Medicine and Health Sciences Commons^™

Optimizing The Management Of Anterior Monteggia Fractures: A Biomechanical Evaluation Of Treatment Options, Kirk D. Vannitamby

Electronic Thesis and Dissertation Repository

Anterior Monteggia injuries are frequently complicated by persistent radial head instability and suboptimal outcomes. Using a cadaveric elbow motion simulator, we quantified the contributions of ligaments of the proximal radius on maintaining radial head stability, evaluated the effectiveness of ulnar overcorrection to create an apex dorsal angulation in stabilizing the radiocapitellar joint, and finally compared the stabilizing effect of annular ligament repair to three different reconstruction techniques. Our results showed increased anterior radial head translation with progressive soft tissue sectioning with the annular ligament as the primary stabilizer. Ulnar overcorrection and forearm pronation were shown to decrease anterior translation of …

Prescribing Protocol For Postoperative Opioids In An Orthopedic Spine Practice, Kelly M. Manda

Doctor of Nursing Practice (DNP) Scholarly Project

Problem: The opioid epidemic is magnified by excessive post-surgery prescriptions. Over six months at an orthopedic spine practice, 50% of patients received two or more opioid refills beyond their first. This highlighted the absence of a clear prescribing policy and emphasized the need for a structured protocol and to promote patient safety.

Aim of the Project: The primary aim was to implement a prescribing protocol to lower opioid refills provided to post-surgical patients in this surgical practice. The desired result was to reduce the number of opioid refills provided to patients after surgery.

Review of the Evidence: Evidence highlighted …

The Shared Contributions Of The Capsule, Labrum, And Bone On The Suction Seal Of The Hip, Alexander J. Hoffer

Electronic Thesis and Dissertation Repository

The hip capsule, labrum, and bone contribute to hip stability. Abnormalities in these structures are associated with pain and microinstability. Previous studies have quantified the individual stabilizing roles of the capsule and labrum and have associated cam over-resection with decreased hip stability.

The first objective of this thesis was to identify the relative biomechanical contributions of the capsule, labrum, and bone to the hip suction seal, as a representation of hip stability. The second objective was to assess the effectiveness of a labral reconstruction in restoring the suction seal after a cam over-resection.

Ten human cadaveric hips were tested in …

The Effects Of Synovial Fluid And Inflammatory Cells On Orthopaedic Implant Alloys, Lisa Phan

Theses and Dissertations (ETD)

Introduction. Total knee arthroplasty (TKA) is a common surgical procedure used to treat end-stage osteoarthritis. The implants used in TKA typically consist of a Cobalt Chromium Molybdenum (CoCrMo) femoral component and a Titanium Aluminum Vanadium (TiAlV) alloy baseplate. These metal alloys are chosen for their mechanical properties, corrosion resistance, high affinity for bone, and biocompatibility. However, they can be susceptible to mechanical and electrochemical wear, leading to the release of metal ions. Osteoarthritis and inflammation can alter the composition of Synovial Fluid (SF), potentially causing implant corrosion and the release of metal ions into the surrounding tissue. These metal ions …

A Biomechanical Comparison Of A Subacromial Balloon Spacer, Superior Capsular Reconstruction, And A Rigid Subacromial Spacer In A Massive Irreparable Rotator Cuff Cadaveric Model, Devin Ferguson

Electronic Thesis and Dissertation Repository

Massive irreparable rotator cuff tears are a common cause of pain and disability. Several different treatments exist; however, they are associated with poor clinical outcomes and survivorship in younger patients without glenohumeral arthritis. The purpose of this thesis was to compare the impact of a subacromial balloon spacer, superior capsular reconstruction, and a rigid subacromial implant on the glenohumeral kinematics and mechanical efficiency of a massive rotator cuff deficient shoulder. The results indicate that each surgical state improves the glenohumeral kinematics of a massive irreparable rotator cuff tear. The subacromial implant leads to mild overcorrection of humeral head translation. No …

Regenerative Medicine For Tendon/Ligament Injuries: De Novo Equine Tendon/Ligament Neotissue Generation And Application, Takashi Taguchi

LSU Doctoral Dissertations

Tendon and ligament injuries are debilitating conditions across species. Poor regenerative capacities of these tissues limit restoration of original functions. The first study evaluated the effect of cellular administration on tendon/ligament injuries in horses using meta-analysis. The cellular administration was effective in restoring ultrasonographic echogenicity and increasing vascularity during early phase of healing. Additionally, it improved microstructural organization of healed tissue in terms of cellularity and fiber alignment. However, the study did not support its use for increasing rate of return to performance, expression/deposition of tendon-specific genes/proteins, or mechanical properties.

The findings led to the second study that engineered implantable …

Assessing Inflammation In The Pathology Of Knee Osteoarthritis, Zachary J. Koudys

Electronic Thesis and Dissertation Repository

Osteoarthritis (OA) is a joint disease that causes pain, stiffness, and loss of function. Inflammation of the synovium plays a role in the pathology of OA. Macrophages are the dominant immune cells in synovial tissue. Activated macrophages over-express the translocator protein (TSPO). [¹⁸F]FEPPA is a 2^nd generation positron emission tomography (PET) tracer that can target TSPO with high specificity. Hybrid [¹⁸F]FEPPA PET/MRI may enable accurate quantification of macrophage activity in vivo. In this work, [¹⁸F]FEPPA tracer uptake in knee synovial tissue was measured ex vivo using autoradiography and was validated to correlate to …

Mesenchymal Stem Cell Use In The Treatment Of Osteoarthritis: A Literature Review, Samantha Arrizon, Nolan Barnes, Teresa Del Toro, Lei Wena Herme, Vanessa Mendoza, Thi Tran, Reeta Zamro

Physician Assistant Studies | Literature Reviews

Mesenchymal stem cell (MSC) therapies have been growing in popularity in research due to their anti-inflammatory, immunomodulatory, and regenerative properties. Many ongoing clinical trials are investigating the safety and efficacy of MSC therapies to treat osteoarthritis, also known as “wear and tear” arthritis. As the average life expectancy increases, with age people are more prone to developing this disease, therefore, increasing its prevalence. This condition is progressive and will lead to functional decline, decreased quality of life, and increased medical costs. Our focus is to discuss the efficacy of mesenchymal stem cell injections in alleviating pain, improving functionality, and slowing …

Development Of A Crosslinked Osteochondral Xenograft And A Collagen Stabilizing Intra-Articular Injection To Remediate Cartilage Focal Lesions To Prevent Osteoarthritis, Mark Lewis Mosher

Theses and Dissertations

Osteoarthritis is one of the most common causes of disability in adults in America. It is a progressive and degenerative disease where the articular cartilage is broken down and lost from the surfaces of bones causing chronic pain and swelling in the joints, and currently has no cure. The most commonly osteoarthritis starts from a focal lesion on the cartilage surface, which will expand on the surface and downwards through the thickness of the tissue. The current gold standard for correcting cartilage focal lesions is the osteochondral autograft/allograft transplantation (OAT), which replaces the defect with a fresh osteochondral graft. The …

Ex Vivo Biomechanical Comparison Of Four Center Of Rotation Angulation Based Leveling Osteotomy Fixation Methods, Melody E. Whitney

Theses and Dissertations

Thirty-two canine tibiae with patellae and patellar tendons were harvested from 17 skeletally mature cadavers. Each tibia was randomly allocated to a construct group: plate and pin (Plate), plate with countersink compression screw (HCS), plate with tension band (TB), or plate with HCS and TB (HCSTB). Samples were loaded by distraction until failure. The stiffness, yield load, and ultimate load were compared between each fixation method. No difference in stiffness of the constructs was detected between groups. Yield load and ultimate load for the HCSTB group was greater than the TB group, the HCS group, and the Plate group. CBLO …

Severe Lower Extremity Trauma In Ontario: A Linked Population-Based Analysis, Stephanie M. Kim

Electronic Thesis and Dissertation Repository

Open tibia fractures (OTF) are a management challenge. Admission to a trauma center (TC) and a coordinated approach to bony fixation and soft-tissue reconstruction (STR) have been shown to improve outcomes. The objective of this study was to describe patients who had OTF in Ontario and analyze their outcomes. Linked population data pertaining to patients who had OTF between the years 2009-2020 were examined. Demographic information, admission location, and management course were collected. 4240 patients were found. The mean age was 47, and majority were males. Patients admitted to TC had greater proportion of having Injury Severity Score >15, and …

Comparison Of A Dynamic Ankle Orthosis To A Walking Boot For Preserving Ankle Joint Motion And Reducing Tibial Bone Load And Strain, Perri Johnson Jr.

Theses and Dissertations (ETD)

Tibial stress fractures are a common overuse injury accounting for 21.9 – 69% of stress fractures among runners and 24 – 51.2% of stress fractures in military cadets. Current treatment involves wearing a walking boot for 3 – 12 weeks, which limits ankle motion and causes lower limb muscle atrophy. A Dynamic Ankle Orthosis (DAO) provided a distractive force that offloaded the ankle and retained sagittal ankle excursion during walking. It remains unclear how tibial loading is affected by a walking boot or the DAO. This thesis presents a feasibility study confirming the offloading effects of the DAO on tibial …

Comparison Of Hip Navigation System Accuracy In Direct Anterior Approach, Jeremy Loh

Electronic Thesis and Dissertation Repository

Introduction

Malposition of the acetabular component has been thought to have an influence on increasing increase the risk instability, impingement, and ultimately revision surgery. Hip navigation technology has been developed to provide the surgeon with real time intraoperative metrics to make critical decisions in implant placement. The goal of this study was to compare the accuracy of acetabular component positioning in direct anterior approach hip replacements using conventional fluoroscopy only technique, fluoroscopic image dependent navigation, and imageless navigation.

Methods

A retrospective data collection and prospective analysis was conducted for this study. After sample size calculations, fifty patients were collected for …

A Long-Term Follow-Up Of The Stability Study: Multicenter Rct Comparing Anterior Cruciate Ligament Reconstruction With And Without Lateral Extra-Articular Tenodesis In Individuals At High Risk Of Graft Failure, Katelyn M. Inch

Electronic Thesis and Dissertation Repository

One hundred and ninety-six patients at the Fowler Kennedy Sport Medicine Clinic (FKSMC) undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) were randomized as part of the multi-center STABILITY study to receive either an isolated ACLR or ACLR with a lateral extra-articular tenodesis (LET). The STABILITY study followed these patients up to two years postoperative, and a long-term follow-up protocol was initiated afterwards. Eighty-two patients from this center were seen at three, five and seven years postoperative as part of a long-term follow-up. Our primary outcome was a composite outcome of instability and graft failure. Secondary outcomes included patient-reported outcome measures …

Total Hip Arthroplasty In Young Patients, Aaron G. Chen

Electronic Thesis and Dissertation Repository

Total hip arthroplasty (THA) is the gold standard in treatment of hip arthritis yet is often avoided in young patients due to concerns of inferior survivorship. We aim to explore the role of THA in young patients and assess whether these historical concerns are valid in contemporary THA by presenting the results of: (1) a systematic review and meta-analysis of the current literature, (2) a retrospective database review, and (3) a retrospective population-based study. We found excellent long-term survivorship with modern THA in young patients, demonstrating greater than 90% revision-free survival up to 15 years. Factors that may increase risk …

Decompression Vs. Decompression And Fusion In Cauda Equina Syndrome Secondary To Massive Lumbar Disc Herniation, Ruheksh Raj

Electronic Thesis and Dissertation Repository

Posterior spinal surgery through either a decompression or additional fusion procedure is the widely accepted standard of care for patients presenting with cauda equina syndrome (CES) secondary to massive disc herniation. A plethora of literature has been published regarding post- surgical outcome, particularly in regards to improvement of lower sacral nerve symptoms in relation to timing of surgery. There is a paucity of data with regards to long term clinical outcomes in patients between the decompression and decompression and fusion groups. We initially hypothesized was that there would be no longer term clinical differences in outcome between the two groups, …

Determination Of The Protective Capacity Of Hand Wraps In Combat Athletes Using Force Analysis, Eva M. Gusnowski

Electronic Thesis and Dissertation Repository

Upper extremity injuries are common in combat athletes, and are highest in the hand/wrist. Although protective hand gear is used, there is a paucity of research investigating its effectiveness. This study addressed this knowledge gap by measuring the level of force transmitted to the hand during striking using two types of hand wraps. This prospective cross over study included six combat athletes. A load cell was placed over the proximal phalanges/metacarpophalangeal joints and was used to measure sustained peak force during striking while covered with either standard linear or gel-reinforced hand wraps and boxing gloves. The gel reinforced wraps consistently …

Biomechanical Characterization Of Semi-Rigid Constructs And The Potential Effect On Proximal Junctional Kyphosis In The Thoracic Spine, Chloe Cadieux

Electronic Thesis and Dissertation Repository

Long spinal fusions are the mainstay of treatment in adult spinal deformity; however, proximal junctional kyphosis (PJK) is a common and potentially catastrophic complication that can occur following this procedure. It has been hypothesized that using semi-rigid constructs at the superior aspect of the instrumentation may decrease this complication. The objective of this thesis was to determine if there is a biomechanical advantage between various semi-rigid constructs utilized in long spinal fusions to help decrease the risk of PJK. Nine human cadaveric spines (T1 – T12) instrumented with the standard all-pedicle-screw construct (APS) were compared to various semi-rigid constructs including …

The Effects Of Covid-19 On Mental Health And Injury Occurrence Of Division Iii College Football Players, Evan Kennaley

Masters Theses/Capstone Projects

Objective: The aim of the study was to investigate if with the lockdown of COVID-19 and the reschedule of the Fall 2020 football season caused an increase in injury in a Division Three College football team.

Methods: A 20 question survey was given to the 2022 Spring Otterbein football team. The survey allowed for self reporting of injuries suffered in the 2019,2020, and 2021 football seasons. The survey also looked to examine if there is any anxiety the players suffered from during the lockdown using the Covid Anxiety Scale.

Results: Of the 63 surveys, it was found that the 2021 …

Quantitative Mri And 3d-Printing For Monitoring Periprosthetic Joint Infection, Greg Hong

Electronic Thesis and Dissertation Repository

Joint replacements are becoming increasingly commonplace with over 130,000 joint arthroplasties being performed annually in Canada. Although joint replacement surgery is highly successful, implants do occasionally fail and need to be replaced via costly and difficult revision surgery. Periprosthetic joint infection (PJI) has recently become the leading reason for revision of both hip and knee replacements, which is unfortunate because PJI is difficult to diagnose and treat effectively; diagnosis is made particularly difficult by the lack of established non-invasive (imaging) means of evaluating PJI. This thesis aims to demonstrate that magnetic resonance imaging (MRI) has potential for diagnosing and monitoring …

The Biomechanical Effects Of Glenoid And Humeral Lateralization On The Rotator Cuff Muscles In Reverse Total Shoulder Arthroplasty, Yousif Atwan

Electronic Thesis and Dissertation Repository

The utilization of reverse total shoulder arthroplasty (RTSA) has continued to increase as its clinical indications expand. The optimization of the rotator cuff function in the setting of RTSA is poorly understood and poor outcomes are associated with lack of external and internal rotation function. The purpose of this study is to evaluate the role of implant parameters on rotator cuff tendon excursion and moment arms in the setting of RTSA.

Using a cadaveric based model, a custom designed modular RTSA system was implanted that allowed for incremental changes to glenoid and humeral lateralization. Using a shoulder simulator and optical …

Variations In Surgeon-Applied Loads During Passive Range Of Motion Following Total Knee Replacement With Relevance To Computational Modeling, Cj Bakle Ii

All Theses

Total knee replacement (TKR) is generally considered a successful treatment for musculoskeletal disorders of the knee. However, as many as 20% of patients report some dissatisfaction in their physical function after TKR. And approximately 50% of early revisions needed to address conditions related to component alignment and soft tissue tension to stabilize the knee. During TKR, surgeons manually perform passive range of motion (ROM) assessments to gain feedback perceived as tension in ligaments and other soft tissues. Such assessments are highly subjective and rely on the surgeon's perception of soft tissue tension rather than quantitative objective means. The variability in …

The Natural History Of Modic Changes - A 5- And 15-Year Follow-Up Study, Parnian Saremi

Electronic Thesis and Dissertation Repository

Modic changes (MCs), defined as bone marrow lesions adjacent to the vertebral endplate seen on MRI, have been associated with back pain. There are different types of MCs, with different histopathological correlates. This community-based study sample comprised 110 men from the Twin Spine Study, with baseline, 5-year, and 15-year follow-up MRIs. Following training and reliability testing, 1320 endplates (T12-S1) were evaluated for MC presence, type, and dimensions at each time point. Results demonstrated that Type 2 Modic Changes (MC2) were the most common type, with approximately half located at the two lowest disc levels. However, Type 1 Modic Changes (MC1) …

Reporter Chondrocyte Optimization Of Bioinks For Zonal 3d Bioprinting Of Cartilage, Kari Martyniak

Electronic Theses and Dissertations, 2020-

Osteoarthritis (OA) is the most common form of arthritis, often thought of as a disease of the elderly, but post traumatic OA predominantly impacts younger individuals. Articular cartilage is the tissue that coats the end of your bones in synovial joints. Since cartilage has limited healing capacity, defects, or injuries to it progressively erodes down to the subchondral bone. Unfortunately, current treatment options all have limitations, particularly for younger patients. Cartilage has a specific zonal architecture that is distinguished by the different cell morphologies and arrangements, biochemical composition, and mechanical properties. 3D bioprinting is a tissue engineering technique that involves …

Comparison Of Landing Biomechanics Between Different Competitive Levels Of Irish Dance, Jade Shields

West Chester University Master’s Theses

Abstract

Objectives: To determine differences in lower limb landing biomechanics and lower extremity function scale scores between champion levels, in young female Irish dancers.

Design: Cross-sectional.

Setting: McDade-Cara School of Irish Dance

Participants: 12 Open Champion (OC) level female Irish dancers (11.9 ± 3.37 years) and 9 Preliminary Champion (PC) Irish dancers (13.5 ± 3.37 years) performed the landing error scoring system test (LESS), and completed the lower extremity functional scale (LEFS) and a descriptive data questionnaire

Main outcome measures: LESS scoring sheet and LEFS PRO

Results: No significant differences found between OC and PC levels on …

The Rotator Cuff Tendon-To-Bone Interface: Maturation, Aging, And 3d Bioprinting For Regeneration, Xiping Jiang

Theses & Dissertations

Rotator cuff tendon injuries often occur at the tendon-to-bone interface (i.e., enthesis) area with a high prevalence for the elderly population. In addition, regeneration of the gradient structure of the enthesis is still a significant clinical challenge. Our studies aim to identify the histological, molecular, and biomechanical alterations of the rotator cuff enthesis with maturation and aging, and develop a novel therapeutic method using three-dimensional (3D) bioprinting technique to regenerate a functional enthesis. Striking variations of the entheses were observed both histologically and biomechanically during the maturation process. The histological features did not show many differences at the insertion site …

Increased Use Of Opioids Perioperatively Leads To Unmanaged Postoperative Pain, Halida Sehic

Nursing | Senior Theses

Background: Total knee and total hip joint arthroplasty are two frequently preformed surgeries, with 5.2 million total knee arthroplasties performed the United States between the year 2000 and 2010 (Williams et al., 2015). Opioids are widely used to manage pain for patients undergoing total joint arthroplasty. However, use of opioids is associated with undesirable adverse effects, such as nausea and respiratory depression, (Johnson et al., 2011). In postoperative patients following total joint replacement, 75 % of the patients complain of inadequately controlled moderate to severe pain (De Luca et al., 2018). Increased use and overprescribing increase tolerance to opioids …

Femoroacetabular Impingement Syndrome: Evaluating Postoperative Rehabilitation Progress And Return To Sport Readiness, Trevor A. Day

Electronic Thesis and Dissertation Repository

Femoroacetabular impingement syndrome (FAIS) is a common cause of non-arthritic hip pain and reduced physical activity in active young adults. It is defined as a motion-related disorder of the hip with a triad of symptoms, clinical signs, and imaging findings that represents symptomatic premature contact between the proximal femur and the acetabulum. There are two anatomical morphologies that can cause FAIS, cam, and pincer, and is a challenging clinical pathology. Patients typically undergo hip arthroscopy to repair damage to the joint and recess the bone causing the impingement. These procedures can result in positive outcomes for the patient, like reduced …

4dct Analysis Of In-Vivo Carpal Kinematics During Fem, Manisha R. Mistry

Electronic Thesis and Dissertation Repository

A consensus, detailed understanding of carpal kinematics remains elusive. 4-dimensional CT (4DCT) is a validated modality capable of accurately studying in-vivokinematic motion. The objective of this work is to quantify normal, in-vivo kinematic motion of the carpus through a flexion-extension arc of motion using 4DCT. Ten healthy, un-injured volunteers underwent a 4DCT scanning protocol through a complete arc of flexion-extension motion. Kinematic changes in motion were quantified using helical axis motion data for each carpal bone. Helical axes were compared between bones and statistical analysis performed using repeated-measures ANOVA to identify difference in kinematic motion between bones (p<0.05). The carpus can be divided into four main kinematic blocks: the distal carpal block, the proximal carpal block and individual scaphoid and trapezial blocks. This work supports an additional segmentation of the trapezium from the distal carpal row, which suggests some modulation between the scaphoid and distal carpal row.

Platelet-Rich Plasma Vs. Traditional Surgical And Nonsurgical Interventions For Rotator Cuff Tendinopathies, Nick Slingerland

Theses and Graduate Projects

Background: Rotator cuff tendinopathies present as one of the most common musculoskeletal injuries of the upper extremity. The rotator cuff consists of four muscles: the supraspinatus, infraspinatus, teres minor, and subscapularis with the supraspinatus the most injured of the group. Over time, variations regarding treatment through surgical or nonsurgical interventions have remained constant. In recent years, the use of platelet-rich plasma (PRP) as an additional alternative has become popular to promote healing and improve functionality of the shoulder. The purpose of this clinical review using various study designs is to assess if the platelet-rich plasma injections are more effective when …