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Is Further Treatment Necessary For Patellar Crepitus After Total Knee Arthroplasty?, Bo-Hyun Hwang, MD, Chang-Hyun Nam, MD, Kwang-Am Jung, MD, Alvin Ong, MD, Su-Chan Lee, MD 2014 Himchan Hospital, Seoul Korea

Is Further Treatment Necessary For Patellar Crepitus After Total Knee Arthroplasty?, Bo-Hyun Hwang, Md, Chang-Hyun Nam, Md, Kwang-Am Jung, Md, Alvin Ong, Md, Su-Chan Lee, Md

Rothman Institute Conference Posters

Introduction:

  • Posterior-stabilized (PS) TKA that sacrifice the cruciate ligaments improves pain and function in patients with advanced osteoarthritis.
  • Patellar crepitus appears to be due to a spectrum of peripatellar fibrosynovial formations and is usually encountered after PS-TKA, which uniquely has an intercondylar box to accept the tibial post.
  • Symptoms of patellar crepitus occur most commonly during terminal knee extension and occur usually from 3 to 9 months after PS-TKA, and in some cases, this phenomenon is symptomatic enough to warrant an arthroscopic procedure or open arthrotomy.
  • The development of patellar crepitus after PS-TKA appears related to many factors such as ...


Anterior Talofibular Ligament Abnormality On Routine Magnetic Resonance Imaging Of The Ankle, Patrick Kane, MD, David Pedowitz, MD, Adam C C. Zoga, MD, Steven M. Raikin, MD 2014 Rothman Institute of Orthopaedics at the Thomas Jefferson University Hospital

Anterior Talofibular Ligament Abnormality On Routine Magnetic Resonance Imaging Of The Ankle, Patrick Kane, Md, David Pedowitz, Md, Adam C C. Zoga, Md, Steven M. Raikin, Md

Rothman Institute Conference Posters

The anterior talo­fibular ligament (ATFL) extends from the anteroinferior border of the ­fibula to the talar neck. Primary restraint to ankle inversion in plantar‑exion. Injury (acute or chronic) can be diagnosed with physical exam, stress X-Rays, ultrasound or magnetic resonance imaging (MRI).

Purpose:

MRI abnormalities in asymptomatic individuals known in other areas of orthopaedics (shoulder and spine). Purpose of our study: determine the prevalence of ATFL abnormalities found on MRI in asymptomatic individuals. Asymptomatic individuals - those undergoing MRI for pathology unrelated to lateral ankle trauma, instability, or inversion injuries.


Cost Benefit Analysis Of Athletic Team Coverage By An Orthopaedic Practice, Brandon Eck, BS, Fotios Tjoumakaris, MD, Matthew Pepe, MD, Kevin Freedman, MD, Katherine Bagnato, ATC, Bradford Tucker, MD 2014 Philadelphia College of Osteopathic Medicine

Cost Benefit Analysis Of Athletic Team Coverage By An Orthopaedic Practice, Brandon Eck, Bs, Fotios Tjoumakaris, Md, Matthew Pepe, Md, Kevin Freedman, Md, Katherine Bagnato, Atc, Bradford Tucker, Md

Rothman Institute Conference Posters

Introduction

- Coverage of high school football by an orthopaedic practice is considered standard of care in many localities.

- Taking time away from an orthopaedic practice to provide on ­field athletic care has potential advantages and disadvantages.

- To this date, the economic value of this endeavor has never been investigated.

- Purpose: to perform a cost/benefi­t analysis of local high school sports coverage by an orthopaedic sports medicine practice.


Risk Factors For Surgical Site Infection Following Total Joint Arthroplasty, Mohammad Rasouli, MD, Camilo Restrepo, MD, Mitchell Maltenfort, PhD, James J. Purtill, MD, Javad Parvizi, MD 2014 Rothman Institute of Orthopaedics at the Thomas Jefferson University Hospital

Risk Factors For Surgical Site Infection Following Total Joint Arthroplasty, Mohammad Rasouli, Md, Camilo Restrepo, Md, Mitchell Maltenfort, Phd, James J. Purtill, Md, Javad Parvizi, Md

Rothman Institute Conference Posters

Surgical Site Infection (SSI) after total joint arthroplasty (TJA) is a rare but devastating complication1. In spite of improvement in the prevention of SSI, these infections are still a signi­ficant cause of morbidity in surgical patients2. Management of Hospital Acquired infections (HAI) including SSI poses a huge economic burden on healthcare3. As part of the mission to reduce the burden of HAI, the Centers for Disease Control and Prevention (CDC) has issued guidelines for the prevention of SSI that are currently being updated4. In addition, CDC requires all hospitals to report HAI through the National Healthcare Safety Network (NHSN ...


Postoperative Urinary Retention (Pour): What Are The Risk Factors?, Eric H. Tischler, BA, Camilo Restrepo, MD, Jennifer Oh, BA, Mitchell Maltenfort, PhD, Javad Parvizi, MD, FRCS 2014 Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital

Postoperative Urinary Retention (Pour): What Are The Risk Factors?, Eric H. Tischler, Ba, Camilo Restrepo, Md, Jennifer Oh, Ba, Mitchell Maltenfort, Phd, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

Introduction

Total hip arthroplasty (THA) is a successful procedure alleviating pain in patients with debilitating arthritis. Postoperative urinary retention (POUR) is a common complication following surgery and is managed with intermittent or continued urinary catheterization. POUR has been estimated in retrospective literature to be on the order of 5% – 70% of surgical cases with early catheter removal or without a catheter. At our institution, and based on a Level 1 study here, urinary catheter is not used routinely in patients undergoing THA under regional anesthesia. The purpose of this study was to evaluate the incidence of POUR and risk factors ...


A Clinical Decision Support Tool To Predict The Risk Of Failure In Patients With Femoroacetabular Impingement Undergoing Hip Preservation Surgery, Claudio Diaz-Ledezma, MD, Mitchell Maltenfort, PhD, Lesley Walinchus, BS, Benjamin Hendy, BS, Thomas Novack, BS, Javad Parvizi, MD, FRCS 2014 Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital

A Clinical Decision Support Tool To Predict The Risk Of Failure In Patients With Femoroacetabular Impingement Undergoing Hip Preservation Surgery, Claudio Diaz-Ledezma, Md, Mitchell Maltenfort, Phd, Lesley Walinchus, Bs, Benjamin Hendy, Bs, Thomas Novack, Bs, Javad Parvizi, Md, Frcs

Rothman Institute Conference Posters

In modern orthopaedics, risk prediction scores can help discriminate between ideal and poor candidates for a specifi­c therapeutic intervention. We consider these tools useful during the process of shared medical decision-making1. To our knowledge, such a strategy has never been explored in the ­field of hip preservation surgery.

The aim of our study is to generate a clinical decision support tool to predict risk of failure after hip preservation surgery among patients with femoroacetabular impingement (FAI).


High Variability In Outcomes Of Two-Stage Exchange To Treat Periprosthetic Joint Infection, Benjamin Zmistowski, BS, Paul Lichstein, MD, Aaron H Carter, MD, Joshua J. Minori, DO, Javad Parvizi, MD 2014 Rothman Institute of Orthopaedics at the Thomas Jefferson University

High Variability In Outcomes Of Two-Stage Exchange To Treat Periprosthetic Joint Infection, Benjamin Zmistowski, Bs, Paul Lichstein, Md, Aaron H Carter, Md, Joshua J. Minori, Do, Javad Parvizi, Md

Rothman Institute Conference Posters

Introduction:

Periprosthetic joint infection (PJI) is a challenging condition to manage with sobering morbidity and mortality.1,2 Treatment options range from simple irrigation and debridement with prosthetic retention to explantation and placement of a temporary cement spacer. Indictations for each option are unclear and non-uniform despite signi­cant efforts to understand the management outcomes. Until recently, a uniform de­nition of success was unavailable, thus clouding the discussion of treatment options. Two-stage exchange is currently considered the “gold-standard” in North America, yet an appropriate understanding of the actual success and ancillary effects of treatment is needed. With the advantage ...


Threshold For Synovial Cell Count And Neutrophil Differential In Diagnosis Of Periprosthetic Knee Infection: A Multi-Institutional Study, Benjamin Zmistowski, BS, Carlos Higuera, MD, Jane Liu, BA, Wael Barsoum, MD, Joseph Mendelis, BA, Craig Della Valle, MD, Javad Parvizi, MD 2014 Rothman Institute of Orthopaedics at Thomas Jefferson University

Threshold For Synovial Cell Count And Neutrophil Differential In Diagnosis Of Periprosthetic Knee Infection: A Multi-Institutional Study, Benjamin Zmistowski, Bs, Carlos Higuera, Md, Jane Liu, Ba, Wael Barsoum, Md, Joseph Mendelis, Ba, Craig Della Valle, Md, Javad Parvizi, Md

Rothman Institute Conference Posters

Introduction:

Synovial fl­uid analysis is an important tool in the work-up of suspected periprosthetic joint infection (PJI). Yet, there is confl­icting guidance for the analysis of synovial fl­uid aspiration, including a lack of uniform thresholds for white blood cell (WBC) count and neutrophil percentage (PMN%)1-3. Therefore, a multi-institutional study was undertaken to reassess these thresholds, compare preoperative versus intraoperative sample collection, and assess variation in results between institutions.


Bifocal Metachronous Giant-Cell Tumour Of Ulna And Distal Radius, Hasnain Raza, Pervaiz Hashmi 2014 Aga Khan University

Bifocal Metachronous Giant-Cell Tumour Of Ulna And Distal Radius, Hasnain Raza, Pervaiz Hashmi

Section of Orthopaedic Surgery

A 36 years old gentleman had giant cell tumour (GCT) in distal ulna for which he underwent resection of distal half of ulna but developed recurrence of the tumour. Following proper evaluation (grading and staging), he underwent wide margin excision of tumour including removal of distal three-fourth of ulna and reconstruction by free vascularised osteocutaneous fibular transfer. The distal reconstructed fibula was stabilized with extensor carpi ulnaris (ECU). Two years after the surgery, he developed a metachronous GCT lesion in ipsilateral distal radius for which he had curettage and bone grafting with preservation of articular surface.


The Hand In Art: Hand Of Hope, John S. Taras, MD 2014 Thomas Jefferson University

The Hand In Art: Hand Of Hope, John S. Taras, Md

Department of Orthopaedic Surgery Faculty Papers

The “Hand of Hope” (Fig. 1) statue was commissioned for display in the street-level lobby of my practice, The Philadelphia Hand Center, by its founders, James M. Hunter, MD, and Lawrence H. Schneider, MD. The work became a hallmark of the practice’s former Walnut Street location as well as a recognizable feature of its neighborhood.

After a sojourn of several years residing next to Thomas Eakins’ portrait of the operative theatre in “The Gross Clinic,” at Thomas Jefferson University, the sculpture has returned to grace our office’s lobby in the historic Benjamin Franklin Hotel.


Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: A 10-Year Study., Michael G Ciccotti, Alfred Atanda, Levon N. Nazarian, Christopher C Dodson, Laurens Holmes, Steven B. Cohen 2014 Thomas Jefferson University

Stress Sonography Of The Ulnar Collateral Ligament Of The Elbow In Professional Baseball Pitchers: A 10-Year Study., Michael G Ciccotti, Alfred Atanda, Levon N. Nazarian, Christopher C Dodson, Laurens Holmes, Steven B. Cohen

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: An injury to the ulnar collateral ligament (UCL) of the elbow is potentially career threatening for elite baseball pitchers. Stress ultrasound (US) of the elbow allows for evaluation of both the UCL and the ulnohumeral joint space at rest and with stress.

HYPOTHESIS: Stress US can identify morphological and functional UCL changes and may predict the risk of a UCL injury in elite pitchers.

STUDY DESIGN: Cross-sectional study; Level of evidence, 3.

METHODS: A total of 368 asymptomatic professional baseball pitchers underwent preseason stress US of their dominant and nondominant elbows over a 10-year period (2002-2012). Stress US examinations ...


Within-Day Test-Retest Reliability Of Transcranial Magnetic Stimulation Measurements Of Corticomotor Excitability For Gastrocnemius And Tibialis Anterior Muscles, Beth E. Fisher, Ya-Yun Lee, Todd E. Davenport, Stephen F. Reischl, Elizabeth Ruckert, Kornelia Kulig 2014 University of Southern California

Within-Day Test-Retest Reliability Of Transcranial Magnetic Stimulation Measurements Of Corticomotor Excitability For Gastrocnemius And Tibialis Anterior Muscles, Beth E. Fisher, Ya-Yun Lee, Todd E. Davenport, Stephen F. Reischl, Elizabeth Ruckert, Kornelia Kulig

School of Pharmacy and Health Sciences Faculty Articles

Background: Manual therapy interventions targeting the talocrural joint can improve gait and balance functions in individuals following ankle sprains. Less is known about the underlying mechanisms of functional improvements after manual therapy. One hypothesis involves change in corticomotor excitability (CE) following manual therapy procedures. Transcranial magnetic stimulation (TMS) is a brain imaging method that could provide important information regarding potential changes in CE associated with manual therapy techniques applied to the talocrural joint. However, within-day reliability of TMS to measure CE must first be established in order to measure CE changes associated with manual therapy procedures.

Objective: To determine the ...


Operative Environment, Pouya Alijanipour MD, Joseph Karam MD, Adolfo Llinas MD, Kelly G. Vince MD, Charalampos Zalavras MD, Matthew Austin MD, Grant Garrigues MD, Snir Heller MD, James Huddleston MD, Brian Klatt MD, Viktor Krebs MD, Christoph Lohmann MD, Edward J. McPherson MD, Robert Molloy MD, Ali Oliashirazi MD, Mitchell Schwaber MD, Eoin Sheehan MD, Eric Smith MD, Robert Sterling MD, Gregory Stocks MD, Shrinand Vaidya MD 2014 Marshall University

Operative Environment, Pouya Alijanipour Md, Joseph Karam Md, Adolfo Llinas Md, Kelly G. Vince Md, Charalampos Zalavras Md, Matthew Austin Md, Grant Garrigues Md, Snir Heller Md, James Huddleston Md, Brian Klatt Md, Viktor Krebs Md, Christoph Lohmann Md, Edward J. Mcpherson Md, Robert Molloy Md, Ali Oliashirazi Md, Mitchell Schwaber Md, Eoin Sheehan Md, Eric Smith Md, Robert Sterling Md, Gregory Stocks Md, Shrinand Vaidya Md

Orthopaedics

Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.2 The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the ...


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 2014 Hofstra Northwell School of Medicine

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 ...


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 2014 Hofstra Northwell School of Medicine

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 ...


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 2014 Hofstra Northwell School of Medicine

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 ...


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 2014 Northwell Health

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 2014 Northwell Health

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.


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

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 2014 Northwell Health

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 ...


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