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Miller EY, Lee W, Lowe T, Zhu H, Argote PF, Dresdner D, Kelly J, Frank RM, McCarty E, Bravman J, Stokes D, Emery NC, Neu CP. MRI-derived Articular Cartilage Strains Predict Patient-Reported Outcomes Six Months Post Anterior Cruciate Ligament Reconstruction. medRxiv 2024:2024.04.27.24306484. [PMID: 38746083 PMCID: PMC11092718 DOI: 10.1101/2024.04.27.24306484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key terms Multicontrast and Multiparametric, Magnetic Resonance Imaging, Osteoarthritis, Functional Biomechanical Imaging, Knee Joint Degeneration What is known about the subject: dualMRI has been used to quantify strains in a healthy human population in vivo and in cartilage explant models. Previously, OA severity, as determined by histology, has been positively correlated to increased shear and transverse strains in cartilage explants. What this study adds to existing knowledge: This is the first in vivo use of dualMRI in a participant demographic post-ACL reconstruction and at risk for developing osteoarthritis. This study shows that dualMRI-derived strains are more significantly correlated with patient-reported outcomes than any MRI relaxometry metric. Background Anterior cruciate ligament (ACL) injuries lead to an increased risk of osteoarthritis, characterized by altered cartilage tissue structure and function. Displacements under applied loading by magnetic resonance imaging (dualMRI) is a novel MRI technique that can be used to quantify mechanical strain in cartilage while undergoing a physiological load. Purpose To determine if strains derived by dualMRI and relaxometry measures correlate with patient-reported outcomes at six months post unilateral ACL reconstruction. Study Design Cohort study. Methods Quantitative MRI (T2, T2*, T1ρ) measurements and transverse, axial, and shear strains were quantified in the medial articular tibiofemoral cartilage of 35 participants at six-months post unilateral ACL reconstruction. The relationships between patient-reported outcomes (WOMAC, KOOS, MARS) and all qMRI relaxation times were quantified using general linear mixed-effects models. A combined best-fit multicontrast MRI model was then developed using backwards regression to determine the patient features and MRI metrics that are most predictive of patient-reported outcome scores. Results Higher femoral strains were significantly correlated with worse patient-reported functional outcomes. Femoral shear and transverse strains were positively correlated with six-month KOOS and WOMAC scores, after controlling for covariates. No relaxometry measures were correlated with patient-reported outcome scores. We identified the best-fit model for predicting WOMAC score using multiple MRI measures and patient-specific information, including sex, age, graft type, femoral transverse strain, femoral axial strain, and femoral shear strain. The best-fit model significantly predicted WOMAC score (p<0.001) better than any one individual MRI metric alone. When we regressed the model-predicted WOMAC scores against the patient-reported WOMAC scores, we found that our model achieved a goodness of fit exceeding 0.52. Conclusions This work presents the first use of dualMRI in vivo in a cohort of participants at risk for developing osteoarthritis. Our results indicate that both shear and transverse strains are highly correlated with patient-reported outcome severity could serve as novel imaging biomarkers to predict the development of osteoarthritis.
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Khoriati AA, Shahid Z, Fok M, Frank RM, Voss A, D'Hooghe P, Imam MA. Artificial intelligence and the orthopaedic surgeon: A review of the literature and potential applications for future practice: Current concepts. J ISAKOS 2024; 9:227-233. [PMID: 37949113 DOI: 10.1016/j.jisako.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Affiliation(s)
- Al-Achraf Khoriati
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Zuhaib Shahid
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK.
| | - Margaret Fok
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam Rd, High West, Hong Kong, China; Asia Pacific Orthopaedic Association, 57000, Malaysia.
| | - Rachel M Frank
- Department of Orthopaedic Surgery, Joint Preservation Program, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045, USA.
| | - Andreas Voss
- Sporthopaedicum Regensburg, Street, Hildegard-von-Bingen-Straße 1, 93053, Regensburg, Germany.
| | - Pieter D'Hooghe
- Aspetar Orthopedic and Sports Medicine Hospital, Aspire Zone, Sportscity Street 1, P.O. Box 29222, Doha, Qatar
| | - Mohamed A Imam
- Rowley Bristow Orthopaedic Centre, Ashford and St Peter's NHS Foundation Trust, Chertsey, KT106PZ, UK; Smart Health Centre, University of East London, University Way, London, E16 2RD, United Kingdom.
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Holers VM, Frank RM, Zuscik M, Keeter C, Scheinman RI, Striebich C, Simberg D, Clay MR, Moreland LW, Banda NK. Decay-Accelerating Factor Differentially Associates With Complement-Mediated Damage in Synovium After Meniscus Tear as Compared to Anterior Cruciate Ligament Injury. Immune Netw 2024; 24:e17. [PMID: 38725672 PMCID: PMC11076301 DOI: 10.4110/in.2024.24.e17] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
We have reported that anterior cruciate ligament (ACL) injury leads to the differential dysregulation of the complement system in the synovium as compared to meniscus tear (MT) and proposed this as a mechanism for a greater post-injury prevalence of post traumatic osteoarthritis (PTOA). To explore additional roles of complement proteins and regulators, we determined the presence of decay-accelerating factor (DAF), C5b, and membrane attack complexes (MACs, C5b-9) in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy, osteoarthritis (OA)-related knee replacement surgery and normal controls. Multiplexed immunohistochemistry was used to detect and quantify complement proteins. To explore the involvement of body mass index (BMI), after these 2 injuries, we examined correlations among DAF, C5b, MAC and BMI. Using these approaches, we found that synovial cells after ACL injury expressed a significantly lower level of DAF as compared to MT (p<0.049). In contrast, C5b staining synovial cells were significantly higher after ACL injury (p<0.0009) and in OA DSST (p<0.039) compared to MT. Interestingly, there were significantly positive correlations between DAF & C5b (r=0.75, p<0.018) and DAF & C5b (r=0.64 p<0.022) after ACL injury and MT, respectively. The data support that DAF, which should normally dampen C5b deposition due to its regulatory activities on C3/C5 convertases, does not appear to exhibit that function in inflamed synovia following either ACL injury or MT. Ineffective DAF regulation may be an additional mechanism by which relatively uncontrolled complement activation damages tissue in these injury states.
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Affiliation(s)
- V. Michael Holers
- Division of Rheumatology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Rachel M. Frank
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael Zuscik
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Carson Keeter
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Robert I. Scheinman
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Christopher Striebich
- Division of Rheumatology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Dmitri Simberg
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael R. Clay
- Department of Pathology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Larry W. Moreland
- Division of Rheumatology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Nirmal K. Banda
- Division of Rheumatology, School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO 80045, USA
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Lim JJ, Belk JW, Wharton BR, McCarthy TP, McCarty EC, Dragoo JL, Frank RM. Most Orthopaedic Platelet-Rich Plasma Investigations Don't Report Protocols and Composition: An Updated Systematic Review. Arthroscopy 2024:S0749-8063(24)00243-3. [PMID: 38522650 DOI: 10.1016/j.arthro.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/15/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE To systematically review the literature to assess the heterogeneity of platelet-rich plasma (PRP) preparation and composition reporting for the treatment of musculoskeletal/orthopaedic pathologies. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I and Level II studies from 2016 to 2022 that evaluated the use of PRP therapy for musculoskeletal pathologies. The search phrase used was "platelet-rich plasma clinical studies." Studies were assessed based on their reporting of the PRP preparation methods and reporting of PRP composition. RESULTS One hundred twenty-four studies (in 120 articles) met inclusion criteria for analysis. Of these studies, 15 (12.1%) provided comprehensive reporting, including a clear, well-described, and reproducible preparation protocol that future investigators can follow. Thirty-three studies (26.6%) quantitatively reported the final PRP product composition. CONCLUSIONS Among the studies using PRP for the treatment of musculoskeletal/orthopaedic pathologies, less than 20% provided a clear, well-described, and reproducible PRP preparation protocol, and only one-fourth of studies reported on the final PRP product composition. CLINICAL RELEVANCE A diverse current reporting of PRP composition between studies provides a high heterogeneity of the term "PRP," which becomes a limitation for a comparison of studies using PRP.
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Affiliation(s)
- Joseph J Lim
- University of Colorado Boulder, Boulder, Colorado, U.S.A..
| | - John W Belk
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Timothy P McCarthy
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jason L Dragoo
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Hohmann E, Keough N, Frank RM, Rodeo S. Micro-Fragmented Adipose Tissue Demonstrates Comparable Clinical Efficacy to Other Orthobiologic Injections in Treating Symptomatic Knee Osteoarthritis: A Systematic Review of Level I to IV Clinical Studies. Arthroscopy 2024:S0749-8063(24)00175-0. [PMID: 38467171 DOI: 10.1016/j.arthro.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE To perform a systematic review of clinical outcomes in patients who underwent treatment with micro-fragmented aspirated tissue for symptoms of knee osteoarthritis. METHODS Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration's tools and the Risk Of Bias In Non-randomised Studies-of Interventions tool. Study quality was assessed with the modified Coleman Methodology Score and Methodological Index for Non-Randomized Studies score. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Twenty-one studies were included. One study had a high ROB, 1 had a critical ROB, 3 had serious ROB, and 16 had a moderate ROB. The mean Coleman score was 58, demonstrating fair study quality; the Methodological Index for Non-Randomized Studies score had a mean value of 13, indicating overall fair quality. Best evidence synthesis revealed moderate evidence. The visual analog scale score improved from 5.2 to 3.2 at 6 and 12 months. Knee injury and Osteoarthritis Outcome Score (KOOS) activities of daily living subscore improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS pain subscore improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS quality of life subscore improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS sports subscore improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS symptoms subscore improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. The Western Ontario and McMaster Universities Osteoarthritis Index score steadily increased from 61.8 at baseline to 78.4 at 12 months. CONCLUSIONS micro-fragmented aspirated tissue injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence, and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Natalie Keough
- Department of Health Sciences, Clinical Anatomy and Imaging, Warwick Medical School, University of Warwick, Coventry, U.K; Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado, School of Medicine, Denver, Colorado, U.S.A
| | - Scott Rodeo
- Sports Medicine and Shoulder Service, New York, New York, U.S.A.; Orthopaedic Soft Tissue Research Program, New York, New York, U.S.A.; Department of Orthopaedic Surgery, Weill Medical College of Cornell University, New York, New York, U.S.A.; The Hospital for Special Surgery, New York, New York, U.S.A.; New York Giants Football, New York, New York, U.S.A
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Strassman AK, Stokes DJ, Sanchez RA, Shinsako KK, Smith PA, DiFelice GS, Frank RM. Anterior Cruciate Ligament Repair Using a Re-tensionable All-Suture Construct. Arthrosc Tech 2024; 13:102890. [PMID: 38584624 PMCID: PMC10995730 DOI: 10.1016/j.eats.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/13/2023] [Accepted: 11/02/2023] [Indexed: 04/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tears are among the most common injuries to the knee. With recent improvements in imaging that allow for more precise identification of ACL tear patterns, improved techniques for repair, and advancements in biological augmentation, there has been a re-emerging interest in primary ACL repair, especially for acute proximal ACL tears. This article aims to describe a surgical technique for primary ACL repair using a re-tensionable all-suture-based construct.
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Affiliation(s)
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | - Kevin K Shinsako
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
| | | | | | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, U.S.A
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Johnson AJ, Wharton BR, Geraghty EH, Bradsell H, Ishikawa A, McCarty EC, Bravman JT, Frank RM. Patient Perception of Social Media Use by Orthopaedic Surgeons: A Pilot Study. Orthop J Sports Med 2024; 12:23259671241232707. [PMID: 38465258 PMCID: PMC10921856 DOI: 10.1177/23259671241232707] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 08/21/2023] [Indexed: 03/12/2024] Open
Abstract
Background Social media (SM) use by orthopaedic surgeons is becoming increasingly common; nonetheless, it needs to be clarified how patients perceive the content posted by physicians. Purpose To characterize SM content posted by orthopaedic surgeons while investigating patient perceptions of this content and how it may influence their health care decisions. Study Design Cross-sectional study. Methods Posts on SM outlets by orthopaedic surgeons were reviewed and categorized. A survey to assess patient perception of these categories was administered between December 2021 and February 2022 in the clinics of 3 orthopaedic surgeons. Survey results were analyzed for differences in patient SM use and perception of SM content types. Results There were 250 completed surveys. SM use was high among all age groups; however, the 18 to 24 years (87.1%) and 25 to 34 years (86.4%) age groups were more likely than older age groups to report daily use (P = .002). Overall, 17% of patients reported using SM to see information about their health care at least once per month, 21% reported reviewing the SM account of a physician at least once per month, 19% reported that they were likely or very likely to view the SM account of their physician, and 23% reported that SM content was likely or very likely to influence which physician they see. Patients held the most consistently positive view of posts that educated patients, discussed sports team coverage, and provided patient testimonials. Patients had consistently neutral views of posts educating colleagues, discussing presentations at national meetings, displaying aspects of surgeons' personal lives, and supporting marginalized groups. Several post categories elicited highly polarized responses-including those discussing research publications and showing surgical techniques or pictures/videos taken during surgery. Respondents had a consistently negative response to posts making political statements. Conclusion SM is likely a useful tool to help physicians interact with patients. Physicians who wish to interact with patients should consider posting content viewed most positively-including posts educating patients, discussing sports team coverage, and providing patient testimonials. Content that is viewed less favorably should be posted sparingly or with a sensitive tag.
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Affiliation(s)
| | | | | | - Hannah Bradsell
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew Ishikawa
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rachel M Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
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Belk JW, Littlefield CP, Smith JRH, McCulloch PC, McCarty EC, Frank RM, Kraeutler MJ. Autograft Demonstrates Superior Outcomes for Revision Anterior Cruciate Ligament Reconstruction When Compared With Allograft: A Systematic Review. Am J Sports Med 2024; 52:859-867. [PMID: 36867049 DOI: 10.1177/03635465231152232] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Multiple studies have compared outcomes among patients undergoing revision anterior cruciate ligament reconstruction (ACLR) with autograft versus allograft, but these data are inconsistently reported and long-term outcomes depending on graft type are yet to be determined. PURPOSE To perform a systematic review of clinical outcomes after revision ACLR (rACLR) with autograft versus allograft. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of the literature was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that compared the outcomes of patients undergoing rACLR with autograft versus allograft. The search phrase used was autograft allograft revision anterior cruciate ligament reconstruction. Graft rerupture rates, return-to-sports rates, anteroposterior laxity, and patient-reported outcome scores (subjective International Knee Documentation Committee, Tegner, Lysholm, and Knee injury and Osteoarthritis Outcome Score) were evaluated. RESULTS Eleven studies met inclusion criteria, including 3011 patients undergoing rACLR with autograft (mean age, 28.9 years) and 1238 patients undergoing rACLR with allograft (mean age, 28.0 years). Mean follow-up was 57.3 months. The most common autograft and allograft types were bone-patellar tendon-bone grafts. Overall, 6.2% of patients undergoing rACLR experienced graft retear, including 4.7% in the autograft group and 10.2% in the allograft group (P < .0001). Among studies that reported return-to-sports rates, 66.2% of patients with an autograft returned to sports as opposed to 45.3% of patients with an allograft (P = .01). Two studies found significantly greater postoperative knee laxity in the allograft group as compared with the autograft group (P < .05). Among all patient-reported outcomes, 1 study found 1 significant difference between groups: patients with an autograft had a significantly higher postoperative Lysholm score when compared with patients with an allograft. CONCLUSION Patients undergoing revision ACLR with an autograft can be expected to experience lower rates of graft retear, higher rates of return to sports, and less postoperative anteroposterior knee laxity when compared with patients undergoing revision ACLR with an allograft.
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Affiliation(s)
- John W Belk
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | | | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rachel M Frank
- Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, USA
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Potyk AG, Belk JW, Bravman JT, Seidl AJ, Frank RM, McCarty EC. Immobilization in External Rotation Versus Arthroscopic Stabilization After Primary Anterior Shoulder Dislocation: A Systematic Review of Level 1 and 2 Studies. Am J Sports Med 2024; 52:544-554. [PMID: 36867050 DOI: 10.1177/03635465231155199] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Arthroscopic stabilization has been established as a superior treatment option for primary glenohumeral instability when compared with immobilization in internal rotation. However, immobilization in external rotation (ER) has recently gained interest as a viable nonoperative treatment option for patients with shoulder instability. PURPOSE To compare the rates of recurrent instability and subsequent surgery in patients undergoing treatment for primary anterior shoulder dislocation with arthroscopic stabilization versus immobilization in ER. STUDY DESIGN Systematic review; Level of evidence, 2. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that'evaluated patients being treated for primary anterior glenohumeral dislocation with either arthroscopic stabilization or immobilization in ER. The search phrase used various combinations of the keywords/phrases "primary closed reduction,""anterior shoulder dislocation,""traumatic,""primary,""treatment,""management,""immobilization,""external rotation,""surgical,""operative,""nonoperative," and "conservative." Inclusion criteria included patients undergoing treatment for primary anterior glenohumeral joint dislocation with either immobilization in ER or arthroscopic stabilization. Rates of recurrent instability, subsequent stabilization surgery, return to sports, positive postintervention apprehension tests, and patient-reported outcomes were evaluated. RESULTS The 30 studies that met inclusion criteria included 760 patients undergoing arthroscopic stabilization (mean age, 23.1 years; mean follow-up time, 55.1 months) and 409 patients undergoing immobilization in ER (mean age, 29.8 years; mean follow-up time, 28.8 months). Overall, 8.8% of operative patients experienced recurrent instability at latest follow-up compared with 21.3% of patients who had undergone ER immobilization (P < .0001). Similarly, 5.7% of operative patients had undergone a subsequent stabilization procedure at latest follow-up compared with 11.3% of patients who had undergone ER immobilization (P = .0015). A higher rate of return to sports was found in the operative group (P < .05), but no other differences were found between groups. CONCLUSION Patients undergoing arthroscopic treatment for primary anterior glenohumeral dislocation with arthroscopic stabilization can be expected to experience significantly lower rates of recurrent instability and subsequent stabilization procedures compared with patients undergoing ER immobilization.
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Affiliation(s)
- Andrew G Potyk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - John W Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
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Hurley ET, Sherman SL, Stokes DJ, Rodeo SA, Shapiro SA, Mautner K, Buford DA, Dragoo JL, Mandelbaum BR, Zaslav KR, Cole BJ, Frank RM. Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Treatment of Musculoskeletal Pathology. Arthroscopy 2024; 40:470-477.e1. [PMID: 37625660 DOI: 10.1016/j.arthro.2023.08.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies. METHODS A consensus process on the treatment of PRP using a modified Delphi technique was conducted. Thirty-five orthopaedic surgeons and sports medicine physicians participated in these consensus statements on PRP. The participants were composed of representatives of the Biologic Association, representing 9 international orthopaedic and musculoskeletal professional societies invited due to their active interest in the study of orthobiologics. Consensus was defined as achieving 80% to 89% agreement, strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. RESULTS There was consensus on 62% of statements about PRP. CONCLUSIONS (1) PRP should be classified based on platelet count, leukocyte count, red blood count, activation method, and pure-plasma versus fibrin matrix; (2) PRP characteristics for reporting in research studies are platelet count, leukocyte count, neutrophil count, red blood cell count, total volume, the volume of injection, delivery method, and the number of injections; (3) the prognostic factors for those undergoing PRP injections are age, body mass index, severity/grade of pathology, chronicity of pathology, prior injections and response, primary diagnosis (primary vs postsurgery vs post-trauma vs psoriatic), comorbidities, and smoking; (4) regarding age and body mass index, there is no minimum or maximum, but clinical judgment should be used at extremes of either; (5) the ideal dose of PRP is undetermined; and (6) the minimal volume required is unclear and may depend on the pathology. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane A Shapiro
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Kenneth Mautner
- Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | | | - Jason L Dragoo
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Bert R Mandelbaum
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California, U.S.A.; Clínica Espregueira, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Kenneth R Zaslav
- Lenox Hill Hospital Northwell Health Orthopedic Institute, New York, New York, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Hohmann E, Bloomfield P, Dvorak J, Echemendia R, Frank RM, Ganda J, Gordon L, Holtzhausen L, Kourie A, Mampane J, Makdissi M, Patricios J, Pieroth E, Putukian M, Janse van Rensburg DC, Viviers P, Williams V, de Wilde J. Return to Sports Following Sports-Related Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy 2024; 40:460-469. [PMID: 37414106 DOI: 10.1016/j.arthro.2023.06.027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 06/05/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To perform a Delphi consensus for return to sports (RTS) following sports-related concussion (SRC). METHODS Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. RESULTS Individualized graduated RTS protocols should be used. A normal clinical, ocular and balance examination with no more headaches, and asymptomatic exertional test allows RTS. Earlier RTS can be considered if athletes are symptom free. The Sports Concussion Assessment Tool 5 and vestibular and ocular motor screening are recognized as useful tools to assist in decision-making. Ultimately RTS is a clinical decision. Baseline assessments should be performed at both collegiate and professional level and a combination of neurocognitive and clinical tests should be used. A specific number of recurrent concussions for season-or career-ending decisions could not be determined but will affect decision making for RTS. CONCLUSIONS Consensus was achieved for 10 of the 25 RTS criteria: early RTS can be considered earlier than 48 to 72 hours if athletes are completely symptom-free with no headaches, a normal clinical, ocular and balance examination. A graduated RTS should be used but should be individualized. Only 2 of the 9 assessment tools were considered to be useful: Sports Concussion Assessment Tool 5 and vestibular and ocular motor screening. RTS is mainly a clinical decision. Only 31% of the baseline assessment items achieved consensus: baseline assessments should be performed at collegiate and professional levels using a combination of neurocognitive and clinical tests. The panel disagreed on the number of recurrent concussions that should be season- or career-ending. LEVEL OF EVIDENCE Level V, expert Opinion.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine; Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Paul Bloomfield
- CMO Manly Sea Eagles, NRL Team; World Rugby Concussion Consultant; Former CMO National Rugby League, Sydney, Australia
| | - Jiri Dvorak
- Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland; Former CMO FIFA
| | - Ruben Echemendia
- Psychological & Neurobehavioral Associates, State College, Pennsylvania, U.S.A.; Department of Psychology, University of Missouri, Kansas City, Missouri, U.S.A.; Co-Chair NHL/NHLPA Concussion Subcommittee; Chair Major League Soccer Concussion Committee
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado Medical School, Aurora, U.S.A.; Head Team Orthopaedic Surgeon Colorado Rapids, Team Physician University of Colorado Buffaloes, U.S. Soccer Network Physician
| | - Janesh Ganda
- Sports Rehab Centre, Cape Town, South Africa; Team Physician SA 7's Rugby Team; Medical Officer South African Sports Association and Olympic Committee
| | - Leigh Gordon
- Cape Sports Med Clinic, Cape Town, South Africa; Department of Sports & Exercise Medicine, Cape Town South Africa; World Rugby Concussion Consultant, Team Physician Rugby 7s, MO International Hockey Federation; Former Team Physician 7's Rugby
| | - Louis Holtzhausen
- Chief of Sports Medicine, Director Aspetar Sports Related Concussion Program; Orthopaedic and Sports Medicine Hospital, Aspetar, Doha, Qatar; Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa; Department of Exercise and Sports Sciences, University of the Free State, Bloemfontein, South Africa; Former Team Physician South African Olympic Team and Professional Rugby, Cricket and Hockey Teams
| | - Alan Kourie
- Head of Department of Sports Medicine, Mediclinic Parkview; Dubai, United Arab Emirates; CMO Dubai Hurricanes, Former Team Doctor Natal Sharks Rugby
| | - Jerome Mampane
- CMO South African Rugby Team (Springboks), CMO Kaizer Chiefs Football Club, former CMO South African Soccer Team (Bafana Bafana)
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia; CMO Australian Football League, Melbourne, Australia; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; World Rugby Concussion Consultant
| | - Jon Patricios
- Wits Sport and Health (WiSH); School of Clinical Medicine, Faculty of Health Sciences; University of the Witwatersrand, Johannesburg, South Africa; Co-Chair of the 6th International Conference on Concussion in Sports; South African and World Rugby Concussion Consultant; UEFA Head Injury Consultant; FIFA Concussion Consultant
| | - Elizabeth Pieroth
- Department of Orthopaedics, Department of Psychiatry and Behavioral Sciences, Rush Medical College, Chicago, USA; Co-Director NFL Neuropsychology Consultant Program; Director NSW Concussion Program; Concussion Specialist for Chicago Bears, Blackhawks White Socks, Fire, Red Stars, Steel, Rockford IceHogs, Indy Fuel
| | | | - Dina C Janse van Rensburg
- Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria South Africa; Medical Advisory Panel, World Netball, Manchester, United Kingdom
| | - Pierre Viviers
- Senior Director Campus Health Service; Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Science, Stellenbosch University, South Africa
| | - Vernon Williams
- Center for Sports Neurology & Pain Medicine, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, U.S.A.; Team Neurologist Los Angeles Rams, LA Dodgers, LA Lakers, LA Clippers, LA Kings, LA Sparks; Vice-Chair California State Athletic Commission, Chair American Academy of Sports Neurology Section
| | - Jean de Wilde
- Musculoskeletal Service Emirates Airline, Dubai, United Arab Emirates; Medical Officer South African Sports Association and Olympic Committee; Former Match Day and Stadium Physician Lions Rugby Team
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Hohmann E, Bloomfield P, Dvorak J, Echemendia R, Frank RM, Ganda J, Gordon L, Holtzhausen L, Kourie A, Mampane J, Makdissi M, Patricios J, Pieroth E, Putukian M, Janse van Rensburg DC, Viviers P, Williams V, de Wilde J. On-Field and Pitch-Side (Sideline) Assessment of Sports Concussion in Collision Sports: An Expert Consensus Statement Using the Modified Delphi Technique. Arthroscopy 2024; 40:449-459.e4. [PMID: 37391103 DOI: 10.1016/j.arthro.2023.06.026] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE To perform a Delphi consensus for on-field and pitch-side assessment of sports-related concussion (SRC). METHODS Open-ended questions in rounds 1 and 2 were answered. The results of the first 2 rounds were used to develop a Likert-style questionnaire for round 3. If agreement at round 3 was ≤80% for an item, if panel members were outside consensus, or there were >30% neither agree/disagree responses, the results were carried forward into round 4. The level of agreement and consensus was defined as 90%. RESULTS Loss of consciousness (LOC) or suspected LOC, motor incoordination/ataxia, balance disturbance, confusion/disorientation, memory disturbance/amnesia, blurred vision/light sensitivity, irritability, slurred speech, slow reaction time, lying motionless, dizziness, headaches/pressure in the head, falling to the ground with no protective action, slow to get up after a hit, dazed look, and posturing/seizures were clinical signs of SRC and indicate removal from play. Video assessment is helpful but should not replace clinical judgment. LOC/unresponsiveness, signs of cervical spine injury, suspicion of other fractures (skull/maxillo-facial), seizures, Glasgow Coma Scale score <14 and abnormal neurologic examination findings are indications for hospitalization. Return to play should only be considered when no clinical signs of SRC are present. Every suspected concussion should be referred to an experienced physician. CONCLUSIONS Consensus was achieved for 85% of the clinical signs indicating concussion. On-field and pitch-side assessment should include the observation of the mechanism, a clinical examination, and cervical spine assessment. Of the 19 signs and red flags requiring removal from play, consensus was reached for 74%. Normal clinical examination and HIA with no signs of concussion allow return to play. Video assessment should be mandatory for professional games but should not replace clinical decision-making. Sports Concussion Assessment Tool, Glasgow Coma Scale, vestibular/ocular motor screening, Head Injury Assessment Criteria 1, and Maddocks questions are useful tools. Guidelines are helpful for non-health professionals. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, United Arab Emirates.
| | - Paul Bloomfield
- CMO Manly Sea Eagles, NRL Team; World Rugby Concussion Consultant; Former CMO National Rugby League, Sydney, Australia
| | - Jiri Dvorak
- Department of Neurology, Spine Unit, Schulthess Clinic, Zurich, Switzerland; Former CMO FIFA
| | - Ruben Echemendia
- Psychological & Neurobehavioral Associates, State College, Pennsylvania, U.S.A.; Department of Psychology, University of Missouri, Kansas City, Missouri, U.S.A.; Co-Chair NHL/NHLPA Concussion Subcommittee; Chair Major League Soccer Concussion Committee
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A.; Head Team Orthopaedic Surgeon Colorado Rapids, Team Physician University of Colorado Buffaloes, U.S. Soccer Network Physician
| | - Janesh Ganda
- Sports Rehab Centre, Cape Town, South Africa; Team Physician SA 7's Rugby Team; Medical Officer South African Sports Association and Olympic Committee
| | - Leigh Gordon
- Cape Sports Med Clinic, Cape Town, South Africa; Department of Sports & Exercise Medicine, Cape Town South Africa; World Rugby Concussion Consultant, Team Physician Rugby 7s, MO International Hockey Federation; Former Team Physician 7's Rugby
| | - Louis Holtzhausen
- Chief of Sports Medicine, Director Aspetar Sports Related Concussion Program; Orthopaedic and Sports Medicine Hospital, Aspetar, Doha, Qatar; Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria, South Africa; Department of Exercise and Sports Sciences, University of the Free State, Bloemfontein, South Africa; Former Team Physician South African Olympic Team and Professional Rugby, Cricket and Hockey Teams
| | - Alan Kourie
- Head of Department of Sports Medicine, Mediclinic Parkview; Dubai, United Arab Emirates; CMO Dubai Hurricanes, Former Team Doctor Natal Sharks Rugby
| | - Jerome Mampane
- CMO South African Rugby Team (Springboks); CMO Kaizer Chiefs Football Club; former CMO South African Soccer Team (Bafana Bafana)
| | - Michael Makdissi
- Olympic Park Sports Medicine Centre, Melbourne, Australia; CMO Australian Football League, Melbourne, Australia; La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia; World Rugby Concussion Consultant
| | - Jon Patricios
- Wits Sport and Health (WiSH); School of Clinical Medicine, Faculty of Health Sciences; University of the Witwatersrand, Johannesburg, South Africa; Co-Chair of the 6th International Conference on Concussion in Sports; South African and World Rugby Concussion Consultant; UEFA Head Injury Consultant; FIFA Concussion Consultant
| | - Elizabeth Pieroth
- Department of Orthopaedics, Department of Psychiatry and Behavioral Sciences; Rush Medical College, Chicago, Illinois, U.S.A.; Co-Director NFL Neuropsychology Consultant Program; Director NSW Concussion Program; Concussion Specialist for Chicago Bears, Blackhawks White Socks, Fire, Red Stars, Steel, Rockford IceHogs, Indy Fuel
| | | | - Dina C Janse van Rensburg
- Section Sports Medicine, University of Pretoria, Faculty of Health Sciences, Pretoria South Africa; Medical Advisory Panel, World Netball, Manchester, United Kingdom
| | - Pierre Viviers
- Senior Director Campus Health Service; Department of Exercise, Sport and Lifestyle Medicine, Faculty of Medicine and Health Science, Stellenbosch University, Stellenbosch, South Africa
| | - Vernon Williams
- Center for Sports Neurology & Pain Medicine, Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, U.S.A.; Team Neurologist Los Angeles Rams, LA Dodgers, LA Lakers, LA Clippers, LA Kings, LA Sparks; Vice-Chair California State Athletic Commission, Chair American Academy of Sports Neurology Section
| | - Jean de Wilde
- Musculoskeletal Service Emirates Airline, Dubai, United Arab Emirates; Medical Officer South African Sports Association and Olympic Committee; Former Match Day and Stadium Physician Lions Rugby Team
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Massey PA, Nicandri G, Frank RM, Warner JJP, Barton RS, Angelo R. Arthroscopic Simulation-Based Training of Orthopaedic Surgery Residents: Past, Present, and Future. Instr Course Lect 2024; 73:109-121. [PMID: 38090891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Simulation-based training is required by many medical specialties. Barriers, however, have prevented widespread implementation of simulators for arthroscopic training. The advantages of arthroscopic simulator-based training of residents include decreased errors, decreased cost of training, and improved patient care. Before an educational program can focus on the type of simulator, it is essential to have a validated curriculum and framework for how to use those simulators. One of the most validated systems is called proficiency-based progression training. Proficiency-based progression is essentially a paradigm in which basic skills must be mastered and demonstrated via objective evaluation, before moving on to more advanced skills. There are a variety of different validation methods and tools that have been described, with the Arthroscopic Surgical Skill Evaluation Tool being the most widely used tool. It is essential that any simulator has evidence and validation that it will ultimately improve surgical skills in the operating room. In the future, emerging technologies such as virtual reality, augmented reality, and three-dimensional printing will likely play a major role in the creation of newer simulators and may improve access to residents throughout the world.
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14
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Stokes DJ, Hassebrock JD, Malyak LA, Frank RM. Preparing for and Executing the Ideal Posterior
Labral Repair. Instr Course Lect 2024; 73:547-557. [PMID: 38090924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Posterior labral tears are a source of pain and instability of the shoulder. Despite being relatively uncommon (reported in approximately 10% of instability cases), the incidence of posterior labral tear is increasingly recognized as underestimated in highly active populations. Posterior labral tears can result from a traumatic posterior dislocation or repetitive microtrauma, leading to posterior chondral/labral attrition. Patients often present with vague, deep-seated shoulder discomfort rather than the sensation of instability. Unfavorable results with nonsurgical management will indicate which patients will most benefit from surgery. Arthroscopic stabilization has proven to be an effective and reliable treatment, and many techniques for posterior labral repair have been described. It is important to highlight the evaluation, preparation, and execution of arthroscopic stabilization of an isolated posterior labral repair using high-strength knotless all-suture anchors to allow for a stable, efficient, reproducible, and reliable repair while maintaining a low-profile construct that minimizes damage to the surrounding tissue.
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Hurley ET, Sherman SL, Chahla J, Gursoy S, Alaia MJ, Tanaka MJ, Pace JL, Jazrawi LM, Hughes AJ, Arendt EA, Ayeni OR, Bassett AJ, Bonner KF, Camp CL, Campbell KA, Carter CW, Ciccotti MG, Cosgarea AJ, Dejour D, Edgar CM, Erickson BJ, Espregueira-Mendes J, Farr J, Farrow LD, Frank RM, Freedman KB, Fulkerson JP, Getgood A, Gomoll AH, Grant JA, Gwathmey FW, Haddad FS, Hiemstra LA, Hinckel BB, Savage-Elliott I, Koh JL, Krych AJ, LaPrade RF, Li ZI, Logan CA, Gonzalez-Lomas G, Mannino BJ, Lind M, Matache BA, Matzkin E, Mandelbaum B, McCarthy TF, Mulcahey M, Musahl V, Neyret P, Nuelle CW, Oussedik S, Verdonk P, Rodeo SA, Rowan FE, Salzler MJ, Schottel PC, Shannon FJ, Sheean AJ, Strickland SM, Waterman BR, Wittstein JR, Zacchilli M, Zaffagnini S. A modified Delphi consensus statement on patellar instability: part II. Bone Joint J 2023; 105-B:1265-1270. [PMID: 38035602 DOI: 10.1302/0301-620x.105b12.bjj-2023-0110.r1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process. Methods This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous. Results Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus. Conclusion Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, USA
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Jorge Chahla
- Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Safa Gursoy
- Ankara Yildirim Beyazit University, Ankara, Turkey
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - J L Pace
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, USA
| | - Andrew J Hughes
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Ashley J Bassett
- The Orthopedic Institute of New Jersey, Morristown, New Jersey, USA
| | | | - Christopher L Camp
- Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Cordelia W Carter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Michael G Ciccotti
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - David Dejour
- Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Lyon, France
| | - Cory M Edgar
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - João Espregueira-Mendes
- Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Jack Farr
- OrthoIndy Knee Preservation and Cartilage Restoration Center, Indianapolis, Indiana, USA
| | - Lutul D Farrow
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kevin B Freedman
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - John P Fulkerson
- Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | - Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - John A Grant
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - F W Gwathmey
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | | | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Ian Savage-Elliott
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jason L Koh
- NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, Illinois, USA
| | - Aaron J Krych
- Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Zachary I Li
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Catherine A Logan
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Brian J Mannino
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Martin Lind
- Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Bogdan A Matache
- Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Canada
| | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | | | - Mary Mulcahey
- Department of Orthopaedic Surgery, School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France
| | - Clayton W Nuelle
- Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Sam Oussedik
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Fiachra E Rowan
- Department of Trauma & Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Matthew J Salzler
- Department of Orthopedics, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Patrick C Schottel
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Fintan J Shannon
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | | | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University Hospital, Durham, North Carolina, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Hurley ET, Hughes AJ, Savage-Elliott I, Dejour D, Campbell KA, Mulcahey MK, Wittstein JR, Jazrawi LM, Alaia MJ, Arendt EA, Ayeni OR, Bassett AJ, Bonner KF, Camp CL, Carter CW, Chahla J, Ciccotti MG, Cosgarea AJ, Edgar CM, Erickson BJ, Espregueira-Mendes J, Farr J, Farrow LD, Frank RM, Freedman KB, Fulkerson JP, Getgood A, Gomoll AH, Grant JA, Gursoy S, Gwathmey FW, Haddad FS, Hiemstra LA, Hinckel BB, Koh JL, Krych AJ, LaPrade RF, Li ZI, Logan CA, Gonzalez-Lomas G, Mannino BJ, Lind M, Matache BA, Matzkin E, McCarthy TF, Mandelbaum B, Musahl V, Neyret P, Nuelle CW, Oussedik S, Pace JL, Verdonk P, Rodeo SA, Rowan FE, Salzler MJ, Schottel PC, Shannon FJ, Sheean AJ, Sherman SL, Strickland SM, Tanaka MJ, Waterman BR, Zacchilli M, Zaffagnini S. A modified Delphi consensus statement on patellar instability: part I. Bone Joint J 2023; 105-B:1259-1264. [PMID: 38037678 DOI: 10.1302/0301-620x.105b12.bjj-2023-0109.r1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Aims The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach. Methods A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous. Results Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus. Conclusion The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Andrew J Hughes
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Ian Savage-Elliott
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - David Dejour
- Orthopaedic Department, Lyon-Ortho-Clinic, Clinique de La Sauvegarde, Lyon, France
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery, School of Medicine, Loyola University, Chicago, Illinois, USA
| | - Jocelyn R Wittstein
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Michael J Alaia
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Canada
| | - Ashley J Bassett
- The Orthopedic Institute of New Jersey, Morristown, New Jersey, USA
| | | | - Christopher L Camp
- Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cordelia W Carter
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Jorge Chahla
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael G Ciccotti
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Cory M Edgar
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | | | - João Espregueira-Mendes
- Dom Research Center, Clinica Espregueira Mendes, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Jack Farr
- OrthoIndy Knee Preservation and Cartilage Restoration Center, Indianapolis, Indiana, USA
| | - Lutul D Farrow
- Cleveland Clinic Orthopaedic and Rheumatologic Institute, Cleveland, Ohio, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kevin B Freedman
- Rothman Orthopaedic Institute at Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - John P Fulkerson
- Department of Orthopaedic Surgery and Rehabilitation, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | - Andreas H Gomoll
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - John A Grant
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Safa Gursoy
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - F W Gwathmey
- Department of Orthopaedic Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Fares S Haddad
- Department of Trauma and Orthopaedic Surgery, University College London Hospitals, London, UK
| | | | - Betina B Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, USA
| | - Jason L Koh
- NorthShore Orthopaedic Institute, NorthShore University Health System, Evanston, Illinois, USA
| | - Aaron J Krych
- Department of Orthopaedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Zachary I Li
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Catherine A Logan
- Center for Regenerative Sports Medicine, Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Brian J Mannino
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA
| | - Martin Lind
- Department of Sports Traumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Bogdan A Matache
- Division of Orthopaedic Surgery, Department of Surgery, Laval University, Quebec, Canada
| | - Elizabeth Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Bert Mandelbaum
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Philippe Neyret
- Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France
| | - Clayton W Nuelle
- Department of Orthopedic Surgery, Missouri Orthopaedic Institute, University of Missouri, Columbia, Missouri, USA
| | - Sam Oussedik
- University College London Hospitals NHS Foundation Trust, London, UK
| | - J L Pace
- Children's Health Andrews Institute for Orthopaedics and Sports Medicine, Plano, Texas, USA
| | - Peter Verdonk
- Antwerp Orthopaedic Center, AZ Monica Hospitals, Antwerp, Belgium
| | - Scott A Rodeo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, USA
| | - Fiachra E Rowan
- Department of Trauma & Orthopaedic Surgery, University Hospital Waterford, Waterford, Ireland
| | - Matthew J Salzler
- Department of Orthopedics, Tufts University School of Medicine, Boston, USA
| | - Patrick C Schottel
- Department of Orthopaedics and Rehabilitation, Larner College of Medicine, Burlington, Vermont, USA
| | - Fintan J Shannon
- Department of Trauma and Orthopaedics, Galway University Hospitals, Galway, Ireland
| | - Andrew J Sheean
- San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | | | - Miho J Tanaka
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | | | - Stefano Zaffagnini
- IIa Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Hassebrock JD, Stokes DJ, Cram TR, Frank RM. Arthroscopic Repair and Reconstruction of Coracoclavicular Ligament. Clin Sports Med 2023; 42:599-611. [PMID: 37716724 DOI: 10.1016/j.csm.2023.05.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Acromioclavicular joint separations are common shoulder injuries that require prompt recognition, diagnosis, and treatment. Deciding on a treatment algorithm relies on a detailed knowledge of anatomy and a thorough understanding of the specific functional demands of the patient in question. When a repair or reconstruction is indicated, arthroscopic assistance can be a helpful tool to ensure a safe, anatomic reconstruction that minimizes morbidity and maximizes the potential return to high-level function.
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Affiliation(s)
- Jeffrey D Hassebrock
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel J Stokes
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Tyler R Cram
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Rachel M Frank
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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18
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Freshman RD, Zhang AL, Benjamin Ma C, Feeley BT, Ortiz S, Patel J, Dunn W, Wolf BR, Hettrich C, Lansdown D, Baumgarten KM, Bishop JY, Bollier MJ, Brophy RH, Bravman JT, Cox CL, Cvetanovich GL, Grant JA, Frank RM, Jones GL, Kuhn JE, Mair SD, Marx RG, McCarty EC, Miller BS, Seidl AJ, Smith MV, Wright RW. Factors Associated With Humeral Avulsion of Glenohumeral Ligament Lesions in Patients With Anterior Shoulder Instability: An Analysis of the MOON Shoulder Instability Cohort. Orthop J Sports Med 2023; 11:23259671231206757. [PMID: 37900861 PMCID: PMC10612462 DOI: 10.1177/23259671231206757] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/19/2023] [Indexed: 10/31/2023] Open
Abstract
Background Humeral avulsion of the glenohumeral ligament (HAGL) lesions are an uncommon cause of anterior glenohumeral instability and may occur in isolation or combination with other pathologies. As HAGL lesions are difficult to detect via magnetic resonance imaging (MRI) and arthroscopy, they can remain unrecognized and result in continued glenohumeral instability. Purpose To compare patients with anterior shoulder instability from a large multicenter cohort with and without a diagnosis of a HAGL lesion and identify preoperative physical examination findings, patient-reported outcomes, imaging findings, and surgical management trends associated with HAGL lesions. Study Design Cross-sectional study; Level of evidence, 3. Methods Patients with anterior glenohumeral instability who underwent surgical management between 2012 and 2020 at 11 orthopaedic centers were enrolled. Patients with HAGL lesions identified intraoperatively were compared with patients without HAGL lesions. Preoperative characteristics, physical examinations, imaging findings, intraoperative findings, and surgical procedures were collected. The Student t test, Kruskal-Wallis H test, Fisher exact test, and chi-square test were used to compare groups. Results A total of 21 HAGL lesions were identified in 915 (2.3%) patients; approximately one-third (28.6%) of all lesions were visualized intraoperatively but not identified on preoperative MRI. Baseline characteristics did not differ between study cohorts. Compared with non-HAGL patients, HAGL patients were less likely to have a Hill-Sachs lesion (54.7% vs 28.6%; P = .03) or an anterior labral tear (87.2% vs 66.7%; P = .01) on preoperative MRI and demonstrated increased external rotation when their affected arm was positioned at 90° of abduction (85° vs 90°; P = .03). Additionally, HAGL lesions were independently associated with an increased risk of undergoing an open stabilization surgery (odds ratio, 74.6 [95% CI, 25.2-221.1]; P < .001). Conclusion Approximately one-third of HAGL lesions were missed on preoperative MRI. HAGL patients were less likely to exhibit preoperative imaging findings associated with anterior shoulder instability, such as Hill-Sachs lesions or anterior labral pathology. These patients underwent open procedures more frequently than patients without HAGL lesions.
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Affiliation(s)
- Ryan D. Freshman
- Investigation performed at the University of California–San Francisco, San Francisco, California, USA
| | - Alan L. Zhang
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - C. Benjamin Ma
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | - Brian T. Feeley
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Jhillika Patel
- Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Warren Dunn
- Fondren Orthopedic Group, Houston, Texas, USA
| | - Brian R. Wolf
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | - Drew Lansdown
- Department of Orthopedic Surgery, University of California–San Francisco, San Francisco, California, USA
| | | | | | - Julie Y. Bishop
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | | | | | - Charles L. Cox
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - John A. Grant
- MedSport, University of Michigan, Ann Arbor, Michigan, USA
| | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Grant L. Jones
- The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - John E. Kuhn
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Eric C. McCarty
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Adam J. Seidl
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Rick W. Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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19
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Jacobs CA, Ortiz SF, Baumgarten KM, Bishop JY, Bollier MJ, Bravman JT, Brophy RH, Cvetanovich GL, Feeley BT, Frank RM, Jones GL, Kuhn JE, Lansdown DA, Ma CB, Mair SD, Marx RG, McCarty EC, Seidl AJ, Wright RW, Zhang AL, Wolf BR, Hettrich CM. Development and Validation of a Short-Form Version of the Western Ontario Shoulder Instability Scale (Short-WOSI). Am J Sports Med 2023; 51:2850-2857. [PMID: 37584514 DOI: 10.1177/03635465231188975] [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] [Indexed: 08/17/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have transitioned from primarily being used as research instruments to becoming increasingly used in the clinical setting to assess recovery and inform shared decision-making. However, there is a need to develop validated short-form PROM instruments to decrease patient burden and ease incorporation into clinical practice. PURPOSE To assess the validity and responsiveness of a shortened version of the Western Ontario Shoulder Instability Index (Short-WOSI) when compared with the full WOSI and other shoulder-related PROM instruments. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS This study was a secondary analysis of data collected as part of an institutional review board-approved, multicenter cohort of 1160 patients undergoing surgical stabilization for shoulder instability. The following PROMs were captured preoperatively and 2 years after surgery: WOSI, American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and 36-Item Health Survey (RAND-36). The cohort was split into 2 data sets: a training set to be used in the development of the Short-WOSI (n = 580) and a test set to be used to assess the validity and responsiveness of the Short-WOSI relative to the full WOSI, ASES, SANE, and RAND-36. RESULTS The Short-WOSI demonstrated excellent internal consistency before surgery (Cronbach α = .83) and excellent internal consistency at the 2-year follow-up (Cronbach α = .93). The baseline, 2-year, and pre- to postoperative changes in Short-WOSI and WOSI were closely correlated (r > 0.90), with both demonstrating large effect sizes (Short-WOSI = 1.92, WOSI = 1.81). Neither the Short-WOSI nor the WOSI correlated well with the other PROM instruments before (r = 0.21-0.33) or after (r = 0.25-0.38) surgery. The Short-WOSI, WOSI, and SANE scores were more responsive than ASES and RAND-36 scores. CONCLUSION The 7-item Short-WOSI demonstrated excellent internal consistency and a lack of floor or ceiling effects. The Short-WOSI demonstrated excellent cross-sectional and longitudinal construct validity and was similarly responsive over time as the full WOSI. Neither the Short-WOSI nor WOSI correlated with more general shoulder PROMs, underscoring the advantage of using instability-specific instruments for this population.
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Affiliation(s)
- Cale A Jacobs
- Mass General Brigham Sports Medicine, Brigham and Women's Hospital, Harvard Medical School Boston, Massachusetts, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, South Dakota, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Matthew J Bollier
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St Louis, Missouri, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Gregory L Cvetanovich
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Grant L Jones
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Scott D Mair
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, Kentucky, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
| | - Carolyn M Hettrich
- North Country Orthopaedics, Clayton, New York, USA
- Investigation performed at the University of Kentucky, Lexington, Kentucky, USA
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Bachmaier S, Monaco E, Smith PA, Frank RM, Matzkin EG, Wijdicks CA. Biomechanical Comparison of 3 Adjustable-Loop Suspensory Devices for All-Inside ACL Reconstruction: A Time-Zero Full-Construct Model. Orthop J Sports Med 2023; 11:23259671231201461. [PMID: 37786476 PMCID: PMC10541758 DOI: 10.1177/23259671231201461] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/19/2023] [Indexed: 10/04/2023] Open
Abstract
Background Little is known about the stability of adjustable-loop devices (ALDs) for anterior cruciate ligament (ACL) reconstruction (ACLR). Purpose To evaluate the stabilization behavior of 3 different types of ALDs for all-inside ACLR in a full-construct surgical technique-based manner. Study Design Controlled laboratory study. Methods The femoral and tibial devices of Ultrabutton (Smith & Nephew), Infinity (Conmed), and TightRope II (Arthrex) were applied to quadrupled bovine tendon grafts (n = 8 each) with tibial-sided traction applied (350 N) for graft tensioning in a simulated fully extended knee. Knotless femoral graft fixation was based on either a suture-locking device (SLD; Ultrabutton), button-locking device (BLD; Infinity), or dual-locking device (DLD; TightRope II). All constructs were progressively loaded (50 N/500 cycles) from 50 to 300 N for 3000 cycles (0.75 Hz), including complete unloading situations and pull to failure (50 mm/min). Construct elongation, stiffness, and ultimate load were analyzed. Results BLD showed significantly greater initial elongation (-2.69 ± 0.15 mm) than DLD (-3.19 ± 0.21 mm; P < .001) but behaved similarly to SLD (-2.93 ± 0.23 mm). While DLD and SLD had the smallest initial elongation at the same significance level, they behaved opposite to each other with gradually increasing peak loading. At the end of testing, DLD had the lowest (-0.64 ± 0.32 mm) and SLD the highest (3.41 ± 1.01 mm) total elongation (P < .003 for both). SLD displayed significantly higher dynamic elongation (6.34 ± 0.23 mm) than BLD (3.21 ± 0.61 mm) and DLD (2.56 ± 0.31 mm) (P < .001 for both). The failure load of BLD (865.0 ± 183.8 N) was significantly lower (P < .026) compared with SLD and DLD (>1000 N). The predominant failure mode was suture rupture and tibial bone breakage with button subsidence (SLD, n = 4). No significant difference in stiffness between constructs was found. Conclusion While DLD successfully restricted critical construct elongation, BLD partially and SLD completely exceeded the clinical failure threshold (>3 mm) of plastic elongation with loop lengthening during increasing cyclic peak loading with complete unloading. Higher failure loads of SLD and DLD implants (>1000 N) were achieved at similar construct stiffness to BLD. Clinical Relevance A detailed biomechanical understanding of the stabilization potential is pertinent to the continued evolution of ALDs to improve clinical outcomes.
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Affiliation(s)
| | - Edoardo Monaco
- Department of Orthopaedics and Traumatology Sant’Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | | | - Rachel M. Frank
- University of Colorado School of Medicine, Aurora, Colorado, USA
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21
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Frank RM. Editorial Commentary: It is Never Wrong to Perform Anterior Cruciate Ligament Revision Reconstruction as a Two-Stage Procedure. Arthroscopy 2023; 39:2112-2113. [PMID: 37543393 DOI: 10.1016/j.arthro.2023.03.021] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 08/07/2023]
Abstract
Revision anterior cruciate ligament (ACL) reconstruction can be performed in a single surgery, but in some instances, it requires 2 stages to get it right. The most common reasons for staged reconstruction include dilated bone tunnels on the tibial or femoral side (>13 mm), imperfectly placed bone tunnels that cannot be reused but cannot be avoided, and/or the need to combine the revision ACL reconstruction with meniscus and/or cartilage allograft transplantation. In my practice, we use prefabricated bone dowels, sizing up 0.5 to 1 mm relative to the size of the tunnel (after debridement) for both the femoral side and tibial side. The benefits are efficiency and reproducibility, while the challenges include cost and the potential need for multiple dowels if the prefabricated dowels are not long enough. We will occasionally add demineralized bone matrix, particularly on the tibial side, in the event that there is <5 mm of unfilled tunnel using the bone dowel. We wait ∼3 months before proceeding to the second stage using only plain radiographs to assess healing (advanced imaging such as computed tomography scan is not routinely used). We have also begun to push the limits of single-stage revision reconstruction, using dowels in a single setting. No matter what, it is never wrong to perform ACL revision reconstruction as a 2-stage procedure. When performed for the appropriate indications, outcomes tend to be good, regardless of the chosen technique.
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22
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Erdogan S, Sakha S, Shanmugaraj A, Prada C, Frank RM, Leroux T, Khan M. Comparing surgical outcomes of anterior capsular release vs circumferential release for persistent capsular stiffness. Shoulder Elbow 2023; 15:360-372. [PMID: 37538519 PMCID: PMC10395412 DOI: 10.1177/17585732221092016] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 08/05/2023]
Abstract
Purpose To consolidate the existing literature evaluating anterior capsular release and circumferential capsular release in the treatment of adhesive capsulitis (AC) of the shoulder. Methods The electronic databases PUBMED, EMBASE, MEDLINE and CENTRAL (Cochrane Central Register of Controlled Trials) were searched from data inception to October 8, 2020. Data are presented descriptively where appropriate. A meta-analysis was conducted for patient-reported outcomes. Results Overall, there were forty-six articles included. The majority of patients underwent circumferential release compared to anterior release (80.1% vs. 19.9%). Concomitant Manipulation Under Anesthesia (MUA) was employed in 25 studies, with a higher occurrence in the anterior compared to the circumferential release group (70% vs 60%). Both groups experienced significant improvements postoperatively in range of motion (ROM) and patient-reported outcomes. Complication rates were low for both anterior release (0.67%) and 360° release (0.44%). Conclusion Both anterior and circumferential release are effective techniques for treating AC with low complication rates. Future studies should improve documentation of patient demographics, surgical techniques and outcomes to determine an individualized treatment protocol for patients. Level of evidence Level IV, Systematic Review of Level I-IV studies.
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Affiliation(s)
- Safiya Erdogan
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Seaher Sakha
- Faculty of Life Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Carlos Prada
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | | | - Timothy Leroux
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Moin Khan
- Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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23
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Rilk S, Saithna A, Achtnich A, Ferretti A, Sonnery-Cottet B, Kösters C, Bottoni CR, Monaco E, Cavaignac E, Ahlbaeumer G, Brandl G, Mackay GM, Vermeijden HD, Dallo I, Pace JL, van der List JP, Moggia JR, Chahla J, Batista JP, Frosch KH, Schneider KN, Smith PA, Frank RM, Hoogeslag RAG, Eggli S, Douoguih WA, Petersen W, DiFelice GS. The modern-day ACL surgeon's armamentarium should include multiple surgical approaches including primary repair, augmentation, and reconstruction: A letter to the Editor. J ISAKOS 2023; 8:279-281. [PMID: 37023928 DOI: 10.1016/j.jisako.2023.03.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/28/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Sebastian Rilk
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Medical University of Vienna, Vienna, 1090, Austria.
| | - Adnan Saithna
- AZBSC Orthopedics, Scottsdale, Arizona, 85255, USA; School of Science & Technology, Nottingham Trent University, Clifton Campus, Nottingham, UK
| | - Andrea Achtnich
- Department of Orthopedic Sports Medicine, Klinikum Rechts der Isar, TU Technische Universität Munich, Munich, 81675, Germany
| | - Andrea Ferretti
- Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, 00197, Italy
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hôpital Privé Jean Mermoz, Lyon, 69008, France
| | - Clemens Kösters
- Department of Orthopaedic, Hand- and Trauma Surgery, Maria-Josef-Hospital Greven, Greven, 48268, Germany
| | - Craig R Bottoni
- Department of Orthopaedics, Tripler Army Medical Center, Honolulu, Hawaii, 96859, USA
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, 00185, Italy
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, 31300, France
| | - Georg Ahlbaeumer
- Center for Bone and Joint Surgery, Klinik Gut St Moritz, St Moritz, 7500, Switzerland
| | - Georg Brandl
- Department of Orthopedic Surgery, St. Vincent Shoulder & Sports Clinic, Vienna, 1030, Austria
| | - Gordon M Mackay
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, UK
| | - Harmen D Vermeijden
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, 1081, the Netherlands
| | | | - J Lee Pace
- Children's Health Andrews Institute Plano, TX, 75024, USA
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam, 1081, the Netherlands
| | - Jesús Rey Moggia
- Servicio de Ortopedia y Traumatología, Hospital "General San Martín", La Plata, Argentina; Unidad de Artroscopía y Traumatología Deportiva, Clínica CROMA y Sanatorio IPENSA, La Plata, Argentina
| | - Jorge Chahla
- Midwest Orthopaedics at Rush, Chicago, IL, 60612, USA
| | - Jorge Pablo Batista
- Boca Juniors Athletic Club Director, Football Medical Department, Brandsen, CABA, Buenos Aires, Argentina
| | - Karl H Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, 20251, Germany
| | - Kristian N Schneider
- Center for Bone and Joint Surgery, Klinik Gut St Moritz, St Moritz, 7500, Switzerland; Department of Orthopaedics and Tumor Orthopaedics, University Hospital of Münster, Münster, 48149, Germany
| | - Patrick A Smith
- Columbia Orthopaedic Group, Columbia, MO, 65201, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, 65201, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, 80045, USA
| | - Roy A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, 7555, the Netherlands
| | - Stefan Eggli
- Department of Orthopaedic Surgery, Sonnenhof Hospital, Bern, 3006, Switzerland
| | - Wiemi A Douoguih
- Department of Orthopaedic Surgery, MedStar Washington Hospital Center, Washington, DC, 20010, USA
| | - Wolf Petersen
- Department of Orthopaedic and Trauma Surgery, Martin-Luther-Hospital, Berlin, 14193, Germany
| | - Gregory S DiFelice
- Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, New York, NY, 10021, USA
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Hassebrock JD, McCarthy TP, Sylvia SM, Stokes DJ, Shinsako KK, Tokish JM, Frank RM. Rotator Cuff Repair with Knotless All-Suture Medial Row Anchors and Biceps Autograft Augmentation. Arthrosc Tech 2023; 12:e1361-e1367. [PMID: 37654888 PMCID: PMC10466225 DOI: 10.1016/j.eats.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/07/2023] [Accepted: 04/11/2023] [Indexed: 09/02/2023] Open
Abstract
Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors.
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Affiliation(s)
- Jeffrey D. Hassebrock
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Timothy P. McCarthy
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Stephen M. Sylvia
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Daniel J. Stokes
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - John M. Tokish
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Rachel M. Frank
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Sylvia SM, Stokes DJ, McCarthy TP, Hassebrock JD, Shinsako KK, Frank RM. Low-Profile Cartilage Repair With Knotless All-Suture Anchors: Surgical Technique. Arthrosc Tech 2023; 12:e1127-e1131. [PMID: 37533926 PMCID: PMC10390841 DOI: 10.1016/j.eats.2023.02.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/06/2023] [Accepted: 02/25/2023] [Indexed: 08/04/2023] Open
Abstract
Osteochondral and pure chondral lesions of the knee are common after patellar dislocations. There are multiple described techniques for the fixation of these lesions, including metallic screws, bioabsorbable screws, bioabsorbable implants, and suture devices. The purpose of this article is to describe a surgical technique for surgical fixation of a lateral condyle chondral lesion using knotless all-suture anchors, with second-look knee arthroscopy illustrating healing of the cartilage repair.
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Affiliation(s)
- Stephen M. Sylvia
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Daniel J. Stokes
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Timothy P. McCarthy
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Jeffrey D. Hassebrock
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado Medical Center, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
- Boulder; and the University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
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Hassebrock JD, Sylvia SM, McCarthy TP, Stokes DJ, Shinsako KK, Frank RM. Posterior Labral Repair Using Knotless "All-Suture" Suture Anchors. Arthrosc Tech 2023; 12:e1219-e1224. [PMID: 37533896 PMCID: PMC10391341 DOI: 10.1016/j.eats.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 08/04/2023] Open
Abstract
Isolated posterior instability is well described but relatively uncommon, accounting for less than 10% of all shoulder instability cases. When nonoperative management fails, surgical outcomes demonstrate improved patient-reported outcomes with a high level of return to sport. Knotless suture anchor and "all-suture" suture anchor technology are now available and used for instability procedures in the shoulder. This technical description describes knotless "all-suture" suture anchor fixation for isolated posterior labral tears.
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Affiliation(s)
- Jeffrey D. Hassebrock
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Stephen M. Sylvia
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Timothy P. McCarthy
- University of Colorado Medical Center, Department of Orthopedic Surgery, Boulder, Colorado, U.S.A
| | - Daniel J. Stokes
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Kevin K. Shinsako
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
| | - Rachel M. Frank
- University of Colorado School of Medicine, Department of Orthopedic Surgery, Aurora, Colorado, U.S.A
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Lee S, Brown JR, Bartolomei C, Turnbull T, Miles JW, Dornan GJ, Frank RM, Vidal AF. Effects of Lateral Opening-Wedge Distal Femoral Osteotomy on Meniscal Allograft Transplantation: A Biomechanical Evaluation. Orthop J Sports Med 2023; 11:23259671231156639. [PMID: 37347021 PMCID: PMC10280523 DOI: 10.1177/23259671231156639] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/08/2022] [Indexed: 06/23/2023] Open
Abstract
Background Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically. Purpose/Hypothesis The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus. Study Design Controlled laboratory study. Methods Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation. Results Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (-41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P > .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (-0.0479 N/mm2), 5.9% (-0.154 N/mm2), and 1.4% (-6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively. Conclusion Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile. Clinical Relevance Our findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient.
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Affiliation(s)
- Simon Lee
- Steadman Philippon Research Institute,
Vail, Colorado, USA
| | | | | | | | - Jon W. Miles
- Steadman Philippon Research Institute,
Vail, Colorado, USA
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Tabbaa SM, Pace JL, Frank RM, Grammens J, Verdonk P. Meniscus Size Differs Between Patient and Donor Populations for Meniscus Allograft Transplantation. Arthrosc Sports Med Rehabil 2023; 5:e569-e576. [PMID: 37388864 PMCID: PMC10300528 DOI: 10.1016/j.asmr.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To determine the extent of variability in meniscus size and anthropometric data between donors (supply) and patients (demand), to evaluate potential factors that may contribute to size discrepancies, and to determine whether the discrepancies lead to longer patient wait times. Methods Lateral and medial meniscal measurements, anthropometric data, and time to match a donor graft were extracted from a tissue supplier database. The frequency and distribution of meniscus size were analyzed. Body mass index (BMI), relative meniscus area, body mass to meniscus area index, and height to meniscus area index were compared between patient and donor pools via χ2 tests and independent samples t-test. The effect of size on time to match was analyzed using analysis of variance and post-hoc Tukey test. Results The lateral meniscus patient population showed a greater frequency of larger size requirements compared to the donor population (P < .001) and the medial meniscus patient population showed a higher frequency of smaller meniscus size requirements (P < .001). The medial meniscus analysis showed significantly smaller meniscus areas (P < .001) in the patient population contributing to the observed trend of an increased body mass to meniscus area index and height to meniscus area index. The time to match a donor meniscus was affected by the patient meniscus size. Conclusions This analysis demonstrates variations in frequency of meniscus sizes between donor and patient populations. This variation is attributed to differences in anthropometric data between patient and donor populations. This work identifies a mismatch between demand and supply for certain patient sizes contributing to longer times to match. Clinical Relevance This work associated donor and patient mismatches with longer wait times. This can be useful for patient counseling as well as provide a framework to determine whether there are solutions within the current meniscus donor pool that can be used to meet this clinical need.
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Affiliation(s)
- Suzanne M. Tabbaa
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - J. Lee Pace
- Department of Orthopedics, University of Connecticut, Farmington, Connecticut, U.S.A
- Elite Sports Medicine @ Connecticut Children’s Medical Center, Farmington, Connecticut, U.S.A
| | - Rachel M. Frank
- Department of Orthopaedic Surgery, University of Colorado, Aurora, Colorado, U.S.A
| | - Jonas Grammens
- Antwerp Surgical Training, Anatomy and Research Center, University of Antwerp, Wilrijk, Belgium
| | - Peter Verdonk
- ORTHOCA, Antwerp, Belgium
- Department of Orthopaedic Surgery, Antwerp University Hospital, Edegem, Belgium
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Pasic N, Bradsell HL, Barandiaran A, Robinson AS, Cole BJ, Vidal AF, Frank RM. Rate of Conversion to Matrix-Induced Autologous Chondrocyte Implantation After a Biopsy: A Multisurgeon Study. Orthop J Sports Med 2023; 11:23259671231160732. [PMID: 37188223 PMCID: PMC10176561 DOI: 10.1177/23259671231160732] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/19/2023] [Indexed: 05/17/2023] Open
Abstract
Background Autologous chondrocyte implantation (ACI) and matrix-induced autologous chondrocyte implantation (MACI) are performed to treat focal chondral defects (FCDs); both are 2-step procedures involving a biopsy, followed by transplantation. There is little published research evaluating ACI/MACI in patients who undergo a biopsy alone. Purpose To determine (1) the value of ACI/MACI cartilage biopsies and concomitant procedures in patients with FCDs of the knee and (2) the conversion rate to cartilage transplantation as well as the rate of reoperation. Study Design Case series; Level of evidence, 4. Methods A retrospective review was performed of 46 patients (63% female) who underwent a MACI (or ACI) biopsy between January 2013 and January 2018. Preoperative data, intraoperative data, and postoperative outcomes were assessed at a minimum of 2 years after the biopsy. The conversion rate from a biopsy to transplantation and the reoperation rate were calculated and analyzed. Results Among the 46 patients included, 17 (37.0%) underwent subsequent surgery, with only 12 undergoing cartilage restoration surgery, for an overall transplantation rate of 26.1%. Of these 12 patients, 9 underwent MACI/ACI, 2 underwent osteochondral allograft transplantation (OCA), and 1 underwent particulated juvenile articular cartilage implantation at 7.2 ± 7.5 months after the biopsy. The reoperation rate was 16.7% (1 patient after MACI/ACI and 1 patient after OCA) at 13.5 ± 2.3 months after transplantation. Conclusion Arthroscopic surgery with debridement, chondroplasty, loose body removal, meniscectomy/meniscal repair, and other treatment approaches of knee compartment abnormalities at the time of a biopsy appeared to be sufficient in improving function and reducing pain in patients with knee FCDs.
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Affiliation(s)
- Nicholas Pasic
- Division of Sports Medicine and
Shoulder Surgery, Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
- Nicholas Pasic, MSc, MD,
London Health Sciences Centre, 800 Commissioners Road East, Room E1-236, London,
ON, Canada N6A5W9 (
)
| | - Hannah L. Bradsell
- Division of Sports Medicine and
Shoulder Surgery, Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
| | - Andres Barandiaran
- Division of Sports Medicine and
Shoulder Surgery, Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
| | - Avi S. Robinson
- Division of Sports Medicine and
Shoulder Surgery, Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
| | - Brian J. Cole
- Department of Orthopaedic Surgery, Rush
University Medical Center, Chicago, Illinois, USA
| | | | - Rachel M. Frank
- Division of Sports Medicine and
Shoulder Surgery, Department of Orthopedics, University of Colorado School of
Medicine, Aurora, Colorado, USA
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McCarthy TP, Stokes DJ, Frank RM, McCarty EC. On-Field Sports Emergencies. Clin Sports Med 2023; 42:335-344. [DOI: 10.1016/j.csm.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Hettrich CM, Magnuson JA, Baumgarten KM, Brophy RH, Kattan M, Bishop JY, Bollier MJ, Bravman JT, Cvetanovich GL, Dunn WR, Feeley BT, Frank RM, Kuhn JE, Lansdown DA, Benjamin Ma C, Marx RG, McCarty EC, Neviaser AS, Ortiz SF, Seidl AJ, Smith MV, Wright RW, Zhang AL, Cronin KJ, Wolf BR. Predictors of Bone Loss in Anterior Glenohumeral Instability. Am J Sports Med 2023; 51:1286-1294. [PMID: 36939180 DOI: 10.1177/03635465231160286] [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: 03/21/2023]
Abstract
BACKGROUND Anterior shoulder instability can result in bone loss of both the anterior glenoid and the posterior humerus. Bone loss has been shown to lead to increased failure postoperatively and may necessitate more complex surgical procedures, resulting in worse clinical outcomes and posttraumatic arthritis. HYPOTHESIS/PURPOSE The purpose of this study was to investigate predictors of glenoid and humeral head bone loss in patients undergoing surgery for anterior shoulder instability. It was hypothesized that male sex, contact sport participation, traumatic dislocation, and higher number of instability events would be associated with greater bone loss. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 892 patients with anterior shoulder instability were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort. The presence and amount of anterior glenoid bone loss and accompanying Hill-Sachs lesions were quantified. Descriptive information and injury history were used to construct proportional odds models for the presence of any bone defect, for defects >10% of the anterior glenoid or humeral head, and for combined bony defects. RESULTS Anterior glenoid bone loss and Hill-Sachs lesions were present in 185 (20.7%) and 470 (52.7%) patients, respectively. Having an increased number of dislocations was associated with bone loss in all models. Increasing age, male sex, and non-White race were associated with anterior glenoid bone defects and Hill-Sachs lesions. Contact sport participation was associated with anterior glenoid bone loss, and Shoulder Actitvity Scale with glenoid bone loss >10%. A positive apprehension test was associated with Hill-Sachs lesions. Combined lesions were present in 19.4% of patients, and for every additional shoulder dislocation, the odds of having a combined lesion was 95% higher. CONCLUSION An increasing number of preoperative shoulder dislocations is the factor most strongly associated with glenoid bone loss, Hill-Sachs lesions, and combined lesions. Early surgical stabilization before recurrence of instability may be the most effective method for preventing progression to clinically significant bone loss. Patients should be made aware of the expected course of shoulder instability, especially in athletes at high risk for recurrence and osseous defects, which may complicate care and worsen outcomes. REGISTRATION NCT02075775 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Carolyn M Hettrich
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | | | - Robert H Brophy
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Michael Kattan
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio, USA
| | | | - Julie Y Bishop
- The Ohio State University Sports Medicine Center, Columbus, Ohio, USA
| | | | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Warren R Dunn
- Fondren Orthopedic Group, Orthopedic Surgery, Houston, Texas, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - John E Kuhn
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin Ma
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, New York, New York, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Adam J Seidl
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew V Smith
- Department of Orthopedics, Washington University Saint Louis, St. Louis, Missouri, USA
| | - Rick W Wright
- Department of Orthopaedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alan L Zhang
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | | | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.,Investigation performed at multicenter facilities and the primary site is at University of Iowa, Iowa City, Iowa, USA
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Belk JW, Lim JJ, Keeter C, McCulloch PC, Houck DA, McCarty EC, Frank RM, Kraeutler MJ. Patients With Knee Osteoarthritis Who Receive Platelet-Rich Plasma or Bone-Marrow Aspirate Concentrate Injections Have Better Outcomes Than Patients Who Receive Hyaluronic Acid: Systematic Review and Meta-analysis. Arthroscopy 2023:S0749-8063(23)00220-7. [PMID: 36913992 DOI: 10.1016/j.arthro.2023.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 11/16/2022] [Revised: 02/13/2023] [Accepted: 03/01/2023] [Indexed: 03/15/2023]
Abstract
PURPOSE To systematically review the literature in order to compare the efficacy and safety of platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and hyaluronic acid (HA) injections for the treatment of knee osteoarthritis (OA). METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I studies that compared the clinical efficacy of at least 2 of the following 3 injection therapies: PRP, BMAC, and HA for knee OA. The search phrase used was knee AND osteoarthritis AND randomized AND ("platelet rich plasma" OR "bone marrow aspirate" OR "hyaluronic acid"). Patients were primarily assessed based on patient-reported outcome scores (PROs) including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) score. RESULTS Twenty-seven studies (all Level I) met inclusion criteria, including 1,042 patients undergoing intra-articular injection(s) with PRP (mean age 57.7 years, mean follow-up 13.5 months), 226 patients with BMAC (mean age 57.0 years, mean follow-up 17.5 months), and 1,128 patients with HA (mean age 59.0 years, mean follow-up 14.4 months). Non-network meta-analyses demonstrated significantly better post-injection WOMAC (p < 0.001), VAS (p < 0.01), and Subjective IKDC scores (p < 0.001) in PRP patients when compared to HA patients. Similarly, network meta-analyses demonstrated significantly better post-injection WOMAC (p < 0.001), VAS (p = 0.03), and Subjective IKDC (p < 0.001) scores in BMAC patients when compared to HA patients. There were no significant differences in post-injection outcome scores when comparing PRP to BMAC. CONCLUSION Patients undergoing treatment for knee OA with PRP or BMAC can be expected to experience improved clinical outcomes when compared to HA patients. LEVEL OF EVIDENCE I, Meta-Analysis of Level I studies.
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Affiliation(s)
- John W Belk
- University of Colorado School of Medicine, Aurora CO 80045
| | - Joseph J Lim
- University of Colorado Boulder, Boulder CO 80309
| | - Carson Keeter
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Patrick C McCulloch
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston TX 77030
| | - Darby A Houck
- University of Colorado School of Medicine, Aurora CO 80045
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Aurora CO 80045
| | - Matthew J Kraeutler
- Houston Methodist Hospital, Department of Orthopedics & Sports Medicine, Houston TX 77030.
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Stokes DJ, McCarthy TP, Frank RM. Physical Therapy for the Treatment of Shoulder Instability. Phys Med Rehabil Clin N Am 2023; 34:393-408. [PMID: 37003660 DOI: 10.1016/j.pmr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Shoulder instability is the separation of the humeral head from the glenoid. Injury to the static and dynamic stabilizers can result in instability. Anterior shoulder instability is the predominant form of instability. It is usually a result of trauma. Posterior shoulder instability often presents with an insidious onset of pain. Multidirectional instability of the shoulder is symptomatic laxity in more than one plane of motion. The primary goal of rehabilitation is to restore pain-free mobility, strength, and functioning. Rehabilitation implements range of motion and strengthening exercises to restore proprioceptive control and scapular kinematics.
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Johnson AJ, Bradsell H, Frank RM. Use of Injections and Biologics for the Nonoperative Treatment of Rotator Cuff Pathology. Clin Sports Med 2023; 42:53-68. [DOI: 10.1016/j.csm.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Marty E, Genuario J, Aretakis A, Shinsako K, Frank RM. Left Knee Open Rectus Femoris Repair With Achilles Allograft Augmentation: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00017. [PMID: 36706196 DOI: 10.2106/jbjs.cc.22.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/10/2022] [Indexed: 01/29/2023]
Abstract
CASE We present a case of a 48-year-old man with a subacute tear of his left rectus femoris, repaired using Achilles tendon allograft. After fixation distally to the patella using suture anchors and a Krackow suture technique, the allograft was fixed proximally to the remnant rectus femoris tendon with multiple sutures in a variety of stitch configurations. The patient recovered excellently, regaining near-normal flexion and an intact straight leg raise without an extensor lag. CONCLUSION The literature regarding repair of subacute and chronic rectus femoris ruptures is limited. We provide an additional option for operative repair of subacute and chronic ruptures using Achilles tendon allograft.
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Affiliation(s)
- Eric Marty
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora, Colorado
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Holers VM, Frank RM, Clauw A, Seifert J, Zuscik M, Asokan S, Striebich C, Clay MR, Moreland LW, Banda NK. Potential causal role of synovial complement system activation in the development of post-traumatic osteoarthritis after anterior cruciate ligament injury or meniscus tear. Front Immunol 2023; 14:1146563. [PMID: 37207197 PMCID: PMC10189880 DOI: 10.3389/fimmu.2023.1146563] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/24/2023] [Indexed: 05/21/2023] Open
Abstract
Anterior cruciate ligament (ACL) injury and meniscal tear (MT) are major causal factors for developing post-traumatic osteoarthritis (PTOA), but the biological mechanism(s) are uncertain. After these structural damages, the synovium could be affected by complement activation that normally occurs in response to tissue injury. We explored the presence of complement proteins, activation products, and immune cells, in discarded surgical synovial tissue (DSST) collected during arthroscopic ACL reconstructive surgery, MT-related meniscectomy and from patients with OA. Multiplexed immunohistochemistry (MIHC) was used to determine the presence of complement proteins, receptors and immune cells from ACL, MT, OA synovial tissue vs. uninjured controls. Examination of synovium from uninjured control tissues did not reveal the presence of complement or immune cells. However, DSST from patients undergoing ACL and MT repair demonstrated increases in both features. In ACL DSST, a significantly higher percentage of C4d+, CFH+, CFHR4+ and C5b-9+ synovial cells were present compared with MT DSST, but no major differences were seen between ACL and OA DSST. Increased cells expressing C3aR1 and C5aR1, and a significant increase in mast cells and macrophages, were found in ACL as compared to MT synovium. Conversely, the percentage of monocytes was increased in the MT synovium. Our data demonstrate that complement is activated in the synovium and is associated with immune cell infiltration, with a more pronounced effect following ACL as compared to MT injury. Complement activation, associated with an increase in mast cells and macrophages after ACL injury and/or MT, may contribute to the development of PTOA.
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Affiliation(s)
- V. Michael Holers
- Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Rachel M. Frank
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Andrew Clauw
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Jennifer Seifert
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael Zuscik
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Sakthi Asokan
- Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Christopher Striebich
- Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Michael R. Clay
- Department of Pathology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Larry W. Moreland
- Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Orthopedics and the Colorado Program for Musculoskeletal Research, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Nirmal K. Banda
- Division of Rheumatology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Nirmal K. Banda,
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Bradsell H, Waterman B, Lansdown D, Hevesi M, Jones K, Frank RM. Incorporating Biologics Into Your Sports Medicine Practice: Who, What, When, Why, and How? Instr Course Lect 2023; 72:431-444. [PMID: 36534871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Orthobiologic techniques can be used in the treatment of a variety of sports medicine pathologies, using an evidence-based approach focused on the value of all available approaches. The orthopaedic surgeon should be aware of the indications for and any technical pearls and pitfalls related to the use of orthobiologic agents as treatment for, or as an adjunct to management of, common sports medicine injuries and pathologies. Expected outcomes, including return to sport/activity, as well as potential complications and how to avoid them, should be considered. Although promising results have been reported, significant lack of high-level studies, inconsistent findings, and variability among current research make it challenging to reach a definitive conclusion about application, target populations, and overall effectiveness.
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Menendez ME, Sudah SY, Denard PJ, Feeley BT, Frank RM, Galvin JW, Garber AC, Crall TS, Crow S, Gramstad GD, Cheung E, Fine L, Costouros JG, Dobbs R, Garg R, Getelman MH, Buerba R, Harmsen S, Mirzayan R, Pifer M, McElvany M, Ma CB, McGoldrick E, Lynch JR, Jurek S, Humphrey CS, Weinstein D, Orvets ND, Solomon DJ, Zhou L, Saleh JR, Hsu J, Shah A, Wei A, Choung E, Shukla D, Ryu RK, Brown DS, Hatzidakis AM, Min KS, Fan R, Guttmann D, Rao AG, Ding D, Andres BM, Cheah J, Mierisch CM, Hoellrich RG, Lee B, Tweet M, Provencher MT, Butler JB, Kraetzer B, Klug RA, Burns EM, Schrumpf MA, Savin D, Sheu C, Magovern B, Williams R, Sears BW, Stone MA, Nugent M, Gomez GV, Amini MH. Surgeon variation in glenoid bone reconstruction procedures for shoulder instability. J Shoulder Elbow Surg 2023; 32:133-140. [PMID: 36208672 DOI: 10.1016/j.jse.2022.09.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/22/2022] [Accepted: 09/04/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Advances in the understanding and management of glenoid bone loss in shoulder instability have led to the development of alternative bony reconstruction techniques to the Latarjet using free bone grafts, but little is known about surgeon adoption of these procedures. This study sought to characterize surgeon variation in the use of glenoid bone reconstruction procedures for shoulder instability and ascertain reasons underlying procedure choice. METHODS A 9-question survey was created and distributed to 160 shoulder surgeons members of the PacWest Shoulder and Elbow Society, of whom 65 (41%) responded. The survey asked questions regarding fellowship training, years in practice, surgical volume, preferred methods of glenoid bone reconstruction, and reasons underlying treatment choice. RESULTS All surgeons completed a fellowship, with an equal number of sports medicine fellowship-trained (46%) and shoulder and elbow fellowship-trained (46%) physicians. The majority had been in practice for at least 6 years (6-10 years: 25%; >10 years: 59%). Most (78%) performed ≤10 glenoid bony reconstructions per year, and 66% indicated that bony procedures represented <10% of their total annual shoulder instability case volume. The open Latarjet was the preferred primary reconstruction method (69%), followed by open free bone block (FBB) (22%), arthroscopic FBB (8%), and arthroscopic Latarjet (1%). Distal tibia allograft (DTA) was the preferred graft (74%) when performing an FBB procedure, followed by iliac crest autograft (18%), and distal clavicle autograft (6%). The top 5 reasons for preferring Latarjet over FBB were the sling effect (57%), the autologous nature of the graft (37%), its robust clinical evidence (22%), low cost (17%), and availability (11%). The top 5 reasons for choosing an FBB procedure were less anatomic disruption (58%), lower complication rate (21%), restoration of articular cartilage interface (16%), graft versatility (11%), and technical ease (11%). Only 20% of surgeons indicated always performing a bony glenoid reconstruction procedure in the noncontact athlete with less than 20% glenoid bone loss. However, that percentage rose to 62% when considering a contact athlete with the same amount of bone loss. CONCLUSIONS Although open Latarjet continues to be the most popular glenoid bony primary reconstruction procedure in shoulder instability, nearly 30% of shoulder surgeons in the western United States have adopted FBB techniques as their preferred treatment modality--with DTA being the most frequently used graft. High-quality comparative clinical effectiveness research is needed to reduce decisional conflict and refine current evidence-based treatment algorithms.
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Affiliation(s)
- Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA
| | - Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, NJ, USA
| | - Patrick J Denard
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, OR, USA.
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Belk JW, Bravman JT, Frank RM, Dragoo JL, McCarty EC. Osteochondral Allograft Transplantation. Video Journal of Sports Medicine 2022. [DOI: 10.1177/26350254221131054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Articular cartilage lesions are a significant cause of morbidity and impaired knee function, and attempts to surgically repair damaged cartilage have failed to reliably reproduce native cartilage. Thus, osteochondral allograft transplantation is an effective one-step procedure to repair large cartilage defects. Indications: Osteochondral allograft transplantation is indicated for young active patients with large focal defects, those with a history of previous cartilage repair, and those with cartilage-related degenerative disorders such as osteonecrosis, osteochondritis dissecans, and/or post-traumatic osteochondral defects. Technique Description: In short, after the focal chondral defect is identified, a socket is created with specific dimensions in depth and diameter. The donor cartilage is then secured in a graft station, and a sizing guide is placed through a bushing to confirm the allograft harvest location. Using stabilization from the graft station arm, a coring reamer is then advanced through the donor cartilage, and a saw is used to allow for easy removal of the graft from the donor condyle. The plug is then fashioned to fit the exact dimensions of the socket created earlier in the procedure. A cut on the donor plug is made to fashion the plug to the appropriate depth. A rongeur is used to make the plug more bullet shaped at the end to allow the plug to enter the socket more easily. Small holes are then drilled into the base of the socket to help promote incorporation of the plug into the socket during the healing process. After the socket is irrigated, the plug is then placed into the socket, and a tamp is used to gently tap the cartilage until it is flush with the surrounding surface. Results: After an appropriate rehabilitation protocol is followed for up to 10 months postoperatively, osteochondral allograft transplantation allows for near-to-complete restoration of patient functionality and strength, with return to full activity possible within 1 year. Conclusion: Acute repair of large focal chondral defects is effective in restoring knee strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- John W. Belk
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T. Bravman
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rachel M. Frank
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jason L. Dragoo
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Eric C. McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
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Belk JW, Bravman JT, Frank RM, Seidl AJ, McCarty EC. Pectoralis Major Tendon Repair: Transosseous Suture Technique. Video Journal of Sports Medicine 2022. [DOI: 10.1177/26350254221131058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Pectoralis major ruptures are rare injuries that occur in young men between 20 and 40 years of age, typically during resistance training in the eccentric phase of muscle contraction. As the incidence of these ruptures increases with increasing activity levels and use of anabolic steroids, it is important to understand effective repair techniques. Indications: Repair of the ruptured pectoralis major tendon is indicated for young, active patients seeking to regain full functionality of the affected upper extremity. Technique Description: In short, after the pectoralis major is identified, the insertion site is revealed just lateral to the biceps tendon. The site for the bone trough is then exposed through cauterization of superficial tissue, and a cortical bone trough is drilled vertically using a small round burr. The location of 3 pilot holes is identified just lateral to the cortical bone trough, and then the holes are drilled to allow for placement of the anchors later in the procedure. The tendon itself is then identified, and sutures are placed in the bulk of the muscle tendon in a Krackow fashion. After the tendon is properly sutured, it is placed under tension to test the structural integrity of the suture pattern and ensure proper load capacity. The sutures are then passed through the pilot holes, the tendon is pulled down into the trough, and the sutures are tied down to the bone. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, the transosseous suture technique in the context of pectoralis major tendon repairs allows for adequate tissue to bone healing and near-complete restoration of patient functionality and strength. Conclusion: Acute repair of pectoralis major tendon tears using a transosseous suture technique is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Belk JW, Bravman JT, Frank RM, Seidl AJ, McCarty EC. Latissimus Dorsi Tendon Repair. Video Journal of Sports Medicine 2022. [DOI: 10.1177/26350254221128040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background: Latissimus dorsi tendon ruptures are rare injuries that can occur in overhead or throwing motions and are almost always sports related. Indications: Latissimus dorsi tendon ruptures are largely treated nonoperatively, although surgical repair is indicated for the young active patient looking to return to a high level of sport and for those with complete avulsion injuries or mid-substance tendon tears. Technique Description: Depending on the degree of tendon retraction, anteroinferior or posteroinferior axillary incision is made. After the tendon is mobilized, sutures are placed in a Krackow fashion through the bulk of the tendon, and the tendon footprint is prepared by gently decorticating the surface of the humerus, just anterior and inferior to the teres major insertion point. Two Arthrex Pec Buttons are then loaded into the superior and inferior limbs of the suture tape and 2 unicortical holes are drilled into the footprint of the insertion site. The superior button is placed first and then tensioned to allow the latissimus dorsi to be pulled to the bone. Next, the second button is placed, though this is not tensioned until later at the time of the biceps tenodesis. Finally, the procedure is visualized and well inspected to ensure appropriate location of the tendon and securing hardware. Results: After an appropriate rehabilitation protocol is followed for up to 6 months postoperatively, acute repair of a ruptured latissimus dorsi tendon allows for near to complete restoration of patient functionality and strength, with return to full activity possible within 6 to 8 months. Conclusion: Surgical repair of a ruptured latissimus dorsi tendon is effective in restoring upper extremity strength and functionality and is associated with high patient satisfaction. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
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Affiliation(s)
- John W. Belk
- Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T. Bravman
- Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Rachel M. Frank
- Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Adam J. Seidl
- Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Eric C. McCarty
- Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, USA
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Bradsell H, Lencioni A, Shinsako K, Frank RM. In-Office Diagnostic Needle Arthroscopy Using the NanoScope™ Arthroscopy System. Arthrosc Tech 2022; 11:e1923-e1927. [PMID: 36457377 PMCID: PMC9705598 DOI: 10.1016/j.eats.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/09/2022] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022] Open
Abstract
Diagnostic needle arthroscopy performed in office is a safe and cost-effective method for accurate evaluation of intra-articular pathology, improving clinical decision making. This minimally invasive approach is an effective alternative to traditional diagnostic techniques of diagnostic surgical arthroscopy and magnetic resonance imaging (MRI). Needle arthroscopy is considered low-risk, with an extremely low complication rate when performed with appropriate technique and indications. The purpose of this article is to describe an approach to an in-office diagnostic procedure using a needle arthroscopy system.
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Affiliation(s)
| | | | | | - Rachel M. Frank
- Address correspondence to Rachel M. Frank, M.D., University of Colorado School of Medicine, 12631 E 17th Ave., Mail Stop B202, Aurora, CO 80045, USA.
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Branche K, Bradsell HL, Lencioni A, Frank RM. Sex-Based Differences in Adult ACL Reconstruction Outcomes. Curr Rev Musculoskelet Med 2022; 15:645-650. [PMID: 36242754 PMCID: PMC9789217 DOI: 10.1007/s12178-022-09801-3] [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] [Accepted: 09/30/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW In the setting of ever improving outcomes following anterior cruciate ligament (ACL) reconstruction, both objectively and subjectively, there remains continued interest in better understanding the differences in outcomes between male and female patients. The current review investigates the recent literature surrounding the roles of biological sex in adult ACL reconstruction outcomes. RECENT FINDINGS Within the past five years, the most prominent and recurrent difference between male and female patient cohorts is the subjective report of pain and function. Female patients have been consistently shown to have worse self-reported outcomes following ACL reconstruction. Specific and quantifiable subjective outcomes that are highlighted include the International Knee Documentation Committee (IKDC) subjective score, the Knee injury and Osteoarthritis Outcome Score (KOOS), and patient-acceptable symptom state (PASS). Current research on the topic of biological sex-based differences in ACL reconstruction outcomes can be divided into four main categories: patient-reported subjective outcomes; physical assessment and gait analysis; kinematics; and rates of reinjury, revision, and contralateral reconstruction. This chapter provides a summary of recent literature focused on these four main areas of interest related to ACL reconstruction outcomes in males and females.
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Affiliation(s)
- Katherine Branche
- grid.266756.60000 0001 2179 926XUniversity of Missouri Kansas City, Kansas City, MO USA
| | - Hannah L. Bradsell
- grid.430503.10000 0001 0703 675XDepartment of Orthopedics, University of Colorado School of Medicine, Aurora, CO USA
| | - Alex Lencioni
- grid.430503.10000 0001 0703 675XUniversity of Colorado School of Medicine, Aurora, CO USA
| | - Rachel M. Frank
- grid.430503.10000 0001 0703 675XDepartment of Orthopaedic Surgery, University of Colorado School of Medicine, 12631 E 17th Ave, Mail Stop B202, Aurora, CO 80045 USA
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Smith JRH, Belk JW, Friedman JL, Dragoo JL, Frank RM, Bravman JT, Wolcott ML, McCarty EC. Predictors of Mid- to Long-Term Outcomes in Patients Experiencing a Knee Dislocation: A Systematic Review of Clinical Studies. J Knee Surg 2022; 35:1333-1341. [PMID: 33545729 DOI: 10.1055/s-0041-1723762] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knee dislocations (KDs) are devastating injuries for patients and present complex challenges for orthopaedic surgeons. Although short-term outcomes have been studied, there are few long-term outcomes of these injuries available in the literature. The purpose of this study is to determine factors that influence mid- to long-term clinical outcomes following surgical treatment of KD. A review of the current literature was performed by searching PubMed, the Cochrane Library, and Embase to identify clinical studies published from 2010 to 2019 with a minimum 2-year follow-up that reported outcomes following surgical treatment of KDs. Ten studies (6 level III, 4 level IV) were included. At mid- (2-10 y) to long-term (>10 y) follow-up, concomitant arterial, cartilage, and combined meniscus damage were predictive factors for inferior Lysholm and International Knee Documentation Committee (IKDC) scores when compared with patients without these associated injuries. Although concomitant neurological damage may influence short-term outcomes due to decreased mobility, at longer follow-up periods it does not appear to predict worse clinical outcomes when compared with patients without concomitant neurological injury. Frank and polytrauma KDs have been associated with worse mid- to long-term outcomes when compared with transient and isolated KDs. Patients who underwent surgery within 6 weeks of trauma experienced better long-term outcomes than those who underwent surgery longer than 6 weeks after the initial injury. However, the small sample size of this study makes it difficult to make valid recommendations. Lastly, female sex, patients older than 30 years at the time of injury and a body mass index (BMI) greater than 35 kg/m2 are factors that have been associated with worse mid- to long-term Lysholm and IKDC scores. The results of this review suggest that female sex, age >30 years, BMI >35 kg/m2, concomitant cartilage damage, combined medial and lateral meniscal damage, KDs that do not spontaneously relocate, and KDs associated with polytrauma may predict worse results at mid- to long-term follow-up.
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Affiliation(s)
- John-Rudolph H Smith
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - John W Belk
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jamie L Friedman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jason L Dragoo
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Michelle L Wolcott
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
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Hall MM, Allen GM, Allison S, Craig J, DeAngelis JP, Delzell PB, Finnoff JT, Frank RM, Gupta A, Hoffman DF, Jacobson JA, Narouze S, Nazarian LN, Onishi K, Ray JW, Sconfienza LM, Smith J, Tagliafico A. Recommended Musculoskeletal and Sports Ultrasound Terminology: A Delphi-Based Consensus Statement. J Ultrasound Med 2022; 41:2395-2412. [PMID: 35103998 DOI: 10.1002/jum.15947] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The current lack of agreement regarding standardized terminology in musculoskeletal and sports ultrasound presents challenges in education, clinical practice, and research. This consensus was developed to provide a reference to improve clarity and consistency in communication. METHODS A multidisciplinary expert panel was convened consisting of 18 members representing multiple specialty societies identified as key stakeholders in musculoskeletal and sports ultrasound. A Delphi process was used to reach consensus which was defined as group level agreement >80%. RESULTS Content was organized into seven general topics including: 1) General Definitions, 2) Equipment and Transducer Manipulation, 3) Anatomic and Descriptive Terminology, 4) Pathology, 5) Procedural Terminology, 6) Image Labeling, and 7) Documentation. Terms and definitions which reached consensus agreement are presented herein. CONCLUSIONS The historic use of multiple similar terms in the absence of precise definitions has led to confusion when conveying information between colleagues, patients, and third-party payers. This multidisciplinary expert consensus addresses multiple areas of variability in diagnostic ultrasound imaging and ultrasound-guided procedures related to musculoskeletal and sports medicine.
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Affiliation(s)
- Mederic M Hall
- Department of Orthopedics & Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Sandra Allison
- Department of Radiology, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joseph Craig
- Department of Radiology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Joseph P DeAngelis
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jonathan T Finnoff
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Atul Gupta
- Department of Radiology, Rochester General Hospital, Rochester, New York, USA
| | - Douglas F Hoffman
- Departments of Orthopedics and Radiology, Essentia Health, Duluth, Minnesota, USA
| | - Jon A Jacobson
- Department of Radiology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Samer Narouze
- Department of Surgery and Anesthesiology, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Levon N Nazarian
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kentaro Onishi
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremiah W Ray
- Departments of Emergency Medicine and Physical Medicine and Rehabilitation, University of California, Davis, Davis, California, USA
| | - Luca M Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
| | - Jay Smith
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Alberto Tagliafico
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Belk JW, Houck DA, Littlefield CP, Kraeutler MJ, Potyk AG, Mei-Dan O, Dragoo JL, Frank RM, McCarty EC. Platelet-Rich Plasma Versus Hyaluronic Acid for Hip Osteoarthritis Yields Similarly Beneficial Short-Term Clinical Outcomes: A Systematic Review and Meta-analysis of Level I and II Randomized Controlled Trials. Arthroscopy 2022; 38:2035-2046. [PMID: 34785294 DOI: 10.1016/j.arthro.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 05/30/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the literature to compare the efficacy of platelet-rich plasma (PRP) and hyaluronic acid (HA) injections for the treatment of hip osteoarthritis (OA). METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that compared the clinical efficacy of PRP and HA injections for hip OA. The search phrase used was hip, osteoarthritis, platelet-rich plasma, hyaluronic acid, randomized. Patients were assessed based on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Visual Analog Scale (VAS) for pain, and the Harris Hip Score (HHS). Subanalyses were performed for any outcome score in which ≥3 studies reported results. RESULTS Six studies (5 level I, 1 level II) met inclusion criteria, including 211 patients undergoing intra-articular injection with PRP (mean age 60.0 years, mean follow-up 12.2 months) and 197 patients with HA (mean age 62.3 years, mean follow-up 11.9 months). No significant differences were found in the weighted improvement of any outcome score (WOMAC, VAS, or HHS) from preinjection to postinjection between groups. When excluding a study with the highest risk of bias to eliminate heterogeneity, pooled subanalysis demonstrated no significant differences in WOMAC subscores between PRP and HA groups. Similarly, in a pooled subanalysis that isolated patients treated with leukocyte-poor PRP, no significant differences in WOMAC subscores were found between PRP and HA groups. CONCLUSION Patients undergoing treatment for hip OA with either PRP or HA injections can expect to experience similarly beneficial short-term clinical outcomes. LEVEL OF EVIDENCE II, systematic review of level I and II studies.
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Affiliation(s)
- John W Belk
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A..
| | - Darby A Houck
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | | | - Matthew J Kraeutler
- Department of Orthopaedic Surgery, St. Joseph's Regional Medical Center, Paterson, New Jersey, U.S.A
| | - Andrew G Potyk
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Omer Mei-Dan
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Jason L Dragoo
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Rachel M Frank
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
| | - Eric C McCarty
- Department of Orthopaedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A
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Lencioni A, Bradsell H, Shinsako K, Frank RM. SpeedBridge Knotless Double-Pulley Rotator Cuff Repair. Arthrosc Tech 2022; 11:e797-e804. [PMID: 35646565 PMCID: PMC9134261 DOI: 10.1016/j.eats.2021.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/23/2021] [Accepted: 12/21/2021] [Indexed: 02/03/2023] Open
Abstract
Rotator cuff tears remain a common injury, and may require rotator cuff repair, one of the most frequently performed orthopaedic procedures. Achieving an ideal construct during rotator cuff repair is crucial, and while many techniques exist to accomplish this, they are continuously evolving to improve stability and biomechanics of the repaired shoulder. Improving efficiency of the procedure alongside the increasing complexity of innovative techniques remains of the utmost importance. The double-pulley SpeedBridge technique achieves medial fixation in a double-row, transosseus-equivalent repair, and the knotless nature of the technique creates for a low-profile construct and improves overall efficiency. The purpose of this Technical Note is to describe a reproducible and efficient approach to arthroscopic rotator cuff repair using the SpeedBridge knotless double-pulley technique.
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Affiliation(s)
| | | | | | - Rachel M. Frank
- Address correspondence to Rachel M. Frank, M.D., University of Colorado School of Medicine, 12631 E. 17th Ave, Mail Stop B202, Aurora, CO 80045, U.S.A.
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Frank RM, Bradsell H, Thompson SR. What's New in Sports Medicine. J Bone Joint Surg Am 2022; 104:667-674. [PMID: 35202043 DOI: 10.2106/jbjs.22.00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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)
- Rachel M Frank
- University of Colorado School of Medicine, Aurora, Colorado
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Barandiaran AF, Houck DA, Schumacher AN, Seidl AJ, Frank RM, Vidal AF, Wolcott ML, McCarty EC, Bravman JT. Shoulder Surgery as an Effective Treatment for Shoulder-Related Sleep Disturbance: A Systematic Review. Arthroscopy 2022; 38:989-1000.e1. [PMID: 34478767 DOI: 10.1016/j.arthro.2021.08.021] [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: 04/14/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review is to evaluate the current literature in an effort to investigate sleep quality and disturbances and the association with clinical outcomes of patients undergoing shoulder surgery. METHODS A systematic review of the PubMed, Embase, and Cochrane Library databases was performed according to PRISMA guidelines. All English-language literature reporting clinical outcomes and sleep quality and disturbance after shoulder surgery was reviewed by 2 independent reviewers. Outcomes assessed included patient-reported outcomes (PROs) and sleep quality. Specific PROs included the Pittsburgh Sleep Quality Index (PSQI), Visual Analog Scale (VAS) for pain, Simple Shoulder Test (SST), University of California Los Angeles (UCLA) Shoulder Rating Scale, and American Shoulder and Elbow Surgeons Score (ASES). Study methodology was assessed using the Modified Coleman Methodology Score. Descriptive statistics are presented. RESULTS Sixteen studies (11 level IV, 2 level III, 3 level II) with a total of 2748 shoulders were included (age, 12-91 years; follow-up, 0.25-132 months). In total, 2198 shoulders underwent arthroscopic rotator cuff repair (RCR), 131 shoulders underwent arthroscopic capsular release, 372 shoulders underwent total shoulder arthroplasty (TSA), 18 shoulders underwent comprehensive arthroscopic management, and 29 shoulders underwent sternoclavicular joint procedures. All shoulder surgeries improved self-reported sleep and PROs from before to after surgery. In RCR patients, PSQI scores were significantly associated with VAS scores, SST scores (r = 0.453, r = -0.490, P < .05, respectively), but not significantly associated with UCLA Shoulder rating scale or the ASES scores (r = 0.04, r = 0.001, P > .05, respectively). In TSA patients, PSQI scores were significantly associated with ASES scores (r = -0.08, P < .05). All 4 RCR studies and 1 TSA study using PSQI found significant improvements in mean PSQI scores within 6 to 24 months (P < .05). CONCLUSIONS Surgical intervention for rotator cuff tear and glenohumeral osteoarthritis significantly improves self-reported sleep in patients with shoulder pain. However, there remains a dearth of available studies assessing the effects of surgical intervention for adhesive capsulitis, sternoclavicular joint instability, and sternoclavicular osteoarthritis on sleep. Future studies should use sleep-specific PROs and quantitative measures of sleep to further elucidate the relationship between sleep and the effect of shoulder surgery. LEVEL OF EVIDENCE Level IV, systematic review of Level II-IV studies.
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Affiliation(s)
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | | | - Michelle L Wolcott
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopedics, Aurora
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50
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Belk JW, Wharton BR, Houck DA, Bravman JT, Kraeutler MJ, Mayer B, Noonan TJ, Seidl AJ, Frank RM, McCarty EC. Shoulder Stabilization Versus Immobilization for First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-analysis of Level 1 Randomized Controlled Trials. Am J Sports Med 2022; 51:1634-1643. [PMID: 35148222 DOI: 10.1177/03635465211065403] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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 Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation (ASD). PURPOSE To systematically review the literature to compare rates of recurrent instability and subsequent instability surgery in patients undergoing treatment for a first-time ASD with surgical stabilization versus shoulder immobilization. STUDY DESIGN Systematic review and meta-analysis; Level of evidence, 1. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized studies that compared outcomes of surgical stabilization versus immobilization for treatment of primary ASD. The following search phrase was used: (glenohumeral OR anterior shoulder) AND (conservative OR nonoperative OR nonsurgical OR physiotherapy) AND (Bankart OR repair OR stabilization OR surgical OR surgery OR arthroscopic OR arthroscopy) AND (instability OR dislocation). Patients with soft tissue disruption alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and subsequent instability surgery rates, the Western Ontario Shoulder Instability Index (WOSI), and range of motion were evaluated. RESULTS A total of 5 studies met inclusion criteria, including 126 patients undergoing surgical stabilization (mean age, 23.6 years; range, 15.0-39.0 years) and 133 patients undergoing treatment with sling immobilization only (mean age, 23.1 years; range, 15.0-31.0 years). Mean follow-up was 59.7 months. Overall, 6.3% of operative patients experienced recurrent instability at latest follow-up compared with 46.6% of nonoperative patients (P < .00001). Similarly, 4.0% of operative patients underwent a subsequent instability surgery compared with 30.8% of nonoperative patients (P < .00001). These same trends were demonstrated when data were isolated to nonoperative patients immobilized in internal rotation. When comparing the operative and nonoperative groups at latest follow-up, 1 study found significantly improved WOSI scores among operative patients (P = .035) and 1 study found significantly improved abducted external rotation in nonoperative patients (P = .02). CONCLUSION Patients, particularly active men in their 20s and 30s, undergoing treatment for a first-time ASD with a surgical stabilization procedure can be expected to experience significantly lower rates of recurrent instability and a significantly decreased need for a future stabilization procedure when compared with patients treated nonoperatively.
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Affiliation(s)
- John W Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Benjamin R Wharton
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Jonathan T Bravman
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- St Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, USA
| | - Braden Mayer
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Thomas J Noonan
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Adam J Seidl
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Rachel M Frank
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, USA
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