Orthopedics Commons^™

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 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 …

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

Faculty, Staff and Student Publications

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 …

Lumbar Motion Is Maintained With Paraspinous Tension Band For Degenerative Spondylolisthesis: Results From 24-Month Fda Study, Kee D. Kim, Rick Sasso, Serena Hu, Alan Villavicencio, S Tim Yoon, William Lavelle, Harvinder Sandhu, Hyun Bae, Jeffrey Fischgrund, Mick Perez-Cruet

Conference Presentation Abstracts

Introduction

Durable outcome for degenerative spondylolisthesis (DS) usually requires decompression and fusion. Fusion, however, places greater stress at adjacent levels with increased incidence of adjacent segment disease. A novel interspinous tension band is proposed for segmental stabilization after decompression for DS, as an alternative to fusion. An FDA IDE study (NCT03115983) compares decompression and stabilization with the tension band (treatment group) to decompression and transforaminal interbody instrumented fusion (control group) for symptomatic DS.

Methods

Prospectively enrolled IDE study subjects with 24 months postoperative radiographic follow-up were included in this analysis. X-rays obtained during the follow-up period for both the treatment …

Risk Factors For Early Symptomatic Femoroacetabular Impingement Following In Situ Fixation Of Slipped Capital Femoral Epiphysis, Melissa M Allen, Ramesh B Ghanta, Matthew Lahey, Scott B Rosenfeld

Faculty, Staff and Students Publications

In situ fixation of slipped capital femoral epiphysis (SCFE) results in residual deformity that can cause femoroacetabular impingement (FAI). It is unknown what factors could help differentiate patients who are more likely to become symptomatic. We performed a retrospective review of 55 hips treated with in situ pinning for SCFE and subsequent secondary deformity correction procedure for symptomatic FAI and compared them to 39 asymptomatic hips with SCFE deformity using multivariable analysis. Case patients were slightly older than controls (12.6 vs 11.3 years, p = 0.0002) but had similar BMI. The mean epiphyseal-diaphyseal angle was 56° in cases versus 44° …

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

Faculty, Staff and Student Publications

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 …

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 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 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 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 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) …

Self-Reported Arm Function Is Associated With Stress And Fear Of Physical Activity Among Women Treated For Breast Cancer, Mary Insana Fisher, Anne Fleischer, Kimberly Ulmer, Megan Mcclure, Renee Waldron, Lynn Difede

Physical Therapy Faculty Publications

Background: Self-reported upper extremity function and objective measures are not strongly associated with each other in women treated for breast cancer (BC). It is not known if the lack of relationship between self-reported upper extremity function and objective measurements may be influenced by perceived levels of stress and fear of physical activity. The purpose of this study was to investigate the relationships between self-reported upper extremity function and the following: perceived stress levels (PS), fear of physical activity (FPA), health-related quality of life (HRQOL), and objective measures of upper extremity function among women treated for BC.

Methods: This cross-sectional observational …

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 …

Mountains Of Evidence, Mary I. Fisher

Physical Therapy Faculty Publications

No abstract provided.

17-Year-Old Ballet Dancer With 4 Years Of Right Upper Extremity Pain, Mariah Sisson, Brian S. Harvey

Posters

History:No known injury. Intermittent, dull, radiating. Starting at the shoulder and moving to the medial elbow, but sometimes only at the medial elbow with numbness of the 4th/5th digits. No limitations in ballet. Extended course to see Sports Medicine. PCP - failed treatment for herpetic whitlow, referred to dermatology. Dermatology - bilateral Raynaud's syndrome & Pernio, referred to rheumatology. Rheumatology - having RUE numbness, referred to neurology & PT. Neurology - tenderness to palpation at the anterior shoulder, referred to Sports Medicine. PT - getting stronger, but symptomatically making minimal improvement. PE:Cardiac: capillary refill normal. MSK: RUE: Inspection: No erythema, …

A Rare Cause Of Elbow Pain With A Controversial Name, Thomas Munro, Brian Harvey

Posters

History: 13-year-old right hand dominant male presenting with 1-year concerns of bilateral elbow locking, popping, and pain. Right elbow tends to be affected more frequently than left. Patient states that at random, when he is trying to extend at the elbow joint, his elbows will "lock up". He will not be able to extend past this region and has significant pain when this occurs. He has to proceed back into elbow flexion and again try to "push through" into full extension. This will result in a loud pop followed by about 5-10 minutes of pain which slowly resolves. This happens …

The Classification Of Scoliosis Braces Developed By Sosort With Srs, Ispo, And Posna And Approved By Esprm., Stefano Negrini, Angelo Gabriele Aulisa, Pavel Cerny, Jean Claude De Mauroy, Jeb Mcaviney, Andrew Mills, Sabrina Donzelli, Theodoros B. Grivas, M Timothy Hresko, Tomasz Kotwicki, Hubert Labelle, Louise Marcotte, Martin Matthews, Joe O'Brien, Eric C. Parent, Nigel Price, Rigo Manuel, Luke Stikeleather, Michael G. Vitale, Man Sang Wong, Grant Wood, James Wynne, Fabio Zaina, Marco Brayda Bruno, Suncica Bulat Würsching, Yilgor Caglar, Patrick Cahill, Eugenio Dema, Patrick Knott, Andrea Lebel, Grigorii Lein, Peter O. Newton, Brian G. Smith

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types.

METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification …

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

Faculty, Staff and Student Publications

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 …

The Rationale Behind And Impact Of One Hospital’S Provision Of Secondary School Athletic Training Services: A Five-Year Case Study, Caroline E. Faure Edd; Atc

Internet Journal of Allied Health Sciences and Practice

Purpose: Sports-related injuries are common and often require physician or hospital care. Since the advent of concussion laws in fifty states, hospitals across the country have come forward to partner with secondary schools in the provision of sports medicine healthcare. The outreach agreements are consistent: Hospitals hire athletic trainers (ATs) and then outsource them to schools. ATs help mitigate risk in sports programs. Onsite at the schools daily, ATs provide immediate evaluation and treatment for injuries that occur and render decisions regarding the appropriateness of an injured athlete’s return to participation. The goal of this case study was to describe …

Enzymatic Depletion Of Mitochondrial Inorganic Polyphosphate (Polyp) Increases The Generation Of Reactive Oxygen Species (Ros) And The Activity Of The Pentose Phosphate Pathway (Ppp) In Mammalian Cells, Vedangi Hambardikar, Mariona Guitart-Mampel, Ernest Scoma, Pedro Urquiza, Gowda Nagana, Daniel Raftery, John Collins, Maria Solesio

Department of Orthopaedic Surgery Faculty Papers

Inorganic polyphosphate (polyP) is an ancient biopolymer that is well preserved throughout evolution and present in all studied organisms. In mammals, it shows a high co-localization with mitochondria, and it has been demonstrated to be involved in the homeostasis of key processes within the organelle, including mitochondrial bioenergetics. However, the exact extent of the effects of polyP on the regulation of cellular bioenergetics, as well as the mechanisms explaining these effects, still remain poorly understood. Here, using HEK293 mammalian cells under Wild-type (Wt) and MitoPPX (cells enzymatically depleted of mitochondrial polyP) conditions, we show that depletion of polyP within mitochondria …

Knowledge Regarding Cancer-Related Fatigue: A Survey Of Physical Therapists And Individuals Diagnosed With Cancer, Shana Harrington, Mary Insana Fisher, Jeannette Lee, Joy C. Cohn, Daniel Malone

Physical Therapy Faculty Publications

Background: Cancer-related fatigue (CRF) is a common side effect and remains under-diagnosed. Screening of CRF by physical therapists (PTs) and patient perspectives of their experiences has not been comprehensively examined.

Purpose: To survey PTs to understand the frequency of CRF screening, and to assess the knowledge and experiences of survivors as it relates to CRF.

Methods: Two separate electronic surveys developed by the authors were distributed. One targeted oncology PTs, the other for adult survivors of cancer.

Results: Of the 199 PT respondents, 36% reported screening for CRF at every encounter. Screening included interviews (46%) and/or standardized questionnaires (37%). The …

Return To School After Anterior Cruciate Ligament Reconstruction: A Prospective Study Of Adolescents And Young Adults., Joseph Brutico, Ryan W. Paul, Margaret Wright, Steven Cohen, Michael G. Ciccotti, Christopher C Dodson, Kevin Freedman, Sommer Hammoud

Rothman Institute Papers

Background: The ability to return to school after orthopaedic surgery is an important consideration for young patients, as there is substantial literature indicating that school attendance is correlated strongly with academic performance.

Purpose: To evaluate the time to return to school, the barriers that students encounter when returning to school, and the academic effect of anterior cruciate ligament reconstruction (ACLR) in high school (HS) and college students.

Study design: Cohort study; Level of evidence, 2.

Methods: Full-time HS and college/graduate school (C/GS) students who underwent ACLR during the 2017 to 2018 and 2018 to 2019 academic periods were included in …

The Role Of Socioeconomic Status, Race, And Gender In Patient-Reported Outcomes Following Total Hip Arthroplasty, Allyn M. Bove, James Porter, Aatif Sayeed, Clair Smith, Brian A. Klatt

Journal of Health Disparities Research and Practice

Background

Disparities in total joint arthroplasty are well-documented. However, much of the research regarding disparities in vulnerable populations receiving total hip arthroplasty (THA) have focused on short-term outcomes. The purpose of this study was to examine the effects of race, gender, and socioeconomic status (SES) on patient-reported outcomes six months following THA.

Methods

Electronic health record data were retrospectively analyzed for 269 individuals who underwent THA at a large urban hospital from 2013-16. Data retrieved included patient demographics, baseline health information, data regarding hospital length of stay when undergoing THA, post-operative complications, and patient-reported function, measured by the Harris Hip …

Consistency Of Acetabular Height In Sequential Bilateral Total Hip Arthroplasty, Qingwu Kong, Walaa Abdelfadeel, Rock Hwang, Arjun Saxena, Andrew Star

Rothman Institute Papers

Background: Achieving appropriate leg length after surgery remains a concern for surgeons performing total hip arthroplasty (THA). The focus of surgeons trying to equalize leg length has been primarily on positioning of the femoral implant. This study evaluates the impact of acetabular height on leg length and its impact on femoral component choices during THA.

Methods: We reviewed standing pelvic radiographs of 100 patients who underwent staged bilateral THA by a single surgeon from 2016 to 2019. Leg length discrepancies and acetabular heights were determined from preoperative and postoperative radiographs. The difference between the first and second operative hips was …