Rotator Cuff Repair with a Tendon-Fibrocartilage-Bone Composite Bridging Patch

PubMed Central

Ji, Xiaoxi; Chen, Qingshan; Thoreson, Andrew R.; Qu, Jin; An, Kai-Nan; Amadio, Peter C.; Steinmann, Scott P.; Zhao, Chunfeng

2015-01-01

Background To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model. Methods Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/sec. Findings The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; P<.001). Stiffness at the greater tuberosity repair site and the patch-infraspinatus tendon repair site was significantly higher than the control repair site (93.96 [27.72] vs 42.62 [17.48] N/mm P<.001; 65.94 [24.51] vs 42.62 [17.48] N/mm P=.02, respectively). Interpretation The tendon-fibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch–greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate. PMID:26190097

Rotator cuff repair with a tendon-fibrocartilage-bone composite bridging patch.

PubMed

Ji, Xiaoxi; Chen, Qingshan; Thoreson, Andrew R; Qu, Jin; An, Kai-Nan; Amadio, Peter C; Steinmann, Scott P; Zhao, Chunfeng

2015-11-01

To compare the mechanical performance of a rotator cuff repaired with a novel tendon-fibrocartilage-bone composite bridging patch vs the traditional Mason-Allen repair in an in vitro canine model. Twenty shoulders and 10 bridging patches from patellar tendon were harvested. The patches were trimmed and sliced into 2 layers. An infraspinatus tendon tear was created in each shoulder. Modified Mason-Allen sutures were used to repair the infraspinatus tendon to the greater tuberosity, with or without the bridging patch (bridging patch group and controls, respectively). Shoulders were loaded to failure under displacement control at a rate of 0.5mm/s. The ultimate tensile load was significantly higher in the bridging patch group than control (mean [SD], 365.46 [36.45] vs 272.79 [48.88] N; P<.001). Stiffness at the greater tuberosity repair site and the patch-infraspinatus tendon repair site was significantly higher than the control repair site (93.96 [27.72] vs 42.62 [17.48] N/mm P<.001; 65.94 [24.51] vs 42.62 [17.48] N/mm P=.02, respectively). The tendon-fibrocartilage-bone composite bridging patch achieved higher ultimate tensile load and stiffness at the patch-greater tuberosity repair site compared with traditional repair in a canine model. This composite tissue transforms the traditional tendon-to-bone healing interface (with dissimilar tissues) into a pair of bone-to-bone and tendon-to-tendon interfaces, which may improve healing quality and reduce retear rate. Copyright © 2015 Elsevier Ltd. All rights reserved.

75 FR 61354 - Safety Zone; Interstate 5 Bridge Repairs, Columbia River, Portland, OR

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

...-AA00 Safety Zone; Interstate 5 Bridge Repairs, Columbia River, Portland, OR AGENCY: Coast Guard, DHS... waters of the Columbia River due to repairs being made to the Interstate 5 Bridge. The safety zone is... would be contrary to public interest since the repairs to the Interstate 5 Bridge would be completed by...

78 FR 61937 - Safety Zone; Port of Galveston, Pelican Island Bridge Repair

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-07

... Zone; Port of Galveston, Pelican Island Bridge Repair AGENCY: Coast Guard, DHS. ACTION: Temporary final... safety during the Pelican Island Bridge Repair Project. This action is necessary to protect public... barge will be placed under the Pelican Island Bridge; therefore immediate action is needed to protect...

Tendoscopic Double-Row Suture Bridge Peroneal Retinaculum Repair for Recurrent Dislocation of Peroneal Tendons in the Ankle.

PubMed

Nishimura, Akinobu; Nakazora, Shigeto; Ito, Naoya; Fukuda, Aki; Kato, Ko; Sudo, Akihiro

2016-06-01

Traumatic dislocation of peroneal tendons in the ankle is an uncommon lesion that mainly affects young adults. Unfortunately, most cases lead to recurrent dislocation of the peroneal tendons of the ankle (RPTD). Therefore, most cases need operative treatment. One of the most common operative procedures is superior peroneal retinaculum (SPR) repair. Recently, surgery for RPTD has been achieved with less invasive arthroscopic procedures. In this article, tendoscopic surgery for RPTD using a double-row suture bridge technique is introduced. This technique consists of debridement of the lateral aspect of the fibula under an intrasheath pseudo-cavity, suture anchor insertion into the fibular ridge, and reattachment of the SPR to the fibula using a knotless anchor screwed into the lateral aspect of the fibula. This technique mimics the double-row suture bridge technique for rotator cuff tear repair. The double-row suture bridge technique requires more surgical steps than the single-row technique, but it provides a wider bone-SPR contact surface and tighter fixation than the single-row technique. This procedure is an attractive option because it is less invasive and has achieved results similar to open procedures.

Predicting fatigue service life extension of RC bridges with externally bonded CFRP repairs : [project brief].

DOT National Transportation Integrated Search

2015-12-01

Externally bonded carbon fiber reinforced polymer composites (CFRPs) are increasingly used to : repair concrete bridges. CFRP design techniques are a proven approach for enhancing the strength : of existing structures. This project investigated the d...

Repair of deteriorated bridge substructures : [summary].

DOT National Transportation Integrated Search

2013-05-01

Degradation of bridge substructure members in Wisconsin is a serious concern. Concrete, steel and timber members all require distinct repair methods which not only address the true cause of the deterioration, but also protect the members from future ...

Developing county bridge repair and retrofit techniques.

DOT National Transportation Integrated Search

2013-08-01

Oklahoma rated first in the Nation in the percentage of bridges that are structurally deficient or : functionally obsolete. According to Federal Highway Administration data, Oklahoma uses : approximately 23,250 bridges maintained by state, County, Ci...

Knotted versus knotless suture bridge repair of the achilles tendon insertion: a biomechanical study.

PubMed

Cox, Joseph T; Shorten, Peter L; Gould, Gregory C; Markert, Ronald J; Barnett, Michael D; Laughlin, Richard T

2014-11-01

Surgical treatment of insertional Achilles tendinopathy often involves detachment and debridement of the Achilles tendon insertion. A recent study has shown that knotted suture bridge fixation of the Achilles to the calcaneus is biomechanically superior to single-row fixation, but there is an absence of literature on the use of different suture bridge constructs to repair the Achilles tendon. There will be no significant difference in the load to failure, mode of failure, tendon strain, tendon stiffness, repair site gapping, or footprint size when comparing knotted suture bridge repair to knotless suture bridge repair of the Achilles tendon after detachment for insertional Achilles tendinopathy. Controlled laboratory study. A single specimen from each pair of 10 cadaveric Achilles tendons was randomized to 1 of 2 Achilles insertion repair groups: knotted (n = 10) or knotless (n = 10) suture bridge repair. Repaired footprint size was measured, and then cyclic testing from 10 to 100 N for 2000 cycles was performed. This was followed by measurement of tendon strain, repair site displacement, load to failure, and tendon stiffness. The knotted suture bridge repair had a significantly higher load to failure compared with the knotless suture bridge (mean ± SD, 317.8 ± 93.6 N vs 196.1 ± 12.1 N, respectively; P = .001). All constructs failed at the tendon-suture interface. Tendon strain after cyclic testing was significantly greater in the knotless (1.20 ± 1.05) compared with the knotted (0.39 ± 0.4) suture repair groups (P = .011). There was no significant difference in footprint size between the knotted (230.3 ± 63.3 mm(2)) and knotless (248.5 ± 48.8 mm(2)) groups (P = .40). There was also no significant difference in stiffness (knotted = 76.4 ± 8.0 N/mm; knotless = 69.6 ± 10.9 N/mm; P = .17) and repair site displacement after cyclic testing (knotted = 2.8 ± 1.2 mm; knotless = 3.6 ± 1.1 mm; P = .17). During suture bridge repair of the Achilles tendon after

Repair methods for prestressed girder bridges.

DOT National Transportation Integrated Search

2009-04-30

It is common practice that aging and structurally damaged prestressed concrete bridge members are taken out of service and replaced. : This, however, is not an efficient use of materials and resources since the member can often be repaired in situ. T...

Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears.

PubMed

Mihata, Teruhisa; Watanabe, Chisato; Fukunishi, Kunimoto; Ohue, Mutsumi; Tsujimura, Tomoyuki; Fujiwara, Kenta; Kinoshita, Mitsuo

2011-10-01

Although previous biomechanical research has demonstrated the superiority of the suture-bridge rotator cuff repair over double-row repair from a mechanical point of view, no articles have described the structural and functional outcomes of this type of procedure. The structural and functional outcomes after arthroscopic rotator cuff repair may be different between the single-row, double-row, and combined double-row and suture-bridge (compression double-row) techniques. Cohort study; Level of evidence, 3. There were 206 shoulders in 201 patients with full-thickness rotator cuff tears that underwent arthroscopic rotator cuff repair. Eleven patients were lost to follow-up. Sixty-five shoulders were repaired using the single-row, 23 shoulders using the double-row, and 107 shoulders using the compression double-row techniques. Clinical outcomes were evaluated at an average of 38.5 months (range, 24-74 months) after rotator cuff repair. Postoperative cuff integrity was determined using Sugaya's classification of magnetic resonance imaging (MRI). The retear rates after arthroscopic rotator cuff repair were 10.8%, 26.1%, and 4.7%, respectively, for the single-row, double-row, and compression double-row techniques. In the subcategory of large and massive rotator cuff tears, the retear rate in the compression double-row group (3 of 40 shoulders, 7.5%) was significantly less than those in the single-row group (5 of 8 shoulders, 62.5%, P < .001) and the double-row group (5 of 12 shoulders, 41.7%, P < .01). Postoperative clinical outcomes in patients with a retear were significantly lower than those in patients without a retear for all 3 techniques. The additional suture bridges decreased the retear rate for large and massive tears. The combination of the double-row and suture-bridge techniques, which had the lowest rate of postoperative retear, is an effective option for arthroscopic repair of the rotator cuff tendons because the postoperative functional outcome in patients

Probabilistic Fatigue Life Updating for Railway Bridges Based on Local Inspection and Repair.

PubMed

Lee, Young-Joo; Kim, Robin E; Suh, Wonho; Park, Kiwon

2017-04-24

Railway bridges are exposed to repeated train loads, which may cause fatigue failure. As critical links in a transportation network, railway bridges are expected to survive for a target period of time, but sometimes they fail earlier than expected. To guarantee the target bridge life, bridge maintenance activities such as local inspection and repair should be undertaken properly. However, this is a challenging task because there are various sources of uncertainty associated with aging bridges, train loads, environmental conditions, and maintenance work. Therefore, to perform optimal risk-based maintenance of railway bridges, it is essential to estimate the probabilistic fatigue life of a railway bridge and update the life information based on the results of local inspections and repair. Recently, a system reliability approach was proposed to evaluate the fatigue failure risk of structural systems and update the prior risk information in various inspection scenarios. However, this approach can handle only a constant-amplitude load and has limitations in considering a cyclic load with varying amplitude levels, which is the major loading pattern generated by train traffic. In addition, it is not feasible to update the prior risk information after bridges are repaired. In this research, the system reliability approach is further developed so that it can handle a varying-amplitude load and update the system-level risk of fatigue failure for railway bridges after inspection and repair. The proposed method is applied to a numerical example of an in-service railway bridge, and the effects of inspection and repair on the probabilistic fatigue life are discussed.

Probabilistic Fatigue Life Updating for Railway Bridges Based on Local Inspection and Repair

PubMed Central

Lee, Young-Joo; Kim, Robin E.; Suh, Wonho; Park, Kiwon

2017-01-01

Railway bridges are exposed to repeated train loads, which may cause fatigue failure. As critical links in a transportation network, railway bridges are expected to survive for a target period of time, but sometimes they fail earlier than expected. To guarantee the target bridge life, bridge maintenance activities such as local inspection and repair should be undertaken properly. However, this is a challenging task because there are various sources of uncertainty associated with aging bridges, train loads, environmental conditions, and maintenance work. Therefore, to perform optimal risk-based maintenance of railway bridges, it is essential to estimate the probabilistic fatigue life of a railway bridge and update the life information based on the results of local inspections and repair. Recently, a system reliability approach was proposed to evaluate the fatigue failure risk of structural systems and update the prior risk information in various inspection scenarios. However, this approach can handle only a constant-amplitude load and has limitations in considering a cyclic load with varying amplitude levels, which is the major loading pattern generated by train traffic. In addition, it is not feasible to update the prior risk information after bridges are repaired. In this research, the system reliability approach is further developed so that it can handle a varying-amplitude load and update the system-level risk of fatigue failure for railway bridges after inspection and repair. The proposed method is applied to a numerical example of an in-service railway bridge, and the effects of inspection and repair on the probabilistic fatigue life are discussed. PMID:28441768

The optimum tension for bridging sutures in transosseous-equivalent rotator cuff repair: a cadaveric biomechanical study.

PubMed

Park, Ji Soon; McGarry, Michelle H; Campbell, Sean T; Seo, Hyuk Jun; Lee, Yeon Soo; Kim, Sae Hoon; Lee, Thay Q; Oh, Joo Han

2015-09-01

Transosseous-equivalent (TOE) rotator cuff repair can increase contact area and contact pressure between the repaired cuff tendon and bony footprint and can show higher ultimate loads to failure and smaller gap formation compared with other repair techniques. However, it has been suggested that medial rotator cuff failure after TOE repair may result from increased bridging suture tension. To determine optimum bridging suture tension in TOE repair by evaluating footprint contact and construct failure characteristics at different tensions. Controlled laboratory study. A total of 18 fresh-frozen cadaveric shoulders, randomly divided into 3 groups, were constructed with a TOE configuration using the same medial suture anchor and placing a Tekscan sensing pad between the repaired rotator cuff tendon and footprint. Nine of the 18 shoulders were used to measure footprint contact characteristics. With use of the Tekscan measurement system, the contact pressure and area between the rotator cuff tendon and greater tuberosity were quantified for bridging suture tensions of 60, 90, and 120 N with glenohumeral abduction angles of 0° and 30° and humeral rotation angles of 30° (internal), 0°, and 30° (external). TOE constructs of all 18 shoulders then underwent construct failure testing (cyclic loading and load to failure) to determine the yield load, ultimate load, stiffness, hysteresis, strain, and failure mode at 60 and 120 N of tension. As bridging suture tension increased, contact force, contact pressure, and peak pressure increased significantly at all positions (P < .05 for all). Regarding contact area, no significant differences were found between 90 and 120 N at all positions, although there were significant differences between 60 and 90 N. The construct failure test demonstrated no significant differences in any parameters according to various tensions (P > .05 for all). Increasing bridging suture tension to over 90 N did not improve contact area but did increase

Repair of earthquake damaged bridge columns with fractured bars.

DOT National Transportation Integrated Search

2013-07-01

The objective of this study is to repair three, half-scale RC bridge columns that will be tested to failure under slow cyclic loading. : These columns will have fractured longitudinal and transverse steel. The ultimate goal is to develop repair metho...

Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study.

PubMed

Gartsman, Gary M; Drake, Gregory; Edwards, T Bradley; Elkousy, Hussein A; Hammerman, Steven M; O'Connor, Daniel P; Press, Cyrus M

2013-11-01

The purpose of this study was to compare the structural outcomes of a single-row rotator cuff repair and double-row suture bridge fixation after arthroscopic repair of a full-thickness supraspinatus rotator cuff tear. We evaluated with diagnostic ultrasound a consecutive series of ninety shoulders in ninety patients with full-thickness supraspinatus tears at an average of 10 months (range, 6-12) after operation. A single surgeon at a single hospital performed the repairs. Inclusion criteria were full-thickness supraspinatus tears less than 25 mm in their anterior to posterior dimension. Exclusion criteria were prior operations on the shoulder, partial thickness tears, subscapularis tears, infraspinatus tears, combined supraspinatus and infraspinatus repairs and irreparable supraspinatus tears. Forty-three shoulders were repaired with single-row technique and 47 shoulders with double-row suture bridge technique. Postoperative rehabilitation was identical for both groups. Ultrasound criteria for healed repair included visualization of a tendon with normal thickness and length, and a negative compression test. Eighty-three patients were available for ultrasound examination (40 single-row and 43 suture-bridge). Thirty of 40 patients (75%) with single-row repair demonstrated a healed rotator cuff repair compared to 40/43 (93%) patients with suture-bridge repair (P = .024). Arthroscopic double-row suture bridge repair (transosseous equivalent) of an isolated supraspinatus rotator cuff tear resulted in a significantly higher tendon healing rate (as determined by ultrasound examination) when compared to arthroscopic single-row repair. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Is the arthroscopic suture bridge technique suitable for full-thickness rotator cuff tears of any size?

PubMed

Lee, Sung Hyun; Kim, Jeong Woo; Kim, Tae Kyun; Kweon, Seok Hyun; Kang, Hong Je; Kim, Se Jin; Park, Jin Sung

2017-07-01

The purpose of this study was to compare functional outcomes and tendon integrity between the suture bridge and modified tension band techniques for arthroscopic rotator cuff repair. A consecutive series of 128 patients who underwent the modified tension band (MTB group; 69 patients) and suture bridge (SB group; 59 patients) techniques were enrolled. The pain visual analogue scale (VAS), Constant, and American Shoulder and Elbow Surgeons (ASES) scores were determined preoperatively and at the final follow-up. Rotator cuff hypotrophy was quantified by calculating the occupation ratio (OR). Rotator cuff integrity and the global fatty degeneration index were determined by using magnetic resonance imaging at 6 months postoperatively. The average VAS, Constant, and ASES scores improved significantly at the final follow-up in both groups (p < 0.05 for all scores). The retear rate of small-to-medium tears was similar in the modified tension band and suture bridge groups (7.0 vs. 6.8%, respectively; p = n.s.). The retear rate of large-to-massive tears was significantly lower in the suture bridge group than in the modified tension band group (33.3 vs. 70%; p = 0.035). Fatty infiltration (postoperative global fatty degeneration index, p = 0.022) and muscle hypotrophy (postoperative OR, p = 0.038) outcomes were significantly better with the suture bridge technique. The retear rate was lower with the suture bridge technique in the case of large-to-massive rotator cuff tears. Additionally, significant improvements in hypotrophy and fatty infiltration of the rotator cuff were obtained with the suture bridge technique, possibly resulting in better anatomical outcomes. The suture bridge technique was a more effective method for the repair of rotator cuff tears of all sizes as compared to the modified tension band technique. Retrospective Cohort Design, Treatment Study, level III.

The bridge technique for pectus bar fixation: a method to make the bar un-rotatable.

PubMed

Park, Hyung Joo; Kim, Kyung Soo; Moon, Young Kyu; Lee, Sungsoo

2015-08-01

Pectus bar rotation is a major challenge in pectus repair. However, to date, no satisfactory technique to completely eliminate bar displacement has been introduced. Here, we propose a bar fixation technique using a bridge that makes the bar unmovable. The purpose of this study was to determine the efficacy of this bridge technique. A total of 80 patients underwent pectus bar repair of pectus excavatum with the bridge technique from July 2013 to July 2014. The technique involved connecting 2 parallel bars using plate-screws at the ends of the bars. To determine bar position change, the angles between the sternum and pectus bars were measured on postoperative day 5 (POD5) and 4 months (POM4) and compared. The mean patient age was 17.5 years (range, 6-38 years). The mean difference between POD5 and POM4 were 0.23° (P=.602) and 0.35° (P=.338) for the upper and lower bars, respectively. Bar position was virtually unchanged during the follow-up, and there was no bar dislocation or reoperation. A "bridge technique" designed to connect 2 parallel bars using plates and screws was demonstrated as a method to avoid pectus bar displacement. This approach was easy to implement without using sutures or invasive devices. Copyright © 2015 Elsevier Inc. All rights reserved.

Healing disturbance with suture bridge configuration repair in rabbit rotator cuff tear.

PubMed

Kim, Sae Hoon; Kim, Jangwoo; Choi, Young Eun; Lee, Hwa-Ryeong

2016-03-01

Medial row failure has been reported in the suture bridge technique of rotator cuff repair. This study compared the healing response of suture bridge configuration repair (SBCR) and parallel type transosseous repair (PTR). Acute rotator cuff repair was performed in 32 rabbits. Both shoulders were repaired using PTR or SBCR. In PTR, simple PTR was performed through 2 parallel transosseous tunnels created using a microdrill. In SBCR, 2 additional crisscross transosseous tunnels were added to mimic arthroscopic SBCR. At 1, 2, and 5 weeks postoperatively, comparative biomechanical testing was performed in 8 rabbits, and histologic analysis, including immunohistochemical staining for CD31, was performed in 4 rabbits. Failure loads at 1 week (38.12 ± 20.43 N vs 52.00 ± 27.23 N; P = .284) and 5 weeks (97.93 ± 48.35 N vs 119.60 ± 60.81 N; P = .218) were not statistically different between the SBCR and PTR groups, respectively, but were significantly lower in the SBCR group than in the PTR group (23.56 ± 13.56 N vs. 44.25 ± 12.53 N; P = .009), respectively, at 2 weeks. Markedly greater fibrinoid deposition was observed in the SBCR group than in the PTR group at 2 weeks. For vascularization, there was a tendency that more vessels could be observed in PTR than in SBCR at 2 weeks (15.9 vs 5.6, P = .068). In a rabbit acute rotator cuff repair model, SBCR exhibited inferior mechanical strength, and fewer blood vessels were observed at the healing site at 2 weeks postoperatively. Medial row tendon failure was more common in SBCR. Surgeons should consider the clinical effect of SBCR when performing rotator cuff repair. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Arthroscopic double row cuff repair with suture-bridging and autologous conditioned plasma injection: Functional and structural results.

PubMed

Werthel, Jean-David; Pelissier, Alexandre; Massin, Philippe; Boyer, Patrick; Valenti, Philippe

2014-10-01

The double row cuff repair with suture bridging is commonly used for arthroscopic rotator cuff repair (RCR). Despite its biomechanical qualities, the rate of iterative tears with this technique is important. The aim of our study was to evaluate the effect of autologous conditioned plasma (ACP) on functional results and on the rate of iterative tears after RCR by suture bridging. A consecutive series of 65 patients who underwent arthroscopic double-row suture bridge (Speed-Bridge, Arthrex) primary cuff repair of symptomatic full-thickness supraspinatus tear (retraction <3 in the Patte classification) were evaluated. Mean patient age was 60 (+/-8). The supraspinatus was repaired by knot-less bridging (SwiveLock, Arthrex) with suture tape material. 2 homogenous groups were created (A: 33 patients, B: 32 patients). In group A, all patients received, besides the cuff repair, an intra-tendinous ACP injection. Constant scores and Simple Shoulder Tests (SST) were measured pre-operatively and after a minimum follow-up period of 12 months post-operatively. Structural integrity of the repairs was evaluated by MRI according to the Sugaya classification. Sugaya >4 were considered as iterative tears. Mean follow-up was 19 months (+/-42) in the 2 groups. The mean quantity of ACP injected was 6ml. (+/-1.5) and no specific complication of the injection was found. Mean preoperative Constant-Murley scores were 41,2 (±7,7) and 38 (±11)in group B. Mean normalized Constant-Murley score increased from 41 points (±7) pre-operatively to 70 points (±8) post-operatively in group A and from 38 points (±11) to 73 points (±11) in group B. There were no significative differences between the two groups (P > 0.05). In group A, 31 repairs were Sugaya 1-3 (94%), vs. 30 in group B (93%), and 1 was type 4 in group A (5%) vs. 2 in group B (8%). In both groups, RCR with suture bridging gave successful functional outcomes, with a low rate of iterative tear. In this preliminary study, the adjuvant

Effect of shoulder abduction angle on biomechanical properties of the repaired rotator cuff tendons with 3 types of double-row technique.

PubMed

Mihata, Teruhisa; Fukuhara, Tetsutaro; Jun, Bong Jae; Watanabe, Chisato; Kinoshita, Mitsuo

2011-03-01

After rotator cuff repair, the shoulder is immobilized in various abduction positions. However, there is no consensus on the proper abduction angle. To assess the effect of shoulder abduction angle on the biomechanical properties of the repaired rotator cuff tendons among 3 types of double-row techniques. Controlled laboratory study. Thirty-two fresh-frozen porcine shoulders were used. A simulated rotator cuff tear was repaired by 1 of 3 double-row techniques: conventional double-row repair, transosseous-equivalent repair, and a combination of conventional double-row and bridging sutures (compression double-row repair). Each specimen underwent cyclic testing followed by tensile testing to failure at a simulated shoulder abduction angle of 0° or 40° on a material testing machine. Gap formation and failure loads were measured. Gap formation in conventional double-row repair at 0° (1.2 ± 0.5 mm) was significantly greater than that at 40° (0.5 ± 0.3mm, P = .01). The yield and ultimate failure loads for conventional double-row repair at 40° were significantly larger than those at 0° (P < .01), whereas those for transosseous-equivalent repair (P < .01) and compression double-row repair (P < .0001) at 0° were significantly larger than those at 40°. The failure load for compression double-row repair was the greatest among the 3 double-row techniques at both 0° and 40° of abduction. Bridging sutures have a greater effect on the biomechanical properties of the repaired rotator cuff tendon at a low abduction angle, and the conventional double-row technique has a greater effect at a high abduction angle. Proper abduction position after rotator cuff repair differs between conventional double-row repair and transosseous-equivalent repair. The authors recommend the use of the combined technique of conventional double-row and bridging sutures to obtain better biomechanical properties at both low and high abduction angles.

Repair systems for deteriorated bridge piles : final report.

DOT National Transportation Integrated Search

2017-04-01

The objective of this research project is to develop a durable repair system for deteriorated steel bridge piles that : can be implemented without the need for dewatering. A rigorous survey of the relevant practice nationwide was : conducted to infor...

Analysis, inspection, and repair methods for pin connections on Illinois bridges

DOT National Transportation Integrated Search

1992-04-01

This report documents methods used in Illinois for analysis, inspection, and repair of pin connections in bridges. Weldable foil strain gages were used to detect the effects of unknown levels of fixity in pins on cantilever truss bridges. Other metho...

Evaluation of Repair Techniques for Impact-Damaged Prestressed Beams

DOT National Transportation Integrated Search

2018-05-01

Collisions between over-height vehicles and bridges occur about 1,000 times per year in the United States. Collision damage to bridges can range from minor to catastrophic, potentially requiring repair or replacement of a bridge beam. For prestressed...

The V-Shaped Distal Triceps Tendon Repair: A Comparative Biomechanical Analysis.

PubMed

Scheiderer, Bastian; Imhoff, Florian B; Morikawa, Daichi; Lacheta, Lucca; Obopilwe, Elifho; Cote, Mark P; Imhoff, Andreas B; Mazzocca, Augustus D; Siebenlist, Sebastian

2018-05-01

Restoring footprint anatomy, minimizing gap formation, and maximizing the strength of distal triceps tendon repairs are essential factors for a successful healing process and return to sport. The novel V-shaped distal triceps tendon repair technique with unicortical button fixation closely restores footprint anatomy, provides minimal gap formation and high ultimate failure load, and minimizes iatrogenic fracture risk in acute/subacute distal triceps tendon tears. Controlled laboratory study. Twenty-four cadaveric elbows (mean ± SD age, 66 ± 5 years) were randomly assigned to 1 of 3 repair groups: the transosseous cruciate repair technique (gold standard), the knotless suture-bridge repair technique, and the V-shaped distal triceps tendon repair technique. Anatomic measurements of the central triceps tendon footprint were obtained in all specimens with a 3-dimensional digitizer before and after the repair. Cyclic loading was performed for a total of 1500 cycles at a rate of 0.25 Hz, pulling in the direction of the triceps. Displacements were measured on the medial and lateral tendon sites with 2 differential variable reluctance transducers. Load to failure and construct failure mode were recorded. The mean triceps bony insertion area was 399.05 ± 81.23 mm 2 . The transosseous cruciate repair technique restored 36.6% ± 16.8% of the native tendon insertion area, which was significantly different when compared with the knotless suture-bridge repair technique (85.2% ± 14.8%, P = .001) and the V-shaped distal triceps tendon repair technique (88.9% ± 14.8%, P = .002). Mean displacement showed no significant difference between the V-shaped distal triceps tendon repair technique (medial side, 0.75 ± 0.56 mm; lateral side, 0.99 ± 0.59 mm) and the knotless suture-bridge repair technique (1.61 ± 0.97 mm and 1.29 ± 0.8 mm) but significance between the V-shaped distal triceps tendon repair technique and the transosseous cruciate repair technique (4.91 ± 1.12 mm and 5

Evaluation of high performance pavement and bridge deck wearing surface repair materials.

DOT National Transportation Integrated Search

2016-08-01

This project provided for a laboratory and field testing of several high performance repair materials for : pavements and concrete bridge decks. The main purpose was to provide ODOT with materials and procedures : to shorten road and bridge closures....

Procedures, cost and effectiveness for deteriorated bridge substructure repair.

DOT National Transportation Integrated Search

2013-03-01

Deterioration of bridge substructures has been a serious concern throughout Wisconsin. Concrete, steel and : timber components all require distinct repair methods which not only address the true cause of the deterioration, : but also protect the comp...

Influence of Rotator Cuff Tear Size and Repair Technique on the Creation and Management of Dog Ear Deformities in a Transosseous-Equivalent Rotator Cuff Repair Model

PubMed Central

Redler, Lauren H.; Byram, Ian R.; Luchetti, Timothy J.; Tsui, Ying Lai; Moen, Todd C.; Gardner, Thomas R.; Ahmad, Christopher S.

2014-01-01

Background: Redundancies in the rotator cuff tissue, commonly referred to as “dog ear” deformities, are frequently encountered during rotator cuff repair. Knowledge of how these deformities are created and their impact on rotator cuff footprint restoration is limited. Purpose: The goals of this study were to assess the impact of tear size and repair method on the creation and management of dog ear deformities in a human cadaveric model. Study Design: Controlled laboratory study. Methods: Crescent-shaped tears were systematically created in the supraspinatus tendon of 7 cadaveric shoulders with increasing medial to lateral widths (0.5, 1.0, and 1.5 cm). Repair of the 1.5-cm tear was performed on each shoulder with 3 methods in a randomized order: suture bridge, double-row repair with 2-mm fiber tape, and fiber tape with peripheral No. 2 nonabsorbable looped sutures. Resulting dog ear deformities were injected with an acrylic resin mixture, digitized 3-dimensionally (3D), and photographed perpendicular to the footprint with calibration. The volume, height, and width of the rotator cuff tissue not in contact with the greater tuberosity footprint were calculated using the volume injected, 3D reconstructions, and calibrated photographs. Comparisons were made between tear size, dog ear measurement technique, and repair method utilizing 2-way analysis of variance and Student-Newman-Keuls multiple-comparison tests. Results: Utilizing 3D digitized and injection-derived volumes and dimensions, anterior dog ear volume, height, and width were significantly smaller for rotator cuff repair with peripheral looped sutures compared with a suture bridge (P < .05) or double-row repair with 2-mm fiber tape alone (P < .05). Similarly, posterior height and width were significantly smaller for repair with looped peripheral sutures compared with a suture bridge (P < .05). Dog ear volumes and heights trended larger for the 1.5-cm tear, but this was not statistically significant

77 FR 21436 - Safety Zone, East River, Brooklyn Bridge Scaffolding Repair, Brooklyn, NY

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

...-AA00 Safety Zone, East River, Brooklyn Bridge Scaffolding Repair, Brooklyn, NY AGENCY: Coast Guard, DHS... navigable waters of the East River, in the vicinity of the Brooklyn Bridge. This action is necessary to... and remove the damaged scaffolding under the eastern span of the bridge. This rule is intended to...

Repair and protection of hydraulic cement concrete bridge decks.

DOT National Transportation Integrated Search

1994-01-01

The report is an updated version of "A Manual for the Repair and Protection of Hydraulic Cement Concrete Bridge Decks" (VTRC 90-TAR2). The report was prepared for Chapter 2 of the Hydraulic Cement Concrete Construction School Study Guide which is dis...

Comparison of repair techniques in small and medium-sized rotator cuff tears in cadaveric sheep shoulders.

PubMed

Onay, Ulaş; Akpınar, Sercan; Akgün, Rahmi Can; Balçık, Cenk; Tuncay, Ismail Cengiz

2013-01-01

The aim of this study was to compare new knotless single-row and double-row suture anchor techniques with traditional transosseous suture techniques for different sized rotator cuff tears in an animal model. The study included 56 cadaveric sheep shoulders. Supraspinatus cuff tears of 1 cm repaired with new knotless single-row suture anchor technique and supraspinatus and infraspinatus rotator cuff tears of 3 cm repaired with double-row suture anchor technique were compared to traditional transosseous suture techniques and control groups. The repaired tendons were loaded with 5 mm/min static velocity with 2.5 kgN load cell in Instron 8874 machine until the repair failure. The 1 cm transosseous group was statistically superior to 1 cm control group (p=0.021, p<0.05) and the 3 cm SpeedBridge group was statistically superior to the 1 cm SpeedFix group (p=0.012, p<0.05). The differences between the other groups were not statistically significant. No significant difference was found between the new knotless suture anchor techniques and traditional transosseous suture techniques.

Development of a guide for prioritization of railway bridges for repair and replacement.

DOT National Transportation Integrated Search

2013-09-01

The objective of this study was to develop evaluation bases for the repair, rehabilitation, and replacement of existing : railway bridges. Considering the importance of bridges to the railway network, the research involved the review and : analysis o...

Evaluation of repair techniques for impact-damaged prestressed beams : final report.

DOT National Transportation Integrated Search

2017-04-01

Collisions between over height vehicles and bridges occur about 1,000 times per year in the United States. Collision damage to : bridges can range from minor to catastrophic, potentially requiring repair or replacement of a bridge beam. For prestress...

Complications after pectus excavatum repair using pectus bars in adolescents and adults: risk comparisons between age and technique groups.

PubMed

Choi, Soohwan; Park, Hyung Joo

2017-10-01

To compare the complications associated with age and technique groups in patients undergoing pectus excavatum (PE) repair. The data of 994 patients who underwent PE repair from March 2011 to December 2015 were retrospectively reviewed. Mean age was 9.59 years (range 31 months-55 years), and 756 patients were men (76.1%). The age groups were defined as follows: Group 1, <5 years; Group 2, 5-9 years; Group 3, 10-14 years; Group 4, 15-17 years; Group 5, 18-19 years; Group 6, 20-24 years; and Group 7, >24 years. The technique groups were defined as follows: Group 1, patients who underwent repair with claw fixators and hinge plates; Group 2, patients who underwent repair with our 'bridge' technique. Complications were compared between age groups and technique groups. No cases of mortality occurred. Complication rates in the age groups 1-7 were 5.4%, 3.6%, 12.1%, 18.2%, 17.3%, 13.9% and 16.7%, respectively. The complication rate tripled after the age of 10. In multivariable analysis, odds ratio of Groups 4, 5 and 7 and asymmetric types were 3.04, 2.81, 2.97 and 1.70 (P < 0.01, P = 0.02, 0.03 and 0.03, respectively). The bar dislocation rate in technique Group 1 was 0.8% (6 of 780). No bar dislocations occurred in technique Group 2. Older patients have more asymmetric pectus deformity and they are also risk factors for complications following PE repair. The bridge technique provides a bar dislocation rate of 0%, even in adult patients. This procedure seems to reduce or prevent major complications following PE repair. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

No patch technique for complete atrioventricular canal repair.

PubMed

Aramendi, José Ignacio; Rodriguez, Miguel Angel; Luis, Teresa; Voces, Roberto

2006-08-01

We describe our initial experience with a new technique, consisting in direct closure of the ventricular septal defect component of the AV canal, by directly attaching the common bridging leaflets to the crest of the ventricular septum with interrupted sutures. After closure of the cleft, the ostium primum defect was closed with a running suture suturing the border of the septum primum to the newly created AV valve annulus. Three patients were operated upon. There was no mortality. Mean ischemic time was 39 min and mean pump time 77 min. All patients remained in sinus rhythm. At follow-up only trivial or mild mitral regurgitation was observed. This new technique permits the repair of complete AV canal without the need for any patch. It is fast, simple and reproducible.

Application of the bridged crack model for evaluation of materials repairing and self-healing

NASA Astrophysics Data System (ADS)

Perelmuter, M.

2017-12-01

The bridged crack model is used for analysis of repairing and self-healing of cracked structures. Material repairing is treated as insertions of external ligaments into cracks or placement of the reinforcing patches over cracks. Bonds destruction and regeneration at the crack bridged zone is evaluated by the thermo-fluctuation kinetic theory. The healing time is dependent on the chemical reaction rate of the healing agent, the crack size and the external loads. The decreasing of the stress intensity factors is used as the measure of the repairing and healing effects. The mathematical background of the problem solution is based on the methods of the singular integral-differential equations. The model can be used for the evaluation of composite materials durability.

Avulsion Fracture of the Calcaneus Treated With a Soft Anchor Bridge and Lag Screw Technique: A Report of Two Cases.

PubMed

Yoshida, Kazushige; Kasama, Kentaro; Akahane, Tsutomu

2016-01-01

The displaced extra-articular avulsion fracture of the calcaneus has been classified as a Böhler type 1c calcaneal fracture, and most cases will require surgical repair. In the present report, we describe 2 patients in whom we performed the soft anchor bridge technique using single loaded suture anchors with lag screws for the repair of Böhler type 1c avulsion fractures of the calcaneus. In one of these patients, clinically relevant osteoporosis complicated the injury. In both cases, bone union was achieved, and by 1.5 months after surgery satisfactory recovery was observed. To our knowledge, the soft anchor bridge technique was first used for the treatment of rotator cuff tears, and the greatest merit of this technique is the ability to generate vertical compression force to the pulled out rotator cuff through the use of knotting sutures. In recent years, the soft anchor bridge technique using 4 suture anchors has also been used for fractures of the greater tuberosity of the humerus, an injury that poses operative difficulties similar to those encountered with an avulsion fracture of the calcaneus owing to the traction force of the rotator cuff and relative weakness of adjacent bone. The outcomes of our patients suggest that the soft anchor bridge technique combined with adjunct lag screws is useful in the fixation of avulsion fractures of the calcaneus. In addition, the result in the elderly patient indicates the possibility of using this technique for patients with osteoporosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Crack Sealing and Repair of Older Serviceable Bridges Using Polymer Sealers

DOT National Transportation Integrated Search

1998-01-01

The objective of this study is to determine the feasibility of using High Molecular Weight Methacrylate (HMWM) and Epoxy Healer Sealers for crack sealing and repair of older serviceable bridges. The study included the field application of two HMWM ma...

Field evaluation of thermographic bridge concrete inspection techniques.

DOT National Transportation Integrated Search

2013-02-01

The goal of this research is to develop new technologies for the condition assessment of concrete to help ensure bridge safety and improve the effectiveness of maintenance and repair. : The objectives of the research are to: : Quantify the capabi...

[Comparative study of the repair of full thickness tear of the supraspinatus by means of "single row" or "suture bridge" techniques].

PubMed

Arroyo-Hernández, M; Mellado-Romero, M A; Páramo-Díaz, P; Martín-López, C M; Cano-Egea, J M; Vilá Y Rico, J

2015-01-01

The purpose of this study is to analyze if there is any difference between the arthroscopic reparation of full-thickness supraspinatus tears with simple row technique versus suture bridge technique. We accomplished a retrospective study of 123 patients with full-thickness supraspinatus tears between January 2009 and January 2013 in our hospital. There were 60 simple row reparations, and 63 suture bridge ones. The mean age in the simple row group was 62.9, and in the suture bridge group was 63.3 years old. There were more women than men in both groups (67%). All patients were studied using the Constant test. The mean Constant test in the suture bridge group was 76.7, and in the simple row group was 72.4. We have also accomplished a statistical analysis of each Constant item. Strength was higher in the suture bridge group, with a significant statistical difference (p 0.04). The range of movement was also greater in the suture bridge group, but was not statistically significant. Suture bridge technique has better clinical results than single row reparations, but the difference is not statistically significant (p = 0.298).

Advances in Tissue Engineering Techniques for Articular Cartilage Repair

PubMed Central

Haleem, AM; Chu, CR

2010-01-01

The limited repair potential of human articular cartilage contributes to development of debilitating osteoarthritis and remains a great clinical challenge. This has led to evolution of cartilage treatment strategies from palliative to either reconstructive or reparative methods in an attempt to delay or “bridge the gap” to joint replacement. Further development of tissue engineering-based cartilage repair methods have been pursued to provide a more functional biological tissue. Currently, tissue engineering of articular cartilage has three cornerstones; a cell population capable of proliferation and differentiation into mature chondrocytes, a scaffold that can host these cells, provide a suitable environment for cellular functioning and serve as a sustained-release delivery vehicle of chondrogenic growth factors and thirdly, signaling molecules and growth factors that stimulate the cellular response and the production of a hyaline extracellular matrix (ECM). The aim of this review is to summarize advances in each of these three fields of tissue engineering with specific relevance to surgical techniques and technical notes. PMID:29430164

Nerve Cross-Bridging to Enhance Nerve Regeneration in a Rat Model of Delayed Nerve Repair

PubMed Central

2015-01-01

There are currently no available options to promote nerve regeneration through chronically denervated distal nerve stumps. Here we used a rat model of delayed nerve repair asking of prior insertion of side-to-side cross-bridges between a donor tibial (TIB) nerve and a recipient denervated common peroneal (CP) nerve stump ameliorates poor nerve regeneration. First, numbers of retrogradely-labelled TIB neurons that grew axons into the nerve stump within three months, increased with the size of the perineurial windows opened in the TIB and CP nerves. Equal numbers of donor TIB axons regenerated into CP stumps either side of the cross-bridges, not being affected by target neurotrophic effects, or by removing the perineurium to insert 5-9 cross-bridges. Second, CP nerve stumps were coapted three months after inserting 0-9 cross-bridges and the number of 1) CP neurons that regenerated their axons within three months or 2) CP motor nerves that reinnervated the extensor digitorum longus (EDL) muscle within five months was determined by counting and motor unit number estimation (MUNE), respectively. We found that three but not more cross-bridges promoted the regeneration of axons and reinnervation of EDL muscle by all the CP motoneurons as compared to only 33% regenerating their axons when no cross-bridges were inserted. The same 3-fold increase in sensory nerve regeneration was found. In conclusion, side-to-side cross-bridges ameliorate poor regeneration after delayed nerve repair possibly by sustaining the growth-permissive state of denervated nerve stumps. Such autografts may be used in human repair surgery to improve outcomes after unavoidable delays. PMID:26016986

Treatment of acute achilles tendon rupture with the panda rope bridge technique.

PubMed

Yin, Liangjun; Wu, Yahong; Ren, Changsong; Wang, Yizhong; Fu, Ting; Cheng, Xiangjun; Li, Ruidong; Nie, Mao; Mu, Yuan

2018-03-01

Although nonsurgical methods and many surgical techniques have been developed for repairing a ruptured Achilles tendon, there is no consensus on its best treatment. In this article, a novel minimally invasive technique called the Panda Rope Bridge Technique (PRBT) is described. Patient with acute Achilles tendon rupture was operated on in the prone position. The PRBT begin with making the proximal bridge anchor (Krackow sutures in the myotendinous junction), the distal bridge anchor (two suture anchors in the calcaneus bone) and the ropes (threads of the suture anchors) stretched between the anchor sites. Then a small incision was made to debride and reattach the stumps of ruptured tendon. After the surgery, no cast or splint fixation was applied. All patients performed enhanced recovery after surgery (ERAS), which included immediate ankle mobilisation from day 1, full weight-bearing walking from day 5 to 7, and gradually take part in athletic exercises from 8 weeks postoperatively. PBRT was performed in 11patients with acute Achilles tendon rupture between June 2012 and June 2015. No wound infection, fistula, skin necrosis, sural nerve damage, deep venous thrombosis or tendon re-rupture was found. One year after the surgery, all patients reported 100 AOFAS ankle-hindfoot score points and the mean ATRS was 96.6. The PRBT is a simple, effective and minimally invasive technique, with no need for immobilisation of the ankle, making possible immediate and aggressive postoperative rehabilitation. Copyright © 2018 Elsevier Ltd. All rights reserved.

Comparable biomechanical results for a modified single-row rotator cuff reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair.

PubMed

Lorbach, Olaf; Kieb, Matthias; Raber, Florian; Busch, Lüder C; Kohn, Dieter; Pape, Dietrich

2012-02-01

To compare the biomechanical properties and footprint coverage of a single-row (SR) repair using a modified suture configuration versus a double-row (DR) suture-bridge repair in small to medium and medium to large rotator cuff tears. We created 25- and 35-mm artificial defects in the rotator cuff of 24 human cadaveric shoulders. The reconstructions were performed as either an SR repair with triple-loaded suture anchors (2 to 3 anchors) and a modified suture configuration or a modified suture-bridge DR repair (4 to 6 anchors). Reconstructions were cyclically loaded from 10 to 60 N. The load was increased stepwise up to 100, 180, and 250 N. Cyclic displacement and load to failure were determined. Furthermore, footprint widths were quantified. In the 25-mm rupture, ultimate load to failure was 533 ± 107 N for the SR repair and 681 ± 250 N for the DR technique (P ≥ .21). In the 35-mm tear, ultimate load to failure was 792 ± 122 N for the SR reconstruction and 891 ± 174 N for the DR reconstruction (P ≥ .28). There were no statistically significant differences for both tested rupture sizes. Cyclic displacement showed no significant differences between the tested configurations at 60 N (P = .563), 100 N (P = .171), 180 N (P = .211), and 250 N (P = .478) for the 25-mm tear. For the 35-mm tear, cyclic displacement showed significantly lower gap formation for the SR reconstruction at 180 N (P = .037) and 250 N (P = .020). No significant differences were found at 60 N (P = .296) and 100 N (P = .077). A significantly greater footprint width (P = .028) was seen for the DR repair (16.2 mm) compared with the SR repair (13.8 mm). However, both reconstructions were able to achieve complete footprint coverage compared with the initial footprint. The tested SR repair using a modified suture configuration was similar in load to failure and cyclic displacement to the DR suture-bridge technique independent of the tested initial sizes of the rupture. The tested DR repair

Repair of earthquake-damaged bridge columns with interlocking spirals and fractured bars.

DOT National Transportation Integrated Search

2014-07-01

During earthquakes, reinforced concrete (RC) bridge columns may experience different levels of damage such as cracking, spalling, or crushing of concrete and yielding, buckling, or fracture of reinforcing bars. Although several repair options exist f...

Seismic retrofit of spliced sleeve connections for precast bridge piers.

DOT National Transportation Integrated Search

2017-03-01

Grouted Splice Sleeve (GSS) connectors are being considered for connecting bridge columns, footings, and pier caps in Accelerated Bridge Construction (ABC). A repair technique for precast reinforced concrete bridge column-to-footing and column-to-pie...

Effects of realistic heat straightening repair on the properties and serviceability of damaged steel beam bridges.

DOT National Transportation Integrated Search

2012-02-01

The permanent deformations in steel beam bridges caused by collision with high profile vehicles can be repaired by heat straightening, : which is a structurally efficient and costeffective repair process developed by many engineers over the years....

Repairing/strengthening of bridges with post-tensioned FRP strands and performance evaluation.

DOT National Transportation Integrated Search

2008-06-01

The proposed project is to take advantage of some new developments in bridge engineering to apply fiber reinforced polymers (FRP) post-tensioning strands on a selected structure. The use of externally post-tensioned FRP strands to repair/strengthen b...

Damage evaluation and repair methods for prestressed concrete bridge members

NASA Astrophysics Data System (ADS)

Shanafelt, G. O.; Horn, W. B.

1980-11-01

The types of accidental damage occurring and the severity and frequency of their occurrence are summarized. Practices and equipment used for assessing damage and making repairs are presented and evaluated. Guidelines for inspection, assessing damage, and selection of repair methods are given. Methods of repair includes adding external prestress, a metal sleeve splice, and splicing broken strands or rods. The findings of this study suggest that in some instances better repair techniques should be used. The findings of this study also indicate that proper selection of repair methods may reduce the number of damaged girders presently being replaced. Plausible methods of repair requiring additional research are identified and techniques for testing are outlined.

A biomechanical and histological comparison of the suture bridge and conventional double-row techniques of the repair of full-thickness rotator cuff tears in a rabbit model.

PubMed

Fei, Wenyong; Guo, Weichun

2015-06-16

The suture bridge (SB) technique and conventional double-row (DR) are both effective in repair of full-thickness rotator cuff tears . However, increasing numbers of scholars believe that the SB technique produces better results than conventional DR because of the higher bone-tendon contact area and pressure. However, The clinical outcomes have been mixed and little direct evidence has been supplied in vivo. This study was designed using the SB and DR techniques to determine which is the better technique. Sixty-four New Zealand white rabbits were randomly divided into 2 groups, the SB group and DR group. SB and DR were then used to repair their rotator cuff tears. Rabbits were then sacrificed at the 2(nd), 4(th), or 8(th) week after surgery and a histological comparison was made. The biomechanical comparison was made at the 8(th) week. The load to failure of the SB group was 134.59 ± 17.69 N at the 8(th) postoperative week, and that was significantly higher than in the DR group (103.83 ± 6.62, P = 0.001), but both repair groups remained lower than in the control group (199.25 ± 14.81). Histological evaluation showed that both the SB and DR groups healed at the bone-tendon interface. But there were subtle differences between the two groups in the structure and morphology of collagen fibers and cartilage cells at bone-tendon interface. In general, the collagen fibers of the SB group were more compact than those of the DR group at all times tested. At the 4(th) and 8(th) weeks, the collagen fibers and cartilage cells in the SB group were arranged in a column modality, but those in the DR group were distributed horizontally. The SB technique facilitated healing more effectively than the conventional DR technique. The difference in morphology of collagen fibers and cartilage cells may be related to the difference in bone-tendon contact pressure.

[Clinical research of arthroscopic separate double-layer suture bridge technique for delaminated rotator cuff tear].

PubMed

Ren, Jiangtao; Xu, Cong; Liu, Xianglin; Wang, Jiansong; Li, Zhihuai; Lü, Yongming

2017-10-01

To explore the effectiveness of the arthroscopic separate double-layer suture bridge technique in treatment of the delaminated rotator cuff tear. Between May 2013 and May 2015, 54 patients with the delaminated rotator cuff tears were recruited in the study. They were randomly allocated into 2 groups to receive repair either using arthroscopic separate double-layer suture bridge technique (trial group, n =28) or using arthroscopic whole-layer suture bridge technique (control group, n =26). There was no significant difference in gender, age, injured side, tear type, and preoperative visual analogue scale (VAS) score, Constants score, American Shoulder and Elbow Surgeons (ASES) score, University of California Los Angeles (UCLA) score, and the range of motion of shoulder joint between 2 groups ( P >0.05). Postoperative functional scores, range of motion, and recurrence rate of tear in 2 groups were observed and compared. The operation time was significant longer in trial group than in control group ( t =8.383, P =0.000). All incisions healed at stage Ⅰ without postoperative complication. All the patients were followed up 12 months. At 12 months postoperatively, the UCLA score, ASES score, VAS score, Constant score, and the range of motion were significantly improved when compared with the preoperative values in 2 groups ( P <0.05). However there was no significant difference in above indexes between 2 groups ( P >0.05). Four cases (14.3%) of rotator cuff tear recurred in trial group while 5 cases (19.2%) in control group, showing no significant difference ( χ 2 =0.237, P =0.626). Compared with the arthroscopic whole-layer suture bridge technique, arthroscopic separate double-layer suture bridge technique presents no significant difference in the shoulder function score, the range of motion, and recurrence of rotator cuff tear, while having a longer operation time.

Paraesophageal Hernia Repair: Techniques for Success.

PubMed

Cohn, Tyler D; Soper, Nathaniel J

2017-01-01

With the introduction of laparoscopy, the outcomes of patients undergoing paraesophageal hernia repair have improved dramatically. When the fundamentals of a proper repair are followed, patients can expect to have improvement in gastroesophageal reflux symptoms, including heartburn, regurgitation, chest pain, dysphagia, and dyspnea. Adhering to these principles will alleviate patients' symptoms and avoid reoperation. This article describes the approach to paraesophageal hernia repair, including patient evaluation, operative technique, and postoperative management. Esophageal lengthening and crural reinforcement with mesh are addressed as well. Adhering to the basic techniques outlined in this article should lead to successful and durable patient outcomes following a paraesophageal hernia repair.

Arthroscopic suture bridge rotator cuff repair: functional outcome, repair integrity, and preoperative factors related to postoperative outcome.

PubMed

Rimmke, Nathan; Maerz, Tristan; Cooper, Ross; Yadavalli, Sailaja; Anderson, Kyle

2016-01-01

To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair. Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography. Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41-79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P < 0.001), VAS pain score (4.69 ± 2.17 to 0.63 ± 1.29, P < 0.001), forward elevation range of motion (144.1° ± 29.9 to 159.69° ± 13.9, P = 0.002), and internal rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs. 2.05 cm ± 0.48, P < 0.001). Preoperative tear size was significantly associated with a postoperative retear (P < 0.001). The duration of preoperative symptoms was significantly associated with pain (P = 0.029), pain improvement (P = 0.013), internal rotation ROM (P = 0.002), and internal rotation strength (P = 0.004). Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes. IV, Case Series.

A cost analysis of single-row versus double-row and suture bridge rotator cuff repair methods.

PubMed

Bisson, Leslie; Zivaljevic, Nikola; Sanders, Samuel; Pula, David

2015-02-01

To calculate the costs to the US healthcare system of transition from single-row (SR) to double-row (DR) rotator cuff repair (RCR) and to calculate the decrease in re-operations for re-tear that DR RCR would need to accomplish in order to render the transition cost-neutral. Standard accounting methods were used to determine the cost of a single RCR, the annual cost to the US healthcare system of rotator cuff surgery, the cost of a single-revision RCR, and the decrease in revision for re-tear rate necessary to make DR or suture bridge (SB) methods cost-neutral in comparison with SR methods. We varied tear size, operating room cost, time required for implant placement, annual tear size distribution, and repair method. The cost of RCR ranged from $7,572 (SR, <1 cm tear) to $12,979 (DR, >5 cm tear). Complete conversion from SR RCR to a DR technique without an associated decrease in revision surgeries would increase the annual US healthcare cost between $80 million and $262 million per year. To obtain cost neutrality, use of DR or SB methods would need to result in one fewer revision in every 17 primary repairs (for tears <1 cm) to one fewer in every four primary repairs (for tears >5 cm). Conversion from SR to DR or SB RCR techniques would result in considerable increases in healthcare expenditures. Since the large decreases in revision surgery rates necessary to justify DR or SB repairs purely on a cost basis may not be realistic or even possible, the use of these methods should be supported by evidence of improved structural healing rates and quality-adjusted life years in comparison with SR methods. IV.

Primary fascial closure with biologic mesh reinforcement results in lesser complication and recurrence rates than bridged biologic mesh repair for abdominal wall reconstruction: A propensity score analysis.

PubMed

Giordano, Salvatore; Garvey, Patrick B; Baumann, Donald P; Liu, Jun; Butler, Charles E

2017-02-01

Previous studies suggest that bridged mesh repair for abdominal wall reconstruction may result in worse outcomes than mesh-reinforced, primary fascial closure, particularly when acellular dermal matrix is used. We compared our outcomes of bridged versus reinforced repair using ADM in abdominal wall reconstruction procedures. This retrospective study included 535 consecutive patients at our cancer center who underwent abdominal wall reconstruction either for an incisional hernia or for abdominal wall defects left after excision of malignancies involving the abdominal wall with underlay mesh. A total of 484 (90%) patients underwent mesh-reinforced abdominal wall reconstruction and 51 (10%) underwent bridged repair abdominal wall reconstruction. Acellular dermal matrix was used, respectively, in 98% of bridged and 96% of reinforced repairs. We compared outcomes between these 2 groups using propensity score analysis for risk-adjustment in multivariate analysis and for 1-to-1 matching. Bridged repairs had a greater hernia recurrence rate (33.3% vs 6.2%, P < .001), a greater overall complication rate (59% vs 30%, P = .001), and worse freedom from hernia recurrence (log-rank P <.001) than reinforced repairs. Bridged repairs also had a greater rate of wound dehiscence (26% vs 14%, P = .034) and mesh exposure (10% vs 1%, P = .003) than mesh-reinforced abdominal wall reconstruction. When the treatment method was adjusted for propensity score in the propensity-score-matched pairs (n = 100), we found that the rates of hernia recurrence (32% vs 6%, P = .002), overall complications (32% vs 6%, P = .002), and freedom from hernia recurrence (68% vs 32%, P = .001) rates were worse after bridged repair. We did not observe differences in wound healing and mesh complications between the 2 groups. In our population of primarily cancer patients at MD Anderson Cancer Center bridged repair for abdominal wall reconstruction is associated with worse outcomes than mesh

Tetrameric Ctp1 coordinates DNA binding and DNA bridging in DNA double-strand-break repair

DOE PAGES

Andres, Sara N.; Appel, C. Denise; Westmoreland, James W.; ...

2015-01-12

Ctp1 (also known as CtIP or Sae2) collaborates with Mre11-Rad50-Nbs1 to initiate repair of DNA double-strand breaks (DSBs), but its functions remain enigmatic. In this paper, we report that tetrameric Schizosaccharomyces pombe Ctp1 contains multivalent DNA-binding and DNA-bridging activities. Through structural and biophysical analyses of the Ctp1 tetramer, we define the salient features of Ctp1 architecture: an N-terminal interlocking tetrameric helical dimer-of-dimers (THDD) domain and a central intrinsically disordered region (IDR) linked to C-terminal 'RHR' DNA-interaction motifs. The THDD, IDR and RHR are required for Ctp1 DNA-bridging activity in vitro, and both the THDD and RHR are required for efficientmore » DSB repair in S. pombe. Finally, our results establish non-nucleolytic roles of Ctp1 in binding and coordination of DSB-repair intermediates and suggest that ablation of human CtIP DNA binding by truncating mutations underlie the CtIP-linked Seckel and Jawad syndromes.« less

Deep patch technique for landslide repair. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Helwany, B.M.

1994-10-01

The report describes the laboratory testing of the `USFS deep patch` technique and a CTI modification of this technique for repairing landslides with geosynthetic reinforcement. The technique involves replacing sections of roadway lost due to landslides on top of a geosynthetically-reinforced embankment. The CTI modification involves replacing the reinforced slope with a geosynthetically-reinforced retaining wall with a truncated base. Both techniques rely on the cantilevering ability of the reinforced mass to limit the load on the foundation with a high slide potential. The tests with road base showed that (1) both the USFS and CTI repair reduced effectively the adversemore » effects of local landsliding on the highway pavement by preventing crack propagation; (2) the USFS repair increased the stability of the repaired slope, which was in progressive failure, by reducing the stresses exerted on it; and (3) the CTI repair produced substantially greater stresses on its foundation due to the truncated base of the reinforced mass.« less

Laparoscopic techniques versus open techniques for inguinal hernia repair.

PubMed

McCormack, K; Scott, N W; Go, P M; Ross, S; Grant, A M

2003-01-01

Inguinal hernia repair is the most frequently performed operation in general surgery. The standard method for inguinal hernia repair had changed little over a hundred years until the introduction of synthetic mesh. This mesh can be placed by either using an open approach or by using a minimal access laparoscopic technique. Although many studies have explored the relative merits and potential risks of laparoscopic surgery for the repair of inguinal hernia, most individual trials have been too small to show clear benefits of one type of surgical repair over another. The objective of this review was to compare minimal access laparoscopic mesh techniques with open techniques. Comparisons of open mesh techniques versus open non-mesh techniques have been considered in a separate Cochrane review. We searched MEDLINE, EMBASE, and The Cochrane Central Controlled Trials Registry for relevant randomised controlled trials. The reference list of identified trials, journal supplements, relevant book chapters and conference proceedings were searched for further relevant trials. Through the EU Hernia Trialists Collaboration (EUHTC) communication took place with authors of identified randomised controlled trials to ask for information on any other recent and ongoing trials known to them. Specialists involved in research on the repair of inguinal hernia were contacted to ask for information about any further completed and ongoing trials. The world wide web was also searched. All published and unpublished randomised controlled trials and quasi-randomised controlled trials comparing laparoscopic groin hernia repair with open groin hernia repair were eligible for inclusion. Trials were included irrespective of the language in which they were reported. Individual patient data were obtained, where possible, from the responsible trialist for all eligible studies. All reanalyses were cross-checked by the reviewers and verified by the trialists before inclusion. Where IPD were unavailable

Wide Panel Testing Technique for Evaluating Repair Weld Strengths

NASA Technical Reports Server (NTRS)

Rogers, Patrick R.; Bynum, Julian E.; Shah, Sandeep R.

1998-01-01

This paper describes a new tensile testing technique for evaluating the overall effect of a repair weld on the strength of a welded joint. Previously, repair weld strengths have been evaluated using one-inch width tensile specimens, but this technique does not capture all of the effects that result from a repair. The new technique involves testing of "wide panel" tensile specimens which contain the full length of a repair weld within a longer initial weld, allowing the specimen to capture the combined effects of residual stresses, local strength degradation, and load redistribution around a repair. The development of strains in the repair area of standard aluminum alloy specimens and new high-performance aluminum-lithium alloy specimens was observed and evaluated using photoelastic material. The results of this evaluation show an increased sensitivity to repair welding residual stresses in the aluminum-lithium alloy specimens.

Minimizing the impact on water quality of placing grout underwater to repair bridge scour damage.

DOT National Transportation Integrated Search

2003-01-01

The Virginia Department of Transportation (VDOT) has routinely used what is commonly referred to as tremie concrete (concrete or grout placed underwater by way of pumping through a metal tremie pipe) to repair bridge substructure and scour damage. VD...

Rotator cuff bridging repair using acellular dermal matrix in large to massive rotator cuff tears: histologic and clinical analysis.

PubMed

Kim, Jong Ok; Lee, Jong-Ho; Kim, Kwang-Sup; Ji, Jong-Hun; Koh, Sung-Jun; Lee, Jae-Ho

2017-11-01

This study investigated the efficacy of the bridging repair using an acellular dermal matrix (ADM) and an ADM with stem cells in rabbits. Also investigated were clinical outcomes of ADM bridging repair for large to massive rotator cuff tears. ADM, with and without stem cells, was used to cover a 5- × 5-mm-sized cuff defect in 17 rabbits, and biomechanical, histologic, and immunohistochemical analyses were conducted. Also evaluated were 24 patients with large to massive rotator cuff tears after ADM bridging repair. In the biomechanical test, the normal rotator cuff, cuff with ADM plus stem cells, and cuff with ADM in the rabbit model showed a maximum load (N) of 287.3, 217.5, and 170.3 and ultimate tensile strength (N/mm 2 ) of 11.1, 8.0, and 5.2, respectively. Histologically, the cuff tendons with the ADM or ADM plus stem cells showed characteristically mature tendons as time passed. In the clinical study, the mean American Shoulder and Elbow Surgeons score improved from preoperative 50 to postoperative 83, the University of California Los Angeles Shoulder Rating Scale from 17 to 30, and the Simple Shoulder Test from 4 to 8, respectively. No further fatty deteriorations or muscle atrophy were observed on follow-up magnetic resonance imaging. A retear was found in 5 of 24 patients (21%). Bridging repair with ADM or stem cells in the rabbit model showed cellular infiltration into the graft and some evidence of neotendon formation. Clinically, ADM repair was a safe alternative that did not show any further fatty deterioration nor muscle atrophy in large to massive rotator cuff tears. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

[Progress of Masquelet technique to repair bone defect].

PubMed

Yin, Qudong; Sun, Zhenzhong; Gu, Sanjun

2013-10-01

To summarize the progress of Masquelet technique to repair bone defect. The recent literature concerning the application of Masquelet technique to repair bone defect was extensively reviewed and summarized. Masquelet technique involves a two-step procedure. First, bone cement is used to fill the bone defect after a thorough debridement, and an induced membrane structure surrounding the spacer formed; then the bone cement is removed after 6-8 weeks, and rich cancellous bone is implanted into the induced membrane. Massive cortical bone defect is repaired by new bone forming and consolidation. Experiments show that the induced membrane has vascular system and is also rich in vascular endothelial growth factor, transforming growth factor beta1, bone morphogenetic protein 2, and bone progenitor cells, so it has osteoinductive property; satisfactory results have been achieved in clinical application of almost all parts of defects, various types of bone defect and massive defect up to 25 cm long. Compared with other repair methods, Masquelet technique has the advantages of reliable effect, easy to operate, few complications, low requirements for recipient site, and wide application. Masquelet technique is an effective method to repair bone defect and is suitable for various types of bone defect, especially for bone defects caused by infection and tumor resection.

Evaluation of bridge cables corrosion using acoustic emission technique

NASA Astrophysics Data System (ADS)

Li, Dongsheng; Ou, Jinping

2010-04-01

Owing to the nature of the stress, corrosion of bridge cable may result in catastrophic failure of the structure. However, using electrochemical techniques isn't fully efficient for the detection and control on line of the corrosion phenomenon. A non-destructive testing method based on acoustic emission technique monitoring bridge cable corrosion was explored. The steel strands were placed at room temperature in 5% NaCl solution. Acoustic emission (AE) characteristic parameters were recorded in the whole corrosion experiment process. Based on the plot of cumulated acoustic activity, the bridge cables corrosion included three stages. It can be clearly seen that different stages have different acoustic emission signal characteristics. The AE characteristic parameters would be increased with cables corrosion development. Finally, the bridge cables corrosion experiment with different stress state and different corrosion environment was performed. The results shows that stress magnitude only affects the bridge cable failure time, however, the AE characteristic parameters value has changed a little. It was verified that AE technique can be used to detect the bridge cable early corrosion, investigating corrosion developing trend, and in monitoring and evaluating corrosion damages.

Cost Effective Repair Techniques for Turbine Airfoils. Volume 2

DTIC Science & Technology

1979-04-01

BLADES , *GUIDE VANES , *REPAIR, TURBOFAN ENGINES , DIFFUSION BONDING, COST EFFECTIVENESS Identifiers: (U) * Turbine vanes , TF-39 engines , Activated...REPAIR TECHNIQUES FOR TURBINE AIRFOILS J. A. WEIN W. R. YOUNG GENERAL ELECTRIC COMPANY AIRCRAFT ENGINE GROUP CINCINNATI, OHIO 45215 APRIL 1979...Author: GENERAL ELECTRIC CO CINCINNATI OH AIRCRAFT ENGINE BUSINESS GROUP Unclassified Title: (U) Cost Effective Repair Techniques for

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

PubMed Central

Murray, Martha M.; Flutie, Brett M.; Kalish, Leslie A.; Ecklund, Kirsten; Fleming, Braden C.; Proffen, Benedikt L.; Micheli, Lyle J.

2016-01-01

Background: This study assessed the safety of the newly developed bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR), which involves suture repair of the ligament combined with a bioactive scaffold to bridge the gap between the torn ligament ends. As the intra-articular environment is complex in its response to implanted materials, this study was designed to determine whether there would be a significant rate of adverse reaction to the implanted scaffold. Hypothesis: The primary hypothesis was that the implanted scaffold would not result in a deep joint infection (arthrocentesis with positive culture) or significant inflammation (clinical symptoms justifying arthrocentesis but negative culture). The secondary hypotheses were that patients treated with BEAR would have early postoperative outcomes that were similar to patients treated with ACL reconstruction with an autologous hamstring graft. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 20 patients were enrolled in this nonrandomized, first-in-human study. Ten patients received BEAR treatment and 10 received a hamstring autograft ACL reconstruction. The BEAR procedure was performed by augmenting a suture repair with a proprietary scaffold, the BEAR scaffold, placed in between the torn ends of the ACL at the time of suture repair. The BEAR scaffold is to our knowledge the only device that fills the gap between the torn ligament ends to have current Investigational Device Exemption approval from the Food and Drug Administration. Ten milliliters of autologous whole blood were added to the scaffold prior to wound closure. Outcomes were assessed at 3 months postoperatively. The outcomes measures included postoperative pain, muscle atrophy, loss of joint range of motion, and implant failure (designated by an International Knee Documentation Committee grade C or D Lachman test and/or an absence of continuous ACL tissue on magnetic resonance images). Results: There were no joint

Estimating bridge stiffness using a forced-vibration technique for timber bridge health monitoring

Treesearch

James P. Wacker; Xiping Wang; Brian Brashaw; Robert J. Ross

2006-01-01

This paper describes an effort to refine a global dynamic testing technique for evaluating the overall stiffness of timber bridge superstructures. A forced vibration method was used to measure the frequency response of several simple-span, sawn timber beam (with plank deck) bridges located in St. Louis County, Minnesota. Static load deflections were also measured to...

Load response and gap formation in a single-row cruciate suture rotator cuff repair.

PubMed

Huntington, Lachlan; Richardson, Martin; Sobol, Tony; Caldow, Jonathon; Ackland, David C

2017-06-01

Double-row rotator cuff tendon repair techniques may provide superior contact area and strength compared with single-row repairs, but are associated with higher material expenses and prolonged operating time. The purpose of this study was to evaluate gap formation, ultimate tensile strength and stiffness of a single-row cruciate suture rotator cuff repair construct, and to compare these results with those of the Mason-Allen and SutureBridge repair constructs. Infraspinatus tendons from 24 spring lamb shoulders were harvested and allocated to cruciate suture, Mason-Allen and SutureBridge repair groups. Specimens were loaded cyclically between 10 and 62 N for 200 cycles, and gap formation simultaneously measured using a high-speed digital camera. Specimens were then loaded in uniaxial tension to failure, and construct stiffness and repair strength were evaluated. Gap formation in the cruciate suture repair was significantly lower than that of the Mason-Allen repair (mean difference = 0.6 mm, P = 0.009) and no different from that of the SutureBridge repair (P > 0.05). Both the cruciate suture repair (mean difference = 15.7 N/mm, P = 0.002) and SutureBridge repair (mean difference = 15.8 N/mm, P = 0.034) were significantly stiffer than that of the Mason-Allen repair; however, no significant differences in ultimate tensile strength between repair groups were discerned (P > 0.05). The cruciate suture repair construct, which may represent a simple and cost-effective alternative to double-row and double-row equivalent rotator cuff repairs, has comparable biomechanical strength and integrity with that of the SutureBridge repair, and may result in improved construct longevity and tendon healing compared with the Mason-Allen repair. © 2017 Royal Australasian College of Surgeons.

Functional and structural comparisons of the arthroscopic knotless double-row suture bridge and single-row repair for anterosuperior rotator cuff tears.

PubMed

Ide, Junji; Karasugi, Tatsuki; Okamoto, Nobukazu; Taniwaki, Takuya; Oka, Kiyoshi; Mizuta, Hiroshi

2015-10-01

We compared the outcomes of knotless double-row suture bridge and single-row repairs in patients undergoing arthroscopic repair for anterosuperior rotator cuff tears. We included 61 full-thickness anterosuperior rotator cuff tears treated by arthroscopic repair, namely, single-row repair (group 1: 25 shoulders; mean patient age, 64 years) and the knotless double-row suture bridge repair (group 2: 36 shoulders; mean patient age, 62 years). Preoperative and postoperative magnetic resonance imaging was performed for all shoulders. Clinical outcomes were evaluated for mean follow-up periods of 81 months (range, 72-96 months) in group 1 and 34 months (range, 24-42 months) in group 2, using the University of California, Los Angeles and Japanese Orthopaedic Association assessments. At the final follow-up, both groups showed improvement in the average University of California, Los Angeles and Japanese Orthopaedic Association scores and range of motion, although no intergroup differences were observed. Both groups showed improved abduction strength, and the average score was higher in group 2 (P = .0112). The lift-off and belly-press test results were improved in both groups. Postoperatively, the incidence of positive lift-off tests tended to be lower (P = .075) and that of positive belly-press tests was lower in group 2, P = .049). The repair failure rate tended to be lower in group 2 (14% [5 of 36]) than in group 1 (32% [8 of 25]; P = .0839). Arthroscopic knotless double-row suture bridge repair of anterosuperior rotator cuff tears yielded functional outcomes equivalent to those of single-row repair and may be useful for improving subscapularis function, abduction strength, and tendon healing. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial.

PubMed

Barber, F Alan

2016-05-01

To compare the structural healing and clinical outcomes of triple-loaded single-row with suture-bridging double-row repairs of full-thickness rotator cuff tendons when both repair constructs are augmented with platelet-rich plasma fibrin membrane. A prospective, randomized, consecutive series of patients diagnosed with full-thickness rotator cuff tears no greater than 3 cm in anteroposterior length were treated with a triple-loaded single-row (20) or suture-bridging double-row (20) repair augmented with platelet-rich plasma fibrin membrane. The primary outcome measure was cuff integrity by magnetic resonance imaging (MRI) at 12 months postoperatively. Secondary clinical outcome measures were American Shoulder and Elbow Surgeons, Rowe, Simple Shoulder Test, Constant, and Single Assessment Numeric Evaluation scores. The mean MRI interval was 12.6 months (range, 12-17 months). A total of 3 of 20 single-row repairs and 3 of 20 double-row repairs (15%) had tears at follow-up MRI. The single-row group had re-tears in 1 single tendon repair and 2 double tendon repairs. All 3 tears failed at the original attachment site (Cho type 1). In the double-row group, re-tears were found in 3 double tendon repairs. All 3 tears failed medial to the medial row near the musculotendinous junction (Cho type 2). All clinical outcome measures were significantly improved from the preoperative level (P < .0001), but there was no statistical difference between groups postoperatively. There is no MRI difference in rotator cuff tendon re-tear rate at 12 months postsurgery between a triple-loaded single-row repair or a suture-bridging double-row repair when both are augmented with platelet-rich plasma fibrin membrane. No difference could be demonstrated between these repairs on clinical outcome scores. I, Prospective randomized study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique.

PubMed

Hirano, Koji; Tokui, Toshiya; Nakamura, Bun; Inoue, Ryosai; Inagaki, Masahiro; Maze, Yasumi; Kato, Noriyuki

2018-01-01

The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

Single molecule techniques in DNA repair: A primer

PubMed Central

Hughes, Craig D.; Simons, Michelle; Mackenzie, Cassidy E.; Van Houten, Bennett; Kad, Neil M.

2016-01-01

A powerful new approach has become much more widespread and offers insights into aspects of DNA repair unattainable with billions of molecules. Single molecule techniques can be used to image, manipulate or characterize the action of a single repair protein on a single strand of DNA. This allows search mechanisms to be probed, and the effects of force to be understood. These physical aspects can dominate a biochemical reaction, where at the ensemble level their nuances are obscured. In this paper we discuss some of the many technical advances that permit study at the single molecule level. We focus on DNA repair to which these techniques are actively being applied. DNA repair is also a process that encompasses so much of what single molecule studies benefit – searching for targets, complex formation, sequential biochemical reactions and substrate hand-off to name just a few. We discuss how single molecule biophysics is poised to transform our understanding of biological systems, in particular DNA repair. PMID:24819596

Full-arch milled titanium implant bridge: technical report.

PubMed

Peché, Wendy-Ann; Van Vuuren, Ludwig Jansen; Park, Chae

2011-09-01

The manufacturing of full-arch fixed implant-supported bridges with the use of the traditional lost wax technique remains a technical challenge. Distortion of the alloy during casting and subsequent heating cycles during porcelain build-up causes numerous problems. Fracturing of porcelain on large restorations is difficult and costly to restore. The fitting problems can be eliminated by utilising CAD/CAM technology in the manufacturing of long-span or full-arch titanium bridges. Repair of damaged porcelain can be simplified with the use of discrete, individually-removable crowns on the bridge.

Serial MRI evaluation following arthroscopic rotator cuff repair in double-row technique.

PubMed

Stahnke, Katharina; Nikulka, Constanze; Diederichs, Gerd; Haneveld, Hendrik; Scheibel, Markus; Gerhardt, Christian

2016-05-01

So far, recurrent rotator cuff defects are described to occur in the early postoperative period after arthroscopic repair. The aim of this study was to evaluate the musculotendinous structure of the supraspinatus, as well as bone marrow edema or osteolysis after arthroscopic double-row repair. Therefore, magnetic resonance (MR) images were performed at defined intervals up to 2 years postoperatively. Case series; Level of evidence, 3. MR imaging was performed within 7 days, 3, 6, 12, 26, 52 and 108 weeks after surgery. All patients were operated using an arthroscopic modified suture bridge technique. Tendon integrity, tendon retraction ["foot-print-coverage" (FPC)], muscular atrophy and fatty infiltration (signal intensity analysis) were measured at all time points. Furthermore, postoperative bone marrow edema and signs of osteolysis were assessed. MR images of 13 non-consecutive patients (6f/7m, ∅ age 61.05 ± 7.7 years) could be evaluated at all time points until ∅ 108 weeks postoperatively. 5/6 patients with recurrent defect at final follow-up displayed a time of failure between 12 and 24 months after surgery. Predominant mode of failure was medial cuff failures in 4/6 cases. The initial FPC increased significantly up to 2 years follow-up (p = 0.004). Evaluations of muscular atrophy or fatty infiltration were not significant different comparing the results of all time points (p > 0.05). Postoperative bone marrow edema disappeared completely at 6 months after surgery, whereas signs of osteolysis appeared at 3 months follow-up and increased to final follow-up. Recurrent defects after arthroscopic reconstruction of supraspinatus tears in modified suture bridge technique seem to occur between 12 and 24 months after surgery. Serial MRI evaluation shows good muscle structure at all time points. Postoperative bone marrow edema disappears completely several months after surgery. Signs of osteolysis seem to appear caused by bio-absorbable anchor

Medial Meniscus Posterior Root Repair Using a Transtibial Technique.

PubMed

Woodmass, Jarret M; Mohan, Rohith; Stuart, Michael J; Krych, Aaron J

2017-06-01

The meniscal roots are critical in maintaining the normal shock absorbing function of the meniscus. If a meniscal root tear is left untreated, meniscal extrusion can occur rendering the meniscus nonfunctional resulting in degenerative arthritis. Two main repair techniques are described: (1) suture anchors (direct fixation) and (2) sutures pulled through a tibial tunnel (indirect fixation). Meniscal root repair using a suture anchor technique is technically challenging requiring a posterior portal and a curved suture passing device that can be difficult to manipulate within the knee. We present a technique for posterior medial meniscus root repair using 3 sutures (1 leader, 2 cinch), standard arthroscopy portals, and transtibial fixation. Overall, this technique simplifies a challenging procedure and allows for familiarity and efficiency.

Dynamic assessment of bridge deck performance considering realistic bridge-traffic interaction

DOT National Transportation Integrated Search

2017-09-01

Concrete bridge decks are directly exposed to daily traffic loads and may experience some surface cracking caused by excessive stress or fatigue accumulation, which requires repair or replacement. Among typical bridges in North America, bridge decks ...

Arthroscopic single-row modified mason-allen repair versus double-row suture bridge reconstruction for supraspinatus tendon tears: a matched-pair analysis.

PubMed

Gerhardt, Christian; Hug, Konstantin; Pauly, Stephan; Marnitz, Tim; Scheibel, Markus

2012-12-01

Arthroscopic double-row fixation of supraspinatus tendon tears compared with single-row techniques is still a matter of debate. Arthroscopic double-row rotator cuff repair using the suture bridge technique provides better clinical results and lower retear rates than does single-row repair using a modified Mason-Allen stitch technique. Cohort study; Level of evidence 3. Forty patients underwent either an arthroscopic single-row modified Mason-Allen stitch (SR) (n = 20; mean age ± SD, 61.5 ± 7.4 y) or a modified suture bridge double-row repair (DR) (n = 20; age, 61.2 ± 7.5 y). The anteroposterior extension was classified as Bateman I in 10% and Bateman II in 90% of patients in the SR group and as Bateman II in 80% and Bateman III in 20% of patients in the DR group. Patients were matched for sex and age. The subjective shoulder value (SSV), Constant-Murley score (CS), and Western Ontario Rotator Cuff Index (WORC) were used for clinical follow-up. Furthermore, MRI scans were conducted for analysis of tendon integrity, muscle atrophy, and fatty infiltration via semiquantitative signal intensity analysis. In addition, re-defect patterns were evaluated. The mean follow-up time in the SR group was 16.8 ± 4.6 months. The mean SSV was 91.0% ± 8.8%, mean CS was 82.2 ± 8.1 (contralateral side, 88.8 ± 5.3), and mean WORC score was 96.5% ± 3.2%. The mean follow-up time in the DR group was 23.4 ± 2.9 months, with patients achieving scores of 92.9% ± 9.6% for the SSV, 77.0 ± 8.6 for the CS (contralateral side, 76.7 ± 17.1), and 90.7% ± 12.6% for the WORC (P > .05). No significant differences were detected in the clinical outcome between groups. Tendon integrity was as follows. Type 1, none in either group; type 2, 4 SR and 5 DR; type 3, 9 SR and 10 DR; type 4, 3 SR and 3 DR; and type 5, 3 SR and 2 DR. The failure rate was 31.6% (n = 6) in the SR group and 25% (n = 5) in the DR group (P > .05). No significant differences were obtained for muscular atrophy or fatty

Biomechanical comparison of single-row arthroscopic rotator cuff repair technique versus transosseous repair technique.

PubMed

Tocci, Stephen L; Tashjian, Robert Z; Leventhal, Evan; Spenciner, David B; Green, Andrew; Fleming, Braden C

2008-01-01

This study determined the effect of tear size on gap formation of single-row simple-suture arthroscopic rotator cuff repair (ARCR) vs transosseous Mason-Allen suture open RCR (ORCR) in 13 pairs of human cadaveric shoulders. A massive tear was created in 6 pairs and a large tear in 7. Repairs were cyclically tested in low-load and high-load conditions, with no significant difference in gap formation. Under low-load, gapping was greater in massive tears. Under high-load, there was a trend toward increased gap with ARCR for large tears. All repairs of massive tears failed in high-load. Gapping was greater posteriorly in massive tears for both techniques. Gap formation of a modeled RCR depends upon the tear size. ARCR of larger tears may have higher failure rates than ORCR, and the posterior aspect appears to be the site of maximum gapping. Specific attention should be directed toward maximizing initial fixation of larger rotator cuff tears, especially at the posterior aspect.

23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

Code of Federal Regulations, 2011 CFR

2011-04-01

... 23 Highways 1 2011-04-01 2011-04-01 false Can bridge maintenance be performed with IRRBP funds... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair of...

23 CFR 661.47 - Can bridge maintenance be performed with IRRBP funds?

Code of Federal Regulations, 2010 CFR

2010-04-01

... ENGINEERING AND TRAFFIC OPERATIONS INDIAN RESERVATION ROAD BRIDGE PROGRAM § 661.47 Can bridge maintenance be performed with IRRBP funds? No. Bridge maintenance repairs, e.g., guard rail repair, deck repairs, repair of... 23 Highways 1 2010-04-01 2010-04-01 false Can bridge maintenance be performed with IRRBP funds...

Bridge deterioration models to support Indiana's bridge management system.

DOT National Transportation Integrated Search

2016-02-01

An effective bridge management system that is equipped with reliable deterioration models enables agency engineers to carry out : monitoring and long-term programming of bridge repair actions. At the project level, deterioration models help the agenc...

Arthroscopic meniscal repair with use of the outside-in technique.

PubMed

Rodeo, S A

2000-01-01

The outside-in technique of arthroscopic repair is effective for repair of most meniscal tears. The overall indications for the use of this technique are similar to those for the commonly used inside-out technique. The outside-in technique is especially useful for suturing the anterior horn of the meniscus as well as for suturing meniscal replacement devices such as a collagen meniscal implant or a meniscal allograft. Other specific advantages of this technique include the ability to predictably avoid neurovascular injury without the need for a large posterior incision. A particular disadvantage is the difficulty of achieving perpendicular orientation of sutures when a tear is adjacent to the site of attachment of the posterior horn. Use of the inside-out technique or an all-inside implant is suggested for these tears. The use of this suturing technique is facilitated by attention to several technical points. The knee should be maintained in flexion for repair of tears of the lateral meniscus (to avoid injury to the peroneal nerve) and in nearly full extension for repair of the posterior aspect of the medial meniscus (to avoid injury to the saphenous nerve and its branches). Care must be taken to avoid tying the sutures around a branch of the saphenous nerve during repair of the medial meniscus. The sutures should be retrieved through a cannula in the anterior portal to avoid the entrapment of the sutures in soft tissue. A probe can be used to prevent displacement of the inner fragment of a bucket handle tear when the needles are placed across the tear, as the entering needles may push the torn fragment into the knee. A vertical suture orientation is preferred in order to evenly co-apt the meniscus to the capsule. If knot-end sutures (so-called Mulberry knots) are used, 2 sutures can be vertically stacked, with 1 on each surface of the meniscus. If a mattress suture is used, a vertical orientation is easily achieved with the outside-in technique. Use of an

Biomechanical characteristics of the horizontal mattress stitch: implication for double-row and suture-bridge rotator cuff repair.

PubMed

Tamboli, Mallika; Mihata, Teruhisa; Hwang, James; McGarry, Michelle H; Kang, Yangmi; Lee, Thay Q

2014-03-01

We investigated the effects of bite-size horizontal mattress stitch (distance between the limbs passed through the tendon) on the biomechanical properties of the repaired tendon. We anchored 20 bovine Achilles tendons to bone using no. 2 high-strength suture and 5-mm titanium suture anchors in a mattress-suture technique. Tendons were allocated randomly into two groups of ten each to receive stitches with a 4- or 10-mm bite. Specimens underwent cyclic loading from 5 to 30 N at 1 mm/s for 30 cycles, followed by tensile testing to failure. Gap formation, tendon strain, hysteresis, stiffness, yield load, ultimate load, energy to yield load, and energy to ultimate load were compared between groups using unpaired t tests. The 4-mm group had less (p < 0.05) gap formation and less (p < 0.05) longitudinal strain than did the 10-mm group. Ultimate load (293.6 vs. 148.9 N) and energy to ultimate load (2,563 vs. 1,472 N-mm) were greater (p < 0.001) for the 10-mm group than the 4-mm group. All tendons repaired with 4-mm suturing failed at the suture-tendon interface, with sutures pulling through the tendon, whereas the suture itself failed before the tendon did in seven of the ten specimens in the 10-mm group. Whereas a 4-mm bite fixed the tendon more tightly but at the cost of decreased ultimate strength, a 10-mm bite conveyed greater ultimate strength but with increased gap and strain. These results suggest that for the conventional double-row repair, small mattress stitches provide a tighter repair, whereas large stitches are beneficial to prevent sutures from pulling through the tendon after surgery. For suture-bridge rotator cuff repair, large stitches are beneficial because the repaired tendon has a higher strength, and the slightly mobile medial knot can be tightened by lateral fixation.

Anatomic deltoid ligament repair with anchor-to-post suture reinforcement: technique tip.

PubMed

Lack, William; Phisitkul, Phinit; Femino, John E

2012-01-01

The deltoid ligament is the primary ligamentous stabilizer of the ankle joint. Both superficial and deep components of the ligament can be disrupted with a rotational ankle fracture, chronic ankle instability, or in late stage adult acquired flatfoot deformity. The role of deltoid ligament repair in these conditions has been limited and its contribution to arthritis is largely unknown. Neglect of the deltoid ligament in the treatment of ankle injuries may be due to difficulties in diagnosis and lack of an effective method for repair. Most acute repair techniques address the superficial deltoid ligament with direct end-to-end repair, fixation through bone tunnels, or suture anchor repair of avulsion injuries. Deep deltoid ligament repair has been described using direct end-to-end repair with sutures, as well as by autograft and allograft tendon reconstruction utilizing various techniques. Newer tenodesis techniques have been described for late reconstruction of both deep and superficial components in patients with stage 4 adult acquired flatfoot deformity. We describe a technique that provides anatomic ligament-to-bone repair of the superficial and deep bundles of the deltoid ligament while reducing the talus toward the medial malleolar facet of the tibiotalar joint with anchor-to-post reinforcement of the ligamentous repair. This technique may protect and allow the horizontally oriented fibers of the deep deltoid ligament to heal with the appropriate resting length while providing immediate stability of the construct.

Prescribing a bridge deck ride quality repair using the South Dakota road profiler and the Dipstick : technical assistance report.

DOT National Transportation Integrated Search

1996-01-01

This report describes how two sophisticated road roughness instruments were used to investigate the feasibility of a bridge deck ride quality repair. The instruments were the South Dakota Road Profiler (SDRP) and the Face Companies' Dipstick. The b...

Animal models of cartilage repair

PubMed Central

Cook, J. L.; Hung, C. T.; Kuroki, K.; Stoker, A. M.; Cook, C. R.; Pfeiffer, F. M.; Sherman, S. L.; Stannard, J. P.

2014-01-01

Cartilage repair in terms of replacement, or regeneration of damaged or diseased articular cartilage with functional tissue, is the ‘holy grail’ of joint surgery. A wide spectrum of strategies for cartilage repair currently exists and several of these techniques have been reported to be associated with successful clinical outcomes for appropriately selected indications. However, based on respective advantages, disadvantages, and limitations, no single strategy, or even combination of strategies, provides surgeons with viable options for attaining successful long-term outcomes in the majority of patients. As such, development of novel techniques and optimisation of current techniques need to be, and are, the focus of a great deal of research from the basic science level to clinical trials. Translational research that bridges scientific discoveries to clinical application involves the use of animal models in order to assess safety and efficacy for regulatory approval for human use. This review article provides an overview of animal models for cartilage repair. Cite this article: Bone Joint Res 2014;4:89–94. PMID:24695750

Numerical simulation of CFRP-repaired reinforced concrete columns.

DOT National Transportation Integrated Search

2014-07-01

The overarching goal of this study was to investigate the influence of repair to individual reinforced concrete bridge columns on the : post-repair seismic performance of the bridge system. A method was developed to rapidly repair an earthquake-damag...

Robotic Posterior Mitral Leaflet Repair: Neochordal versus Resectional Techniques

PubMed Central

Mihaljevic, Tomislav; Pattakos, Gregory; Gillinov, A. Marc; Bajwa, Gurjyot; Planinc, Mislav; Williams, Sarah J.; Blackstone, Eugene H.

2013-01-01

Background Resectional techniques are the established method of posterior mitral valve leaflet repair for degenerative disease; however, use of neochordae in a robotically assisted approach is gaining acceptance because of its versatility for difficult multi-segment disease. The purposes of this study were to compare the versatility, safety, and effectiveness of neochordal vs. resectional techniques for robotic posterior mitral leaflet repair. Methods From 12/2007 to 7/2010, 334 patients underwent robotic posterior mitral leaflet repair for degenerative disease by a resectional (n=248) or neochordal (n=86) technique. Outcomes were compared unadjusted and after propensity score matching. Results Neochordae were more likely to be used than resection in patients with two (28% vs. 13%, P=.002) or three (3.7% vs. 0.87%, P=.08) diseased posterior leaflet segments. Three resection patients (0.98%) but no neochordal patient required reoperation for hemodynamically significant systolic anterior motion (SAM). Residual mitral regurgitation (MR) at hospital discharge was similar for matched neochordal vs. resection patients (P=.14) (MR 0+, 82% vs. 89%; MR 1+, 14% vs. 8.2%; MR 2+, 2.3% vs. 2.6%; one neochordal patient had 4+ MR and was reoperated). Among matched patients, postoperative mortality and morbidity were similarly low. Conclusion Compared with a resectional technique, robotic posterior mitral leaflet repair with neochordae is associated with shorter operative times and no occurrence of SAM. The versatility, effectiveness, and safety of this repair make it a good choice for patients with advanced multi-segment disease. PMID:23103008

Cyclic Testing of the 6-Strand Tang and Modified Lim-Tsai Flexor Tendon Repair Techniques.

PubMed

Kang, Gavrielle Hui-Ying; Wong, Yoke-Rung; Lim, Rebecca Qian-Ru; Loke, Austin Mun-Kitt; Tay, Shian-Chao

2018-03-01

In this study, we compared the Tang repair technique with the 6-strand modified Lim-Tsai repair technique under cyclic testing conditions. Twenty fresh-frozen porcine flexor tendons were randomized into 2 groups for repair with either the modified Lim-Tsai or the Tang technique using Supramid 4-0 core sutures and Ethilon 6-0 epitendinous running suture. The repaired tendons were subjected to 2 stage cyclic loading. The survival rate and gap formation at the repair site were recorded. Tendons repaired by the Tang technique achieved an 80% survival rate. None of the modified Lim-Tsai repairs survived. The mean gap formed at the end of 1000 cycles was 1.09 mm in the Tang repairs compared with 4.15 mm in the modified Lim-Tsai repairs. The Tang repair is biomechanically stronger than the modified Lim-Tsai repair under cyclic loading. The Tang repair technique may exhibit a higher tolerance for active mobilization after surgery with less propensity for gap formation. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evolution of Autologous Chondrocyte Repair and Comparison to Other Cartilage Repair Techniques

PubMed Central

Dewan, Ashvin K.; Gibson, Matthew A.; Elisseeff, Jennifer H.; Trice, Michael E.

2014-01-01

Articular cartilage defects have been addressed using microfracture, abrasion chondroplasty, or osteochondral grafting, but these strategies do not generate tissue that adequately recapitulates native cartilage. During the past 25 years, promising new strategies using assorted scaffolds and cell sources to induce chondrocyte expansion have emerged. We reviewed the evolution of autologous chondrocyte implantation and compared it to other cartilage repair techniques. Methods. We searched PubMed from 1949 to 2014 for the keywords “autologous chondrocyte implantation” (ACI) and “cartilage repair” in clinical trials, meta-analyses, and review articles. We analyzed these articles, their bibliographies, our experience, and cartilage regeneration textbooks. Results. Microfracture, abrasion chondroplasty, osteochondral grafting, ACI, and autologous matrix-induced chondrogenesis are distinguishable by cell source (including chondrocytes and stem cells) and associated scaffolds (natural or synthetic, hydrogels or membranes). ACI seems to be as good as, if not better than, microfracture for repairing large chondral defects in a young patient's knee as evaluated by multiple clinical indices and the quality of regenerated tissue. Conclusion. Although there is not enough evidence to determine the best repair technique, ACI is the most established cell-based treatment for full-thickness chondral defects in young patients. PMID:25210707

Single-row versus double-row rotator cuff repair: techniques and outcomes.

PubMed

Dines, Joshua S; Bedi, Asheesh; ElAttrache, Neal S; Dines, David M

2010-02-01

Double-row rotator cuff repair techniques incorporate a medial and lateral row of suture anchors in the repair configuration. Biomechanical studies of double-row repair have shown increased load to failure, improved contact areas and pressures, and decreased gap formation at the healing enthesis, findings that have provided impetus for clinical studies comparing single-row with double-row repair. Clinical studies, however, have not yet demonstrated a substantial improvement over single-row repair with regard to either the degree of structural healing or functional outcomes. Although double-row repair may provide an improved mechanical environment for the healing enthesis, several confounding variables have complicated attempts to establish a definitive relationship with improved rates of healing. Appropriately powered rigorous level I studies that directly compare single-row with double-row techniques in matched tear patterns are necessary to further address these questions. These studies are needed to justify the potentially increased implant costs and surgical times associated with double-row rotator cuff repair.

Single-Port Laparoscopic Parastomal Hernia Repair with Modified Sugarbaker Technique

PubMed Central

Turingan, Isidro; Zajkowska, Marta; Tran, Kim

2014-01-01

Introduction: Laparoscopic parastomal hernia repair with modified Sugarbaker technique has become increasingly the operation of choice because of its low recurrence rates. This study aimed to assess feasibility, safety, and efficiency of performing the same operation with single-incision laparoscopic surgery. Materials and Methods: All patients referred from March 2010 to February 2013 were considered for single-port laparoscopic repair with modified Sugarbaker technique. A SILS port (Covidien, Norwalk, Connecticut, USA) was used together with conventional straight dissecting instruments and a 5.5- mm/52-cm/30° laparoscope. Important technical aspects include modified dissection techniques, namely, “inline” and “chopsticks” to overcome loss of triangulation, insertion of a urinary catheter into an ostomy for ostomy limb identification, safe adhesiolysis by avoiding electocautery, saline -jet dissection to demarcate tissue planes, dissection of an entire laparotomy scar to expose incidental incisional hernias, adequate mobilization of an ostomy limb for lateralization, and wide overlapping of defect with antiadhesive mesh. Results: Of 6 patients, 5 underwent single-port laparoscopic repair, and 1 (whose body mass index [BMI] of 39.4 kg/m2 did not permit SILS port placement) underwent multiport repair. Mean defect size was 10 cm, and mean mesh size was 660 cm2 with 4 patients having incidental incisional hernias repaired by the same mesh. Mean operation time was 270 minutes, and mean hospital stay was 4 days. Appliance malfunction ceased immediately, and pain associated with parastomal hernia disappeared. There was no recurrence with a follow-up of 2 to 36 months. Conclusion: Compared with multiport repair, single-port laparoscopic parastomal repair with modified Sugarbaker technique is safe and efficient, and it may eventually become the standard of care. PMID:24680140

Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

PubMed

Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

2013-11-01

Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Arthroscopically Assisted Reconstruction of Acute Acromioclavicular Joint Dislocations: Anatomic AC Ligament Reconstruction With Protective Internal Bracing—The “AC-RecoBridge” Technique

PubMed Central

Izadpanah, Kaywan; Jaeger, Martin; Ogon, Peter; Südkamp, Norbert P.; Maier, Dirk

2015-01-01

An arthroscopically assisted technique for the treatment of acute acromioclavicular joint dislocations is presented. This pathology-based procedure aims to achieve anatomic healing of both the acromioclavicular ligament complex (ACLC) and the coracoclavicular ligaments. First, the acromioclavicular joint is reduced anatomically under macroscopic and radiologic control and temporarily transfixed with a K-wire. A single-channel technique using 2 suture tapes provides secure coracoclavicular stabilization. The key step of the procedure consists of the anatomic repair of the ACLC (“AC-Reco”). Basically, we have observed 4 patterns of injury: clavicular-sided, acromial-sided, oblique, and midportion tears. Direct and/or transosseous ACLC repair is performed accordingly. Then, an X-configured acromioclavicular suture tape cerclage (“AC-Bridge”) is applied under arthroscopic assistance to limit horizontal clavicular translation to a physiological extent. The AC-Bridge follows the principle of internal bracing and protects healing of the ACLC repair. The AC-Bridge is tightened on top of the repair, creating an additional suture-bridge effect and promoting anatomic ACLC healing. We refer to this combined technique of anatomic ACLC repair and protective internal bracing as the “AC-RecoBridge.” A detailed stepwise description of the surgical technique, including indications, technical pearls and pitfalls, and potential complications, is given. PMID:26052493

Repair techniques for celion/LARC-160 graphite/polyimide composite structures

NASA Technical Reports Server (NTRS)

Jones, J. S.; Graves, S. R.

1984-01-01

The large stiffness-to-weight and strength-to-weight ratios of graphite composite in combination with the 600 F structural capability of the polyimide matrix can reduce the total structure/TPS weight of reusable space vehicles by 20-30 percent. It is inevitable that with planned usage of GR/PI structural components, damage will occur either in the form of intrinsic flaw growth or mechanical damage. Research and development programs were initiated to develop repair processes and techniques specific to Celion/LARC-160 GR/PI structure with emphasis on highly loaded and lightly loaded compression critical structures for factory type repair. Repair processes include cocure and secondary bonding techniques applied under vacuum plus positive autoclave pressure. Viable repair designs and processes are discussed for flat laminates, honeycomb sandwich panels, and hat-stiffened skin-stringer panels. The repair methodology was verified through structural element compression tests at room temperature and 315 C (600 F).

Transverse joint configuration development and testing for a modular bridge deck replacement system.

DOT National Transportation Integrated Search

2011-03-01

According to the 2009 Report Card for Americas Infrastructure, one in four of the nations bridges are listed as : structurally deficient of functionally obsolete, establishing a dire need for new and innovative repair and replacement : techniqu...

Primary Sutureless Repair Using Biatrial Incision: Suture-And-Open Technique.

PubMed

Kim, Hyungtae; Sung, Si Chan; Choi, Kwang Ho; Lee, Hyoung Doo; Kim, Geena; Ko, Hoon

2018-06-08

We used a suture-and-open technique with a biatrial incision for primary sutureless repair of total anomalous pulmonary venous connection (TAPVC). With this technique, the common pulmonary venous sinus and its branching pulmonary veins are opened after completion of suturing of the left atrial incision to the pericardium around the common pulmonary venous sinus and its branching veins. The technique allows the primary sutureless repair of TAPVC to be done in a less bloody field under full-flow cardiopulmonary bypass. We have performed this technique in our recent 5 consecutive TAPVC patients without significant complications. Copyright © 2018. Published by Elsevier Inc.

Innovative slide repair techniques guidebook for Missouri.

DOT National Transportation Integrated Search

2011-09-01

Soil slides often require immediate action to keep traffic moving safely. This study will : focus on developing newer (innovative) approaches to evaluate slope failures and : provide cost-effective repair and mitigation techniques. Typically slides a...

Arthroscopic trans-osseous rotator cuff repair

PubMed Central

Chillemi, Claudio; Mantovani, Matteo

2017-01-01

Summary Background: Mechanical factors are at the basis of any tendon healing process, being pressure an aspect able to positively influence it. For this reason transosseous rotator cuff repair represents the gold standard procedure for patients affected by a cuff tear, maximizing the tendon footprint contact area and reducing motion at the tendon to bone interface. Methods: The Authors present an all arthroscopic suture bridge-like transosseous repair with the preparation of a single transosseous tunnel perfor med thanks to a precise dedicated instrument (Compasso®) and one implant (Elite-SPK®) with the use of only 3 suture wires. In addition this technique permits to accurately prepare the bony side of the lesion without any risk or complication, such as anchor pull-out and greater tuberosity bone osteolysis. Conclusions: However, even if this technique seems less demanding, the arthroscopic transosseous repair is still an advanced procedure, and should be performed only by well prepared arthroscopic shoulder surgeons. Level of evidence: V. PMID:28717607

A very simple technique to repair Grynfeltt-Lesshaft hernia.

PubMed

Solaini, Leonardo; di Francesco, F; Gourgiotis, S; Solaini, Luciano

2010-08-01

A very simple technique to repair a superior lumbar hernia is described. The location of this type of hernia, also known as the Grynfeltt-Lesshaft hernia, is defined by a triangle placed in the lumbar region. An unusual case of a 67-year-old woman with a superior lumbar hernia is reported. The diagnosis was made by physical examination. The defect of the posterior abdominal wall was repaired with a polypropylene dart mesh. The patient had no evidence of recurrence at 11 months follow up. The surgical approach described in this paper is simple and easy to perform, and its result is comparable with other techniques that are much more sophisticated. No cases on the use of dart mesh to repair Grynfeltt-Lesshaft hernia have been reported by surgical journals indexed in PubMed.

Laparoscopic Repair of Ileal Conduit Parastomal Hernia Using the Sling Technique

PubMed Central

Chand, Bipan

2008-01-01

Laparoscopic parastomal hernia repair has become a viable option to overcome the challenges that face the hernia surgeon. Multiple techniques have been described over the last 5 years, one of which is the lateralizing “sling” technique, first described by Sugarbaker in1980. In this study, we report the technique and our early results with the laparoscopic modified Sugarbaker repair of parastomal hernias after ileal conduit. PMID:18435893

The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex.

PubMed

Park, Hyung Joo; Kim, Kyung Soo

2016-09-01

Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t -test or Wilcoxon signed rank tests. The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair.

Repair of a complete radial tear in the midbody of the medial meniscus using a novel crisscross suture transtibial tunnel surgical technique: a case report.

PubMed

James, Evan W; LaPrade, Christopher M; Feagin, John A; LaPrade, Robert F

2015-09-01

Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. An emphasis on meniscal preservation is important in order to restore native meniscal function. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. This technique secured the anterior and posterior meniscal horns, which were released from their extruded and scarred position along the capsule, using crisscrossing sutures passed through two transtibial tunnels and secured over a bone bridge on the anterolateral tibia. In addition, the repair was supplemented with the injection of platelet-rich plasma and bone marrow aspirate concentrate to promote the healing of the meniscal tissue. Complete healing on second-look arthroscopy is presented, including in the previously unreported white-white meniscal zone.

Predictors of outcomes after arthroscopic transosseous equivalent rotator cuff repair in 155 cases: a propensity score weighted analysis of knotted and knotless self-reinforcing repair techniques at a minimum of 2 years.

PubMed

Millett, Peter J; Espinoza, Chris; Horan, Marilee P; Ho, Charles P; Warth, Ryan J; Dornan, Grant J; Christoph Katthagen, J

2017-10-01

To evaluate the outcomes of two commonly used transosseous-equivalent (TOE) arthroscopic rotator cuff repair (RCR) techniques for full-thickness supraspinatus tendon tears (FTST) using a robust multi-predictor model. 155 shoulders in 151 patients (109 men, 42 women; mean age 59 ± 10 years) who underwent arthroscopic RCR of FTST, using either a knotted suture bridging (KSB) or a knotless tape bridging (KTB) TOE technique were included. ASES and SF-12 PCS scores assessed at a minimum of 2 years postoperatively were modeled using propensity score weighting in a multiple linear regression model. Patients able to return to the study center underwent a follow-up MRI for evaluation of rotator cuff integrity. The outcome data were available for 137 shoulders (88%; n = 35/41 KSB; n = 102/114 KTB). Seven patients (5.1%) that underwent revision rotator cuff surgery were considered failures. The median postoperative ASES score of the remaining 130 shoulders was 98 at a mean follow-up of 2.9 years (range 2.0-5.4 years). A higher preoperative baseline outcome score and a longer follow-up had a positive effect, whereas a previous RCR and workers' compensation claims (WCC) had a negative effect on final ASES or SF 12 PCS scores. The repair technique, age, gender and the number of anchors used for the RCR had no significant influence. Fifty-two patients returned for a follow-up MRI at a mean of 4.4 years postoperatively. Patients with a KSB RCR were significantly more likely to have an MRI-diagnosed full-thickness rotator cuff re-tear (p < 0.05). Excellent outcomes can be achieved at a minimum of 2 years following arthroscopic KSB or KTB TOE RCR of FTST. The preoperative baseline outcome score, a prior RCR, WCC and the length of follow-up significantly influenced the outcome scores. The repair technique did not affect the final functional outcomes, but patients with KTB TOE RCR were less likely to have a full-thickness rotator cuff re-tear. Level III, Retrospective

The effectiveness of the bone bridge transtibial amputation technique: A systematic review of high-quality evidence.

PubMed

Kahle, Jason T; Highsmith, M Jason; Kenney, John; Ruth, Tim; Lunseth, Paul A; Ertl, Janos

2017-06-01

This literature review was undertaken to determine if commonly held views about the benefits of a bone bridge technique are supported by the literature. Four databases were searched for articles pertaining to surgical strategies specific to a bone bridge technique of the transtibial amputee. A total of 35 articles were identified as potential articles. Authors included methodology that was applied to separate topics. Following identification, articles were excluded if they were determined to be low quality evidence or not pertinent. Nine articles were identified to be pertinent to one of the topics: Perioperative Care, Acute Care, Subjective Analysis and Function. Two articles sorted into multiple topics. Two articles were sorted into the Perioperative Care topic, 4 articles sorted into the Acute Care topic, 2 articles into the Subjective Analysis topic and 5 articles into the Function topic. There are no high quality (level one or two) clinical trials reporting comparisons of the bone bridge technique to traditional methods. There is limited evidence supporting the clinical outcomes of the bone bridge technique. There is no agreement supporting or discouraging the perioperative and acute care aspects of the bone bridge technique. There is no evidence defining an interventional comparison of the bone bridge technique. Current level III evidence supports a bone bridge technique as an equivalent option to the non-bone bridge transtibial amputation technique. Formal level I and II clinical trials will need to be considered in the future to guide clinical practice. Clinical relevance Clinical Practice Guidelines are evidence based. This systematic literature review identifies the highest quality evidence to date which reports a consensus of outcomes agreeing bone bridge is as safe and effective as alternatives. The clinical relevance is understanding bone bridge could additionally provide a mechanistic advantage for the transtibial amputee.

The sandwich technique for repair of pectus carinatum and excavatum/carinatum complex

PubMed Central

Kim, Kyung Soo

2016-01-01

Background Simple external compression of pectus carinatum seems to have its limitations, particularly the repair of asymmetric pectus carinatum or excavatum/carinatum complex. We devised the sandwich technique (press-molding) to remodel the entire chest wall. The purpose of this study is to introduce the sandwich technique and appraise the early results. Methods Between January 2007 and January 2016, 523 consecutive patients with pectus carinatum and its variants were analyzed retrospectively. No patients were excluded during the study period. The sandwich 1 and 2 techniques using the internal and external pectus bars were for pectus carinatum repair. Modified techniques using the external string and the internal bar were to treat the lower costal flare (the flare-buster) and focal protuberances (the magic string) in pectus excavatum repair. Statistical analyses were carried out using paired and unpaired t-test or Wilcoxon signed rank tests. Results The sandwich repair with the external and internal bars was applied to 58 pectus carinatum patients: seven symmetric (12.1%), 14 asymmetric (24.1%), and 37 carinatum-excavatum complex (63.8%). After pectus excavatum repair, 426 patients had the flare-buster and 39 patients received the magic string. The sandwich 1 technique achieved near-complete resolution of carinatum in 52 patients (86.2%). The sandwich 2 technique accomplished almost symmetric configuration with no residual carinatum in all six cases. Conclusions The sandwich technique using the external and internal bars seems to be effective in treating asymmetric pectus carinatum and complex excavatum/carinatum deformities. The flare-buster and the magic string effectively relieve the costal flare and focal protuberances in pectus excavatum repair. PMID:27747176

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

PubMed

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

Biliary access in technically difficult biliary cannulation: the mucosal bridge technique

PubMed Central

Thomas, Rebecca; Shah, Suhaila Rizal; Worthley, Christopher S

2009-01-01

Background: The use of precut sphincterotomy during endoscopic retrograde cholangiopancreatography (ERCP) facilitates selective bile duct access in difficult procedures. However, it is also associated with high rates of complications. Several techniques for precut sphincterotomy have been described in the literature. This paper reports our experience with a non-needle-knife technique for precut sphincterotomy, namely, the mucosal bridge technique. Methods: We analysed the experience of a single surgical endoscopist at our centre in performing precut sphincterotomies by retrospectively examining information in the database for January 2002 to February 2008, which had been stored prospectively using Endoscribe. Results: The mucosal bridge technique was performed in 16 (3.19%) of 501 patients. Success rates were 75% and 100% after first and second ERCPs, respectively. The failure of initial procedures was caused by bleeding, tissue oedema, poorly visualized papilla or a poorly distensible duodenum and oedematous papilla. There were four cases of complications, which included periductular extravasation of contrast, bleeding, and sepsis in two patients. However, these complications were not a direct consequence of the precut sphincterotomy. Conclusions: The mucosal bridge technique can be used to increase the likelihood of successful bile duct cannulation, thus preventing the need for a second intervention. PMID:19590645

One trocar needlescopic assisted inguinal hernia repair in children: a novel technique.

PubMed

Shalaby, Rafik; Elsayaad, Ibrahim; Alsamahy, Omar; Ibrahem, Refaat; El-Saied, Adham; Ismail, Maged; Shamseldin, Abdelmoniem; Shehata, Sameh; Magid, Mohamad

2017-08-31

Inguinal hernia repair using a percutaneous internal ring suturing technique is an effective alternative technique to conventional laparoscopic hernia repair. It is one of the most commonly used approaches for laparoscopic hernia repair in children. However, most percutaneous techniques have utilized extracorporeal knotting of the suture and burying the knot subcutaneously. This approach has several drawbacks. The aim of this study is to present a modified technique for single cannula needlescopic assisted hernia repair in children. Three-hundred and fifty-seven patients with 397 indirect inguinal hernias underwent a one port needlescopic assisted inguinal hernia repair. The open internal inguinal ring [IIR] was closed using an 18-gauge epidural needle [EN], a 14-gauge venous access cannula [VAC], and a homemade suture device. Saline was injected extraperitoneally around the IIR for hydrodissection. The main outcome measurements were: feasibility, safety of the technique, operative time, recurrence rate, and cosmetic results. This prospective study was conducted on 357 patients at Al-Azhar, Alexandria, and Mansoura University Hospitals during the period from June 2012 to October 2015. There were 286 males and 71 females. The mean age was 2.6±1.3years (range=4months to 6years). One-hundred and ninety-eight patients presented with a right-sided inguinal hernia, 119 patients with a left-sided hernia, and 40 patients with bilateral inguinal hernia. The mean operative time was 12.6±1.7min (range=8-15min) for unilateral cases and 18.6±1.7min (range=14-20min) for the bilateral repairs. No wound complications or umbilical hernias developed. The mean follow-up period was 18.6±1.2months (range=11-36months). During the follow-up period, no recurrence was detected, and the scars were nearly invisible. This preliminary study shows that a single port needlescopic assisted hernia repair in infants and children is a very promising technique to achieve nearly scarless surgery

Diagnostic evaluation and repair of deteriorated concrete bridges.

DOT National Transportation Integrated Search

2004-12-01

Concrete bridge deck degradation has been observed in several bridges located in north Mississippi. In this study a : survey was conducted to collect and document instances of deterioration in concrete bridges located throughout the State. The : main...

Integrating modal-based NDE techniques and bridge management systems using quality management

NASA Astrophysics Data System (ADS)

Sikorsky, Charles S.

1997-05-01

The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.

Key Royale bridge five year evaluation : [summary].

DOT National Transportation Integrated Search

2013-06-01

The Florida Department of Transportation (FDOT) : maintains more than 6,500 bridges. Considering : the expense of repair and replacement of bridges, : extending their durability and service life is : important. Of special concern for bridges in : mar...

Diagnostic evaluation and repair of deteriorated concrete bridges

DOT National Transportation Integrated Search

2004-12-01

Concrete bridge deck degradation has been observed in several bridges located in north Mississippi. In this study a survey was conducted to collect and document instances of deterioration in concrete bridges located throughout the State. The main cau...

[TECHNIQUES IN MITRAL VALVE REPAIR VIA A MINIMALLY INVASIVE APPROACH].

PubMed

Ito, Toshiaki

2016-03-01

In mitral valve repair via a minimally invasive approach, resection of the leaflet is technically demanding compared with that in the standard approach. For resection and suture repair of the posterior leaflet, premarking of incision lines is recommended for precise resection. As an alternative to resection and suture, the leaflet-folding technique is also recommended. For correction of prolapse of the anterior leaflet, neochordae placement with the loop technique is easy to perform. Premeasurement with transesophageal echocardiography or intraoperative measurement using a replica of artificial chordae is useful to determine the appropriate length of the loops. Fine-tuning of the length of neochordae is possible by adding a secondary fixation point on the leaflet if the loop is too long. If the loop is too short, a CV5 Gore-Tex suture can be passed through the loop and loosely tied several times to stack the knots, with subsequent fixation to the edge of the leaflet. Finally, skill in the mitral valve replacement technique is necessary as a back-up for surgeons who perform minimally invasive mitral valve repair.

Mitral valve repair: an echocardiographic review: Part 2.

PubMed

Maslow, Andrew

2015-04-01

Echocardiographic imaging of the mitral valve before and immediately after repair is crucial to the immediate and long-term outcome. Prior to mitral valve repair, echocardiographic imaging helps determine the feasibility and method of repair. After the repair, echocardiographic imaging displays the new baseline anatomy, assesses function, and determines whether or not further management is necessary. Three-dimensional imaging has improved the assessment of the mitral valve and facilitates communication with the surgeon by providing the surgeon with an image that he/she might see upon opening up the atrium. Further advancements in imaging will continue to improve the understanding of the function and dysfunction of the mitral valve both before and after repair. This information will improve treatment options, timing of invasive therapies, and advancements of repair techniques to yield better short- and long-term patient outcomes. The purpose of this review was to connect the echocardiographic evaluation with the surgical procedure. Bridging the pre- and post-CPB imaging with the surgical procedure allows a greater understanding of mitral valve repair.

Repair-oriented classification of aortic insufficiency: impact on surgical techniques and clinical outcomes.

PubMed

Boodhwani, Munir; de Kerchove, Laurent; Glineur, David; Poncelet, Alain; Rubay, Jean; Astarci, Parla; Verhelst, Robert; Noirhomme, Philippe; El Khoury, Gébrine

2009-02-01

Valve repair for aortic insufficiency requires a tailored surgical approach determined by the leaflet and aortic disease. Over the past decade, we have developed a functional classification of AI, which guides repair strategy and can predict outcome. In this study, we analyze our experience with a systematic approach to aortic valve repair. From 1996 to 2007, 264 patients underwent elective aortic valve repair for aortic insufficiency (mean age - 54 +/- 16 years; 79% male). AV was tricuspid in 171 patients bicuspid in 90 and quadricuspid in 3. One hundred fifty three patients had type I dysfunction (aortic dilatation), 134 had type II (cusp prolapse), and 40 had type III (restrictive). Thirty six percent (96/264) of the patients had more than one identified mechanism. In-hospital mortality was 1.1% (3/264). Six patients experienced early repair failure; 3 underwent re-repair. Functional classification predicted the necessary repair techniques in 82-100% of patients, with adjunctive techniques being employed in up to 35% of patients. Mid-term follow up (median [interquartile range]: 47 [29-73] months) revealed a late mortality rate of 4.2% (11/261, 10 cardiac). Five year overall survival was 95 +/- 3%. Ten patients underwent aortic valve reoperation (1 re-repair). Freedoms from recurrent Al (>2+) and from AV reoperation at 5 years was 88 +/- 3% and 92 +/- 4% respectively and patients with type I (82 +/- 9%; 93 +/- 5%) or II (95 +/- 5%; 94 +/- 6%) had better outcomes compared to type III (76 +/- 17%; 84 +/- 13%). Aortic valve repair is an acceptable therapeutic option for patients with aortic insufficiency. This functional classification allows a systematic approach to the repair of Al and can help to predict the surgical techniques required as well as the durability of repair. Restrictive cusp motion (type III), due to fibrosis or calcification, is an important predictor for recurrent Al following AV repair.

Research notes : repairing cracked bridges with plastic.

DOT National Transportation Integrated Search

2006-07-01

Oregon has many reinforced concrete bridges built from the late 40s to the early 60s that now exhibit diagonal cracks in the concrete girders. The general assumption is that the load carrying capacity of the concrete and therefore the bridge is reduc...

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique.

PubMed

Mook, William R; Greenspoon, Joshua A; Millett, Peter J

2016-01-01

Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

Concrete bridge deck condition assessment and improvement strategies.

DOT National Transportation Integrated Search

2004-11-01

The aging and deterioration of bridges in Utah mandates increasingly cost-effective strategies for bridge maintenance, rehabilitation, and repair (MR&R). Although the substructures and superstructures of bridges in Utah are in relatively good structu...

Eversion-Inversion Labral Repair and Reconstruction Technique for Optimal Suction Seal.

PubMed

Moreira, Brett; Pascual-Garrido, Cecilia; Chadayamurri, Vivek; Mei-Dan, Omer

2015-12-01

Labral tears are a significant cause of hip pain and are currently the most common indication for hip arthroscopy. Compared with labral debridement, labral repair has significantly better outcomes in terms of both daily activities and athletic pursuits in the setting of femoral acetabular impingement. The classic techniques described in the literature for labral repair all use loop or pass-through intrasubstance labral sutures to achieve a functional hip seal. This hip seal is important for hip stability and optimal joint biomechanics, as well as in the prevention of long-term osteoarthritis. We describe a novel eversion-inversion intrasubstance suturing technique for labral repair and reconstruction that can assist in restoration of the native labrum position by re-creating an optimal seal around the femoral head.

Self-repair of cracks in brittle material systems

NASA Astrophysics Data System (ADS)

Dry, Carolyn M.

2016-04-01

One of the most effective uses for self repair is in material systems that crack because the cracks can allow the repair chemical to flow into the crack damage sites in all three dimensions. In order for the repair chemical to stay in the damage site and flow along to all the crack and repair there must be enough chemical to fill the entire crack. The repair chemical must be designed appropriately for the particular crack size and total volume of cracks. In each of the three examples of self repair in crackable brittle systems, the viscosity and chemical makeup and volume of the repair chemicals used is different for each system. Further the chemical delivery system has to be designed for each application also. Test results from self repair of three brittle systems are discussed. In "Self Repair of Concrete Bridges and Infrastructure" two chemicals were used due to different placements in bridges to repair different types of cracks- surface shrinkage and shear cracks, In "Airplane Wings and Fuselage, in Graphite" the composite has very different properties than the concrete bridges. In the graphite for airplane components the chemical also had to survive the high processing temperatures. In this composite the cracks were so definite and deep and thin that the repair chemical could flow easily and repair in all layers of the composite. In "Ceramic/Composite Demonstrating Self Repair" the self repair system not only repaired the broken ceramic but also rebounded the composite to the ceramic layer

Preservation treatment for wood bridge application

Treesearch

Jake Bigelow; Stan Lebow; Carol A. Clausen; Lowell Greimann; Terry J. Wipf

2009-01-01

Timber can often be a cost-effective construction material for new bridges. The durability of the bridge greatly depends on proper attention to construction details and fabrication, as well as proper preservative treatment before, during, and after construction. Material repair and replacement costs for bridges are a considerable expense for highway agencies. To...

Guidelines to restoring structural integrity of covered bridge members

Treesearch

Ronald W. Anthony

2018-01-01

These guidelines are designed for decision makers (selectmen, county commissioners, city planners, preservation officers, etc.) that have responsibility for repairing and maintaining existing covered bridges to help them understand what goes into making effective decisions about how, and when, to repair a covered bridge. The purpose of these guidelines is to present...

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

PubMed Central

Mook, William R.; Greenspoon, Joshua A.; Millett, Peter J.

2016-01-01

Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results: The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion: Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears. PMID:27733881

A Novel Technique of Posterolateral Suturing in Thoracoscopic Diaphragmatic Hernia Repair

PubMed Central

Boo, Yoon Jung; Rohleder, Stephan; Muensterer, Oliver J.

2017-01-01

Background  Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. Case  We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic approach. The posterolateral part of the defect was repaired by percutaneous transcostal suturing and extracorporeal knot tying. To assure correct placement of the sutures and knots, a Tuohy needle was used to guide the suture around the rib and out through the same subcutaneous tract. The total operative time was 145 minutes and there were no perioperative complications. The patient was followed up for 3 months, during which there was no recurrence. Conclusion  Our percutaneous Tuohy technique for closure of the posterolateral part of CDH enables a secure, rapid, and tensionless repair. PMID:28804698

A Novel Technique of Posterolateral Suturing in Thoracoscopic Diaphragmatic Hernia Repair.

PubMed

Boo, Yoon Jung; Rohleder, Stephan; Muensterer, Oliver J

2017-01-01

Background  Closure of the posterolateral defect in some cases of congenital diaphragmatic hernia (CDH) can be difficult. Percutaneous transcostal suturing is often helpful to create a complete, watertight closure of the diaphragm. A challenge with the technique is passing the needle out the same tract that it entered so that no skin is caught when the knots are laid down into the subcutaneous tissue. This report describes a novel technique using a Tuohy needle to percutaneously suture the posterolateral defect during thoracoscopic repair of CDH. Case  We report a case of a 6-week-old infant who presented with a CDH and ipsilateral intrathoracic kidney that was repaired using thoracoscopic approach. The posterolateral part of the defect was repaired by percutaneous transcostal suturing and extracorporeal knot tying. To assure correct placement of the sutures and knots, a Tuohy needle was used to guide the suture around the rib and out through the same subcutaneous tract. The total operative time was 145 minutes and there were no perioperative complications. The patient was followed up for 3 months, during which there was no recurrence. Conclusion  Our percutaneous Tuohy technique for closure of the posterolateral part of CDH enables a secure, rapid, and tensionless repair.

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure: An Early Feasibility Cohort Study.

PubMed

Murray, Martha M; Flutie, Brett M; Kalish, Leslie A; Ecklund, Kirsten; Fleming, Braden C; Proffen, Benedikt L; Micheli, Lyle J

2016-11-01

This study assessed the safety of the newly developed bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR), which involves suture repair of the ligament combined with a bioactive scaffold to bridge the gap between the torn ligament ends. As the intra-articular environment is complex in its response to implanted materials, this study was designed to determine whether there would be a significant rate of adverse reaction to the implanted scaffold. The primary hypothesis was that the implanted scaffold would not result in a deep joint infection (arthrocentesis with positive culture) or significant inflammation (clinical symptoms justifying arthrocentesis but negative culture). The secondary hypotheses were that patients treated with BEAR would have early postoperative outcomes that were similar to patients treated with ACL reconstruction with an autologous hamstring graft. Cohort study; Level of evidence, 2. A total of 20 patients were enrolled in this nonrandomized, first-in-human study. Ten patients received BEAR treatment and 10 received a hamstring autograft ACL reconstruction. The BEAR procedure was performed by augmenting a suture repair with a proprietary scaffold, the BEAR scaffold, placed in between the torn ends of the ACL at the time of suture repair. The BEAR scaffold is to our knowledge the only device that fills the gap between the torn ligament ends to have current Investigational Device Exemption approval from the Food and Drug Administration. Ten milliliters of autologous whole blood were added to the scaffold prior to wound closure. Outcomes were assessed at 3 months postoperatively. The outcomes measures included postoperative pain, muscle atrophy, loss of joint range of motion, and implant failure (designated by an International Knee Documentation Committee grade C or D Lachman test and/or an absence of continuous ACL tissue on magnetic resonance images). There were no joint infections or signs of significant inflammation in either group

Anterior cruciate ligament repair - past, present and future.

PubMed

Mahapatra, Piyush; Horriat, Saman; Anand, Bobby S

2018-06-15

This article provides a detailed narrative review on the history and current concepts surrounding ligamentous repair techniques in athletic patients. In particular, we will focus on the anterior cruciate ligament (ACL) as a case study in ligament injury and ligamentous repair techniques. PubMed (MEDLINE), EMBASE and Cochrane Library databases for papers relating to primary anterior cruciate ligament reconstruction were searched by all participating authors. All relevant historical papers were included for analysis. Additional searches of the same databases were made for papers relating to biological enhancement of ligament healing. The poor capacity of the ACL to heal is one of the main reasons why the current gold standard surgical treatment for an ACL injury in an athletic patient is ACL reconstruction with autograft from either the hamstrings or patella tendon. It is hypothesised that by preserving and repairing native tissues and negating the need for autograft that primary ACL repair may represent a key step change in the treatment of ACL injuries. The history of primary ACL repair will be discussed and the circumstances that led to the near-abandonment of primary ACL repair techniques will be reviewed. There has been a recent resurgence in interest with regards to primary ACL repair. Improvements in imaging now allow for identification of tear location, with femoral-sided injuries, being more suitable for repair. We will discuss in details strategies for improving the mechanical and biological environment in order to allow primary healing to occur. In particular, we will explain mechanical supplementation such as Internal Brace Ligament Augmentation and Dynamic Intraligamentary Stabilisation techniques. These are novel techniques that aim to protect the primary repair by providing a stabilising construct that connects the femur and the tibia, thus bridging the repair. In addition, biological supplementation is being investigated as an adjunct and we will

Outcome Comparison Between in Situ Repair Versus Tear Completion Repair for Partial Thickness Rotator Cuff Tears.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Bae, Sung-Ho; Jin, Hyonki; Song, Hyun Seok

2015-11-01

To compare the clinical outcomes of arthroscopic in situ repair with the tear completion repair technique for partial-thickness rotator cuff tears (PT-RCTs). We prospectively enrolled 100 cases with articular-sided and bursal-sided PT-RCTs exceeding 50% of tendon thickness and allocated them randomly. An in situ repair was performed in group 1 (n = 50). Completion of the remaining cuff tissue and repair were performed in group 2 (n = 50). The medial row was knotted as transosseous repair (suture-bridge technique) in all cases. American Shoulder Elbow Society (ASES) score, Constant shoulder (CS) score, Simple shoulder (SS) score, and Korean shoulder (KS) score, and visual analog scale (VAS) for pain and range of motion were assessed at 3, 6, and 12 months and at the last visit. Repaired tendon integrity was determined at 6 to 12 months by magnetic resonance imaging. Eight cases were lost to follow-up. Ultimately, 92 cases were analyzed. The average follow-up was 19.1 months (range, 12 to 42 months). Significant improvements in the VAS for pain and functional outcomes were observed in both groups postoperatively (P = .001 for VAS; P < .001 for ASES score; P < .001 for CS score; P = .001 for SS score; P<.001 for KS score). No significant difference in the clinical results was observed at any time between the groups. No difference of retear rate on articular-sided PT-RCT was observed between the groups (P = .34). Retears on the bursal-sided PT-RCT were more frequent in group 2 (P = .02). Arthroscopic repair of PT-RCT exceeding 50% of the thickness provided functional improvements and pain relief regardless of the repair technique. The retear rate for bursal-sided PT-RCT was higher in group 2, although the retear rate for the articular-sided PT-RCT was not different. Level II, prospective comparative study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row.

PubMed

Mall, Nathan A; Lee, Andrew S; Chahal, Jaskarndip; Van Thiel, Geoffrey S; Romeo, Anthony A; Verma, Nikhil N; Cole, Brian J

2013-02-01

Double-row and transosseous-equivalent repair techniques have shown greater strength and improved healing than single-row techniques. The purpose of this study was to determine whether tying of the medial-row sutures provides added stability during biomechanical testing of a transosseous-equivalent rotator cuff repair. We performed a systematic review of studies directly comparing biomechanical differences. Five studies met the inclusion and exclusion criteria. Of the 5 studies, 4 showed improved biomechanical properties with tying the medial-row anchors before bringing the sutures laterally to the lateral-row anchors, whereas the remaining study showed no difference in contact pressure, mean failure load, or gap formation with a standard suture bridge with knots tied at the medial row compared with knotless repairs. The results of this systematic review and quantitative synthesis indicate that the biomechanical factors ultimate load, stiffness, gap formation, and contact area are significantly improved when medial knots are tied as part of a transosseous-equivalent suture bridge construct compared with knotless constructs. Further studies comparing the clinical healing rates and functional outcomes between medial knotted and knotless repair techniques are needed. This review indicates that biomechanical factors are improved when the medial row of a transosseous-equivalent rotator cuff is tied compared with a knotless repair. However, this has not been definitively proven to translate to improved healing rates clinically. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Sportsmen’s Groin—Diagnostic Approach and Treatment With the Minimal Repair Technique

PubMed Central

Muschaweck, Ulrike; Berger, Luise Masami

2010-01-01

Context: Sportsmen’s groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms. Methods: The authors developed an innovative open suture repair—the Minimal Repair technique—to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures. Results: The following advantages of the Minimal Repair technique were found: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median). Conclusion: The Minimal Repair technique is an effective and safe way to treat sportsmen’s groin. PMID:23015941

Use of electrochemical chloride extraction and associated repairs to extend the beneficial life of reinforced concrete substructures.

DOT National Transportation Integrated Search

2016-05-01

One of the biggest causes of bridge deterioration is corrosion of the reinforcement in concrete structures. Therefore, repair : techniques that mitigate corrosion and extend the service life of reinforced concrete are of great value to the Virginia D...

Exploration Challenges: Transferring Ground Repair Techniques to Space Flight Application

NASA Technical Reports Server (NTRS)

McLemore, Carole A.; Kennedy, James P.; Rose, Frederick A.; Evans, Brian W.

2007-01-01

Fulfilling NASA's Vision for Space Exploration will demand an extended presence in space at distances from our home planet that exceed our current experience in space logistics and maintenance. The ability to perform repairs in lieu of the customary Orbital Replacement Unit (ORU) process where a faulty part is replaced will be elevated from contingency to routine to sustain operations. The use and cost effectiveness of field repairs for ground based operations in industry and the military have advanced with the development of technology in new materials, new repair techniques and new equipment. The unique environments, accessibility constraints and Extra Vehicular Activity (EVA) issues of space operations will require extensive assessment and evolution of these technologies to provide an equivalent and expected level of assurance to mission success. Challenges include the necessity of changes in design philosophy and policy, extremes in thermal cycling, disruptive forces (such as static charge and wind entrainment) on developed methods for control of materials, dramatically increased volatility of chemicals for cleaning and other compounds due to extremely low pressures, the limits imposed on dexterity and maneuverability by current EVA equipment and practices, and the necessity of unique verification methodology. This paper describes these challenges in and discusses the effects on the established ground techniques for repair. The paper also describes the leading repair methodology candidates and their beneficial attributes for resolving these issues with the evolution of technology.

Overview of existing cartilage repair technology.

PubMed

McNickle, Allison G; Provencher, Matthew T; Cole, Brian J

2008-12-01

Currently, autologous chondrocyte implantation and osteochondral grafting bridge the gap between palliation of cartilage injury and resurfacing via arthroplasty. Emerging technologies seek to advance first generation techniques and accomplish several goals including predictable outcomes, cost-effective technology, single-stage procedures, and creation of durable repair tissue. The biologic pipeline represents a variety of technologies including synthetics, scaffolds, cell therapy, and cell-infused matrices. Synthetic constructs, an alternative to biologic repair, resurface a focal chondral defect rather than the entire joint surface. Scaffolds are cell-free constructs designed as a biologic "net" to augment marrow stimulation techniques. Minced cartilage technology uses stabilized autologous or allogeneic fragments in 1-stage transplantation. Second and third generation cell-based methods include alternative membranes, chondrocyte seeding, and culturing onto scaffolds. Despite the promising early results of these products, significant technical obstacles remain along with unknown long-term durability. The vast array of developing technologies has exceptional promise and the potential to revolutionize the cartilage treatment algorithm within the next decade.

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study.

PubMed

Black, James C; Ricci, William M; Gardner, Michael J; McAndrew, Christopher M; Agarwalla, Avinesh; Wojahn, Robert D; Abar, Orchid; Tang, Simon Y

2016-12-01

Patellar tendon ruptures commonly are repaired using transosseous patellar drill tunnels with modified-Krackow sutures in the patellar tendon. This simple suture technique has been associated with failure rates and poor clinical outcomes in a modest proportion of patients. Failure of this repair technique can result from gap formation during loading or a single catastrophic event. Several augmentation techniques have been described to improve the integrity of the repair, but standardized biomechanical evaluation of repair strength among different techniques is lacking. The purpose of this study was to describe a novel figure-of-eight suture technique to augment traditional fixation and evaluate its biomechanical performance. We hypothesized that the augmentation technique would (1) reduce gap formation during cyclic loading and (2) increase the maximum load to failure. Ten pairs (two male, eight female) of fresh-frozen cadaveric knees free of overt disorders or patellar tendon damage were used (average donor age, 76 years; range, 65-87 years). For each pair, one specimen underwent the standard transosseous tunnel suture repair with a modified-Krackow suture technique and the second underwent the standard repair with our experimental augmentation method. Nine pairs were suitable for testing. Each specimen underwent cyclic loading while continuously measuring gap formation across the repair. At the completion of cyclic loading, load to failure testing was performed. A difference in gap formation and mean load to failure was seen in favor of the augmentation technique. At 250 cycles, a 68% increase in gap formation was seen for the control group (control: 5.96 ± 0.86 mm [95% CI, 5.30-6.62 mm]; augmentation: 3.55 ± 0.56 mm [95% CI, 3.12-3.98 mm]; p = 0.02). The mean load to failure was 13% greater in the augmentation group (control: 899.57 ± 96.94 N [95% CI, 825.06-974.09 N]; augmentation: 1030.70 ± 122.41 N [95% CI, 936.61-1124.79 N]; p = 0.01). This biomechanical

Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques.

PubMed

Sherman, Seth L; Copeland, Marilyn E; Milles, Jeffrey L; Flood, David A; Pfeiffer, Ferris M

2016-06-01

To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model. Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading. The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel. Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques. Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to

A modified repair technique for tricuspid incompetence in Ebstein's anomaly.

PubMed

Hetzer, R; Nagdyman, N; Ewert, P; Weng, Y G; Alexi-Meskhisvili, V; Berger, F; Pasic, M; Lange, P E

1998-04-01

A modified technique for tricuspid valve repair in Ebstein's anomaly restructures the valve mechanism at the level of the true tricuspid anulus by using the most mobile leaflet for valve closure without plication of the atrialized chamber. Midterm results of this therapeutic approach for patients with Ebstein's anomaly and tricuspid valve incompetence are reported. Between October 1988 and April 1997, the incompetent tricuspid valve was repaired with our technique in 19 patients (12 female, 7 male; 2 to 54 years, mean 21 years). The indication for operation was congestive heart failure of various degrees in all patients. Tricuspid incompetence was grade II in two patients, grade III in 14, and grade IV in three. Associated congenital malformations were simultaneously repaired (interatrial communication in 18, ventricular septal defect in two, pulmonary stenosis in two, mitral valve prolapse in one). Follow-up ranged between 10 and 103 months (median 28 months) and was complete for all patients. There were no operative deaths. One patient with active endocarditis and pulmonary abscess died 2 months after the operation of recurrent sepsis; there were no late deaths. During follow-up, New York Heart Association functional class improved from 2.8 before the operation to 1.9 without recurrent cyanosis, and tricuspid incompetence decreased from a mean grade of 3.1 to one of 0.9, without any echocardiographic deterioration of the tricuspid valve function or right ventricular dilation. Our technique allows tricuspid valve repair in patients with Ebstein's anomaly, even in cases usually reserved for primary valve replacement, without late functional deterioration.

Quantitative Feedback Technique (QFT): Bridging the Gap

DTIC Science & Technology

2003-05-01

with Eq. (2) illustrates: (a) the effect of changes of the uncertainty set P(s) upon the output of the closed -loop control system is reduced by the...Bridging the Gap root-locus technique the dominant closed -loop poles are determined for a ζ= 0.45. Table 3 presents the required value of Kx and...degree of decoupling will have been enhanced. Method 1 is then more readily applicable, with the additional benefit of reduced closed -loop BW. E.R.2

Patch-augmented rotator cuff repair: influence of the patch fixation technique on primary biomechanical stability.

PubMed

Jung, Christian; Spreiter, Gregor; Audigé, Laurent; Ferguson, Stephen J; Flury, Matthias

2016-05-01

There is an ongoing debate about the potential of patch augmentation to improve biomechanical stability and healing associated with rotator cuff repair. The biomechanical properties of three different patch-augmented rotator cuff repair techniques were assessed in vitro and compared with a standard repair. Dermal collagen patch augmentation may increase the primary stability and strength of the repaired tendon in vitro, depending on the technique used for patch application. Forty cadaveric sheep shoulders with dissected infraspinatus tendons were randomized into four groups (n = 10/group) for tendon repair using a knotless double-row suture anchor technique. A xenologous dermal extracellular matrix patch was used for augmentation in the three test groups using an "integrated", "cover", or "hybrid" technique. Tendons were preconditioned, cyclically loaded from 10 to 30 N at 1 Hz, and then loaded monotonically to failure. Biomechanical properties and the mode of failure were evaluated. Patch augmentation significantly increased the maximum load at failure by 61 % in the "cover" technique test group (225.8 N) and 51 % in the "hybrid" technique test group (211.4 N) compared with the non-augmented control group (140.2 N) (P ≤ 0.015). For the test group with "integrated" patch augmentation, the load at failure was 28 % lower (101.6 N) compared with the control group (P = 0.043). There was no significant difference in initial and linear stiffness among the four experimental groups. The most common mode of failure was tendon pullout. No anchor dislocation, patch disruption or knot breakage was observed. Additional patch augmentation with a collagen patch influences the biomechanical properties of a rotator cuff repair in a cadaveric sheep model. Primary repair stability can be significantly improved depending on the augmentation technique.

Two-stage repair with long channel technique for primary severe hypospadias.

PubMed

Yang, Tianyou; Xie, Qigen; Liang, Qifeng; Xu, Yeqing; Su, Cheng

2014-07-01

To introduce a 2-stage repair with long channel technique for primary severe hypospadias. Between March 2010 and November 2013, 16 children with primary severe hypospadias underwent 2-stage repair with long channel technique. The technique applied in the first stage was almost the same as Bracka 2-stage repair. The second stage was usually performed 6 months later. A small transverse skin incision, distal to the meatal opening and about 1 cm in length, was made. Dissection was carried out deep into the surface of corpora cavernosa and a plane between the subcutaneous tissue and corpora cavernosa was reached. A long channel between the subcutaneous tissue and corpora cavernosa was created from the para-meatus incision to the apex of glans. A rectangle, pedicle scrotal septal skin flap was elevated and tubularized into neourethra around a stenting tube. The neourethra was delivered through the subcutaneous channel and fixed at the apex of glans. The mean operation time of the first and second stages was 65 and 55 minutes, respectively. The mean age at the first and second operation was 28 and 36 months, respectively. The mean follow-up was 10 months. No fistula, glans dehiscence, urethral stricture, and meatal stenosis were recorded. One scrotal surgical wound infection occurred after second stage and healed successfully with antibiotics treatment. The overall cosmetic and functional outcomes after second stage were excellent. Two-stage repair with long channel technique was applicable for primary severe hypospadias, with excellent short-term outcomes. Copyright © 2014 Elsevier Inc. All rights reserved.

Eccentric circummeatal based flap with limited urethral mobilization: An easy technique for distal hypospadias repair.

PubMed

Ekinci, Saniye; Çiftçi, Arbay Özden; Karnak, İbrahim; Şenocak, Mehmet Emin

2016-04-01

Hypospadias is a common congenital anomaly. Over 300 techniques have been described for repairing hypospadias. Eccentric circummeatal based flap with combined limited urethral mobilization technique (ECMB-LUM) is a simple procedure to repair distal hypospadias with minimal complication rate. This study presents results of this technique, highlighting surgical pitfalls to achieve the best result. Medical records of patients with distal hypospadias operated on using the same technique between 1998 and 2011 were reviewed retrospectively. Age at surgery, position of meatus preoperatively and postoperatively, duration of urethral catheterization and hospitalization, early and late complications, previous hypospadias repairs, and secondary surgical interventions were evaluated. In the surgical technique an eccentric circummeatal based flap is outlined. The proximal part of the flap is dissected from the underlying urethra and Buck's fascia. If the flap is not long enough, the distal urethra is mobilized a few millimeters (Figure). The eccentric flap is sutured to the tip of the glans. The glans wings are approximated in the midline. A urethral catheter of 6 Fr or 8 Fr is passed and left in the bulbous urethra or the urinary bladder. Diverged limbs of corpus spongiosum are approximated on the urethra, then, the glans and skin of the penile shaft are sutured. Of the 171 consecutive patients operated on using the ECMB-LUM technique; 115 had coronal, 47 had subcoronal, and nine had glanular meatus. The mean age at surgery was 4.5 (1-17) years. Patients were hospitalized for 2.2 ± 0.7 days. Mean duration of urethral catheterization was 2.3 ± 0.5 days. All but eight patients had ECBF-LUM as primary repair. There were no early complications such as bleeding, hematoma, and wound infection. All patients voided spontaneously after catheter removal. Late complications were meatal stenosis, urethrocutaneous fistula, meatal regression, and glandular dehiscence (Table). These

Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears.

PubMed

Wellmann, Mathias; Wiebringhaus, Philipp; Lodde, Ina; Waizy, Hazibullah; Becher, Christoph; Raschke, Michael J; Petersen, Wolf

2009-12-01

The purpose of the study was to compare a single-row repair and a double-row repair technique for the specific characteristics of a complete subscapularis lesion. Ten pairs of human cadaveric shoulder human shoulder specimens were tested for stiffness and ultimate tensile strength of the intact tendons in a load to failure protocol. After a complete subscapularis tear was provoked, the specimens were assigned to two treatment groups: single-row repair (1) and a double-row repair using a "suture bridge" technique (2). After repair cyclic loading a subsequent load to failure protocol was performed to determine the ultimate tensile load, the stiffness and the elongation behaviour of the reconstructions. The intact subscapularis tendons had a mean stiffness of 115 N/mm and a mean ultimate load of 720 N. The predominant failure mode of the intact tendons was a tear at the humeral insertion site (65%). The double-row technique restored 48% of the ultimate load of the intact tendons (332 N), while the single-row technique revealed a significantly lower ultimate load of 244 N (P = 0.001). In terms of the stiffness, the double-row technique showed a mean stiffness of 81 N/mm which is significantly higher compared to the stiffness of the single-row repairs of 55 N/mm (P = 0.001). The double-row technique has been shown to be stronger and stiffer when compared to a conventional single-row repair. Therefore, this technique is recommended from a biomechanical point of view irrespectively if performed by an open or arthroscopic approach.

Graft Utilization in the Bridging Reconstruction of Irreparable Rotator Cuff Tears: A Systematic Review.

PubMed

Lewington, Matthew R; Ferguson, Devin P; Smith, T Duncan; Burks, Robert; Coady, Catherine; Wong, Ivan Ho-Bun

2017-11-01

Rotator cuff tears are one of the most common conditions affecting the shoulder. Because of the difficulty in managing massive rotator cuff tears and the inability of standard techniques to prevent arthropathy, surgeons have developed several novel techniques to improve outcomes and ideally alter the natural history. To systematically review the existing literature and analyze reported outcomes to evaluate the effectiveness of using a bridging graft reconstruction technique to treat large to massive irreparable rotator cuff tears. Systematic review. A systematic search of PubMed, EMBASE, CINAHL, and CENTRAL was employed with the key terms "tear," "allograft," and "rotator cuff." Eligibility was determined by a 3-phase screening process according to the outlined inclusion/exclusion criteria. Data in relation to the primary and secondary outcomes were summarized. The results were synthesized according to the origin of the graft and the level of evidence. Fifteen studies in total were included in this review: 2 comparative studies and 13 observational case series. Both the biceps tendon and the fascia lata autograft groups had significantly superior structural integrity rates on magnetic resonance imaging at 12-month minimum follow-up when compared with their partial primary repair counterparts (58% vs 26%, P = .036; 79% vs 58%, P < .05), respectively. Multiple noncomparative case series investigating allografts, xenografts, and synthetic materials for bridging reconstruction of large to massive rotator cuff tears demonstrated high structural healing rates (74%-90%, 73%-100%, and 60%-90%, respectively). Additionally, both comparative studies and case series demonstrated a general improvement of patients' functional outcome scores. Using a graft for an anatomic bridging rotator cuff repair results in improved function on objective testing and may be functionally better than nonanatomic or partial repair of large to massive rotator cuff tears. Allograft or xenograft

Repair of lesser tuberosity osteotomy for shoulder arthroplasty: biomechanical evaluation of the Backpack and Dual Row techniques.

PubMed

Heckman, Daniel S; Hoover, Stephen A; Weinhold, Paul S; Spang, Jeffrey T; Creighton, R Alexander

2011-04-01

Subscapularis dysfunction following total shoulder arthroplasty can result in permanent loss of function. The lesser tuberosity osteotomy (LTO) has been proposed as a method which utilizes bone-to-bone healing to improve subscapularis function. This study evaluates the biomechanical properties of two described techniques for LTO repair. We hypothesized that a Dual Row repair would be stronger and demonstrate less cyclic displacement than a Backpack repair. Ten matched pairs of cadaveric humeri were dissected, leaving the subscapularis intact, and a lesser tuberosity osteotomy was performed. Matched shoulders were randomized to either a Backpack repair or a Dual Row repair. Repairs were subjected to cyclic loading to 180 N for 500 cycles, followed by ramp-up loading to ultimate failure. Clinical failure was defined as displacement >5 mm after 500 cycles. Displacement after 500 cycles was significantly greater for the Backpack repair (6.9 mm) than for the Dual Row repair (4.6 mm) (P = .007). Most displacement occurred on the first cycle (Backpack, 4.6 mm; Dual Row, 2.1 mm) (P < .001). There was a trend toward a higher clinical failure rate for the Backpack repair (8/10) than the Dual Row repair (3/10). Ultimate tensile strength was significantly greater for the Dual Row repair (632.3 N) than for the Backpack repair (510.9 N) (P = .01). The Dual Row technique is significantly stronger and demonstrates less cyclic displacement than the Backpack technique. Clinical studies are needed to determine the impact of LTO repair technique on subscapularis function following shoulder arthroplasty. Copyright © 2011. Published by Mosby, Inc.

Repair vs replacement of direct composite restorations: a survey of teaching and operative techniques in Oceania.

PubMed

Brunton, Paul A; Ghazali, Amna; Tarif, Zahidah H; Loch, Carolina; Lynch, Christopher; Wilson, Nairn; Blum, Igor R

2017-04-01

To evaluate the teaching and operative techniques for the repair and/or replacement of direct resin-based composite restorations (DCRs) in dental schools in Oceania. A 14-item questionnaire was mailed to the heads of operative dentistry in 16 dental schools in Oceania (Australia, New Zealand, Fiji and Papua New Guinea). The survey asked whether the repair of DCRs was taught within the curriculum; the rationale behind the teaching; how techniques were taught, indications for repair, operative techniques, materials used, patient acceptability, expected longevity and recall systems. All 16 schools participated in the study. Thirteen (81%) reported the teaching of composite repairs as an alternative to replacement. Most schools taught the theoretical and practical aspects of repair at a clinical level only. All 13 schools (100%) agreed on tooth substance preservation being the main reason for teaching repair. The main indications for repair were marginal defects (100%), followed by secondary caries (69%). All 13 schools that performed repairs reported high patient acceptability, and considered it a definitive measure. Only three schools (23%) claimed to have a recall system in place following repair of DCRs. Most respondents either did not know or did not answer when asked about the longevity of DCRs. Repair of DCRs seems to be a viable alternative to replacement, which is actively taught within Oceania. Advantages include it being minimally invasive, preserving tooth structure, and time and money saving. However, standardised guidelines need to be developed and further clinical long-term studies need to be carried out. The decision between replacing or repairing a defective composite restoration tends to be based on what clinicians have been taught, tempered by experience and judgement. This study investigated the current status of teaching and operative techniques of repair of direct composite restorations in dental schools in Oceania. Copyright © 2017 Elsevier Ltd

Evaluation of pile repair splice design.

DOT National Transportation Integrated Search

2015-12-01

The Oregon Department of Transportation (ODOT) Major Bridge Maintenance Engineer has proposed an in-house pile repair scheme for decayed piles. This repair scheme involves removing decayed area within the pile leaving a 2 outer shell, filling it u...

Investigations of a precast bridge deck system.

DOT National Transportation Integrated Search

2010-07-01

Improved methods of bridge deck construction are greatly needed. Bridge decks are often the first element to require repair or replacement because of its direct exposure to the elements and tire wear. This report presents a new precast overhang syste...

Durham Smith Vest-Over-Pant Technique: Simple Procedure for a Complex Problem (Post-Hypospadias Repair Fistula).

PubMed

Gite, Venkat A; Patil, Saurabh R; Bote, Sachin M; Siddiqui, Mohd Ayub Karam Nabi; Nikose, Jayant V; Kandi, Anitha J

2017-01-01

Urethrocutaneous fistula, which occurs after hypospadias surgery, is often a baffling problem and its treatment is challenging. The study aimed to evaluate the results of the simple procedure (Durham Smith vest-over-pant technique) for this complex problem (post-hypospadias repair fistula). During the period from 2011 to 2015, 20 patients with post-hypospadias repair fistulas underwent Durham Smith repair. Common age group was between 5 and 12 years. Site wise distribution of fistula was coronal 2 (10%), distal penile 7 (35%), mid-penile 7 (35%), and proximal-penile 4 (20%). Out of 20 patients, 15 had fistula of size <5 mm (75%) and 5 patients had fistula of size >5 mm (25%). All cases were repaired with Durham Smith vest-over-pant technique by a single surgeon. In case of multiple fistulas adjacent to each other, all fistulas were joined to form single fistula and repaired. We have successfully repaired all post-hypospadias surgery urethrocutaneous fistulas using the technique described by Durham Smith with 100% success rate. Durham Smith vest-over-pant technique is a simple solution for a complex problem (post hypospadias surgery penile fistulas) in properly selected patients. © 2017 S. Karger AG, Basel.

Biomechanical Performance of Medial Row Suture Placement Relative to the Musculotendinous Junction in Transosseous Equivalent Suture Bridge Double-Row Rotator Cuff Repair.

PubMed

Virk, Mandeep S; Bruce, Benjamin; Hussey, Kristen E; Thomas, Jacqueline M; Luthringer, Tyler A; Shewman, Elizabeth F; Wang, Vincent M; Verma, Nikhil N; Romeo, Anthony A; Cole, Brian J

2017-02-01

To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model. A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system. The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RCT group (100; P = .07) because 3 specimens failed in the MTJ group during cyclic loading. There were no significant differences between the 2 study groups with respect to biomechanical properties during the load to failure testing. In a cadaveric TOE-SB DR RCR model, medial row sutures through the MTJ results in a significantly higher rate of medial row failure. In rotator cuff tears with tendon tissue loss, passage of medial row sutures through the MTJ should be avoided in a TOE-SB RCR technique because of the risk of medial row failure. Copyright © 2016. Published by Elsevier Inc.

Linear beam raster magnet driver based on H-bridge technique

DOEpatents

Sinkine, Nikolai I.; Yan, Chen; Apeldoorn, Cornelis; Dail, Jeffrey Glenn; Wojcik, Randolph Frank; Gunning, William

2006-06-06

An improved raster magnet driver for a linear particle beam is based on an H-bridge technique. Four branches of power HEXFETs form a two-by-two switch. Switching the HEXFETs in a predetermined order and at the right frequency produces a triangular current waveform. An H-bridge controller controls switching sequence and timing. The magnetic field of the coil follows the shape of the waveform and thus steers the beam using a triangular rather than a sinusoidal waveform. The system produces a raster pattern having a highly uniform raster density distribution, eliminates target heating from non-uniform raster density distributions, and produces higher levels of beam current.

[Plug-technique for umbilical hernia repair in the adult].

PubMed

Brancato, G; Privitera, A; Gandolfo, L; Donati, M; Caglià, P

2002-02-01

Umbilical hernia represents 6% of all abdominal wall hernias in the adult. Surgical repair should always be carried out due to possible occurrence of complications. Aim of this paper is to evaluate the efficacy of the plug-technique. From October 1995 to April 2000, the authors performed 21 operations for acquired umbilical hernia with a defect smaller than 4 cm. Local anesthesia was used and a light intravenous sedation added in particularly anxious patients. The repair was achieved by insertion of a polypropylene dart plug sutured to the margins of the hernial defect. All patients were up and about straightaway and were discharged within 24 hours of surgery. Postoperative pain was mild and required hospital analgesia in only 19% of cases and domiciliary analgesia in 24%. During a follow-up ranging from 6 to 60 months (mean 30), only one recurrence has been recorded. This tension-free technique allows immediate rehabilitation, with few complications and a low recurrence rate.

Use of electrochemical chloride extraction and associated repairs to extend the beneficial life of reinforced concrete substructures: VCTIR report detail.

DOT National Transportation Integrated Search

2016-01-01

One of the biggest causes of bridge deterioration is corrosion of the reinforcement in concrete structures. Therefore, repair techniques that mitigate corrosion and extend the service life of reinforced concrete are of great value to the Virginia Dep...

Note: A non-invasive electronic measurement technique to measure the embedded four resistive elements in a Wheatstone bridge sensor

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ravelo Arias, S. I.; Ramírez Muñoz, D.; Cardoso, S.

2015-06-15

The work shows a measurement technique to obtain the correct value of the four elements in a resistive Wheatstone bridge without the need to separate the physical connections existing between them. Two electronic solutions are presented, based on a source-and-measure unit and using discrete electronic components. The proposed technique brings the possibility to know the mismatching or the tolerance between the bridge resistive elements and then to pass or reject it in terms of its related common-mode rejection. Experimental results were taken in various Wheatstone resistive bridges (discrete and magnetoresistive integrated bridges) validating the proposed measurement technique specially when themore » bridge is micro-fabricated and there is no physical way to separate one resistive element from the others.« less

Laparoscopic bridging vs. anatomic open reconstruction for midline abdominal hernia mesh repair [LABOR]: single-blinded, multicenter, randomized, controlled trial on long-term functional results.

PubMed

Stabilini, Cesare; Bracale, Umberto; Pignata, Giusto; Frascio, Marco; Casaccia, Marco; Pelosi, Paolo; Signori, Alessio; Testa, Tommaso; Rosa, Gian Marco; Morelli, Nicola; Fornaro, Rosario; Palombo, Denise; Perotti, Serena; Bruno, Maria Santina; Imperatore, Mikaela; Righetti, Carolina; Pezzato, Stefano; Lazzara, Fabrizio; Gianetta, Ezio

2013-10-28

Re-approximation of the rectal muscles along the midline is recommended by some groups as a rule for incisional and ventral hernia repairs. The introduction of laparoscopic repair has generated a debate because it is not aimed at restoring abdominal wall integrity but instead aims just to bridge the defect. Whether restoration of the abdominal integrity has a real impact on patient mobility is questionable, and the available literature provides no definitive answer. The present study aims to compare the functional results of laparoscopic bridging with those of re-approximation of the rectal muscle in the midline as a mesh repair for ventral and incisional abdominal defect through an "open" access. We hypothesized that, for the type of defect suitable for a laparoscopic bridging, the effect of an anatomical reconstruction is near negligible, thus not a fixed rule. The LABOR trial is a multicenter, prospective, two-arm, single-blinded, randomized trial. Patients of more than 60 years of age with a defect of less than 10 cm at its greatest diameter will be randomly submitted to open Rives or laparoscopic defect repair. All the participating patients will have a preoperative evaluation of their abdominal wall strength and mobility along with volumetry, respiratory function test, intraabdominal pressure and quality of life assessment.The primary outcome will be the difference in abdominal wall strength as measured by a double leg-lowering test performed at 12 months postoperatively. The secondary outcomes will be the rate of recurrence and changes in baseline abdominal mobility, respiratory function tests, intraabdominal pressure, CT volumetry and quality of life at 6 and 12 months postoperatively. The study will help to define the most suitable treatment for small-medium incisional and primary hernias in patients older than 60 years. Given a similar mid-term recurrence rate in both groups, if the trial shows no differences among treatments (acceptance of the null

Small-strain measurement in bridge connections using the digital image correlation (DIC) technique

NASA Astrophysics Data System (ADS)

Desai, Niranjan

2016-04-01

Structural health monitoring (SHM) is emerging as a vital tool to help civil engineers improve the safety, maintainability, and reliability of critical structures and assists infrastructure owners with timely information for the continued safe and economic operation of their structure. SHM involves implementing a strategy that identifies and characterizes damage or undesirable performance in engineering structures. The goal of this research project was to determine the smallest strains measurable using standard digital image correlation (DIC) based SHM equipment. This practical investigation that had strong ties to the industry was motivated by damage observed in a real-world bridge, which was initially undetected. Its early detection would have led to reduced repair costs. To accomplish the aforementioned goal, tests were performed on a laboratory specimen that replicated a steel beam-to-column connection of the concerned bridge, involving progressively loading it in a manner in which it was loaded in the actual bridge, while simultaneously measuring the strains that developed in it using the aforementioned DIC-based equipment and software. Under the controlled conditions in the laboratory, the minimum resolution of the state-of-the-art system used in this investigation was determined. Due to the challenges faced in making these small-strain measurements even under highly controlled laboratory conditions, it was concluded that it is currently unrealistic to use the existing DIC technology in a real-world situation to measure strains as small as those that would need to be measured to detect the onset of damage in bridge connections. More work needs to be done in this area.

Development of flexural vibration inspection techniques to rapidly assess the structural health of rural bridge systems

Treesearch

Brian K. Brashaw; Robert Vatalaro; Xiping Wang; Kevin Sarvela; James P. Wacker

2008-01-01

Approximately 4,000 vehicle bridges in the State of Minnesota contain structural timber members. Recent research at the University of Minnesota Duluth Natural Resources Research Institute (UMD NRRI) has been conducted on vibration testing of timber bridges as a means of developing rapid in-place testing techniques for assessing the structural health of bridges. The...

Laparoscopic Pediatric Inguinal Hernia Repair: Overview of "True Herniotomy" Technique and Review of Current Evidence.

PubMed

Feehan, Brendan P; Fromm, David S

2017-05-01

Inguinal hernia repair is one of the most commonly performed operations in the pediatric population. While the majority of pediatric surgeons routinely use laparoscopy in their practices, a relatively small number prefer a laparoscopic inguinal hernia repair over the traditional open repair. This article provides an overview of the three port laparoscopic technique for inguinal hernia repair, as well as a review of the current evidence with respect to visualization and identification of hernias, recurrence rates, operative times, complication rates, postoperative pain, and cosmesis. The laparoscopic repair presents a viable alternative to open repair and offers a number of benefits over the traditional approach. These include superior visualization of the relevant anatomy, ability to assess and repair a contralateral hernia, lower rates of metachronous hernia, shorter operative times in bilateral hernia, and the potential for lower complication rates and improved cosmesis. This is accomplished without increasing recurrence rates or postoperative pain. Further research comparing the different approaches, including standardization of techniques and large randomized controlled trials, will be needed to definitively determine which is superior. Copyright© South Dakota State Medical Association.

Outcomes after Ventral Hernia Repair Using the Rives-Stoppa, Endoscopic, and Open Component Separation Techniques.

PubMed

Muse, Thomas O; Zwischenberger, Brittany A; Miller, M Troy; Borman, Daniel A; Davenport, Daniel L; Roth, J Scott

2018-03-01

Complex ventral hernias remain a challenge for general surgeons despite advances in minimally invasive surgical techniques. This study compares outcomes following Rives-Stoppa (RS) repair, components separation technique with mesh (CST-M) or without mesh (CST), and endoscopic components separation technique (ECST). A retrospective review of patients undergoing open ventral hernia repair between 2006 and 2011 was performed. Analysis included patient demographics, surgical site occurrences, hernia recurrence, hospital readmission, and mortality. The search was limited to open repairs, specifically the RS, CST-M, CST, and ECST with mesh techniques. A total of 362 patients underwent repair with RS (66), CST-M (126), CST (117), or ECST (53). The groups were demographically similar. ECST was more frequently used for patients with a history of two or more recurrences (P < 0.001). The RS method had the lowest rate of recurrence (9.1%) compared with CST and CST-M with 28 and 25 per cent recurrences, respectively (P = 0.011). The RS recurrence rate was not significantly different than ECST (15%). There were no significant differences between groups for surgical site occurrences (P = 0.305), hospital readmission (P = 0.288), or death (P = 0.197). When components separation is necessary for complex ventral hernia repair, ECST is a viable option without added morbidity or mortality.

Innovative chimney-graft technique for endovascular repair of a pararenal abdominal aortic aneurysm.

PubMed

Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A; Krajcer, Zvonimir

2015-02-01

After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta.

One-Step Cartilage Repair Technique as a Next Generation of Cell Therapy for Cartilage Defects: Biological Characteristics, Preclinical Application, Surgical Techniques, and Clinical Developments.

PubMed

Zhang, Chi; Cai, You-Zhi; Lin, Xiang-Jin

2016-07-01

To provide a comprehensive overview of the basic science rationale, surgical technique, and clinical outcomes of 1-step cartilage repair technique used as a treatment strategy for cartilage defects. A systematic review was performed in the main medical databases to evaluate the several studies concerning 1-step procedures for cartilage repair. The characteristics of cell-seed scaffolds, behavior of cells seeded into scaffolds, and surgical techniques were also discussed. Clinical outcomes and quality of repaired tissue were assessed using several standardized outcome assessment tools, magnetic resonance imaging scans, and biopsy histology. One-step cartilage repair could be divided into 2 types: chondrocyte-matrix complex (CMC) and autologous matrix-induced chondrogenesis (AMIC), both of which allow a simplified surgical approach. Studies with Level IV evidence have shown that 1-step cartilage repair techniques could significantly relieve symptoms and improve functional assessment (P < .05, compared with preoperative evaluation) at short-term follow-up. Furthermore, magnetic resonance imaging showed that 76% cases in all included case series showed at least 75% defect coverage in each lesion, and 3 studies clearly showed hyaline-like cartilage tissue in biopsy tissues by second-look arthroscopy. The 1-step cartilage repair technique, with its potential for effective, homogeneous distribution of chondrocytes and multipotent stem cells on the surface of the cartilage defect, is able to regenerate hyaline-like cartilage tissue, and it could be applied to cartilage repair by arthroscopy. Level IV, systematic review of Level II and IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions.

PubMed

Spiegl, Ulrich J; Smith, Sean D; Todd, Jocelyn N; Coatney, Garrett A; Wijdicks, Coen A; Millett, Peter J

2014-08-01

Single- and double-row arthroscopic reconstruction techniques for acute bony Bankart lesions have been described in the literature. The double-row fixation technique would provide superior reduction and stability of a simulated bony Bankart lesion at time zero in a cadaveric model compared with the single-row technique. Controlled laboratory study. Testing was performed on 14 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. The quality of fracture reduction was measured with a coordinate measuring machine. To determine the biomechanical stability of the repairs, specimens were preconditioned with 10 sinusoidal cycles between 5 and 25 N at 0.1 Hz and then pulled to failure in the anteromedial direction at a rate of 5 mm/min. Loads at 1 mm and 2 mm of fracture displacement were determined. The double-row technique required significantly higher forces to achieve fracture displacements of 1 mm (mean, 60.6 N; range, 39.0-93.3 N; P = .001) and 2 mm (mean, 94.4 N; range, 43.4-151.2 N; P = .004) than the single-row technique (1 mm: mean, 30.2 N; range, 14.0-54.1 N and 2 mm: mean, 63.7 N; range, 26.6-118.8 N). Significantly reduced fracture displacement was seen after double-row repair for both the unloaded condition (mean, 1.1 mm; range, 0.3-2.4 mm; P = .005) and in response to a 10-N anterior force applied to the defect (mean, 1.6 mm; range, 0.5-2.7 mm; P = .001) compared with single-row repair (unloaded: mean, 2.1 mm; range, 1.3-3.4 mm and loaded: mean, 3.4 mm; range, 1.9-4.7 mm). The double-row fixation technique resulted in improved fracture reduction and superior stability at time zero in this cadaveric model. This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols

Atrioventricular valve repair in patients with single-ventricle physiology: mechanisms, techniques of repair, and clinical outcomes.

PubMed

Honjo, Osami; Mertens, Luc; Van Arsdell, Glen S

2011-01-01

Significant atrioventricular (AV) valve insufficiency in patient with single ventricle-physiology is strongly associated with poor survival. Herein we discuss the etiology and mechanism of development of significant AV valve insufficiency in patients with single-ventricle physiology, surgical indication and repair techniques, and clinical outcomes along with our 10-year surgical experience. Our recent clinical series and literature review indicate that it is of prime importance to appreciate the high incidence and clinical effect of the structural abnormalities of AV valve. Valve repair at stage II palliation may minimize the period of volume overload, thereby potentially preserving post-repair ventricular function. Since 85% of the AV valve insufficiency was associated with structural abnormalities, inspection of an AV valve that has more than mild to moderate insufficiency is recommended because they are not likely to be successfully treated with volume unloading surgery alone. Copyright © 2011 Elsevier Inc. All rights reserved.

Patient selection, echocardiographic screening and treatment strategies for interventional tricuspid repair using the edge-to-edge repair technique.

PubMed

Hausleiter, Jörg; Braun, Daniel; Orban, Mathias; Latib, Azeem; Lurz, Philipp; Boekstegers, Peter; von Bardeleben, Ralph Stephan; Kowalski, Marek; Hahn, Rebecca T; Maisano, Francesco; Hagl, Christian; Massberg, Steffen; Nabauer, Michael

2018-04-24

Severe tricuspid regurgitation (TR) has long been neglected despite its well known association with mortality. While surgical mortality rates remain high in isolated tricuspid valve surgery, interventional TR repair is rapidly evolving as an alternative to cardiac surgery in selected patients at high surgical risk. Currently, interventional edge-to-edge repair is the most frequently applied technique for TR repair even though the device has not been developed for this particular indication. Due to the inherent differences in tricuspid and mitral valve anatomy and pathology, percutaneous repair of the tricuspid valve is challenging due to a variety of factors including the complexity and variability of tricuspid valve anatomy, echocardiographic visibility of the valve leaflets, and device steering to the tricuspid valve. Furthermore, it remains to be clarified which patients are suitable for a percutaneous tricuspid repair and which features predict a successful procedure. On the basis of the available experience, we describe criteria for patient selection including morphological valve features, a standardized process for echocardiographic screening, and a strategy for clip placement. These criteria will help to achieve standardization of valve assessment and the procedural approach, and to further develop interventional tricuspid valve repair using either currently available devices or dedicated tricuspid edge-to-edge repair devices in the future. In summary, this manuscript will provide guidance for patient selection and echocardiographic screening when considering edge-to-edge repair for severe TR.

Restoration of labral anatomy and biomechanics after superior labral anterior-posterior repair: comparison of mattress versus simple technique.

PubMed

Boddula, Madhav R; Adamson, Gregory J; Gupta, Akash; McGarry, Michelle H; Lee, Thay Q

2012-04-01

Both simple and mattress repair techniques have been utilized with success for type II superior labral anterior-posterior (SLAP) lesions; however, direct anatomic and biomechanical comparisons of these techniques have yet to be clearly demonstrated. For type II SLAP lesions, the mattress suture repair technique will result in greater labral height and better position on the glenoid face and exhibit stronger biomechanical characteristics, when cyclically loaded and loaded to failure through the biceps, compared with the simple suture repair technique. Controlled laboratory study. Six matched pairs of cadaveric shoulders were dissected, and a clock face was created on the glenoid from 9 o'clock (posterior) to 3 o'clock (anterior). For the intact specimen, labral height and labral distance from the glenoid edge were measured using a MicroScribe. A SLAP lesion was then created from 10 o'clock to 2 o'clock. Lesions were repaired with two 3.0-mm BioSuture-Tak anchors placed at 11 o'clock and 1 o'clock. For each pair, a mattress repair was used for one shoulder, and a simple repair was used for the contralateral shoulder. After repair, labral height and labral distance from the glenoid edge were again measured. The specimens were then cyclically loaded and loaded to failure through the biceps using an Instron machine. A paired t test was used for statistical analysis. After mattress repair, a significant increase in labral height occurred compared with intact from 2.5 ± 0.3 mm to 4.3 ± 0.3 mm at 11 o'clock (P = .013), 2.7 ± 0.5 mm to 4.2 ± 0.7 mm at 12:30 o'clock (P = .007), 3.1 ± 0.5 mm to 4.2 ± 0.7 mm at 1 o'clock (P = .006), and 2.8 ± 0.7 mm to 3.7 ± 0.8 mm at 1:30 o'clock (P = .037). There was no significant difference in labral height between the intact condition and after simple repair at any clock face position. Labral height was significantly increased in the mattress repairs compared with simple repairs at 11 o'clock (mean difference, 2.0 mm; P = .008

[Plastic repair of tricuspid valve: Carpentier's ring annuloplasty versus De VEGA technique].

PubMed

Charfeddine, Salma; Hammami, Rania; Triki, Faten; Abid, Leila; Hentati, Mourad; Frikha, Imed; Kammoun, Samir

2017-01-01

Tricuspid valve disease has been neglected for a long time by cardiologists and surgeons, but for some years now leakage of tricuspid valve has been demonstrated as a prognostic factor in the evolution of patients with left heart valve disease undergoing surgery. Several techniques for plastic repair of tricuspid valve have been developed and the published studies differ on the results of these techniques; we conducted this study to assess the results of plastic repair of tricuspid valve in a population of patients with a high prevalence of rheumatic disease and to compare Carpentier's ring annuloplasty techniques with DEVEGA plasty. We conducted a retrospective study of patients undergoing plastic repair of tricuspid valve in the Department of Cardiology at the Medicine University of Sfax over a period of 25 years. We compared the results from the Group 1 (Carpentier's ring annuloplasty) with Group 2 (DeVEGA plasty). 91 patients were included in our study, 45 patients in the Group 1 and 46 patients in the Group 2. Most patients had mean or severe TI (83%) before surgery, ring dilation was observed in 90% of patients with no significant difference between the two groups. Immediate results were comparable between the two techniques but during monitoring recurrent, at least mean, insufficiency was significantly more frequent in the DeVEGA plasty Group. The predictive factors for significant recurring long term TI were DeVEGA technique (OR=3.26[1.12-9.28]) in multivariate study and preoperative pulmonary artery systolic pressure (OR=1.06 (1.01-1.12)). Plastic repair of tricuspid valve using Carpentier's ring seems to guarantee better results than DeVEGA plasty. On the other hand, preoperative high PASP is predictive of recurrent leakage of tricuspid valve even after plasty; hence the importance of surgery in the treatment of patients at an early stage of the disease.

Current surgical practices in cleft care: cleft palate repair techniques and postoperative care.

PubMed

Katzel, Evan B; Basile, Patrick; Koltz, Peter F; Marcus, Jeffrey R; Girotto, John A

2009-09-01

The purpose of this study was to objectively report practices commonly used in cleft palate repair in the United States. This study investigates current surgical techniques, postoperative care, and complication rates for cleft palate repair surgery. All 803 surgeon members of the American Cleft Palate-Craniofacial Association were sent online and/or paper surveys inquiring about their management of cleft palate patients. Three-hundred six surveys were received, a 38 percent response rate. This represented responses of surgeons from 100 percent of American Cleft Palate-Craniofacial Association registered cleft teams. Ninety-six percent of respondents perform a one-stage repair. Eighty-five percent of surgeons perform palate surgery when the patient is between 6 and 12 months of age. The most common one-stage repair techniques are the Bardach style (two flaps) with intravelar veloplasty and the Furlow palatoplasty. After surgery, 39 percent of surgeons discharge patients within 24 hours. Another 43 percent discharge patients within 48 hours. During postoperative management, 92 percent of respondents implement feeding restrictions. Eighty-five percent of physicians use arm restraints. Surgeons' self-reported complications rates are minimal: 54 percent report a fistula in less than 5 percent of cases. The reported need for secondary speech surgery varies widely. The majority of respondents repair clefts in one stage. The most frequently used repair techniques are the Furlow palatoplasty and the Bardach style with intravelar veloplasty. After surgery, the majority of surgeons discharge patients in 1 or 2 days, and nearly all surgeons implement feeding restrictions and the use of arm restraints. The varying feeding protocols are reviewed in this article.

Cusp repair in aortic valve reconstruction: does the technique affect stability?

PubMed

Aicher, Diana; Langer, Frank; Adam, Oliver; Tscholl, Dietmar; Lausberg, Henning; Schäfers, Hans-Joachim

2007-12-01

Cusp prolapse may be an isolated cause of aortic regurgitation or may exist in conjunction with dilatation of the proximal aorta. Prolapse can be corrected by central plication, triangular resection, or pericardial patch implantation. We retrospectively analyzed our results with these techniques. From October 1995 to December 2006, 604 patients (aged 3-86 years) underwent aortic valve repair. Cusp prolapse was found in 427 patients (246 tricuspid, 181 bicuspid). Prolapse was corrected by central plication (n = 275) or triangular resection (n = 80). A pericardial patch was implanted for pre-existing cusp defects or after excision of calcium (n = 72). One cusp was repaired in 198 patients; the remaining patients underwent repair of 2 (n = 189) or 3 cusps (n = 40). In 102 patients more than one technique was used, and the patients were allocated to the group of the assumedly more complex repair (central plication < triangular resection < pericardial patch plasty). Cumulative follow-up was 1238 patient-years (mean 35 +/- 27 months). Hospital mortality was 2.6% (11/427). Actuarial freedom from aortic regurgitation of grade II or more at 5 years was 92% (central plication), 90% (triangular resection), and 90% (pericardial patch plasty). Thirteen patients were reoperated on, with prolapse as the most common reason for failure (n = 7); 6 underwent re-repair. Freedom from reoperation at 5 years was 95% (central plication), 94% (triangular resection), and 94% (pericardial patch plasty). Freedom from valve replacement at 5 years was 97% (central plication), 99% (triangular resection), and 98% (pericardial patch plasty). In aortic valve repair, cusp prolapse can be treated reliably by central plication. In the presence of more complex disease, triangular resection or pericardial patch plasty may be used without compromising midterm durability.

Cell Seeding Densities in Autologous Chondrocyte Implantation Techniques for Cartilage Repair.

PubMed

Foldager, Casper Bindzus; Gomoll, Andreas H; Lind, Martin; Spector, Myron

2012-04-01

Cartilage repair techniques have been among the most intensively investigated treatments in orthopedics for the past decade, and several different treatment modalities are currently available. Despite the extensive research effort within this field, the generation of hyaline cartilage remains a considerable challenge. There are many parameters attendant to each of the cartilage repair techniques that can affect the amount and types of reparative tissue generated in the cartilage defect, and some of the most fundamental of these parameters have yet to be fully investigated. For procedures in which in vitro-cultured autologous chondrocytes are implanted under a periosteal or synthetic membrane cover, or seeded onto a porous membrane or scaffold, little is known about how the number of cells affects the clinical outcome. Few published clinical studies address the cell seeding density that was employed. The principal objective of this review is to provide an overview of the cell seeding densities used in cell-based treatments currently available in the clinic for cartilage repair. Select preclinical studies that have informed the use of specific cell seeding densities in the clinic are also discussed.

Fatigue crack modeling in bridge deck connection details

DOT National Transportation Integrated Search

1999-12-01

Many steel bridges built prior to 1960 have bridge deck connections that are subject to high cycle fatigue. These connections may be nearing their fatigue limit and will require increased inspection and repair over the next 10 - 20 years. Current ins...

Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

PubMed Central

Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.

2015-01-01

After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

Evaluation of FRP repair method for cracked bridge members.

DOT National Transportation Integrated Search

2005-01-01

This research program was undertaken to investigate the effects Carbon Fiber Reinforced Polymers (CFRP) have on the shear strength on under-reinforced, lab-scale prestressed concrete (PC) bridge girders. Many bridges in the states of Missouri and Kan...

Articular contact pressures of meniscal repair techniques at various knee flexion angles.

PubMed

Flanigan, David C; Lin, Fang; Koh, Jason L; Zhang, Li-Qun

2010-07-13

Articular cartilage injury can occur after meniscal repair with biodegradable implants. Previous contact pressure analyses of the knee have been based on the tibial side of the meniscus at limited knee flexion angles. We investigated articular contact pressures on the posterior femoral condyle with different knee flexion angles and surgical repair techniques. Medial meniscus tears were repaired in 30 fresh bovine knees. Knees were mounted on a 6-degrees-of-freedom jig and statically loaded to 200 N at 45 degrees, 70 degrees, 90 degrees, and 110 degrees of knee flexion under 3 conditions: intact meniscus, torn meniscus, and meniscus after repair. For each repair, 3 sutures or biodegradable implants were used. A pressure sensor was used to determine the contact area and peak pressure. Peak pressures over each implant position were measured. Peak pressure increased significantly as knee flexion increased in normal, injured, and repaired knees. The change in peak pressure in knees with implant repairs was significantly higher than suture repairs at all knee flexion angles. Articular contact pressure on the posterior femoral condyle increased with knee flexion. Avoidance of deep knee flexion angles postoperatively may limit increases in articular contact pressures and potential chondral injury. Copyright 2010, SLACK Incorporated.

Cost Effective Repair Techniques for Turbine Airfoils. Volume I

DTIC Science & Technology

1978-11-01

Turbine blades and vanes in current engines are subjected to the most hostile environment...payoff potential in turbine vanes / blades . The criteria used included: • Incidence of damage - Scrapped or damaged turbine airfoils at the ALC centers...Corporate Author: GENERAL ELECTRIC CO CINCINNATI OHIO AIRCRAFT ENGINE GROUP Unclassified Title: (U) Cost Effective Repair Techniques for Turbine

Practical Repair Method for Unilateral Cleft Lips: Straight-Line Advanced Release Technique.

PubMed

Baek, Rong-Min; Choi, Jun-Ho; Kim, Baek-Kyu

2016-04-01

Straight-line closure repair of unilateral cleft lips was first introduced in the 1840s, and since then, many different techniques have been attempted for cleft repair. However, these methods have several disadvantages and are difficult to adopt. In this study, we describe our novel technique, known as Straight-Line Advanced Release Technique (StART), and its application in treating several cases of unilateral cleft lip. The preoperative design of the surgical method is drawn on the skin, the vermilion, and the oral mucosa. A total of 13 points are marked (points 0-12). The A flap, B flap, triangular flap, M (medial mucosal) flap, and L (lateral mucosal) flap are designed. After completion of the preoperative marking, the wide dissection is performed to separate the orbicularis oris muscle completely from the abnormally inserted bony structure and the enveloped skin-mucosal flap. The freed orbicularis oris muscle is then reconstructed with full width. After all planes of the lip wound are closed, a straight vertical skin suture line is achieved without any unnecessary transverse scar. Unilateral cleft lip repair using StART was conducted in 145 patients between 1993 and 2012. Cases of microform cleft lip were excluded. A total of 21 patients (14%) required a secondary operation on the lip after the first unilateral cheiloplasty. In all patients, satisfactory surgical outcomes were obtained with an indistinct straight-lined scar and a well-aligned lip contour. To acquire a natural and balanced shape in unilateral cleft lip repair, we recommend the novel StART.

Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

PubMed

Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

2013-12-01

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

24. Photocopy of 1936 repair drawing for 'Walpole, N.H. Westminster' ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

24. Photocopy of 1936 repair drawing for 'Walpole, N.H. Westminster' by State of New Hampshire Highway Department. (Filed with N.H. Department of Transportation, Bridge Design Division plan archives, Concord, N.H.) Sheet: 1 of 1 Repair and steel/concrete reinforcement details for east and west October 21, 1936 - Walpole-Westminster Bridge, Spanning Connecticut River between Walpole, NH & Westminster, VT, Walpole, Cheshire County, NH

All-inside arthroscopic lateral collateral ligament repair for ankle instability with a knotless suture anchor technique.

PubMed

Vega, Jordi; Golanó, Pau; Pellegrino, Alexandro; Rabat, Eduard; Peña, Fernando

2013-12-01

Recently, arthroscopic-assisted techniques have been described to treat lateral ankle instability with excellent results. However, complications including neuritis of the superficial peroneal or sural nerve, and pain or discomfort due to a prominent anchor or suture knot have been reported. The aim of this study was to describe a novel technique, the "all-inside arthroscopic lateral collateral ankle ligament repair," and its results for treating patients with ankle instability. Sixteen patients (10 men and 6 women, mean age 29.3 years, 17-46) with lateral ankle instability were treated with an arthroscopic procedure. Using a suture passer and a knotless anchor, the ligaments were repaired with an all-inside technique. The right ankle was affected in 10 cases. Mean follow-up was 22.3 (12-35) months. On arthroscopic examination, 13 patients had an isolated anterior talofibular ligament (ATFL) injury, and in 3 patients, both the ATFL and calcaneofibular ligament (CFL) were affected. All-inside arthroscopic anatomic repair of the lateral collateral ligament complex was performed in all cases. All patients reported subjective improvement of their ankle instability. The mean AOFAS score increased from 67 preoperatively to 97 at final follow-up. No major complications were reported. The all-inside arthroscopic ligament repair was a safe, reliable, and reproducible technique that both provided an anatomic repair of the lateral collateral ligament complex and restored ankle stability while preserving all the advantages of an arthroscopic technique. Level IV, retrospective case series.

Longer Lasting Bridge Deck Overlays

DOT National Transportation Integrated Search

2018-04-01

The objective of this report is to determine the most effective method for bridge deck overlay construction and repair by assessing current practices; examining new products and technologies; and reviewing NCHRP (National Cooperative Highway Research...

Research notes : listening to bridges.

DOT National Transportation Integrated Search

2008-09-01

The Federal Highway Administration requires owners of structurally deficient bridges to repair, replace, restrict truck loads, or conduct analysis and testing to maintain a safe highway system. Past experiments on reinforced concrete beams showed aco...

One Year Outcomes of 101 BeGraft Stent Grafts used as Bridging Stents in Fenestrated Endovascular Repairs.

PubMed

Spear, Rafaelle; Sobocinski, Jonathan; Hertault, Adrien; Delloye, Matthieu; Azzauiu, Richard; Fabre, Dominique; Haulon, Stéphan

2018-04-01

To evaluate the outcomes of the second generation BeGraft balloon expandable covered stent Graft System (Bentley InnoMed, Hechingen, Germany) implanted as bridging stent grafts during fenestrated endovascular aortic repair (FEVAR) of complex aneurysms. This was a single centre prospective study including all consecutive patients treated by FEVAR performed with second generation BeGraft stent grafts as bridging stents. Demographics of patients, diameter and length of the bridging stent grafts, technical success, re-interventions, occlusions, post-operative events, and imaging (Cone Beam CT and/or CT scan, and contrast enhanced ultrasound) were prospectively collected in an electronic database. Duplex ultrasound was performed before discharge and at 6 month follow-up. At 1 year, patients were evaluated clinically and by imaging (CT and ultrasound). Between November 2015 and September 2016, 39 consecutive patients (one woman) were treated with custom made fenestrated endografts (2-5 fenestrations) for complex aneurysms or type 1 endoleak after EVAR, using a variety of bridging stents including the BeGraft. All 101 BeGraft stent grafts were successfully delivered and deployed. There was no in hospital mortality. Early fenestration patency rate was 99% (96/97); the sole target vessel post-operative occlusion was secondary to a dissection of the renal artery distal to the stent. Complementary stenting was unsuccessful in recovering renal artery patency; bilateral renal stent occlusion was observed in the same patient on a CT scan performed 2 months after the procedure. He required post-operative dialysis. No additional renal impairment was observed. During follow-up (median 13 months [11-15]), all fenestrations stented with BeGraft stent grafts remained patent (95/97, 98%). One type 1b endoleak was detected and treated (2.6%). BeGraft stent grafts used as bridging stents during FEVAR are associated with favourable outcomes at 1 year follow-up. Long-term follow-up is

49 CFR 237.133 - Supervision of repairs and modifications.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Supervision of repairs and modifications. 237.133... Supervision of repairs and modifications. Each repair or modification pursuant to this part shall be performed under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who...

49 CFR 237.133 - Supervision of repairs and modifications.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Supervision of repairs and modifications. 237.133... Supervision of repairs and modifications. Each repair or modification pursuant to this part shall be performed under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who...

49 CFR 237.133 - Supervision of repairs and modifications.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Supervision of repairs and modifications. 237.133... Supervision of repairs and modifications. Each repair or modification pursuant to this part shall be performed under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who...

49 CFR 237.133 - Supervision of repairs and modifications.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Supervision of repairs and modifications. 237.133... Supervision of repairs and modifications. Each repair or modification pursuant to this part shall be performed under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who...

49 CFR 237.133 - Supervision of repairs and modifications.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Supervision of repairs and modifications. 237.133... Supervision of repairs and modifications. Each repair or modification pursuant to this part shall be performed under the immediate supervision of a railroad bridge supervisor as defined in § 237.55 of this part who...

Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire.

PubMed

He, Ze-yang; Chai, Ming-xiang; Liu, Yue-ju; Zhang, Xiao-ran; Zhang, Tao; Song, Lian-xin; Ren, Zhi-xin; Wu, Xi-rui

2015-11-01

The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures. © 2015 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Capstan screw rotator cuff repair: a novel two-row mini-open technique

PubMed Central

Goubran, Alex; Jaques, Aishling; Smith, Christopher; Bunker, Tim

2014-01-01

Background Prospective data collection occurred between 2000 and 2010 on 143 consecutive patients with symptomatic rotator cuff tears, aiming to examine the end-result of a new technique of mini-open double row repair: the Capstan screw technique. Methods All patients had a pre- and postoperative Oxford Shoulder Score (OSS), American Shoulder and Elbow Surgeons (ASES) score and range of movement measurements. All were followed up for a minimum of 1 year with an exit questionnaire. Subscapularis repairs, small (<1 cm) and massive (>5 cm) supraspinatus repairs were excluded. Ninety-nine patients fitted the inclusion and exclusion criteria of whom 87 had a complete data set. Results The mean (SD) pre-operative OSS was 21.85 (8.6) and the mean (SD) postoperative OSS was 44.58 (5.2) (p < 0.0001). The mean (SD) pre-operative ASES score was 51.5 (19.4) and the mean (SD) postoperative ASES score was 86.42 (17.06) (p < 0.0001). Flexion improved from a mean of 119° to 170° (p < 0.0001). The clinical re-tear rate was 3.4% and the imaged re-tear rate was 6.8%. In total, 91% of patients were satisfied with the procedure. There were no deep infections and two (2%) minor wound infections. There was no single instance of deltoid dysfunction. Conclusions The Capstan screw technique represents a simple, rapid, strong and reliable mini-open technique. PMID:27582933

Inguinoscrotal hernia containing the urinary bladder successfully repaired using laparoscopic transabdominal preperitoneal repair technique: A case report.

PubMed

Tazaki, Tatsuya; Sasaki, Masaru; Kohyama, Mohei; Sugiyama, Yoichi; Uegami, Shinnosuke; Shintakuya, Ryuta; Imamura, Yuji; Nakamitsu, Atsushi

2018-05-23

We report herein a patient with an inguinoscrotal hernia containing the urinary bladder. The hernia was safely repaired using the laparoscopic transabdominal preperitoneal repair technique. A 76-year-old man was admitted to our hospital with abdominal pain, vomiting, and diarrhea. His scrotum was swollen to fist size. Abdominal CT showed herniation of the sigmoid colon and the bladder into the right inguinal region, and his abdominal pain was attributed to incarceration of the sigmoid colon; this was manually reduced. About 1 month later, we performed transabdominal preperitoneal repair. After the direct hernial orifice was identified, the bladder was noted to be sliding from the medial side of the hernia; this was reduced. Peeling on the medial side was carried out to the middle of the abdominal wall, and the myopectineal orifice was covered with mesh. The patient was discharged on postoperative day 1. © 2018 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

Corrosion inhibitors for concrete bridges.

DOT National Transportation Integrated Search

2004-12-01

Deicing salts and salt-water spray can cause serious corrosion problems for reinforced concrete bridge structures. : These problems can lead to costly and labor-intensive repair and even replacement of the structure. Surface applied : corrosion inhib...

Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches.

PubMed

Carvalho, Gustavo L; Loureiro, Marcelo P; Bonin, Eduardo A; Claus, Christiano P; Silva, Frederico W; Cury, Antonio M; Fernandes, Flavio A M

2012-01-01

Endoscopic surgical repair of inguinal hernia is currently conducted using 2 techniques: the totally extraperitoneal (TEP) and the transabdominal (TAPP) hernia repair. The TEP procedure is technically advantageous, because of the use of no mesh fixation and the elimination of the peritoneal flap, leading to less postoperative pain and faster recovery. The drawback is that TEP is not performed as frequently, because of its complexity and longer learning curve. In this study, we propose a hybrid technique that could potentially become the gold standard of minimally invasive inguinal hernia surgery. This will be achieved by combining established advantages of TEP and TAPP associated with the precision and cosmetics of minilaparoscopy (MINI). Between January and July 2011, 22 patients were admitted for endoscopic inguinal hernia repair. The combined technique was initiated with TAPP inspection and direct visualization of a minilaparoscopic trocar dissection of the preperitoneum space. A10-mm trocar was then placed inside the previously dissected preperitoneal space, using the same umbilical TAPP skin incision. Minilaparoscopic retroperitoneal dissection was completed by TEP, and the surgical procedure was finalized with intraperitoneal review and correction of the preperitoneal work. The minilaparoscopic TEP-TAPP combined approach for inguinal hernia is feasible, safe, and allows a simple endoscopic repair. This is achieved by combining features and advantages of both TAPP and TEP techniques using precise and sophisticated MINI instruments. Minilaparoscopic preperitoneal dissection allows a faster and easier creation of the preperitoneal space for the TEP component of the procedure.

The FasT-Fix Repair Technique for Ramp Lesion of the Medial Meniscus.

PubMed

Li, Wei-Ping; Chen, Zhong; Song, Bin; Yang, Rui; Tan, Weiquan

2015-03-01

This technical note describes a new arthroscopic technique to repair the peripheral attachment lesion of the posterior horn of the medial meniscus. The operation was performed under arthroscopy using a standard anterior portal. A FasT-Fix needle was inserted obliquely close to the tibial plateau and the first implant was inserted into the joint capsule depending on its bending angle underneath the meniscus. The second implant was inserted through 1/3 periphery of the meniscus into the meniscocapsular area. The pre-tied self-sliding knot was tensioned to achieve secure fixation of the posterior meniscal peripheral attachment at the original attachment point. From August 2011 to February 2014, 23 knees were diagnosed as ramp lesion, underwent meniscal repair using FasT-Fix technique. All patients were followed up for average 14 months. The Lysholm score improved from preoperative 64.4±4.52 to postoperative 91.2±4.60. We believe that the FasT-Fix technique via the standard anterior portal can be a more convenient and less traumatic alternative for repair of the peripheral attachment lesion of the posterior horn of the medial meniscus in the anterior cruciate ligament deficient knee.

Evaluation of a New Knotless Suture Anchor Repair in Acute Achilles Tendon Ruptures: A Biomechanical Comparison of Three Techniques.

PubMed

Cottom, James M; Baker, Joseph S; Richardson, Phillip E; Maker, Jared M

Acute ruptures of the Achilles tendon are a common injury, and debate has continued in published studies on how best to treat these injuries. Specifically, controversy exists regarding the surgical approaches for Achilles tendon repair when one considers percutaneous versus open repair. The present study investigated the biomechanical strength of 3 different techniques for Achilles tendon repair in a cadaveric model. A total of 36 specimens were divided into 3 groups, each of which received a different construct. The first group received a traditional Krackow suture repair, the second group was repaired using a jig-assisted percutaneous suture, and the third group received a repair using a jig-assisted percutaneous repair modified with suture anchors placed into the calcaneus. The specimens were tested with cyclical loading and to ultimate failure. Cyclical loading showed a trend toward a stronger repair with the use of suture anchors after 10 cycles (p = .295), 500 cycles (p = .120), and 1000 cycles (p = .040). The ultimate load to failure was greatest in the group repaired with the modified knotless technique using the suture anchors (p = .098). The results of the present study show a clear trend toward a stronger construct in Achilles repair using a knotless suture anchor technique, which might translate to a faster return to activity and be more resistant to an early and aggressive rehabilitation protocol. Further clinical studies are warranted to evaluate this technique in a patient population. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Sportsmen's Groin-Diagnostic Approach and Treatment With the Minimal Repair Technique: A Single-Center Uncontrolled Clinical Review.

PubMed

Muschaweck, Ulrike; Berger, Luise Masami

2010-05-01

Sportsmen's groin, also called sports hernia and Gilmore groin, is one of the most frequent sports injuries in athletes and may place an athletic career at risk. It presents with acute or chronic groin pain exacerbated with physical activity. So far, there is little consensus regarding pathogenesis, diagnostic criteria, or treatment. There have been various attempts to explain the cause of the groin pain. The assumption is that a circumscribed weakness in the posterior wall of the inguinal canal, which leads to a localized bulge, induces a compression of the genital branch of the genitofemoral nerve, considered responsible for the symptoms. The authors developed an innovative open suture repair-the Minimal Repair technique-to fit the needs of professional athletes. With this technique, the circumscribed weakness of the posterior wall of the inguinal canal is repaired by an elastic suture; the compression on the nerve is abolished, and the cause of the pain is removed. In contrast with that of common open suture repairs, the defect of the posterior wall is not enlarged, the suture is nearly tension free, and the patient can return to full training and athletic activity within a shorter time. The outcome of patients undergoing operations with the Minimal Repair technique was compared with that of commonly used surgical procedures. THE FOLLOWING ADVANTAGES OF THE MINIMAL REPAIR TECHNIQUE WERE FOUND: no insertion of prosthetic mesh, no general anesthesia required, less traumatization, and lower risk of severe complications with equal or even faster convalescence. In 2009, a prospective cohort of 129 patients resumed training in 7 days and experienced complete pain relief in an average of 14 days. Professional athletes (67%) returned to full activity in 14 days (median). The Minimal Repair technique is an effective and safe way to treat sportsmen's groin.

Cranial tibial wedge osteotomy: a technique for eliminating cranial tibial thrust in cranial cruciate ligament repair.

PubMed

Slocum, B; Devine, T

1984-03-01

Cranial tibial wedge osteotomy, surgical technique for cranial cruciate ligament rupture, was performed on 19 stifles in dogs. This procedure leveled the tibial plateau, thus causing weight-bearing forces to be compressive and eliminating cranial tibial thrust. Without cranial tibial thrust, which was antagonistic to the cranial cruciate ligament and its surgical reconstruction, cruciate ligament repairs were allowed to heal without constant loads. This technique was meant to be used as an adjunct to other cranial cruciate ligament repair techniques.

Umbilical cord sparing technique for repair of congenital hernia into the cord and small omphalocele.

PubMed

Ceccanti, Silvia; Falconi, Ilaria; Frediani, Simone; Boscarelli, Alessandro; Musleh, Layla; Cozzi, Denis A

2017-01-01

Current repair of small omphaloceles and hernias into the umbilical cord is a straightforward procedure, whose repair may result in a suboptimal cosmetic outcome. We describe a novel repair technique retaining the umbilical cord elements in an attempt to improve the cosmetic appearance of the umbilicus. Eight neonates were consecutively treated more than a ten-year period. Size of the fascial defects ranged 1 to 3cm (median, 2). Present technique entails incision of the amniotic sac without its detachment from the skin, reduction of the extruded contents under direct vision, and closure of the abdominal wall defect by circumferential suturing of peritoneum and fascia around the base of the amniotic sac. The amniotic sac is then re-approximated and folded to create an umbilical stump, which is trimmed and left to shed naturally. All patients achieved a scarless abdomen with a normal appearing umbilicus in 6. The remaining 2 patients are awaiting surgery for persisting umbilical hernia repair and umbilicoplasty, respectively. Poor esthetic outcome was significantly associated with initial fascial defect ≥2.5cm in size (p=0.03). Present technique is a simple and cosmetically appealing repair for umbilical cord hernias and small omphaloceles, especially effective when the size of the fascial defect is less than 2.5cm. IV (Treatment Study). Copyright © 2017 Elsevier Inc. All rights reserved.

An Enhanced Vacuum Cure Technique for On-Aircraft Repair of Carbon-Bismaleimide Composites

NASA Astrophysics Data System (ADS)

Rider, Andrew N.; Baker, Alan A.; Wang, Chun H.; Smith, Graeme

2011-06-01

Carbon/bismaleimide (BMI) composite is increasingly employed in critical load carrying aircraft structures designed to operate at temperatures approaching 180°C. The high post-cure temperature (above 220°C) required to fully react the BMI resin, however, renders existing on-aircraft prepreg or wet layup repair methods invalid. This paper presents a new on-aircraft repair technique for carbon/BMI composites. The composite prepregs are first warm-staged to improve the ability to evacuate entrapped air. Then the patch is cured in the scarf cavity using the vacuum bag technique, followed by off-aircraft post-cure. The fully cured patch then can be bonded using a structural adhesive.

Verification of image orthorectification techniques for low-cost geometric inspection of masonry arch bridges

NASA Astrophysics Data System (ADS)

González-Jorge, Higinio; Riveiro, Belén; Varela, María; Arias, Pedro

2012-07-01

A low-cost image orthorectification tool based on the utilization of compact cameras and scale bars is developed to obtain the main geometric parameters of masonry bridges for inventory and routine inspection purposes. The technique is validated in three different bridges by comparison with laser scanning data. The surveying process is very delicate and must make a balance between working distance and angle. Three different cameras are used in the study to establish the relationship between the error and the camera model. Results depict nondependence in error between the length of the bridge element, the type of bridge, and the type of element. Error values for all the cameras are below 4 percent (95 percent of the data). A compact Canon camera, the model with the best technical specifications, shows an error level ranging from 0.5 to 1.5 percent.

Environmental, mechanical and life-cycle cost analysis of bridge columns.

DOT National Transportation Integrated Search

2014-08-01

Corrosion of RC bridge element is one of the major deterioration distresses in US Highway Bridges. FRP composites jackets can be : the economic and effective corrosion repair in future, though its practices and field installation as a means of corros...

Fatigue crack modeling in bridge deck connection details : final report.

DOT National Transportation Integrated Search

1999-12-01

Many steel bridges built prior to 1960 have bridge deck connections that are subject to high cycle fatigue. These connections may be nearing their fatigue limit and will require increased inspection and repair over the next 10 - 20 years. Current ins...

Cartilage Repair Surgery: Outcome Evaluation by Using Noninvasive Cartilage Biomarkers Based on Quantitative MRI Techniques?

PubMed Central

Jungmann, Pia M.; Baum, Thomas; Bauer, Jan S.; Karampinos, Dimitrios C.; Link, Thomas M.; Li, Xiaojuan; Trattnig, Siegfried; Rummeny, Ernst J.; Woertler, Klaus; Welsch, Goetz H.

2014-01-01

Background. New quantitative magnetic resonance imaging (MRI) techniques are increasingly applied as outcome measures after cartilage repair. Objective. To review the current literature on the use of quantitative MRI biomarkers for evaluation of cartilage repair at the knee and ankle. Methods. Using PubMed literature research, studies on biochemical, quantitative MR imaging of cartilage repair were identified and reviewed. Results. Quantitative MR biomarkers detect early degeneration of articular cartilage, mainly represented by an increasing water content, collagen disruption, and proteoglycan loss. Recently, feasibility of biochemical MR imaging of cartilage repair tissue and surrounding cartilage was demonstrated. Ultrastructural properties of the tissue after different repair procedures resulted in differences in imaging characteristics. T2 mapping, T1rho mapping, delayed gadolinium-enhanced MRI of cartilage (dGEMRIC), and diffusion weighted imaging (DWI) are applicable on most clinical 1.5 T and 3 T MR scanners. Currently, a standard of reference is difficult to define and knowledge is limited concerning correlation of clinical and MR findings. The lack of histological correlations complicates the identification of the exact tissue composition. Conclusions. A multimodal approach combining several quantitative MRI techniques in addition to morphological and clinical evaluation might be promising. Further investigations are required to demonstrate the potential for outcome evaluation after cartilage repair. PMID:24877139

Determining flexor-tendon repair techniques via soft computing

NASA Technical Reports Server (NTRS)

Johnson, M.; Firoozbakhsh, K.; Moniem, M.; Jamshidi, M.

2001-01-01

An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

Determining flexor-tendon repair techniques via soft computing.

PubMed

Johnson, M; Firoozbakhsh, K; Moniem, M; Jamshidi, M

2001-01-01

An SC-based multi-objective decision-making method for determining the optimal flexor-tendon repair technique from experimental and clinical survey data, and with variable circumstances, was presented. Results were compared with those from the Taguchi method. Using the Taguchi method results in the need to perform ad-hoc decisions when the outcomes for individual objectives are contradictory to a particular preference or circumstance, whereas the SC-based multi-objective technique provides a rigorous straightforward computational process in which changing preferences and importance of differing objectives are easily accommodated. Also, adding more objectives is straightforward and easily accomplished. The use of fuzzy-set representations of information categories provides insight into their performance throughout the range of their universe of discourse. The ability of the technique to provide a "best" medical decision given a particular physician, hospital, patient, situation, and other criteria was also demonstrated.

Anterior Urethral Advancement as a Single-Stage Technique for Repair of Anterior Hypospadias: Our Experience.

PubMed

Gite, Venkat A; Nikose, Jayant V; Bote, Sachin M; Patil, Saurabh R

2017-07-02

Many techniques have been described to correct anterior hypospadias with variable results. Anterior urethral advancement as one stage technique was first described by Ti Chang Shing in 1984. It was also used for the repair of strictures and urethrocutaneous fistulae involving distal urethra. We report our experience of using this technique with some modification for the repair of anterior hypospadias. In the period between 2013-2015, 20 cases with anterior hypospadias including 2 cases of glanular, 3 cases of coronal, 12 cases of subcoronal and 3 cases of distal penile hypospadias were treated with anterior urethral advancement technique. Patients' age groups ranged from 18 months to 10 years. Postoperatively, patients were passing urine from tip of neomeatus with satisfactory stream during follow up period of 6 months to 2 years. There were no major complications in any of our patients except in one patient who developed meatal stenosis which was treated by periodic dilatation. Three fold urethral mobilization was sufficient in all cases. Anterior urethral advancement technique is a single-stage procedure with good cosmetic results and least complications for anterior hypospadias repair in properly selected cases.

Strengthening steel bridge girders using CFRP.

DOT National Transportation Integrated Search

2010-06-01

While traditional retrofitting methods for steel bridge girders could be time consuming and uneconomical, an alternative repair method is suggested using Carbon Fiber Reinforced Polymers (CFRP) laminate strips, providing engineers with a competitive ...

A new approach to umbilical hernia repair: the circular suture technique for defects less than 2 cm.

PubMed

Yıldız, Ihsan; Koca, Yavuz Savas

2017-01-01

Umbilical hernia, unlike other abdominal wall hernias, occurs when the umbilical ring opens and expands. Its' symptoms and complications show similarities with other hernias. Although there are various repair techniques, there is not a standard technique yet. This paper investigated the outcomes of double layer circular suture technique as a new approach in the repair of umbilical hernia. A total number of 282 patients comprised of 102 males and 180 females with an age range of 18-89 whose umbilical hernias were repaired between 2002 and 2013, retrospectively studied in two groups group 1 (circular suture technique) and group 2 (open primary suture). The subjects were investigated with regards to age, sex, body mass index (BMI), accompanying disease, anesthesia method, surgical complications, hospital stay, total costs, mortality and recurrence. The study participants were 282 patients with an age average of 49, 09 ± 16, 62 including 182 patients in group 1 (male/female ratio 76/106) and 100 patients in group 2 (26/74). There was a significant difference between the groups in terms of time and recurrence. During the follow-up period, 9 patients in group 1 (4.94%) and 16 patients in group 2 (16%) had a recurrence. This result was statistically significant (p=0.014) CONCLUSION: We believe that the double layer circular suture technique is practical, inexpensive and effective in the repair of umbilical hernia defects, which are smaller than 2 cm diameter. Key words: Hernia, Repair, Umbilical hernia.

Assessment of the integrity of concrete bridge structures by acoustic emission technique

NASA Astrophysics Data System (ADS)

Yoon, Dong-Jin; Park, Philip; Jung, Juong-Chae; Lee, Seung-Seok

2002-06-01

This study was aimed at developing a new method for assessing the integrity of concrete structures. Especially acoustic emission technique was used in carrying out both laboratory experiment and field application. From the previous laboratory study, we confirmed that AE analysis provided a promising approach for estimating the level of damage and distress in concrete structures. The Felicity ratio, one of the key parameter for assessing damage, exhibits a favorable correlation with the overall damage level. The total number of AE events under stepwise cyclic loading also showed a good agreement with the damage level. In this study, a new suggested technique was applied to several concrete bridges in Korea in order to verify the applicability in field. The AE response was analyzed to obtain key parameters such as the total number and rate of AE events, AE parameter analysis for each event, and the characteristic features of the waveform as well as Felicity ratio analysis. Stepwise loading-unloading procedure for AE generation was introduced in field test by using each different weight of vehicle. According to the condition of bridge, for instance new or old bridge, AE event rate and AE generation behavior indicated many different aspects. The results showed that the suggested analyzing method would be a promising approach for assessing the integrity of concrete structures.

Real-Time Bridge Monitoring : Developing Wireless Nanosensors to Monitor Structural Integrity

DOT National Transportation Integrated Search

2013-04-17

With steel bridges representing approximately 34 percent of the nearly 600,000 highway bridges in the United States, continual monitoring and early detection of deterioration in these structures is vital to prevent expensive repairs or catastrophic f...

Repair and tissue engineering techniques for articular cartilage.

PubMed

Makris, Eleftherios A; Gomoll, Andreas H; Malizos, Konstantinos N; Hu, Jerry C; Athanasiou, Kyriacos A

2015-01-01

Chondral and osteochondral lesions due to injury or other pathology commonly result in the development of osteoarthritis, eventually leading to progressive total joint destruction. Although current progress suggests that biologic agents can delay the advancement of deterioration, such drugs are incapable of promoting tissue restoration. The limited ability of articular cartilage to regenerate renders joint arthroplasty an unavoidable surgical intervention. This Review describes current, widely used clinical repair techniques for resurfacing articular cartilage defects; short-term and long-term clinical outcomes of these techniques are discussed. Also reviewed is a developmental pipeline of acellular and cellular regenerative products and techniques that could revolutionize joint care over the next decade by promoting the development of functional articular cartilage. Acellular products typically consist of collagen or hyaluronic-acid-based materials, whereas cellular techniques use either primary cells or stem cells, with or without scaffolds. Central to these efforts is the prominent role that tissue engineering has in translating biological technology into clinical products; therefore, concomitant regulatory processes are also discussed.

Sensory Recovery Outcome after Digital Nerve Repair in Relation to Different Reconstructive Techniques: Meta-Analysis and Systematic Review

PubMed Central

Wolf, Petra; Harder, Yves; Kern, Yasmin; Paprottka, Philipp M.; Machens, Hans-Günther; Lohmeyer, Jörn A.

2013-01-01

Good clinical outcome after digital nerve repair is highly relevant for proper hand function and has a significant socioeconomic impact. However, level of evidence for competing surgical techniques is low. The aim is to summarize and compare the outcomes of digital nerve repair with different methods (end-to-end and end-to-side coaptations, nerve grafts, artificial conduit-, vein-, muscle, and muscle-in-vein reconstructions, and replantations) to provide an aid for choosing an individual technique of nerve reconstruction and to create reference values of standard repair for nonrandomized clinical studies. 87 publications including 2,997 nerve repairs were suitable for a precise evaluation. For digital nerve repairs there was practically no particular technique superior to another. Only end-to-side coaptation had an inferior two-point discrimination in comparison to end-to-end coaptation or nerve grafting. Furthermore, this meta-analysis showed that youth was associated with an improved sensory recovery outcome in patients who underwent digital replantation. For end-to-end coaptations, recent publications had significantly better sensory recovery outcomes than older ones. Given minor differences in outcome, the main criteria in choosing an adequate surgical technique should be gap length and donor site morbidity caused by graft material harvesting. Our clinical experience was used to provide a decision tree for digital nerve repair. PMID:23984064

Development of flexural vibration inspection techniques to rapidly assess the structural health of timber bridge systems

Treesearch

Xiping Wang; James P. Wacker; Robert J. Ross; Brian K. Brashaw; Robert Vatalaro

2005-01-01

This paper describes an effort to develop a global dynamic testing technique for evaluating the overall stiffness of timber bridge superstructures. A forced vibration method was used to measure the natural frequency of single-span timber bridges in the laboratory and field. An analytical model based on simple beam theory was proposed to represent the relationship...

Development and performance evaluation of fiber reinforced polymer bridge : [technical summary].

DOT National Transportation Integrated Search

2014-03-01

Conventionally, highway bridge decks in the US are predominantly made of steel-reinforced concrete. However, repair and : maintenance costs of these bridges incurred at the federal and state levels are overwhelming. As a result, for many years, there...

Repair and tissue engineering techniques for articular cartilage

PubMed Central

Makris, Eleftherios A.; Gomoll, Andreas H.; Malizos, Konstantinos N.; Hu, Jerry C.; Athanasiou, Kyriacos A.

2015-01-01

Chondral and osteochondral lesions due to injury or other pathology commonly result in the development of osteoarthritis, eventually leading to progressive total joint destruction. Although current progress suggests that biologic agents can delay the advancement of deterioration, such drugs are incapable of promoting tissue restoration. The limited ability of articular cartilage to regenerate renders joint arthroplasty an unavoidable surgical intervention. This Review describes current, widely used clinical repair techniques for resurfacing articular cartilage defects; short-term and long-term clinical outcomes of these techniques are discussed. Also reviewed is a developmental pipeline of regenerative biological products that over the next decade could revolutionize joint care by functionally healing articular cartilage. These products include cell-based and cell-free materials such as autologous and allogeneic cell-based approaches and multipotent and pluripotent stem-cell-based techniques. Central to these efforts is the prominent role that tissue engineering has in translating biological technology into clinical products; therefore, concomitant regulatory processes are also discussed. PMID:25247412

Repair, Evaluation, Maintenance, and Rehabilitation Research Program. Underwater Repair of Concrete Damaged by Abrasion-Erosion

DTIC Science & Technology

1991-12-01

and compatible placement tech- niques that can ensure successful and cost effective repairs of scour holes of different sizes and depths under water...bridge foundation in Japan. The valve was attached to the bottom of a pump line and was moved to cast concrete in successive layers at several locations...surfaces, reinforc- ing steel, and dowel bars in order to ensure successful and durable repairs. Thi. is ( specizlly important since it is not practical to

Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study.

PubMed

de la Fuente, C; Carreño-Zillmann, G; Marambio, H; Henríquez, H

2016-01-01

To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared. A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond(®) suture to 4.5cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (α=.05), and the maximum resistances using the Student t test (α=.05). There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique. The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Long-term monitoring of mechanical properties of FRP repair materials.

DOT National Transportation Integrated Search

2013-07-01

Fiber- reinforced polymer composites (FRP) are an attractive repair option for existing concrete structures. : CDOT has used this material on some projects, in particular the repair of the Castlewood Canyon Bridge in : 2003. Further use of the materi...

Inside-Out Meniscus Repair

PubMed Central

Nelson, Clay G.; Bonner, Kevin F.

2013-01-01

Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique. PMID:24400199

Health diagnosis of arch bridge suspender by acoustic emission technique

NASA Astrophysics Data System (ADS)

Li, Dongsheng; Ou, Jinping

2007-01-01

Conventional non-destructive methods can't be dynamically monitored the suspenders' damage levels and types, so acoustic emission (AE) technique is proposed to monitor its activity. The validity signals are determined by the relationship with risetime and duration. The ambient noise is eliminated using float threshold value and placing a guard sensor. The cement mortar and steel strand damage level is analyzed by AE parameter method and damage types are judged by waveform analyzing technique. Based on these methods, all the suspenders of Sichuan Ebian Dadu river arch bridge have been monitored using AE techniques. The monitoring results show that AE signal amplitude, energy, counts can visually display the suspenders' damage levels, the difference of waveform and frequency range express different damage type. The testing results are well coincide with the practical situation.

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair.

PubMed

Baums, M H; Buchhorn, G H; Gilbert, F; Spahn, G; Schultz, W; Klinger, H-M

2010-09-01

This experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated. In 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason-Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine. Group 4 showed lowest load-to-failure result with 155.7 +/- 31.1 N compared to group 1 (293.4 +/- 16.1 N) and group 2 (397.7 +/- 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 +/- 7.3 N/mm) and lowest in group 4 (84.4 +/- 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001). A double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used.

Injury-induced ctgfa directs glial bridging and spinal cord regeneration in zebrafish

PubMed Central

Mokalled, Mayssa H.; Patra, Chinmoy; Dickson, Amy L.; Endo, Toyokazu; Stainier, Didier Y. R.; Poss, Kenneth D.

2016-01-01

Unlike mammals, zebrafish efficiently regenerate functional nervous system tissue after major spinal cord injury. Whereas glial scarring presents a roadblock for mammalian spinal cord repair, glial cells in zebrafish form a bridge across severed spinal cord tissue and facilitate regeneration, a relatively unexplored process. Here, we performed a genome-wide profiling screen for secreted factors that are upregulated during zebrafish spinal cord regeneration. We find that connective tissue growth factor a (ctgfa) is induced in and around glial cells that participate in initial bridging events. Mutations in ctgfa disrupt spinal cord repair, while transgenic ctgfa overexpression and local human CTGF recombinant protein delivery accelerate bridging and functional regeneration. Our study reveals that CTGF is necessary and sufficient to stimulate glial bridging and natural spinal cord regeneration. PMID:27811277

Robotic-assisted laparoscopic repair of ureteral injury: an evidence-based review of techniques and outcomes.

PubMed

Tracey, Andrew T; Eun, Daniel D; Stifelman, Michael D; Hemal, Ashok K; Stein, Robert J; Mottrie, Alexandre; Cadeddu, Jeffrey A; Stolzenburg, J Uwe; Berger, Andre K; Buffi, Niccolò; Zhao, Lee C; Lee, Ziho; Hampton, Lance; Porpiglia, Francesco; Autorino, Riccardo

2018-06-01

Iatrogenic ureteral injuries represent a common surgical problem encountered by practicing urologists. With the rapidly expanding applications of robotic-assisted laparoscopic surgery, ureteral reconstruction has been an important field of recent advancement. This collaborative review sought to provide an evidence-based analysis of the latest surgical techniques and outcomes for robotic-assisted repair of ureteral injury. A systematic review of the literature up to December 2017 using PubMed/Medline was performed to identify relevant articles. Those studies included in the systematic review were selected according to Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria. Additionally, expert opinions were included from study authors in order to critique outcomes and elaborate on surgical techniques. A cumulative outcome analysis was conducted analyzing comparative studies on robotic versus open ureteral repair. Thirteen case series have demonstrated the feasibility, safety, and success of robotic ureteral reconstruction. The surgical planning, timing of intervention, and various robotic reconstructive techniques need to be tailored to the specific case, depending on the location and length of the injury. Fluorescence imaging can represent a useful tool in this setting. Recently, three studies have shown the feasibility and technical success of robotic buccal mucosa grafting for ureteral repair. Soon, additional novel and experimental robotic reconstructive approaches might become available. The cumulative analysis of the three available comparative studies on robotic versus open ureteral repair showed no difference in operative time or complication rate, with a decreased blood loss and hospital length of stay favoring the robotic approach. Current evidence suggests that the robotic surgical platform facilitates complex ureteral reconstruction in a minimally invasive fashion. High success rates of ureteral repair using the robotic approach

[Modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis for repairing soft tissue defects in middle and lower segments of leg].

PubMed

Yang, Lin; Liu, Hongjun; Zhang, Wenzhong; Song, Guoxun; Xia, Shicong; Zhang, Naichen; Gu, Jiaxiang; Yuan, Chaoqun

2017-10-01

To explore the effectiveness of modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis in treatment of soft tissue defects in the middle and lower segments of the leg. Between March 2011 and June 2015, 15 cases with skin and soft tissue defects in the middle and lower segments of the legs were treated. There were 9 males and 6 females, aged 22-48 years (mean, 32.6 years). Of whom, 8 patients caused by traffic accidents, 5 by machine twist, and 2 by crash injury of heavy object. The mean interval from injury to admission was 82.6 hours (range, 2 hours to 1 week). The area of defect ranged from 13 cm×9 cm to 23 cm×16 cm. After primary debridement and vaccum sealing drainage treatment, the defects were repaired with modified anterolateral thigh perforator flap pedicled by cross-bridge microvascular anastomosis. The size of flap ranged from 15 cm×10 cm to 25 cm×15 cm. The donor sites were sutured directly or repaired with the skin grafts. The pedicle division was done at 4 weeks after operation. After operation, venous crisis occurred in 1 case and distal skin necrosis in 2 cases which was healed by dressing change. The other tissue flaps survived successfully and wounds healed by first intention. All skin grafts at donor site survived after operation, and primary healing of wound was obtained. All patients were followed up 6-24 months (mean, 13 months). All flaps were characterized by soft texture, satisfactory appearance, and restoring the protective sensation. Moreover, the two-point discrimination ranged from 15 to 28 mm (mean, 19.5 mm) at 6 months after operation. The function of both lower extremities were normal without obvious contracture of scar at donor site. Modified free anterolateral thigh perforator flap, with little damage in donor site, a reliable blood supply by making a cross-bridge microvascular anastomosis with pretibial or posterior tibial blood vessel on normal leg, is a reliable alternative method for

Application of Circular Patch Plasty (Dor Procedure) or Linear Repair Techniques in the Treatment of Left Ventricular Aneurysms.

PubMed

Kaya, Ugur; Çolak, Abdurrahim; Becit, Necip; Ceviz, Munacettin; Kocak, Hikmet

2018-01-01

The aim of this study was to evaluate early clinical outcomes and echocardiographic measurements of the left ventricle in patients who underwent left ventricular aneurysm repair using two different techniques associated to myocardial revascularization. Eighty-nine patients (74 males, 15 females; mean age 58±8.4 years; range: 41 to 80 years) underwent post-infarction left ventricular aneurysm repair and myocardial revascularization performed between 1996 and 2016. Ventricular reconstruction was performed using endoventricular circular patch plasty (Dor procedure) (n=48; group A) or linear repair technique (n=41; group B). Multi-vessel disease in 55 (61.7%) and isolated left anterior descending (LAD) disease in 34 (38.2%) patients were identified. Five (5.6%) patients underwent aneurysmectomy alone, while the remaining 84 (94.3%) patients had aneurysmectomy with bypass. The mean number of grafts per patient was 2.1±1.2 with the Dor procedure and 2.9±1.3 with the linear repair technique. In-hospital mortality occurred in 4.1% and 7.3% in group A and group B, respectively (P>0.05). The results of our study demonstrate that post-infarction left ventricular aneurysm repair can be performed with both techniques with acceptable surgical risk and with satisfactory hemodynamic improvement.

Single site and conventional totally extraperitoneal techniques for uncomplicated inguinal hernia repair: A comparative study.

PubMed

de Araújo, Felipe Brandão Corrêa; Starling, Eduardo Simão; Maricevich, Marco; Tobias-Machado, Marcos

2014-10-01

To demonstrate the feasibility of endoscopic extraperitoneal single site (EESS) inguinal hernia repair and compare it outcomes with the conventional totally extraperitoneal (TEP) technique. TEP inguinal hernia repair is a widely accepted alternative to conventional open technique with several perioperative advantages. Transumbilical laparoendoscopic singlesite surgery (LESS) is an emerging approach and has been reported for a number of surgical procedures with superior aesthetic results but other advantages need to be proven. Thirty-eight uncomplicated inguinal hernias were repaired by EESS approach between January 2010 and January 2011. All procedures were performed through a 25 cm infraumbilical incision using the Alexis wound retractor attached to a surgical glove and three trocars. Body mass index, age, operative time, blood loss, complications, conversion rate, analgesia requirement, hospital stay, return to normal activities and patient satisfaction with aesthetic results were analysed and compared with the last 38 matched-pair group of patients who underwent a conventional TEP inguinal hernia repair by the same surgeon. All procedures were performed successfully with no conversion. In both unilateral and bilateral EESS inguinal repairs, the mean operative time was longer than conventional TEP (55± 20 vs. 40± 15 min, P = 0.049 and 70± 15 vs. 55± 10 min, P = 0.014). Aesthetic result was superior in the EESS group (2.88± 0.43 vs. 2.79± 0.51, P = 0.042). There was no difference between the two approaches regarding blood loss, complications, hospital stay, time until returns to normal activities and analgesic requirement. EESS inguinal hernia repair is safe and effective, with superior cosmetic results in the treatment of uncomplicated inguinal hernias. Other advantages of this new technique still need to be proven.

Renal Fenestration Closure Technique in Fenestrated Endovascular Repair for Pararenal Aortic Aneurysm.

PubMed

Gallitto, Enrico; Gargiulo, Mauro; Faggioli, Gianluca; Sonetto, Alessia; Mascoli, Chiara; Pini, Rodolfo; Abualhin, Mohamhed; Stella, Andrea

2018-05-01

To describe an endovascular technique to close a renal artery fenestration during fenestrated endograft implant for a pararenal abdominal aortic aneurysm (p-AAA) without interfering with other visceral vessels. A 76-year-old man with p-AAA underwent repair by a 4 fenestrations custom-made endograft. At the intraprocedural angiography, the right renal artery was occluded. To avoid a high-flow endoleak from fenestration, we performed the following technique: a 9F-steerable sheath was used to advance a 7F sheath through the fenestration into aneurism. A balloon-expandable covered stent was deployed across the fenestration and then occluded by 2 vascular plugs. At the completion angiography, there was no endoleak from the right renal fenestration, and at 6-month period, p-AAA remained completely excluded. The present technique can be a safe and effective therapeutic option to propose in cases of impossible target visceral vessels cannulation during p-AAA repair using a custom-made device to avoid the aneurysmal sac perfusion. Copyright © 2018 Elsevier Inc. All rights reserved.

Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.

PubMed

DeHaan, Alexander M; Axelrad, Thomas W; Kaye, Elizabeth; Silvestri, Lorenzo; Puskas, Brian; Foster, Timothy E

2012-05-01

The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. Systematic review. The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There

Smart Rocks for Bridge Scour Monitoring: Design and Localization Using Electromagnetic Techniques and Embedded Orientation Sensors

NASA Astrophysics Data System (ADS)

Radchenko, Andro

River bridge scour is an erosion process in which flowing water removes sediment materials (such as sand, rocks) from a bridge foundation, river beds and banks. As a result, the level of the river bed near a bridge pier is lowering such that the bridge foundation stability can be compromised, and the bridge can collapse. The scour is a dynamic process, which can accelerate rapidly during a flood event. Thus, regular monitoring of the scour progress is necessary to be performed at most river bridges. Present techniques are usually expensive, require large man/hour efforts, and often lack the real-time monitoring capabilities. In this dissertation a new method--'Smart Rocks Network for bridge scour monitoring' is introduced. The method is based on distributed wireless sensors embedded in ground underwater nearby the bridge pillars. The sensor nodes are unconstrained in movement, are equipped with years-lasting batteries and intelligent custom designed electronics, which minimizes power consumption during operation and communication. The electronic part consists of a microcontroller, communication interfaces, orientation and environment sensors (such as are accelerometer, magnetometer, temperature and pressure sensors), supporting power supplies and circuitries. Embedded in the soil nearby a bridge pillar the Smart Rocks can move/drift together with the sediments, and act as the free agent probes transmitting the unique signature signals to the base-station monitors. Individual movement of a Smart Rock can be remotely detected processing the orientation sensors reading. This can give an indication of the on-going scour progress, and set a flag for the on-site inspection. The map of the deployed Smart Rocks Network can be obtained utilizing the custom developed in-network communication protocol with signals intensity (RSSI) analysis. Particle Swarm Optimization (PSO) is applied for map reconstruction. Analysis of the map can provide detailed insight into the scour

Bridges of the 21st Century.

DOT National Transportation Integrated Search

1988-01-01

Although the future cannot be predicted with certainty, there are a number of potentially useful new bridge concepts and ideas in the offing that give forecasting some credibility. These are discussed first with regard to the repair or rehabilitation...

Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.

PubMed

Savvidou, Christiana; Tsai, Tsu-Min

2015-06-01

The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation.

A biomechanical comparison of 2 transosseous-equivalent double-row rotator cuff repair techniques using bioabsorbable anchors: cyclic loading and failure behavior.

PubMed

Spang, Jeffrey T; Buchmann, Stefan; Brucker, Peter U; Kouloumentas, Panos; Obst, Tobias; Schröder, Manuel; Burgkart, Rainer; Imhoff, Andreas B

2009-08-01

A novel double-row configuration was compared with a traditional double-row configuration for rotator cuff repair. In 10 matched-pair sheep shoulders in vitro repair was performed with either a double-row technique with corkscrew suture anchors for the medial row and insertion anchors for the lateral row (group A) or a double-row technique with a new tape-like suture material with insertion anchors for both the medial and lateral rows (group B). Each specimen underwent cyclic loading from 10 to 150 N for 100 cycles, followed by unidirectional failure testing. Gap formation and strain within the repair area for the first and last cycles were analyzed with a video digitizing system, and stiffness and failure load were determined from the load-elongation curve. The results were similar for the 2 repair types. There was no significant difference between the ultimate failure loads of the 2 techniques (421 +/- 150 N in group A and 408 +/- 66 N in group B, P = .31) or the stiffness of the 2 techniques (84 +/- 26 N/mm in group A and 99 +/- 20 N/mm in group B, P = .07). In addition, gap formation was not different between the repair types. Strain over the repair area was also not different between the repair types. Both tested rotator cuff repair techniques had high failure loads, limited gap formation, and acceptable strain patterns. No significant difference was found between the novel and conventional double-row repair types. Two double-row techniques-one with corkscrew suture anchors for the medial row and insertion anchors for the lateral row and one with insertion anchors for both the medial and lateral rows-provided excellent biomechanical profiles at time 0 for double-row repairs in a sheep model. Although the sheep model may not directly correspond to in vivo conditions, all-insertion anchor double-row constructs are worthy of further investigation.

23. RAILROAD, RR BRIDGE MISSISSIPPI, CLAY CO., WAVERLY 1.5 mi. ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

23. RAILROAD, RR BRIDGE MISSISSIPPI, CLAY CO., WAVERLY 1.5 mi. S of MS. 50 Southern R'wy Co. in Ms. Repairs to Tombigbee River Bridge' gears and turn machinery. DWG # S. 30303. Scale: 1-1/2' = l'. July 21, 1913. Credit: Columbus & Greenville RR, Columbus, Ms. Sarcone Photography, Columbus, Ms. Sep 1978. - Bridges of the Upper Tombigbee River Valley, Columbus, Lowndes County, MS

Robotic Inguinal Hernia Repair: Technique and Early Experience.

PubMed

Arcerito, Massimo; Changchien, Eric; Bernal, Oscar; Konkoly-Thege, Adam; Moon, John

2016-10-01

Laparoscopic inguinal hernia repair has been shown to have multiple advantages compared with open repair such as less postoperative pain and earlier resume of daily activities with a comparable recurrence rate. We speculate robotic inguinal hernia repair may yield equivalent benefits, while providing the surgeon added dexterity. One hundred consecutive robotic inguinal hernia repairs with mesh were performed with a mean age of 56 years (25-96). Fifty-six unilateral hernias and 22 bilateral hernias were repaired amongst 62 males and 16 females. Polypropylene mesh was used for reconstruction. All but, two patients were completed robotically. Mean operative time was 52 minutes per hernia repair (45-67). Five patients were admitted overnight based on their advanced age. Regular diet was resumed immediately. Postoperative pain was minimal and regular activity was achieved after an average of four days. One patient recurred after three months in our earlier experience and he was repaired robotically. Mean follow-up time was 12 months. These data, compared with laparoscopic approach, suggest similar recurrence rates and postoperative pain. We believe comparative studies with laparoscopic approach need to be performed to assess the role robotic surgery has in the treatment of inguinal hernia repair.

Advantages of Arthroscopic Rotator Cuff Repair With a Transosseous Suture Technique: A Prospective Randomized Controlled Trial.

PubMed

Randelli, Pietro; Stoppani, Carlo Alberto; Zaolino, Carlo; Menon, Alessandra; Randelli, Filippo; Cabitza, Paolo

2017-07-01

Rotator cuff tear is a common finding in patients with painful, poorly functioning shoulders. The surgical management of this disorder has improved greatly and can now be fully arthroscopic. To evaluate clinical and radiological results of arthroscopic rotator cuff repair using 2 different techniques: single-row anchor fixation versus transosseous hardware-free suture repair. Randomized controlled trial; Level of evidence, 1. Sixty-nine patients with rotator cuff tears were enrolled: 35 patients were operated with metal anchors and 34 with standardized transosseous repair. The patients were clinically evaluated before surgery, during the 28 days after surgery, and at least 1 year after the operation by the use of validated rating scores (Constant score, QuickDASH, and numerical rating scale [NRS]). Final follow-up was obtained at more than 3 years by a QuickDASH evaluation to detect any difference from the previous follow-up. During the follow-up, rotator cuff integrity was determined through magnetic resonance imaging and was classified according to the 5 Sugaya categories. Patients operated with the transosseous technique had significantly less pain, especially from the 15th postoperative day: In the third week, the mean NRS value for the anchor group was 3.00 while that for transosseous group was 2.46 ( P = .02); in the fourth week, the values were 2.44 and 1.76, respectively ( P < .01). No differences in functional outcome were noted between the 2 groups at the final evaluation. In the evaluation of rotator cuff repair integrity, based on Sugaya magnetic resonance imaging classification, no significant difference was found between the 2 techniques in terms of retear rate ( P = .81). No significant differences were found between the 2 arthroscopic repair techniques in terms of functional and radiological results. However, postoperative pain decreased more quickly after the transosseous procedure, which therefore emerges as a possible improvement in the surgical

Repair and Protection of Small Railway Viaduct with Jammed Span at the Mining Influence

NASA Astrophysics Data System (ADS)

Bętkowski, Piotr

2017-10-01

This paper is about the maintenance of bridge objects on mining areas. Based on several years of observation is shown as functional parameters and technical conditions were deteriorated. As a result of the mining area deformations appeared among others following damages: block of bearings, jam of span, cracks on the abutments. The article describes series of clever maintenance repairs (such as the restoration of displacement freedom on non-standard tangent bearings) which enabled the exploitation of the viaduct without interruptions of railway communication. The region of the bridge is planned to further mining activities, which prejudged, that a repair of the viaduct was necessary to realization. The article discusses the predicted mining area deformation and analyses their influence on the bridge structure. Repair of the viaduct is a comprehensive example of the mining facility protection with the restoration of the expansion joints, bearings replacement, widening benches under bearings, stitching cracks and strengthening abutments, recreating the isolation and the drainage system damaged by mining influences, performance strut in the foundation level. An important element in determining the durability of repair is the selection of appropriate materials and repair technology, which is analysed in the article. All of these tasks completed in less than four months. Article illustrates the photo documentation made before and after repairs and technical drawings that show the range of the repairs.

New Surface-Treatment Technique of Concrete Structures Using Crack Repair Stick with Healing Ingredients

PubMed Central

Ahn, Tae-Ho; Kim, Hong-gi; Ryou, Jae-Suk

2016-01-01

This study focused on the development of a crack repair stick as a new repair method along with self-healing materials that can be used to easily repair the cracks in a concrete structure at the construction site. In developing this new repair technique, the self-healing efficiency of various cementitious materials was considered. Likewise, a crack repair stick was developed to apply to concrete structures with 0.3 mm or lower crack widths. The crack repair stick was made with different materials, such as cement, an expansive material (C12A7), a swelling material, and calcium carbonate, to endow it with a self-healing property. To verify the performance of the crack repair stick for concrete structures, two types of procedures (field experiment and field absorption test) were carried out. As a result of such procedures, it was concluded that the developed crack repair stick could be used on concrete structures to reduce repair expenses and for the improved workability, usability, and serviceability of such structures. On the other hand, to evaluate the self-healing performance of the crack repair stick, various tests were conducted, such as the relative dynamic modulus of elasticity test, the water tightness test, the water permeability test, observation via a microscope, and scanning electron microscope (SEM) analysis. From the results, it is found that water leakage can be prevented and that the durability of a concrete structure can be improved through self-healing. Also, it was verified that the cracks were perfectly closed after 28 days due to application of the crack repair stick. These results indicate the usability of the crack repair stick for concrete structures, and its self-healing efficiency. PMID:28773776

Radiolucent rings around bioabsorbable anchors after rotator cuff repair are not associated with clinical outcomes.

PubMed

Park, Jin-Young; Jang, Suk-Hwan; Oh, Kyung-Soo; Li, Yi Jin

2017-11-01

Various researchers have observed small areas of osteolysis after using bioabsorbable anchors in shoulder surgeries. The purpose of this study is to determine whether radiographic perianchor radiolucent rings after rotator cuff repair are associated with the failure of repair and also assess their clinical implications. Further, the most frequent location of the radiolucent rings in the double-row suture bridge configuration was also assessed. One hundred and twenty-nine consecutive patients who underwent arthroscopic rotator cuff repair by suture bridge technique were retrospectively evaluated radiographically and clinically. The number and size of the rings that appeared at each follow-up were recorded. Also, the locations of each ring were recorded as anterior, middle or posterior, and medial or lateral according to the construct of the anchors used for suture bridge technique. The size of the tear, the number of anchors used and age of the patients were compared. Re-tear rates according to ultrasound examinations were also analyzed. After rotator cuff repair, the mean American Shoulder and Elbow Surgeons (ASES) score increased from 46.7 to 88.0 and the overall re-tear rate was 8.5% (11 cases). Seventy-three patients (56.6%) showed RR (total number of 99 rings) at least once during the course of their follow-up and the rings appeared at a mean period of 18.2 months after surgery. Mean size of the rings initially was 5.6 mm and the rings increased or decreased in mean size of 0.4 mm during mean follow-up of 37 months. No correlation was seen with the number of RRs and the rate of re-tears, number of anchors, size of tears, and clinical outcome as determined by the ASES score. Radiolucent ring measurement reproducibility was confirmed by independent, repeated measurements. The rings appeared mostly at anteromedial anchors (75 rings, 75.8%) and the authors suggest that mechanical factors may play a role for the cause of radiolucent rings. The number and the

Initial load-to-failure and failure analysis in single- and double-row repair techniques for rotator cuff repair

PubMed Central

Buchhorn, G. H.; Gilbert, F.; Spahn, G.; Schultz, W.; Klinger, H.-M.

2010-01-01

Aim This experimental study aimed to compare the load-to-failure rate and stiffness of single- versus double-row suture techniques for repairing rotator cuff lesions using two different suture materials. Additionally, the mode of failure of each repair was evaluated. Method In 32 sheep shoulders, a standardized tear of the infraspinatus tendon was created. Then, n = 8 specimen were randomized to four repair methods: (1) Double-row Anchor Ethibond® coupled with polyester sutures, USP No. 2; (2) Double-Row Anchor HiFi® with polyblend polyethylene sutures, USP No. 2; (3) Single-Row Anchor Ethibond® coupled with braided polyester sutures, USP No. 2; and (4) Single-Row Anchor HiFi® with braided polyblend polyethylene sutures, USP No. 2. Arthroscopic Mason–Allen stitches were placed (single-row) and combined with medial horizontal mattress stitches (double-row). All specimens were loaded to failure at a constant displacement rate on a material testing machine. Results Group 4 showed lowest load-to-failure result with 155.7 ± 31.1 N compared to group 1 (293.4 ± 16.1 N) and group 2 (397.7 ± 7.4 N) (P < 0.001). Stiffness was highest in group 2 (162 ± 7.3 N/mm) and lowest in group 4 (84.4 ± 19.9 mm) (P < 0.001). In group 4, the main cause of failure was due to the suture cutting through the tendon (n = 6), a failure case observed in only n = 1 specimen in group 2 (P < 0.001). Conclusions A double-row technique combined with arthroscopic Mason-Allen/horizontal mattress stitches provides high initial failure strength and may minimize the risk of the polyethylene sutures cutting through the tendon in rotator cuff repair when a single load force is used. PMID:20049605

Transverse mucoperiosteal flap inset by rotation for cleft palate repair: technique and outcomes.

PubMed

Black, Jonathan S; Gampper, Thomas J

2014-01-01

Cleft palate is a relatively common deformity with various techniques described for its repair. Most techniques address the hard palate portion of the cleft with bilateral mucoperiosteal flaps transposed to the midline. This results in superimposed, linear closure layers directly over the cleft and may predispose the repair to oronasal fistula formation. This report details an alternative technique of flap rotation with an outcome analysis. A retrospective chart analysis was performed of all patients having undergone primary palatoplasty for cleft palate. Demographics and cleft Veau type were recorded. Postoperative speech outcomes were assessed by standardized speech evaluation performed by 2 speech language pathologists. The presence and location of oronasal fistulae was assessed and recorded by the surgeon and speech language pathologists in follow-up evaluations. The study revealed an overall incidence of velopharyngeal insufficiency of 5.7% using this surgical technique. It also revealed a fistula rate of 8.6%. Secondary surgery has been successful in those patients in which it was indicated. Eleven (31%) patients were diagnosed with Robin sequence. This technique demonstrates excellent early outcomes in a difficult subset of cleft patients including a high proportion of those with Pierre Robin sequence. The technique addresses the inherent disadvantages to a linear closure over the bony cleft. The variability in its design provides the surgeon another option for correction of this deformity.

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

PubMed

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 < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged

Efficacy of bone marrow-stimulating technique in rotator cuff repair.

PubMed

Bilsel, Kerem; Yildiz, Fatih; Kapicioglu, Mehmet; Uzer, Gokcer; Elmadag, Mehmet; Pulatkan, Anil; Esrefoglu, Mukaddes; Bozdag, Ergun; Milano, Giuseppe

2017-08-01

This study used a chronic rotator cuff (RC) tear model to investigate the effect of microfracture as a bone marrow-stimulating (BMS) technique for RC healing. A chronic retracted RC tendon tear model was created bilaterally in the subscapularis tendons of 20 New Zealand rabbits. The tendons were repaired after 8 weeks using a single-row configuration. Tendons in the right shoulder were repaired in standard fashion (control group). Microfractures were performed in the left shoulders before repair (microfracture group). The animals were euthanized 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness, and elongation at failure. Gross and histologic evaluations of the tendon-to-bone healing were evaluated. Macroscopically, subscapularis tendons were attached on the lesser tuberosity. In the microfracture group, collagen fibers were organized in relatively thicker bundles. The mean ultimate failure load of the microfracture group was significantly greater at 8 weeks (148.4 ± 31 N vs. 101.4 ± 26 N, respectively; P = .011) and 16 weeks (155 ± 30 N vs. 114.9 ± 25 N, respectively; P = .017) after repair. There were no significant differences between the groups for linear stiffness at 8 weeks (15.9 ± 2.7 N/mm vs. 15.8 ± 1.3 N/mm, respectively; P = .798) and 16 weeks (16.9 ± 4.3 N/mm vs. 17.1 ± 3.6 N/mm, respectively, P = .848) and elongation at failure at 8 weeks (4.7 ± 1.1 mm vs. 4.7 ± 1.3 mm, respectively; P = .848) and 16 weels (4.8 ± 1.5 mm vs. 4.9 ± 0.9 mm, respectively; P = .749). The microfracture on the tuberosity of the repaired chronic rotator cuff tear promoted dynamic tendon healing with significantly increased ultimate force to failure and with thicker collagen bundles and more fibrocartilage histologically at 8 weeks. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of

Fetoscopic Open Neural Tube Defect Repair: Development and Refinement of a Two-Port, Carbon Dioxide Insufflation Technique.

PubMed

Belfort, Michael A; Whitehead, William E; Shamshirsaz, Alireza A; Bateni, Zhoobin H; Olutoye, Oluyinka O; Olutoye, Olutoyin A; Mann, David G; Espinoza, Jimmy; Williams, Erin; Lee, Timothy C; Keswani, Sundeep G; Ayres, Nancy; Cassady, Christopher I; Mehollin-Ray, Amy R; Sanz Cortes, Magdalena; Carreras, Elena; Peiro, Jose L; Ruano, Rodrigo; Cass, Darrell L

2017-04-01

To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized. Obstetric, maternal, fetal, and early neonatal outcomes were compared. Standard parametric and nonparametric tests were used as appropriate. Data for 28 patients (22 endoscopic only, four hybrid, two abandoned) are reported, but only those with a complete fetoscopic repair were analyzed (iterative technique [n=10] compared with standardized technique [n=12]). Maternal demographics and gestational age (median [range]) at fetal surgery (25.4 [22.9-25.9] compared with 24.8 [24-25.6] weeks) were similar, but delivery occurred at 35.9 (26-39) weeks of gestation with the iterative technique compared with 39 (35.9-40) weeks of gestation with the standardized technique (P<.01). Duration of surgery (267 [107-434] compared with 246 [206-333] minutes), complication rates, preterm prelabor rupture of membranes rates (4/12 [33%] compared with 1/10 [10%]), and vaginal delivery rates (5/12 [42%] compared with 6/10 [60%]) were not statistically different in the iterative and standardized techniques, respectively. In 6 of 12 (50%) compared with 1 of 10 (10%), respectively (P=.07), there was leakage of cerebrospinal fluid from the repair site at birth. Management of Myelomeningocele Study criteria for hydrocephalus-death at discharge were met in 9 of 12 (75%) and 3 of 10 (30%), respectively, and 7 of 12 (58%) compared with 2 of 10 (20%) have been treated for hydrocephalus to date. These latter differences were not statistically significant. Fetoscopic open neural tube defect repair does

Evaluation of fleet management techniques for timber highway bridges

Treesearch

Brent M. Phares; Travis K. Hosteng; Justin Dahlberg; Michael A. Ritter

2011-01-01

The general condition of the nation's bridges presents a complex management issue when considering cost, safety, and time. Consequently, the management of those bridges can become an overwhelming task. The need for a management system that is specific to rural systems may help to improve the management of this significant number of bridges. Although individual...

Pigeon chest: comparative analysis of surgical techniques in minimal access repair of pectus carinatum (MARPC).

PubMed

Muntean, Ancuta; Stoica, Ionica; Saxena, Amulya K

2018-02-01

After minimally invasive repair for pectus excavatum (MIRPE), similar procedures for pectus carinatum were developed. This study aimed to analyse the various published techniques of minimal access repair for pectus carinatum (MARPC) and compare the outcomes. Literature was reviewed on PubMed with the terms "pectus carinatum", "minimal access repair", "thoracoscopy" and "children". Twelve MARPC techniques that included 13 articles and 140 patients with mean age 15.46 years met the inclusion criteria. Success rate of corrections was n = 125, about 89% in cumulative reports, with seven articles reporting 100%. The complication rate was 39.28%. Since the pectus bar is placed over the sternum and has a large contact area, skin irritation was the most frequent morbidity (n = 20, 14.28%). However, within the complication group (n = 55), wire breakage (n = 21, 38.18%) and bar displacement (n = 10, 18.18%) were the most frequent complications. Twenty-two (15.71%) patients required a second procedure. Recurrences have been reported in four of twelve techniques. There were no lethal outcomes. MARPC techniques are not standardized, as MIRPE are, so comparative analysis is difficult as the only common denominator is minimal access. Surgical morbidity is high in MARPC and affects > 2/3rd patients with about 15% requiring surgery for complication management.

Percutaneous Tricuspid Valve Regurgitation Repair With the MitraClip Device Using an Edge-to-Edge Bicuspidization Technique.

PubMed

Gafoor, Sameer; Petrescu, O Madalina; Lehr, Eric J; Puls, Charles; Zhang, Ming; Petersen, John L; Olsen, John V; Penev, Irina; Agrawal, Mayank; Sharma, Rahul; Barnhart, Glenn

2017-03-01

Patients who present with both severe mitral and tricuspid regurgitation who are symptomatic despite optimal medical therapy and at prohibitive risk for surgery pose a significant therapeutic challenge. The MitraClip device (Abbott Vascular) is approved for percutaneous mitral valve repair in high-risk and non-operative patients, and has also been used for tricuspid valve repair. Imaging support for percutaneous edge-to-edge tricuspid valve repair has not been reported and is a vital part of the procedure. Here, we present a periprocedural imaging strategy for percutaneous tricuspid valve repair with the MitraClip device using a bicuspidization technique.

Evaluation of Asphalt Bridge Deck Joint Systems.

DOT National Transportation Integrated Search

2009-12-01

Asphaltic Plug Joint is an expansion joint that is used for new and rehabilitated bridges. It provides a smooth and watertight surface free of debris; and offers simple, easy and staged construction. Asphaltic plug joint can be repaired segmentally a...

Biomechanical effects of a 2 suture-pass medial inter-implant mattress on transosseous-equivalent rotator cuff repair and considerations for a "technical efficiency ratio".

PubMed

Park, Maxwell C; Peterson, Alexander; Patton, John; McGarry, Michelle H; Park, Chong J; Lee, Thay Q

2014-03-01

Rotator cuff repair involving fewer tendon suture passes without compromising biomechanical performance would represent a technical advancement. An inter-implant "medial pulley-mattress" transosseous-equivalent (MP-TOE) repair requiring fewer tendon suture-passes was hypothesized to provide equivalent biomechanical characteristics compared to the control. In 6 human cadaveric shoulders, a transosseous-equivalent (TOE) repair (control) was performed utilizing 2 separate medial mattresses resulting in 4 tendon-bridging sutures. In 6 matched-pairs, 2 single-loaded anchors were used to create a medial inter-implant mattress construct (all sutures shuttled in 1 tendon pass per anchor)-after knot-tying, the same tendon-bridging pattern as the control was created. A materials testing machine cyclically loaded each repair from 10-180 N for 30 cycles; each repair subsequently underwent failure testing. Gap and strain were measured with a video digitizing system. A "technical efficiency ratio" (TER) was defined as: (#knots + #suture passes + #suture limbs)/#fixation points. Cyclic and failure testing demonstrated no significant differences between constructs. Gap formation at cycle 30 was 5.3 ± 0.8 mm (TOE) and 5.0 ± 0.3 mm (MP-TOE) (P = .62). Cycle 30 anterior strain values were -16.0 ± 7.3% (TOE) and -15.8 ± 6.6% (MP-TOE) (P = .99). Yield loads were 208.7 ± 2.7 N (TOE) and 204.0 ± 1.3 N (MP-TOE) (P = .17). Mode of failure demonstrated less tendon cut-out with the MP-TOE repair. The MP-TOE repair has a TER of 2.0 vs 2.5 for the control. The MP-TOE repair requiring fewer tendon suture passes, yet creating an additional inter-implant mattress configuration, is biomechanically equivalent to the original TOE technique, and may limit failure with improved medial load-sharing capacity. A TER may help quantify technical ease and help standardize comparisons between repair techniques. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights

77 FR 1020 - Regulated Navigation Area; S99 Alford Street Bridge Rehabilitation Project, Mystic River, MA

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-09

...-AA11 Regulated Navigation Area; S99 Alford Street Bridge Rehabilitation Project, Mystic River, MA... Mystic River under and surrounding the S99 Alford Street Bridge which crosses the Mystic River between... construction workers by restricting vessel traffic during periods where the bridge is being repaired. DATES...

Integrated technique of planning the capital repair of residential buildings and objects of transport infrastructure

NASA Astrophysics Data System (ADS)

Dement'eva, Marina

2017-10-01

The paper presents the results of a comparative analysis of two fundamentally different methods for planning capital repairs of objects of transport infrastructure and residential development. The first method was based on perspective long-term plans. Normative service life were the basis for planning the periodicity of repairs. The second method was based on the performance of repairs in fact of the onset of the malfunction. Problems of financing repair work, of the uneven aging of constructs and engineering systems, different wear mechanism in different conditions of exploitation, absence of methods of planning repairs of administrative and production buildings (depots, stations, etc.) justify the need to optimize methods of planning the repair and the relevance of this paper. The aim of the study was to develop the main provisions of an integrated technique for planning the capital repair of buildings of any functional purpose, which combines the advantages of each of the discussed planning methods. For this purpose, the consequences of technical and economic risk were analyzed of the buildings, including stations, depots, transport transfer hubs, administrative buildings, etc when choosing different planning methods. One of the significant results of the study is the possibility of justifying the optimal period of capital repairs on the basis of the proposed technical and economic criteria. The adjustment of the planned repair schedule is carried out taking into account the reliability and cost-effectiveness of the exploitation process.

Biomechanical comparison of single-row, double-row, and transosseous-equivalent repair techniques after healing in an animal rotator cuff tear model.

PubMed

Quigley, Ryan J; Gupta, Akash; Oh, Joo-Han; Chung, Kyung-Chil; McGarry, Michelle H; Gupta, Ranjan; Tibone, James E; Lee, Thay Q

2013-08-01

The transosseous-equivalent (TOE) rotator cuff repair technique increases failure loads and contact pressure and area between tendon and bone compared to single-row (SR) and double-row (DR) repairs, but no study has investigated if this translates into improved healing in vivo. We hypothesized that a TOE repair in a rabbit chronic rotator cuff tear model would demonstrate a better biomechanical profile than SR and DR repairs after 12 weeks of healing. A two-stage surgical procedure was performed on 21 New Zealand White Rabbits. The right subscapularis tendon was transected and allowed to retract for 6 weeks to simulate a chronic tear. Repair was done with the SR, DR, or TOE technique and allowed to heal for 12 weeks. Cyclic loading and load to failure biomechanical testing was then performed. The TOE repair showed greater biomechanical characteristics than DR, which in turn were greater than SR. These included yield load (p < 0.05), energy absorbed to yield (p < 0.05), and ultimate load (p < 0.05). For repair of a chronic, retracted rotator cuff tear, the TOE technique was the strongest biomechanical construct after healing followed by DR with SR being the weakest. Copyright © 2013 Orthopaedic Research Society.

Cyclic loading of rotator cuff reconstructions: single-row repair with modified suture configurations versus double-row repair.

PubMed

Lorbach, Olaf; Bachelier, Felix; Vees, Jochen; Kohn, Dieter; Pape, Dietrich

2008-08-01

Double-row repair is suggested to have superior biomechanical properties in rotator cuff reconstruction compared with single-row repair. However, double-row rotator cuff repair is frequently compared with simple suture repair and not with modified suture configurations. Single-row rotator cuff repairs with modified suture configurations have similar failure loads and gap formations as double-row reconstructions. Controlled laboratory study. We created 1 x 2-cm defects in 48 porcine infraspinatus tendons. Reconstructions were then performed with 4 single-row repairs and 2 double-row repairs. The single-row repairs included transosseous simple sutures; double-loaded corkscrew anchors in either a double mattress or modified Mason-Allen suture repair; and the Magnum Knotless Fixation Implant with an inclined mattress. Double-row repairs were either with Bio-Corkscrew FT using modified Mason-Allen stitches or a combination of Bio-Corkscrew FT and PushLock anchors using the SutureBridge Technique. During cyclic load (10 N to 60-200 N), gap formation was measured, and finally, ultimate load to failure and type of failure were recorded. Double-row double-corkscrew anchor fixation had the highest ultimate tensile strength (398 +/- 98 N) compared to simple sutures (105 +/- 21 N; P < .0001), single-row corkscrews using a modified Mason-Allen stitch (256 +/- 73 N; P = .003) or double mattress repair (290 +/- 56 N; P = .043), the Magnum Implant (163 +/- 13 N; P < .0001), and double-row repair with PushLock and Bio-Corkscrew FT anchors (163 +/- 59 N; P < .0001). Single-row double mattress repair was superior to transosseous sutures (P < .0001), the Magnum Implant (P = .009), and double-row repair with PushLock and Bio-Corkscrew FT anchors (P = .009). Lowest gap formation was found for double-row double-corkscrew repair (3.1 +/- 0.1 mm) compared to simple sutures (8.7 +/- 0.2 mm; P < .0001), the Magnum Implant (6.2 +/- 2.2 mm; P = .002), double-row repair with PushLock and Bio

The Collapse of the I-35W Bridge in Minneapolis

ERIC Educational Resources Information Center

Feldman, Bernard J.

2010-01-01

On Wednesday, Aug. 1, 2007, at 6:05 p.m. (during evening rush hour), the I-35W bridge across the Mississippi River in Minneapolis collapsed, killing 13 people and injuring 145. At the time of the collapse, repair work was in progress on the deck of the bridge, resulting in an additional 287 tons of construction material and equipment being on the…

Rotator cuff repair

MedlinePlus

... techniques are used to repair a rotator cuff tear: During open repair, a surgical incision is made ... repair is done for large or more complex tears. During arthroscopy, the arthroscope is inserted through small ...

Constructing a new nigrostriatal pathway in the Parkinsonian model with bridged neural transplantation in substantia nigra.

PubMed

Zhou, F C; Chiang, Y H; Wang, Y

1996-11-01

The physical repair and restoration of a completely damaged pathway in the brain has not been achieved previously. In a previous study, using excitatory amino acid bridging and fetal neural transplantation, we demonstrated that a bridged mesencephalic transplant in the substantia nigra generated an artificial nerve pathway that reinnervated the striatum of 6-hydroxydopamine (6-OHDA)-lesioned rats. In the current study, we report that a bridged mesencephalic transplant can anatomically, neurochemically, and functionally reinstate the 6-OHDA-eradicated nigro-striatal pathway. An excitatory amino acid, kainic acid, laid down in a track during the transplant generated a trophic environment that effectively guided the robust growth of transplanted neuronal fibers in a bundle to innervate the distal striatum. Growth occurred at the remarkable speed of approximately 200 microm/d. Two separate and distinct types of dopamine (DA) innervation from the transplant have been achieved for the first time: (1) DA innervation of the striatum, and (2) DA innervation of the pars reticularis of the substantia nigra. In addition, neuronal tracing revealed that reciprocal connections were achieved. The grafted DA neurons in the SNr innervated the host's striatum, whereas the host's striatal neurons, in turn, innervated the graft within 3-8 weeks. Electrochemical volt- ammetry recording revealed the restoration of DA release and clearance in a broad striatal area associated with the DA reinnervation. Furthermore, the amphetamine-induced rotation was attenuated, which indicates that the artificial pathways were motor functional. This study provides additional evidences that our bridged transplantation technique is a potential means for the repair of a completely damaged neuronal pathway.

77 FR 73916 - Regulated Navigation Area; S99 Alford Street Bridge Rehabilitation Project, Mystic River, MA

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-12

...-AA11 Regulated Navigation Area; S99 Alford Street Bridge Rehabilitation Project, Mystic River, MA... against hazardous conditions created by repair work on the S99 Alford Street Bridge across the Mystic... Coast Guard to establish a regulated navigation area in connection with the S99 Alford Street Bridge...

Novel technique for repairing posterior medial meniscus root tears using porcine knees and biomechanical study.

PubMed

Wu, Jia-Lin; Lee, Chian-Her; Yang, Chan-Tsung; Chang, Chia-Ming; Li, Guoan; Cheng, Cheng-Kung; Chen, Chih-Hwa; Huang, Hsu-Shan; Lai, Yu-Shu

2018-01-01

Transtibial pullout suture (TPS) repair of posterior medial meniscus root (PMMR) tears was shown to achieve good clinical outcomes. The purpose of this study was to compare biomechanically, a novel technique designed to repair PMMR tears using tendon graft (TG) and conventional TPS repair. Twelve porcine tibiae (n = 6 each) TG group: flexor digitorum profundus tendon was passed through an incision in the root area, created 5 mm postero-medially along the edge of the attachment area. TPS group: a modified Mason-Allen suture was created using no. 2 FiberWire. The tendon grafts and sutures were threaded through the bone tunnel and then fixed to the anterolateral cortex of the tibia. The two groups underwent cyclic loading followed by a load-to-failure test. Displacements of the constructs after 100, 500, and 1000 loading cycles, and the maximum load, stiffness, and elongation at failure were recorded. The TG technique had significantly lower elongation and higher stiffness compared with the TPS. The maximum load of the TG group was significantly lower than that of the TPS group. Failure modes for all specimens were caused by the suture or graft cutting through the meniscus. Lesser elongation and higher stiffness of the constructs in TG technique over those in the standard TPS technique might be beneficial for postoperative biological healing between the meniscus and tibial plateau. However, a slower rehabilitation program might be necessary due to its relatively lower maximum failure load.

Proposed technique for open repair of a small umbilical hernia and rectus divarication with self-gripping mesh.

PubMed

Privett, B J; Ghusn, M

2016-08-01

There are a group of patients in which umbilical or epigastric hernias co-exist with rectus divarication. These patients have weak abdominal musculature and are likely to pose a higher risk of recurrence following umbilical hernia repair. We would like to describe a technique for open repair of small (<4 cm) midline hernias in patients with co-existing rectus divarication using self-adhesive synthetic mesh. The use of a self-adhesive mesh avoids the need for suture fixation of the mesh in the superior portion of the abdomen, allowing for a smaller skin incision. In 173 patients, preperitoneal self-fixating mesh has been used for the repair of midline hernias <4 cm in diameter. In 58 of these patients, the mesh was extended superiorly to reinforce a concurrent divarication. The described technique offers a simple option for open repair of small midline hernias in patients with co-existing rectus divarication, to decrease the risk of upper midline recurrence in an at-risk patient group. This initial case series is able to demonstrate a suitably low rate of recurrence and complications.

Critical and subcritical damage monitoring of bonded composite repairs using innovative non-destructive techniques

NASA Astrophysics Data System (ADS)

Grammatikos, S. A.; Kordatos, E. Z.; Aggelis, D. G.; Matikas, T. E.; Paipetis, A. S.

2012-04-01

Infrared Thermography (IrT) has been shown to be capable of detecting and monitoring service induced damage of repair composite structures. Full-field imaging, along with portability are the primary benefits of the thermographic technique. On-line lock-in thermography has been reported to successfully monitor damage propagation or/and stress concentration in composite coupons, as mechanical stresses in structures induce heat concentration phenomena around flaws. During mechanical fatigue, cyclic loading plays the role of the heating source and this allows for critical and subcritical damage identification and monitoring using thermography. The Electrical Potential Change Technique (EPCT) is a new method for damage identification and monitoring during loading. The measurement of electrical potential changes at specific points of Carbon Fiber Reinforced Polymers (CFRPs) under load are reported to enable the monitoring of strain or/and damage accumulation. Along with the aforementioned techniques Finally, Acoustic Emission (AE) method is well known to provide information about the location and type of damage. Damage accumulation due to cyclic loading imposes differentiation of certain parameters of AE like duration and energy. Within the scope of this study, infrared thermography is employed along with AE and EPCT methods in order to assess the integrity of bonded repair patches on composite substrates and to monitor critical and subcritical damage induced by the mechanical loading. The combined methodologies were effective in identifying damage initiation and propagation of bonded composite repairs.

49 CFR Appendix A to Part 237 - Supplemental Statement of Agency Policy on the Safety of Railroad Bridges

Code of Federal Regulations, 2014 CFR

2014-10-01

... for the design of a bridge can generally be used to determine and rate the load capacity of a bridge... from the service loads can be correlated to the stresses for which the bridge was designed or rated. 3... bridge should keep design, construction, maintenance and repair records readily accessible to permit the...

49 CFR Appendix A to Part 237 - Supplemental Statement of Agency Policy on the Safety of Railroad Bridges

Code of Federal Regulations, 2013 CFR

2013-10-01

... for the design of a bridge can generally be used to determine and rate the load capacity of a bridge... from the service loads can be correlated to the stresses for which the bridge was designed or rated. 3... bridge should keep design, construction, maintenance and repair records readily accessible to permit the...

49 CFR Appendix A to Part 237 - Supplemental Statement of Agency Policy on the Safety of Railroad Bridges

Code of Federal Regulations, 2010 CFR

2010-10-01

... for the design of a bridge can generally be used to determine and rate the load capacity of a bridge... from the service loads can be correlated to the stresses for which the bridge was designed or rated. 3... bridge should keep design, construction, maintenance and repair records readily accessible to permit the...

Correlation between histological outcome and surgical cartilage repair technique in the knee: A meta-analysis.

PubMed

DiBartola, Alex C; Everhart, Joshua S; Magnussen, Robert A; Carey, James L; Brophy, Robert H; Schmitt, Laura C; Flanigan, David C

2016-06-01

Compare histological outcomes after microfracture (MF), autologous chondrocyte implantation (ACI), and osteochondral autograft transfer (OATS). Literature review using PubMed MEDLINE, SCOPUS, Cumulative Index for Nursing and Allied Health Literature (CINAHL), and Cochrane Collaboration Library. Inclusion criteria limited to English language studies International Cartilage Repair Society (ICRS) grading criteria for cartilage analysis after ACI (autologous chondrocyte implantation), MF (microfracture), or OATS (osteochondral autografting) repair techniques. Thirty-three studies investigating 1511 patients were identified. Thirty evaluated ACI or one of its subtypes, six evaluated MF, and seven evaluated OATS. There was no evidence of publication bias (Begg's p=0.48). No statistically significant correlation was found between percent change in clinical outcome and percent biopsies showing ICRS Excellent scores (R(2)=0.05, p=0.38). Percent change in clinical outcome and percent of biopsies showing only hyaline cartilage were significantly associated (R(2)=0.24, p=0.024). Mean lesion size and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Most common lesion location and histological outcome were not correlated based either on percent ICRS Excellent (R(2)=0.03, p=0.50) or percent hyaline cartilage only (R(2)=0.01, p=0.67). Microfracture has poorer histologic outcomes than other cartilage repair techniques. OATS repairs primarily are comprised of hyaline cartilage, followed closely by cell-based techniques, but no significant difference was found cartilage quality using ICRS grading criteria among OATS, ACI-C, MACI, and ACI-P. IV, meta-analysis. Copyright © 2016 Elsevier B.V. All rights reserved.

Repairing/strengthening of bridges with post-tensioned FRP materials and performance evaluation.

DOT National Transportation Integrated Search

2015-09-01

One of the challenges that transportation agencies are facing is to keep bridges in good condition during their service life. : Numerous bridges are classified as structurally and/or functionally deficient in the country. In the state of Louisiana, 4...

Repair of steel beam/girder ends with ultra high-strength concrete - phase II.

DOT National Transportation Integrated Search

2016-01-01

A novel repair method has been developed at the University of Connecticut for corroded steel bridge girder : ends. The repair method consists of encasing the corroded steel area with UHPC. The UHPC panel is bonded : to the steel girder using headed s...

Evaluation and repair of existing bridges in extreme environments.

DOT National Transportation Integrated Search

2016-01-26

The research described in this report consisted of analysis and experimental testing of steel bridge details susceptible to fatigue and end regions of precast prestressed concrete girder ends subjected to reinforcement corrosion. Locations most affec...

Is the Abramson technique effective in pectus carinatum repair?

PubMed

Katrancioglu, Ozgur; Akkas, Yucel; Karadayi, Sule; Sahin, Ekber; Kaptanoğlu, Melih

2018-01-01

The minimally invasive pectus carinatum (PC) surgery described by Abramson has been performed in many centers. We have been using this technique since 2011. This article describes our experience with PC correction. Between 2011 and 2016, 32 patients at our institution underwent minimally invasive repair of a PC deformity. All patients presented with cosmetic complaints. The deformity involved the lower sternum (all had chondrogladiolar type PC), and three patients had asymmetrical deformities. All operations followed the principles defined by Abramson. Satisfactory esthetic results were achieved in our patients. The hospital stay averaged 5.3 days (range 4-7 days). The most common early complication was pneumothorax, and the most common late complication was wire suture breakage. The Abramson technique is an effective, minimally invasive procedure for PC with shorter operating and hospitalization times and low morbidity rates. Copyright © 2016. Published by Elsevier Taiwan.

Shear repair of P/C box beams using carbon fiber reinforced polymer (CFRP) fabric.

DOT National Transportation Integrated Search

2006-01-01

The report documents the retrofit work carried out on the KY3297 Bridge over Little Sandy River in Carter County, Kentucky. Field investigation and evaluation revealed that the bridge superstructure was deficient in shear. The repair work was carried...

A retrospective analysis of mathieu and tip urethroplasty techniques for distal hypospadias repair; A 20 year experience.

PubMed

Oztorun, Kenan; Bagbanci, Sahin; Dadali, Mumtaz; Emir, Levent; Karabulut, Ayhan

2017-09-01

We aimed to identify the changes in the application rate of two surgical techniques in distal hypospadias repair in years and compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, the factors that affect the outcomes, which were performed over a 20 year period. In this study, the records of 492 consecutive patients that had undergone an operation for distal hypospadias in the urology clinic of Ankara between May 1990 and December 2010 using either Mathieu or TIPU surgical techniques were reviewed retrospectively. The patients who had glanular, coronal, and subcoronal meatus, were accepted as distal hypospadias cases. Among the 492 examined medical records, it was revealed that 331 and 161 surgical interventions were performed by using the Mathieu urethroplasty technique (Group-1) and TIP urethroplasty technique (Group-2), respectively. Group-1 was divided into two subgroups; namely Group-1a (patients with primary hypospadias) and Group-1b (patients with previous hypospadias operation). Likewise, Group-2 was divided into two subgroups; namely group-2a and group-2b. The patients' ages, number of previously urethroplasty operations, localization of the external urethral meatus prior to the operation, chordee state, length of the newly formed urethra, whether urinary diversion was done or not, post-operative complications and data regarding the follow-up period were evaluated, and the effects of these variables on the surgical outcome were investigated via statistical analyses. The primary objective of this study is to identify the changes in the application rate of two surgical techniques in distal hypospadias repair over the a 20 year period, and the secondary objectives are to compare the most popular two surgical repair techniques for distal hypospadias in terms of surgical outcomes, and the factors affecting the outcomes. Independent samples t test and Pearson's Chisquare test was used for statistical

Laparoscopic Repair of Inguinal Hernia with Biomimetic Matrix

PubMed Central

2012-01-01

Background and Objectives: Materials utilized for the repair of hernias fall into 2 broad categories, synthetics and biologics. Each has its merits and drawbacks. The synthetics have a permanent, inherent strength but are associated with some incidence of chronic pain. The biologics rely on variable tissue regeneration to give strength to the repair, limiting their use to specific situations. However, thanks to their transient presence and tissue ingrowth, the biologics do not result in a significant incidence of chronic pain. We studied the use of a biomimetic (REVIVE, Biomerix Corporation, Fremont, CA) in this setting in an attempt to obviate the disadvantages of each material. Methods: Fourteen patients underwent laparoscopic repair by totally extraperitoneal and transabdominal preperitoneal techniques of 16 inguinal hernias. Follow-up was as long as 19 mo, and 8 patients were followed for > 12 mo. There were no recurrences and a 5% incidence of functionally insignificant discomfort. Results: REVIVE is shown in histology and in vivo to demonstrate regeneration and tissue ingrowth into the polycarbonate/polyuria matrix similar to that in the biologics rather than scarring or encapsulation. There were no recurrences, indicating its strength and resilience as a permanent repair similar to that in the synthetics. Conclusion: This is proof of the concept that a biomimetic may bridge the gap between the biologics and synthetics and may be able to be utilized on a regular basis with the benefits of both materials and without their drawbacks. PMID:23484565

Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair.

PubMed

Kim, David H; Elattrache, Neal S; Tibone, James E; Jun, Bong-Jae; DeLaMora, Sergai N; Kvitne, Ronald S; Lee, Thay Q

2006-03-01

Reestablishment of the native footprint during rotator cuff repair has been suggested as an important criterion for optimizing healing potential and fixation strength. A double-row rotator cuff footprint repair will demonstrate superior biomechanical properties compared with a single-row repair. Controlled laboratory study. In 9 matched pairs of fresh-frozen cadaveric shoulders, the supraspinatus tendon from 1 shoulder was repaired with a double-row suture anchor technique: 2 medial anchors with horizontal mattress sutures and 2 lateral anchors with simple sutures. The tendon from the contralateral shoulder was repaired using a single lateral row of 2 anchors with simple sutures. Each specimen underwent cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure. Gap formation and strain over the footprint area were measured using a video digitizing system; stiffness and failure load were determined from testing machine data. Gap formation for the double-row repair was significantly smaller (P < .05) when compared with the single-row repair for the first cycle (1.67 +/- 0.75 mm vs 3.10 +/- 1.67 mm, respectively) and the last cycle (3.58 +/- 2.59 mm vs 7.64 +/- 3.74 mm, respectively). The initial strain over the footprint area for the double-row repair was nearly one third (P < .05) the strain of the single-row repair. Adding a medial row of anchors increased the stiffness of the repair by 46% and the ultimate failure load by 48% (P < .05). Footprint reconstruction of the rotator cuff using a double-row repair improved initial strength and stiffness and decreased gap formation and strain over the footprint when compared with a single-row repair. To achieve maximal initial fixation strength and minimal gap formation for rotator cuff repair, reconstructing the footprint attachment with 2 rows of suture anchors should be considered.

A novel remaining tendon preserving repair technique leads to improved outcomes in special rotator cuff tear patterns.

PubMed

Jeon, Yoon Sang; Kim, Rag Gyu; Shin, Sang-Jin

2018-05-16

The purpose of this study was to identify the tear pattern that could be anatomically repaired by preserving the remaining tendon on footprint and evaluate clinical outcomes of patients who underwent remaining tendon preserving cuff repair. Of 523 patients with full-thickness rotator cuff tears who underwent arthroscopic repair, 41 (7.8%) patients had repairable rotator cuff tear while preserving the remaining tendon. Among them, 31 patients were followed-up for more than 2 years, including 26 patients with posterior L-shaped tear and 5 patients with transtendinous tear patterns. Clinical outcomes were evaluated using ASES and Constant score, SANE score for patient satisfaction, and VAS for pain. MRI was taken for tendon integrity 6 months postoperatively. Of the 31 patients, 11 (35.5%) had previous injury history before rotator cuff tear, including 7 (26.9%) of the 26 patients with posterior L-shaped tear and 4 (80%) of the 5 patients with transtendinous tear. The average size of preoperative cuff tear was 17.8 ± 6.8 mm in anterior-to-posterior direction and 15.2 ± 5.1 mm in medial-to-lateral direction. ASES and Constant score, SANE score, and VAS for pain were significantly (p < 0.001) improved after remaining tendon preserving rotator cuff repair. Rotator cuff tendons of 22(84.6%) patients with posterior L-shaped tear and 4(80%) patients with transtendinous tear patterns were healed. Patients who underwent rotator cuff repair with preservation of the remaining tendon on the footprint obtained satisfactory functional outcomes. Rotator cuff tears in patients who had posterior L-shaped tear extending between supraspinatus and infraspinatus tendons or transtendinous tear pattern with substantial remaining tendon could be repaired using remaining tendon preserving repair technique. Anatomic reduction of torn cuff tendon without undue tension could be achieved using the remaining tendon preserving repair technique.

Arthroscopic repair of the posterior horn of the medial meniscus with opening wedge high tibial osteotomy: surgical technique.

PubMed

Jung, Kwang Am; Kim, Sung Jae; Lee, Su Chan; Jeong, Jae Hoon; Song, Moon Bok; Lee, Choon Key

2009-07-01

Simultaneous repair of a radial tear at the tibial attachment site of the posterior horn of the medial meniscus under special circumstances requiring tibial valgus osteotomy is technically difficult. First, most patients who need an osteotomy have a narrowed medial tibiofemoral joint space. In such a situation, the pull-out suture technique is more difficult to perform than in a normal joint space. Second, pulling out suture strands that penetrate the posterior horn of the medial meniscus to the anterior tibial cortex increases the risk of transection during osteotomy. We performed a meniscus repair combined with an opening wedge tibial valgus osteotomy without complications and present our technique as a new method for use in selective cases necessitating both meniscus repair of a complete radial tear and opening wedge tibial osteotomy.

High Performance ZVT with Bus Clamping Modulation Technique for Single Phase Full Bridge Inverters

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xia, Yinglai; Ayyanar, Raja

2016-03-20

This paper proposes a topology based on bus clamping modulation and zero-voltage-transition (ZVT) technique to realize zero-voltage-switching (ZVS) for all the main switches of the full bridge inverters, and inherent ZVS and/or ZCS for the auxiliary switches. The advantages of the strategy include significant reduction in the turn-on loss of the ZVT auxiliary switches which typically account for a major part of the total loss in other ZVT circuits, and reduction in the voltage ratings of auxiliary switches. The modulation scheme and the commutation stages are analyzed in detail. Finally, a 1kW, 500 kHz switching frequency inverter of the proposedmore » topology using SiC MOSFETs has been built to validate the theoretical analysis. The ZVT with bus clamping modulation technique of fixed timing and adaptive timing schemes are implemented in DSP TMS320F28335 resulting in full ZVS for the main switches in the full bridge inverter. The proposed scheme can save up to 33 % of the switching loss compared with no ZVT case.« less

Effect of voids in grouted post-tensioned concrete bridge construction : inspection and repair manual for external tendons in segmental, post-tensioned bridges.

DOT National Transportation Integrated Search

2009-11-01

Segmental, post-tensioned (PT) bridges are major structures that carry significant traffic. These bridges are designed and constructed because they are economical for spanning long distances. In Texas, there are several signature PT bridges. In the l...

Assessment of bridge scour in the lower, middle, and upper Yangtze River estuary with riverbed sonar profiling techniques.

PubMed

Zheng, Shuwei; Xu, Y Jun; Cheng, Heqin; Wang, Bo; Lu, Xuejun

2017-12-12

Riverbed scour of bridge piers can cause rapid loss in foundation strength, leading to sudden bridge collapse. This study used multi-beam echo sounders (Seabat 7125) to map riverbed surrounding the foundations of four major bridges in the lower, middle, and upper reaches of the 700-km Yangtze River Estuary (YRE) during June 2015 and September 2016. The high-resolution data were utilized to analyze the morphology of the bridge scour and the deformation of the wide-area riverbed (i.e., 5-18 km long and 1.3-8.3 km wide). In addition, previous bathymetric measurements collected in 1998, 2009, and 2013 were used to determine riverbed erosion and deposition at the bridge reaches. Our study shows that the scour depth surrounding the bridge foundations progressed up to 4.4-19.0 m in the YRE. Over the past 5-15 years, the total channel erosion in some river reaches was up to 15-17 m, possessing a threat to the bridge safety in the YRE. Tide cycles seemed to have resulted in significant variation in the scour morphology in the lower and middle YRE. In the lower YRE, the riverbed morphology displayed one long erosional ditch on both sides of the bridge foundations and a long-strip siltation area distributed upstream and downstream of the bridge foundations; in the middle YRE, the riverbed morphology only showed erosional morphology surrounding the bridge foundations. Large dunes caused deep cuts and steeper contours in the bridge scour. Furthermore, this study demonstrates that the high-resolution grid model formed by point cloud data of multi-beam echo sounders can clearly display the morphology of the bridge scour in terms of wide areas and that the sonar technique is a very useful tool in the assessment of bridge scours.

A combined endovascular and open ''reverse hybrid'' technique for repair of complex juxtarenal inflammatory aortic aneurysms.

PubMed

Rigberg, David; Jimenez, Juan Carlos; Lawrence, Peter; Gelabert, Hugh

2009-01-01

Inflammatory abdominal aortic aneurysms (IAAA) can present significant challenges to surgeons, especially in the juxtarenal location where they may not be amenable to endovascular repair. The dense, inflammatory component of these lesions can encase adjacent structures including the duodenum, ureters, and inferior vena cava putting them at risk for injury during open exposure. We report a novel ''reverse hybrid'' technique using a combined endovascular and open approach for repair of large, juxtarenal IAAA's.

[STUDY ON WOUND HEALING AFTER Sommerlad TECHNIQUE REPAIR OF ISOLATED CLEFT PALATE].

PubMed

Lu, Yong; Shi, Bing; Wang, Zhiyong; Zhan, Xin

2014-07-01

To study the inhibitory effect of Sommerlad technique on the growth of the maxilla by comparing the wound healing between Sommerlad and Von Langenbeck techniques in repair of isolated cleft palate. A retrospective cohort study was conducted on 54 patients with isolated cleft palate who received palatoplasty with levator veli palatini retropositioning according to Sommerlad between June 2005 and August 2011 as trial group; 89 cleft patients received Von Langenbeck technique repair between June 2003 and September 2006 as control group. There was no significant difference in gender and age between 2 groups (P > 0.05). The operation time, intraoperative blood loss, body temperature, and fever were recorded and compared; the wound healing was observed, and the palatal mucosa was graded according to Karsten standard. The operation time of trial group [(72.2 ± 5.5) minutes] was significantly longer than that of control group [(58.1 ± 6.8) minutes] (t = 4.494, P = 0.000); the intraoperative blood loss of trial group [(18.6 ± 6.5) mL] was significantly less than that of control group [(34.2 ± 10.2) mL] (t = 2.447, P = 0.000). Within postoperative 48 hours, the highest body temperature was 36.6-37.6°C (mean, 36.9°C) in trial group, and was 36.8-38.2°C (mean, 37.3°C) in control group; fever occurred in 5 patients (9.3%) of trial group and 21 patients (23.6%) of control group, showing significant difference (χ2 = 4.640, P = 0.030). The patients were followed up 3-18 months (mean, 9 months) in the trial group, and 3-6 years (mean, 4 years) in the control group. Scar was rated as level 0, level 1, and level 2 in 38, 13, and 3 cases of trial group, and in 6, 35, and 48 cases of control group, showing significant difference (Z = -7.785, P = 0.000). The isolated cleft palate repair using Sommerlad technique has the advantages of less injury and less scar tissue, indicating no inhibitory effect on the growth of the maxilla.

Damage detection and repair methods for GFRP bridge decks.

DOT National Transportation Integrated Search

2011-12-01

Glass fiber-reinforced polymer (GFRP) decks are being considered for use as a replacement for worn steel grid bridge : decks due to their high strength-to-weight ratio and fast installation time. In this research, two nondestructive evaluation : tech...

Use of fiber reinforced concrete in bridge approach slabs.

DOT National Transportation Integrated Search

2008-12-01

Bridge approach slabs are deteriorating at a much faster rate than expected resulting in a massive need for repairs and premature replacement : costing millions of dollars annually. Both environmental and traffic loading causes the concrete to worsen...

Maintenance, repair, and rehabilitation unit costs for PONTIS.

DOT National Transportation Integrated Search

1995-01-01

In the summer of 1993, the Bridge Management Task Force chairman requested that the Virginia Transportation Research Council begin a study of the maintenance, repair, and rehabilitation unit costs needed for the operation of the Pontis system. Becaus...

Preservation of bursal-sided tendon in partial-thickness articular-sided rotator cuff tears: a novel arthroscopic transtendon anatomic repair technique.

PubMed

Shin, Sang-Jin; Jeong, Jae-Hoon; Jeon, Yoon Sang; Kim, Rag Gyu

2016-12-01

The purpose of this study was to introduce a novel arthroscopic transtendon anatomic repair technique that spares the intact bursal-sided tendon in articular-sided partial-thickness rotator cuff tears (PTRCT) and to present shoulder functional outcomes in patients with symptomatic articular-sided PCRCT that involves more than 50 % of its thickness after arthroscopic repair using a novel technique. Eighteen patients with symptomatic articular-sided PCRCT involving more than 50 % of the tendon's thickness underwent arthroscopic repair using a devised technique. The devised technique restores only the torn articular portion of the rotator cuff at the anatomical footprint using a suture anchor, and preserves the integrity of the corresponding bursal-sided tendon by tying knots at the most lateral bursal side on the subacromial space. Clinical and functional outcome using ASES and Constant scores were evaluated. The structural integrity of the rotator cuff was evaluated by MRI at 6 months postoperatively. Pain relief and shoulder functional outcomes were encouraging during the recovery phase after operation. ASES (preoperative 54.0 ± 10.3 to postoperative 92.6 ± 8.0), Constant score (61.2 ± 8.5-88.0 ± 5.3), VAS for pain (4.9 ± 2.6-0.6 ± 0.7) improved significantly after arthroscopic transtendon anatomic repair (p < 0.001). No patients had rotator cuff retears on 6-month MRI. No complications related to surgical procedures had occurred. The devised technique of arthroscopic transtendon repair provided satisfactory functional outcomes without postoperative discomforts. This technique minimizes over-tightening of the articular layer and reduces tension mismatches between the articular and bursal layers, which are considered as important factors for improvement of postoperative shoulder motion.

31. General view of piers showin 1983 repair resulting in ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

31. General view of piers showin 1983 repair resulting in different deck chord configurations. VIEW NORTHWEST - Chelsea Street Bridge & Draw Tender's House, Spanning Chelsea River, Boston, Suffolk County, MA

A comparison of the techniques of direct pars interarticularis repairs for spondylolysis and low-grade spondylolisthesis: a meta-analysis.

PubMed

Mohammed, Nasser; Patra, Devi Prasad; Narayan, Vinayak; Savardekar, Amey R; Dossani, Rimal Hanif; Bollam, Papireddy; Bir, Shyamal; Nanda, Anil

2018-01-01

OBJECTIVE Spondylosis with or without spondylolisthesis that does not respond to conservative management has an excellent outcome with direct pars interarticularis repair. Direct repair preserves the segmental spinal motion. A number of operative techniques for direct repair are practiced; however, the procedure of choice is not clearly defined. The present study aims to clarify the advantages and disadvantages of the different operative techniques and their outcomes. METHODS A meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following databases were searched: PubMed, Cochrane Library, Web of Science, and CINAHL ( Cumulative Index to Nursing and Allied Health Literature). Studies of patients with spondylolysis with or without low-grade spondylolisthesis who underwent direct repair were included. The patients were divided into 4 groups based on the operative technique used: the Buck repair group, Scott repair group, Morscher repair group, and pedicle screw-based repair group. The pooled data were analyzed using the DerSimonian and Laird random-effects model. Tests for bias and heterogeneity were performed. The I 2 statistic was calculated, and the results were analyzed. Statistical analysis was performed using StatsDirect version 2. RESULTS Forty-six studies consisting of 900 patients were included in the study. The majority of the patients were in their 2nd decade of life. The Buck group included 19 studies with 305 patients; the Scott group had 8 studies with 162 patients. The Morscher method included 5 studies with 193 patients, and the pedicle group included 14 studies with 240 patients. The overall pooled fusion, complication, and outcome rates were calculated. The pooled rates for fusion for the Buck, Scott, Morscher, and pedicle screw groups were 83.53%, 81.57%, 77.72%, and 90.21%, respectively. The pooled complication rates for the Buck, Scott, Morscher, and pedicle

Single incision laparoscopic surgery (SILS) inguinal hernia repair - recent clinical experiences of this novel technique.

PubMed

Yussra, Y; Sutton, P A; Kosai, N R; Razman, J; Mishra, R K; Harunarashid, H; Das, S

2013-01-01

Inguinal hernia remains the most commonly encountered surgical problem. Various methods of repair have been described, and the most suitable one debated. Single port access (SPA) surgery is a rapidly evolving field, and has the advantage of affording 'scarless' surgery. Single incision laparoscopic surgery (SILS) for inguinal hernia repair is seen to be feasible in both total extraperitoneal (TEP) and transabdominal pre-peritoneal (TAPP) approaches. Data and peri-operative information on both of these however are limited. We aimed to review the clinical experience, feasibility and short term complications related to laparoscopic inguinal hernia repair via single port access. A literature search was performed using Google Scholar, Springerlink Library, Highwire Press, Surgical Endoscopy Journal, World Journal of Surgery and Medscape. The following search terms were used: laparoscopic hernia repair, TAPP, TEP, single incision laparoscopic surgery (SILS). Fourteen articles in English language related to SILS inguinal hernia repair were identified. Nine articles were related to TEP repair and the remaining 5 to TAPP. A total of 340 patients were reported within these studies: 294 patients having a TEP repair and 46 a TAPP. Only two cases of recurrence were reported. Various ports have been utilized, including the SILS port, Tri-Port and a custom- made port using conventional laparoscopic instruments. The duration of surgery was 40-100 minutes and the average length of hospital stay was one day. Early outcomes of this novel technique show it to be feasible, safe and with potentially better cosmetic outcome.

Fact Sheet: Control Techniques Guidelines (CTG) for Shipbuilding and Ship Repair Facilities Operation (Surface Coating)

EPA Pesticide Factsheets

This page contains an August 1996 fact sheet with information regarding the CTG and Alternative Control Techniques (ACT) for Surface Coating at Shipbuilding and Ship Repair Facilities Operations. This document provides a summary of this guidance

FDOT Protocol for Condition Assessment of Steel Strands in Post-tensioned Segmental Concrete Bridges : Volume II

DOT National Transportation Integrated Search

2012-06-01

Post-tensioned bridges require a detailed inspection of their post-tensioning systems since damage in : these systems is not evident and can result in costly repairs/replacements, loss of integrity and reduction : in safety of the bridge. Different n...

Conversion between network-level and project-level units of measure for use in a bridge-management system.

DOT National Transportation Integrated Search

1998-01-01

VDOT is implementing Pontis 3.0 to provide the analytical component of its Bridge Management System (BMS). This system prioritizes bridge maintenance, repair, rehabilitation, and replacement (MRR & R) needs using cost/benefit analysis. The accuracy o...

Phase I development of an aesthetic, precast concrete bridge rail.

DOT National Transportation Integrated Search

2012-02-01

Precast concrete bridge rail systems offer several advantages over traditional cast-in-place rail designs, including reduced construction : time and costs, installation in a wide range of environmental conditions, easier maintenance and repair, impro...

Recurrent tricuspid insufficiency: is the surgical repair technique a risk factor?

PubMed

Kara, Ibrahim; Koksal, Cengiz; Cakalagaoglu, Canturk; Sahin, Muslum; Yanartas, Mehmet; Ay, Yasin; Demir, Serdar

2013-01-01

This study compares the medium-term results of De Vega, modified De Vega, and ring annuloplasty techniques for the correction of tricuspid insufficiency and investigates the risk factors for recurrent grades 3 and 4 tricuspid insufficiency after repair. In our clinic, 93 patients with functional tricuspid insufficiency underwent surgical tricuspid repair from May 2007 through October 2010. The study was retrospective, and all the data pertaining to the patients were retrieved from hospital records. Functional capacity, recurrent tricuspid insufficiency, and risk factors aggravating the insufficiency were analyzed for each patient. In the medium term (25.4 ± 10.3 mo), the rates of grades 3 and 4 tricuspid insufficiency in the De Vega, modified De Vega, and ring annuloplasty groups were 31%, 23.1%, and 6.1%, respectively. Logistic regression analysis revealed that chronic obstructive pulmonary disease, left ventricular dysfunction (ejection fraction, < 0.50), pulmonary artery pressure ≥60 mmHg, and the De Vega annuloplasty technique were risk factors for medium-term recurrent grades 3 and 4 tricuspid insufficiency. Medium-term survival was 90.6% for the De Vega group, 96.3% for the modified De Vega group, and 97.1% for the ring annuloplasty group. Ring annuloplasty provided the best relief from recurrent tricuspid insufficiency when compared with DeVega annuloplasty. Modified De Vega annuloplasty might be a suitable alternative to ring annuloplasty when rings are not available.

Mini- or Less-open Sublay Operation (MILOS): A New Minimally Invasive Technique for the Extraperitoneal Mesh Repair of Incisional Hernias.

PubMed

Reinpold, Wolfgang; Schröder, Michael; Berger, Cigdem; Nehls, Jennifer; Schröder, Alexander; Hukauf, Martin; Köckerling, Ferdinand; Bittner, Reinhard

2018-01-16

Improvement of ventral hernia repair. Despite the use of mesh and other recent improvements, the currently popular techniques of ventral hernia repair have specific disadvantages and risks. We developed the endoscopically assisted mini- or less-open sublay (MILOS) concept. The operation is performed transhernially via a small incision with light-holding laparoscopic instruments either under direct, or endoscopic visualization. An endoscopic light tube was developed to facilitate this approach (EndotorchTM Wolf Company). Each MILOS operation can be converted to standard total extraperitoneal gas endoscopy once an extraperitoneal space of at least 8 cm has been created. All MILOS operations were prospectively documented in the German Hernia registry with 1 year questionnaire follow-up. Propensity score matching of incisional hernia operations comparing the results of the MILOS operation with the laparoscopic intraperitoneal onlay mesh operation (IPOM) and open sublay repair from other German Hernia registry institutions was performed. Six hundred fifteen MILOS incisional hernia operations were included. Compared with laparoscopic IPOM incisional hernia operation, the MILOS repair is associated with significantly a fewer postoperative surgical complications (P < 0.001) general complications (P < 0.004), recurrences (P < 0.001), and less chronic pain (P < 0.001). Matched pair analysis with open sublay repair revealed significantly a fewer postoperative complications (P < 0.001), reoperations (P < 0.001), infections (P = 0.007), general complications (P < 0.001), recurrences (P = 0.017), and less chronic pain (P < 0.001). The MILOS technique allows minimally invasive transhernial repair of incisional hernias using large retromuscular/preperitoneal meshes with low morbidity. The technique combines the advantages of open sublay and the laparoscopic IPOM repair.ClinicalTrials.gov Identifier NCT03133000.

Satisfaction, function and repair integrity after arthroscopic versus mini-open rotator cuff repair.

PubMed

Barnes, L A Fink; Kim, H M; Caldwell, J-M; Buza, J; Ahmad, C S; Bigliani, L U; Levine, W N

2017-02-01

Advances in arthroscopic techniques for rotator cuff repair have made the mini-open approach less popular. However, the mini-open approach remains an important technique for repair for many surgeons. The aims of this study were to compare the integrity of the repair, the function of the shoulder and satisfaction post-operatively using these two techniques in patients aged > 50 years. We identified 22 patients treated with mini-open and 128 patients treated with arthroscopic rotator cuff repair of July 2007 and June 2011. The mean follow-up was two years (1 to 5). Outcome was assessed using the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores, and satisfaction. The integrity of the repair was assessed using ultrasonography. A power analysis ensured sufficient enrolment. There was no statistically significant difference between the age, function, satisfaction, or pain scores (p > 0.05) of the two groups. The integrity of the repair and the mean SST scores were significantly better in the mini-open group (91% of mini-open repairs were intact versus 60% of arthroscopic repairs, p = 0.023; mean SST score 10.9 (standard deviation (sd) 1.3) in the mini-open group; 8.9 (sd 3.5) in arthroscopic group; p = 0.003). The ASES scores were also higher in the mini-open group (mean ASES score 91.0 (sd 10.5) in mini-open group; mean 82.70 (sd 19.8) in the arthroscopic group; p = 0.048). The integrity of the repair and function of the shoulder were better after a mini-open repair than after arthroscopic repair of a rotator cuff tear in these patients. The functional difference did not translate into a difference in satisfaction. Mini-open rotator cuff repair remains a useful technique despite advances in arthroscopy. Cite this article: Bone Joint J 2017;99-B:245-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Novel technique for repair of severed peripheral nerves in rats using polyurea crosslinked silica aerogel scaffold.

PubMed

Sabri, Firouzeh; Gerth, David; Tamula, George-Rudolph M; Phung, Thien-Chuong N; Lynch, Kyle J; Boughter, John D

2014-10-01

To design, synthesize, and test in vivo an aerogel-based top-open peripheral nerve scaffold to simultaneously support and guide multiple completely severed peripheral nerves in a rat model. Also, to explore options for immobilizing severed nerves on the aerogel material without the use of sutures resulting in reduced surgical time. A novel material and approach was developed for the reattachment of severed peripheral nerves. Nerve confinement and alignment in this case relies on the surface properties of a lightweight, highly porous, polyurea crosslinked silica aerogel scaffold. The distal and proximal ends of completely transected nerve terminals were positioned inside prefabricated "top-open" corrugated channels that cradled approximately two thirds of the circumference of the nerve trunk and connectivity of the severed nerves was evaluated using sciatic function index (SFI) technique for five months post-surgery on 10 female Sprague-Dawley rats then compared with the gold standard for peripheral nerve repair. The interaction of nerves with the surface of the scaffold was investigated also. Multichannel aerogel-based nerve support scaffold showed similar SFI recovery trend as the case suture repair technique. Usage of an adhesion-promoting coating reduced the friction between the nerve and the scaffold leading to slippage and lack of attachment between nerve and surface. The aerogel scaffold used in this study did not collapse under pressure during the incubation period and allowed for a rapid and non-invasive peripheral nerve repair approach without the demands of microsurgery on both time and surgical expertise. This technique may allow for simultaneous repair and reconnection of multiple severed nerves particularly relevant to nerve branching sites.

Experimental rotator cuff repair. A preliminary study.

PubMed

Gerber, C; Schneeberger, A G; Perren, S M; Nyffeler, R W

1999-09-01

The repair of chronic, massive rotator cuff tears is associated with a high rate of failure. Prospective studies comparing different repair techniques are difficult to design and carry out because of the many factors that influence structural and clinical outcomes. The objective of this study was to develop a suitable animal model for evaluation of the efficacy of different repair techniques for massive rotator cuff tears and to use this model to compare a new repair technique, tested in vitro, with the conventional technique. We compared two techniques of rotator cuff repair in vivo using the left shoulders of forty-seven sheep. With the conventional technique, simple stitches were used and both suture ends were passed transosseously and tied over the greater tuberosity of the humerus. With the other technique, the modified Mason-Allen stitch was used and both suture ends were passed transosseously and tied over a cortical-bone-augmentation device. This device consisted of a poly(L/D-lactide) plate that was fifteen millimeters long, ten millimeters wide, and two millimeters thick. Number-3 braided polyester suture material was used in all of the experiments. In pilot studies (without prevention of full weight-bearing), most repairs failed regardless of the technique that was used. The simple stitch always failed by the suture pulling through the tendon or the bone; the suture material did not break or tear. The modified Mason-Allen stitch failed in only two of seventeen shoulders. In ten shoulders, the suture material failed even though the stitches were intact. Thus, we concluded that the modified Mason-Allen stitch is a more secure method of achieving suture purchase in the tendon. In eight of sixteen shoulders, the nonaugmented double transosseous bone-fixation technique failed by the suture pulling through the bone. The cortical-bone-augmentation technique never failed. In definite studies, prevention of full weight-bearing was achieved by fixation of a ten

Investigating causes and determine repair needs to mitigate falling concrete from bridge decks.

DOT National Transportation Integrated Search

2012-09-01

This study developed a procedure to identify concrete bridge decks that are exhibiting the characteristics associated : with falling concrete. Field exploratory work on reinforced concrete bridge decks was supported by analytical and : laboratory inv...

Optimizing pressurized contact area in rotator cuff repair: the diamondback repair.

PubMed

Burkhart, Stephen S; Denard, Patrick J; Obopilwe, Elifho; Mazzocca, Augustus D

2012-02-01

The purpose of this study was to compare tendon-bone footprint contact area over time under physiologic loads for 4 different rotator cuff repair techniques: single row (SR), triangle double row (DR), chain-link double row (CL), and diamondback double row (DBK). A supraspinatus tear was created in 28 human cadavers. Tears were fixed with 1 of 4 constructs: SR, DR, CL, or DBK. Immediate post-repair measurements of pressurized contact area were taken in neutral rotation and 0° of abduction. After a static tensile load, pressurized contact area was observed over a 160-minute period after repair. Cyclic loading was then performed. The DBK repair had the highest pressurized contact area initially, as well as the highest pressurized contact area and lowest percentage decrease in pressurized contact area after 160 minutes of testing. The DBK repair had significantly larger initial pressurized contact than CL (P = .003) and SR (P = .004) but not DR (P = .06). The DBK technique was the only technique that produced a pressurized contact area that exceeded the native footprint both at initial repair (P = .01) and after 160 minutes of testing (P = .01). DBK had a significantly larger mean pressurized contact area than all the repairs after 160 minutes of testing (P = .01). DBK had a significantly larger post-cyclic loading pressurized contact area than CL (P = .01) and SR (P = .004) but not DR (P = .07). This study showed that a diamondback repair (a modification of the transosseous repair) can significantly increase the rotator cuff pressurized contact area in comparison with other standard rotator cuff repair constructs when there is sufficient tendon mobility to perform a double-row repair without excessive tension on the repair site. The persistent pressurized contact area of a DBK repair may be desirable to enhance healing potential when there is sufficient tendon mobility to perform a double-row repair, particularly for large or massive rotator cuff tears where it is

Delineation of tidal scour through marine geophysical techniques at Sloop Channel and Goose Creek bridges, Jones Beach State Park, Long Island, New York

USGS Publications Warehouse

Stumm, Frederick; Chu, Anthony; Reynolds, Richard J.

2001-01-01

Inspection of the Goose Creek Bridge in southeastern Nassau County in April 1998 by the New York State Department of Transportation (NYSDOT) indicated a separation of bridge piers from the road bed as a result of pier instability due to apparent seabed scouring by tidal currents. This prompted a cooperative study by the U.S. Geological Survey with the NYSDOT to delineate the extent of tidal scour at this bridge and at the Sloop Channel Bridge, about 0.5 mile to the south, through several marine- geophysical techniques. These techniques included use of a narrow-beam, 200-kilohertz, research-grade fathometer, a global positioning system accurate to within 3 feet, a 3.5 to 7-kilohertz seismic-reflection profiler, and an acoustic Doppler current profiler (ADCP). The ADCP was used only at the Sloop Channel Bridge; the other techniques were used at both bridges.Results indicate extensive tidal scour at both bridges. The fathometer data indicate two major scour holes nearly parallel to the Sloop Channel Bridge—one along the east side, and one along the west side (bridge is oriented north-south). The scour-hole depths are as much as 47 feet below sea level and average more than 40 feet below sea level; these scour holes also appear to have begun to connect beneath the bridge. The deepest scour is at the north end of the bridge beneath the westernmost piers. The east-west symmetry of scour at Sloop Channel Bridge suggests that flood and ebb tides produce extensive scour.The thickness of sediment that has settled within scour holes could not be interpreted from fathometer data alone because fathometer frequencies cannot penetrate beneath the sea-floor surface. The lower frequencies used in seismic-reflection profiling can penetrate the sea floor and underlying sediments, and indicate the amount of infilling of scour holes, the extent of riprap under the bridge, and the assemblages of clay, sand, and silt beneath the sea floor. The seismic- reflection surveys detected 2 to

Technique of laser chromosome welding for chromosome repair and artificial chromosome creation.

PubMed

Huang, Yao-Xiong; Li, Lin; Yang, Liu; Zhang, Yi

2018-04-01

Here we report a technique of laser chromosome welding that uses a violet pulse laser micro-beam for welding. The technique can integrate any size of a desired chromosome fragment into recipient chromosomes by combining with other techniques of laser chromosome manipulation such as chromosome cutting, moving, and stretching. We demonstrated that our method could perform chromosomal modifications with high precision, speed and ease of use in the absence of restriction enzymes, DNA ligases and DNA polymerases. Unlike the conventional methods such as de novo artificial chromosome synthesis, our method has no limitation on the size of the inserted chromosome fragment. The inserted DNA size can be precisely defined and the processed chromosome can retain its intrinsic structure and integrity. Therefore, our technique provides a high quality alternative approach to directed genetic recombination, and can be used for chromosomal repair, removal of defects and artificial chromosome creation. The technique may also have applicability on the manipulation and extension of large pieces of synthetic DNA.

A Novel Repair Technique for the Internal Thermal Control System Dual-Membrane Gas Trap

NASA Technical Reports Server (NTRS)

Leimkuehler, Thomas O.; Patel, Vipul; Reeves, Daniel R.; Holt, James M.

2005-01-01

A dual-membrane gas trap is currently used to remove gas bubbles from the Internal Thermal Control System (ITCS) coolant on board the International Space Station (ISS). The gas trap consists of concentric tube membrane pairs, comprised of outer hydrophilic tubes and inner hydrophobic fibers. Liquid coolant passes through the outer hydrophilic membrane, which traps the gas bubbles. The inner hydrophobic fiber allows the trapped gas bubbles to pass through and vent to the ambient atmosphere in the cabin. The gas trap was designed to last for the entire lifetime of the ISS, and therefore was not designed to be repaired. However, repair of these gas traps is now a necessity due to contamination from the on-orbit ITCS fluid and other sources on the ground as well as a limited supply of flight gas traps. This paper describes a novel repair technique that has been developed that will allow the refurbishment of contaminated gas traps and their return to flight use.

Femoral fracture repair using a locking plate technique in an adult captive polar bear (Ursus maritimus).

PubMed

Zimmerman, Dawn M; Dew, Terry; Douglass, Michael; Perez, Edward

2010-02-01

To report successful femoral fracture repair in a polar bear. Case report. Female polar bear (Ursus maritimus) 5 years and approximately 250 kg. A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.

Retrofit of the Louisa-Fort Gay Bridge using CFRP laminates.

DOT National Transportation Integrated Search

2007-06-01

This report details the processes pertaining to the repair and strengthening of the Louisa-Fort Gay Bridge, Lawrence County, KY, using advanced composite materials. Site inspections revealed flexural cracks in the reinforced concrete girders of the c...

Technique and outcomes of laparoscopic bulge repair after abdominal free flap reconstruction.

PubMed

Lee, Johnson C; Whipple, Lauren A; Binetti, Brian; Singh, T Paul; Agag, Richard

2016-01-21

Bulges and hernias after abdominal free flap surgery are uncommon with rates ranging from as low as 0-36%. In the free flap breast reconstruction population, there are no clear guidelines or optimal strategies to treating postoperative bulges. We describe our minimally invasive technique and outcomes in managing bulge complications in abdominal free flap breast reconstruction patients. A retrospective review was performed on all abdominal free flap breast reconstruction patients at Albany Medical Center from 2011 to 2014. All patients with bulges on clinical exam underwent abdominal CT imaging prior to consultation with a minimally invasive surgeon. Confirmed symptomatic bulges were repaired laparoscopically and patients were monitored regularly in the outpatient setting. Sixty-two patients received a total of 80 abdominal free flap breast reconstructions. Flap types included 41 deep inferior epigastric perforator (DIEP), 36 muscle-sparing transverse rectus abdominus myocutaneous (msTRAM), 2 superficial inferior epigastric artery, and 1 transverse rectus abdominus myocutaneous flap. There were a total of 9 (14.5%) bulge complications, with the majority of patients having undergone msTRAM or DIEP reconstruction. There were no complications, revisions, or recurrences from laparoscopic bulge repair after an average follow-up of 181 days. Although uncommon, bulge formation after abdominal free flap reconstruction can create significant morbidity to patients. Laproscopic hernia repair using composite mesh underlay offers an alternative to traditional open hernia repair and can be successfully used to minimize scarring, infection, and pain to free flap patients who have already undergone significant reconstructive procedures. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2016 Wiley Periodicals, Inc.

A Modified Suture Bridge Technique for Application With Bone Anchors in Foot and Ankle Surgery.

PubMed

Walters, Jeremy; Correa, Christopher; Moss, Mark

2015-01-01

We present a suture bridge technique for reattachment of tendon or ligament to bone for use in foot and ankle surgery. The method is a simple, strong, and reproducible technique that could decrease the risk of irritation of the overlying cutaneous barrier and minimizes the likelihood of tendon strangulation when combined with soft tissue bone anchors. The present report serves as a guide to the use of this suture technique for reattachment of the Achilles tendon. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Comparison of histologic healing and biomechanical characteristics between repair techniques for a delaminated rotator cuff tear in rabbits.

PubMed

Cheon, Sang-Jin; Kim, Jung-Han; Gwak, Heui-Chul; Kim, Chang-Wan; Kim, Jeon-Kyo; Park, Ji-Hwan

2017-05-01

The purpose of this study was to compare histologic healing and biomechanical characteristics between 2 repair techniques (layer by layer, repair of each layer to bone separately; and whole layer, repair of each layer to the bone en masse) for delaminated rotator cuff tear. Rabbits were used as subjects and classified into 2 groups: group A, right side, the layer-by-layer repair group; and group B, left side, the whole-layer repair group. Histologic evaluations were done at 3 weeks (n = 7) and 6 weeks (n = 4) after operation. Biomechanical tests to evaluate the tensile property were done at time 0 (n = 5) and 3 weeks (n = 5) after operation. Histologic healing improved in all groups. A smaller cleft was found between layers in group B compared with the cleft in group A at 3 weeks after operation. At time 0, group A showed a higher yield load and ultimate failure load (67 ± 10.5 N and 80 ± 7.8 N, respectively). However, at 3 weeks after operation, group B showed a higher yield load (48 ± 7.6 N). In the delaminated rotator cuff tear model in the rabbit, the whole-layer repair showed a narrow gap between layers and a higher yield load at 3 weeks after operation. Surgical techniques that unite the cleft in a delaminated tear could improve biomechanical strength after operation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Design procedures for heat-straightening repair : an engineering guide.

DOT National Transportation Integrated Search

1992-12-01

This report summarizes over four years of research on heat-straightening repairs and provides a prototype engineering guide for the application of heat-straightening to bridge structures. It is based on the research results detailed in a companion re...

Suture slippage in knotless suture anchors resulting in subacromial-subdeltoid bursitis.

PubMed

Hayeri, Mohammad Reza; Keefe, Daniel T; Chang, Eric Y

2016-05-01

Rotator cuff repair using a suture bridge and knotless suture anchors is a relatively new, but increasingly used technique. The suture bridge technique creates an anatomically similar and more secure rotator cuff repair compared with conventional arthroscopic techniques and the use of knotless anchors eliminates the challenges associated with knot tying during arthroscopic surgery. However, previous in vitro biomechanical tests have shown that the hold of the suture in a knotless suture anchor is far lower than the pullout strength of the anchor from bone. Up until now slippage has been a theoretical concern. We present a prospectively diagnosed case of in vivo suture loosening after rotator cuff repair using a knotless bridge technique resulting in subacromial-subdeltoid bursitis.

[PART-KESSLER TECHNIQUE WITH SUTURE ANCHOR IN REPAIR OF SPONTANEOUS Achilles TENDON RUPTURE].

PubMed

Qi, Jie; Duan, Liang; Li, Weiwei; Wei, Wenbo

2016-02-01

To summarize the application and experience of repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor. Between January 2011 and December 2013, 31 patients with spontaneous Achilles tendon rupture were treated by part-Kessler technique with suture anchor. Of 31 cases, 23 were male and 8 were female, aged 16-53 years (mean, 38 years). The left side was involved in 15 cases and the right side in 16 cases. The causes of injury included sudden heel pain and walking weakness during sports in 22 cases; no surefooted down-stairs, slip, and carrying heavy loads in 9 cases. The distance from broken site to the calcaneus adhension of Achilles tendon was 3-6 cm (mean, 4.2 cm). The time from injury to operation was 7 hours to 4 days (mean, 36.8 hours). All incisions healed by first intention without nerve injury or adhering with skin. The patients were followed up 6-24 months (mean, 15 months). All patients could complete 25 times heel raising without difficulty at 6 months after operation. No Achilles tendon rupture occurred again during follow-up. At 6 months after operation, the range of motion of the ankle joint in dorsiflexion and plantar flexion showed no significant difference between normal and affected sides (t=0.648, P=0.525; t=0.524, P=0.605). The circumference of the affected leg was significantly smaller than that of normal leg at 6 months after operation (t=2.074, P=0.041), but no significant difference was found between affected and normal sides at 12 months after operation (t=0.905, P=0.426). The American Orthopedic Foot and Ankle Society (AOFAS) scores at 6, 12, 18, and 24 months after operation were significantly higher than preoperative score (P<0.05); the score at 6 months after operation was significantly lower than that at other time points (P<0.05), but no significant difference was shown between the other time points (P>0.05). Repairing spontaneous Achilles tendon rupture by part-Kessler technique with suture anchor

Internally cured concrete for pavement and bridge deck applications : [summary].

DOT National Transportation Integrated Search

2015-08-01

High-strength-high-performance concrete (HSHPC) is used for rapid repair of concrete : bridge decks and pavement. However, HSHPC has very high early shrinkage, often leading to : cracking, made worse by high ambient temperatures and a large surface a...

Volume balance and toxicity analysis for the cross lake bridge.

DOT National Transportation Integrated Search

2009-09-01

There were two overall objectives for this project: (1) to assess leakage from the bridge once repairs to the collection system were completed and (2) to investigate Microtox, a toxicity screening tool manufactured by Azur environmental, as a m...

Design, construction and testing of the Neal Bridge in Pittsfield, Maine.

DOT National Transportation Integrated Search

2009-10-01

Highway bridges in the US are quickly becoming deficient due to increasing traffic volumes, rapid : deterioration, extended service life, and increasing load requirements. Repair or replacement of deficient : structures is expensive, time and labor i...

A new technique for repair of a dislocated sternoclavicular joint using a sternal tension cable system.

PubMed

Janson, Jacques T; Rossouw, Gawie J

2013-02-01

An unstable anterior or posterior sternoclavicular joint dislocation can cause severe morbidity with poor shoulder movement and strength. These dislocations need to be repaired, which can be challenging. Many different procedures have been described to obtain a stable joint fixation with varying results. We report a new technique for repairing a sternoclavicular joint dislocation by using a figure-of-eight sternal cable system. This procedure is relatively simple and reproducible to create a stable and functional sternoclavicular joint. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Advanced techniques for repair of irradiated PWR fuel assemblies

DOE Office of Scientific and Technical Information (OSTI.GOV)

Knaab, H.; Westphal, M.

Kraftwerk union has recently designed and built a portable repair unit for use in nuclear power plants for repair of defective fuel assemblies where space limitations do not allow permanent installation of repair equipment. This new equipment is designed to be easily disassembled and decontaminated. The main component of the equipment is the fuel assembly reconstitution unit (FARU) which is placed on the floor of the spent fuel pool. The use of the FARU is described in the paper.

Damage detection and repair methods for GFRP bridge decks : [summary].

DOT National Transportation Integrated Search

2011-01-01

Glass fiber-reinforced polymer (GFRP) decks offer : advantages as replacements for worn steel bridge : decks because of their high strength-to-weight : ratio and fast installation time. However, before : GFRP decks can be put into service, methods : ...

Arthroscopic labral repair of the hip, using a through-labral double-stranded single-pass suture technique.

PubMed

Ye, Ken; Singh, Parminder J

2014-10-01

The normal labrum is crucial to the biomechanical function of the hip joint, not only increasing the surface area and depth of the acetabulum but also maintaining a suction seal to assist in normal synovial fluid flow from the peripheral to the central compartment. Simple loop suture repairs of the labrum may evert the labrum, thus losing the optimal seal, as well as causing abrasion of the articular cartilage. Vertical mattress suture and labral base fixation techniques aim to leave the free edge of the labrum intact and undisturbed, therefore improving the contact of the labrum to the femoral head and neck to improve the seal of the acetabulum. We aim to describe a double-stranded single-pass vertical mattress suture technique that may allow greater versatility to the surgeon in repairing thinner labrums while still achieving a free and continuous free edge.

Research on evaluation and standardization of accelerated bridge construction techniques, part II.

DOT National Transportation Integrated Search

2015-09-01

The Michigan Department of Transportation (MDOT) uses Accelerated bridge construction : (ABC) to reduce delays and minimize construction impacts. MDOT contracted and completed : several bridges using prefabricated bridge elements and systems (PBES). ...

Research on evaluation and standardization of accelerated bridge construction techniques, part I.

DOT National Transportation Integrated Search

2015-09-01

The Michigan Department of Transportation (MDOT) uses Accelerated bridge construction : (ABC) to reduce delays and minimize construction impacts. MDOT contracted and completed : several bridges using prefabricated bridge elements and systems (PBES). ...

Lateral clavicle fracture with coracoclavicular ligament injury: a biomechanical study of 4 different repair techniques.

PubMed

Alaee, Farhang; Apostolakos, John; Singh, Hardeep; Holwein, Christian; Diermeier, Theresa; Cote, Mark P; Beitzel, Knut; Imhoff, Andreas B; Mazzocca, Augustus D; Voss, Andreas

2017-07-01

To investigate the biomechanical performance of four different methods used for coracoclavicular (CC) ligament reconstruction in a lateral clavicle fracture repair. Native displacement, translation, and rotation at the acromioclavicular joint of 24 fresh-frozen cadaveric shoulders were tested. A reproducible fracture in the lateral third of the clavicle was created by dissecting both CC ligaments. Each specimen was then repaired with plate fixation of the fracture and the following CC repair technique: (1) Cortical button. (2) Suture anchor and plate button. (3) Suture anchor no plate button, and (4) Suture around coracoid. All reconstructed specimens were then re-tested for displacement, translation, and load to failure, and compared to their native results. Groups 1 and 3 were investigated for rotational load. There was no difference in load to failure between the repaired groups (p: ns). Group 1 showed less superior and anterior translations (p < 0.05). Group 2 showed significantly less superior translation (p = 0.003), but no significance with anterior and posterior translations to the native joint. Group 3 showed less superior and posterior translations (p = 0.005 and p = 0.039). Anterior and posterior translations were increased in group 4 (p < 0.05). The biomechanical analyses did not show any significance in load to failure or displacement after cyclic loading among the study groups. All repairs were effective in preventing superior translation. Groups 1 and 2 demonstrated increased horizontal stability compared to the native state. All 4 methods are clinically viable options for CC ligament repair.

Failure strength of a new meniscus arrow repair technique: biomechanical comparison with horizontal suture.

PubMed

Albrecht-Olsen, P; Lind, T; Kristensen, G; Falkenberg, B

1997-04-01

A new method for arthroscopic all-inside repair of vertical meniscus lesions by use of a biodegradable fixation device ("meniscus arrow") has been developed, including a set of cannulas for easy insertion via standard arthroscopic portals. The technique is described. A study to test the fixation properties was performed in the laboratory. Twenty-four fresh frozen bovine medial menisci were defreezed and divided into three groups. In all menisci an artificial vertical lesion was created with a scalpel 3mm from the peripheral rim. Repair in group I was done with a single horizontal Maxon-O suture using an Acufex double-barrel cannula (Acufex Meniscal Stitcher; Acufex Microsurgical, Norwood, MA). A knot was tied on the capsular side. Repair in group II was made with one 13 mm Biofix Meniscus arrow (Bioscience Ltd, Tampere, Finland). In group III repair was performed like in group II but the menisci were incubated in isotonic saline at 21 degrees C for 24 hours before testing. Menisci in group I and II were tested within 3 hours after defreezing. Prior to testing total separation of central and peripheral part of meniscus was performed. Thus only the repair site was tested. Pull-out tests to failure were made in a computer-based Nene M5 testing machine with a cross-head speed of 5 mm/min. Median failure load in group I: 49 N (range 43 to 77 N), in group II: 53 N (range 42 to 65 N) and in group III: 54 N (range 35 to 74 N). No statistically significant differences in failure load was found between the groups. Thus initial failure strength for arrow-repaired bovine menisci is comparable to that of a horizontal suture.

Laparoscopic versus open repair of perforated peptic ulcer: Improving outcomes utilizing a standardized technique.

PubMed

Siow, Sze Li; Mahendran, Hans Alexander; Wong, Chee Ming; Hardin, Mark; Luk, Tien Loong

2018-03-01

The objective of this study was to compare the outcomes of patients who underwent laparoscopic and open repair of perforated peptic ulcers (PPUs) at our institution. This is a retrospective review of a prospectively collected database of patients who underwent emergency laparoscopic or open repair for PPU between December 2010 and February 2014. A total of 131 patients underwent emergency repair for PPU (laparoscopic repair, n=63, 48.1% vs. open repair, n=68, 51.9%). There were no significant differences in baseline characteristics between both groups in terms of age (p=0.434), gender (p=0.305), body mass index (p=0.180), and presence of comorbidities (p=0.214). Both groups were also comparable in their American Society of Anesthesiologists (ASA) scores (p=0.769), Boey scores 0/1 (p=0.311), Mannheim Peritonitis Index > 27 (p=0.528), shock on admission (p<0.99), and the duration of symptoms > 24 hours (p=0.857). There was no significant difference in the operating time between the two groups (p=0.618). Overall, the laparoscopic group had fewer complications compared with the open group (14.3% vs. 36.8%, p=0.005). When reviewing specific complications, only the incidence of surgical site infection was statistically significant (laparoscopic 0.0% vs. open 13.2%, p=0.003). The other parameters were not statistically significant. The laparoscopic group did have a significantly shorter mean postoperative stay (p=0.008) and lower pain scores in the immediate postoperative period (p<0.05). Mortality was similar in both groups (open, 1.6% vs. laparoscopic, 2.9%, p < 0.99). Laparoscopic repair resulted in reduced wound infection rates, shorter hospitalization, and reduced postoperative pain. Our single institution series and standardized technique demonstrated lower morbidity rates in the laparoscopic group. Copyright © 2016. Published by Elsevier Taiwan.

Foot force models of crowd dynamics on a wobbly bridge

PubMed Central

Belykh, Igor; Jeter, Russell; Belykh, Vladimir

2017-01-01

Modern pedestrian and suspension bridges are designed using industry standard packages, yet disastrous resonant vibrations are observed, necessitating multimillion dollar repairs. Recent examples include pedestrian-induced vibrations during the opening of the Solférino Bridge in Paris in 1999 and the increased bouncing of the Squibb Park Bridge in Brooklyn in 2014. The most prominent example of an unstable lively bridge is the London Millennium Bridge, which started wobbling as a result of pedestrian-bridge interactions. Pedestrian phase locking due to footstep phase adjustment is suspected to be the main cause of its large lateral vibrations; however, its role in the initiation of wobbling was debated. We develop foot force models of pedestrians’ response to bridge motion and detailed, yet analytically tractable, models of crowd phase locking. We use biomechanically inspired models of crowd lateral movement to investigate to what degree pedestrian synchrony must be present for a bridge to wobble significantly and what is a critical crowd size. Our results can be used as a safety guideline for designing pedestrian bridges or limiting the maximum occupancy of an existing bridge. The pedestrian models can be used as “crash test dummies” when numerically probing a specific bridge design. This is particularly important because the U.S. code for designing pedestrian bridges does not contain explicit guidelines that account for the collective pedestrian behavior. PMID:29296679

Foot force models of crowd dynamics on a wobbly bridge.

PubMed

Belykh, Igor; Jeter, Russell; Belykh, Vladimir

2017-11-01

Modern pedestrian and suspension bridges are designed using industry standard packages, yet disastrous resonant vibrations are observed, necessitating multimillion dollar repairs. Recent examples include pedestrian-induced vibrations during the opening of the Solférino Bridge in Paris in 1999 and the increased bouncing of the Squibb Park Bridge in Brooklyn in 2014. The most prominent example of an unstable lively bridge is the London Millennium Bridge, which started wobbling as a result of pedestrian-bridge interactions. Pedestrian phase locking due to footstep phase adjustment is suspected to be the main cause of its large lateral vibrations; however, its role in the initiation of wobbling was debated. We develop foot force models of pedestrians' response to bridge motion and detailed, yet analytically tractable, models of crowd phase locking. We use biomechanically inspired models of crowd lateral movement to investigate to what degree pedestrian synchrony must be present for a bridge to wobble significantly and what is a critical crowd size. Our results can be used as a safety guideline for designing pedestrian bridges or limiting the maximum occupancy of an existing bridge. The pedestrian models can be used as "crash test dummies" when numerically probing a specific bridge design. This is particularly important because the U.S. code for designing pedestrian bridges does not contain explicit guidelines that account for the collective pedestrian behavior.

Surface-geophysical techniques used to detect existing and infilled scour holes near bridge piers

USGS Publications Warehouse

Placzek, Gary; Haeni, F.P.

1995-01-01

Surface-geophysical techniques were used with a position-recording system to study riverbed scour near bridge piers. From May 1989 to May 1993. Fathometers, fixed- and swept-frequency con- tinuous seismic-reflection profiling (CSP) systems, and a ground-penetrating radar (GPR) system were used with a laser-positioning system to measure the depth and extent of existing and infilled scour holes near bridge piers. Equipment was purchased commercially and modified when necessary to interface the components and (or) to improve their performance. Three 200-kHz black-and-white chart- recording Fathometers produced profiles of the riverbed that included existing scour holes and exposed pier footings. The Fathometers were used in conjunction with other geophysical techniques to help interpret the geophysical data. A 20-kHz color Fathometer delineated scour-hole geometry and, in some cases, the thickness of fill material in the hole. The signal provided subbottom information as deep as 10 ft in fine-grained materials and resolved layers of fill material as thin as 1 foot thick. Fixed-frequency and swept-frequency CSP systems were evaluated. The fixed-frequency system used a 3.5-, 7.0-, or 14-kHz signal. The 3.5-kHz signal pene- trated up to 50 ft of fine-grained material and resolved layers as thin as 2.5-ft thick. The 14-kHz signal penetrated up to 20 ft of fine-grained material and resolved layers as thin as 1-ft thick. The swept-frequency systems used a signal that swept from 2- to 16-kHz. With this system, up to 50 ft of penetration was achieved, and fill material as thin as 1 ft was resolved. Scour-hole geometry, exposed pier footings, and fill thickness in scour holes were detected with both CSP systems. The GPR system used an 80-, 100-, or 300-megahertz signal. The technique produced records in water up to 15 ft deep that had a specific conductance less than 200x11ms/cm. The 100-MHz signal penetrated up to 40 ft of resistive granular material and resolved layers as

Laparoscopic repair of inguinal hernias.

PubMed

Carter, Jonathan; Duh, Quan-Yang

2011-07-01

For patients with recurrent inguinal hernia, or bilateral inguinal hernia, or for women, laparoscopic repair offers significant advantages over open techniques with regard to recurrence risk, pain, and recovery. For unilateral first-time hernias, either laparoscopic or open repair with mesh can offer excellent results. The major drawback of laparoscopy is that the technique requires a significant number of cases to master. For surgeons in group practice, it makes sense to have one surgeon in the group perform laparoscopic repairs so that experience can be concentrated. For others, the best technique remains the approach that the surgeon is most comfortable and experienced performing.

Repairing Chipped Silicide Coatings on Refractory Metal Substrates

NASA Technical Reports Server (NTRS)

Youngquist, Robert

2006-01-01

The space shuttle orbiter s reaction control system (RCS) is a series of small thrusters that use hypergolic fuels to orient the orbiter in space. The RCS thrusters are constructed from a special niobium-based alloy -- the C-103. This alloy retains excellent mechanical properties from cryogenic temperature all the way up to 2,500 F (1,370 C). C-103 is susceptible to rapid oxidation at elevated temperatures. The authors have developed two methods to repair damaged R512a coatings on C-103. For the first repair technique, metal foundries, semiconductor manufacturers, and many other industries have developed and routinely use coatings that can easily be painted on metal to protect it from corrosion, including oxidation, to temperatures in excess of 2,500 F (1,370 C). This first repair technique is considered somewhat temporary. The second repair technique is based on using the native coating material of the RCS nozzles. the chipped area is ground out and a "green" R512a coating is applied to the repair area. Both repair techniques can be applied for moderate protection until the permanent laser-repair technique is available to the repair area.

Distal re-entry closure with neobranching technique after thoracic endovascular aortic repair of Type B aortic dissection.

PubMed

Yamamoto, Masaki; Fukutomi, Takashi; Noguchi, Tatsuya; Orihashi, Kazumasa

2018-04-01

Retrograde false-lumen flow after thoracic endovascular aortic repair of Type B aortic dissection occurs occasionally and may have a negative impact on aortic remodelling and even prevent the decompression of the false lumen. A 67-year-old man with a Type B aortic dissection underwent thoracic endovascular aortic repair for severe compression of the true lumen and visceral malperfusion 7 weeks after the onset. Intraoperative angiography revealed proximal entry tear closure, but the false-lumen flow increased because of retrograde flow through the re-entry tear. Additional intervention including re-entry tear closure was performed with a neobranching technique with covered stent placement in the visceral artery from the aortic true lumen through the distal re-entry tear. We report a case of Type B aortic dissection and discuss the surgical techniques used.

A novel suture technique using the FasT-Fix combined with Ultrabraid for pullout repair of the medial meniscus posterior root tear.

PubMed

Fujii, Masataka; Furumatsu, Takayuki; Kodama, Yuya; Miyazawa, Shinichi; Hino, Tomohito; Kamatsuki, Yusuke; Yamada, Kazuki; Ozaki, Toshifumi

2017-05-01

Medial meniscus posterior root has an important role in the maintenance of knee articular cartilage. Although pullout repair of the medial meniscus posterior root tear has become a gold standard, it has several difficulties for suturing. We have developed a modified Mason-Allen suture technique using the FasT-Fix all-inside suture device combined with Ultrabraid. The present suture technique allows a strong grasping of the medial meniscus posterior horn for arthroscopic pullout repair.

Outcome of repair of chronic tear of the pectoralis major using corkscrew suture anchors by box suture sliding technique.

PubMed

Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay

2016-10-18

To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle.

Outcome of repair of chronic tear of the pectoralis major using corkscrew suture anchors by box suture sliding technique

PubMed Central

Joshi, Deepak; Jain, Jitesh Kumar; Chaudhary, Deepak; Singh, Utkarsh; Jain, Vineet; Lal, Ajay

2016-01-01

AIM To assess the functional and clinical results of repair of chronic tears of pectoralis major using corkscrew and sliding suture technique. METHODS In this retrospective study, we reviewed the results of pectoralis major repair in 11 chronic cases (> 6 wk) done between September 2011 and December 2014 at our institute. In all cases repair was done by same surgeon using corkscrew suture anchors and box suture sliding technique. At 6 mo, after surgery magnetic resonance imaging was done to see the integrity of the repair. Functional evaluation was done using Penn and ASES scores. Pre and postoperative Isokinetic strength was measured. RESULTS Average follow-up was 48.27 ± 21.0 mo. The Wilcoxon signed rank test was used to evaluate the outcome scores. The average ASES score increased from an average of 54.63 ± 13.0 preoperatively to 95.09 ± 2.60 after surgery at their last follow-up. The average Penn score also increased from 5.72 ± 0.78, 2.81 ± 1.32 and 45.81 ± 1.72 to 9.36 ± 0.80, 8.27 ± 0.90 and 59 ± 1.34 for pain, satisfaction and function respectively. Follow up magnetic resonance imaging (MRI) (at 6 mo) showed continuity and the bulk of pectoralis major muscle in all cases. Average isokinetic strength deficiency in horizontal adduction at 60° was 13.63% ± 6.93% and at 120° was 10.18% ± 4.93% and in flexion at 60° was 10.72% ± 5.08% and at 120° was 6.63% + 3.74%. Results showed that both ASES and Penn score improved significantly (2 tailed P value = 0.0036). CONCLUSION We could conclude from this series that pectoralis major repair even in chronic cases using 5.5 mm corkscrew anchors give excellent functional and cosmetic results. In chronic cases the repairable length of the tendon is not available and sliding suture technique allows for fixation of worn out tendomuscular junction to bone without letting cutting through the muscle. PMID:27795949

Finite element analysis for edge-to-edge technique to treat post-mitral valve repair systolic anterior motion.

PubMed

Zhong, Qi; Zeng, Wenhua; Huang, Xiaoyang; Zhao, Xiaojia

2014-01-01

Systolic anterior motion of the mitral valve is an uncommon complication of mitral valve repair, which requires immediate supplementary surgical action. Edge-to-edge suture is considered as an effective technique to treat post-mitral valve repair systolic anterior motion by clinical researchers. However, the fundamentals and quantitative analysis are vacant to validate the effectiveness of the additional edge-to-edge surgery to repair systolic anterior motion. In the present work, finite element models were developed to simulate a specific clinical surgery for patients with posterior leaflet prolapse, so as to analyze the edge-to-edge technique quantificationally. The simulated surgery procedure concluded several actions such as quadrangular resection, mitral annuloplasty and edge-to-edge suture. And the simulated results were compared with echocardiography and measurement data of the patients under the mitral valve surgery, which shows good agreement. The leaflets model with additional edge-to-edge suture has a shorter mismatch length than that of the model merely under quadrangular resection and mitral annuloplasty actions at systole, which assures a better coaptation status. The stress on the leaflets after edge-to-edge suture is lessened as well.

An Anatomic and Biomechanical Comparison of Bankart Repair Configurations.

PubMed

Judson, Christopher H; Voss, Andreas; Obopilwe, Elifho; Dyrna, Felix; Arciero, Robert A; Shea, Kevin P

2017-11-01

Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Controlled laboratory study. Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P < .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was

A new minimally invasive technique for the repair of femoral hernia in children: about 13 laparoscopic repairs in 10 patients.

PubMed

Matthyssens, Lucas E M; Philippe, Paul

2009-05-01

Femoral hernias in children are rare and often misdiagnosed. The classic treatment is through an open anterior approach. Since the advent of laparoscopic treatment of inguinal hernia in children, laparoscopy has been proposed to offer an accurate diagnosis and treatment, especially in case of recurrent hernia or bilateral disease. This review was undertaken to report our experience with the primary laparoscopic diagnosis and treatment of pediatric femoral hernias and to investigate its safety and feasibility. All cases of pediatric femoral hernia in a consecutive series of children treated laparoscopically for groin hernias in a single institution over a 7-year period (2001-2007) were identified and studied for patient characteristics, presentation, pre- and perioperative findings, details of the operative repair, and postoperative outcome. Out of a prospectively studied series of 462 laparoscopic pediatric inguinal hernia repairs in 389 patients, 13 femoral hernias were treated in 10 patients (6 boys), with a mean age of 71/2 years (range, 1.7-12). The preoperative diagnosis of femoral hernia was accurate in 7 patients. Seven femoral hernias were exclusively right sided; 3 were bilateral. All 13 femoral hernias were successfully treated by a standardized transabdominal laparoscopic approach with the use of three 3.5-mm trocars. All patients were treated in a day care setting. No postoperative complications occurred. No recurrences were seen until the present time, with a mean follow-up of 31/2 years. Laparoscopy provides a straightforward, accurate diagnosis for the rare and often missed pediatric femoral hernias. The new technique described offers a safe and efficient minimally invasive anatomical repair of the crural orifice in children, even when not suspected preoperatively. The laparoscopic diagnosis of 13 femoral hernias from a cohort of 462 laparoscopic groin hernia repairs (2.8%) may suggest a higher prevalence rate of this unusual type of hernia in

Repairing/strengthening of bridges with post-tensioned FRP materials and performance evaluation : [tech summary].

DOT National Transportation Integrated Search

2015-09-01

One of the challenges that transportation agencies are facing is keeping bridges in good condition during their : service life. Numerous bridges are classi ed as structurally and/or functionally de cient in the country. In the : state of Louisi...

Development of inspection robots for bridge cables.

PubMed

Yun, Hae-Bum; Kim, Se-Hoon; Wu, Liuliu; Lee, Jong-Jae

2013-01-01

This paper presents the bridge cable inspection robot developed in Korea. Two types of the cable inspection robots were developed for cable-suspension bridges and cable-stayed bridge. The design of the robot system and performance of the NDT techniques associated with the cable inspection robot are discussed. A review on recent advances in emerging robot-based inspection technologies for bridge cables and current bridge cable inspection methods is also presented.

Abdominal Wall Reconstruction with Concomitant Ostomy-Associated Hernia Repair: Outcomes and Propensity Score Analysis.

PubMed

Mericli, Alexander F; Garvey, Patrick B; Giordano, Salvatore; Liu, Jun; Baumann, Donald P; Butler, Charles E

2017-03-01

The optimal strategy for abdominal wall reconstruction in the presence of a stomal-site hernia is unclear. We hypothesized that the rate of ventral hernia recurrence in patients undergoing a combined ventral hernia repair and stomal-site herniorraphy would not differ clinically from the ventral hernia recurrence rate in patients undergoing an isolated ventral hernia repair. We also hypothesized that bridged ventral hernia repairs result in worse outcomes compared with reinforced repairs, regardless of stomal hernia. We retrospectively reviewed prospectively collected data from consecutive abdominal wall reconstructions performed with acellular dermal matrix (ADM) at a single center between 2000 and 2015. We compared patients who underwent a ventral hernia repair alone (AWR) and those who underwent both a ventral hernia repair and ostomy-associated herniorraphy (AWR+O). We conducted a propensity score matched analysis to compare the outcomes between the 2 groups. Multivariable Cox proportional hazards and logistic regression models were used to study associations between potential predictive or protective reconstructive strategies and surgical outcomes. We included 499 patients (median follow-up 27.2 months; interquartile range [IQR] 12.4 to 46.6 months), 118 AWR+O and 381 AWR. After propensity score matching, 91 pairs were obtained. Ventral hernia recurrence was not statistically associated with ostomy-associated herniorraphy (adjusted hazard ratio [HR] 0.7; 95% CI 0.3 to 1.5; p = 0.34). However, the AWR+O group experienced a significantly higher percentage of surgical site occurrences (34.1%) than the AWR group (18.7%; adjusted odds ratio 2.3; 95% CI 1.4 to 3.7; p < 0.001). In the AWR group, there were significantly fewer ventral hernia recurrences when the repair was reinforced compared with bridged (5.3% vs 38.5%; p < 0.001). There was no statistically significant difference in ventral hernia recurrence between the AWR and AWR+O groups. Bridging was associated

A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair.

PubMed

Burkhart, Stephen S; Adams, Christopher R; Burkhart, Sarah S; Schoolfield, John D

2009-03-01

The purpose of this study was to compare the biomechanical fixation parameters of a standard double-row rotator cuff repair with those of a knotless footprint reconstruction using the double-row SwiveLock-FiberChain technique (Arthrex, Naples, FL). Seven matched pairs of human cadaveric shoulders were used for testing (mean age, 48 +/- 10.3 years). A shoulder from each matched pair was randomly selected to receive a standard 4-anchor double-row repair of the supraspinatus tendon, and the contralateral shoulder received a 4-anchor double-row SwiveLock-FiberChain repair. The tendon was cycled from 10 N to 100 N at 1 Hz for 500 cycles, followed by a single-cycle pull to failure at 33 mm/s. Yield load, ultimate load, cyclic displacement, and mode of failure were recorded. Yield load and ultimate load were higher for the SwiveLock-FiberChain repair compared with the standard double-row repair for 6 of the 7 treatment pairs; however, 1 cadaver had a contrary outcome, so the overall mean differences in yield load and ultimate load were not significantly different from 0 by Student t test (P > .15). Furthermore, smaller differences between yield load and ultimate load for the SwiveLock-FiberChain repair in 5 of the 7 treatment pairs showed a self-reinforcing mechanism. Double-row footprint reconstruction with the knotless SwiveLock-FiberChain system in this study had yield loads, ultimate loads, and cyclic displacements that were statistically equivalent to those of standard double-row rotation cuff reconstructions. The SwiveLock-FiberChain system's combination of strength, self-reinforcement, and decreased operating time may offer advantages to the surgeon, particularly when dealing with older patients in whom poor tissue quality and total operative time are important considerations.

Improved Inspection Techniques for Steel Prestressing/Post-tensioning Strand : Volume I

DOT National Transportation Integrated Search

2012-06-01

Post-tensioned bridges require a detailed inspection of their post-tensioning systems since damage in these : systems is not evident and can result in costly repairs/replacements, loss of integrity and reduction in safety : of the bridge. Different n...

Identification of sudden stiffness changes in the acceleration response of a bridge to moving loads using ensemble empirical mode decomposition

NASA Astrophysics Data System (ADS)

Aied, H.; González, A.; Cantero, D.

2016-01-01

The growth of heavy traffic together with aggressive environmental loads poses a threat to the safety of an aging bridge stock. Often, damage is only detected via visual inspection at a point when repairing costs can be quite significant. Ideally, bridge managers would want to identify a stiffness change as soon as possible, i.e., as it is occurring, to plan for prompt measures before reaching a prohibitive cost. Recent developments in signal processing techniques such as wavelet analysis and empirical mode decomposition (EMD) have aimed to address this need by identifying a stiffness change from a localised feature in the structural response to traffic. However, the effectiveness of these techniques is limited by the roughness of the road profile, the vehicle speed and the noise level. In this paper, ensemble empirical mode decomposition (EEMD) is applied by the first time to the acceleration response of a bridge model to a moving load with the purpose of capturing sudden stiffness changes. EEMD is more adaptive and appears to be better suited to non-linear signals than wavelets, and it reduces the mode mixing problem present in EMD. EEMD is tested in a variety of theoretical 3D vehicle-bridge interaction scenarios. Stiffness changes are successfully identified, even for small affected regions, relatively poor profiles, high vehicle speeds and significant noise. The latter is due to the ability of EEMD to separate high frequency components associated to sudden stiffness changes from other frequency components associated to the vehicle-bridge interaction system.

Cleft palate repair and variations

PubMed Central

Agrawal, Karoon

2009-01-01

Cleft palate affects almost every function of the face except vision. Today a child born with cleft palate with or without cleft lip should not be considered as unfortunate, because surgical repair of cleft palate has reached a highly satisfactory level. However for an average cleft surgeon palatoplasty remains an enigma. The surgery differs from centre to centre and surgeon to surgeon. However there is general agreement that palatoplasty (soft palate at least) should be performed between 6-12 months of age. Basically there are three groups of palatoplasty techniques. One is for hard palate repair, second for soft palate repair and the third based on the surgical schedule. Hard palate repair techniques are Veau-Wardill-Kilner V-Y, von Langenbeck, two-flap, Aleveolar extension palatoplasty, vomer flap, raw area free palatoplasty etc. The soft palate techniques are intravelar veloplasty, double opposing Z-plasty, radical muscle dissection, primary pharyngeal flap etc. And the protocol based techniques are Schweckendiek's, Malek's, whole in one, modified schedule with palatoplasty before lip repair etc. One should also know the effect of each technique on maxillofacial growth and speech. The ideal technique of palatoplasty is the one which gives perfect speech without affecting the maxillofacial growth and hearing. The techniques are still evolving because we are yet to design an ideal one. It is always good to know all the techniques and variations so that one can choose whichever gives the best result in one's hands. A large number of techniques are available in literature, and also every surgeon incorporates his own modification to make it a variation. However there are some basic techniques, which are described in details which are used in various centres. Some of the important variations are also described. PMID:19884664

Feasibility of using high-strength steel and MMFX rebar in bridge design.

DOT National Transportation Integrated Search

2009-07-01

Pressed by increases in construction costs coupled with insufficient funding for maintenance and new construction, many state and federal agencies are now specifying a service life of 75 years for all concrete bridges without significant repairs. In ...

Best Practices for Construction and Repair of Bridge Approaches and Departures

DOT National Transportation Integrated Search

2018-03-01

Florida Department of Transportation (FDOT) has experienced frequent distresses in bridge approach/departure asphalt pavements in its highway system. Commonly observed distresses include alligator cracking and rutting, which reduce roadway smoothness...

New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case.

PubMed

Berezina, Tamara L; Fechtner, Robert D; Cohen, Amir; Kim, Eliott E; Chu, David S

2015-01-01

We present the case of successful repair of an exposed glaucoma drainage tube by cornea graft fixation with tissue adhesive, and without subsequent coverage by adjacent conjunctiva or donor tissues. Patient with history of keratoglobus with thin cornea and sclera, and phthisical contralateral eye, underwent three unsuccessful corneal grafts followed by Boston type 1 keratoprosthesis in the right eye. Ahmed drainage device with sclera patch graft was implanted to control the intraocular pressure. Two years later the tube eroded through sclera graft and conjunctiva. Repair was performed by covering the tube with a corneal patch graft secured by tissue adhesive after the conjunctiva in this area was dissected away. The cornea graft was left uncovered due to fragility of adjacent conjunctiva. The healing of ocular and graft surfaces was complete prior to the 1 month follow-up. Conjunctival epithelium covered the corneal patch graft. At 12 months follow-up, the graft and the tube remained stable. Our report suggests that corneal patch graft fixation to the sclera by means of tissue adhesive, without closing the conjunctiva, can be considered as an effective alternative surgical approach for managing exposed glaucoma drainage tube, accompanied by adjacent conjunctiva tissue deficiency. How to cite this article: Berezina TL, Fechtner RD, Cohen A, Kim EE, Chu DS. New Technique of Exposed Glaucoma Drainage Tube Repair: Report of a Case. J Curr Glaucoma Pract 2015;9(2):62-64.

New In-Field Composite Repair Techniques for Transmission or Distribution Pipelines

DOT National Transportation Integrated Search

2009-05-18

In-field repair of a damaged pipeline must be performed safely, efficiently, rapidly and reliably. Reinforcement of damaged pipelines is typically accomplished by welding a repair patch and then recoating the repaired area. The welded full-encircleme...

A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading.

PubMed

Bhatia, Sanjeev; Civitarese, David M; Turnbull, Travis Lee; LaPrade, Christopher M; Nitri, Marco; Wijdicks, Coen A; LaPrade, Robert F

2016-03-01

Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses. A newly proposed 2-tunnel radial meniscal repair method will result in decreased gapping and increased ultimate failure loads compared with the double horizontal mattress suture repair technique under cyclic loading. Controlled laboratory study. Ten matched pairs of male human cadaveric knees (average age, 58.6 years; range, 48-66 years) were used. A complete radial medial meniscal tear was made at the junction of the posterior one-third and middle third of the meniscus. One knee underwent a horizontal mattress inside-out repair, while the contralateral knee underwent a radial meniscal repair entailing the same technique with a concurrent novel 2-tunnel repair. Specimens were potted and mounted on a universal testing machine. Each specimen was cyclically loaded 1000 times with loads between 5 and 20 N before experiencing a load to failure. Gap distances at the tear site and failure load were measured. The 2-tunnel repairs exhibited a significantly stronger ultimate failure load (median, 196 N; range, 163-212 N) than did the double horizontal mattress suture repairs (median, 106 N; range, 63-229 N) (P = .004). In addition, the 2-tunnel repairs demonstrated decreased gapping at all testing states (P < .05) with a final measured gapping of 1.7 mm and 4.1 mm after 1000 cycles for the 2-tunnel and double horizontal mattress suture repairs, respectively. The 2-tunnel repairs displayed significantly less gapping distance after cyclic loading and had significantly stronger ultimate failure loads

The Importance of Bridging

ERIC Educational Resources Information Center

Zamboni, Camilla

2014-01-01

In this article, I will discuss the importance of the fundamental aspect of "bridging" in the wider context of language teaching. I will use "bridging" particularly in terms of cultural differences and underline the pivotal role of specific techniques, in a language class as well as in a pedagogy class or seminar, to help…

Extensive traumatic anterior skull base fractures with cerebrospinal fluid leak: classification and repair techniques using combined vascularized tissue flaps.

PubMed

Archer, Jacob B; Sun, Hai; Bonney, Phillip A; Zhao, Yan Daniel; Hiebert, Jared C; Sanclement, Jose A; Little, Andrew S; Sughrue, Michael E; Theodore, Nicholas; James, Jeffrey; Safavi-Abbasi, Sam

2016-03-01

This article introduces a classification scheme for extensive traumatic anterior skull base fracture to help stratify surgical treatment options. The authors describe their multilayer repair technique for cerebrospinal fluid (CSF) leak resulting from extensive anterior skull base fracture using a combination of laterally pediculated temporalis fascial-pericranial, nasoseptal-pericranial, and anterior pericranial flaps. Retrospective chart review identified patients treated surgically between January 2004 and May 2014 for anterior skull base fractures with CSF fistulas. All patients were treated with bifrontal craniotomy and received pedicled tissue flaps. Cases were classified according to the extent of fracture: Class I (frontal bone/sinus involvement only); Class II (extent of involvement to ethmoid cribriform plate); and Class III (extent of involvement to sphenoid bone/sinus). Surgical repair techniques were tailored to the types of fractures. Patients were assessed for CSF leak at follow-up. The Fisher exact test was applied to investigate whether the repair techniques were associated with persistent postoperative CSF leak. Forty-three patients were identified in this series. Thirty-seven (86%) were male. The patients' mean age was 33 years (range 11-79 years). The mean overall length of follow-up was 14 months (range 5-45 months). Six fractures were classified as Class I, 8 as Class II, and 29 as Class III. The anterior pericranial flap alone was used in 33 patients (77%). Multiple flaps were used in 10 patients (3 salvage) (28%)--1 with Class II and 9 with Class III fractures. Five (17%) of the 30 patients with Class II or III fractures who received only a single anterior pericranial flap had persistent CSF leak (p < 0.31). No CSF leak was found in patients who received multiple flaps. Although postoperative CSF leak occurred only in high-grade fractures with single anterior flap repair, this finding was not significant. Extensive anterior skull base

Development of Inspection Robots for Bridge Cables

PubMed Central

Kim, Se-Hoon; Lee, Jong-Jae

2013-01-01

This paper presents the bridge cable inspection robot developed in Korea. Two types of the cable inspection robots were developed for cable-suspension bridges and cable-stayed bridge. The design of the robot system and performance of the NDT techniques associated with the cable inspection robot are discussed. A review on recent advances in emerging robot-based inspection technologies for bridge cables and current bridge cable inspection methods is also presented. PMID:24459453

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report.

PubMed

Dacambra, Mark P; Walker, Richard Ea; Hildebrand, Kevin A

2013-08-23

The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a 'pop' on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps tendon ruptures successfully treated with a single

Simultaneous bilateral distal biceps tendon ruptures repaired using an endobutton technique: a case report

PubMed Central

2013-01-01

Introduction The simultaneous rupture of both distal biceps tendons is a rare clinical entity that is difficult to treat and can have poor outcomes. A variety of treatment and rehabilitation options exist and have been reported for single sided and staged bilateral repairs, but none have described an approach for acute bilateral ruptures. Repairing distal biceps tendon ruptures using a single anterior incision and a cortical suspensory button technique has become increasingly popular in recent years. We present a report of our surgical approach using an endobutton technique and rehabilitation algorithm for this unusual injury pattern. Case presentation A 43-year-old Caucasian man presented with acute onset bilateral elbow pain while lifting a large sheet of drywall off the ground. He initially felt a ‘pop’ on the right and almost immediately felt another on the left after having to quickly shift the weight. He was unable to continue working and sought medical attention. His pain was predominantly in his bilateral antecubital fossae and he had significant swelling and ecchymoses. His clinical examination demonstrated no palpable tendon, a retracted biceps muscle belly, and clear supination weakness. Magnetic resonance imaging was performed and showed bilateral distal biceps tendon ruptures with retraction on both sides. After discussion with our patient, we decided that both sides would be repaired using a single anterior incision with endobutton fixation, first his right followed by his left six weeks later. Conclusion Overall, our patient did very well and had returned to full manual work by our last follow-up at 30 months. Although he was never able to return to competitive recreational hockey and was left with mild lateral antebrachial cutaneous nerve dysesthesias on his right, he felt he was at 85% of his premorbid level of function. We describe what we believe to be, to the best of our knowledge, the first case of simultaneous bilateral distal biceps

Avoiding the use of a femoral bridging catheter using a two-stage Hemodialysis Reliable Outflow (HeRO) graft implantation technique.

PubMed

Yoon, William J; Lorelli, David R

2015-01-01

To evaluate a two-stage Hemodialysis Reliable Outflow (HeRO) implantation technique that avoids the use of a femoral bridging catheter versus the conventional one-stage technique requiring a bridging catheter in selected patients. A retrospective review was performed on 20 end-stage renal disease patients with an internal jugular vein (IJV) catheter selected for two-stage HeRO implantation at our institution between January 2010 and March 2013. The arterial graft component (AGC) was implanted without anastomosing it to the target artery (first stage). After AGC incorporation, the venous outflow component was inserted (second stage). The preexisting IJV catheter was maintained for hemodialysis access during the interstage period. Patient characteristics, patency using Kaplan-Meier method and infection rates were analyzed. A total of 17 patients with a mean age of 59 years (70.6% women) completed the two-stage procedure. During the interstage period (mean 12 weeks, range 4-22 weeks), no graft- or surgery-related infection occurred. The need of a femoral bridging catheter was avoided by utilizing the preexisting IJV dialysis catheter. The accumulated HeRO days were 3,916 days with a mean follow-up of 7.7 months (range 1-22.6 months). The HeRO-related infection rate was 0.3/1,000 days. The primary assisted and secondary patency rates at 6 months were 69% and 82%, respectively, which were similar to those of arteriovenous grafts. Staging conferred immediate vascular accessibility. Avoiding the use of a femoral bridging catheter using the two-stage technique may lower infection rate, with comparable primary assisted and secondary patency to arteriovenous grafts and added benefit of immediate cannulatability in this subset of patients.

Agar-based bridges as biocompatible candidates to provide guide cues in spinal cord injury repair.

PubMed

Martín-López, Eduardo; Darder, Margarita; Ruiz-Hitzky, Eduardo; Nieto Sampedro, Manuel

2013-01-01

Spinal bridge implants are strategic to provide growth surfaces for axonal regeneration after spinal cord injuries. The design of an appropriate substrate, one that is suitable for implantation, must involve careful testing of the biomaterial properties both in vitro and in vivo. The goal of this work was to test the structure, stability and biological response after spinal bridges implantation of several biopolymers, composed of mixtures of agar (AG), as structural matrix scaffold, with κ-carrageenan (Kc), gelatin (G), xanthan gum (Xn) and polysulfone (PS). Biopolymer structures were studied by environmental scanning electron microscopy, whereas the stability of gels was analyzed by in vitro degradation and swelling tests. The biocompatibility of these materials and their ability to promote cell growth and axonal regeneration were studied by implantation of spinal bridges containing empty linear channels in an acute rat spinal cord transection model at thoracic level (T8). All gel mixtures gave rise to porous structures and they were stables to degradation, excepting the AG+G mixture. Spinal bridges constructed from all mixtures were implanted during a month in adult rats. After this time a low host reaction occurred to all bridge materials as well as neurite and cell ingrowths through the empty channels. Neurites within the bridges were mostly peripheral sensory fibers such as those positive for CGRP, whereas there was a lack of regeneration of central axons crossing from the spinal tissue to bridges. Many of these neurites established closed contacts with non-myelin Schwann cells. The histological analysis revealed a high accumulation of collagen fibers within the channels. Unexpected was the apparent loss of channels linearity which affected the growth of neurites and cells, indicating the need for additional regeneration strategies and vertebrae bridge fixing.

Applications of Non-destructive methods (GPR and 3D Laser Scanner) in Historic Masonry Arch Bridge Assessment

NASA Astrophysics Data System (ADS)

Alani, Amir; Banks, Kevin

2014-05-01

There exist approximately 70,000 masonry arch bridge spans (brick and stone) in the UK with tens of thousands more throughout Europe. A significant number of these bridges are still in operation and form part of the road and rail network systems in many countries. A great majority of these bridges are in desperate need of repair and maintenance. Applications of non-destructive testing methods such as ground penetrating radar (GPR), 3D laser scanning, accelerometer sensors and vibration detecting sensors amongst many others have been used to assess and monitor such structures in the past few years. This presentation provides results of the applications of a 2GHz GPR antenna system and a 3D laser scanner on a historic masonry arch bridge (the Old Bridge, Aylesford) located in Kent, in the south east of England. The older part of the bridge (the mid-span) is 860 years old. The bridge was the subject of a major alteration in 1811. This presentation forms part of a larger ongoing study which is using the two above mentioned non-destructive methods for long-term monitoring of the bridge. The adopted survey planning strategy and technique, data acquisition and processing as well as challenges encountered during actual survey and fieldworks have been discussed in this presentation. As a result of this study the position of different layers of the deck structure has been established with the identification of the original stone base of the bridge. This information in addition to the location of a number of structural ties (anchors - remedial work carried out previously) in the absence of reliable and accurate design details proved to be extremely useful for the modelling of the bridge using the finite element method. Results of the 3D laser scanning of the bridge have also been presented which have provided invaluable data essential for the accurate modelling of the bridge as well as the long term monitoring of the bridge. 2014 EGU-GA GI3.1 Session, organised by COST Action

Repair of Double Head Pectoralis Major Tendon Avulsion into its Native Footprint Using Bi-cortical EndoButtons and Tendon Sliding Technique.

PubMed

Prabhu, Jagadish; Faqi, Mohammed Khalid; Alkhalifa, Fahad; Tayara, Bader Kamal; Awad, Rashad Khamis

2017-01-01

Injuries to the pectoralis major muscle are relatively infrequent. The mechanism of injury is usually an eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. We report a case that presented to us with a history of sudden pain in the left pectoral region while doing heavy bench press exercise. The patient sustained a type III D pectoralis muscle -tendon avulsion. Surgical repair was done through a bi-cortical tendon sliding technique using two cortical buttons. In this article we describe our modifications to the previously described surgical technique for the pectoralis major tendon repair using the EndoButton and tension - slide technique, aiming to overcome the possible complications.

Bridge A1187 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A3406 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A1479 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A2966 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A2111 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A1297 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A1193 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A0569 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge K0197 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A3017 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Bridge A3405 : Missouri S&T nondestructive evaluation of bridge decks - pilot study.

DOT National Transportation Integrated Search

2014-03-01

This research has examined the use of nondestructive techniques for concrete bridge deck condition : assessments. The primary nondestructive testing/evaluation (NDT/NDE) technique utilized in this research : was ground-coupled ground penetrating rada...

Biomaterial-mediated strategies targeting vascularization for bone repair.

PubMed

García, José R; García, Andrés J

2016-04-01

Repair of non-healing bone defects through tissue engineering strategies remains a challenging feat in the clinic due to the aversive microenvironment surrounding the injured tissue. The vascular damage that occurs following a bone injury causes extreme ischemia and a loss of circulating cells that contribute to regeneration. Tissue-engineered constructs aimed at regenerating the injured bone suffer from complications based on the slow progression of endogenous vascular repair and often fail at bridging the bone defect. To that end, various strategies have been explored to increase blood vessel regeneration within defects to facilitate both tissue-engineered and natural repair processes. Developments that induce robust vascularization will need to consolidate various parameters including optimization of embedded therapeutics, scaffold characteristics, and successful integration between the construct and the biological tissue. This review provides an overview of current strategies as well as new developments in engineering biomaterials to induce reparation of a functional vascular supply in the context of bone repair.

Anatomic suture anchor versus the Broström technique for anterior talofibular ligament repair: a biomechanical comparison.

PubMed

Waldrop, Norman E; Wijdicks, Coen A; Jansson, Kyle S; LaPrade, Robert F; Clanton, Thomas O

2012-11-01

Despite the popularity of the Broström procedure for secondary repair of chronic lateral ankle instability, there have been no biomechanical studies reporting on the strength of this secondary repair method, whether using suture fixation or suture anchors. The purpose of our study was to perform a biomechanical comparison of the ultimate load to failure and stiffness of the traditional Broström technique using only a suture repair compared with a suture anchor repair of the anterior talofibular ligament (ATFL) at time zero. We believed that fixation strength of the suture anchor repair would be closer to the strength of the native ligament and allow more aggressive rehabilitation. Controlled laboratory study. Twenty-four fresh-frozen cadaveric ankles were randomly divided into 4 groups of 6 specimens. One group was an intact control group, and the other groups consisted of the traditional Broström and 2 suture anchor modifications (suture anchors in talus or fibula) of the Broström procedure. The specimens were loaded to failure to determine the strength and stiffness of each construct. In load-to-failure testing, ultimate failure loads of the Broström (68.2 ± 27.8 N; P = .013), suture anchor fibula (79.2 ± 34.3 N; P = .037), and suture anchor talus (75.3 ± 45.6 N; P = .027) repairs were significantly lower than that of the intact (160.9 ± 72.2 N) ATFL group. Stiffness of the Broström (6.0 ± 2.5 N/mm; P = .02), suture anchor fibula (6.8 N/mm ± 2.7; P = .05), and suture anchor talus (6.6 N/mm ± 4.0; P = .04) repairs were significantly lower than that of the intact (12.4 N/mm ± 4.1 N/mm) ATFL group. The 3 repair groups were not significantly different from each other, but all 3 were substantially lower in strength and stiffness when compared to the intact ATFL. The use of suture anchors to repair the ATFL produces a repair that can withstand loads to failure similar to the suture-only Broström repair. However, all 3 repair groups were much weaker than

Cost-effective and rapid concrete repair techniques.

DOT National Transportation Integrated Search

2016-02-08

Concrete is a principal component of many transportation structures. While highly durable, a : variety of processes degrade and damage concrete. Replacement is expensive. Many cases : warrant repair instead of replacement. Since many damage processes...

Effective way to reconstruct arch bridges using concrete walls and transverse strands

NASA Astrophysics Data System (ADS)

Klusáček, Ladislav; Pěkník, Robin; Nečas, Radim

2017-09-01

There are more than 500 masonry arch bridges in the Czech Road system and about 2500 in the Czech Railway system. Many of them are cracked in the longitudinal (span) direction. The barrel vaults are separated by the cracks into partial masonry arches without load bearing connection in transverse direction. These constructions are about 150 years old and they are also too narrow for the current road system. This paper presents a strengthening method for masonry arch bridges using transverse post-tensioning. This method is very useful not only for strengthening in the transverse direction, but widening of masonry arches can be taken as secondary effect especially in case of road bridges. Several bridges were successfully repaired with the use of this system which seems to be effective and reliable.

Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome?

PubMed

Pauly, Stephan; Gerhardt, Christian; Chen, Jianhai; Scheibel, Markus

2010-12-01

Several techniques for arthroscopic repair of rotator cuff defects have been introduced over the past years. Besides established techniques such as single-row repairs, new techniques such as double-row reconstructions have gained increasing interest. The present article therefore provides an overview of the currently available literature on both repair techniques with respect to several anatomical, biomechanical, clinical and structural endpoints. Systematic literature review of biomechanical, clinical and radiographic studies investigating or comparing single- and double-row techniques. These results were evaluated and compared to provide an overview on benefits and drawbacks of the respective repair type. Reconstructions of the tendon-to-bone unit for full-thickness tears in either single- or double-row technique differ with respect to several endpoints. Double-row repair techniques provide more anatomical reconstructions of the footprint and superior initial biomechanical characteristics when compared to single-row repair. With regard to clinical results, no significant differences were found while radiological data suggest a better structural tendon integrity following double-row fixation. Presently published clinical studies cannot emphasize a clearly superior technique at this time. Available biomechanical studies are in favour of double-row repair. Radiographic studies suggest a beneficial effect of double-row reconstruction on structural integrity of the reattached tendon or reduced recurrent defect rates, respectively.

Greater Success of Primary Fascial Closure of the Open Abdomen: A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results.

PubMed

Kääriäinen, M; Kuuskeri, M; Helminen, M; Kuokkanen, H

2017-06-01

The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Open abdomen patients (n = 61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p = 0.039) and the highest fascial repair rate (p = 0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component

Shear repair methods for conventionally reinforced concrete girders and bent caps.

DOT National Transportation Integrated Search

2009-12-01

Thirteen large-scale girders and two bent caps that replicated as close as possible bridge components from the 1950s were cast and loaded to cause initial cracking similar to that observed in the field. The girders were repaired with epoxy crack inje...

Bone Marrow Stimulation Technique Augmented by an Ultrapurified Alginate Gel Enhances Cartilage Repair in a Canine Model.

PubMed

Baba, Rikiya; Onodera, Tomohiro; Matsuoka, Masatake; Hontani, Kazutoshi; Joutoku, Zenta; Matsubara, Shinji; Homan, Kentaro; Iwasaki, Norimasa

2018-05-01

The optimal treatment for a medium- or large-sized cartilage lesion is still controversial. Since an ultrapurified alginate (UPAL) gel enhances cartilage repair in animal models, this material is expected to improve the efficacy of the current treatment strategies for cartilage lesions. The bone marrow stimulation technique (BMST) augmented by UPAL gel can induce hyaline-like cartilage repair. Controlled laboratory study. Two cylindrical osteochondral defects were created in the patellar groove of 27 beagle dogs. A total of 108 defects were divided into 3 groups: defects without intervention (control group), defects with the BMST (microfracture group), and defects with the BMST augmented by implantation of UPAL gel (combined group). At 27 weeks postoperatively, macroscopic and histological evaluations, micro-computed tomography assessment, and mechanical testing were performed for each reparative tissue. The defects in the combined group were almost fully covered with translucent reparative tissues, which consisted of hyaline-like cartilage with well-organized collagen structures. The macroscopic score was significantly better in the combined group than in the control group ( P < .05). The histological scores in the combined group were significantly better than those in the control group ( P < .01) and microfracture group ( P < .05). Although the repaired subchondral bone volumes were not influenced by UPAL gel augmentation, the mechanical properties of the combined group were significantly better than those of the microfracture group ( P < .05). The BMST augmented by UPAL gel elicited hyaline-like cartilage repair that had characteristics of rich glycosaminoglycan and matrix immunostained by type II collagen antibody in a canine osteochondral defect model. The present results suggest that the current technique has the potential to be one of the autologous matrix-induced chondrogenesis techniques of the future and to expand the operative indications for the BMST

Shoulder abduction diminishes self-reinforcement in transosseous-equivalent rotator cuff repair in both knotted and knotless techniques.

PubMed

Smith, Geoffrey C S; Lam, Patrick H

2018-06-20

The self-reinforcement mechanism after double row suturebridge rotator cuff repair generates increasing compressive forces at the tendon footprint with increasing tendon load. Passive range of motion is usually allowed after rotator cuff repair. The mechanism of self-reinforcement could be adversely affected by shoulder abduction. Rotator cuff tears were created ex vivo in nine pairs of ovine shoulders. Two different repair techniques were used. One group was repaired using a double row 'suturebridge' construct with tied horizontal medial row mattress sutures (Knotted repair group). The other group was repaired identically except that medial row knots were not tied (Knotless repair group). Footprint compression was measured at varying amounts of abduction and under tendon loads of 0, 10, 20, 30, 40, 50 and 60N. The rate of increase of contact pressure (degree of self-reinforcement) was calculated for each abduction angle. Abduction diminishes footprint contact pressure in both knotted and knotless double row suturebridge constructs. Progressive abduction from 0 to 40 abduction in the knotless group and 0-30 in the knotted group results in a decrease in self-reinforcement. Abduction beyond this does not cause a further decrease in self-reinforcement. There was no difference in the rate of increase of footprint contact pressure at each angle of abduction when comparing the knotted and knotless groups. In the post-operative period, high tendon load combined with minimal abduction would be expected to generate the greatest amount of footprint compression which may improve tendon healing. Therefore, to maximize footprint compression the use of abduction pillows should be avoided while early isometric strengthening should be used.

Aquarium Portal Technique for PASTA Lesion Repair.

PubMed

Meyer, Dominik C; Gerber, Christian; Familiari, Filippo

2017-10-01

The simultaneous arthroscopic exposure of the subacromial and intra-articular space of the shoulder is challenging in the presence of only partial-thickness rotator cuff tears. We present our experience and method of entering the joint through the opened rotator cuff interval from an anterosuperior portal between the coracoid process and anterior acromion. With moderate (approximately 30°) abduction and external rotation, the rotator interval opens readily, offering a view with the camera toward the anterior edge of the supraspinatus tendon. An anterior view on the anterior leading edge of the supraspinatus tendon is obtained, showing the subacromial space above and the glenohumeral space below the tendon, similar to the view in an aquarium. The rotator cuff can be elevated using a rod inserted intra-articularly from posterior, whereas anchors and other instruments may be inserted from lateral. This approach offers the advantages of full exposure of the posterior undersurface of the rotator cuff insertion; a convenient approximately 90° angle between the camera and instruments; and no need to change portals for anchor placement, tendon stitching, or suture handling. The objective of this Technical Note is to describe our arthroscopic repair approach (aquarium technique) to PASTA (partial articular supraspinatus tendon avulsion) lesions.

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

PubMed

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 (p<0.0001 at each angle). Repair of the radial tear using the all-inside technique as well as the inside-out technique resulted in significantly decreased compartment pressures compared to partial meniscectomies (p<0.0001 at each angle). There were no significant differences between peak pressures in the intact state and after repair with the all-inside 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.

Construction of crack-free bridge decks.

DOT National Transportation Integrated Search

2017-04-01

This serves as the final report on Transportation Pooled-Fund Program Project No. TPF-5(174), Construction : of Crack-Free Bridge Decks. The goal of the study was to implement the most cost-effective techniques for : improving bridge deck life ...

Effect of voids in grouted, post-tensioned concrete bridge construction : volume 2--inspection, repair, materials, and risks.

DOT National Transportation Integrated Search

2009-09-01

Post-tensioned (PT) bridges are major structures that carry significant traffic. These bridges are designed and : constructed because they are economical for spanning long distances. In Texas, there are several signature PT : bridges. In the late 199...

Three Bridge Fryer's Ford Bridge, Nimrod Bridge, and Ward's ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Three Bridge - Fryer's Ford Bridge, Nimrod Bridge, and Ward's Crossing Bridge - Fryer's Ford Bridge, Spanning East Fork of Point Remove Creek at Fryer Bridge Road (CR 67), Solgohachia, Conway County, AR

Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial.

PubMed

Andersson, Bodil; Hallén, Magnus; Leveau, Per; Bergenfelz, Anders; Westerdahl, Johan

2003-05-01

This study was designed to compare an open tension-free technique (Lichtenstein repair) with a laparoscopic totally extraperitoneal hernia repair (TEP). One hundred sixty-eight men aged 30 to 65 years with primary or recurrent inguinal hernia were randomized to TEP or open mesh technique in the manner of Lichtenstein. Follow-up was after 1 and 6 weeks, and 1 year. Eighty-one patients were randomized to TEP, and 87 to open repair. For 1 patient in each group, the operation was converted to a different type of repair. No difference was seen in overall complications between the 2 groups. However, 1 patient in the TEP group underwent operation for small bowel obstruction after surgery. A higher frequency of postoperative hematomas was seen in the open group (P <.05). Patients in the TEP group consumed less analgesic after surgery (P <.001), returned to work earlier (P <.01), and had a shorter time to full recovery (P <.01). Two recurrences occurred in the TEP group 1 year after surgery. The TEP technique was associated with less postoperative pain, a shorter time to full recovery, and an earlier return to work compared with the open tension-free repair. No difference was seen in overall complications. However, 2 recurrences did occur after 1 year in the TEP group.