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Amsterdam-Zuidoost, Netherlands

van Eck C.F.,University of Pittsburgh | van Eck C.F.,Orthopaedic Research Center Amsterdam | Schreiber V.M.,University of Pittsburgh | Liu T.T.,University of Pittsburgh | Fu F.H.,University of Pittsburgh
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2010

The anatomic approach is gaining popularity in anterior cruciate ligament (ACL) reconstruction. It is predominantly applied during primary ACL reconstruction. However, following the same principles as during primary surgery, the anatomic approach can also be applied during revision and augmentation surgery. This paper discusses the surgical technique for anatomic single- and double-bundle ACL reconstruction, for primary, revision and augmentation surgery. During primary reconstruction, the choice for single- or double-bundle reconstruction and graft size should be based on ACL insertion site and femoral intercondylar notch dimensions. When there is an isolated anteromedial (AM) or posterolateral (PL) bundle rupture, augmentation of a single-bundle can be performed while protecting the integrity of the intact bundle. Especially during revision surgery, there are many potential situations the surgeon may encounter when entering the knee. There are multiple possible solutions for all of these different situations leading to an anatomic end result. Three-dimensional computed tomography (CT) scanning should be used to evaluate the current tunnel positions and determine the operative strategy. © 2010 Springer-Verlag.

van Eck C.F.,University of Pittsburgh | van Eck C.F.,Orthopaedic Research Center Amsterdam | Lesniak B.P.,University of Pittsburgh | Schreiber V.M.,University of Pittsburgh | Fu F.H.,University of Pittsburgh
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2010

Anatomy is the foundation of orthopaedic surgery, and the advancing knowledge of the anterior cruciate ligament (ACL) anatomy has led to the development of improved modern reconstruction techniques that approach the anatomy of the native ACL. Current literature on the anatomy of the ACL and its reconstruction techniques, as well as our surgical experience, was used to develop a flowchart that can aid the surgeon in performing anatomic ACL reconstruction. We define anatomic ACL reconstruction as the functional restoration of the ACL to its native dimensions, collagen orientation, and insertion sites. A guideline was written to accompany this flowchart with more detailed information on anatomic ACL reconstruction and its pitfalls, all accompanied by relevant literature and helpful figures. Although there is still much to learn about anatomic ACL reconstruction methods, we believe this is a helpful document for surgeons. We continue to modify the flowchart as more information about the anatomy of the ACL, and how to more closely reproduce it, becomes available. © 2010 Arthroscopy Association of North America.

Schreiber V.M.,University of Pittsburgh | Van Eck C.F.,Orthopaedic Research Center Amsterdam | Fu F.H.,University of Pittsburgh
Sports Medicine and Arthroscopy Review | Year: 2010

Rupture of the anterior cruciate ligament (ACL) is one of the most frequent forms of knee trauma. The traditional surgical treatment for ACL rupture is single-bundle reconstruction. However, during the past few years there has been a shift in interest toward double-bundle reconstruction to closely restore the native ACL anatomy. This paper evaluates the basis for double-bundle ACL reconstruction including anatomy, biomechanics and kinematics, describes our surgical technique, and discusses why we prefer anatomic double-bundle ACL reconstruction, as well as its outcome, the choices, and the controversies of double-bundle ACL reconstruction. Pitfalls of traditional ACL surgery are also discussed, the recognition of which is the key to performing anatomic ACL reconstruction. © 2010 Lippincott Williams & Wilkins, Inc.

Muller B.,University of Pittsburgh | Muller B.,Orthopaedic Research Center Amsterdam | Bowman K.F.,University of Pittsburgh | Bedi A.,University of Michigan
Clinics in Sports Medicine | Year: 2013

Operative reconstruction of a torn anterior cruciate ligament (ACL) has become the most broadly accepted treatment. An important, but underreported, outcome of ACL reconstruction is graft failure, which poses a challenge for the orthopedic surgeon. An understanding of the tendon-bone healing and the intra-articular ligamentization process is crucial for orthopedic surgeons to make appropriate graft choices and to be able to initiate optimal rehabilitation protocols after surgical ACL reconstruction. This article focuses on the current understanding of the tendon-to-bone healing process for both autografts and allografts and discusses strategies to biologically augment healing. © 2013 Elsevier Inc.

Bruinsma W.E.,University of Groningen | Becker S.J.E.,Massachusetts General Hospital | Guitton T.G.,Orthopaedic Research Center Amsterdam | Kadzielski J.,South Shore Orthopedics | Ring D.,Harvard University
Clinical Orthopaedics and Related Research | Year: 2015

Background: So-called “hazardous attitudes” (macho, impulsive, antiauthority, resignation, invulnerable, and confident) were identified by the Federal Aviation Administration and the Canadian Air Transport Administration as contributing to road traffic incidents among college-aged drivers and felt to be useful for the prevention of aviation accidents. The concept of hazardous attitudes may also be useful in understanding adverse events in surgery, but it has not been widely studied. Questions/purposes: We surveyed a cohort of orthopaedic surgeons to determine the following: (1) What is the prevalence of hazardous attitudes in a large cohort of orthopaedic surgeons? (2) Do practice setting and/or demographics influence variation in hazardous attitudes in our cohort of surgeons? (3) Do surgeons feel they work in a climate that promotes patient safety? Methods: We asked the members of the Science of Variation Group—fully trained, practicing orthopaedic and trauma surgeons from around the world—to complete a questionnaire validated in college-aged drivers measuring six attitudes associated with a greater likelihood of collision and used by pilots to assess and teach aviation safety. We accepted this validation as applicable to surgeons and modified the questionnaire accordingly. We also asked them to complete the Modified Safety Climate Questionnaire, a questionnaire assessing the absence of a safety climate that is based on the patient safety cultures in healthcare organizations instrument. Three hundred sixty-four orthopaedic surgeons participated, representing a 47% response rate of those with correct email addresses who were invited. Results: Thirty-eight percent (137 of 364 surgeons) had at least one score that would have been considered dangerously high in pilots (> 20), including 102 with dangerous levels of macho (28%) and 41 with dangerous levels of self-confidence (11%). After accounting for possible confounding variables, the variables most closely associated with a macho attitude deemed hazardous in pilots were supervision of surgical trainees in the operating room (p = 0.003); location of practice in Canada (p = 0.059), Europe (p = 0.021), and the United States (p = 0.005); and being an orthopaedic trauma surgeon (p = 0.046) (when compared with general orthopaedic surgeons), but accounted for only 5.3% of the variance (p < 0.001). On average, 19% of surgeon responses to the Modified Safety Climate Questionnaire implied absence of a safety climate. Conclusions: Hazardous attitudes are common among orthopaedic surgeons and relate in small part to demographics and practice setting. Future studies should further validate the measure of hazardous attitudes among surgeons and determine if they are associated with preventable adverse events. We agree with aviation safety experts that awareness of amelioration of such attitudes might improve safety in all complex, high-risk endeavors, including surgery—a line of thinking that merits additional research. © 2014, The Association of Bone and Joint Surgeons®.

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