Potential market for new meniscus repair strategies: evaluation of the MOON cohort.
ABSTRACT This study aimed to determine the incidence of meniscal tears and describe the tear morphology and selected treatment in patients undergoing anterior cruciate ligament (ACL) reconstruction. We also will discuss the potential market for future tissue engineering aimed at preserving meniscal function. A multicenter cohort of 1014 patients undergoing ACL reconstruction between January 2002 and December 2003 was evaluated. Data on patient demographics, presence of a meniscus tear at time of ACL reconstruction, tear morphology, and meniscal treatment were collected prospectively. Meniscal tears were categorized into 3 potential tissue engineering treatment strategies: all-biologic repair, advanced repair, and scaffold replacement. Of the knees, 36% had medial meniscal tears and 44% had lateral meniscal tears. Longitudinal tears were the most common tear morphology. The most frequent treatment method was partial meniscectomy. Thirty percent of medial meniscal tears and 10% of lateral meniscal tears are eligible for all-biologic repair; 35% of medial meniscal tears and 35% of lateral meniscal tears are eligible for an advanced repair technique; and 35% of medial meniscal tears and 55% of lateral meniscal tears are eligible for scaffold replacement. Although meniscal preservation is generally accepted in the treatment of meniscal tears, most tears in this cohort were not repairable, despite contemporary methods. The results of this cohort will hopefully stimulate and focus future research and development of new tissue engineering strategies for meniscus repair.
Conference Paper: Control software in the ARCS vehicle[Show abstract] [Hide abstract]
ABSTRACT: The central control computer of the ARCS (Autonomous Remotely Controlled Submersible) consists of three microprocessors residing on a common bus and communicating with each other via shared memory. This paper will review the general design approach used to meet the operational requirements of the vehicle, and discuss the types of problems encountered during implementation and preliminary testing.Unmanned Untethered Submersible Technology, Proceedings of the 1985 4th International Symposium on; 07/1985
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ABSTRACT: This article proposes a "bedside-to-bench" approach as a model to improve clinical outcomes for patients through functional tissue engineering (TE). The link between the highest level of clinical research and evaluation criteria for musculoskeletal TE is in identifying clinically proven predictors that are amenable to functional TE. The TE solutions developed in the laboratory should then be tested in translational models to evaluate efficacy and safety prior to controlled clinical trials. The best available evidence for potentially decreasing the incidence of radiographically confirmed osteoarthritis after anterior cruciate ligament injury is preservation of meniscus function. Meniscus tears occur concurrently in approximately 50% of anterior cruciate ligament tears. TE could promote repair of torn meniscus and/or replacement of meniscus loss because meniscus tear is a proven predictor of clinically relevant outcomes (such as osteoarthritis) in patients and is amenable to a potential TE solution.Tissue Engineering Part B Reviews 02/2010; 16(1):117-21. DOI:10.1089/ten.teb.2009.0302 · 4.64 Impact Factor
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ABSTRACT: The purpose of this study was to correlate clinical pivot shift grading with femoral condyle size as measured on pre-operative magnet resonance imaging (MRI) of patients with anterior cruciate ligament (ACL) injury. Forty-nine consecutive patients for anterior cruciate ligament (ACL) surgery were examined under anesthesia. The pivot shift was graded according to Galway et al. and MacIntosh et al. by a single observer. The grade of pivot shift, Lachman, and collateral laxity was recorded. Intraoperative findings of injury patterns to the ACL and other soft tissue structures were recorded. The anterior-posterior (AP) and medial-lateral (ML) diameter of femoral condyles and tibial plateaus were measured on pre-operative MRI. Patients were grouped into a grade 1 pivot shift group and a grade 2 pivot shift group. ANOVA and independent t tests were used to compare bony dimensions between grade 1 and 2 pivot shifts and by sex. Significance was set at P < 0.05. Twenty-seven patients had a grade 1 pivot shift and 22 a grade 2 pivot shift. Associated pathology was present in 11/27 patients (41%) with a grade 1 pivot shift and 21/22 patients (95%) with a grade 2 pivot shift. The ML diameter of the lateral tibial plateau was significantly smaller in patients with a grade 2 pivot shift (35.5 +/- 3.7 mm) compared to patients with a grade 1 pivot shift (30.3 +/- 3.2 mm; P < 0.05). No difference was detected for any of the other measurements taken (NS). When analyzed by sex this difference existed in women (group I: 31.1 +/- 3.2, group II: 28.8 +/- 2.0; P < 0.05) but not in men (group I: 34.1 +/- 3.7, group II: 33.1 +/- 3.1; NS). All morphologic measurements were larger in men (P < 0.05). A smaller (ML) lateral tibial plateau diameter may contribute to a patient's higher-grade pivot shift. When analyzed by sex this was true for women but not for men. There are other factors contributing to the magnitude of the pivot shift, such as concomitant generalized laxity, injury to the knee joint capsule, and size/or injury of other soft tissue structures that were not analyzed in this study.Knee Surgery Sports Traumatology Arthroscopy 04/2010; 18(9):1232-8. DOI:10.1007/s00167-010-1129-x · 2.84 Impact Factor