the age, sex, and number of mice per cage. By contrast, ammonia levels were similar between CP-bedded and CC-bedded static cages. Collectively, these data support the use of CP bedding as a refinement for CC in ventilated mouse cages, in light of increased husbandry efficiency and its positive effect on the welfare of mice.

Charged particle radiation induced changes to optical properties of acousto-optic materials.

We report on the measurement of the transmittance and reflectance of unpolarized light (425-700 nm) in three birefringent, acousto-optic materials, including quartz, lithium niobate, and tellurium dioxide, after exposure to varying fluences of proton radiation ($ {10^{14}} {-} {10^{18}}\;{\rm protons}/{{\rm cm}^2} $1014-1018protons/cm2) delivered by a 10 keV hydrogen ion beamline. We observe a general monotonic decrease in transmittance with increasing fluence for all three materials, but with varying rates of change and critical points of change. Reflectance measurements also exhibit a general monotonic trend with fluence, but increases in quartz are observed versus decreases in both lithium niobate and tellurium dioxide. These observations are used to assess the suitability of the materials for acousto-optic applications in the space environment where charged particles from the solar wind are dominant and pose a threat to device operation. Our measurements agree with previously reported work concluding that tellurium dioxide is suitable for space applications at low fluences (below $ {{10}^{16}}\;{\rm ions}/{{\rm cm}^2} $1016ions/cm2), but our findings also raise previously unreported concerns for higher accumulated fluences observed for longer mission lifetimes of greater than five to 10 years in space in an unshielded configuration.

Accuracy of Acetabular Component Positioning Using Computer-assisted Navigation in Direct Anterior Total Hip Arthroplasty.

Background  Appropriate component positioning in total hip arthroplasty (THA) is imperative for long-term survivorship. C-arm fluoroscopy provides visual guidance in the direct anterior approach (DAA), but it is limited by qualitative properties. Conversely, imageless computer-assisted navigation systems (CAS) provide surgeons with intraoperative, three-dimensional (3D) quantitative measurements for cup position, although the accuracy of such systems has not been extensively addressed in the DAA. We evaluated the ability of an imageless CAS to deliver measurements for acetabular cup position with accuracy in the DAA. Materials and methods  A retrospective analysis of 69 primary THA procedures was conducted. Acetabular cup position measurements (anteversion and inclination) obtained intraoperatively by imageless navigation were compared to standard, postoperative anteroposterior pelvic radiographic measurements. Statistical comparisons were made using the Bland-Altman technique. Results  The mean difference between device and radiographic measurements for anteversion was 3.4° (standard deviation (SD): 4.1°; absolute mean difference (ABS): 4.2°), and 4.0° for inclination (SD: 3.6°; ABS: 4.3°). Bland-Altman analysis demonstrated excellent agreement; 93% (64/69) and 97% (67/69) of anteversion pairings fell within the statistical and clinical limits of agreement, whereas 94% (65/69) and 100% (69/69) of inclination pairings were within the statistical and clinical limits, respectively. Conclusions  Measurements obtained intraoperatively for acetabular cup position using imageless navigation in the DAA are agreeable with the current clinical standard.

Intramuscular Administration of Alfaxalone Alone and in Combination for Sedation and Anesthesia of Rabbits (Oryctolagus cuniculus).

This study compared alfaxalone, alone and in combination with other medications, for sedative and anesthetic properties after intramuscular administration in New Zealand white rabbits. In the main portion of the study, 6 female rabbits were assigned to 5 treatment regimens in a blinded crossover design. Alfaxalone (6 mg/kg IM) was administered alone and in combination with each of the following: 0.3 mg/kg butorphanol; 1 mg/kg midazolam; 0.2 mg/kg dexmedetomidine; and both 0.3 mg/kg butorphanol and 0.2 mg/kg dexmedetomidine. An additional 6 rabbits received 0.2 mg/kg dexmedetomidine for comparison. The median time to onset of recumbency ranged from 2.0 to 5.5 min, with times significantly shorter for animals that received alfaxalone with either midazolam or dexmedetomidine than for those given dexmedetomidine only. Duration of sedation (mean ± 1 SD) was: alfaxalone only, 40 ± 7.3 min; alfaxalone with butorphanol, 47.8 ± 9.9 min; alfaxalone with midazolam, 65.2 ± 6.5 min; alfaxalone with dexmedetomidine, 157.5 ± 22.4 min; alfaxalone with butorphanol and dexmedetomidine, 157.7 ± 22.3 min, and dexmedetomidine only, 93.7 ± 11.9 min. Response to noxious stimuli was absent in 2 of the rabbits given dexmedetomidine only, 4 of those given alfaxalone with dexmedetomidine, and all 6 of the animals dosed with alfaxalone, butorphanol, and dexmedetomidine; this last group displayed the longest absence of a toe-pinch response (57 ± 3 min).

Effects of subcutaneous alfaxalone alone and in combination with dexmedetomidine and buprenorphine in guinea pigs (Cavia porcellus).

OBJECTIVE: To characterize alfaxalone administered subcutaneously (SC) in guinea pigs, both alone and in combination with dexmedetomidine and buprenorphine. STUDY DESIGN: Prospective, blinded, crossover study. ANIMALS: A total of 15 healthy female guinea pigs weighing 400-600 g. METHODS: Alfaxalone (10, 20 and 40 mg kg-1) was administered SC to three guinea pigs as a pilot dose-finding study. Alfaxalone (20 mg kg-1; A20) was selected for comparison against combination protocols of alfaxalone (15 and 20 mg kg-1) with dexmedetomidine (0.25 mg kg-1) and buprenorphine (0.05 mg kg-1; A15DB, A20DB). Each protocol was randomly administered to 12 guinea pigs separated by ≥7 days. Time and quality of induction and recovery, heart rate, respiratory rate, peripheral hemoglobin oxygen saturation, rectal temperature, pedal withdrawal reflex and adverse effects were recorded. RESULTS: The median time to induction for A20, A15DB and A20DB was 6.8-8.0 minutes with no significant difference between treatments. Mean duration of recumbency for A20 was 73.6 ± 19.6 minutes. Recumbency duration for A15DB and A20DB extended to 90 minutes, at which time dexmedetomidine was antagonized using atipamezole (0.025 mg kg-1 SC). Physiological variables were within normal limits with the exception of one animal that died 45 minutes following treatment with A20DB. Pedal withdrawal reflex remained intact with all treatments. Minor side effects such as twitching or bruxism occurred sporadically with treatment A20 but not with A15DB and A20DB. CONCLUSIONS AND CLINICAL RELEVANCE: SC alfaxalone produced uncomplicated sedation that may be recommended for nonpainful procedures that do not require complete immobility. The addition of dexmedetomidine and buprenorphine increased the duration of sedation and immobility, but did not result in general anesthesia. This combination sedation protocol may be useful for nonpainful procedures requiring extended immobility.

Protein-Energy Malnutrition Exacerbates Stroke-Induced Forelimb Abnormalities and Dampens Neuroinflammation.

Protein-energy malnutrition (PEM) pre-existing at stroke onset is believed to worsen functional outcome, yet the underlying mechanisms are not fully understood. Since brain inflammation is an important modulator of neurological recovery after stroke, we explored the impact of PEM on neuroinflammation in the acute period in relation to stroke-initiated sensori-motor abnormalities. Adult rats were fed a low-protein (LP) or normal protein (NP) diet for 28 days before inducing photothrombotic stroke (St) in the forelimb region of the motor cortex or sham surgery; the diets continued for 3 days after the stroke. Protein-energy status was assessed by a combination of body weight, food intake, serum acute phase proteins and corticosterone, and liver lipid content. Deficits in motor function were evaluated in the horizontal ladder walking and cylinder tasks at 3 days after stroke. The glial response and brain elemental signature were investigated by immunohistochemistry and micro-X-ray fluorescence imaging, respectively. The LP-fed rats reduced food intake, resulting in PEM. Pre-existing PEM augmented stroke-induced abnormalities in forelimb placement accuracy on the ladder; LP-St rats made more errors (29 ± 8%) than the NP-St rats (15 ± 3%; P < 0.05). This was accompanied by attenuated astrogliosis in the peri-infarct area by 18% and reduced microglia activation by up to 41 and 21% in the peri-infarct area and the infarct rim, respectively (P < 0.05). The LP diet altered the cortical Zn, Ca, and Cl signatures (P < 0.05). Our data suggest that proactive treatment of pre-existing PEM could be essential for optimal post-stroke recovery.

Animal Models of Zika Virus.

Zika virus has garnered great attention over the last several years, as outbreaks of the disease have emerged throughout the Western Hemisphere. Until quite recently Zika virus was considered a fairly benign virus, with limited clinical severity in both people and animals. The size and scope of the outbreak in the Western Hemisphere has allowed for the identification of severe clinical disease that is associated with Zika virus infection, most notably microcephaly among newborns, and an association with Guillian-Barré syndrome in adults. This recent association with severe clinical disease, of which further analysis strongly suggested causation by Zika virus, has resulted in a massive increase in the amount of both basic and applied research of this virus. Both small and large animal models are being used to uncover the pathogenesis of this emerging disease and to develop vaccine and therapeutic strategies. Here we review the animal-model-based Zika virus research that has been performed to date.

Laser system refinements to reduce variability in infarct size in the rat photothrombotic stroke model.

BACKGROUND: The rat photothrombotic stroke model can induce brain infarcts with reasonable biological variability. Nevertheless, we observed unexplained high inter-individual variability despite using a rigorous protocol. Of the three major determinants of infarct volume, photosensitive dye concentration and illumination period were strictly controlled, whereas undetected fluctuation in laser power output was suspected to account for the variability. NEW METHOD: The frequently utilized Diode Pumped Solid State (DPSS) lasers emitting 532 nm (green) light can exhibit fluctuations in output power due to temperature and input power alterations. The polarization properties of the Nd:YAG and Nd:YVO4 crystals commonly used in these lasers are another potential source of fluctuation, since one means of controlling output power uses a polarizer with a variable transmission axis. Thus, the properties of DPSS lasers and the relationship between power output and infarct size were explored. RESULTS: DPSS laser beam intensity showed considerable variation. Either a polarizer or a variable neutral density filter allowed adjustment of a polarized laser beam to the desired intensity. When the beam was unpolarized, the experimenter was restricted to using a variable neutral density filter. COMPARISON WITH EXISTING METHOD(S): Our refined approach includes continuous monitoring of DPSS laser intensity via beam sampling using a pellicle beamsplitter and photodiode sensor. This guarantees the desired beam intensity at the targeted brain area during stroke induction, with the intensity controlled either through a polarizer or variable neutral density filter. CONCLUSIONS: Continuous monitoring and control of laser beam intensity is critical for ensuring consistent infarct size.

Nanoscale imaging of freestanding nitrogen doped single layer graphene.

Graphene can be p-type or n-type doped by introduction of specific species. Doping can modulate the electronic properties of graphene, but opening a sizable-well-tuned bandgap is essential for graphene-based tunable electronic devices. N-doped graphene is widely used for device applications and is mostly achieved by introducing ammonia into the synthesis gas during the chemical vapor deposition (CVD) process. Post synthesis treatment studies to fine-tune the electron hole doping in graphene are limited. In this work realization of N-doping in large area freestanding single layer graphene (LFG) is achieved by post treatment in nitrogen plasma. The changes in the chemical and electronic properties of graphene are followed with Raman microscopy and mapped via synchrotron based scanning transmission X-ray microscopy (STXM) at the nanoscale.

Short- and long-term memory are modulated by multiple isoforms of the fragile X mental retardation protein.

The diversity of protein isoforms arising from alternative splicing is thought to modulate fine-tuning of synaptic plasticity. Fragile X mental retardation protein (FMRP), a neuronal RNA binding protein, exists in isoforms as a result of alternative splicing, but the contribution of these isoforms to neural plasticity are not well understood. We show that two isoforms of Drosophila melanogaster FMRP (dFMR1) have differential roles in mediating neural development and behavior functions conferred by the dfmr1 gene. These isoforms differ in the presence of a protein interaction module that is related to prion domains and is functionally conserved between FMRPs. Expression of both isoforms is necessary for optimal performance in tests of short- and long-term memory of courtship training. The presence or absence of the protein interaction domain may govern the types of ribonucleoprotein (RNP) complexes dFMR1 assembles into, with different RNPs regulating gene expression in a manner necessary for establishing distinct phases of memory formation.

Tibiofemoral compression force differences using laxity- and force-based initial graft tensioning techniques in the anterior cruciate ligament-reconstructed cadaveric knee.

PURPOSE: Our purpose was to document the tibiofemoral (TF) compression forces produced during clinical initial graft tension protocols. METHODS: An image analysis system was used to track the position of the tibia relative to the femur in 11 cadaveric knees. TF compression forces were quantified by use of thin-film pressure sensors. Before anterior cruciate ligament (ACL) reconstructions were performed with patellar tendon grafts, measurements of TF compression force were obtained from the ACL-intact knee with knee flexion. ACL reconstructions were then performed by use of "force-based" and "laxity-based" graft tension approaches. Within each approach, high- and low-tension conditions were compared with the ACL-intact condition over the range of knee flexion angles. RESULTS: The TF compression forces for all initial graft tension conditions were significantly greater than those of the normal knee when the knee was in full extension (0 degrees ). The TF compression forces produced with the laxity-based approach were greater than those produced with the force-based approach. However, the laxity-based approach was necessary to restore normal laxity at the time of surgery. CONCLUSIONS: The results of this study show that initial graft tension conditions influence TF compressive forces at the time of surgery and that clinically relevant initial graft tension conditions produce different TF compressive forces. CLINICAL RELEVANCE: This study showed that the TF compression forces were greater in the ACL-reconstructed knee for all of the initial graft tension conditions when compared with the ACL-intact knee and that clinically relevant initial graft tension conditions produce different TF compressive forces.

A comparison of prospective and retrospective assessment of functional outcome after rotator cuff repair.

Prospective outcome studies are generally considered to be better than retrospective studies. The purpose of this study was to assess correlations between prospective and retrospective outcome assessment after rotator cuff repair. One-hundred and twelve patients (118 shoulders) with chronic rotator cuff tears were evaluated at a mean of 54 months (34-85) after rotator cuff repair, using several outcome measures including a retrospective assessment of improvement. The retrospective assessment of post-operative pain, function, and quality of life had fair correlations with the prospectively determined improvement (R = .23-.25, P < .01). Post-operative patient satisfaction was more highly correlated with all retrospective evaluations than with the prospective improvement in all functional outcome measures. Retrospective and prospective evaluations of the outcome of rotator cuff repair are different. Patient satisfaction has a greater correlation with retrospective outcomes. Retrospective evaluation may aid in supplementing prospective evaluations, as it may better reflect a patient's perception of the success after surgery.

Resorbable fillers reduce stress risers from empty screw holes.

BACKGROUND: Empty screw holes after hardware removal are stress risers that weaken bone and can lead to refracture in an active individual. We sought to reduce these stress risers. We hypothesize that resorbable screws used as hole fillers would (1) provide immediate strength and (2) maintain this strength during resorption. METHODS: Randomized, prospective controlled animal laboratory study with 75 live New Zealand white rabbits' paired femurs. Single mid-diaphyseal holes were filled with a metal or resorbable screw; contralateral femurs were paired empty hole controls. Main outcome measurements included histologic analysis, torsion to failure, peak torque, energy to failure, and stiffness at baseline, 1 week, and 13 weeks postimplantation. RESULTS: At time baseline, resorbable fillers produced an immediate 30% increase in the peak torque (p = 0.01) and 73% increase in peak energy (p = 0.006). Metal screws produced a 17% increase in peak torque (p = 0.038), and a 58% increase in the amount of energy to failure (p = 0.009). At 1 week, although the resorbable (p = 0.01) but not the metal (p = 0.82) screws increased the peak torque, both metal (p = 0.003) and resorbable (p = 0.050) screws increased the peak energy compared with contralateral empty controls. At 13 weeks, metal and resorbable screw-filled bones were as strong as the healed contralateral femurs. Partial screw resorption and new bone formation without lysis was demonstrated histologically. Resorbable screw hole fillers immediately increase the strength of bones without weakening during early resorption. CONCLUSIONS: Placing resorbable fillers in bone defects after hardware removal could reduce the likelihood of refracture.

Factors influencing patient satisfaction after rotator cuff repair.

A number of variables are used to assess the outcome of rotator cuff repair (RCR), including patient satisfaction. The purpose of this study was to determine the factors that affect patient satisfaction after RCR. The study assessed 112 patients (118 shoulders) with chronic rotator cuff tears preoperatively and at a mean of 54 months (range, 34-85 months) after RCR by using several functional outcome questionnaires and an evaluation of patient satisfaction. Of these, 95% were satisfied with the outcome of the surgery. Satisfaction was significantly correlated with the improvement in functional outcomes and general health status and absolute postoperative functional outcomes. Married, currently working, and nondisabled patients had greater satisfaction. High preoperative and postoperative met expectations were also positively correlated with patient satisfaction. Patient satisfaction is most highly correlated with the pain, function, and general health status of the patient after RCR. We conclude that aspects of treatment that maximize the functional outcome are important in achieving patient satisfaction after RCR.

Porcine small intestine submucosa for repair of goat meniscal defects.

This study evaluated the effectiveness of small intestine submucosa used as a graft to fill surgically created meniscal defects in a large animal model. Four goats underwent unilateral interior subtotal meniscectomies (approximately 70%) within the avascular portion of the medial meniscus. The contralateral meniscus acted as a control. Grafts of porcine small intestine submucosa were trimmed to fill the resected defects and sutured into place. After surgery the operated knees were casted in partial flexion to limit weight bearing on the affected limb. All of the animals were sacrificed at 12 weeks at which point meniscal regeneration and articular cartilage degradation were evaluated by gross and histologic examination. Grossly, the defects in the small intestine submucosa-grafted goats were partially filled with meniscal-appearing connective tissue. Histologically, the replacement tissue was typified by the presence of dense, cellular, irregularly organized connective tissue. Evaluation of the articular cartilage displayed increased degeneration in the grafted compartment of the operative knees. Each of the operative menisci partially regenerated. The grafts were conducive to repopulation with host meniscal elements. Despite partial meniscal regeneration, comparatively more articular cartilage degeneration in the treated knees was observed than in the untreated contralateral controls.