Sports Medicine and Shoulder Service

Medicine Lodge, United States

Sports Medicine and Shoulder Service

Medicine Lodge, United States
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Bedi A.,Sports Medicine and Shoulder Service | Raphael B.,Sports Medicine and Shoulder Service | Maderazo A.,Imaging Hospital for Special Surgery | Pavlov H.,Imaging Hospital for Special Surgery | Williams III R.J.,Sports Medicine and Shoulder Service
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2010

Purpose: To compare the obliquity and length of femoral tunnels prepared with transtibial versus anteromedial portal drilling for anterior cruciate ligament (ACL) reconstruction and identify potential risks associated with the anteromedial portal reaming technique. Methods: We used 18 human cadaveric knees (9 matched pairs) without ACL injury or pre-existing arthritis for the study. Femoral tunnels for ACL reconstruction were prepared by either a transtibial (n = 6) or anteromedial portal (n = 12) technique. For the anteromedial portal technique, a guidewire was advanced through the medial portal in varying degrees of knee flexion (100° [n = 4], 110° [n = 4], or 120° [n = 4]) as measured with a goniometer. By use of a 6-mm femoral offset guide, two 6-mm femoral tunnels were reamed with the guide placed (1) as far posterior and lateral in the notch as possible and (2) as far medial and vertical in the notch as possible to define the range of maximal and minimal achievable coronal obliquity for each technique. All knees were imaged with high-resolution, 3-dimensional fluoroscopy to define (1) coronal tunnel obliquity relative to the lateral tibial plateau, (2) sagittal tunnel obliquity relative to the long axis of the femur, (3) intraosseous tunnel length, and (4) the presence of posterior cortical wall blowout. Data analysis was performed with a paired t-test and repeated-measures analysis of variance, with P < .05 defined as significant. Results: Preparation of a vertical tunnel was possible with both transtibial and anteromedial portal drilling. The maximal achievable coronal obliquity, however, was significantly better with an anteromedial portal compared with transtibial drilling. However, 7 of 36 tunnels (19.4%) showed violation of the posterior tunnel wall, and all of these cases occurred with the anteromedial portal drilling technique. In addition, 1 of 6 oblique femoral tunnels (16.7%) drilled with the transtibial technique and 5 of 12 oblique femoral tunnels (41.7%) drilled with the anteromedial portal had an intraosseous length less than 25 mm. Increasing knee flexion with anteromedial portal drilling was associated with a significant reduction in tunnel length, increase in coronal obliquity, increase in sagittal obliquity, and increased risk of posterior wall blowout (P < .05). Conclusions: The anteromedial portal technique allows for slightly greater femoral tunnel obliquity compared with transtibial drilling. However, there is a substantially increased risk of critically short tunnels (<25 mm) and posterior tunnel wall blowout when a conventional offset guide is used. Increasing knee flexion with anteromedial portal drilling allows for greater coronal obliquity of the femoral tunnel but is accompanied by a greater risk of critically short tunnels and posterior wall compromise. Clinical Relevance: Our findings provide insight into the potential risks and advantages of a transtibial versus an anteromedial femoral tunnel drilling technique in ACL reconstruction. © 2010 Arthroscopy Association of North America.

News Article | October 31, 2016

The prognosis for patients diagnosed with scleroderma - an autoimmune disease characterized by fibrosis of the skin - is not typically a rosy one. With limited treatment options available, those suffering from the disorder can face disabling hardening and tightening of their skin. Scleroderma can also affect the blood vessels, lungs and other internal organs. New and ongoing research at Hospital for Special Surgery in New York City has identified a possible mechanism behind the fibrosis that occurs in scleroderma - a mechanism that may one day lead to a treatment for the disease. Published in the Journal of Clinical Investigation on October 10, the study reports that in laboratory research, a population of stem cells called "adipose-derived stromal cells (ADSCs)" is reduced in number in the layer of fat sitting under the skin. It appears that loss of these ADSCs may contribute to the skin fibrosis characteristic of scleroderma. Moreover, the study authors found that the survival of those ADSCs that do remain beneath the skin in scleroderma are dependent on immune cells called "dendritic cells." Dendritic cells release a compound called lymphotoxin B that promotes ADSC survival; when antibodies that stimulate the lymphotoxin B receptor were administered with ADSCs to replenish the lost ADSCs, ADSC survival was found to be increased, suggesting a means for reversing the fibrosis of the skin. "Injecting ADSCs is being tried in scleroderma; the possibility of stimulating the lymphotoxin B pathway to increase the survival of these stem cells is very exciting," says lead study author Theresa T. Lu, MD, PhD. "By uncovering these mechanisms and targeting them with treatments, perhaps one day we can better treat the disease." Dr. Lu also feels this strategy could be used to target stem-cells from other tissue sources in order to treat rheumatological and other conditions -- such as lupus and rheumatoid arthritis - and also to facilitate bone and cartilage repair. In the coming years, Dr. Lu and her colleagues hope to test the applicability of their work in human cells, which could provide scleroderma patients with a welcome treatment option if proven safe and effective. "Improving ADSC therapy would be a major benefit to the field of rheumatology and to patients suffering from scleroderma," she says. Other HSS authors include first author Jennifer Chia, Tong Zhu, Susan Chyou, Dragos Dasoveanu, and Camila Carballo, and HSS faculty members Drs. Jessica Gordon and Rob Spiera of the HSS Scleroderma and Vasculitis Center and Dr. Scott Rodeo of the Sports Medicine and Shoulder Service.

PubMed | Sports Medicine and Shoulder Service. and The Hospital for Special Surgery
Type: | Journal: Clinical imaging | Year: 2016

Acute adductor longus ruptures occur infrequently and have been rarely described in the literature. Schlegel et al. reviewed a series of adductor longus tendon ruptures and found that all ruptured proximally. A 42-year-old man with right hip pain 3 weeks following a skiing injury underwent magnetic resonance imaging (MRI), which demonstrated a distal adductor longus avulsion. The diagnosis of acute adductor longus injury can be difficult on physical examination alone, but MRI can accurately depict the site of injury. Surgery may be indicated for a proximal avulsion, but a distal injury may heal with nonoperative treatment, as in our case.

Grawe B.M.,University of Cincinnati | Fabricant P.D.,Hospital for Special Surgery | Chin C.S.,Sports Medicine and Shoulder Service | Allen A.A.,Sports Medicine and Shoulder Service | And 4 more authors.
Orthopedics | Year: 2016

This study evaluated clinical and patient-reported outcomes and return to sport after surgical treatment of medial epicondylitis with suture anchor fixation. Consecutive patients were evaluated after undergoing debridement and suture anchor repair of the flexor-pronator mass for the treatment of medial epicondylitis. Demographic variables, a short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, Oxford Elbow Score (OES), and 10-point pain and satisfaction scales were collected. Ability and time to return to sport after surgery were evaluated, and the relationship between predictor variables and both elbow function and return to sport was investigated. Median age at the time of surgery was 55 years (range, 29-65 years), with median follow-up of 40 months (range, 12-67 months). Median QuickDASH score and OES at final follow-up were 2.3 (range, 0-38.6) and 45 (range, 22-48), respectively. Most patients returned to premorbid sporting activities at a median of 4.5 months (range, 2.5-12 months), whereas 4 patients (14%) reported significant limitations at final follow-up. Older age at the time of surgery was predictive of better QuickDASH score and OES (P=.05 and P=.02, respectively). Patients who underwent surgery after a shorter duration of symptoms had better outcomes, but the difference did not reach statistical significance (QuickDASH, P=.09; OES, P=.10). Surgical treatment of recalcitrant medial epicondylitis with suture anchor fixation offers good pain relief and patient satisfaction, with little residual disability. Older age at the time of surgery predicts a better outcome. Copyright © SLACK Incorporated.

Hutchinson I.D.,Hospital for Special Surgery | Moran C.J.,Sports Medicine and Shoulder Service | Potter H.G.,Hospital for Special Surgery | Warren R.F.,Sports Medicine and Shoulder Service | Rodeo S.A.,Sports Medicine and Shoulder Service
American Journal of Sports Medicine | Year: 2014

Over the past 2 decades there has been a profound shift in our perception of the role of the meniscus in the knee joint. Orthopaedic opinion now favors salvaging and restoring the damaged meniscus where possible. Basic science is characterizing its form (anatomy) and functionality (biological and biomechanical) in an attempt to understand the effect of meniscal injury and repair on the knee joint as a whole. The meniscus is a complex tissue and has warranted extensive basic science translational, and clinical research to identify techniques to augment healing and even replace the meniscus. The application of quantitative magnetic resonance image sequencing to the meniscus and articular cartilage of the affected compartment promises to add a quantifiable outcome measure to the body of clinical evidence that supports restoration of the meniscus. This article discusses the recent advances and outcomes in the pursuit of meniscal restoration with particular focus on the use of augmentation strategies in meniscal repair, meniscal imaging, and translational strategies. © 2013 The Author(s).

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