Objectives: The Latarjet procedure has been shown to be effective in treating recurrent shoulder ... more Objectives: The Latarjet procedure has been shown to be effective in treating recurrent shoulder instability, especially in the setting of glenoid bone loss and after failed previous Bankart repair. Several studies have additionally shown a significant reduction in recurrent instability rates when compared to Bankart repair in contact athletes when the Latarjet procedure is performed in a primary setting. We have identified an additional population of patients that provides greater challenges beyond the common athlete including those involved in contact sports. Termed “consequence athletes,” these patients are defined as athletes who perform in high risk, uncontrolled environments for whom an injury is likely to threaten life or livelihood. This population includes elite military forces, law enforcement and federal agents, motocross, elite skiers/snowboarders, whitewater kayak and rafters, and rock climbers. The purpose of this study is to evaluate minimum 2-year outcomes of primary...
Objectives: To retrospectively evaluate the impact of early(<6 months) vs standard(>6months... more Objectives: To retrospectively evaluate the impact of early(<6 months) vs standard(>6months) return to play(RTP) on the rate of failure, volume of play, and career longevity following ACL reconstruction in a cohort of professional European soccer players. It was hypothesized that athletes returning to professional competition earlier than 6 month after ACL reconstruction would not have an increased risk of failure, volume of play, and a shorter professional career. Methods: Professional soccer players treated for anterior cruciate ligament tear by a single surgeon were included in this retrospective study. The study was approved by the institutional review board. The inclusion criteria were that the patient was a (1) male, (2) professional soccer player with an (3) injury of the anterior cruciate ligament. Exclusion criteria were revision ACL, extra-articular ligamentous reconstruction, and previous contralateral ACL reconstruction. A total of 178 players who were all in the f...
Objectives: Synovial fluid profiles in the setting of intra-articular ligament injury remains lar... more Objectives: Synovial fluid profiles in the setting of intra-articular ligament injury remains largely undefined and may play a significant role in graft incorporation and the development of fibrosis and PTOA. Senescence, a characteristic of cellular aging, has been recently linked to the acceleration of osteoarthritis (OA), but has yet to be examined in the setting of acute knee injury. To our knowledge, the presence of senescent profiles, including senescent cells and their senescence associated secretory phenotype (SASP) factors, have not been evaluated following an acute intraarticular ligament injury in humans. The purpose of this study was to prospectively identify, measure and compare senescent profiles between synovial fluid and peripheral blood mononuclear cells (PBMCs) in patients that have sustained an acute knee injury within 48 hours. Methods: Eight subjects between 18-65 years of age who presented within 0-48 hours of an acute knee effusion with a confirmed ACL or poste...
There are several anatomic areas in which to perform a long head of the biceps (LHB) tendon tenod... more There are several anatomic areas in which to perform a long head of the biceps (LHB) tendon tenodesis. Distal subpectoral techniques have been advocated in both primary and revision cases. They have been found to minimize pain and reliably allow for early return of function. A primary distal subpectoral technique removes the LHB from the bicipital groove, likely diminishing the chances for residual symptomatic groove tendonitis or impingement. One way to revise a painful, failed proximal tenodesis is by completing a distal subpectoral tenodesis. In this procedure, any remaining scar, inflammation, or proximal areas of impingement may be addressed as the biceps is relocated to a distal subpectoral location, while preserving the length-tension relationship. This case highlights a patient with persistent pain and limitation of overhead activities attributable to failed proximal biceps tenodesis. Revision to a distal subpectoral tenodesis, including proximal scar removal, was undertaken with excellent pain relief and return of function. We have found this to be a reliable and predictable revision procedure in a patient who presents with persistent pain and dysfunction attributable to a failed proximal biceps tenodesis.
Recurrent patellar instability is a common pathology and typically affects younger and more activ... more Recurrent patellar instability is a common pathology and typically affects younger and more active patients. To prevent complete lateral dislocation of the patella, several osseous and soft-tissue procedures have been previously described, including reconstruction of the medial patellofemoral ligament (MPFL), which has been identified as the primary medial stabilizer of the patella. Several techniques have been reported for reconstruction of the MPFL, sometimes in conjunction with other procedures, with the majority showing success in the treatment and resolution of patellar instability. However, MPFL reconstruction is not free of complications, with previous reports of recurrence of medial patellar instability and patellar fracture after surgery. The objective of this Technical Note is to describe our preferred technique, comprising anchor as well as interference screw fixation, for reconstruction of the MPFL in a primary or revision setting.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2021
PURPOSE The purpose of this study was to establish an international expert consensus using the mo... more PURPOSE The purpose of this study was to establish an international expert consensus using the modified Delphi technique on the evaluation and management of glenohumeral instability with associated bone loss METHODS: A working group of five individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on three occasions to establish a consensus on the statements. Items achieved consensus with over 70% agreement and less than 10% disagreement. RESULTS After all three rounds, 33statements achieved consensus. 1) Eighty-six percent of the experts agreed that a history of multiple previous dislocations and previous failed soft tissue surgery should raise suspicioun about the possibility of an associated bone deficit. 2) Ninety-five percent of the experts agreed that 3D CT is the most accurate diagnostic method to evaluate and quantify bone loss 3) Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate, however, 91% percent of the experts think that an 'en face' view of the glenoid using 3D CT provides the most accurate method. 4) Ninety-five percent of the experts agreed that Hill Sachs lesions are poorly quantified and classified by current imaging systems 5) Ninety percent of the experts agreed that in cases with a glenoid bone deficit > 20%, a glenoid bone graft reconstruction should be performed and any of the available options is valid. 6) There was no consensus among experts on how Hill Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. CONCLUSIONS The essential statements where the experts reached consensus included: A history of multiple previous dislocations and previous failed soft tissue surgery should make surgeons consider the possibility of an associated bone deficit; 3DCT is the most accurate diagnostic method to evaluate and quantify bone loss; Although any of the available methods to measure glenoid bone deficiency is adequate an 'en face' view of the glenoid using 3DCT provides the most accurate method; Hill Sachs lesions are poorly quantified and classified by current imaging systems, and finally; in cases with a glenoid bone deficit > 20%, a glenoid bone graft reconstruction should be performed. STUDY DESIGN Consensus statement, Level V.
The American journal of sports medicine, Jan 27, 2018
There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone blo... more There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. Systematic review and meta-analysis; Level of evidence, 4. A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. Thirteen articles ...
Jones fractures result in subsequent dysfunction and remain an issue for athletes. To (1) describ... more Jones fractures result in subsequent dysfunction and remain an issue for athletes. To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players' early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Cohort study; Level of evidence, 3. All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dors...
American football is a leading cause of sports-related injuries, with the knee, ankle, and should... more American football is a leading cause of sports-related injuries, with the knee, ankle, and shoulder most commonly involved. The purpose of this study was to describe the epidemiology, characteristics, and imaging findings of ankle injuries in football players at the National Football League (NFL) Combine and determine the relationship to player position. We hypothesized that there would be a high relative incidence of ankle injuries in these players compared with other sports and that there would be a direct correlation between the incidence of ankle injuries and player position. Cross-sectional study; Level of evidence, 3. A retrospective chart review of data collected from NFL Combine participants between 2009 and 2015 was performed. Patient demographics, history, physical examination results, and imaging findings were reviewed. Of 2285 players, 1216 (53.2%) had a history of ankle injuries; of these, 987 (81.2%) had unilateral injuries, while 229 (18.8%) had bilateral injuries (to...
Journal of shoulder and elbow surgery, Jan 2, 2018
Recurrent instability is a frequent complication following arthroscopic Bankart repair. The purpo... more Recurrent instability is a frequent complication following arthroscopic Bankart repair. The purpose of this study was to investigate risk factors for poor patient-reported clinical outcome scores and failure rates. Patients who underwent arthroscopic Bankart repair at least 2 years earlier were included. Preoperative and postoperative Single Assessment Numeric Evaluation; Quick Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and satisfaction scores were collected. The relationship of the following factors with outcomes and failure rates was assessed: (1) previous arthroscopic stabilization, (2) 3 or more dislocations prior to surgery, (3) glenoid labral articular disruption (GLAD) lesion, (4) concurrent superior labral anterior-to-posterior tear repair, and (5) concurrent biceps tenodesis. The study included 72 patients with a median age of 23 years (range, 14-49 years). Subsequent revision was required in 9 (12.5%); 1 additional patient (1.4%) had ...
Fibular collateral ligament (FCL) tears are challenging to diagnose. Left untreated, FCL tears le... more Fibular collateral ligament (FCL) tears are challenging to diagnose. Left untreated, FCL tears lead to residual ligament instability and increased joint loading on the medial compartment of the knee. Additionally, when a concomitant anterior cruciate ligament (ACL) reconstruction is performed, increased forces on reconstruction grafts occur, which may lead to premature graft failure. Stress radiographs constitute a reliable and validated technique for the objective assessment of a complete grade III FCL tear. To evaluate side-to-side difference (SSD) values of lateral compartment gapping on varus stress radiographs in patients with a grade III injury to the FCL. Additionally, to evaluate the reliability and reproducibility of 3 different measurement techniques that used various radiographic reference points. Cohort study (diagnosis); Level of evidence, 2. Inclusion criteria were patients who sustained an FCL with or without a concomitant ACL injury and underwent a combined FCL + ACL...
The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide... more The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide primary static and dynamic stability to valgus stress of the elbow in overhead-throwing athletes. Quantitative anatomic relationships between the dynamic and static stabilizers have not been described. To perform qualitative and quantitative anatomic evaluations of the medial elbow-UCL complex with specific attention to pertinent osseous and soft tissue landmarks. Descriptive laboratory study. Ten nonpaired, fresh-frozen human cadaveric elbows (mean age, 54.1 years [range, 42-64 years]; all male) were utilized for this study. Quantitative analysis was performed with a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks and tendon and ligament footprints on the humerus, ulna, and radius. The anterior bundle of the UCL attached 8.5 mm (95% CI, 6.9-10.0) distal and 7.8 mm (95% CI, 6.6-9.1) lateral to the medial epicondyle, 1.5 mm (95% CI, 0.5-2.5)...
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2018
To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attac... more To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attachment sites of the conjoint tendon, the pectoralis minor, the coracoacromial ligament (CAL), and the coracoclavicular (CC) ligaments in relation to pertinent osseous and soft tissue landmarks; (2) CC ligaments' attachments on the clavicle; and (3) CAL attachment on the acromion in relation to surgically relevant anatomic landmarks to assist in planning of the Latarjet procedure, acromioclavicular (AC) joint reconstructions, and CAL resection distances avoiding iatrogenic injury to surrounding structures. Ten nonpaired fresh-frozen human cadaveric shoulders (mean age 52 years, range 33-64 years) were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. The ligament and tendon attachment perimeters and center points on the coracoid, clavicle, and acromion were identified and s...
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 21, 2018
To perform a systematic review of the available literature on clinical and radiographic outcomes ... more To perform a systematic review of the available literature on clinical and radiographic outcomes after surgical treatment for acromioclavicular (AC) joint instability. A systematic review was performed according to PRISMA guidelines. Inclusion criteria were AC joint and coracoclavicular (CC) ligament reconstruction outcomes, English language, human studies, more than 10 patients in the study and a 2-year minimum follow-up. Exclusion criteria were animal studies, cadaveric studies, clinical studies without reported follow-up period or patient-reported outcomes, clinical studies of nonoperative treatment, AC reconstructions with concurrent lateral clavicle fracture, editorial articles, abstracts, presentations, reviews, case reports, and surveys. The systematic review identified 34 studies (939 patients) after inclusion and exclusion criteria application. Postoperative American Shoulder and Elbow Surgeons (ASES) scores ranged from 93.8 to 96, 81.8 to 97.8, and 88.1 for free tendon gra...
Chondral lesions of the knee can occur secondary to limb malalignment. To address these interrela... more Chondral lesions of the knee can occur secondary to limb malalignment. To address these interrelated problems, a high tibial osteotomy with concomitant osteochondral allograft transfer may be performed. It is important to address these chondral lesions as they often affect the young and active population and cause morbidity in an otherwise healthy population. Although numerous approaches for the treatment of chondral lesions have been described, long-term results demonstrating regeneration of hyaline cartilage have yet to be reported. Furthermore, larger, full-thickness cartilage defects, which can be caused by limb malalignment, have proven to be particularly challenging to treat. This Technical Note details our technique for multicompartmental osteochondral allograft transplantation with concomitant high tibial osteotomy in a patient with 2 focal cartilage lesions in the knee.
Objectives: The Latarjet procedure has been shown to be effective in treating recurrent shoulder ... more Objectives: The Latarjet procedure has been shown to be effective in treating recurrent shoulder instability, especially in the setting of glenoid bone loss and after failed previous Bankart repair. Several studies have additionally shown a significant reduction in recurrent instability rates when compared to Bankart repair in contact athletes when the Latarjet procedure is performed in a primary setting. We have identified an additional population of patients that provides greater challenges beyond the common athlete including those involved in contact sports. Termed “consequence athletes,” these patients are defined as athletes who perform in high risk, uncontrolled environments for whom an injury is likely to threaten life or livelihood. This population includes elite military forces, law enforcement and federal agents, motocross, elite skiers/snowboarders, whitewater kayak and rafters, and rock climbers. The purpose of this study is to evaluate minimum 2-year outcomes of primary...
Objectives: To retrospectively evaluate the impact of early(<6 months) vs standard(>6months... more Objectives: To retrospectively evaluate the impact of early(<6 months) vs standard(>6months) return to play(RTP) on the rate of failure, volume of play, and career longevity following ACL reconstruction in a cohort of professional European soccer players. It was hypothesized that athletes returning to professional competition earlier than 6 month after ACL reconstruction would not have an increased risk of failure, volume of play, and a shorter professional career. Methods: Professional soccer players treated for anterior cruciate ligament tear by a single surgeon were included in this retrospective study. The study was approved by the institutional review board. The inclusion criteria were that the patient was a (1) male, (2) professional soccer player with an (3) injury of the anterior cruciate ligament. Exclusion criteria were revision ACL, extra-articular ligamentous reconstruction, and previous contralateral ACL reconstruction. A total of 178 players who were all in the f...
Objectives: Synovial fluid profiles in the setting of intra-articular ligament injury remains lar... more Objectives: Synovial fluid profiles in the setting of intra-articular ligament injury remains largely undefined and may play a significant role in graft incorporation and the development of fibrosis and PTOA. Senescence, a characteristic of cellular aging, has been recently linked to the acceleration of osteoarthritis (OA), but has yet to be examined in the setting of acute knee injury. To our knowledge, the presence of senescent profiles, including senescent cells and their senescence associated secretory phenotype (SASP) factors, have not been evaluated following an acute intraarticular ligament injury in humans. The purpose of this study was to prospectively identify, measure and compare senescent profiles between synovial fluid and peripheral blood mononuclear cells (PBMCs) in patients that have sustained an acute knee injury within 48 hours. Methods: Eight subjects between 18-65 years of age who presented within 0-48 hours of an acute knee effusion with a confirmed ACL or poste...
There are several anatomic areas in which to perform a long head of the biceps (LHB) tendon tenod... more There are several anatomic areas in which to perform a long head of the biceps (LHB) tendon tenodesis. Distal subpectoral techniques have been advocated in both primary and revision cases. They have been found to minimize pain and reliably allow for early return of function. A primary distal subpectoral technique removes the LHB from the bicipital groove, likely diminishing the chances for residual symptomatic groove tendonitis or impingement. One way to revise a painful, failed proximal tenodesis is by completing a distal subpectoral tenodesis. In this procedure, any remaining scar, inflammation, or proximal areas of impingement may be addressed as the biceps is relocated to a distal subpectoral location, while preserving the length-tension relationship. This case highlights a patient with persistent pain and limitation of overhead activities attributable to failed proximal biceps tenodesis. Revision to a distal subpectoral tenodesis, including proximal scar removal, was undertaken with excellent pain relief and return of function. We have found this to be a reliable and predictable revision procedure in a patient who presents with persistent pain and dysfunction attributable to a failed proximal biceps tenodesis.
Recurrent patellar instability is a common pathology and typically affects younger and more activ... more Recurrent patellar instability is a common pathology and typically affects younger and more active patients. To prevent complete lateral dislocation of the patella, several osseous and soft-tissue procedures have been previously described, including reconstruction of the medial patellofemoral ligament (MPFL), which has been identified as the primary medial stabilizer of the patella. Several techniques have been reported for reconstruction of the MPFL, sometimes in conjunction with other procedures, with the majority showing success in the treatment and resolution of patellar instability. However, MPFL reconstruction is not free of complications, with previous reports of recurrence of medial patellar instability and patellar fracture after surgery. The objective of this Technical Note is to describe our preferred technique, comprising anchor as well as interference screw fixation, for reconstruction of the MPFL in a primary or revision setting.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2021
PURPOSE The purpose of this study was to establish an international expert consensus using the mo... more PURPOSE The purpose of this study was to establish an international expert consensus using the modified Delphi technique on the evaluation and management of glenohumeral instability with associated bone loss METHODS: A working group of five individuals generated a list of statements related to history and physical examination, imaging and specialized diagnostic tests, bone loss quantification and classification, treatment outcomes and complications, and rehabilitation for the management of glenohumeral instability associated with bone loss to form the basis of an initial survey for rating by a group of experts. The expert group (composed of 22 high-volume glenohumeral instability experts) was surveyed on three occasions to establish a consensus on the statements. Items achieved consensus with over 70% agreement and less than 10% disagreement. RESULTS After all three rounds, 33statements achieved consensus. 1) Eighty-six percent of the experts agreed that a history of multiple previous dislocations and previous failed soft tissue surgery should raise suspicioun about the possibility of an associated bone deficit. 2) Ninety-five percent of the experts agreed that 3D CT is the most accurate diagnostic method to evaluate and quantify bone loss 3) Eighty-six percent of the experts agreed that any of the available methods to measure glenoid bone deficiency is adequate, however, 91% percent of the experts think that an 'en face' view of the glenoid using 3D CT provides the most accurate method. 4) Ninety-five percent of the experts agreed that Hill Sachs lesions are poorly quantified and classified by current imaging systems 5) Ninety percent of the experts agreed that in cases with a glenoid bone deficit > 20%, a glenoid bone graft reconstruction should be performed and any of the available options is valid. 6) There was no consensus among experts on how Hill Sachs injuries should be managed or on how postoperative rehabilitation should be carried out. CONCLUSIONS The essential statements where the experts reached consensus included: A history of multiple previous dislocations and previous failed soft tissue surgery should make surgeons consider the possibility of an associated bone deficit; 3DCT is the most accurate diagnostic method to evaluate and quantify bone loss; Although any of the available methods to measure glenoid bone deficiency is adequate an 'en face' view of the glenoid using 3DCT provides the most accurate method; Hill Sachs lesions are poorly quantified and classified by current imaging systems, and finally; in cases with a glenoid bone deficit > 20%, a glenoid bone graft reconstruction should be performed. STUDY DESIGN Consensus statement, Level V.
The American journal of sports medicine, Jan 27, 2018
There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone blo... more There is increasing evidence to suggest that the amount of glenoid bone loss to indicate bone block procedures may be lower than previously thought, particularly in the presence of a Hill-Sachs defect. To better establish treatment recommendations for anterior shoulder instability among patients with bipolar bone lesions. Systematic review and meta-analysis; Level of evidence, 4. A systematic review of the literature was performed with PubMed, EMBASE, Cochrane Library, and Scopus databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating outcomes of operative management in anterior shoulder instability that also reported glenoid bone loss in the presence of Hill-Sachs defects were included. Recurrence rates, glenoid bone loss, and humeral bone loss were pooled and analyzed with forest plots stratified by surgical procedure. Methods of quantification were analyzed for each article qualitatively. Thirteen articles ...
Jones fractures result in subsequent dysfunction and remain an issue for athletes. To (1) describ... more Jones fractures result in subsequent dysfunction and remain an issue for athletes. To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players' early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Cohort study; Level of evidence, 3. All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dors...
American football is a leading cause of sports-related injuries, with the knee, ankle, and should... more American football is a leading cause of sports-related injuries, with the knee, ankle, and shoulder most commonly involved. The purpose of this study was to describe the epidemiology, characteristics, and imaging findings of ankle injuries in football players at the National Football League (NFL) Combine and determine the relationship to player position. We hypothesized that there would be a high relative incidence of ankle injuries in these players compared with other sports and that there would be a direct correlation between the incidence of ankle injuries and player position. Cross-sectional study; Level of evidence, 3. A retrospective chart review of data collected from NFL Combine participants between 2009 and 2015 was performed. Patient demographics, history, physical examination results, and imaging findings were reviewed. Of 2285 players, 1216 (53.2%) had a history of ankle injuries; of these, 987 (81.2%) had unilateral injuries, while 229 (18.8%) had bilateral injuries (to...
Journal of shoulder and elbow surgery, Jan 2, 2018
Recurrent instability is a frequent complication following arthroscopic Bankart repair. The purpo... more Recurrent instability is a frequent complication following arthroscopic Bankart repair. The purpose of this study was to investigate risk factors for poor patient-reported clinical outcome scores and failure rates. Patients who underwent arthroscopic Bankart repair at least 2 years earlier were included. Preoperative and postoperative Single Assessment Numeric Evaluation; Quick Disabilities of the Arm, Shoulder and Hand; American Shoulder and Elbow Surgeons; and satisfaction scores were collected. The relationship of the following factors with outcomes and failure rates was assessed: (1) previous arthroscopic stabilization, (2) 3 or more dislocations prior to surgery, (3) glenoid labral articular disruption (GLAD) lesion, (4) concurrent superior labral anterior-to-posterior tear repair, and (5) concurrent biceps tenodesis. The study included 72 patients with a median age of 23 years (range, 14-49 years). Subsequent revision was required in 9 (12.5%); 1 additional patient (1.4%) had ...
Fibular collateral ligament (FCL) tears are challenging to diagnose. Left untreated, FCL tears le... more Fibular collateral ligament (FCL) tears are challenging to diagnose. Left untreated, FCL tears lead to residual ligament instability and increased joint loading on the medial compartment of the knee. Additionally, when a concomitant anterior cruciate ligament (ACL) reconstruction is performed, increased forces on reconstruction grafts occur, which may lead to premature graft failure. Stress radiographs constitute a reliable and validated technique for the objective assessment of a complete grade III FCL tear. To evaluate side-to-side difference (SSD) values of lateral compartment gapping on varus stress radiographs in patients with a grade III injury to the FCL. Additionally, to evaluate the reliability and reproducibility of 3 different measurement techniques that used various radiographic reference points. Cohort study (diagnosis); Level of evidence, 2. Inclusion criteria were patients who sustained an FCL with or without a concomitant ACL injury and underwent a combined FCL + ACL...
The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide... more The anterior bundle of the medial ulnar collateral ligament (UCL) and the forearm flexors provide primary static and dynamic stability to valgus stress of the elbow in overhead-throwing athletes. Quantitative anatomic relationships between the dynamic and static stabilizers have not been described. To perform qualitative and quantitative anatomic evaluations of the medial elbow-UCL complex with specific attention to pertinent osseous and soft tissue landmarks. Descriptive laboratory study. Ten nonpaired, fresh-frozen human cadaveric elbows (mean age, 54.1 years [range, 42-64 years]; all male) were utilized for this study. Quantitative analysis was performed with a 3-dimensional coordinate measuring device to quantify the location of pertinent bony landmarks and tendon and ligament footprints on the humerus, ulna, and radius. The anterior bundle of the UCL attached 8.5 mm (95% CI, 6.9-10.0) distal and 7.8 mm (95% CI, 6.6-9.1) lateral to the medial epicondyle, 1.5 mm (95% CI, 0.5-2.5)...
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2018
To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attac... more To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attachment sites of the conjoint tendon, the pectoralis minor, the coracoacromial ligament (CAL), and the coracoclavicular (CC) ligaments in relation to pertinent osseous and soft tissue landmarks; (2) CC ligaments' attachments on the clavicle; and (3) CAL attachment on the acromion in relation to surgically relevant anatomic landmarks to assist in planning of the Latarjet procedure, acromioclavicular (AC) joint reconstructions, and CAL resection distances avoiding iatrogenic injury to surrounding structures. Ten nonpaired fresh-frozen human cadaveric shoulders (mean age 52 years, range 33-64 years) were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. The ligament and tendon attachment perimeters and center points on the coracoid, clavicle, and acromion were identified and s...
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 21, 2018
To perform a systematic review of the available literature on clinical and radiographic outcomes ... more To perform a systematic review of the available literature on clinical and radiographic outcomes after surgical treatment for acromioclavicular (AC) joint instability. A systematic review was performed according to PRISMA guidelines. Inclusion criteria were AC joint and coracoclavicular (CC) ligament reconstruction outcomes, English language, human studies, more than 10 patients in the study and a 2-year minimum follow-up. Exclusion criteria were animal studies, cadaveric studies, clinical studies without reported follow-up period or patient-reported outcomes, clinical studies of nonoperative treatment, AC reconstructions with concurrent lateral clavicle fracture, editorial articles, abstracts, presentations, reviews, case reports, and surveys. The systematic review identified 34 studies (939 patients) after inclusion and exclusion criteria application. Postoperative American Shoulder and Elbow Surgeons (ASES) scores ranged from 93.8 to 96, 81.8 to 97.8, and 88.1 for free tendon gra...
Chondral lesions of the knee can occur secondary to limb malalignment. To address these interrela... more Chondral lesions of the knee can occur secondary to limb malalignment. To address these interrelated problems, a high tibial osteotomy with concomitant osteochondral allograft transfer may be performed. It is important to address these chondral lesions as they often affect the young and active population and cause morbidity in an otherwise healthy population. Although numerous approaches for the treatment of chondral lesions have been described, long-term results demonstrating regeneration of hyaline cartilage have yet to be reported. Furthermore, larger, full-thickness cartilage defects, which can be caused by limb malalignment, have proven to be particularly challenging to treat. This Technical Note details our technique for multicompartmental osteochondral allograft transplantation with concomitant high tibial osteotomy in a patient with 2 focal cartilage lesions in the knee.
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Papers by Matthew Provencher