News Article | February 15, 2017
Dr. Kim brings reputation as one of the top replacement surgeons in the country VAIL, CO--(Marketwired - February 08, 2017) - The roster of world class orthopaedic physicians at The Steadman Clinic is expanding in February with the addition of joint replacement specialist Dr. Raymond Kim to the medical staff. Dr. Marc J. Philippon, Managing Partner of The Steadman Clinic and Co-chair of the Steadman Philippon Research Institute (SPRI), and Dan Drawbaugh, CEO, made the announcement on Wednesday, February 8, 2017. Dr. Kim will join The Steadman Clinic full time in Vail on February 24th. His sterling reputation both in the Colorado region and nationwide has drawn much praise. "We are honored to have a surgeon of Dr. Kim's expertise join our team here at The Steadman Clinic and SPRI," said Dr. Philippon. "Dr. Kim is one of the finest joint replacement specialists in the nation and is well known throughout Colorado. Dr. Kim has received numerous honors for his groundbreaking work in knee and hip replacement surgery." Dr. Kim specializes in adult reconstruction with a focus on primary and revision knee and hip replacements. This includes the focus on the minimally invasive anterior approach to total hip replacements which provides patients the potential for less pain, faster recovery and improved mobility. He was awarded the prestigious John Insall Award for research on total knee replacements and was named as one of the top 22 knee surgeons in the U.S. by Orthopedics This Week. Dr. Kim received undergraduate degrees in both biomedical and electrical engineering from Johns Hopkins University in Baltimore, Md., and his medical degree from Marshall University School of Medicine in Huntington, W.Va. He completed his orthopaedic surgery residency at Mayo Graduate School of Medicine in Rochester, Minn., and the Insall Scott Kelly Fellowship in Sports Medicine and Adult Reconstruction in New York, N.Y. "The addition of Dr. Kim further strengthens our diverse team at The Steadman Clinic and the Steadman Philippon Research Institute," said Drawbaugh. "Our doctors are among the finest in the nation in treating and rehabilitating knee, hip and other joint injuries. Dr. Kim further advances the world class medical care capabilities."
News Article | March 2, 2017
Colorado shoulder specialist Peter Millett, MD, MSc published new research on the comprehensive arthroscopic management (CAM) procedure which serves as a shoulder replacement alternative for young, active patients with shoulder osteoarthritis. As a pioneer of the CAM procedure, Dr. Millett has done extensive research on the success of the CAM procedure. Recent research published by Dr. Millett in the American Journal of Sports Medicine showed improved pain and function in a properly selected patient population with high patient satisfaction and survivorship rate after a minimum of 5 years postoperatively. Patient selection is critical when choosing between a total shoulder arthroplasty and the CAM procedure, a shoulder replacement alternative for young, active patients. Dr. Millett’s study “Comprehensive Arthroscopic Management of Glenohumeral Osteoarthritis” identified prognostic factors predictive of early failure in patients who undergo the CAM procedure. A total of 107 shoulders in 98 patients with a minimum of a 2-year follow-up who underwent CAM performed by Dr. Millett were evaluated. The data found that the CAM procedure was reliable in improving pain and function in active patients with shoulder osteoarthritis; however, it is important to inform patients about the potential limitations of the procedure. Patients with less joint space and abnormal posterior glenoid shape were significantly more likely to progress to early failure. In the American Journal of Sports Medicine March 2017 Podcast, Dr. Millett discusses this study. Prior to Dr. Millett’s study “Survivorship and Patient-Reported Outcomes After Comprehensive Arthroscopic Management of Gelnohumeral Osteoarthritis” there was little data on midterm outcomes after the arthroscopic management of shoulder osteoarthritis in young, active patients. Forty-six consecutive patients who underwent CAM procedure performed by Dr. Millett were used to collect the data. At a minimum of 5 years postoperatively, this study found significant improvements in midterm clinical outcomes and high patient satisfaction following the CAM procedure, with a 76.9% survivorship rate. Dr. Millett and his research team concluded that the CAM procedure provides reasonable outcomes for young, active patients seeking a shoulder replacement alternative for the treatment of shoulder arthritis. “We now have a minimally-invasive joint preserving procedure, that can reliably help young, active patients suffering from glenohumeral osteoarthritis," said Dr. Millett. "This is very exciting! Now, we can better select patients for the procedure and we can achieve durable, and long-lasting results.” In 2001, Dr. Millett began using a series of surgical procedures to treat young patients with shoulder arthritis that, over the course of five years, evolved into the the CAM procedure. The CAM procedure is performed arthroscopically. During the procedure, Dr. Millett first removes loose cartilage and large bone spurs and then decompresses the axillary nerve to alleviate pain. Due to the complexity of this procedure, it is very important that patients have a highly skilled surgeon performing the CAM procedure. Dr. Peter J. Millett is a partner at the Steadman Clinic and specializes in disorders of the shoulder, knee, elbow and sports-related injuries. He serves as director of shoulder surgery and is a researcher and board member at the Steadman Philippon Research Institute. Dr. Millett has been consistently selected as one of the “Best Doctors in America” and has been ranked in the top 1% of Orthopaedic Surgeons by U.S. News and World Reports. Keeping active people active through excellence in clinical care, orthopedic research and education is Dr. Millett’s mission.
Foad A.,Quality Care Clinic and Surgery Center |
Wijdicks C.A.,Steadman Philippon Research Institute
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2012
Purpose: The main purpose of this study was to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in detecting subscapularis tears identified during the gold standard of arthroscopy and determine whether MRI can reliably predict which patients have subscapularis tears. A second purpose was to determine whether magnetic resonance (MR) arthrograms could better identify a subscapularis tear than conventional MRI. Methods: This was a retrospective study evaluating 39 consecutive patients (40 shoulders) who had a preoperative 1.5-T MRI study and underwent an arthroscopic subscapularis tendon repair. All cases were performed between December 2007 and November 2010. Results: Subscapularis tears were missed on preoperative MR scanning in 25 of 40 shoulders (62.5%). The sensitivity of noncontrast MRI was 40%, the sensitivity of MR arthrography was 36%, and the overall MR sensitivity was 37.5%. Conclusions: Preoperative 1.5-T MRI of the shoulder does not reliably predict subscapularis tendon tears, regardless of whether conventional MRI or MR arthrography is used. Level of Evidence: Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard. © 2012 Arthroscopy Association of North America.
Briggs K.K.,Steadman Philippon Research Institute
The journal of knee surgery | Year: 2012
The purpose of this study was to determine if short form (SF)-12 physical component would increase with unloader brace use. Patient expectations and predictors of significant improvement were determined. Our hypothesis was that patients with unloader braces will have increases in general physical health (SF-12) and function (Western Ontario and McMaster Universities Arthritis Index [WOMAC]). Patients were enrolled in institutional review board-approved prospective cohort study. They completed a self-administered questionnaire (SF-12; WOMAC, Tegner activity scale, expectations) at enrollment, 3 weeks, 6 weeks, and 6 months. In this study, 39 patients, 23 males and 16 females (average age = 61 years [range 44 to 87]), were prescribed an unloader brace. Patients had significant improvement in quality of life (SF-12) (p < 0.05). There was significant improvement in pain, stiffness, and function (WOMAC) (p < 0.05). Patients who reported Tegner of 3 or greater at final follow-up had significantly higher SF-12 physical component (48 vs. 37; p = 0.023). Return to recreational sports was very important in 83% and somewhat important in 17%. Improving ability to walk was very important in 89%. Pain relief was very important in 69%, somewhat important in 17%. Of these, 39% expected most pain to be relieved and 57% expected all pain to be relieved. The most important expectations were to have confidence in knee (97% very important), avoid future knee degeneration (90% very important), and improve ability to maintain general health (93% very important). Patients demonstrated a significant decrease in pain and disability. Patients saw improvement in SF-12 physical component. Braces specifically designed to unload the degenerative compartment of the knee can be an effective treatment to decrease pain and maintain activity level to increase overall physical health. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Lertwanich P.,Steadman Philippon Research Institute
The American journal of sports medicine | Year: 2011
Suture anchors are commonly used to reattach a torn labrum to the acetabular rim. The acetabular rim anatomy is not uniform, and the safety margin for inserting suture anchors is unknown. The acetabular rim angle is an anatomic measurement that is indicative of the safety margin for inserting suture anchors. To investigate the acetabular rim angle as a function of clock position, to evaluate the effect of drill depth on the acetabular rim angle, and to evaluate the effect of rim trimming on the acetabular rim angle. Descriptive laboratory study. Three-dimensional acetabular models were reconstructed from computed tomography scans of 20 nonpaired cadaveric hip specimens, and the acetabular rim angle, which quantifies the angle between the subchondral margin and the outer cortex of the acetabulum, was measured from the 8- to 4-o'clock positions. At each position, the acetabular rim angle was measured for 5 drill depths (10, 12.5, 15, 20, and 25 mm) to simulate different lengths of suture anchors or drill bit depths on the acetabular rim angle. To simulate rim trimming, the acetabular rim angle was measured at the points that would become the suture anchor insertion points after 2.5- and 5-mm rim trimming. Clock position, drill depth, and rim trimming all had significant effects on the acetabular rim angle (P < .0001). The acetabular rim angle was largest at the 2-o'clock and smallest at the 3-o'clock position. Greater drill depths provided smaller acetabular rim angles, whereas rim trimming provided larger acetabular rim angles. The acetabular rim angle varied significantly as a function of the location on the acetabular rim. A shorter drill depth and a greater amount of rim trimming provided a larger acetabular rim angle. Surgeons should be aware of the acetabular rim variations, especially in the anterosuperior quadrant, as well as the effects of drill depth and rim trimming, when selecting the optimal insertion angle for suture anchor placement to avoid articular cartilage penetration. The acetabular safety angle was smallest at the 3-o'clock position. Therefore, extra care must be taken when drilling or inserting anchors around the 3-o'clock position.
Stull J.D.,Steadman Philippon Research Institute
The American journal of sports medicine | Year: 2011
Femoroacetabular impingement (FAI) is becoming a prevalent overuse injury diagnosis among hockey players. In the adult ice hockey stride, the "at-risk" hip position, defined by internal rotation during flexion and external rotation during abduction, reportedly increases hip vulnerability to labral injury as a result of FAI. Peewee youth ice hockey players display the kinematics for both described at-risk hip positions (internal rotation during flexion and external rotation during abduction) in the ice hockey sprint start. Descriptive laboratory study. Twelve healthy male Peewee ice hockey players (mean age, 10.8 ± 0.6 years) participated in this study. Thirty-five anatomic landmarks were used to analyze the 3-dimensional kinematic and kinetic variables of the hip associated with the ice hockey sprint start. Ten high-speed (120-Hz) infrared cameras recorded the trials, which were subsequently analyzed with Motion Monitor software. The sprint start was recorded over 4 defined periods of motion: start, push, swing, and even. In the "push" period, 11.5° of external rotation was observed concurrently with 13.2° of abduction in the push leg, and 6.8° of internal rotation occurred with 33.8° of flexion in the lead leg. During the recovery phase of the "swing" period, maximum internal rotation was 5.6° with concurrent hip flexion of 44.2° in the push leg, while lead leg internal rotation reached a maximum of 10.8° with hip flexion of 35.1° during the "even" period. During the sprint start, youth ice hockey players externally rotate in abduction during the push-off phase and internally rotate through increasing hip flexion during the recovery phase, displaying the at-risk hip positions of the ice hockey skating stride. During the sprint start, youth ice hockey players position their hips in a manner that can cause impingement of the femoral neck against the acetabulum and potentially lead to labral tears and/or articular cartilage damage. This knowledge could be applied to assist in the prevention of overuse injuries of the hip as youth hockey players mature and increase in skill level.
Myers C.A.,Steadman Philippon Research Institute
The American journal of sports medicine | Year: 2011
Recent biomechanical reports have described the function of the acetabular labrum and iliofemoral ligament in providing hip stability, but the relative stability provided by each structure has not been well described. Both the iliofemoral ligament and acetabular labrum are important for hip stability by limiting external rotation and anterior translation, with increased stability provided by the iliofemoral ligament compared with the acetabular labrum. Controlled laboratory study. Fifteen fresh-frozen male cadaveric hips were utilized for this study. Each specimen was selectively skeletonized down to the hip capsule. Four tantalum beads were embedded into each femur and pelvis to accurately measure hip translations and rotations using biplane fluoroscopy while either a standardized 5 N·m external or internal rotation torque was applied. The hips were tested in 4 hip flexion angles (10° of extension, neutral, and 10° and 40° of flexion) in the intact state and then by sectioning and later repairing the acetabular labrum and iliofemoral ligament in a randomized order. External rotation significantly increased from the intact condition (41.5° ± 7.4°) to the sectioned iliofemoral ligament condition (54.4° ± 6.6°) and both-sectioned condition (61.5° ± 5.7°; P < .01), but there was no significant increase in external rotation when the labrum alone was sectioned (45.6° ± 5.9°). The intact and fully repaired conditions were not significantly different. External rotation and internal rotation significantly decreased when the hip flexion angle decreased from 40° of flexion to 10° of extension (P < .01) regardless of sectioned condition. Anterior translation varied significantly across sectioned conditions but not across flexion angles (P < .001). The ligament-sectioned (1.4 ± 0.5 mm), both-sectioned (2.2 ± 0.2 mm), and labrum-repaired (1.1 ± 0.2 mm) conditions all resulted in significantly greater anterior translation than the intact condition (-0.4 ± 0.1 mm) (P < .001). The iliofemoral ligament had a significant role in limiting external rotation and anterior translation of the femur, while the acetabular labrum provided a secondary stabilizing role for these motions. These results suggest that, if injured, both the acetabular labrum and iliofemoral ligament should be surgically repaired to restore native hip rotation and translation. In addition, a careful repair of an arthroscopic capsulotomy should be performed to avoid increased external hip rotation and anterior translation after arthroscopy.
Steadman J.R.,Steadman Philippon Research Institute
The journal of knee surgery | Year: 2012
The purpose of this study was to document outcomes following the healing response procedure for treatment of complete, proximal anterior cruciate ligament (ACL) tears in a mature, active population. Healing response is an all-arthroscopic procedure that preserves the native ACL and makes use of an arthroscopic awl with a 45-degree angle to make holes in the femoral attachment of the ACL and in the body of the ACL. Patients were included in this IRB-approved study if they were > or =40 years old, had a complete proximal ACL tear, and who had healing response within 6 weeks of initial injury. In this study 48 patients (35 females, 13 males) with an average age of 51 years (range: 41 to 68 years) underwent the healing response procedure. Of these four female patients (8.9%) required subsequent ACL reconstruction. Mean time to ACL reconstruction was 34.5 months (range, 14.3 to 61.2 months). Of the 44, 41 patients (93%) had minimum of 2-year follow-up at an average of 7.6 years (range, 2.2 to 13.4 years). Average preoperative Lysholm score was 54 (range, 10 to 82) and improved to an average of 90 postoperatively (p = 0.001). Median Tegner activity scale at follow-up was 5 (range, 2 to 9). Median patient satisfaction was 10 (range, 4 to 10). Higher patient satisfaction was correlated with increased Lysholm score at follow-up (rho = 0.39, p = 0.02). Tegner activity scale was associated with postoperative Lysholm score (rho = 0.35, p = 0.04). This study demonstrates the effectiveness of the healing response procedure to allow patients to return to high levels of recreational activity and to restore knee function to normal levels. In a select group of mature patients with acute proximal ACL tears, the healing response procedure is an effective treatment technique.
Steadman Philippon Research Institute | Date: 2011-09-14
This disclosure describes systems, methods, and apparatus for a knee brace providing a dynamic resistance or anterior force to a shank of a leg in order to replicate PCL forces of a healthy PCL. A dynamic force dependent upon knee flexion angle provides faster and safer PCL injury healing since the dynamic force better replicates the forces that a healthy PCL would exert on the tibia and femur.
Steadman Philippon Research Institute | Date: 2012-05-22
This disclosure describes systems, methods, and apparatus for generating a 3D rendering of and quantitative analysis of biochemical MRI voxels corresponding to a tissue or organ of interest. Voxels corresponding to the tissue or organ of interest can be identified from anatomical MRI voxels and aligned with biochemical MRI voxels. The biochemical MRI voxels aligned with the tissue or organ of interest can be isolated and then provided to one or more modules for 3D rendering and quantitative analysis.