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Editorial Comment: Symposium: Biologics And Tissue Healing In Orthopaedics, A. Bedi, J. Dines Jan 2015

Editorial Comment: Symposium: Biologics And Tissue Healing In Orthopaedics, A. Bedi, J. Dines

Journal Articles

No abstract provided.


Association Of Meniscal Status, Lower Extremity Alignment, And Body Mass Index With Chondrosis At Revision Anterior Cruciate Ligament Reconstruction, R. H. Brophy, A. K. Haas, L. J. Huston, S. K. Nwosu, R. W. Wright, E. Hershman Jan 2015

Association Of Meniscal Status, Lower Extremity Alignment, And Body Mass Index With Chondrosis At Revision Anterior Cruciate Ligament Reconstruction, R. H. Brophy, A. K. Haas, L. J. Huston, S. K. Nwosu, R. W. Wright, E. Hershman

Journal Articles

BACKGROUND: Knees undergoing revision anterior cruciate ligament reconstruction (rACLR) have a high prevalence of articular cartilage lesions. HYPOTHESIS: The prevalence of chondrosis at the time of rACLR is associated with meniscal status and lower extremity alignment. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Data from the prospective Multicenter ACL Revision Study (MARS) cohort were reviewed to identify patients with preoperative lower extremity alignment films. Lower extremity alignment was defined by the weightbearing line (WBL) as a percentage of the tibial plateau width, while the chondral and meniscal status of each weightbearing compartment was recorded at the time of …


Pregabalin And Pain After Total Knee Arthroplasty: A Double-Blind, Randomized, Placebo-Controlled, Multidose Trial, J. T. Yadeau, Y. Lin, D. J. Mayman, E. A. Goytizolo, M. M. Alexiades, D. E. Padgett, K. G. Fields, A. K. Goon, J. Curren, G. H. Westrich, +4 Additional Authors Jan 2015

Pregabalin And Pain After Total Knee Arthroplasty: A Double-Blind, Randomized, Placebo-Controlled, Multidose Trial, J. T. Yadeau, Y. Lin, D. J. Mayman, E. A. Goytizolo, M. M. Alexiades, D. E. Padgett, K. G. Fields, A. K. Goon, J. Curren, G. H. Westrich, +4 Additional Authors

Journal Articles

BACKGROUND: Pregabalin may reduce postoperative pain and opioid use. Higher doses may be more effective, but may cause sedation and confusion. This prospective, randomized, blinded, placebo-controlled study tested the hypothesis that pregabalin reduces pain at 2 weeks after total knee arthroplasty, but increases drowsiness and confusion. METHODS: Patients (30 per group) received capsules containing pregabalin (0, 50, 100, or 150 mg); two capsules before surgery, one capsule twice a day until postoperative day (POD) 14, one on POD15, and one on POD16. Multimodal analgesia included femoral nerve block, epidural analgesia, oxycodone-paracetamol, and meloxicam. The primary outcome was pain with flexion …


Doha Agreement Meeting On Terminology And Definitions In Groin Pain In Athletes, A. Weir, P. Brukner, E. Delahunt, J. Ekstrand, G. Lovell, T. Tyler, G. Verrall, R. J. De Vos, Z. Vuckovic, P. Holmich, +14 Additional Authors Jan 2015

Doha Agreement Meeting On Terminology And Definitions In Groin Pain In Athletes, A. Weir, P. Brukner, E. Delahunt, J. Ekstrand, G. Lovell, T. Tyler, G. Verrall, R. J. De Vos, Z. Vuckovic, P. Holmich, +14 Additional Authors

Journal Articles

Background Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. Aim The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. Methods A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting. …


Systemic Lupus Erythematosus Is Not A Risk Factor For Poor Outcomes After Total Hip And Total Knee Arthroplasty, U. H. Shah, L. A. Mandl, C. Mertelsmann-Voss, Y. Y. Lee, M. M. Alexiades, M. P. Figgie, S. M. Goodman Jan 2015

Systemic Lupus Erythematosus Is Not A Risk Factor For Poor Outcomes After Total Hip And Total Knee Arthroplasty, U. H. Shah, L. A. Mandl, C. Mertelsmann-Voss, Y. Y. Lee, M. M. Alexiades, M. P. Figgie, S. M. Goodman

Journal Articles

OBJECTIVES: Historically, arthroplasty in systemic lupus erythematosus (SLE) patients has been less successful than for patients with osteoarthritis (OA). It is not known if SLE remains an independent risk factor for poor arthroplasty outcomes or if other factors, such as avascular necrosis (AVN), continue to play a role. METHODS: A case-control study using data from a single-institution arthroplasty registry compared SLE total hip arthroplasty (THA) and total knee arthroplasty (TKA) with OA controls matched by age, gender and presence of AVN. Baseline, two-year administrative and self-report data, and diagnosis leading to arthroplasty were evaluated. RESULTS: A total of 54 primary …


Minimally Invasive Scoliosis Surgery: A Novel Technique In Patients With Neuromuscular Scoliosis, V. Sarwahi, T. Amaral, S. Wendolowski, R. Gecelter, M. Gambassi, C. Plakas, B. Liao, S. Kalantre, C. Katyal Jan 2015

Minimally Invasive Scoliosis Surgery: A Novel Technique In Patients With Neuromuscular Scoliosis, V. Sarwahi, T. Amaral, S. Wendolowski, R. Gecelter, M. Gambassi, C. Plakas, B. Liao, S. Kalantre, C. Katyal

Journal Articles

Minimally invasive surgery (MIS) has been described in the treatment of adolescent idiopathic scoliosis (AIS) and adult scoliosis. The advantages of this approach include less blood loss, shorter hospital stay, earlier mobilization, less tissue disruption, and relatively less pain. However, despite these significant benefits, MIS approach has not been reported in neuromuscular scoliosis patients. This is possibly due to concerns with longer surgery time, which is further increased due to more levels fused and instrumented, challenges of pelvic fixation, size and number of incisions, and prolonged anesthesia. We modified the MIS approach utilized in our AIS patients to be implemented …


Platelet-Rich Plasma And Other Cellular Strategies In Orthopedic Surgery, P. N. Williams, G. Moran, J. P. Bradley, N. S. Elattrache, J. S. Dines Jan 2015

Platelet-Rich Plasma And Other Cellular Strategies In Orthopedic Surgery, P. N. Williams, G. Moran, J. P. Bradley, N. S. Elattrache, J. S. Dines

Journal Articles

The use of biologics in the treatment of musculoskeletal disease has become increasingly more common as research studies continue to provide further elucidation of their mechanisms in healing. Platelet-rich plasma, patches, growth factors, and stem cells are among the many biologics under active investigation and have varying levels of success in augmenting surgical or nonoperative interventions. However, the limitations of these treatments exist, and clear guidelines for their indications and application have yet to be established. Well-designed clinical trials will help determine the appropriate future use of biologics to ensure consistent outcomes.


Patient Expectations And Long-Term Outcomes In Rheumatoid Arthritis Patients: Results From The Sara (Silicone Arthroplasty In Rheumatoid Arthritis) Study, K. C. Chung, K. W. Nellans, P. B. Burns, E. F. S. Wilgis, F. D. Burke, D. A. Fox, H. M. Kim Jan 2015

Patient Expectations And Long-Term Outcomes In Rheumatoid Arthritis Patients: Results From The Sara (Silicone Arthroplasty In Rheumatoid Arthritis) Study, K. C. Chung, K. W. Nellans, P. B. Burns, E. F. S. Wilgis, F. D. Burke, D. A. Fox, H. M. Kim

Journal Articles

Little evidence exists to understand the influence of patient expectations on outcomes for silicone metacarpophalangeal arthroplasty (SMPA). The purpose of this paper is to compare long-term treatment outcome experiences regarding hand function/appearance for a surgical and nonsurgical cohort of rheumatoid arthritis (RA) patients and contrast them to expectations at baseline. This sample is part of a larger multicenter prospective cohort study of RA patients enrolled from 2004 to 2008. A total of 169 RA patients with severe deformities at the metacarpophalangeal (MCP) joints were recruited in the original study. Expectations for SMPA were collected at enrollment. A follow-up patient-reported questionnaire …


Effect Of Bone Loss In Anterior Shoulder Instability, G. H. Garcia, J. N. Liu, D. M. Dines, J. S. Dines Jan 2015

Effect Of Bone Loss In Anterior Shoulder Instability, G. H. Garcia, J. N. Liu, D. M. Dines, J. S. Dines

Journal Articles

Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment …


Coping With Congenital Hand Differences, L. E. Franzblau, K. C. Chung, N. Carlozzi, A. Y. T. Chin, K. W. Nellans, J. F. Waljee Jan 2015

Coping With Congenital Hand Differences, L. E. Franzblau, K. C. Chung, N. Carlozzi, A. Y. T. Chin, K. W. Nellans, J. F. Waljee

Journal Articles

Background: Although functional outcomes following reconstruction for congenital hand differences are frequently described, much less is known regarding children's ability to cope with the psychosocial effects of these conditions. The authors qualitatively explored stress and coping mechanisms among children following reconstructive surgery for congenital hand differences. Methods: Forty patients and their parents participated in semistructured interviews examining children's stress related to hand functioning and appearance, emotional responses to stress, and coping strategies. Interviews were audiotaped, transcribed, and analyzed thematically. A consensus taxonomy for classifying content evolved from comparisons of coding by two reviewers. Themes expressed by participants were studied for …


Comorbid Profile Rather Than Age Determines Hip Fracture Mortality In A Nonagenarian Population, A. Graver, S. Merwin, L. Collins, N. Kohn, A. Goldman Jan 2015

Comorbid Profile Rather Than Age Determines Hip Fracture Mortality In A Nonagenarian Population, A. Graver, S. Merwin, L. Collins, N. Kohn, A. Goldman

Journal Articles

BACKGROUND: In light of poor outcomes with nonoperative management of hip fractures, orthopedic surgeons are faced with difficult decisions about which patients are too ill or too old for surgical treatment. QUESTIONS/PURPOSES: This study sought to investigate if patients over 90 years had different preoperative laboratory, clinical, and injury characteristics than younger patients with the same injury. We compared our cohort with previously published data. We wished to identify if there were pre-injury risk factors associated with 30-day mortality, which could be modified to enhance postoperative outcomes. METHODS: This is a retrospective review of 198 operatively managed hip fractures in …


Integrating Biodegradable 3-Dimensional-Printing Into Tracheal Reconstruction, T. Goldstein, L. Smith, B. Smith, D. Grande, D. Zeltsman Jan 2015

Integrating Biodegradable 3-Dimensional-Printing Into Tracheal Reconstruction, T. Goldstein, L. Smith, B. Smith, D. Grande, D. Zeltsman

Journal Articles

No abstract provided.


Shoulder Arthroplasty: Return To Sport, M. M. Khair, J. S. Dines, D. M. Dines Jan 2015

Shoulder Arthroplasty: Return To Sport, M. M. Khair, J. S. Dines, D. M. Dines

Journal Articles

CONTEXT: Increasingly, total shoulder arthroplasty is being performed not only to treat the pain associated with glenohumeral arthritis but also to return patients to the level of activity and function they enjoyed prior to the development of arthritis. While return to sport and activity have been studied in the total knee and total hip replacement literature, it is only relatively recently that the same focus has been placed on total shoulder replacements. EVIDENCE ACQUISITION: PubMed database from the years 2000 to 2014. All studies relevant to shoulder arthroplasty and return to sport were included in the review. STUDY DESIGN: Clinical …


A New Method For Calculating Femoral Anterior Cortex Point Location And Its Effect On Component Sizing And Placement, M. R. Mahfouz, E. E. A. Fatah, L. Bowers, G. Scuderi Jan 2015

A New Method For Calculating Femoral Anterior Cortex Point Location And Its Effect On Component Sizing And Placement, M. R. Mahfouz, E. E. A. Fatah, L. Bowers, G. Scuderi

Journal Articles

Variation in anterior femoral cortex morphology can cause improper component placement and alignment. When surgical inaccuracies occur, the mechanical properties of the distal femur may be altered, which could result in lower surgical success rates and an increased chance of postoperative complications. The purpose of the study is to come up with a reproducible computational algorithm to simulate what the surgeon does in the operating room. This method could help in surgical preplanning, patient-specific instruments, and implant design. From there, we evaluated (1) the angular difference between reference alignment axes; and (2) whether the location of the anterior cortex point …


Cruciate-Retaining Tka Is An Option In Patients With Prior Patellectomy, K. R. Reinhardt, S. J. Huffaker, T. S. Thornhill, R. D. Scott Jan 2015

Cruciate-Retaining Tka Is An Option In Patients With Prior Patellectomy, K. R. Reinhardt, S. J. Huffaker, T. S. Thornhill, R. D. Scott

Journal Articles

The recommendation for using posterior-stabilized (PS) implants in patellectomy patients undergoing total knee arthroplasty (TKA) is based on older case series with heterogeneous patient populations. The use of cruciate-retaining implants in these patients has not been evaluated with more contemporary implant designs. The purpose of this study was to evaluate the survivorship and functional outcomes (Knee Society score, presence of an extensor lag, and range of motion) of cruciate-retaining (CR) TKA in patients with prior patellectomy. Between 1986 and 2012, we performed 27 CR TKAs in 25 patients after patellectomy. Of those, 23 CR TKAs in 21 patients were available …


Multirater Agreement Of The Causes Of Anterior Cruciate Ligament Reconstruction Failure: A Radiographic And Video Analysis Of The Mars Cohort, M. J. Matava, R. A. Arciero, K. M. Baumgarten, J. A. Hannafin, B. S. Miller, C. W. Nissen, T. N. Taft, B. R. Wolf, E. B. Hershman, R. W. Wright, +3 Additional Authors Jan 2015

Multirater Agreement Of The Causes Of Anterior Cruciate Ligament Reconstruction Failure: A Radiographic And Video Analysis Of The Mars Cohort, M. J. Matava, R. A. Arciero, K. M. Baumgarten, J. A. Hannafin, B. S. Miller, C. W. Nissen, T. N. Taft, B. R. Wolf, E. B. Hershman, R. W. Wright, +3 Additional Authors

Journal Articles

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction failure occurs in up to 10% of cases. Technical errors are considered the most common cause of graft failure despite the absence of validated studies. Limited data are available regarding the agreement among orthopaedic surgeons regarding the causes of primary ACL reconstruction failure and accuracy of graft tunnel placement. HYPOTHESIS: Experienced knee surgeons have a high level of interobserver reliability in the agreement about the causes of primary ACL reconstruction failure, anatomic graft characteristics, and tunnel placement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Twenty cases of revision ACL reconstruction were …


Biologics In Achilles Tendon Healing And Repair: A Review, E. Shapiro, D. Grande, M. Drakos Jan 2015

Biologics In Achilles Tendon Healing And Repair: A Review, E. Shapiro, D. Grande, M. Drakos

Journal Articles

Injuries of the Achilles tendon are relatively common with potentially devastating outcomes. Healing Achilles tendons form a fibrovascular scar resulting in a tendon which may be mechanically weaker than the native tendon. The resulting strength deficit causes a high risk for reinjury and other complications. Treatments using biologics aim to restore the normal properties of the native tendon and reduce the risk of rerupture and maximize tendon function. The purpose of this review was to summarize the current findings of various therapies using biologics in an attempt to improve the prognosis of Achilles tendon ruptures and tendinopathies. A PubMed search …


Minimally Invasive Knee Arthroplasty: An Overview, A. J. Tria, G. R. Scuderi Jan 2015

Minimally Invasive Knee Arthroplasty: An Overview, A. J. Tria, G. R. Scuderi

Journal Articles

Minimally invasive surgery (MIS) for arthroplasty of the knee began with surgery for unicondylar knee arthroplasty (UKA). Partial knee replacements were designed in the 1970s and were amenable to a more limited exposure. In the 1990s Repicci popularized the MIS for UKA. Surgeons began to apply his concepts to total knee arthroplasty. Four MIS surgical techniques were developed: quadriceps sparing, mini-mid vastus, mini-subvastus, and mini-medial parapatellar. The quadriceps sparing technique is the most limited one and is also the most difficult. However, it is the least invasive and allows rapid recovery. The mini-midvastus is the most common technique because it …


Arthroscopic Subscapularis Bankart Technique As A Salvage Procedure For Failed Anterior Shoulder Stabilization, S. Chaudhury, D. Delos, J. S. Dines, D. W. Altchek, C. C. Dodson, A. M. Newman, S. J. O'Brien Jan 2014

Arthroscopic Subscapularis Bankart Technique As A Salvage Procedure For Failed Anterior Shoulder Stabilization, S. Chaudhury, D. Delos, J. S. Dines, D. W. Altchek, C. C. Dodson, A. M. Newman, S. J. O'Brien

Journal Articles

BACKGROUND: Shoulder instability is a relatively common problem. Even with contemporary surgical techniques, instability can recur following both open and arthroscopic fixation. Surgical management of capsular insufficiency in anterior shoulder stabilization represents a significant challenge, particularly in young, active patients. There are a limited number of surgical treatment options. The Laterjet technique can present with a number of intraoperative challenges and postoperative complication.; DESCRIPTION OF TECHNIQUE: We report an arthroscopic subscapularis tenodesis technique as a salvage procedure for challenging glenohumeral instability cases. Sutures are passed through the subscapularis tendon and capsule before they are tied as one in the subdeltoid …


Shoulder Instability After Total Shoulder Arthroplasty: A Case Of Arthroscopic Repair, A. O. Gee, M. E. Angeline, J. S. Dines, D. M. Dines Jan 2014

Shoulder Instability After Total Shoulder Arthroplasty: A Case Of Arthroscopic Repair, A. O. Gee, M. E. Angeline, J. S. Dines, D. M. Dines

Journal Articles

No abstract provided.


A Clinical Pathway For Total Shoulder Arthroplasty-A Pilot Study, A. K. Goon, D. M. Dines, E. V. Craig, M. A. Gordon, E. A. Goytizolo, Y. Lin, E. Lin, J. T. Yadeau Jan 2014

A Clinical Pathway For Total Shoulder Arthroplasty-A Pilot Study, A. K. Goon, D. M. Dines, E. V. Craig, M. A. Gordon, E. A. Goytizolo, Y. Lin, E. Lin, J. T. Yadeau

Journal Articles

BACKGROUND: Appropriate pain management after total shoulder arthroplasty (TSA) facilitates rehabilitation and may improve clinical outcomes.; QUESTIONS/PURPOSES: This prospective, observational study evaluated a multimodal analgesia clinical pathway for TSA.; METHODS: Ten TSA patients received an interscalene nerve block (25cm(3) 0.375% ropivacaine) with intraoperative general anesthesia. Postoperative analgesia included regularly scheduled non-opioid analgesics (meloxicam, acetaminophen, and pregabalin) and opioids on demand (oral oxycodone and intravenous patient-controlled hydromorphone). Patients were evaluated twice daily to assess pain, anterior deltoid strength, handgrip strength, and sensory function.; RESULTS: The nerve block lasted an average of 18h. Patients had minimal pain after surgery; 0 (median score …


Does The Direct Anterior Approach In Tha Offer Faster Rehabilitation And Comparable Safety To The Posterior Approach?, J. A. Rodriguez, A. J. Deshmukh, P. A. Rathod, M. L. Greiz, P. P. Deshmane, M. S. Hepinstall, A. S. Ranawat Jan 2014

Does The Direct Anterior Approach In Tha Offer Faster Rehabilitation And Comparable Safety To The Posterior Approach?, J. A. Rodriguez, A. J. Deshmukh, P. A. Rathod, M. L. Greiz, P. P. Deshmane, M. S. Hepinstall, A. S. Ranawat

Journal Articles

Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy. We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement. In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and …


Tissue Engineered Meniscus Repair: Influence Of Cell Passage Number, Tissue Origin, And Biomaterial Carrier, J. A. Schwartz, W. Wang, T. Goldstein, D. A. Grande Jan 2014

Tissue Engineered Meniscus Repair: Influence Of Cell Passage Number, Tissue Origin, And Biomaterial Carrier, J. A. Schwartz, W. Wang, T. Goldstein, D. A. Grande

Journal Articles

Objective. Studies have shown that meniscal repairs have better outcomes over both partial and total meniscectomies. Tissue engineering strategies to repair meniscus tears have been explored using cell sources that involve a donor as well as a period of in vitro cell expansion before use. This study explored cell sources that could be easily harvested and rapidly isolated by enzymatic digestion and cannulated delivery. Methods. Bovine menisci were used to create a bucket handle tear. Cell lines were established from meniscus, synovium, and adipose tissue and fluorescently labeled. At passages P2, P4, and P8, cells were added to the defect …


Minimally Invasive Lateral Lumbar Interbody Fusion With Direct Psoas Visualization, P. S. Yuan, K. Rowshan, R. B. Verma, L. E. Miller, J. E. Block Jan 2014

Minimally Invasive Lateral Lumbar Interbody Fusion With Direct Psoas Visualization, P. S. Yuan, K. Rowshan, R. B. Verma, L. E. Miller, J. E. Block

Journal Articles

Background: Minimally invasive lateral approaches to the lumbar spine have been adopted to allow access to the intervertebral disc space while avoiding the complications associated with anterior or posterior approaches. This report describes a minimally invasive technique for lateral lumbar interbody fusion LLIF that allows direct intraoperative visualization of the psoas and surrounding neurovasculature (DV-LIF). Methods: The technique utilizes a radiolucent tubular retractor and a secondary psoas retractor that allows a muscle-sparing approach while offering excellent visualization of the operative site. The unique advantage of this procedure is that the psoas muscle and surrounding nerves can be directly visualized intraoperatively …


Effect Of Graft Choice On The Outcome Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter Acl Revision Study (Mars) Cohort, R. W. Wright, L. J. Huston, A. K. Haas, K. P. Spindler, S. K. Nwosu, C. R. Allen, A. F. Anderson, D. E. Cooper, E. B. Hershman, J. J. York, +83 Additional Authors Jan 2014

Effect Of Graft Choice On The Outcome Of Revision Anterior Cruciate Ligament Reconstruction In The Multicenter Acl Revision Study (Mars) Cohort, R. W. Wright, L. J. Huston, A. K. Haas, K. P. Spindler, S. K. Nwosu, C. R. Allen, A. F. Anderson, D. E. Cooper, E. B. Hershman, J. J. York, +83 Additional Authors

Journal Articles

Background: Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome; however, graft choice for revision may be limited due to previously used grafts. Hypotheses: Autograft use would result in increased sports function, increased activity level, and decreased osteoarthritis symptoms (as measured by validated patient-reported outcome instruments). Autograft use would result in decreased graft failure and reoperation rate 2 years after revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons at 52 sites. Data collected …