We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular ... more We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular impingement that provides excellent access to the central and peripheral compartments while preserving the biomechanically crucial components of hip joint stability. The hip capsule and the ligaments within it have been shown to be integral to hip biomechanical stability. Other popular techniques such as interportal and T-capsulotomy inherently damage the capsuloligamentous complex of the hip and can be associated with postoperative gross instability, micro-instability, heterotopic ossification, and seroma. Capsular closure may mitigate some of these effects but has been associated with capsular insufficiency and requires postoperative restrictions that can be prolonged. Our surgical technique focuses on careful portal placement, replacement when necessary, use of a switching stick to maximize peripheral compartment visualization, and joint access in the most minimally invasive manner while avoiding complications associated with extended capsulotomy. The objective of this Technical Note is to describe a technique by which full access to the joint can be obtained while not disrupting the biomechanics of the joint capsule.
Objective: Lubricin is the principal boundary lubricant on articular cartilage. We aimed to descr... more Objective: Lubricin is the principal boundary lubricant on articular cartilage. We aimed to describe the distribution of lubricin in the other articulating structures in the human knee and hip-menisci and labra-and to relate this distribution to the degree of tissue degeneration. Methods: Eighteen menisci and 6 labra were obtained from patients with osteoarthritis undergoing total knee and total hip replacements, respectively. Macroscopically intact specimens were fixed in formalin and processed for H&E staining and immunohistochemical evaluation with an antilubricin monoclonal antibody. Results: Lubricin was found in all tissues as a discrete layer on the tissue surface, within the extracellular matrix, and intracellularly, indicating that it plays a role in the tribology of these tissues in human subjects, and can be synthesized by cells within the tissues. While none of the samples displayed macroscopic tears, approximately 40% of the surface of the menisci and 80% of the surface of the labra displayed microscopic fibrillations and slight fraying. There was no effect of the degenerative changes on the distribution of lubricin. Conclusions: Lubricin coats nearly the entirety of the surfaces of menisci and labra, including microfibrillations and tears, with possible implications towards the tribology of the tissues and healing of tissue damage.
Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patie... more Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications. RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic-diastolic hypertension aged 18-75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence wa...
Treatment of a maxillary central incisor with an associated cystic lesion by conventional endodon... more Treatment of a maxillary central incisor with an associated cystic lesion by conventional endodontic therapy combined with decompression is reported. Although small cystic lesions frequently heal simply with endodontic therapy, larger lesions may need additional treatment. If surgical enucleation is elected, other teeth or structures may be damaged unnecessarily. Therefore, a case can be made for first attempting the more conservative treatment of decompression, and a workable protocol for this is presented. In this case, 6 weeks with latex tubing in place and daily irrigation with 0.12% chlorhexidine led to complete healing with no need for further surgery or other root canal therapy on teeth initially surrounded by this lesion. At the 2-year recall, the lesion has completely resolved, and the adjacent teeth remain vital and normal.
Optical coherence tomography (OCT), a new method of high resolution imaging, has shown feasibilit... more Optical coherence tomography (OCT), a new method of high resolution imaging, has shown feasibility for assessing articular cartilage to identify early changes in osteoarthritis (OA) and monitor therapy. OCT is analogous to ultrasound, measuring the intensity of backreflected infrared light rather than sound. The resolution of this technology is up to 25 times higher than existing methods. We investigated the correlation between changes observed by OCT and the degree of collagen organization in OA cartilage. Polarization sensitive OCT (PSOCT) imaging was used to assess changes in cartilage collagen organization in vitro. The presence (or absence) of PSOCT changes correlated with collagen organization (or disorganization) on histology as assessed by picrosirius polarization microscopy (no significant difference). In multiple cases, cartilage was abnormal by both PSOCT and polarization microscopy, but was grossly normal by routine staining, showing cartilage thickness > 2 mm and no ...
We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular ... more We describe an arthroscopic technique for the treatment of labral pathology and femoroacetabular impingement that provides excellent access to the central and peripheral compartments while preserving the biomechanically crucial components of hip joint stability. The hip capsule and the ligaments within it have been shown to be integral to hip biomechanical stability. Other popular techniques such as interportal and T-capsulotomy inherently damage the capsuloligamentous complex of the hip and can be associated with postoperative gross instability, micro-instability, heterotopic ossification, and seroma. Capsular closure may mitigate some of these effects but has been associated with capsular insufficiency and requires postoperative restrictions that can be prolonged. Our surgical technique focuses on careful portal placement, replacement when necessary, use of a switching stick to maximize peripheral compartment visualization, and joint access in the most minimally invasive manner while avoiding complications associated with extended capsulotomy. The objective of this Technical Note is to describe a technique by which full access to the joint can be obtained while not disrupting the biomechanics of the joint capsule.
Objective: Lubricin is the principal boundary lubricant on articular cartilage. We aimed to descr... more Objective: Lubricin is the principal boundary lubricant on articular cartilage. We aimed to describe the distribution of lubricin in the other articulating structures in the human knee and hip-menisci and labra-and to relate this distribution to the degree of tissue degeneration. Methods: Eighteen menisci and 6 labra were obtained from patients with osteoarthritis undergoing total knee and total hip replacements, respectively. Macroscopically intact specimens were fixed in formalin and processed for H&E staining and immunohistochemical evaluation with an antilubricin monoclonal antibody. Results: Lubricin was found in all tissues as a discrete layer on the tissue surface, within the extracellular matrix, and intracellularly, indicating that it plays a role in the tribology of these tissues in human subjects, and can be synthesized by cells within the tissues. While none of the samples displayed macroscopic tears, approximately 40% of the surface of the menisci and 80% of the surface of the labra displayed microscopic fibrillations and slight fraying. There was no effect of the degenerative changes on the distribution of lubricin. Conclusions: Lubricin coats nearly the entirety of the surfaces of menisci and labra, including microfibrillations and tears, with possible implications towards the tribology of the tissues and healing of tissue damage.
Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patie... more Early studies suggest that radiofrequency-based renal denervation reduces blood pressure in patients with moderate hypertension. We investigated whether an alternative technology using endovascular ultrasound renal denervation reduces ambulatory blood pressure in patients with hypertension in the absence of antihypertensive medications. RADIANCE-HTN SOLO was a multicentre, international, single-blind, randomised, sham-controlled trial done at 21 centres in the USA and 18 in Europe. Patients with combined systolic-diastolic hypertension aged 18-75 years were eligible if they had ambulatory blood pressure greater than or equal to 135/85 mm Hg and less than 170/105 mm Hg after a 4-week discontinuation of up to two antihypertensive medications and had suitable renal artery anatomy. Patients were randomised (1:1) to undergo renal denervation with the Paradise system (ReCor Medical, Palo Alto, CA, USA) or a sham procedure consisting of renal angiography only. The randomisation sequence wa...
Treatment of a maxillary central incisor with an associated cystic lesion by conventional endodon... more Treatment of a maxillary central incisor with an associated cystic lesion by conventional endodontic therapy combined with decompression is reported. Although small cystic lesions frequently heal simply with endodontic therapy, larger lesions may need additional treatment. If surgical enucleation is elected, other teeth or structures may be damaged unnecessarily. Therefore, a case can be made for first attempting the more conservative treatment of decompression, and a workable protocol for this is presented. In this case, 6 weeks with latex tubing in place and daily irrigation with 0.12% chlorhexidine led to complete healing with no need for further surgery or other root canal therapy on teeth initially surrounded by this lesion. At the 2-year recall, the lesion has completely resolved, and the adjacent teeth remain vital and normal.
Optical coherence tomography (OCT), a new method of high resolution imaging, has shown feasibilit... more Optical coherence tomography (OCT), a new method of high resolution imaging, has shown feasibility for assessing articular cartilage to identify early changes in osteoarthritis (OA) and monitor therapy. OCT is analogous to ultrasound, measuring the intensity of backreflected infrared light rather than sound. The resolution of this technology is up to 25 times higher than existing methods. We investigated the correlation between changes observed by OCT and the degree of collagen organization in OA cartilage. Polarization sensitive OCT (PSOCT) imaging was used to assess changes in cartilage collagen organization in vitro. The presence (or absence) of PSOCT changes correlated with collagen organization (or disorganization) on histology as assessed by picrosirius polarization microscopy (no significant difference). In multiple cases, cartilage was abnormal by both PSOCT and polarization microscopy, but was grossly normal by routine staining, showing cartilage thickness > 2 mm and no ...
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