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Chainani PH, Buzo Mena M, Yeritsyan D, Caro D, Momenzadeh K, Galloway JL, DeAngelis JP, Ramappa AJ, Nazarian A. Successive tendon injury in an in vivo rat overload model induces early damage and acute healing responses. Front Bioeng Biotechnol 2024; 12:1327094. [PMID: 38515627 PMCID: PMC10955762 DOI: 10.3389/fbioe.2024.1327094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 03/23/2024] Open
Abstract
Introduction: Tendinopathy is a degenerative condition resulting from tendons experiencing abnormal levels of multi-scale damage over time, impairing their ability to repair. However, the damage markers associated with the initiation of tendinopathy are poorly understood, as the disease is largely characterized by end-stage clinical phenotypes. Thus, this study aimed to evaluate the acute tendon responses to successive fatigue bouts of tendon overload using an in vivo passive ankle dorsiflexion system. Methods: Sprague Dawley female rats underwent fatigue overloading to their Achilles tendons for 1, 2, or 3 loading bouts, with two days of rest in between each bout. Mechanical, structural, and biological assays were performed on tendon samples to evaluate the innate acute healing response to overload injuries. Results: Here, we show that fatigue overloading significantly reduces in vivo functional and mechanical properties, with reductions in hysteresis, peak stress, and loading and unloading moduli. Multi-scale structural damage on cellular, fibril, and fiber levels demonstrated accumulated micro-damage that may have induced a reparative response to successive loading bouts. The acute healing response resulted in alterations in matrix turnover and early inflammatory upregulations associated with matrix remodeling and acute responses to injuries. Discussion: This work demonstrates accumulated damage and acute changes to the tendon healing response caused by successive bouts of in vivo fatigue overloads. These results provide the avenue for future investigations of long-term evaluations of tendon overload in the context of tendinopathy.
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Affiliation(s)
- Pooja H. Chainani
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Mechanical Engineering, Boston University, Boston, MA, United States
| | - Maria Buzo Mena
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jenna L. Galloway
- Center for Regenerative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Joseph P. DeAngelis
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Arun J. Ramappa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Mechanical Engineering, Boston University, Boston, MA, United States
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
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Chainani PH, Williamson PM, Yeritsyan D, Momenzadeh K, Kheir N, DeAngelis JP, Ramappa AJ, Nazarian A. A Passive Ankle Dorsiflexion Testing System for an In Vivo Model of Overuse-induced Tendinopathy. J Vis Exp 2024. [PMID: 38497634 DOI: 10.3791/65803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Abstract
Tendinopathy is a chronic tendon condition that results in pain and loss of function and is caused by repeated overload of the tendon and limited recovery time. This protocol describes a testing system that cyclically applies mechanical loads via passive dorsiflexion to the rat Achilles tendon. The custom-written code consists of pre- and post-cyclic loading measurements to assess the effects of the loading protocol along with the feedback control-based cyclic fatigue loading regimen. We used 25 Sprague-Dawley rats for this study, with 5 rats per group receiving either 500, 1,000, 2,000, 3,600, or 7,200 cycles of fatigue loads. The percentage differences between the pre- and post-cyclic loading measurements of the hysteresis, peak stress, and loading and unloading moduli were calculated. The results demonstrate that the system can induce varying degrees of damage to the Achilles tendon based on the number of loads applied. This system offers an innovative approach to apply quantified and physiological varying degrees of cyclic loads to the Achilles tendon for an in vivo model of fatigue-induced overuse tendon injury.
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Affiliation(s)
- Pooja H Chainani
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Mechanical Engineering Department, Boston University
| | - Patrick M Williamson
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Mechanical Engineering Department, Boston University
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Mechanical Engineering Department, Boston University; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Orthopaedic Surgery, Yerevan State Medical University;
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Villarreal-Espinosa JB, Kay J, Ramappa AJ. Arthroscopic Bankart with remplissage results in lower rates of recurrent instability with similar range of motion compared to isolated arthroscopic Bankart for anterior glenohumeral instability: A systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:243-256. [PMID: 38258962 DOI: 10.1002/ksa.12054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
PURPOSE The addition of the remplissage procedure to an arthroscopic Bankart procedure has been shown to improve clinical outcomes, yet at the expense of potentially decreasing shoulder range of motion. The purpose of this study was to assess recurrent instability, range of motion, functional outcomes and rates of return to sport outcomes in patients undergoing an isolated arthroscopic Bankart repair compared to those undergoing arthroscopic Bankart repair in addition to the remplissage procedure. METHODS According to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a search was conducted using three databases (MEDLINE/OVID, EMBASE and PubMed). Retrieved studies were screened based on predefined inclusion and exclusion criteria for comparative studies. Data were extracted and meta-analysis performed using a random-effects model. RESULTS A total of 16 studies (13 level III studies, 2 level II studies and 1 level I) were included with a total of 507 and 704 patients in the Bankart plus remplissage and isolated Bankart repair groups, respectively. No studies reported glenoid bone loss of >20% with the least percentage of glenoid bone loss reported among studies being <1%. There was a significantly increased rate of recurrent dislocations (odds ratio [OR] = 4.22, 95% confidence interval [CI]: 2.380-7.48, p < 0.00001) and revision procedures (OR = 3.36, 95% CI: 1.52-7.41, p = 0.003) in the isolated Bankart repair group compared to the Bankart plus remplissage group. Additionally, there were no significant differences between groups in terms of external rotation at side (n.s.), in abduction (n.s.) or at forward flexion (n.s.) at final follow-up. Furthermore, return to preinjury level of sport favoured the Bankart plus remplissage group (OR = 0.54, 95% CI: 0.35-0.85, p = 0.007). CONCLUSION Patients undergoing arthroscopic Bankart plus remplissage for anterior shoulder instability have lower rates of recurrent instability, higher rates of return to sport, and no significant difference in range of motion at final follow-up when compared to an isolated arthroscopic Bankart repair. Further large, prospective studies are needed to further determine which patients and degree of bone loss would benefit most from augmentation with the remplissage procedure. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Juan Bernardo Villarreal-Espinosa
- Carl J. Shapiro Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey Kay
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Williamson PM, Yeritsyan D, Peacock T, Chainani P, Momenzadeh K, Asciutto D, Pathirana P, Avakian C, Stewart I, Kheir N, Abbasian M, DeAngelis JP, Ramappa AJ, Nazarian A. A passive ankle dorsiflexion testing system to assess mechanobiological and structural response to cyclic loading in rat Achilles tendon. J Biomech 2023; 156:111664. [PMID: 37302164 PMCID: PMC10439675 DOI: 10.1016/j.jbiomech.2023.111664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/16/2023] [Accepted: 05/23/2023] [Indexed: 06/13/2023]
Abstract
Tendinopathy is thought to be caused by repeated overload of the tendon with insufficient recovery time, leading to an inadequate healing response and incomplete recovery of preinjury material strength and function. The etiology of tendinopathy induced by mechanical load is being explored with a variety of mechanical load scenarios in small animals. This study establishes a testing system that applies passive ankle dorsiflexion to a rat hindlimb, estimates the force applied to the tendon during cyclic loading and enables the assessment of subsequent structural and biological changes. We demonstrated that the system had no drift in the applied angle, and the registered maximum angle and torque inputs and outputs were consistent between tests. We showed that cyclic loading decreased hysteresis and loading and unloading moduli with increasing cycles applied to the tendon. Histology showed gross changes to tendon structure. This work establishes a system for passively loading the rat Achilles tendon in-vivo in a physiological manner, facilitating future studies that will explore how mechanics, structure, and biology are altered by mechanical repetitive loading.
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Affiliation(s)
- Patrick M Williamson
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Boston University, Mechanical Engineering Department, Boston, MA
| | - Diana Yeritsyan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Thomas Peacock
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Pooja Chainani
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Boston University, Mechanical Engineering Department, Boston, MA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Dominic Asciutto
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Priyan Pathirana
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christina Avakian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Isabella Stewart
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Yerevan State Medical University. Yerevan, Armenia.
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Williamson P, Garcia M, Momenzadeh K, Abbasian M, Kheir N, Stewart I, DeAngelis JP, Ramappa AJ, Nazarian A. A Validated Three-Dimensional, Heterogenous Finite Element Model of the Rotator Cuff and The Effects of Collagen Orientation. Ann Biomed Eng 2023; 51:1002-1013. [PMID: 36469168 PMCID: PMC10428175 DOI: 10.1007/s10439-022-03114-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
Continuum mechanics-based finite element models of the shoulder aim to quantify the mechanical environment of the joint to aid in clinical decision-making for rotator cuff injury and disease. These models allow for the evaluation of the internal loading of the shoulder, which cannot be measured in-vivo. This study uses human cadaveric rotator cuff samples with surface tendon strain estimates, to validate a heterogeneous finite element model of the supraspinatus-infraspinatus complex during various load configurations. The computational model was considered validated when the absolute difference in average maximum principal strain for the articular and bursal sides for each load condition estimated by the model was no greater than 3% compared to that measured in the biomechanical study. The model can predict the strains for varying infraspinatus loads allowing for the study of load sharing between these two tightly coordinated tendons. The future goal is to use the modularity of this validated model to study the initiation and propagation of rotator cuff tear and other rotator cuff pathologies to ultimately improve care for rotator cuff tear patients.
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Affiliation(s)
- Patrick Williamson
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Mason Garcia
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Kaveh Momenzadeh
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Isabella Stewart
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN121, Boston, MA, 02115, USA
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN121, Boston, MA, 02115, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA.
- Mechanical Engineering Department, Boston University, Boston, MA, USA.
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN121, Boston, MA, 02115, USA.
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal and Articular Cartilage Predictors of Outcome After Revision ACL Reconstruction: A 6-Year Follow-up Cohort Study. Am J Sports Med 2023; 51:605-614. [PMID: 36734487 PMCID: PMC10338044 DOI: 10.1177/03635465231151389] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Meniscal and chondral damage is common in the patient undergoing revision anterior cruciate ligament (ACL) reconstruction. PURPOSE To determine if meniscal and/or articular cartilage pathology at the time of revision ACL surgery significantly influences a patient's outcome at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were prospectively enrolled between 2006 and 2011. Data collection included baseline demographics, surgical technique, pathology, treatment, and scores from 4 validated patient-reported outcome instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx Activity Rating Scale. Patients were followed up at 6 years and asked to complete the identical set of outcome instruments. Regression analysis assessed the meniscal and articular cartilage pathology risk factors for clinical outcomes 6 years after revision ACL reconstruction. RESULTS An overall 1234 patients were enrolled (716 males, 58%; median age, 26 years). Surgeons reported the pathology at the time of revision surgery in the medial meniscus (45%), lateral meniscus (36%), medial femoral condyle (43%), lateral femoral condyle (29%), medial tibial plateau (11%), lateral tibial plateau (17%), patella (30%), and trochlea (21%). Six-year follow-up was obtained on 79% of the sample (980/1234). Meniscal pathology and articular cartilage pathology (medial femoral condyle, lateral femoral condyle, lateral tibial plateau, trochlea, and patella) were significant drivers of poorer patient-reported outcomes at 6 years (IKDC, KOOS, WOMAC, and Marx). The most consistent factors driving outcomes were having a medial meniscal excision (either before or at the time of revision surgery) and patellofemoral articular cartilage pathology. Six-year Marx activity levels were negatively affected by having either a repair/excision of the medial meniscus (odds ratio range, 1.45-1.72; P≤ .04) or grade 3-4 patellar chondrosis (odds ratio, 1.72; P = .04). Meniscal pathology occurring before the index revision surgery negatively affected scores on all KOOS subscales except for sports/recreation (P < .05). Articular cartilage pathology significantly impaired all KOOS subscale scores (P < .05). Lower baseline outcome scores, higher body mass index, being a smoker, and incurring subsequent surgery all significantly increased the odds of reporting poorer clinical outcomes at 6 years. CONCLUSION Meniscal and chondral pathology at the time of revision ACL reconstruction has continued significant detrimental effects on patient-reported outcomes at 6 years after revision surgery.
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Affiliation(s)
| | | | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA
| | | | | | | | | | | | | | | | | | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | - C Benjamin Ma
- University of California, San Francisco, California, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | | | | | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
| | | | | | | | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
- Investigation performed at Vanderbilt University, Nashville, Tennessee, USA
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7
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DeFroda SF, Owens BD, Wright RW, Huston LJ, Pennings JS, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting. Am J Sports Med 2022; 50:2397-2409. [PMID: 35833922 DOI: 10.1177/03635465221104470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described. PURPOSE To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics. RESULTS A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group. CONCLUSION Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.
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Affiliation(s)
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- Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven F DeFroda
- University of Missouri, Columbia, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett D Owens
- Brown Alpert Medical School, Providence, Rhode Island, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Amanda K Haas
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brett Brick A Lantz
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert H Brophy
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - J Brad Butler
- Orthopedic and Fracture Clinic, Portland, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, IL USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, St Paul, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert W Frederick
- Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elizabeth A Garofoli
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Norman Lindsay Harris
- Grand River Health-Rifle, Rifle, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Rudolf G Hoellrich
- Slocum Research & Education Foundation, Eugene, Oregon, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce A Levy
- Mayo Clinic Rochester, Rochester, Minnesota, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew J Matava
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Matthew V Smith
- Washington University in St Louis, St Louis, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA.,Investigation performed at the Department of Orthopaedics, Brown Alpert Medical School, Providence, Rhode Island, USA
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8
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Bigouette JP, Owen EC, Lantz BBA, Hoellrich RG, Wright RW, Huston LJ, Haas AK, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Spindler KP, Stuart MJ, Albright JP, Amendola A(N, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Robert Giffin J, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, York JJ. Returning to Activity After Anterior Cruciate Ligament Revision Surgery: An Analysis of the Multicenter Anterior Cruciate Ligament Revision Study (MARS) Cohort at 2 Years Postoperative. Am J Sports Med 2022; 50:1788-1797. [PMID: 35648628 PMCID: PMC9756873 DOI: 10.1177/03635465221094621] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with anterior cruciate ligament (ACL) revision report lower outcome scores on validated knee questionnaires postoperatively compared to cohorts with primary ACL reconstruction. In a previously active population, it is unclear if patient-reported outcomes (PROs) are associated with a return to activity (RTA) or vary by sports participation level (higher level vs. recreational athletes). HYPOTHESES Individual RTA would be associated with improved outcomes (ie, decreased knee symptoms, pain, function) as measured using validated PROs. Recreational participants would report lower PROs compared with higher level athletes and be less likely to RTA. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS There were 862 patients who underwent a revision ACL reconstruction (rACLR) and self-reported physical activity at any level preoperatively. Those who did not RTA reported no activity 2 years after revision. Baseline data included patient characteristics, surgical history and characteristics, and PROs: International Knee Documentation Committee questionnaire, Marx Activity Rating Scale, Knee injury and Osteoarthritis Outcome Score, and the Western Ontario and McMaster Universities Osteoarthritis Index. A binary indicator was used to identify patients with same/better PROs versus worse outcomes compared with baseline, quantifying the magnitude of change in each direction, respectively. Multivariable regression models were used to evaluate risk factors for not returning to activity, the association of 2-year PROs after rACLR surgery by RTA status, and whether each PRO and RTA status differed by participation level. RESULTS At 2 years postoperatively, approximately 15% did not RTA, with current smokers (adjusted odds ratio [aOR] = 3.3; P = .001), female patients (aOR = 2.9; P < .001), recreational participants (aOR = 2.0; P = .016), and those with a previous medial meniscal excision (aOR = 1.9; P = .013) having higher odds of not returning. In multivariate models, not returning to activity was significantly associated with having worse PROs at 2 years; however, no clinically meaningful differences in PROs at 2 years were seen between participation levels. CONCLUSION Recreational-level participants were twice as likely to not RTA compared with those participating at higher levels. Within a previously active cohort, no RTA was a significant predictor of lower PROs after rACLR. However, among patients who did RTA after rACLR, approximately 20% reported lower outcome scores. Most patients with rACLR who were active at baseline improved over time; however, patients who reported worse outcomes at 2 years had a clinically meaningful decline across all PROs.
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Affiliation(s)
| | - Erin C. Owen
- Slocum Research & Education Foundation, Eugene, OR USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | - Robert G. McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - James J. York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, MD
| | - James J York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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9
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Salvatore G, Berton A, Orsi A, Egan J, Walley KC, Johns WL, Kheir N, Ramappa AJ, DeAngelis JP, Longo UG, Denaro V, Nazarian A. Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability. Arthroscopy 2022; 38:953-964. [PMID: 34411682 DOI: 10.1016/j.arthro.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and validate a finite element (FE) model of the patellofemoral (PF) joint to characterize patellofemoral instability, and to highlight the effect of lateral retinacular release in combination with tibial tuberosity transfer with respect to contact pressures (CP), contact area (CA), and kinematics during knee flexion. METHODS A comprehensive, dynamic FE model of the knee joint was developed and validated through parametric comparison of PF kinematics, CP, and CA between FE simulations and in vitro, cadaveric experiments. Using this FE model, we characterized the effect of patellar instability, lateral retinacular release (LR), and tibial tuberosity transfer (TTT) in the setting of medial patellofemoral ligament injury during knee flexion. RESULTS There was a high level of agreement in CP, CA, lateral patellar displacement, anterior patellar displacement, and superior patellar displacement between the FE model and the in vitro data (P values 0.19, 0.16, 0.81, 0.10, and 0.36, respectively). Instability conditions demonstrated the greatest CP compared to all of the other conditions. During all degrees of flexion, TTT and concomitant lateral release (TTT + LR) decreased CP significantly. TTT alone shows a consistently lower CA compared to nonrelease conditions with subsequent lateral release further decreasing CA. CONCLUSIONS The results of this study demonstrate that the FE model described reliably simulates PF kinematics and CP within 1 SD in uncomplicated cadaveric specimens. The FE model is able to show that tibial tubercle transfer in combination with lateral retinacular release markedly decreases patellofemoral CP and CA and increases lateral patellar displacement that may decrease bony stabilization of the patella within the trochlear groove and promote lateral patellar instability. CLINICAL RELEVANCE The goal of surgical correction for patellar instability focuses on reestablishing normal PF kinematics. By developing an FE model that can demonstrate patient PF kinematics and the results of different surgical approaches, surgeons may tailor their treatment to the best possible outcome. Of the surgical approaches that have been described, the biomechanical effects of the combination of TTT with lateral retinacular release have not been studied. Thus, the FE analysis will help shed light on the effect of the combination of TTT with lateral retinacular release on PF kinematics.
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Affiliation(s)
- Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Jonathan Egan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan
- Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Kheir N, Salvatore G, Berton A, Orsi A, Egan J, Mohamadi A, DeAngelis JP, Ramappa AJ, Longo UG, Denaro V, Nazarian A. Lateral release associated with MPFL reconstruction in patients with acute patellar dislocation. BMC Musculoskelet Disord 2022; 23:139. [PMID: 35148741 PMCID: PMC8832651 DOI: 10.1186/s12891-022-05013-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Medial patellofemoral ligament (MPFL) injury occurs in the majority of the cases of acute patellar dislocation. The role of concomitant lateral retinaculum release with MPFL reconstruction is not clearly understood. Even though the lateral retinaculum plays a role in both medial and lateral patellofemoral joint stability in MPFL intact knees, studies have shown mixed clinical outcomes following its release during MPFL reconstruction surgery. Better understanding of the biomechanical effects of the release of the lateral retinaculum during MPFL reconstruction is warranted. We hypothesize that performing a lateral release concurrent with MPFL reconstruction will disrupt the patellofemoral joint biomechanics and result in lateral patellar instability. Methods A previously developed and validated finite element (FE) model of the patellofemoral joint was used to understand the effect of lateral retinaculum release following MPFL reconstruction. Contact pressure (CP), contact area (CA) and lateral patellar displacement were recorded. abstract. Results FE modeling and analysis demonstrated that lateral retinacular release following MPFL reconstruction with tibial tuberosity-tibial groove distance (TT-TG) of 12 mm resulted in a 39% decrease in CP, 44% decrease in CA and a 20% increase in lateral patellar displacement when compared to a knee with an intact MPFL. In addition, there was a 45% decrease in CP, 44% decrease in CA and a 21% increase in lateral displacement when compared to a knee that only had an MPFL reconstruction. Conclusion This FE-based analysis exhibits that concomitant lateral retinaculum release with MPFL reconstruction results in decreased PF CA, CP and increased lateral patellar displacement with increased knee flexion, which may increase the risk of patellar instability.
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Affiliation(s)
- Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Jonathan Egan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Amin Mohamadi
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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11
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Williamson PM, Freedman BR, Kwok N, Beeram I, Pennings J, Johnson J, Hamparian D, Cohen E, Galloway JL, Ramappa AJ, DeAngelis JP, Nazarian A. Tendinopathy and tendon material response to load: What we can learn from small animal studies. Acta Biomater 2021; 134:43-56. [PMID: 34325074 DOI: 10.1016/j.actbio.2021.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
Tendinopathy is a debilitating disease that causes as much as 30% of all musculoskeletal consultations. Existing treatments for tendinopathy have variable efficacy, possibly due to incomplete characterization of the underlying pathophysiology. Mechanical load can have both beneficial and detrimental effects on tendon, as the overall tendon response depends on the degree, frequency, timing, and magnitude of the load. The clinical continuum model of tendinopathy offers insight into the late stages of tendinopathy, but it does not capture the subclinical tendinopathic changes that begin before pain or loss of function. Small animal models that use high tendon loading to mimic human tendinopathy may be able to fill this knowledge gap. The goal of this review is to summarize the insights from in-vivo animal studies of mechanically-induced tendinopathy and higher loading regimens into the mechanical, microstructural, and biological features that help characterize the continuum between normal tendon and tendinopathy. STATEMENT OF SIGNIFICANCE: This review summarizes the insights gained from in-vivo animal studies of mechanically-induced tendinopathy by evaluating the effect high loading regimens have on the mechanical, structural, and biological features of tendinopathy. A better understanding of the interplay between these realms could lead to improved patient management, especially in the presence of painful tendon.
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12
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Wright RW, Huston LJ, Haas AK, Pennings JS, Allen CR, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort. Am J Sports Med 2021; 49:2589-2598. [PMID: 34260326 PMCID: PMC9236596 DOI: 10.1177/03635465211027170] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome. HYPOTHESIS In the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery. RESULTS A total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87). CONCLUSION BTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.
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Affiliation(s)
- Rick W Wright
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Laura J Huston
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda K Haas
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jacquelyn S Pennings
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christina R Allen
- Yale University, New Haven, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel E Cooper
- W.B. Carrell Memorial Clinic, Dallas, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas M DeBerardino
- The San Antonio Orthopaedic Group, San Antonio, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Warren R Dunn
- Texas Orthopedic Hospital, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett Brick A Lantz
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kurt P Spindler
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Stuart
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John P Albright
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Annunziato Ned Amendola
- Duke University, Durham, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jack T Andrish
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Annunziata
- Commonwealth Orthopaedics & Rehabilitation, Arlington, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bernard R Bach
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Champ L Baker
- The Hughston Clinic, Columbus, Georgia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur R Bartolozzi
- 3B Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffery R Bechler
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Geoffrey A Bernas
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen F Brockmeier
- University of Virginia, Charlottesville, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert H Brophy
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles A Bush-Joseph
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - J Brad Butler V
- Orthopedic and Fracture Clinic, Portland, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James E Carpenter
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan M Cooper
- HealthPartners Specialty Center, Saint Paul, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles L Cox
- Vanderbilt University, Nashville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - R Alexander Creighton
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Diane L Dahm
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Flanigan
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elizabeth A Garofoli
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sharon L Hame
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher D Harner
- University of Texas Health Center, Houston, Texas, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Norman Lindsay Harris
- Grand River Health, Rifle, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Keith S Hechtman
- UHZ Sports Medicine Institute, Coral Gables, Florida, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Elliott B Hershman
- Lenox Hill Hospital, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rudolf G Hoellrich
- Slocum Research and Education Foundation, Eugene, Oregon, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David C Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy S Johnson
- National Sports Medicine Institute, Leesburg, Virginia, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H Jones
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christopher C Kaeding
- The Ohio State University, Columbus, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas E Klootwyk
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce A Levy
- Mayo Clinic, Rochester, Minnesota, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - C Benjamin Ma
- University of California, San Francisco, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - G Peter Maiers
- Methodist Sports Medicine Center, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew J Matava
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gregory M Mathien
- Knoxville Orthopaedic Clinic, Knoxville, Tennessee, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David R McAllister
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric C McCarty
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Bruce S Miller
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel F O'Neill
- Littleton Regional Healthcare, Littleton, New Hampshire, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard D Parker
- Cleveland Clinic, Cleveland, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mark L Purnell
- Aspen Orthopedic Associates, Aspen, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur C Rettig
- Methodist Sports Medicine, Indianapolis, Indiana, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kevin G Shea
- Intermountain Orthopaedics, Boise, Idaho, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Orrin H Sherman
- NYU Hospital for Joint Diseases, New York, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James R Slauterbeck
- University of South Alabama, Mobile, Alabama, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew V Smith
- Washington University in Saint Louis, Saint Louis, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joachim J Tenuta
- Albany Medical Center, Albany, New York, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, Washington, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Armando F Vidal
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Darius G Viskontas
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A White
- Fitzgibbon's Hospital, Marshall, Missouri, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James S Williams
- Cleveland Clinic, Euclid, Ohio, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michelle L Wolcott
- University of Colorado Denver School of Medicine, Denver, Colorado, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasadena, Maryland, USA
- Investigation performed at Vanderbilt University Medical Center, Nashville, Tennessee, USA
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13
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Brophy RH, Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Bush-Joseph CA, Butler JBV, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Alexander Creighton R, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Benjamin Ma C, Peter Maiers G, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Li X, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Rate of infection following revision anterior cruciate ligament reconstruction and associated patient- and surgeon-dependent risk factors: Retrospective results from MOON and MARS data collected from 2002 to 2011. J Orthop Res 2021; 39:274-280. [PMID: 33002248 PMCID: PMC7854959 DOI: 10.1002/jor.24871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/08/2020] [Accepted: 09/14/2020] [Indexed: 02/04/2023]
Abstract
Infection is a rare occurrence after revision anterior cruciate ligament reconstruction (rACLR). Because of the low rates of infection, it has been difficult to identify risk factors for infection in this patient population. The purpose of this study was to report the rate of infection following rACLR and assess whether infection is associated with patient- and surgeon-dependent risk factors. We reviewed two large prospective cohorts to identify patients with postoperative infections following rACLR. Age, sex, body mass index (BMI), smoking status, history of diabetes, and graft choice were recorded for each patient. The association of these factors with postoperative infection following rACLR was assessed. There were 1423 rACLR cases in the combined cohort, with 9 (0.6%) reporting postoperative infections. Allografts had a higher risk of infection than autografts (odds ratio, 6.8; 95% CI, 0.9-54.5; p = .045). Diabetes (odds ratio, 28.6; 95% CI, 5.5-149.9; p = .004) was a risk factor for infection. Patient age, sex, BMI, and smoking status were not associated with risk of infection after rACLR.
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Affiliation(s)
- Robert H Brophy
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | | | - Amanda K Haas
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Christina R Allen
- University of California, San Francisco, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | - Robert A Arciero
- University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | | | - Arthur R Bartolozzi
- Bat Orthopaedics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | | | | | - Jeffrey H Berg
- Town Center Orthopaedic Associates, Reston, Virginia, USA
| | | | | | | | | | - John D Campbell
- Bridger Orthopedic and Sports Medicine, Bozeman, Montana, USA
| | - James L Carey
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Brian J Cole
- Rush University Medical Center, Chicago, Illinois, USA
| | | | | | | | | | - Tal S David
- Synergy Specialists Medical Group, San Diego, California, USA
| | | | - Robert W Frederick
- The Rothman Institute/Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Theodore J Ganley
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Charles J Gatt
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | - Steven R Gecha
- Princeton Orthopaedic Associates, Princeton, New Jersey, USA
| | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada
| | - Sharon L Hame
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Jo A Hannafin
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | | | | | - Timothy M Hosea
- University Orthopaedic Associates LLC, Princeton, New Jersey, USA
| | | | | | | | | | - Ganesh V Kamath
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Robert G Marx
- Hospital for Special Surgery, New York, New York, USA
| | | | | | | | - Eric C McCarty
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Robert G McCormack
- University of British Columbia/Fraser Health Authority, British Columbia, Canada
| | | | - Carl W Nissen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
| | | | - Brett D Owens
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | | | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael A Rauh
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Jon K Sekiya
- University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Xulei Li
- Vanderbilt University, Nashville, Tennessee, USA
| | - James R Slauterbeck
- Robert Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Matthew V Smith
- Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jeffrey T Spang
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - Ltc Steven J Svoboda
- Keller Army Community Hospital, United States Military Academy, West Point, New York, USA
| | - Timothy N Taft
- University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | | | - Edwin M Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA, USA
| | - Armando F Vidal
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | | | | | | | - Michelle L Wolcott
- School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa, Iowa, USA
| | - James J York
- Orthopaedic and Sports Medicine Center, LLC, Pasedena, Maryland, USA
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14
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Wright RW, Huston LJ, Haas AK, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Pennings JS, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Steven J Svoboda L, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: Results From the MARS Cohort. Am J Sports Med 2020; 48:2978-2985. [PMID: 32822238 PMCID: PMC8171059 DOI: 10.1177/0363546520948850] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal preservation has been demonstrated to contribute to long-term knee health. This has been a successful intervention in patients with isolated tears and tears associated with anterior cruciate ligament (ACL) reconstruction. However, the results of meniscal repair in the setting of revision ACL reconstruction have not been documented. PURPOSE To examine the prevalence and 2-year operative success rate of meniscal repairs in the revision ACL setting. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS All cases of revision ACL reconstruction with concomitant meniscal repair from a multicenter group between 2006 and 2011 were selected. Two-year follow-up was obtained by phone and email to determine whether any subsequent surgery had occurred to either knee since the initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify the pathologic condition and subsequent treatment. RESULTS In total, 218 patients (18%) from 1205 revision ACL reconstructions underwent concurrent meniscal repairs. There were 235 repairs performed: 153 medial, 48 lateral, and 17 medial and lateral. The majority of these repairs (n = 178; 76%) were performed with all-inside techniques. Two-year surgical follow-up was obtained on 90% (197/218) of the cohort. Overall, the meniscal repair failure rate was 8.6% (17/197) at 2 years. Of the 17 failures, 15 were medial (13 all-inside, 2 inside-out) and 2 were lateral (both all-inside). Four medial failures were treated in conjunction with a subsequent repeat revision ACL reconstruction. CONCLUSION Meniscal repair in the revision ACL reconstruction setting does not have a high failure rate at 2-year follow-up. Failure rates for medial and lateral repairs were both <10% and consistent with success rates of primary ACL reconstruction meniscal repair. Medial tears underwent reoperation for failure at a significantly higher rate than lateral tears.
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15
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Spang R, Egan J, Hanna P, Lechtig A, Haber D, DeAngelis JP, Nazarian A, Ramappa AJ. Comparison of Patellofemoral Kinematics and Stability After Medial Patellofemoral Ligament and Medial Quadriceps Tendon-Femoral Ligament Reconstruction. Am J Sports Med 2020; 48:2252-2259. [PMID: 32551965 DOI: 10.1177/0363546520930703] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There is a lack of evidence regarding the optimum extensor-sided fixation method for medial patellofemoral ligament (MPFL) reconstruction. There is increased interest in avoiding patellar drilling via soft tissue-only fixation to the distal quadriceps, thus reconstructing the medial quadriceps tendon-femoral ligament (MQTFL). The biomechanical implications of differing extensor-sided fixation constructs remain unknown. HYPOTHESIS The null hypothesis was there would be no differences between traditional MPFL reconstruction and MQTFL reconstruction with respect to resistance to lateral translation, patellar position, or patellofemoral contact pressures. STUDY DESIGN Controlled laboratory study. METHODS Nine adult knee specimens were mounted on a jig that applied static, physiologic loads to the quadriceps tendons. Patellar position and orientation, knee flexion angle, and patellofemoral pressure were recorded at 8 different flexion angles between 0° and 110°. Additionally, a lateral patellar excursion test was conducted wherein a load was applied directly to the patella in the lateral direction with the knee at 30° of flexion and subjected to 2-N quadriceps loads. Testing was conducted under 4 conditions: intact, transected MPFL, MQTFL reconstruction, and MPFL reconstruction. For MQTFL reconstruction, the surgical technique established by Fulkerson was employed. For MPFL reconstruction, a traditional technique was utilized. RESULTS The patellar excursion test showed no significant difference between the MQTFL and intact states with respect to lateral translation. MPFL reconstruction led to significantly less lateral translation (P < .05) than all other states. There were no significant differences between MPFL and MQTFL reconstructions with respect to peak patellofemoral contact pressure. MPFL and MQTFL reconstructions both resulted in increased internal rotation of the patella with the knee in full extension. CONCLUSION Soft tissue-only extensor-sided fixation to the distal quadriceps (MQTFL) during patella stabilization appears to re-create native stability in this time 0 cadaver model. Fixation to the patella (MPFL) was associated with increased resistance to lateral translation. CLINICAL RELEVANCE Evolving anatomic knowledge and concern for patellar fracture has led to increased interest in MQTFL reconstruction. Both MQTFL and MPFL reconstructions restored patellofemoral stability to lateral translation without increasing contact pressures under appropriate graft tensioning, with MQTFL more closely restoring native resistance to lateral translation at the time of surgery.
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Affiliation(s)
- Robert Spang
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Egan
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Philip Hanna
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Aron Lechtig
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Haber
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, New England Baptist Hospital, Boston, Massachusetts, USA
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16
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Williamson PM, Hanna P, Momenzadeh K, Lechtig A, Okajima S, Ramappa AJ, DeAngelis JP, Nazarian A. Effect of rotator cuff muscle activation on glenohumeral kinematics: A cadaveric study. J Biomech 2020; 105:109798. [PMID: 32423544 DOI: 10.1016/j.jbiomech.2020.109798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
Abstract
Healthy shoulder function requires the coordination of the rotator cuff muscles to maintain the humeral head's position in the glenoid. While glenohumeral stability has been studied in various settings, few studies have characterized the effect of dynamic rotator cuff muscle loading on glenohumeral translation during shoulder motion. We hypothesize that dynamic rotator cuff muscle activation decreases joint translation during continuous passive abduction of the humerus in a cadaveric model of scapular plane glenohumeral abduction. The effect of different rotator cuff muscle activity on glenohumeral translation was assessed using a validated shoulder testing system. The Dynamic Load profile is a novel approach, based on musculoskeletal modeling of human subject motion. Passive humeral elevation in the scapular plane was applied via the testing system arm, while the rotator cuff muscles were activated according to the specified force profiles using stepper motors and a proportional control feedback loop. Glenohumeral translation was defined according to the International Society of Biomechanics. The Dynamic load profile minimized superior translation of the humeral head relative to the conventional loading profiles. The total magnitude of translation was not significantly different (0.805) among the loading profiles suggesting that the compressive forces from the rotator cuff primarily alter the direction of humeral head translation, not the magnitude. Rotator cuff muscle loading is an important element of cadaveric shoulder studies that must be considered to accurately simulate glenohumeral motion. A rotator cuff muscle activity profile based on human subject muscle activity reduces superior glenohumeral translation when compared to previous RC loading profiles.
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Affiliation(s)
- Patrick M Williamson
- Boston University, Mechanical Engineering Department, Boston, MA, USA; Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Philip Hanna
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Kaveh Momenzadeh
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Aron Lechtig
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stephen Okajima
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph P DeAngelis
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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17
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Wright RW, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Nwosu SK, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Brad Butler V J, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:2394-2401. [PMID: 31318611 PMCID: PMC7335592 DOI: 10.1177/0363546519862279] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients. PURPOSE/HYPOTHESIS The purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery. RESULTS A total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery. CONCLUSION PROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.
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18
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Bigouette JP, Owen EC, Lantz B(BA, Hoellrich RG, Huston LJ, Haas AK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Mann B, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures. Am J Sports Med 2019; 47:2056-2066. [PMID: 31225999 PMCID: PMC6939628 DOI: 10.1177/0363546519856348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery. HYPOTHESES Participants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates. RESULTS Two-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS-Sports and Recreation (P = .04), and KOOS-Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates. CONCLUSION Participation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.
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Affiliation(s)
| | - John P. Bigouette
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Erin C. Owen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rudolf G. Hoellrich
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Laura J. Huston
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Amanda K. Haas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christina R. Allen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Allen F. Anderson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel E. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas M. DeBerardino
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Warren R. Dunn
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Barton Mann
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kurt P. Spindler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael J. Stuart
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Rick W. Wright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John P. Albright
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Jack T. Andrish
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | | | - Robert A. Arciero
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bernard R. Bach
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Champ L. Baker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur R. Bartolozzi
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith M. Baumgarten
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffery R. Bechler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey H. Berg
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Geoffrey A. Bernas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Stephen F. Brockmeier
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert H. Brophy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles A. Bush-Joseph
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - J. Brad Butler
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - John D. Campbell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James L. Carey
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James E. Carpenter
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian J. Cole
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jonathan M. Cooper
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles L. Cox
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - R. Alexander Creighton
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Diane L. Dahm
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Tal S. David
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Flanigan
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert W. Frederick
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Theodore J. Ganley
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elizabeth A. Garofoli
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Charles J. Gatt
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven R. Gecha
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James Robert Giffin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Sharon L. Hame
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jo A. Hannafin
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher D. Harner
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Norman Lindsay Harris
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Keith S. Hechtman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Elliott B. Hershman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy M. Hosea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David C. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy S. Johnson
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Morgan H. Jones
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Christopher C. Kaeding
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Ganesh V. Kamath
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Thomas E. Klootwyk
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce A. Levy
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - C. Benjamin Ma
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - G. Peter Maiers
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. Marx
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew J. Matava
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Gregory M. Mathien
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - David R. McAllister
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Eric C. McCarty
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Robert G. McCormack
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Bruce S. Miller
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Carl W. Nissen
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Daniel F. O’Neill
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brett D. Owens
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard D. Parker
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Mark L. Purnell
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arun J. Ramappa
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michael A. Rauh
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Arthur C. Rettig
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jon K. Sekiya
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Kevin G. Shea
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Orrin H. Sherman
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James R. Slauterbeck
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Matthew V. Smith
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Jeffrey T. Spang
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Steven J. Svoboda
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Timothy N. Taft
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Joachim J. Tenuta
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Edwin M. Tingstad
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Armando F. Vidal
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Darius G. Viskontas
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Richard A. White
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James S. Williams
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Michelle L. Wolcott
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - Brian R. Wolf
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
| | - James J. York
- Investigation performed at Slocum Research and Education Foundation, Eugene, Oregon, USA
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Williamson P, Mohamadi A, Ramappa AJ, DeAngelis JP, Nazarian A. Shoulder biomechanics of RC repair and Instability: A systematic review of cadaveric methodology. J Biomech 2019; 82:280-290. [DOI: 10.1016/j.jbiomech.2018.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/19/2018] [Accepted: 11/01/2018] [Indexed: 01/11/2023]
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Cooper DE, Dunn WR, Huston LJ, Haas AK, Spindler KP, Allen CR, Anderson AF, DeBerardino TM, Lantz B(BA, Mann B, Stuart MJ, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ, Wright RW. Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group. Am J Sports Med 2018; 46:2836-2841. [PMID: 29882693 PMCID: PMC6170681 DOI: 10.1177/0363546518777732] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR. RESULTS Analyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03). CONCLUSION This study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).
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Affiliation(s)
| | - Daniel E. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Warren R. Dunn
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Laura J. Huston
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Amanda K. Haas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kurt P. Spindler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christina R. Allen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Allen F. Anderson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett (Brick) A. Lantz
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Barton Mann
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael J. Stuart
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John P. Albright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Annunziato (Ned) Amendola
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jack T. Andrish
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Annunziata
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert A. Arciero
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bernard R. Bach
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Champ L. Baker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith M. Baumgarten
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffery R. Bechler
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey H. Berg
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert H. Brophy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - J. Brad Butler V
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - John D. Campbell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James L. Carey
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James E. Carpenter
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian J. Cole
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jonathan M. Cooper
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles L. Cox
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - R. Alexander Creighton
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Diane L. Dahm
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Tal S. David
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Flanigan
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert W. Frederick
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Theodore J. Ganley
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Charles J. Gatt
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven R. Gecha
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James Robert Giffin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Sharon L. Hame
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jo A. Hannafin
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher D. Harner
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Norman Lindsay Harris
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Keith S. Hechtman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Elliott B. Hershman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy M. Hosea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David C. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy S. Johnson
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Morgan H. Jones
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Christopher C. Kaeding
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Ganesh V. Kamath
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce A. Levy
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - C. Benjamin Ma
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - G. Peter Maiers
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. Marx
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew J. Matava
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Gregory M. Mathien
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - David R. McAllister
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Eric C. McCarty
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Robert G. McCormack
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Bruce S. Miller
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Carl W. Nissen
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Daniel F. O’Neill
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brett D. Owens
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard D. Parker
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Mark L. Purnell
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arun J. Ramappa
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michael A. Rauh
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Arthur C. Rettig
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jon K. Sekiya
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Kevin G. Shea
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Orrin H. Sherman
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James R. Slauterbeck
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Matthew V. Smith
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Jeffrey T. Spang
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Steven J. Svoboda
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Timothy N. Taft
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Joachim J. Tenuta
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Edwin M. Tingstad
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Armando F. Vidal
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Darius G. Viskontas
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Richard A. White
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James S. Williams
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Michelle L. Wolcott
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Brian R. Wolf
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - James J. York
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
| | - Rick W. Wright
- Investigation performed at The Carrell Clinic, Dallas, Texas, USA; Department of Orthopaedics, Washington University School of Medicine, St Louis, Missouri, USA; Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA; and Reedsburg Area Medical Center, Reedsburg, Wisconsin, USA
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Xiao RC, DeAngelis JP, Smith CC, Ramappa AJ. Evaluating Nonoperative Treatments for Adhesive Capsulitis. J Surg Orthop Adv 2018; 26:193-199. [PMID: 29461189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients commonly present with shoulder complaints to the primary care and orthopaedic setting. The differential includes rotator cuff tears, subacromial impingement, osteoarthritis, and adhesive capsulitis, also known as frozen shoulder. Despite the prevalence of adhesive capsulitis, it is commonly misdiagnosed and management remains unclear. This article reviews the presentation of adhesive capsulitis, presents an overview of the pathophysiology of this poorly understood disease, and evaluates nonoperative treatment options for adhesive capsulitis. (Journal of Surgical Orthopaedic Advances 26(4):193-199, 2017).
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Affiliation(s)
- Ryan C Xiao
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Joseph P DeAngelis
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christopher C Smith
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Arun J Ramappa
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Address correspondence to: Arun J. Ramappa, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215; e-mail:
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22
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Spang Iii RC, Nasr MC, Mohamadi A, DeAngelis JP, Nazarian A, Ramappa AJ. Rehabilitation following meniscal repair: a systematic review. BMJ Open Sport Exerc Med 2018; 4:e000212. [PMID: 29682310 PMCID: PMC5905745 DOI: 10.1136/bmjsem-2016-000212] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2018] [Indexed: 02/01/2023] Open
Abstract
Objective To review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery. Methods and data sources Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies. Results Seventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair. Conclusions There is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.
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Affiliation(s)
- Robert C Spang Iii
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Nasr
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Amin Mohamadi
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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23
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Magnussen RA, Borchers JR, Pedroza AD, Huston LJ, Haas AK, Spindler KP, Wright RW, Kaeding CC, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz BA, Mann B, Stuart MJ, Albright JP, Amendola A, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study. Am J Sports Med 2018; 46:557-564. [PMID: 29244532 PMCID: PMC7004295 DOI: 10.1177/0363546517741484] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Articular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage. HYPOTHESIS Larger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Subjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery. RESULTS A total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had <33% of the medial meniscus excised at the time of the primary reconstruction had 4.8-times greater odds of progression of articular cartilage injury than those with an intact medial meniscus ( P = .02). Odds of significant chondral surface change increased by 5% in the lateral compartment and 6% in the medial compartment for each increased year of age ( P ≤ .02). For the patellofemoral compartment, the use of allograft in primary reconstruction was associated with a 15-fold increased odds of progression of articular cartilage damage relative to a patellar tendon autograft ( P < .001). Each 1-unit increase in BMI at the time of revision surgery was associated with a 10% increase in the odds of progression of articular cartilage damage ( P = .046) in the patellofemoral compartment. CONCLUSION Excision of the medial and lateral meniscus at primary ACL reconstruction increases the odds of articular cartilage damage in the corresponding compartment at the time of revision ACL reconstruction. Increased age is a risk factor for deterioration of articular cartilage in both tibiofemoral compartments, while increased BMI and the use of allograft for primary ACL reconstruction are associated with an increased risk of progression in the patellofemoral compartment.
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Affiliation(s)
| | - Robert A. Magnussen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Borchers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Angela D. Pedroza
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Laura J. Huston
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Amanda K. Haas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kurt P. Spindler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rick W. Wright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher C. Kaeding
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christina R. Allen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Allen F. Anderson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel E. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas M. DeBerardino
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Warren R. Dunn
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett A. Lantz
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Barton Mann
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael J. Stuart
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John P. Albright
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Annunziato Amendola
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jack T. Andrish
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Robert A. Arciero
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bernard R. Bach
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Champ L. Baker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur R. Bartolozzi
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith M. Baumgarten
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffery R. Bechler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey H. Berg
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Geoffrey A. Bernas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Stephen F. Brockmeier
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert H. Brophy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles A. Bush-Joseph
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - J. Brad Butler
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John D. Campbell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James L. Carey
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James E. Carpenter
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian J. Cole
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan M. Cooper
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles L. Cox
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - R. Alexander Creighton
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Diane L. Dahm
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tal S. David
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Flanigan
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert W. Frederick
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Theodore J. Ganley
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elizabeth A. Garofoli
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Charles J. Gatt
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven R. Gecha
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James Robert Giffin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sharon L. Hame
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jo A. Hannafin
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Christopher D. Harner
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Norman Lindsay Harris
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Keith S. Hechtman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Elliott B. Hershman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rudolf G. Hoellrich
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy M. Hosea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David C. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy S. Johnson
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Morgan H. Jones
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Ganesh V. Kamath
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Thomas E. Klootwyk
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce A. Levy
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - C. Benjamin Ma
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - G. Peter Maiers
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. Marx
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew J. Matava
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gregory M. Mathien
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David R. McAllister
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Eric C. McCarty
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert G. McCormack
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bruce S. Miller
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Carl W. Nissen
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Daniel F. O’Neill
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brett D. Owens
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard D. Parker
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mark L. Purnell
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arun J. Ramappa
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michael A. Rauh
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Arthur C. Rettig
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jon K. Sekiya
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kevin G. Shea
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Orrin H. Sherman
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James R. Slauterbeck
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Matthew V. Smith
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jeffrey T. Spang
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Steven J. Svoboda
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Timothy N. Taft
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joachim J. Tenuta
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Edwin M. Tingstad
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Armando F. Vidal
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Darius G. Viskontas
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Richard A. White
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James S. Williams
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Michelle L. Wolcott
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brian R. Wolf
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - James J. York
- Investigation performed at The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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24
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Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz B(BA, Mann B, Nwosu SK, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler V JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O’Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda LTCSJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2017; 45:2586-2594. [PMID: 28696164 PMCID: PMC5675127 DOI: 10.1177/0363546517712952] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Revision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction. HYPOTHESIS Certain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Patients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction. RESULTS A total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort. CONCLUSION There are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tal S. David
- Synergy Specialists Medical Group, San Diego, CA USA
| | | | | | | | | | | | | | - James Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London Ontario, Canada
| | - Sharon L. Hame
- David Geffen School of Medicine at UCLA, Los Angeles, CA USA
| | | | | | | | | | | | | | | | | | | | | | | | - Ganesh V. Kamath
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | | | | | | | | | | | | | | | - Eric C. McCarty
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brett D. Owens
- Warren Alpert Medical School, Brown University, Providence, RI USA
| | | | | | | | | | | | | | | | | | | | | | - Jeffrey T. Spang
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Timothy N. Taft
- University of North Carolina Medical Center, Chapel Hill, NC USA
| | | | - Edwin M. Tingstad
- Inland Orthopaedic Surgery and Sports Medicine Clinic, Pullman, WA USA
| | - Armando F. Vidal
- University of Colorado Denver School of Medicine, Denver, CO USA
| | | | | | | | | | - Brian R. Wolf
- University of Iowa Hospitals and Clinics, Iowa City, IA USA
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Ding DY, Zhang AL, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Haas AK, Huston LJ, Lantz BBA, Mann B, Spindler KP, Stuart MJ, Wright RW, Albright JP, Amendola AN, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Garofoli EA, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort. Am J Sports Med 2017; 45:2068-2076. [PMID: 28557557 PMCID: PMC5513777 DOI: 10.1177/0363546517707207] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. PURPOSE To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. RESULTS Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. CONCLUSION There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR.
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Affiliation(s)
- MARS Group
- Department of Orthopaedic Surgery, University of California San Francisco
| | | | - Alan L Zhang
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christina R Allen
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Allen F Anderson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel E Cooper
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas M DeBerardino
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Warren R Dunn
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Amanda K Haas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Laura J Huston
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brett Brick A Lantz
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Barton Mann
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kurt P Spindler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J Stuart
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rick W Wright
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John P Albright
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Annunziato Ned Amendola
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jack T Andrish
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher C Annunziata
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert A Arciero
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bernard R Bach
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Champ L Baker
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arthur R Bartolozzi
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Keith M Baumgarten
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffery R Bechler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey H Berg
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey A Bernas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Stephen F Brockmeier
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert H Brophy
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles A Bush-Joseph
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - J Brad Butler
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - John D Campbell
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James L Carey
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James E Carpenter
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian J Cole
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jonathan M Cooper
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles L Cox
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - R Alexander Creighton
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Diane L Dahm
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Tal S David
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David C Flanigan
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert W Frederick
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Theodore J Ganley
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Elizabeth A Garofoli
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Charles J Gatt
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven R Gecha
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James Robert Giffin
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sharon L Hame
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jo A Hannafin
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher D Harner
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Norman Lindsay Harris
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Keith S Hechtman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Elliott B Hershman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rudolf G Hoellrich
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy M Hosea
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David C Johnson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy S Johnson
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Morgan H Jones
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Christopher C Kaeding
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Ganesh V Kamath
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Thomas E Klootwyk
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bruce A Levy
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - G Peter Maiers
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Matava
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Gregory M Mathien
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - David R McAllister
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Eric C McCarty
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G McCormack
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Bruce S Miller
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Carl W Nissen
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Daniel F O'Neill
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brett D Owens
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard D Parker
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Mark L Purnell
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arun J Ramappa
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael A Rauh
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Arthur C Rettig
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jon K Sekiya
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Kevin G Shea
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Orrin H Sherman
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James R Slauterbeck
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew V Smith
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey T Spang
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Steven J Svoboda
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Timothy N Taft
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Joachim J Tenuta
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Edwin M Tingstad
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Armando F Vidal
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Darius G Viskontas
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Richard A White
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James S Williams
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michelle L Wolcott
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian R Wolf
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - James J York
- Investigation performed at the Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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Lacey M, Lamplot J, Walley KC, DeAngelis JP, Ramappa AJ. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling. World J Orthop 2017; 8:379-384. [PMID: 28567341 PMCID: PMC5434344 DOI: 10.5312/wjo.v8.i5.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/03/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail.
METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match the diameter of the prepared femoral tunnel. If the diameter of the patient’s autologous hamstring graft is insufficient to fill the prepared femoral tunnel, the autograft may be supplemented with an allograft. The remainder of the reconstruction is performed according to surgeon preference.
RESULTS The presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In cruciate ligament reconstruction, distal femoral and proximal tibial implants hardware may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft.
CONCLUSION This report demonstrates how the femoral tunnel can be created using the anteromedial portal instead of a transtibial approach for reconstruction of the ACL.
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Beamer BS, Walley KC, Okajima S, Manoukian OS, Perez-Viloria M, DeAngelis JP, Ramappa AJ, Nazarian A. Changes in Contact Area in Meniscus Horizontal Cleavage Tears Subjected to Repair and Resection. Arthroscopy 2017; 33:617-624. [PMID: 27956232 DOI: 10.1016/j.arthro.2016.09.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the changes in tibiofemoral contact pressure and contact area in human knees with a horizontal cleavage tear before and after treatment. METHODS Ten human cadaveric knees were tested. Pressure sensors were placed under the medial meniscus and the knees were loaded at twice the body weight for 20 cycles at 0°, 10°, and 20° of flexion. Contact area and pressure were recorded for the intact meniscus, the meniscus with a horizontal cleavage tear, after meniscal repair, after partial meniscectomy (single leaflet), and after subtotal meniscectomy (double leaflet). RESULTS The presence of a horizontal cleavage tear significantly increased average peak contact pressure and reduced effective average tibiofemoral contact area at all flexion angles tested compared with the intact state (P < .03). There was approximately a 70% increase in contact pressure after creation of the horizontal cleavage tear. Repairing the horizontal cleavage tear restored peak contact pressures and areas to within 15% of baseline, statistically similar to the intact state at all angles tested (P < .05). Partial meniscectomy and subtotal meniscectomy significantly increased average peak contact pressure and reduced average contact area at all degrees of flexion compared with the intact state (P < .05). CONCLUSIONS The presence of a horizontal cleavage tear in the medial meniscus causes a significant reduction in contact area and a significant elevation in contact pressure. These changes may accelerate joint degeneration. A suture-based repair of these horizontal cleavage tears returns the contact area and contact pressure to nearly normal, whereas both partial and subtotal meniscectomy lead to significant reductions in contact area and significant elevations in contact pressure within the knee. Repairing horizontal cleavage tears may lead to improved clinical outcomes by preserving meniscal tissue and the meniscal function. CLINICAL RELEVANCE Understanding contact area and peak contact pressure resulting from differing strategies for treating horizontal cleavage tears will allow the surgeon to evaluate the best strategy for treating his or her patients who present with this meniscal pathology.
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Affiliation(s)
- Brandon S Beamer
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Stephen Okajima
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Miguel Perez-Viloria
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A..
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Walley KC, Haghpanah B, Hingsammer A, Harlow ER, Vaziri A, DeAngelis JP, Nazarian A, Ramappa AJ. Influence of disruption of the acromioclavicular and coracoclavicular ligaments on glenohumeral motion: a kinematic evaluation. BMC Musculoskelet Disord 2016; 17:480. [PMID: 27855670 PMCID: PMC5112880 DOI: 10.1186/s12891-016-1330-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/06/2016] [Indexed: 12/18/2022] Open
Abstract
Background Changes to the integrity of the acromioclavicular (AC) joint impact scapulothoracic and clavicular kinematics. AC ligaments provide anterior-posterior stability, while the coracoclavicular (CC) ligaments provide superior-inferior stability and a restraint to scapular internal rotation. The purpose of this cadaveric study was to describe the effect of sequential AC and CC sectioning on glenohumeral (GH) kinematics during abduction (ABD) of the arm. We hypothesized that complete AC ligament insult would result in altered GH translation in the anterior-posterior plane during abduction, while subsequent sectioning of both CC ligaments would result in an increasing inferior shift in GH translation. Methods Six cadaveric shoulders were studied to evaluate the impact of sequential sectioning of AC and CC ligaments on GH kinematics throughout an abduction motion in the coronal plane. Following an examination of the baseline, uninjured kinematics, the AC ligaments were then sectioned sequentially: (1) Anterior, (2) Inferior, (3) Posterior, and (4) Superior. Continued sectioning of CC ligamentous structures followed: the (5) trapezoid and then the (6) conoid ligaments. For each group, the GH translation and the area under the curve (AUC) were measured during abduction using an intact cadaveric shoulder. Total translation was calculated for each condition between ABD 30° and ABD 150° using the distance formula, and a univariate analysis was used to compare total translation for each axis during the different conditions. Results GH kinematics were not altered following sequential resection of the AC ligaments. Disruption of the trapezoid resulted in significant anterior and lateral displacement of the center of GH rotation. Sectioning the conoid ligament further increased the inferior shift in GH displacement. Conclusion A combined injury of the AC and CC ligaments significantly alters GH kinematics during abduction. Type III AC separations, result in a significant change in the shoulder’s motion and may warrant surgical reconstruction to restore normal function.
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Affiliation(s)
- Kempland C Walley
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Babak Haghpanah
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Andreas Hingsammer
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. .,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA, 02215, USA.
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Haghpanah B, Walley KC, Hingsammer A, Harlow ER, Oftadeh R, Vaziri A, Ramappa AJ, DeAngelis JP, Nazarian A. The effect of the rotator interval on glenohumeral kinematics during abduction. BMC Musculoskelet Disord 2016; 17:46. [PMID: 26818612 PMCID: PMC4730735 DOI: 10.1186/s12891-016-0898-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 01/19/2016] [Indexed: 11/14/2022] Open
Abstract
Background The rotator interval (RI) has been exploited as a potentially benign point of entry into the glenohumeral (GH) joint. Bounded by the supraspinatus, subscapularis and coracoid process of the scapula, the RI is believed to be important in the shoulder’s soft tissue balancing and function. However, the role of the RI in shoulder kinematics is not fully understood. The purpose of this study is to describe the effect of the RI on GH motion during abduction of the arm. Methods Six shoulders from three cadaveric torsos were studied to assess the impact of changes in the RI during abduction under four conditions: Intact (Baseline), Opened, Repaired (repaired with side-to-side tissue approximation, no overlap) and Tightened (repaired with 1 cm overlap). For each group, the GH translation and area under the Curve (AUC) were measured during abduction using an intact cadaveric shoulder (intact torso). Results GH kinematics varied in response to each intervention and throughout the entire abduction arc. Opening the RI caused a significant change in GH translation. The Repair and Tightened groups behaved similarly along all axes of GH motion. Conclusions The RI is central to normal GH kinematics. Any insult to the tissue’s integrity alters the shoulder’s motion throughout abduction. In this model, closing the RI side-to-side has the same effect as tightening the RI. Since suture closure may offer the same benefit as tightening the RI, clinicians should consider this effect when treating patients with shoulder laxity. This investigation provides an improved perspective on the role of the RI on GH kinematics during abduction. When managing shoulder pathology, surgeons should consider how these different methods of RI closure affect the joint’s motion. In different circumstances, the surgical approach to the RI can be tailored to address each patient’s specific needs.
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Affiliation(s)
- Babak Haghpanah
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA. .,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.
| | - Andreas Hingsammer
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA.
| | - Ramin Oftadeh
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA. .,Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
| | - Ashkan Vaziri
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN115, Boston, MA, 02215, USA. .,Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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DeAngelis JP, Hertz B, Wexler MT, Patel N, Walley KC, Harlow ER, Manoukian OS, Masoudi A, Vaziri A, Ramappa AJ, Nazarian A. Posterior Capsular Plication Constrains the Glenohumeral Joint by Drawing the Humeral Head Closer to the Glenoid and Resisting Abduction. Orthop J Sports Med 2015; 3:2325967115599347. [PMID: 26535390 PMCID: PMC4622307 DOI: 10.1177/2325967115599347] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Shoulder pain is a common problem, with 30% to 50% of the American population affected annually. While the majority of these shoulder problems improve, there is a high rate of recurrence, as 54% of patients experience persistent symptoms 3 years after onset. PURPOSE Posterior shoulder tightness has been shown to alter glenohumeral (GH) kinematics. Clinically, posterior shoulder contractures result in a significant loss of internal rotation and abduction (ABD). In this study, the effect of a posterior capsular contracture on GH kinematics was investigated using an intact cadaveric shoulder without violating the joint capsule or the rotator cuff. STUDY DESIGN Controlled laboratory study. METHODS Glenohumeral motion, humeral load, and subacromial contact pressure were measured in 6 fresh-frozen left shoulders during passive ABD from 60° to 100° using an automated robotic upper extremity testing system. Baseline values were compared with the experimental condition in which the full thickness of posterior tissues was plicated without decompressing the joint capsule. RESULTS Posterior soft tissue plication resulted in increased compression between the humeral head and the glenoid (axial load) at 90° of ABD. Throughout ABD, the posterior contracture increased the anterior and superior moment on the humeral head, but it did not change the GH kinematics in this intact model. As a result, there was no increase in the subacromial contact pressure during ABD with posterior plication. CONCLUSION In an intact cadaveric shoulder, posterior contracture does not alter GH motion or subacromial contact pressure during passive ABD. By tightening the soft tissue envelope posteriorly, there is an increase in compressive load on the articular cartilage and anterior/superior force on the humeral head. These findings suggest that subacromial impingement in the setting of a posterior soft tissue contracture may result from alterations in scapulothoracic motion, not changes in GH kinematics. CLINICAL RELEVANCE This investigation demonstrates that posterior capsular plication increases the axial load on the shoulder joint during ABD. While a significant difference from baseline was observed in the plicated condition, posterior capsular plication did not change GH motion or subacromial contact pressure significantly.
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Affiliation(s)
- Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benjamin Hertz
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Michael T Wexler
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Nehal Patel
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Mechanical Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA. ; Department of Biomedical Engineering, University of Connecticut, Storrs, Connecticut, USA
| | - Aidin Masoudi
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ashkan Vaziri
- Department of Mechanical Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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DeAngelis JP, Chen A, Wexler M, Hertz B, Grimaldi Bournissaint L, Nazarian A, Ramappa AJ. Biomechanical characterization of unicortical button fixation: a novel technique for proximal subpectoral biceps tenodesis. Knee Surg Sports Traumatol Arthrosc 2015; 23:1434-1441. [PMID: 24253375 DOI: 10.1007/s00167-013-2775-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 11/07/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE Proximal biceps tenodesis is one method for treating biceps-related pain. Tenodesis protects the length-tension relationship of the biceps muscle, maintains strength, and provides a better cosmetic appearance than tenotomy. The purpose of this investigation was to compare the mechanical properties of a unicortical metal button and an interference screw in proximal biceps tenodesis. METHODS Six pairs of fresh-frozen shoulders were dissected, leaving the proximal biceps tendon as a free graft. On each pair of shoulders, a biceps tenodesis was performed using an interference screw or a unicortical metal button. The specimens were mounted and a cyclic load (10-60 N) was applied at 1 Hz for 200 cycles, followed by an axial load to failure. The displacement, ultimate load to failure, and mode of failure were recorded. RESULTS Displacement in response to cyclic loading was 3.7 ± 2.2 mm for the interference screw and 1.9 ± 1.0 mm for the cortical button (P = 0.03). Load at failure for the interference screw was 191 ± 64 N (stiffness: 24 ± 11 N/mm) and 183 ± 61 N (stiffness: 24 ± 7. N/mm) for the unicortical button (P = n.s. for both cases). CONCLUSIONS As a novel technique for subpectoral biceps tenodesis, a unicortical button demonstrated significantly less displacement in response to cyclic loading than the interference screw. The ultimate load to failure and stiffness for the two methods were not different. In this way, a unicortical button may provide a reliable alternative method of fixation with a potentially lower risk of post-operative humeral fracture and a construct that permits early mobilization following biceps tenodesis.
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Affiliation(s)
- Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, USA.
| | - Alvin Chen
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael Wexler
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Benjamin Hertz
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Leandro Grimaldi Bournissaint
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Department of Orthopaedic Surgery, Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA, USA
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Masoudi A, Beamer BS, Harlow ER, Manoukian OS, Walley KC, Hertz B, Haeussler C, Olson JJ, Zurakowski D, Nazarian A, Ramappa AJ, DeAngelis JP. Biomechanical evaluation of an all-inside suture-based device for repairing longitudinal meniscal tears. Arthroscopy 2015; 31:428-34. [PMID: 25442653 DOI: 10.1016/j.arthro.2014.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/15/2014] [Accepted: 08/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE A device for all-inside suture-based meniscal repairs has been introduced (NovoStitch; Ceterix, Menlo Park, CA) that passes the suture vertically through the meniscus, thereby encircling the tear, and does not require an additional incision or extra-capsular anchors. Our aim was to compare this all-inside suture-based repair with an inside-out suture repair and an all-inside anchor-based repair (FasT-Fix 360°; Smith & Nephew, Andover, MA). METHODS Longitudinal tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using an all-inside suture-based meniscal repair device, an all-inside anchor-based repair, and an inside-out suture repair. They were tested with cyclic loading and load-to-failure testing. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded. The stiffness of the constructs was calculated as well. RESULTS The all-inside suture-based repairs and the inside-out repairs showed significantly higher loads to failure than the all-inside anchor-based repairs. The stiffness values for the 3 repairs were not different. There were no differences in initial displacement. After 100, 300, and 500 cycles, the inside-out repair had higher gap formation (displacement) than the other 2 groups. Suture failure was the predominant mode of failure across all repair techniques. CONCLUSIONS The all-inside suture-based repairs and inside-out repairs did not exhibit different load-to-failure values. In addition, the all-inside suture-based repairs and the all-inside anchor-based repairs did not exhibit different displacement values during cyclic loading. CLINICAL RELEVANCE When addressing a longitudinal meniscal tear, surgeons should consider biomechanical data of various repair devices and techniques in their decision-making process to maximize the mechanical strength and healing probability of the repair.
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Affiliation(s)
- Aidin Masoudi
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Brandon S Beamer
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Benjamin Hertz
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudia Haeussler
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey J Olson
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Zurakowski
- Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A..
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Beamer BS, Masoudi A, Walley KC, Harlow ER, Manoukian OS, Hertz B, Haeussler C, Olson JJ, Deangelis JP, Nazarian A, Ramappa AJ. Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears. Arthroscopy 2015; 31:293-8. [PMID: 25312766 DOI: 10.1016/j.arthro.2014.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. METHODS Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. RESULTS The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P < .001). CONCLUSIONS For repair of radial tears of the meniscus, the vertical suture configuration created by the all-inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. CLINICAL RELEVANCE In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes.
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Affiliation(s)
- Brandon S Beamer
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Aidin Masoudi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ben Hertz
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudia Haeussler
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey J Olson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P Deangelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A..
| | - Arun J Ramappa
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
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Cereatti A, Rosso C, Nazarian A, DeAngelis JP, Ramappa AJ, Croce UD. Scapular Motion Tracking Using Acromion Skin Marker Cluster: In Vitro Accuracy Assessment. J Med Biol Eng 2015. [DOI: 10.1007/s40846-015-0010-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rosso C, Mueller AM, McKenzie B, Entezari V, Cereatti A, Della Croce U, Ramappa AJ, Nazarian A, DeAngelis JP. Bulk effect of the deltoid muscle on the glenohumeral joint. J Exp Orthop 2014; 1:14. [PMID: 26914759 PMCID: PMC4546007 DOI: 10.1186/s40634-014-0014-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/31/2014] [Indexed: 11/10/2022] Open
Abstract
Background There remains controversy on the role of the deltoid on glenohumeral translations during basic and pitching motions. We thus studied the passive effect of the deltoid on the deltoid glenohumeral joint center (GHJC). Methods Six shoulders were tested using an automated mechanical system. A baseline motion pattern of the intact specimen was contrasted with glenohumeral translation after removal of the deltoid. Each condition was evaluated in abduction (ABD) and an abbreviated throwing motion (ATM) using retro-reflective, bone-embedded markers. The absolute trajectory and the area under the curve (AUC) for each motion were calculated and glenohumeral kinematics with respect to the GH translation were compared. Results The removal of the deltoid resulted in significant changes of the GH translation. During 30-60° of ABD, it resulted in a superior and more anterior GH translation, while in the 60-90° segment in a more inferior and medial GH translation. During 90-120°, the GH translation was medialized. In the pitching motion from maximum external rotation to 90° of external rotation (ER), the removal of the deltoid resulted in a more superior, anterior and lateral GH translation. Thus limits anterior translation in the abduction-external rotation position. In the remaining segments (90-80° and 80-45° of ER), it resulted in a lateralization of the GH translation. Conclusions Modelling the throwing shoulder, the deltoid has a significant influence on glenohumeral motion. Athletes with deltoid dysfunction and limited range of motion are at risk for injury due to the resulting change in their throwing mechanics.
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Affiliation(s)
- Claudio Rosso
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. .,Orthopaedic Department, University Hospital Basel and University of Basel, Basel, Switzerland. .,Altius Swiss Sportsmed Center, Rheinfelden, Switzerland.
| | - Andreas M Mueller
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA. .,Orthopaedic Department, University Hospital Basel and University of Basel, Basel, Switzerland.
| | - Brett McKenzie
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Vahid Entezari
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Andrea Cereatti
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy.
| | - Ugo Della Croce
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy.
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, 02215, MA, USA.
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, 02215, MA, USA.
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Wright RW, Huston LJ, Haas AK, Spindler KP, Nwosu SK, Allen CR, Anderson AF, Cooper DE, DeBerardino TM, Dunn WR, Lantz B(BA, Stuart MJ, Garofoli EA, Albright JP, Amendola A(N, Andrish JT, Annunziata CC, Arciero RA, Bach BR, Baker CL, Bartolozzi AR, Baumgarten KM, Bechler JR, Berg JH, Bernas GA, Brockmeier SF, Brophy RH, Bush-Joseph CA, Butler JB, Campbell JD, Carey JL, Carpenter JE, Cole BJ, Cooper JM, Cox CL, Creighton RA, Dahm DL, David TS, Flanigan DC, Frederick RW, Ganley TJ, Gatt CJ, Gecha SR, Giffin JR, Hame SL, Hannafin JA, Harner CD, Harris NL, Hechtman KS, Hershman EB, Hoellrich RG, Hosea TM, Johnson DC, Johnson TS, Jones MH, Kaeding CC, Kamath GV, Klootwyk TE, Levy BA, Ma CB, Maiers GP, Marx RG, Matava MJ, Mathien GM, McAllister DR, McCarty EC, McCormack RG, Miller BS, Nissen CW, O'Neill DF, Owens BD, Parker RD, Purnell ML, Ramappa AJ, Rauh MA, Rettig AC, Sekiya JK, Shea KG, Sherman OH, Slauterbeck JR, Smith MV, Spang JT, Svoboda SJ, Taft TN, Tenuta JJ, Tingstad EM, Vidal AF, Viskontas DG, White RA, Williams JS, Wolcott ML, Wolf BR, York JJ. Effect of graft choice on the outcome of revision anterior cruciate ligament reconstruction in the Multicenter ACL Revision Study (MARS) Cohort. Am J Sports Med 2014; 42:2301-10. [PMID: 25274353 PMCID: PMC4447184 DOI: 10.1177/0363546514549005] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
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 included baseline demographics, surgical technique, pathologic abnormalities, and the results of a series of validated, patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating score). Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Incidences of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft rerupture, and reoperation rate at 2 years after revision surgery. RESULTS A total of 1205 patients (697 [58%] males) were enrolled. The median age was 26 years. In 88% of patients, this was their first revision, and 341 patients (28%) were undergoing revision by the surgeon who had performed the previous reconstruction. The median time since last ACL reconstruction was 3.4 years. Revision using an autograft was performed in 583 patients (48%), allograft was used in 590 (49%), and both types were used in 32 (3%). Questionnaire follow-up was obtained for 989 subjects (82%), while telephone follow-up was obtained for 1112 (92%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at 2-year follow-up (P < .001). In contrast, the 2-year Marx activity score demonstrated a significant decrease from the initial score at enrollment (P < .001). Graft choice proved to be a significant predictor of 2-year IKDC scores (P = .017). Specifically, the use of an autograft for revision reconstruction predicted improved score on the IKDC (P = .045; odds ratio [OR] = 1.31; 95% CI, 1.01-1.70). The use of an autograft predicted an improved score on the KOOS sports and recreation subscale (P = .037; OR = 1.33; 95% CI, 1.02-1.73). Use of an autograft also predicted improved scores on the KOOS quality of life subscale (P = .031; OR = 1.33; 95% CI, 1.03-1.73). For the KOOS symptoms and KOOS activities of daily living subscales, graft choice did not predict outcome score. Graft choice was a significant predictor of 2-year Marx activity level scores (P = .012). Graft rerupture was reported in 37 of 1112 patients (3.3%) by their 2-year follow-up: 24 allografts, 12 autografts, and 1 allograft and autograft. Use of an autograft for revision resulted in patients being 2.78 times less likely to sustain a subsequent graft rupture compared with allograft (P = .047; 95% CI, 1.01-7.69). CONCLUSION Improved sports function and patient-reported outcome measures are obtained when an autograft is used. Additionally, use of an autograft shows a decreased risk in graft rerupture at 2-year follow-up. No differences were noted in rerupture or patient-reported outcomes between soft tissue and bone-patellar tendon-bone grafts. Surgeon education regarding the findings of this study has the potential to improve the results of revision ACL reconstruction.
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Affiliation(s)
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- Arthroscopic and Orthopedic Sports Medicine Associates
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- Keller Army Community Hospital-United States Military Academy
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Mueller AM, Rosso C, Entezari V, McKenzie B, Hasebroock A, Cereatti A, Della Croce U, Nazarian A, Ramappa AJ, DeAngelis JP. The effect of supraspinatus tears on glenohumeral translations in passive pitching motion. Am J Sports Med 2014; 42:2455-62. [PMID: 25201441 DOI: 10.1177/0363546514547348] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Supraspinatus tears are common in pitchers. However, the effect of these tears on glenohumeral (GH) mechanics is incompletely understood. PURPOSE/HYPOTHESIS To describe the effect of supraspinatus tears and repairs on GH kinematics during an abbreviated throwing motion using the intact shoulder girdle. The hypothesis was that supraspinatus tears would lead to an increase of GH translation in the coronal plane and supraspinatus repairs would restore GH kinematics. STUDY DESIGN Controlled laboratory study. METHODS Six shoulders from 3 fresh-frozen cadavers were tested in a novel 7 degrees of freedom robotic testing system. Torsos were mounted and the wrist was pinned to an actuator mounted on an upper frame. After the deltoid was removed, the shoulders were studied during an abbreviated throwing motion (ATM) from maximum external rotation to the midcoronal plane to establish a baseline. The ATM was repeated after creation of a 1-cm supraspinatus tear, after creation of a 3-cm supraspinatus tear, and after repair with a transosseous equivalent (TOE) technique. Retroreflective bone markers and high-speed infrared cameras were used to measure GH kinematics and calculate the center of rotation of the GH joint (CORGH) instantaneously. RESULTS The 1- and 3-cm supraspinatus tears did not significantly alter GH translation. The TOE repair shifted the CORGH posteriorly, as evidenced by a significant decrease in the overall GH translation in all 3 planes (P = .003, .019, and .026, for x-y, y-z, and x-z planes, respectively). CONCLUSION In contrast to a TOE repair of the supraspinatus tendon, isolated supraspinatus tears did not perturb GH kinematics in this cadaveric model of the throwing shoulder. CLINICAL RELEVANCE In throwing athletes, treatment of rotator cuff tears should be addressed with caution to avoid an unintended alteration in GH kinematics due to overtightening of the tendon.
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Affiliation(s)
- Andreas M Mueller
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Claudio Rosso
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Orthopaedic Department, University Hospital Basel, Basel, Switzerland
| | - Vahid Entezari
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Brett McKenzie
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Hasebroock
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Ugo Della Croce
- Information Engineering Unit, POLCOMING Department, University of Sassari, Sassari, Italy
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Ramappa AJ, Patel V, Goswami K, Zurakowski D, Yablon C, Rodriguez EK, Appleton P, DeAngelis JP. Using computed tomography to assess proximal humerus fractures. Am J Orthop (Belle Mead NJ) 2014; 43:E43-E47. [PMID: 24660183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Computed tomography (CT) scans are often used to evaluate proximal humerus fractures. We conducted a study to determine if use of preoperative CT scans affects surgical decision-making with respect to proximal humerus fractures. Three board-certified orthopedic surgeons interpreted plain radiographs of 40 proximal humerus fractures and then CT scans with reformatted images. Results were assessed for interrater reliability. Use of CT significantly improved interobserver reliability in fracture characterization and assessment. Surgeons were more likely to identify a displaced fracture (P < .01), an impaction (P < .001), and involvement of the anatomical neck (P < .03). However, CT did not improve agreement with use of AO (Arbeitsgemeinschaft für Osteosynthesefragen) fracture classification and did not significantly alter treatment recommendations. CT scans provide more detail about the character of proximal humerus fractures (displacement, involved segments) but do not significantly influence surgical treatment recommendations when compared with plain radiographs alone.
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Affiliation(s)
- Arun J Ramappa
- Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA.
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Ramappa AJ, Chen A, Hertz B, Wexler M, Grimaldi Bournissaint L, DeAngelis JP, Nazarian A. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair. Am J Sports Med 2014; 42:194-9. [PMID: 24114752 DOI: 10.1177/0363546513505190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. PURPOSE To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. STUDY DESIGN Controlled laboratory study. METHODS Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. RESULTS The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. CONCLUSION With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. CLINICAL RELEVANCE The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.
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Affiliation(s)
- Arun J Ramappa
- Ara Nazarian, Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN115, Boston, MA 02215.
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Rosso C, Müller AM, Entezari V, Dow WA, McKenzie B, Stanton SK, Li D, Cereatti A, Ramappa AJ, DeAngelis JP, Nazarian A, Della Croce U. Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics. J Orthop Surg Res 2013; 8:24. [PMID: 23883431 PMCID: PMC3724692 DOI: 10.1186/1749-799x-8-24] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/15/2013] [Indexed: 11/12/2022] Open
Abstract
Background The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. Methods To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. Results We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. Discussion The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision.
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Affiliation(s)
- Claudio Rosso
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Mueller AM, Entezari V, Rosso C, McKenzie B, Hasebrock A, Cereatti A, Della Croce U, Deangelis JP, Nazarian A, Ramappa AJ. The effect of simulated scapular winging on glenohumeral joint translations. J Shoulder Elbow Surg 2013; 22:986-92. [PMID: 23313371 DOI: 10.1016/j.jse.2012.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS In this study, we aim to test whether scapular winging results in a significant change in glenohumeral translation in the initial phase of the throwing motion. METHODS Six shoulders underwent an abbreviated throwing motion (ATM) from late cocking to the end of acceleration by use of a validated robotic system. The intact specimens were tested to establish a baseline. The position of the scapula was then affected to simulate scapular winging by placing a cylindrical wedge under the inferior angle of the scapula, and the ATM was performed again. For both conditions, the average glenohumeral translations and scapular rotations were plotted over time to calculate the area under the curve, as a representative of the overall glenohumeral translations and scapular rotations observed during the ATM. RESULTS Throughout the motion, the winged scapulae showed, on average, 7.7° more upward rotation, 1.6° more internal rotation, and 5.3° more anterior tipping as compared with the baseline. The scapular position relative to the hanging arm was significantly different between the baseline and scapular winging conditions in all arm positions, except for maximal external rotation and the neutral position. Comparing the area under the curve at baseline and with scapular winging indicated that scapular winging significantly increased anterior translation of the glenohumeral joint whereas translation in the superior/inferior and medial/lateral directions did not result in a change in translation. DISCUSSION These results may suggest a more important role of abnormalities in scapular position in predisposing throwing athletes to shoulder injuries of the anterior capsulolabral structures and consecutive glenohumeral instability.
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Affiliation(s)
- Andreas M Mueller
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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McGlaston TJ, Kim DW, Schrodel P, DeAngelis JP, Ramappa AJ. Few insurance-based differences in upper extremity elective surgery rates after healthcare reform. Clin Orthop Relat Res 2012; 470:1917-24. [PMID: 22451335 PMCID: PMC3369096 DOI: 10.1007/s11999-012-2305-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 02/22/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND Before the US Patient Protection and Affordable Care Act of 2010, there were documented insurance-based disparities in access to orthopaedic surgeons and care of orthopaedic conditions. While Massachusetts passed healthcare reform in 2007 with many similar provisions, it is unknown whether the disparities were present during the period of the law's enactment. QUESTIONS/PURPOSES We asked whether differences in rates of surgery between patients with novel government-subsidized healthcare plans and other forms of insurance, and between uninsured and insured patients, were similar after institution of the Massachusetts reform laws. METHODS We identified 7577 patients diagnosed with upper extremity injuries between January 1, 2007 and October 1, 2010. From an institutional administrative database, we extracted demographics, insurance status, and plan of care. Insurance categories included government-subsidized healthcare plan (Commonwealth Care), private insurance, workers compensation, military-related (TriCare), Medicare, Medicaid (MassHealth), non-Commonwealth Care, and other insured and uninsured. After adjusting for age, gender, and diagnosis, we compared the proportions of patients who underwent elective surgery. RESULTS Of 7577 patients, 1685 (22%) underwent elective upper extremity surgery. The adjusted rates of surgery were similar across most insurance categories, with higher rates in the workers compensation and TriCare categories compared with Commonwealth Care. Uninsured patients were as likely to undergo surgery as insured patients. CONCLUSION In a population with near-universal health insurance, a government-run health insurance exchange, and novel, government-subsidized, managed care plans, we found few insurance-based differences in rates of elective upper extremity orthopaedic surgery in a cohort of patients after healthcare reform.
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Affiliation(s)
- Timothy J. McGlaston
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115 USA
| | - Daniel W. Kim
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115 USA
| | - Philip Schrodel
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115 USA
| | - Joseph P. DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115 USA
| | - Arun J. Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Stoneman 10, Boston, MA 02115 USA
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Entezari V, Trechsel BL, Dow WA, Stanton SK, Rosso C, Müller A, McKenzie B, Vartanians V, Cereatti A, Della Croce U, Deangelis JP, Ramappa AJ, Nazarian A. Design and manufacture of a novel system to simulate the biomechanics of basic and pitching shoulder motion. Bone Joint Res 2012; 1:78-85. [PMID: 23610675 PMCID: PMC3626244 DOI: 10.1302/2046-3758.15.2000051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 04/11/2012] [Indexed: 11/05/2022] Open
Abstract
Objectives Cadaveric models of the shoulder evaluate discrete motion segments
using the glenohumeral joint in isolation over a defined trajectory.
The aim of this study was to design, manufacture and validate a
robotic system to accurately create three-dimensional movement of
the upper body and capture it using high-speed motion cameras. Methods In particular, we intended to use the robotic system to simulate
the normal throwing motion in an intact cadaver. The robotic system
consists of a lower frame (to move the torso) and an upper frame
(to move an arm) using seven actuators. The actuators accurately
reproduced planned trajectories. The marker setup used for motion
capture was able to determine the six degrees of freedom of all
involved joints during the planned motion of the end effector. Results The testing system demonstrated high precision and accuracy based
on the expected versus observed displacements of individual axes.
The maximum coefficient of variation for displacement of unloaded
axes was less than 0.5% for all axes. The expected and observed
actual displacements had a high level of correlation with coefficients
of determination of 1.0 for all axes. Conclusions Given that this system can accurately simulate and track simple
and complex motion, there is a new opportunity to study kinematics
of the shoulder under normal and pathological conditions in a cadaveric
shoulder model.
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Affiliation(s)
- V Entezari
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, USA
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Lin MM, Goldsmith JD, Resch SC, DeAngelis JP, Ramappa AJ. Histologic examinations of arthroplasty specimens are not cost-effective: a retrospective cohort study. Clin Orthop Relat Res 2012; 470:1452-60. [PMID: 22057818 PMCID: PMC3314760 DOI: 10.1007/s11999-011-2149-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 10/10/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many hospitals require all operative specimens be sent to pathologists for routine examination. Although previous studies indicate this practice increases medical cost, it remains unclear whether it alters patient management and whether it is cost-effective. QUESTIONS/PURPOSES We therefore (1) determined the rate of discordance between clinical and histologic examinations of routine operative specimens during elective primary arthroplasties, (2) determined the cost of routine histologic screening, and (3) estimated its cost-effectiveness in terms of cost per quality-adjusted life year gained, as compared with gross examination or no examination. METHODS We retrospectively reviewed medical records of 1247 patients who underwent 1363 routine elective primary total joint arthroplasties between January 18, 2006 and March 15, 2010. We compared preoperative, postoperative, and histologic diagnoses for each patient and categorized them into three classes: concordant (clinical and histologic diagnoses agreed), discrepant (diagnoses differed but with no resultant change in treatment), and discordant (diagnoses differed with resultant change in treatment). Medicare reimbursements were determined through the pathology department's administrative office. RESULTS In 1363 cases, 1335 (97.9%) clinical and histologic diagnoses were concordant, 28 (2.1%) were discrepant, and none were discordant. Total reimbursement for routine pathological examination was $139,532, or $102.37 per specimen. The average cost to identify each discrepant case was $4983.29. Routine histologic examination did not alter patient management, and there was no direct gain in quality-adjusted life years. CONCLUSIONS Our observations show routine histologic examinations of routine operative specimens during elective primary arthroplasties increase medical cost but rarely alter patient management and are not cost-effective. LEVEL OF EVIDENCE Level I, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michael M. Lin
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215 USA
| | - Jeffrey D. Goldsmith
- Department of Anatomic Pathology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Stephen C. Resch
- Center for Health Decision Science, Harvard School of Public Health, Boston, MA USA
| | - Joseph P. DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215 USA
| | - Arun J. Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215 USA
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Rosso C, Kovtun K, Dow W, McKenzie B, Nazarian A, DeAngelis JP, Ramappa AJ. Comparison of all-inside meniscal repair devices with matched inside-out suture repair. Am J Sports Med 2011; 39:2634-9. [PMID: 21997730 DOI: 10.1177/0363546511424723] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair. HYPOTHESIS All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing. STUDY DESIGN Controlled laboratory study. METHODS Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated. RESULTS The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested (P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P < .001) and the Ultra FasT-Fix (88.3 ± 14.3 N, P = .002). It was not significantly higher than the inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure. CONCLUSION An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch. CLINICAL RELEVANCE Inside-out sutures and all-inside devices have similar responses to cyclic loading.
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Affiliation(s)
- Claudio Rosso
- Center for Advanced Orthopaedic Studies, Harvard Medical School, Boston, Massachusetts, USA
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46
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Abstract
BACKGROUND Uninsured and underinsured Americans face barriers to access to medical care. The objective of this study was to characterize the effect of insurance status on whether patients with a torn meniscus proceed to elective arthroscopic knee surgery. METHODS The records from January 2003 through April 2006 at a single academic orthopaedic surgery institution in Massachusetts were retrospectively reviewed to identify patients diagnosed with a meniscal tear and to determine whether surgery had been performed within six months after the diagnosis. Six categories of insurance were identified: private insurance, Workers' Compensation, Medicare, Medicaid, Uncompensated Care Pool, and self pay. A comparison of the proportions of insured and uninsured patients who underwent surgery was the primary outcome measure. RESULTS A total of 1127 patients were identified, and 446 (40%) of them underwent surgery within six months after an office visit. The patients with and without surgery had similar age and sex distributions. When patients were divided, according to their insurance status, into insured and uninsured groups, no significant difference was found in the rate of surgery (p = 0.23). However, subgroup analysis revealed significant differences among the six insurance categories. Logistic regression analysis showed that patients in the self-pay group had a lower rate of surgery than those with private insurance (odds ratio, 0.33; 95% confidence interval, 0.14 to 0.75; p = 0.008), whereas patients receiving Workers' Compensation (odds ratio, 1.93; 95% confidence interval, 1.05 to 3.55; p = 0.034) and those receiving Medicaid (odds ratio, 1.63; 95% confidence interval, 1.09 to 2.42; p = 0.016) had higher surgical rates than those with private insurance. CONCLUSIONS The rate of elective arthroscopic knee surgery for meniscal tears varied significantly for some insurance categories at this single academic institution in Massachusetts. Further work is necessary to clarify the patient and surgeon factors influencing these disparities in clinical decision-making.
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Affiliation(s)
- Kenneth R Gundle
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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47
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Julien TP, Ramappa AJ, Rodriguez EK. Femoral condylar fracture through a femoral tunnel eleven years after anterior cruciate ligament reconstruction: a case report. J Bone Joint Surg Am 2010; 92:963-7. [PMID: 20360522 DOI: 10.2106/jbjs.i.00408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Terrill P Julien
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215, USA
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48
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Steadman JR, Ramappa AJ, Maxwell RB, Briggs KK. An arthroscopic treatment regimen for osteoarthritis of the knee. Arthroscopy 2007; 23:948-55. [PMID: 17868833 DOI: 10.1016/j.arthro.2007.03.097] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Revised: 03/23/2007] [Accepted: 03/27/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the functional and subjective outcomes of patients with moderate to severe osteoarthritis of the knee who underwent a comprehensive arthroscopic treatment regimen. METHODS Between August 2000 and November 2001, 69 knees in 61 patients were treated with an arthroscopic regimen. Inclusion criteria included severe osteoarthritis and a minimum 2-year follow-up. Arthroscopic treatment included joint insufflation, lysis of adhesions, anterior interval release, contouring of cartilage defects to a stable rim, shaping of meniscus tears to a stable rim, synovectomy, removal of loose bodies, and removal of osteophytes that affected terminal extension. Exclusion criteria included the treatment of chondral defects with microfracture. Failure was defined as knees requiring arthroplasty because this was what patients were trying to avoid. RESULTS The average patient age was 57 (range, 37-78), with 35 men and 26 women. Patients had an average of 1.5 previous surgeries (range, 0-12). The average preoperative Lysholm score was 49 (range, 14-79). On average, knees were insufflated with 170 mL of lactated Ringer's solution (range, 120-240). Nine knees failed, with survivorship of 83% at 3 years. At an average follow-up of 31 months (range, 24-41), the average Lysholm score was 74 (range, 37-100), with an average improvement of 25 points. The average Tegner score was 4 (range, 0-8). Average patient satisfaction was 8 (range, 1-10). The average Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain score was 4 (range, 0-14), WOMAC stiffness was 2 (range, 0-4), and WOMAC function was 11 (range, 0-44). Independent predictors of improvement in Lysholm score included a shift in the weight-bearing axis and preoperative Lysholm score. CONCLUSIONS This arthroscopic treatment regimen can improve function and activity levels in patients with moderate to severe osteoarthritis. Of 69 patients, 60 (87%) patients had a satisfactory result. However, in this group of 60, 11 patients needed a second procedure, resulting in a 71% satisfactory result after 1 surgery. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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49
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Abstract
A noninvasive method to assess the repair tissue produced by chondral defect treatment techniques has not been established. The purpose of this study was to evaluate the ability of magnetic resonance imaging (MRI) specialized sequences to predict the presence and quality of repair tissue of knee articular cartilage defects treated by microfracture. Nineteen recreational or high-level athletes underwent standard microfracture technique for 22 traumatic full-thickness chondral defects. Patients subsequently underwent repeat arthroscopy for unrelated knee pathology. Magnetic resonance imaging studies were obtained prior to the second-look arthroscopies and evaluated for the presence of full-thickness articular cartilage defects and for the quality of repair tissue. At arthroscopy, the quality and quantity of the repair tissue was assessed. Twenty-one defects had 100% coverage with repair tissue, whereas 1 defect continued to have areas with full-thickness cartilage loss. Magnetic resonance imaging had sensitivity and specificity of 100% in predicting the presence of a full-thickness lesion after microfracture. In determining whether the repair tissue was of good or poor quality, MRI had a sensitivity of 80% and specificity of 82% using arthroscopy as the standard. Magnetic resonance imaging using specialized sequences proved to be a satisfactory technique for evaluating repair tissue in full-thickness traumatic defects treated by microfracture.
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50
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Ramappa AJ, Hawkins RJ, Suri M. Shoulder disorders in the overhead athlete. Instr Course Lect 2007; 56:35-43. [PMID: 17472290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Overhead athletes place enormous loads on shoulder structures during the throwing cycle. These extraordinary stresses can result in a variety of injuries. Many of these injuries can coexist and are often associated with excessive anterior shoulder laxity, sometimes referred to as instability, thereby making the diagnosis and treatment of the athlete's shoulder extremely challenging. Although elite throwers represent a small percentage of individuals with shoulder disorders, the evaluation of this subgroup can provide insight for the treatment of the general patient with a shoulder disorder.
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Affiliation(s)
- Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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