Histologic evaluation of the glenohumeral joint capsule after the laser-assisted capsular shift procedure for glenohumeral instability.

Glenohumeral joint capsule obtained from 42 patients who had undergone an arthroscopic laser-assisted capsular shift procedure was evaluated histologically. A total of 53 samples from the anterior inferior glenohumeral ligament of the joint capsule were collected before and at various times after the procedure (range, 0 to 38 months). Despite glenohumeral instability, joint capsule of the patients before the procedure showed no significant histologic lesions. Laser treatment significantly altered the histologic properties of the tissue as evidenced by hyalinization of collagen and necrotic cells (time 0). Tissues sampled during the short-term period (3 to 6 months) after the procedure demonstrated fibrous connective tissue with reactive cells and vasculature. Collagen and cell morphology returned to normal in the middle- to long-term period (7 to 38 months) after the procedure, while the number of fibroblasts remained elevated. Joint capsule collected from the shoulders of six patients who experienced stiffness after the procedure showed persistent synovial, cellular, and vascular reaction even after 1 year postoperatively, the cause of which is unclear. This study revealed histologic evidence of robust tissue healing and maturation after thermal treatment by the laser-assisted capsular shift procedure, although mechanical and biochemical characterization of the tissue was not evaluated. Correlation with clinical follow-up must be performed to further clarify the advantages and disadvantages of this procedure.

Usefulness of aerobic microbial culture and cytologic evaluation of corneal specimens in the diagnosis of infectious ulcerative keratitis in animals.

OBJECTIVE: To determine the diagnostic value of aerobic microbial culture and cytologic evaluation of corneal specimens in the diagnosis of infectious ulcerative keratitis (IUK). DESIGN: Prospective study. ANIMALS: 48 animals (26 dogs, 13 horses, 7 cats, 1 bird, and 1 llama) with corneal ulcers. PROCEDURE: Scrapings from corneal ulcers were examined cytologically. Corneal swab specimens were submitted for microbial culture. Animals were grouped according to whether they had been receiving antimicrobials at the time of admission. RESULTS: Of the 38 animals receiving antimicrobials, 19 had positive results for IUK on cytologic evaluation, 20 on microbial culture, and 26 on cytologic evaluation, microbial culture, or both. Of the 10 animals not receiving antimicrobials at the time of admission, 7 had positive results for IUK on cytologic evaluation, and 9 had positive results on microbial culture. In this group of 10 animals, additional animals with IUK were not identified on the basis of cytologic evaluation alone. When all 48 animals were considered irrespective of antimicrobial treatment, 26 and 29 had positive results for IUK on cytologic evaluation and microbial culture, respectively, whereas IUK was confirmed in 35 animals on the basis of cytologic evaluation, microbial culture results, or both. CONCLUSIONS AND CLINICAL RELEVANCE: Microbial culture and cytologic evaluation of corneal specimens maximizes identification of IUK, especially in animals receiving antimicrobial treatment. Because of serious consequences of untreated IUK, we recommend that both diagnostic tests be used to tailor treatment and reduce risk of vision impairment in animals.

The effect of thermal heating on the length and histologic properties of the glenohumeral joint capsule.

The purpose of this study was to evaluate the effect of temperature on shrinkage and the histologic properties of glenohumeral joint capsular tissue. Six fresh-frozen cadaveric shoulders were used for this study. Seven joint capsule specimens were taken from different regions from each glenohumeral joint and assigned to one of seven treatment groups (37 degrees, 55 degrees, 60 degrees, 65 degrees, 70 degrees, 75 degrees, 80 degrees C) using a randomized block design. Specimens were placed in a tissue bath heated to one of the designated temperatures for 10 minutes. Specimens treated with temperatures at or above 65 degrees C experienced significant shrinkage compared with those treated with a 37 degrees C bath. The posttreatment lengths in the 70 degrees, 75 degrees, and 80 degrees C groups were significantly less than the pretreatment lengths. Histologic analysis revealed significant thermal alteration characterized by hyalinization of collagen in the 65 degrees, 70 degrees, 75 degrees, and 80 degrees C groups. This study demonstrated that temperatures at or above 65 degrees C caused significant shrinkage of glenohumeral joint capsular tissue. These results are consistent with histologic findings, which revealed significant thermal changes of collagen in the 65 degrees, 70 degrees, 75 degrees, and 80 degrees C groups. To verify the validity of laser application for shrinkage of joint capsule, studies designed to compare these findings with the effects of laser energy must be performed.

Treatment of inflammatory arthritis by synovial ablation: a comparison of the holmium: YAG laser, electrocautery, and mechanical ablation in a rabbit model.

BACKGROUND AND OBJECTIVE: Although the majority of patients with immune-mediated inflammatory arthritis are managed conservatively, some patients may require synovectomy if they have persistent pain secondary to chronic unresponsive swelling of a joint. In this study, three methods of synovial ablation using laser energy, electrocautery, and mechanical debridement were compared in an in vivo chronic synovitis rabbit model. STUDY DESIGN/MATERIALS, AND METHODS: In the first phase of this study, the optimal laser energy/pulse frequency combination for synovial ablation in this model was determined. In the study's second phase, 48 mature rabbits were then divided into four equal groups: laser synovectomy, electrocautery synovectomy, mechanical synovectomy, and control. Chronic synovitis was induced in both stifles of all treatment groups and in the right stifle of the control rabbits. Synovectomy was performed on one stifle of each rabbit; the contralateral stifle served as a sham-operated control. Six rabbits per group were euthanized 2 weeks and 3 months after surgery, respectively. RESULTS: There were no differences among groups in synovial fluid parameters, except at 2 weeks, when the electrocautery group had significantly more white blood cells than the laser and mechanical debridement groups. Histologic examination revealed that mechanical debridement resulted in significantly more synovial hemorrhage, capillary dilatation, plasma cell infiltration, lymphocyte infiltration, joint capsular defects, and poorer synovial ablation than ablation achieved with either laser energy or electrocautery. CONCLUSION: Laser energy and electrocautery achieved similar results when used for ablative purposes, although electrocautery did not achieve the same degree of synovial ablation as laser energy.