Orthopedics Commons^™

Does Prehabilitation Prior To Ulnar Collateral Ligament Surgery Affect Return To Sport Rate Or Time In Baseball Players With Partial Ucl Tears?, Joshua Spada, Kourtney Snigar, Ryan W. Paul, Usman Zareef, Anya Hall, Brandon J. Erickson, Michael G. Ciccotti, Stephen J. Thomas

Stratford Campus Research Day

Those who suffer a partial thickness ulnar collateral ligament (UCL) tear often undergo a period of nonoperative management including physical therapy rehabilitation. This treatment is aimed at optimizing range of motion (ROM) and strengthening the supporting structures around the elbow to help offload the UCL.

Unfortunately, some of these patients fail nonoperative management and require surgical intervention. This creates a unique set of patients who essentially underwent “prehabilitation” prior to their UCL surgery. Prehabilitation is considered a period of structured physical therapy rehabilitation aimed at strengthening structures surrounding an injured tendon or ligament, to allow for dissipation of stress away …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Stratford Campus Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

The Use Of Computerized Tomography Scans In Elective Knee And Hip Arthroplasty-What Do They Tell Us And At What Risk?, Taylor D'Amore, Gregg R Klein, Jess H. Lonner

Rothman Institute Faculty Papers

The average background radiation exposure in the United States has nearly doubled over the previous quarter century, with almost all the increase derived from medical imaging. Nearly 2% of all cancers in the United States may be attributable to radiation from computerized tomography (CT) scans. Given the nondiagnostic nature of CT scans that are used in elective knee and hip arthroplasty today, special consideration should be given to the inherent risk of radiation exposure with routine use of this technology. Methods to decrease radiation exposure including modulating the settings of the CT machine and using alternative non-CT-based systems can decrease …

Comparison Of Clinical Outcomes Following Osteochondral Allograft Transplantation For Osteochondral Versus Chondral Defects In The Knee, John Reza Matthews, Joseph Brutico, Jeremy Heard, Kashyap Chauhan, Bradford Tucker, Kevin Freedman

Rothman Institute Faculty Papers

Purpose: Osteochondral allograft (OCA) transplantation is a restorative technique for addressing articular cartilage defects by transferring mature viable chondrocytes with subchondral bone into size-matched lesions. The purpose of this study was to compare differences in clinical and functional outcomes in patients treated with OCA for osteochondral defects compared with isolated chondral pathology.

Methods: A retrospective review identified patients who underwent OCA transplantation and grouped them into osteochondral or isolated chondral pathology. Demographic data, surgical history, lesion characteristics, complications, and rate of subsequent surgery were reviewed. The review included 86 patients (24 osteochondral, 62 chondral) with a mean follow-up of 5.4 …

When Problems Become Solutions: Harnessing The Osteogenic Capacity Of Disease-Causing Stem Cells To Repair Bone Fractures, Mehreen Pasha

University Scholar Projects

While we often perceive disease as negative, there is potential to engineer seemingly negative biological phenomena into therapeutics to treat a variety of human illnesses. Fibrodysplasia ossificans progressiva (FOP) is a genetic disorder involving uncontrolled, widespread, extraskeletal bone growth, or heterotopic ossification (HO). In FOP patients, stem cells called fibro/adipogenic progenitors (FAPs) follow an abnormal, osteogenic pathway. In the present study, we investigate whether we can adapt these Acvr1 mutant FAPs, which are exceptional at producing bone, to repair bone fractures in otherwise normal patients. The primary aims of this study are (1) to devise and optimize a novel method …

Arthroscopically Assisted Acromioclavicular And Coracoclavicular Reconstruction With A Looped Braided Polyester Suture Band And Buckle Device., Kurt E Stoll, Benjamin Hendy, Treg Brown, Nathaniel Cohen, Thay Q Lee, Surena Namdari, Phil Davidson

Rothman Institute Faculty Papers

Acromioclavicular (AC) joint injuries occur with a traumatic load to the lateral aspect of the shoulder and account for 9% of all shoulder girdle injuries. Rockwood classified AC joint injuries as type I though type VI, based on severity of injury, radiographic findings, and reducibility of the AC joint. Type I and II injuries are typically managed nonoperatively, whereas type IV, V, and VI are managed operatively to address the significant soft tissue disruption, persistent AC joint instability, and apical shoulder deformation. Treatment of type III injuries remain controversial. Several techniques have been described to treat AC joint injuries with …

An Irreducible Posterior Shoulder Fracture-Dislocation: A Case Report, Josiah Valk, Jacob Shermetaro, David Sosnoski, Kelley Brossy

Posters

Introduction • The shoulder is the most frequently dislocated joint in the body, but most commonly dislocated anteriorly • Posterior fracture-dislocations of the shoulder are exceedingly rare orthopedic injuries that only account for 2-5% of traumatic shoulder dislocations • These injuries have a reported annual prevalence of 0.6/100,0001 • Most commonly they are a result of high energy trauma, electrocution, or seizures caused by forced flexion, adduction and internal rotation of the shoulder • Timely diagnosis is critical for appropriate early treatment in order to help prevent complications such as avascular necrosis • Thorough physical and radiographic examination are needed …

Asymmetric Bilateral Hip Dislocations With An Associated Unstable Pelvic Ring Injury: A Case Report, Jacob Shermetaro, Jourdan Gard, Kelley Brossy

Posters

Introduction • Asymmetric bilateral hip dislocations are rare injuries with one hip dislocating posteriorly while the contralateral hip dislocates anteriorly • .01%-0.02% of all joint dislocations1 • Even fewer of these injuries have been reported with an associated unstable pelvic ring injury • We report a case of asymmetric bilateral hip dislocations with an associated unstable pelvic ring injury and femoral head fracture

Bilateral Total Hip Arthroplasty: Outcomes Of Staged Vs. Simultaneous Tha Performed Using The Anterior Based Muscle Sparing Approach, Brian J. Mcgrory, George Babikian, Adam Rana

Costas T. Lambrew Research Retreat 2022

•Total Hip Arthroplasty (THA) procedures are becoming increasingly common globally. •There is current debate surrounding the efficacy of simultaneous versus staged bilateral total hip arthroplasty, mainly with regards to patient outcomes and complications. •This study examines the perioperative and postoperative outcomes of simultaneous and staged bilateral THA procedures using the Anterior Based Muscle Sparing (ABMS) approach, also known as the ABLE Advanced Anterior Approach.

Hand Surgery Patient Perspectives On Medical Cannabis: A Survey Of Over 600 Patients, Lilah Fones, Clay Townsend, Harry Hoyen, Frederic Liss, Mark L. Wang, Ari C. Greis, Asif M. Ilyas

Rothman Institute Faculty Papers

Purpose: Medical cannabis (MC) has been proposed as a potential addition to multimodal pain man- agement regimens in orthopedics. This study evaluates hand and upper-extremity patient perspectives of MC as a treatment for common orthopedic and musculoskeletal pain conditions. This study also aims to identify the proportion of patients already using MC, perceived barriers to MC use, and opinions on insurance coverage and legality of cannabis.

Methods: An anonymous cross-sectional survey study was conducted of all patients at least 18 years old presenting from October 2020 to January 2021 to a hand and upper-extremity outpatient clinic. The survey collected information …

New-Onset Acute Ischemic Stroke Following Covid-19: A Case-Control Study, Fariborz Khorvash, Mohammad Amin Najafi, Mohsen Kheradmand, Mohammad Saadatnia, Rojin Chegini, Farideh Najafi

Rothman Institute Faculty Papers

Background: Neurological manifestations of coronavirus disease 2019 (COVID-19) have been highlighted. COVID-19 potentially increases the risk of thromboembolism. We aimed to compare patients with COVID-19 with and without new-onset acute ischemic stroke (AIS).

Materials and methods: In this single-center retrospective case-control study, demographics, clinical characteristics, laboratory findings, and clinical outcomes were compared between 51 patients with both COVID-19 and AIS (group A) and 160 patients with COVID-19 and without AIS (group B).

Results: Patients in group A were significantly older, more likely to present with critical COVID-19 (P = 0.004), had higher rates of admission in the intensive care …

Optimizing The Performance And Treatment Of The Female Athlete, Sommer Hammoud, Robin V. West

Department of Orthopaedic Surgery Faculty Papers

No abstract provided.

Injection Options For Non-Surgical Knee Pain Patients: A Quality Improvement Project, Alicia Emery

Epsilon Sigma at-Large Research Conference

Purpose: In an Orthopedic office in Northeast Tennessee clinical decision making about injection options for non-surgical candidates with knee osteoarthritis is unclear.

Aims: This quality improvement project will develop a clinical guideline so that providers know criteria for choosing optimal knee alternative treatments for non-surgical knee patients.

Outcome measures: An expert panel gave feedback and advice on the information presented for the injection types of Platelet Rich Plasma, Corticosteroids, Amniotic Allograft and Hyaluronic Acid. They edited the guideline then sent the edits back to be complied and edited using the Delphi method.

Process and Methods: The …

Comparing Orthopedic Randomized Control Trials Published In High-Impact Medical And Orthopedic Journals, Andrew Lachance, Emily Dissler

Costas T. Lambrew Research Retreat 2022

PURPOSE To compare study characteristics, methodologic quality and outcome direction among operative randomized orthopedic trials published in high-impact medical and orthopedic journals and to identify study attributes associated with greater exposure and impact

Comprehensive Analysis Of Opioid Use After Common Elective Outpatient Orthopaedic Surgeries, Michael U Okoli, Alexander J. Rondon, Clay B Townsend, Matthew Sherman, Asif M. Ilyas, Rothman Opioid Foundation

Rothman Institute Faculty Papers

Background: Prescription opioid abuse remains an ongoing public health crisis, especially in orthopaedic surgery. The purpose of the present study is to analyze opioid-prescribing patterns and investigate risk factors for prolonged opioid use after common outpatient orthopaedic surgical procedures.

Methods: After institutional review board approval, a review of 1,384 patients undergoing common elective outpatient orthopaedic procedures from January 2018 to June 2019 was conducted. Data on controlled substance prescriptions were obtained from the prescription drug monitoring program website. Statistical analysis was done to identify predictors for a second opioid prescription and prolonged opioid use (>6 months).

Results: Over 10% …

Causes Of Early Hip Revision Vary By Age And Sex: Analysis Of Data From A Statewide Quality Registry, Jacob F. Markel, John A. Driscoll, Richard Hughes, Jamers Verner, Thomas Zheng, Brian Halstrom, David C. Markel

Conference Presentation Abstracts

INTRODUCTION: While THA is extremely successful, early failures do occur. The purpose of this study was to determine the cause of revision in specific patient demographic groups at three timepoints to improve quality. The data should guide treatment regimens and implant choice. METHODS: Data for cases performed between 2012 and 2018 from a statewide, quality improvement arthroplasty registry was used. The database included 79,205 THA cases and 1,433 revisions with identified etiology (1,584 total). All revisions performed at < 5 years from the primary THA were reviewed. Six groups: men/women, <65, 65-75, and >75 years, were compared at revision timepoints <6 mo, <1 year, and <5 years. RESULTS: There were obvious and significant differences between subgroups based on demographics and timepoints (p<.0001). The most common etiologies within 1 year (961 revisions) were: fracture (324, 33.7%), dislocation (235, 24.5%) and infection (164, 17.0%). 756 (78%) of the 1-year revisions occurred within 6 months, the vast majority within 6 weeks. At this early timepoint, the most common revision cause was fracture for all groups and ages (316, 42%) ranging from 27.6% in young men to 60% in older women. Joint instability became the leading cause for revision after 6 months in younger women whereas for younger men infection became the primary issue. The most striking finding was the incidence of fracture as the leading cause of revision at all time points for both men and women >75 years. CONCLUSION: This quality project demonstrated clinically significant differences in the reason for THA …

Augmented Immunomodulation Of Endogenous Marrow-Derived Stem Cells In The Setting Of Acl Rupture, Mackenzie Fleischer, Michael Newton, Samantha Hartner, John A. Driscoll, Anthony Arveschoug, Chritopher C. Vasileff, Kevin Baker

Conference Presentation Abstracts

PURPOSE: Augmentation of MSC immunomodulation is an unexplored, potentially useful therapeutic to combat PTOA following ACLR. Lower kynurenine-to-tryptophan ratios observed in synovial fluid of ACL rupture (ACLR) rats suggests decreased activity of tryptophan metabolizing enzyme, Ido, known to be secreted by MSCs to promote T-reg expansion and Th17 suppression. This study aims to characterize the immunomodulatory capacity of pharmacologically mobilized MSCs in conjunction with exogenously delivered Ido. METHODS: Rats (N = 48) underwent ACLR to evaluate the effects of mobilized MCSs on Ido1 and inflammatory cytokine expression profiles in the synovial fluid. Additionally, rats (N = 160) underwent ACLR to …

Meloxicam Versus Celecoxib For Postoperative Analgesia After Total Knee Arthroplasty: Safety, Efficacy And Cost, Amer Haffar, Yale A Fillingham, Leigham Breckenridge, D'Andrew Gursay, Jess H Lonner

Rothman Institute Faculty Papers

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as part of multimodal analgesia in total knee arthroplasty (TKA). Selective cyclooxygenase (COX)-2 inhibitors (e.g., celecoxib) are believed to have fewer gastrointestinal (GI) adverse effects than nonselective NSAIDS. Meloxicam is less selective for COX-2 than celecoxib is and partially inhibits COX-1 at higher doses. Nonetheless, some surgeons prefer using nonselective NSAIDs because of their lower expense.

METHODS: Four thousand nine hundred ninety-four patients who underwent TKA between January 2015 and February 2020 and took either celecoxib (n = 3,174), meloxicam 15 mg/d (n = 1,819), or meloxicam 7.5 mg/d (n = 451) …

A Scoping Review Of Injuries In Amateur And Professional Men's Ice Hockey, Patrick F Szukics, Peters T Otlans, Alfonso Arevalo, Matthew Meade, Peter Deluca, John P Salvo

Orthopedic Surgery Resident Research

Background: Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose: Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design: Scoping review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms "hockey" and "injuries" using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were …

A Scoping Review Of Injuries In Amateur And Professional Men's Ice Hockey., Patrick F Szukics, Peters T Otlans, Alfonso Arevalo, Matthew Meade, Peter Deluca, John P Salvo

Orthopedic Surgery Resident Research

Background: Orthopaedic injuries are common in ice hockey at all levels and can result in physical and psychological adverse effects on these athletes.

Purpose: Primarily, to summarize published data on orthopaedic hockey injuries at the junior through professional level. Secondarily, to characterize the literature based on anatomic site injured, return-to-play rates, cause/mechanism of injury, time lost, and treatments used.

Study Design: Scoping review; Level of evidence, 4.

Methods: PubMed, EMBASE, Cochrane library, and SCOPUS were searched using the terms "hockey" and "injuries" using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and 4163 studies involving orthopaedic injuries were …