Orthopedics Commons^™

Review: Discogenic Back Pain: Update On Treatment, Edgar Remotti, Chinoso Nduaguba, Parker A Woolley, Ryan Ricciardelli, Anh Phung, Rosa Kim, Ivan Urits, Alan David Kaye, Jamal Hasoon, Thomas Simopoulos, Cyrus Yazdi, Christopher L Robinson

Faculty, Staff and Student Publications

Purpose of review: Lower back pain (LBP) has a lifetime prevalence of 80% in the United States population. Discogenic back pain (DBP), a subcategory of LBP, occurs as a result of the interverbal disc degeneration without disc herniation. Diagnosis relies on history, physical exam, and imaging such as MRI, provocative discography, or CT discography.

Recent findings: Treatment of DBP involves a multifaceted approach with an emphasis on conservative measures including behavioral modification, pharmacologic management, and other non-pharmacologic interventions with invasive therapy reserved for select patients. Due to the paucity of data on the treatment of DBP, treatment also relies on …

Return To Sport Following Acl Reconstruction With Slope-Correcting High Tibial Osteotomy In The Elite Athlete, Walter R Lowe, Alfred Mansour, Steven Higbie, Connor Galloway, Jacquelyn Kleihege, Lane Bailey

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Background: Increased posterior tibial slope is a strong predictor of anterior cruciate ligament (ACL) graft re-injury. A concomitant slope-reducing high tibial osteotomy (HTO) has been suggested to decrease re-tear risk in these cases although little is known regarding outcomes following ACL reconstruction with HTO, especially in elite athletic patients.

Indications: A 19-year-old National Collegiate Athletics Association (NCAA) Division 1 running back presented with an ACL tear, lateral meniscus tear, and posterior tibial slope of 19° (case 1). A 19-year-old NCAA Division 1 soccer forward presented with an ACL graft re-tear and posterior tibial slope of 21° (case 2).

Technique: Anterior …

Increasing Rates Of Ulnar Collateral Ligament Repair Outpace Reconstruction In Isolated Injuries: Review Of A Texas Surgical Database, Taylor J Willenbring, Eden C Epner, Ryan J Warth, James M Gregory

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BACKGROUND: The gold standard of treatment for ulnar collateral ligament (UCL) injuries has been reconstruction. Despite early repair studies yielding less than satisfactory results, there has been recent renewed interest in UCL repair due to improved outcomes and new technologies. Data regarding clinical use of these procedures are lacking. The purpose of this study was to define the epidemiological trends of UCL repair and reconstruction surgery from 2010 to 2019, compare demographic characteristics of patients undergoing either procedure, and determine incidence of concomitant procedures in each surgical group as well as comparing respective patient-level charges.

METHODS: A retrospective database analysis …

Self-Administered Transcranial Direct Current Stimulation Treatment Of Knee Osteoarthritis Alters Pain-Related Fnirs Connectivity Networks, Samuel Montero-Hernandez, Luca Pollonini, Lindsey Park, Geraldine Martorella, Hongyu Miao, Kenneth B Mathis, Hyochol Ahn

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SIGNIFICANCE: Knee osteoarthritis (OA) is a disease that causes chronic pain in the elderly population. Currently, OA is mainly treated pharmacologically with analgesics, although research has shown that neuromodulation via transcranial direct current stimulation (tDCS) may be beneficial in reducing pain in clinical settings. However, no studies have reported the effects of home-based self-administered tDCS on functional brain networks in older adults with knee OA.

AIM: We used functional near-infrared spectroscopy (fNIRS) to investigate the functional connectivity effects of tDCS on underlying pain processing mechanisms at the central nervous level in older adults with knee OA.

APPROACH: Pain-related brain connectivity …

A Computational Method For Estimating Trunk Muscle Activations During Gait Using Lower Extremity Muscle Synergies, Geng Li, Di Ao, Marleny M Vega, Mohammad S Shourijeh, Payam Zandiyeh, Shuo-Hsiu Chang, Valerae O Lewis, Nicholas J Dunbar, Ata Babazadeh-Naseri, Andrew J Baines, Benjamin J Fregly

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One of the surgical treatments for pelvic sarcoma is the restoration of hip function with a custom pelvic prosthesis after cancerous tumor removal. The orthopedic oncologist and orthopedic implant company must make numerous often subjective decisions regarding the design of the pelvic surgery and custom pelvic prosthesis. Using personalized musculoskeletal computer models to predict post-surgery walking function and custom pelvic prosthesis loading is an emerging method for making surgical and custom prosthesis design decisions in a more objective manner. Such predictions would necessitate the estimation of forces generated by muscles spanning the lower trunk and all joints of the lower …

It’S Not Arthritis! Resolution Of The Illusion Of Joint Space Narrowing With Acetabuloplasty And Labral Reconstruction For The Calcified Labrum, Jade S Owens, Benjamin R Saks, Kara B Miecznikowski, David R Maldonado, Andrew E Jimenez, Ajay C Lall, Benjamin G Domb

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Labral calcification may be part of the natural history of untreated femoroacetabular impingement syndrome (FAIS) in certain patients, making it a potential target for intervention with the goal of preserving the hip joint. The purpose of this study was to investigate if calcified labra create the appearance of lateral joint space narrowing and report minimum 2-year patient-reported outcome measures (PROMs) after treating patients with arthroscopic acetabuloplasty and labral reconstruction. Prospectively collected data on patients who underwent primary hip arthroscopy for FAIS and labral tearing from February 2015 to April 2021 were reviewed. Patients treated with primary labral reconstruction for an …

Quantification Of Manipulation Forces Needed For Robot-Assisted Reduction Of The Ankle Syndesmosis: An Initial Cadaveric Study, Mikias Gebremeskel, Babar Shafiq, Ali Uneri, Niral Sheth, Corey Simmerer, Wojciech Zbijewski, Jeffrey H Siewerdsen, Kevin Cleary, Gang Li

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PURPOSE: Manual surgical manipulation of the tibia and fibula is necessary to properly align and reduce the space in ankle fractures involving sprain of the distal tibiofibular syndesmosis. However, manual reduction is highly variable and can result in malreduction in about half of the cases. Therefore, we are developing an image-guided robotic assistant to improve reduction accuracy. The purpose of this study is to quantify the forces associated with reduction of the ankle syndesmosis to define the requirements for our robot design.

METHODS: Using a cadaveric specimen, we designed a fixture jig to fix the tibia securely on the operating …

Effects Of Gabapentin And Pregabalin On Calcium Homeostasis: Implications For Physical Rehabilitation Of Musculoskeletal Tissues, Perla C Reyes Fernandez, Christian S Wright, Stuart J Warden, Julia Hum, Mary C Farach-Carson, William R Thompson

Faculty, Staff and Student Publications

Purpose of review: In this review, we discuss the mechanism of action of gabapentinoids and the potential consequences of long-term treatment with these drugs on the musculoskeletal system.

Recent findings: Gabapentinoids, such as gabapentin (GBP) and pregabalin (PGB) were designed as antiepileptic reagents and are now commonly used as first-line treatment for neuropathic pain and increasingly prescribed off-label for other pain disorders such as migraines and back pain. GBP and PGB exert their analgesic actions by selectively binding the α2δ1 auxiliary subunit of voltage-sensitive calcium channels, thereby inhibiting channel function. Numerous tissues express the α2δ1 subunit where GBP and PGB …

Optimisation Of Imaging Parameters During Ct Guided Interventional Procedures In Patients With Total Hip Arthroplasty, Anish Patel, Christine Azzopardi, Scott Evans, A Mark Davies, Steven James, Rajesh Botchu

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OBJECTIVE: To determine the optimal KV and mAs settings during CT guided injections in the presence of a total hip arthroplasty so that image quality is maintained whist keeping the dose as low as reasonably achievable.

METHODS: A total hip arthroplasty phantom with needles with differing gauges was scanned using different CT parameters (from low dose to high dose) and evaluating if this had any effect on needle conspicuity. Conspicuity was graded from 1 to 3 by 2 independent blinded reviewers.

RESULTS: Irrespective of the CT settings used (high dose or low dose parameters) needle conspicuity was not adversely affected …

Hypertrophy Of The Sublime Tubercle In Elbow Ulnar Collateral Ligament Injuries: A Case Series Of Baseball Pitchers Undergoing Ulnar Collateral Ligament Reconstruction With Short-Term Follow-Up, Ravi Vaswani, Michael C Fu, Joshua S Dines, Venkat Boddapati, Brandon J Erickson, George F Lebus, Dean N Papaliodis, John E Conway, David W Altchek

Faculty, Staff and Student Publications

Background: The ulnar collateral ligament (UCL) of the elbow is subject to repetitive stress in overhead throwing athletes. This can lead to morphologic changes at the bony attachments of the UCL and hypertrophy of the sublime tubercle. The purpose of this case series is to describe the surgical details and clinical outcomes of a series of competitive baseball pitchers with hypertrophic sublime tubercles who underwent UCL reconstruction (UCLR).

Methods: All baseball pitchers who were treated for UCL injuries with significant hypertrophy of the sublime tubercle on preoperative imaging were included in the series. Clinical history, preoperative imaging, intraoperative findings during …

Dexterity Of The Less Affected Hand In Children With Hemiplegic Cerebral Palsy, Matthew B Burn, Gloria R Gogola

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BACKGROUND: To determine if the "unaffected" hand in children with hemiplegic cerebral palsy (CP) is truly unaffected.

METHODS: We performed a retrospective review of manual dexterity as measured by the Functional Dexterity Test (FDT) in 66 children (39 boys, 27 girls, mean age: 11 years 4 months) with hemiplegic CP. Data were stratified by Manual Ability Classification System (MACS) level, birth weight, and gestational age at birth, and compared with previously published normative values.

RESULTS: The FDT speed of the less affected hand is significantly lower than typically developing (TD) children (

CONCLUSIONS: Both dexterity and rate of fine motor …

Hip Osteoarthritis: A Novel Network Analysis Of Subchondral Trabecular Bone Structures, Mohsen Dorraki, Dzenita Muratovic, Anahita Fouladzadeh, Johan W Verjans, Andrew Allison, David M Findlay, Derek Abbott

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Hip osteoarthritis (HOA) is a degenerative joint disease that leads to the progressive destruction of subchondral bone and cartilage at the hip joint. Development of effective treatments for HOA remains an open problem, primarily due to the lack of knowledge of its pathogenesis and a typically late-stage diagnosis. We describe a novel network analysis methodology for microcomputed tomography (micro-CT) images of human trabecular bone. We explored differences between the trabecular bone microstructure of femoral heads with and without HOA. Large-scale automated extraction of the network formed by trabecular bone revealed significant network properties not previously reported for bone. Profound differences …

Anchor Arthropathy Caused By Cartilage Penetration: An Approach To Revision Hip Arthroscopy With Removal Of Problematic Anchors, Payam W Sabetian, Olivia A Paraschos, W Taylor Harris, Paulo P Padilla, David R Maldonado, Benjamin G Domb

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Hip arthroscopy has been proven to effectively treat labral tears in the setting of femoroacetabular impingement. Anchors used for this treatment have constantly evolved and improved to ensure safety and minimal invasion. However, acetabular drilling and anchor placement are technically challenging due to the concavity of the acetabular articular surface, limited angles for anchor insertion, and finite bone availability in the anterior and posterior column. Inadequate technique can result in protruding anchors, which may lead to full-thickness articular cartilage damage, manifesting in pain, mechanical symptoms, and impaired function. This Technical Note demonstrates arthroscopic removal of protruding anchors and management of …

Is Prior Hip Arthroscopy Associated With Higher Complication Rates Or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study, Bailey J Ross, Ryan J Wortman, Olivia C Lee, Alfred A Mansour, Wendell W Cole, William F Sherman

Faculty, Staff and Student Publications

BACKGROUND: Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear.

PURPOSE: To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of …

Comparison Of The Neer Classification To The 2018 Update Of The Orthopedic Trauma Association/Ao Fracture Classification For Classifying Proximal Humerus Fractures, Meir T Marmor, Julie Agel, Jarrod Dumpe, James F Kellam, Geoffrey S Marecek, Eric Meinberg, Mai P Nguyen, Stephen Sims, Gillian L Soles, Matthew D Karam

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BACKGROUND: The classification of fractures is necessary to ensure a reliable means of communication for clinical interaction, education and research. The Neer classification is the most commonly used classification for proximal humerus fractures. In 2018 the Orthopedic Trauma Association (OTA) and the AO Foundation provided an update to the OTA/AO Fracture Classification Scheme addressing many of the concerns about the previous versions of the classification. The objective of the present study was to evaluate the rater reliability of the 2 classifications and if the classifications subjectively better characterized the fracture patterns.

METHODS: X-rays and CT scans of 24 proximal humerus …

Is Prior Hip Arthroscopy Associated With Higher Complication Rates Or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study, Bailey J Ross, Ryan J Wortman, Olivia C Lee, Alfred A Mansour, Wendell W Cole, William F Sherman

Faculty, Staff and Student Publications

BACKGROUND: Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear.

PURPOSE: To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of …

Development Of A Personalized Shared Decision-Making Tool For Knee Osteoarthritis And User-Testing With African American And Latina Women, Lynne C Jones, Anne M Maurer, Michael L Parks, Philip C Noble, Carla Harwell, Melvyn Harrington, Katherine G Bay, Charles L Nelson, Mary I O'Connor

Faculty, Staff and Student Publications

BACKGROUND: Patients with chronic knee pain are often unaware of treatment options and likely outcomes-information that is critical to decision-making. A consistent framework for communicating patient-personalized information enables clinicians to provide consistent, targeted, and relevant information. Our objective was to user-test a shared decision-making (SDM) tool for chronic knee pain.

METHODS: A cross-functional team developed a Markov-based health economics model and tested the model outputs with patient panels, patient and clinician focus groups, and clinical specialists. The resulting SDM tool was user-tested in a parallel-designed, randomized controlled study with 52 African American and 52 Latina women from geographically representative areas …

Metaphyseal Dysplasia, Spahr Type; A Case Report Of Variable Expressivity In Non-Consanguineous Filipino Siblings, Kailash Panchapakesan, Brennan Roper, Kate Mowrey, Paul Hillman, Shiraz Younas

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Introduction:

Metaphyseal dysplasia describes a heterogenous group of skeletal dysplasias with varying inheritance patterns, which preferentially demonstrate dysplastic changes within the metaphyseal region of long bones. The clinical consequences of these dysplastic changes are highly variable, but most uniformly include decreased stature, increased upper-to-lower segment proportions, genu varus, and knee pain. Metaphyseal dysplasia, Spahr type (MDST) [MIM: 250400] is a rare primary bone dysplasia that was first clinically described in 1961 in four of five siblings with moderate short stature, metaphyseal dysplasia, mild genu vara, and no biochemical signs of rickets. For many decades, MDST was a clinical diagnosis, but …

Minimal Clinically Important Differences Of Promis Pf In Ankle Fracture Patients, Luke Myhre, Patrick Kellam, Graham Dekeyser, Haojia Li, Yue Zhang, Amy M Cizik, Justin Haller

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BACKGROUND: Evaluating the minimal clinically important differences (MCIDs) in patient-reported outcome scores is essential for use of clinical outcomes data. The purpose of the current study was to calculate MCID of Patient Reported Outcome Information System Physical Function (PROMIS PF) scores for ankle fracture patients.

METHODS: All patients who underwent operative fixation for ankle fractures at a single level 1 trauma center were identified by

RESULTS: A total of 331 patients were included in the distribution-based analysis, and 195 patients were included in the anchor-based analysis. Mean age was 45.3 years (SD 17.5), and 59.4% of participants were female. MCID …

Bone Mineral Density, Serum Calcium, And Vitamin D Levels In Adult Thalassemia Major Patients: Experience From A Single Center In Eastern India, Soumya Santra, Kunal Sharma, Ipsita Dash, Shaikat Mondal, Himel Mondal

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Background and objective Patients suffering from thalassemia major are at higher risk of osteoporosis. Due to their decreased life expectancy, the number of adult patients is low. However, their bone health is rarely checked in developing countries like India. There is no data available in the literature on the bone mineral density (BMD) of adult (aged ≥18 years) thalassemia major patients in eastern India. In this study, we aimed to measure the BMD and serum calcium and vitamin D levels in adult thalassemia major patients and to compare them with healthy controls. Materials and methods We conducted this cross-sectional observational …

Outcomes And Return-To-Sport Rates For Elite Athletes With Femoral Retroversion Undergoing Hip Arthroscopy: A Propensity-Matched Analysis With Minimum 2-Year Follow-Up, Jade S Owens, Andrew E Jimenez, Michael S Lee, David R Maldonado, Ajay C Lall, Benjamin G Domb

Faculty, Staff and Student Publications

BACKGROUND: Return to sports (RTS) and patient-reported outcomes (PROs) for elite athletes with femoral version abnormalities undergoing hip arthroscopy have not been well established.

PURPOSES: To (1) report minimum 2-year PROs and RTS rates in elite athletes with femoral retroversion who underwent primary hip arthroscopy and (2) compare clinical results to those of a propensity-matched control group of elite athletes with normal femoral version who underwent primary hip arthroscopy.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Data were prospectively collected and retrospectively reviewed for elite (professional and collegiate) athletes with femoral version1, hip dysplasia, and previous ipsilateral hip …

Is Nonoperative Treatment Appropriate For All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study Of The Tibial Spine Research Interest Group, Jilan L Shimberg, Tomasina M Leska, Aristides I Cruz, Henry B Ellis, Neeraj M Patel, Yi-Meng Yen, Tibial Spine Research Interest Group, Gregory A Schmale, R Justin Mistovich, Peter D Fabricant, Theodore J Ganley, Daniel W Green, Benjamin Johnson, Indranil Kushare, R Jay Lee, Scott D Mckay, Todd A Milbrandt, Jason Rhodes, Brant Sachleben, Jessica L Traver

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BACKGROUND: Type 1 tibial spine fractures are nondisplaced or ≤2 mm-displaced fractures of the tibial eminence and anterior cruciate ligament (ACL) insertion that are traditionally managed nonoperatively with immobilization.

HYPOTHESIS: Type 1 fractures do not carry a significant risk of associated injuries and therefore do not require advanced imaging or additional interventions aside from immobilization.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: We reviewed 52 patients who were classified by their treating institution with type 1 tibial spine fractures. Patients aged ≤18 years with pretreatment plain radiographs and ≤ 1 year of follow-up were included. Pretreatment imaging was …

Treatment Of Acromioclavicular Joint Instability With A Tunnel-Free Reconstruction Technique, Michelle M Gosselin, Brandon S Denney, James M Gregory

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Acromioclavicular joint injuries are a common shoulder injury encountered by orthopaedic surgeons. Many different surgical techniques have been described for the operative treatment of these injuries with no single, clear gold standard technique on which surgeons agree. Among the most common complications after surgical management of acromioclavicular injuries are loss of reduction, infection, fracture of clavicle or coracoid, and need for reoperation. We propose an arthroscopic-assisted, tunnel-free surgical technique using a tibialis anterior allograft combined with a FiberTape Cerclage (Arthrex, Naples, FL) to manage both acute and chronic acromioclavicular joint injuries. No bony tunnels are drilled and no hardware is …

Dynamic Posterior Instability Test: A New Test For Posterior Glenohumeral Instability, Justin W Arner, Michael S Nickoli, Tracye J Lawyer, John E Conway, James P Bradley

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BACKGROUND: Recurrent posterior shoulder instability has become an increasingly recognized cause of shoulder disability, especially among athletes. The presentation can be vague and therefore its clinical diagnosis is often overlooked. Few diagnostic tests exist and these tests are difficult to perform in an anxious and apprehensive patient. Many also lack high specificity and do not effectively distinguish posterior labral tears from other shoulder pathologies. As a result, the authors worked to develop a new test, the dynamic posterior instability test (DPIT). The purpose of this study was to describe the DPIT as well as a modified DPIT test and to …

Trends In Acromioplasty Utilization During Arthroscopic Rotator Cuff Repair: An Epidemiological Study Of 139,586 Patients, Taylor J Willenbring, Marijke J Devos, Ryan J Warth, James M Gregory

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INTRODUCTION: Acromioplasty remains very common during rotator cuff repair (RCR) despite limited evidence of clinical efficacy. This study observed the incidence of acromioplasty from 2010 to 2018 in Texas using a publicly available database.

METHODS: A total of 139,586 records were analyzed from the Texas Healthcare Information Collection database ranging from 2010 to 2018. These cases were divided into those with and without acromioplasty (N = 107,427 and N = 32,159, respectively). Acromioplasty use was standardized as the number of acromioplasties per RCR (acromioplasty rate). Two subgroup analyses were conducted: surgical institution type and payor status.

RESULTS: In 2010, acromioplasty …

Wavelet Analysis Reveals Differential Lower Limb Muscle Activity Patterns Long After Anterior Cruciate Ligament Reconstruction, Payam Zandiyeh, Lauren R Parola, Braden C Fleming, Jillian E Beveridge

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The purpose of this study was to test whether differences in muscle activity patterns between anterior cruciate ligament-reconstructed patients (ACLR) and healthy controls could be detected 10 to 15 years post-surgery using a machine learning classification approach. Eleven ACLR subjects and 12 healthy controls were recruited from an ongoing prospective randomized clinical trial. Surface electromyography (EMG) signals were recorded from gastrocnemius medialis and lateralis, tibialis anterior, vastus medialis, rectus femoris, biceps femoris, and semitendinosus muscles. Muscle activity was analyzed using wavelet analysis and examined within four sub-phases of the hop test, as well as an average of the task as …

Arthroscopic Stabilization Of Posterior Shoulder Instability Without Glenoid Bone Loss, Shawn D Feinstein, James M Gregory

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BACKGROUND: Contact athletes who experience posterior shoulder instability have a high likelihood of recurrence necessitating surgery.

INDICATIONS: Patients with posterior shoulder instability without glenoid or humeral head bone loss who have failed activity modification, bracing, and physical therapy may benefit from arthroscopic stabilization surgery.

TECHNIQUE DESCRIPTION: We describe a technique for arthroscopic labral repair with capsular plication through 4 portals in the lateral decubitus position.

RESULTS: Arthroscopic capsulolabral reconstruction is an effective and reliable treatment for posterior shoulder instability with good patient-reported outcomes, low recurrence rates, and high rate of return-to-play.

DISCUSSION/CONCLUSION: Arthroscopic capsulolabral reconstruction in the lateral decubitus position …

Patient-Reported Outcomes Of Primary Total Ankle Arthroplasty In Patients Aged <50 Years, M Pierce Ebaugh, Travis Alford, Kamen Kutzarov, Elizabeth Davis, Michael Greaser, William C Mcgarvey

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Background:

Compared to more prevalent arthritic conditions, ankle arthritis is complicated by an earlier age of onset. Recently published data demonstrates excellent survivorship and complication rates in short-/midterm follow-up of younger patients who received a primary total ankle arthroplasty (TAA). Additionally, older TAA patients display comparable reported outcomes relative to hip/knee arthroplasty. However, there remains a paucity of literature surrounding the reported outcomes of younger patients undergoing TAA. Thus, our aim was to assess the reported outcomes of individuals aged <50 years receiving a primary TAA.

Methods:

A retrospective cohort analysis of adult patients <50 years who received a primary total ankle replacement was conducted. Patient demographics, diagnosis, treatment, and outcome characteristics were recorded from a chart review of 41 patients with at least 1 year of postoperative clinical follow-up. Postoperative reported outcomes were obtained via telephone interviews. Primary outcomes that were measured included emotional and physical health, activity limitation, ambulation, and global health. Measures used included the 36-Item Short Form Health Survey (SF-36), Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health, and Sickness Impact Profile Ambulation. The functional outcomes in our study sample were compared with age- and gender-matched norms from a general US population, and 95% CIs were calculated for each functional outcome mean. Student t test was used for continuous variables, and χ2 analysis was used …

Evaluation Of Bone Formation On Orthopedic Implant Surfaces Using An Ex-Vivo Bone Bioreactor System, Rupak Dua, Hugh Jones, Philip C Noble

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Recent advances in materials and manufacturing processes have allowed the fabrication of intricate implant surfaces to facilitate bony attachment. However, refinement and evaluation of these new design strategies are hindered by the cost and complications of animal studies, particularly during early iterations in the development process. To address this problem, we have previously constructed and validated an ex-vivo bone bioreactor culture system that can maintain the viability of bone samples for an extended period ex-vivo. In this study, we investigated the mineralization of a titanium wire mesh scaffold under both static and dynamic culturing using our ex vivo bioreactor system. …

The Contribution Of Age-Related Changes In The Gut-Brain Axis To Neurological Disorders, M Kareem Shaath, Stephen J Warner, James F Kellam, Timothy S Achor

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INTRODUCTION: In 2018, orthopaedic trauma had the lowest match rate among orthopaedic subspecialties. The purpose of this study was to determine the importance of factors evaluated by orthopaedic trauma fellowship directors when ranking applicants after the interview.

METHODS: An electronic survey was submitted to fellowship directors and consisted of 16 factors included in a fellowship application. Respondents were asked to rate the importance of these factors for applicants they interviewed on a 1 to 5 Likert scale, with 1 being not at all important and 5 being critical.

RESULTS: Thirty-seven fellowship directors responded (63.8%). The highest-rated factor was the applicant …