Annalise Peebles - Academia.edu (original) (raw)

Papers by Annalise Peebles

Research paper thumbnail of How to Fashion the Bone Block for Reconstruction of the Glenoid in Anterior and Posterior Instability

The American Journal of Sports Medicine

Background: Glenoid restoration techniques to address glenohumeral instability–induced anterior a... more Background: Glenoid restoration techniques to address glenohumeral instability–induced anterior and posterior glenoid bone loss (AGBL and PGBL) often require reconstruction, but best-fit bone block (BFBB) modeling has not been developed. Purpose: To provide glenoid bony reconstruction models for anterior and posterior instability of the shoulder using a bone loss instability cohort with high-fidelity 3-dimensional (3D) imaging. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We reviewed consecutive patients indicated for operative stabilization who had posterior glenohumeral instability and suspected GBL who underwent 2-dimensional (2D) computed tomography (CT). Patients were matched by sex, laterality, and age to patients who underwent operative stabilization of anterior glenohumeral instability. Mimics software was used to convert all 2D CT scans into 3D models of the scapula. A BFBB model was designed to digitally reconstruct GBL and was used to predict the am...

Research paper thumbnail of Talar Allograft Preparation for Treatment of Reverse Hill-Sachs Defect in Recurrent Posterior Shoulder Instability

Research paper thumbnail of Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study

Orthopaedic Journal of Sports Medicine

Background: Surgical pectoralis major (PM) repair can offer improved functional outcomes over non... more Background: Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment. Purpose: To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structures at risk. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen male cadavers were dissected. The relevant landmarks that were collected and measured included (1) PM footprint length at the humeral insertion (total, sternal head, and clavicular head insertions); (2) PM tendon length from the humeral insertion to the musculotendinous junction; (3) distance from the PM humeral insertion to the lateral (LPN) and medial (MPN) pectoral nerves; and (4) distance from the coracoid process to the musculocutaneous nerve (MCN) in anatomical position. Results: The total PM footprint length was 81.4 mm (95% CI, 71.4-91.3). The ster...

Research paper thumbnail of Impact of Prior Anterior Instability on Shoulder Arthroplasty Outcomes: A Systematic Review

Research paper thumbnail of Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma

Arthroscopy, Sports Medicine, and Rehabilitation

Research paper thumbnail of Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation

Arthroscopy Techniques

Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joi... more Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joint dislocations account for 8% of all joint dislocations and are even more common in contact sports. These injuries are graded as type I through type VI on the basis of the Rockwood classification method. Types I and II are generally treated without surgery whereas types IV, V, and VI are best treated operatively. Type III dislocations remain controversial in terms of treatment, and many surgeons recommend nonoperative treatment first and operative treatment in case of continued symptoms such as pain, instability, or shoulder girdle dysfunction. The goal of operative treatment is to restore AC joint stability, which involves addressing both the coracoclavicular and coracoacromial ligaments to achieve a desirable patient outcome. The objective of this Technical Note is to describe our technique for management of a failed acromioclavicular stabilization, treated with a coracoclavicular and AC joint capsular reconstruction using tibialis anterior and semitendinosus allografts.

Research paper thumbnail of Poster 162: Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis

Orthopaedic Journal of Sports Medicine

Objectives: The purpose of this study was to 1.) qualitatively and quantitatively analyze the int... more Objectives: The purpose of this study was to 1.) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSL) in a cohort of anterior instability patients using 3-dimensional (3-D) imaging software and 2.) assess the relationships between GBL and HSL characteristics. Methods: Patients with anterior shoulder instability with a minimum of 5% GBL with evidence of HSL confirmed on computed tomography were identified. 3-D models of the unilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using Mimics (Materialise NV, Leuven, Belgium) software. GBL as well as surface area (SA), width, defect length, and glenoid track width was quantified. The volume, SA, width, and depth of identified HSLs were quantified along with their location (medial, superior, and inferior extent) on the humeral head. The severity of glenoid bone loss was categorized by low grade (0-10%), moderate grade (>10% to...

Research paper thumbnail of Poster 161: Consequence Athletes with Anterior Shoulder Instability: Consider Latarjet

Orthopaedic Journal of Sports Medicine

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...

Research paper thumbnail of Paper 28: Early Versus Standard Return to Sport Following ACL Reconstruction. Impact on Volume of Play and Career Logevity in 180 Professional European Soccer Players

Orthopaedic Journal of Sports Medicine

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...

Research paper thumbnail of Poster 135: Minimum 2 year Clinical Outcomes after Latarjet for anterior shoulder instability: clinical and imaging factors that correlate with success or failure

Orthopaedic Journal of Sports Medicine

Objectives: The open Latarjet procedure has been demonstrated to be reliable in achieving accepta... more Objectives: The open Latarjet procedure has been demonstrated to be reliable in achieving acceptable patient reported outcomes (PROs). However, clinical predictors of outcome, return to sport and complications/failures have been more variable. The purpose of this study is to report patient reported outcomes (PROs), clinical correlations, and predictors of failure in patients who have received an open Latarjet surgery. Methods: Patients who received an open Latarjet with by two fellowship–trained surgeons between August 2006 - November 2018 were included. Prospectively collected data was reviewed, and PROs included ASES, SF–12 PCS, SANE, QuickDASH, and satisfaction. Age, sex, sports participation, pain, primary vs. revision (prior failed arthroscopic/open Bankart) surgery, dislocation number, glenoid bone loss (GBL), glenoid track concept, and projected glenoid track were evaluated. Projected track was calculated using the axial diameter of the corcoid as part of the glenoid track co...

Research paper thumbnail of Subscapularis repair techniques for reverse total shoulder arthroplasty: A systematic review

Journal of ISAKOS

Repair of the subscapularis can be effective in the setting of reverse total shoulder arthroplast... more Repair of the subscapularis can be effective in the setting of reverse total shoulder arthroplasty (rTSA). However, there has yet to be a consensus on an optimal repair technique. Objectives: The purpose of this systematic review is to consolidate current high-quality studies comparing outcomes after rTSA with different subscapularis repair techniques. Evidence review: A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews and meta-Analyses using the PubMed, Embase, Scopus and Cochrane databases for original, English-language studies observing outcomes of rTSA after subscapularis repair published between January 1, 2000 and December 31, 2020. Subscapularis management techniques were repair to (1) tendon (tendon-tendon), (2) prosthetic stem, (3) lesser tuberosity (bone tunnels) or (4) a subscapularis-preserving approach (intact). The repair technique was recorded for included studies, and clinical and functional subjective scores were extracted from text, tables and figures. Forest plots were created to allow for qualitative comparison of the outcomes of interest between subscapularis repair techniques. Findings: Seven comprehensive studies were identified, which included 367 patients. The mean age of patient at the time of surgery was 71.1 AE 2.8 years (range ¼ 47-87 years). Overall, 259 patients underwent tendon-tendon repair, 48 patients underwent repair to prosthetic stem, 40 patients underwent repair with bone tunnels and 20 patients' subscapularis remained intact. Significant improvement was seen in most studies for Single Assessment Numeric Evaluation (range, Δ 42.6-Δ 46.0 out of 3), American Shoulder and Elbow Surgeons (range, Δ44.2-Δ43.6 out of 3) and Visual Analogue Scale pain scores (range Δ 4.2-Δ 6 out of 5). Active forward elevation (range Δ 40.4-Δ 57.3 out of 4) and active external rotation (range Δ 2.9-Δ 16.0 out of 4) significantly improved, but forward elevation varied by nearly 17 (Δ16.94), while external rotation varied by 13 (Δ13.16) among repair techniques. Complications were reported in only one study, which used a tendon-tendon technique. Conclusions and relevance: This study summarizes the current evidence regarding subscapularis repair techniques after rTSA including functional and subjective clinical outcome scores. Several different subscapularis repair techniques during rTSA appear to lend to sufficient improvement in clinical and subjective outcomes. This information can help guide future studies in this area and highlights the need for high quality studies comparing different subscapularis repair techniques. Level of evidence: III.

Research paper thumbnail of Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes

JSES Reviews, Reports, and Techniques

Research paper thumbnail of Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis

The American Journal of Sports Medicine

Background: While the glenoid track concept presents a useful prediction for recurrent glenohumer... more Background: While the glenoid track concept presents a useful prediction for recurrent glenohumeral instability, little is known about the humeral head bony architecture as it relates to glenoid erosion in the setting of bipolar bone loss. Purpose: To (1) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSLs) in a cohort of patients with anterior instability using 3-dimensional imaging software and (2) assess the relationships between GBL and HSL characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were identified who had anterior shoulder instability with a minimum 5% GBL and evidence of HSL confirmed on computed tomography. Unilateral 3-dimensional models of the ipsilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using MIMICS software (Materialise NV). GBL surface area, width, defect length, and glenoid track width were quantified...

Research paper thumbnail of Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review

Arthroscopy, Sports Medicine, and Rehabilitation

To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophiz... more To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS). Methods: Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (! 30 < 70 years old) with FSCS. Results: Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline. Conclusion: Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.

Research paper thumbnail of Primary Distal Tibia Allograft for Restoration of Glenohumeral Stability with Anterior Glenoid Bone Loss

Arthroscopy Techniques

Recurrent shoulder instability with glenoid bone deficiency remains an increasing risk for failed... more Recurrent shoulder instability with glenoid bone deficiency remains an increasing risk for failed shoulder stabilization surgery. Numerous free bone block procedures for primary treatment of anterior shoulder stability have been introduced as an alternative for the Latarjet procedure, including both autografts and allografts. Among such options is the fresh distal tibial allograft (DTA), a dense weightbearing bone without donor site morbidity and excellent conformity to the native glenoid. The aim of this Technical Note is therefore to describe our surgical technique for use of fresh DTA as a free bone block choice in the setting of primary anterior glenoid reconstruction in a patient with recurrent shoulder instability.

Research paper thumbnail of Shoulder Arthroscopy in Conjunction With an Open Latarjet Procedure Can Identify Pathology That May Not Be Accounted for With Magnetic Resonance Imaging

Arthroscopy, Sports Medicine, and Rehabilitation, 2021

To review arthroscopic findings at the time of open Latarjet procedures to determine whether preo... more To review arthroscopic findings at the time of open Latarjet procedures to determine whether preoperative magnetic resonance imaging reports (MRRs) correlate with arthroscopic findings, as well as whether the arthroscopic findings critically affected surgical interventions performed at the time of a Latarjet procedure. Methods: This was a retrospective case series of all patients who received a Latarjet procedure between 2006 and 2018. Patients were excluded if they had inadequate records or underwent revision of a bony reconstruction procedure. Both primary Latarjet procedures and Latarjet procedures for revision of a failed arthroscopic procedure were included. MRRs, arthroscopic findings, and diagnoses were collected, and differences were noted. A "critical difference" was one that affected the surgical intervention in a significantly anatomic or procedural fashion or that affected rehabilitation. Results: In total, 154 of 186 patients (83%) were included. Of these, 96 of 154 (62%) underwent revision Latarjet procedures. The average bone loss percentage reported was 20.6% (range, 0%-40%). A critical difference between MRR and arthroscopic findings was noted in 60 of 154 patients (39%), with no difference between Latarjet procedures and revision Latarjet procedures. Of 154 patients, 29 (19%) received an additional 52 intra-articular procedures for diagnoses not made on magnetic resonance imaging, with no difference between primary and revision procedures. This included biceps and/or SLAP pathology requiring a tenodesis, debridement, or repair; rotator cuff pathology requiring debridement or repair; complex (>180) labral tears requiring repair; loose bodies; and chondral damage requiring debridement or microfracture. Patients undergoing revision Latarjet procedures were less likely to have bone loss mentioned or quantified in the MRR. Conclusions: Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony perspective and a soft-tissue perspective. In this series, diagnostic arthroscopy affected the surgical plan in addition to the Latarjet

Research paper thumbnail of Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy

Arthroscopy Techniques, 2022

In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique f... more In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique for restoration of hyaline cartilage; however, in patients with genu varum, the diseased compartment of the knee is generally offloaded as well. A high tibial osteotomy presents a biomechanical solution to malalignment of the knee and offloading of the diseased compartment of the knee. The purpose of this Technical Note is to present our preferred technique to treat focal cartilage damage in a varus misaligned knee coupling a high tibial osteotomy with an osteochondral allograft to the medial femoral condyle, along with partial medial and lateral meniscectomy.

Research paper thumbnail of Open Excision of a Painful Fabella

Arthroscopy Techniques, 2022

Fabella syndrome is a relatively rare but potentially debilitating condition that causes posterol... more Fabella syndrome is a relatively rare but potentially debilitating condition that causes posterolateral knee pain and swelling, as well as issues with flexion and/or extension of the knee. Irritation, pain, and cartilage damage ensue as the capsule and fabella make contact with the posterior lateral femoral condyle. This condition should be considered in cases of posterolateral knee pain in which other more common pathologies are not readily identified and when patients present with a positive finding of tenderness on examination at the fabella. Initial treatment consists of activity modification and rest, physical therapy, and potentially cortisone injections. When these fail, surgical excision of the fabella should be considered. Surgery in the posterolateral knee, however, requires careful consideration of the immediate and surrounding anatomic structures and arthroscopy, which can be technically challenging. The objective of this technical note is to describe our open technique for symptomatic fabella excision that is easily reproducible, with pearls to minimize risk to the posterolateral structures of the knee.

Research paper thumbnail of High rate of return to sport and excellent patient-reported outcomes after an open Latarjet procedure

Journal of Shoulder and Elbow Surgery, 2022

PURPOSE To report return to sport, patient reported outcomes (PROs), subjective outcomes, and com... more PURPOSE To report return to sport, patient reported outcomes (PROs), subjective outcomes, and complications/failures in patients who underwent open Latarjet surgery. METHODS Patients who underwent open Latarjet with by two fellowship-trained surgeons between August 2006 - November 2018 were included. Prospectively collected data were reviewed. Recurrent instability and revision surgeries were recorded. Subjective outcomes included return to sport, fear of reinjury or activity modification as a result of their instability history. PROs included ASES, SF-12 PCS, SANE, QuickDASH, and satisfaction. Age, sex, sports participation, pain, primary vs. revision (prior failed arthroscopic/open Bankart) surgery, dislocation number, glenoid bone loss (GBL), glenoid track concept, and projected glenoid track were evaluated. ASES <70, recurrent dislocation, or revision instability surgery were considered failures. RESULTS 126 shoulders (125 patients) met inclusion criteria with mean age of 28.1 years (range 15-57). 7/126 (5.5%) had additional procedures prior to final follow-up and were excluded from outcomes analyses, 6 of which were failures. Mean follow-up 3.7 years (range 2-9.3 years) was attained in 86.6% (103/119) of patients. All PROs significantly improved from preoperative baseline (ASES: 69.7→90.2; SANE: 55.8→85.9; QuickDASH: 28.4→10.5). PROs did not differ with sex, sport participation type, dislocation with/without sports, primary/revision procedure, and preoperative dislocation number. No correlations existed between PROs and age, GBL, or number of previous surgeries. On-track (50/105, 47.6%) and projected on-track (90/105, 85.7%) lesions correlated with better patient satisfaction, but not PROs. Despite not suffering recurrences, 63/99 (63.6%) and 44/99 (44.4%) reported activity modifications and feared reinjury, respectively. These groups had statistically worse PROs, although did not meet the minimal clinical important difference. 97% (86/89) returned to sport, with 74% (66/89) at the same/slightly below pre-injury level. 6/126 (4.8%) required revision stabilization surgery and 6/103 (5.8%) had ASES scores <70. CONCLUSION The open Latarjet procedure leads to significant improvements in all PROs, and overall 97% of patients returned to sport. Fear of reinjury and activity modifications were common after open Latarjet procedures, but did not appear to affect clinical outcome. On-track and projected on-track measurements correlated with better patient satisfaction, but not improved PROs.

Research paper thumbnail of Arthroscopic Characterization, Treatment, and Outcomes of Glenoid Labral Articular Disruption Lesions

The American Journal of Sports Medicine, 2022

Background: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been incon... more Background: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature. Purpose/Hypothesis: The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (PROs). We hypothesized that greater degrees of bony and cartilaginous involvement would correlate with worse outcomes. Study Design: Case series; Level of evidence, 4. Methods: All patients with a diagnosis of a GLAD lesion or a reverse GLAD (RGLAD) lesion at the time of diagnostic arthroscopy (January 2006–February 2019) were included in this study. Patients with ≥13.5% bone loss or previous ipsilateral shoulder surgery were excluded. Patient charts and operative reports/photos were used to identify the location of injury, extent of injury (labral, chondral, and bony), associated injuries, demographic factors, and treatment performed. Three ...

Research paper thumbnail of How to Fashion the Bone Block for Reconstruction of the Glenoid in Anterior and Posterior Instability

The American Journal of Sports Medicine

Background: Glenoid restoration techniques to address glenohumeral instability–induced anterior a... more Background: Glenoid restoration techniques to address glenohumeral instability–induced anterior and posterior glenoid bone loss (AGBL and PGBL) often require reconstruction, but best-fit bone block (BFBB) modeling has not been developed. Purpose: To provide glenoid bony reconstruction models for anterior and posterior instability of the shoulder using a bone loss instability cohort with high-fidelity 3-dimensional (3D) imaging. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We reviewed consecutive patients indicated for operative stabilization who had posterior glenohumeral instability and suspected GBL who underwent 2-dimensional (2D) computed tomography (CT). Patients were matched by sex, laterality, and age to patients who underwent operative stabilization of anterior glenohumeral instability. Mimics software was used to convert all 2D CT scans into 3D models of the scapula. A BFBB model was designed to digitally reconstruct GBL and was used to predict the am...

Research paper thumbnail of Talar Allograft Preparation for Treatment of Reverse Hill-Sachs Defect in Recurrent Posterior Shoulder Instability

Research paper thumbnail of Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study

Orthopaedic Journal of Sports Medicine

Background: Surgical pectoralis major (PM) repair can offer improved functional outcomes over non... more Background: Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment. Purpose: To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structures at risk. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen male cadavers were dissected. The relevant landmarks that were collected and measured included (1) PM footprint length at the humeral insertion (total, sternal head, and clavicular head insertions); (2) PM tendon length from the humeral insertion to the musculotendinous junction; (3) distance from the PM humeral insertion to the lateral (LPN) and medial (MPN) pectoral nerves; and (4) distance from the coracoid process to the musculocutaneous nerve (MCN) in anatomical position. Results: The total PM footprint length was 81.4 mm (95% CI, 71.4-91.3). The ster...

Research paper thumbnail of Impact of Prior Anterior Instability on Shoulder Arthroplasty Outcomes: A Systematic Review

Research paper thumbnail of Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma

Arthroscopy, Sports Medicine, and Rehabilitation

Research paper thumbnail of Treatment of a Failed Type V Acromioclavicular Separation Due to Coracoid Fracture: Revision of Acromioclavicular-Coracoclavicular Reconstruction and Coracoid Fixation

Arthroscopy Techniques

Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joi... more Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joint dislocations account for 8% of all joint dislocations and are even more common in contact sports. These injuries are graded as type I through type VI on the basis of the Rockwood classification method. Types I and II are generally treated without surgery whereas types IV, V, and VI are best treated operatively. Type III dislocations remain controversial in terms of treatment, and many surgeons recommend nonoperative treatment first and operative treatment in case of continued symptoms such as pain, instability, or shoulder girdle dysfunction. The goal of operative treatment is to restore AC joint stability, which involves addressing both the coracoclavicular and coracoacromial ligaments to achieve a desirable patient outcome. The objective of this Technical Note is to describe our technique for management of a failed acromioclavicular stabilization, treated with a coracoclavicular and AC joint capsular reconstruction using tibialis anterior and semitendinosus allografts.

Research paper thumbnail of Poster 162: Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis

Orthopaedic Journal of Sports Medicine

Objectives: The purpose of this study was to 1.) qualitatively and quantitatively analyze the int... more Objectives: The purpose of this study was to 1.) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSL) in a cohort of anterior instability patients using 3-dimensional (3-D) imaging software and 2.) assess the relationships between GBL and HSL characteristics. Methods: Patients with anterior shoulder instability with a minimum of 5% GBL with evidence of HSL confirmed on computed tomography were identified. 3-D models of the unilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using Mimics (Materialise NV, Leuven, Belgium) software. GBL as well as surface area (SA), width, defect length, and glenoid track width was quantified. The volume, SA, width, and depth of identified HSLs were quantified along with their location (medial, superior, and inferior extent) on the humeral head. The severity of glenoid bone loss was categorized by low grade (0-10%), moderate grade (>10% to...

Research paper thumbnail of Poster 161: Consequence Athletes with Anterior Shoulder Instability: Consider Latarjet

Orthopaedic Journal of Sports Medicine

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...

Research paper thumbnail of Paper 28: Early Versus Standard Return to Sport Following ACL Reconstruction. Impact on Volume of Play and Career Logevity in 180 Professional European Soccer Players

Orthopaedic Journal of Sports Medicine

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...

Research paper thumbnail of Poster 135: Minimum 2 year Clinical Outcomes after Latarjet for anterior shoulder instability: clinical and imaging factors that correlate with success or failure

Orthopaedic Journal of Sports Medicine

Objectives: The open Latarjet procedure has been demonstrated to be reliable in achieving accepta... more Objectives: The open Latarjet procedure has been demonstrated to be reliable in achieving acceptable patient reported outcomes (PROs). However, clinical predictors of outcome, return to sport and complications/failures have been more variable. The purpose of this study is to report patient reported outcomes (PROs), clinical correlations, and predictors of failure in patients who have received an open Latarjet surgery. Methods: Patients who received an open Latarjet with by two fellowship–trained surgeons between August 2006 - November 2018 were included. Prospectively collected data was reviewed, and PROs included ASES, SF–12 PCS, SANE, QuickDASH, and satisfaction. Age, sex, sports participation, pain, primary vs. revision (prior failed arthroscopic/open Bankart) surgery, dislocation number, glenoid bone loss (GBL), glenoid track concept, and projected glenoid track were evaluated. Projected track was calculated using the axial diameter of the corcoid as part of the glenoid track co...

Research paper thumbnail of Subscapularis repair techniques for reverse total shoulder arthroplasty: A systematic review

Journal of ISAKOS

Repair of the subscapularis can be effective in the setting of reverse total shoulder arthroplast... more Repair of the subscapularis can be effective in the setting of reverse total shoulder arthroplasty (rTSA). However, there has yet to be a consensus on an optimal repair technique. Objectives: The purpose of this systematic review is to consolidate current high-quality studies comparing outcomes after rTSA with different subscapularis repair techniques. Evidence review: A comprehensive literature review was conducted according to the preferred reporting items for systematic reviews and meta-Analyses using the PubMed, Embase, Scopus and Cochrane databases for original, English-language studies observing outcomes of rTSA after subscapularis repair published between January 1, 2000 and December 31, 2020. Subscapularis management techniques were repair to (1) tendon (tendon-tendon), (2) prosthetic stem, (3) lesser tuberosity (bone tunnels) or (4) a subscapularis-preserving approach (intact). The repair technique was recorded for included studies, and clinical and functional subjective scores were extracted from text, tables and figures. Forest plots were created to allow for qualitative comparison of the outcomes of interest between subscapularis repair techniques. Findings: Seven comprehensive studies were identified, which included 367 patients. The mean age of patient at the time of surgery was 71.1 AE 2.8 years (range ¼ 47-87 years). Overall, 259 patients underwent tendon-tendon repair, 48 patients underwent repair to prosthetic stem, 40 patients underwent repair with bone tunnels and 20 patients' subscapularis remained intact. Significant improvement was seen in most studies for Single Assessment Numeric Evaluation (range, Δ 42.6-Δ 46.0 out of 3), American Shoulder and Elbow Surgeons (range, Δ44.2-Δ43.6 out of 3) and Visual Analogue Scale pain scores (range Δ 4.2-Δ 6 out of 5). Active forward elevation (range Δ 40.4-Δ 57.3 out of 4) and active external rotation (range Δ 2.9-Δ 16.0 out of 4) significantly improved, but forward elevation varied by nearly 17 (Δ16.94), while external rotation varied by 13 (Δ13.16) among repair techniques. Complications were reported in only one study, which used a tendon-tendon technique. Conclusions and relevance: This study summarizes the current evidence regarding subscapularis repair techniques after rTSA including functional and subjective clinical outcome scores. Several different subscapularis repair techniques during rTSA appear to lend to sufficient improvement in clinical and subjective outcomes. This information can help guide future studies in this area and highlights the need for high quality studies comparing different subscapularis repair techniques. Level of evidence: III.

Research paper thumbnail of Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes

JSES Reviews, Reports, and Techniques

Research paper thumbnail of Glenoid Bone Loss Directly Affects Hill-Sachs Morphology: An Advanced 3-Dimensional Analysis

The American Journal of Sports Medicine

Background: While the glenoid track concept presents a useful prediction for recurrent glenohumer... more Background: While the glenoid track concept presents a useful prediction for recurrent glenohumeral instability, little is known about the humeral head bony architecture as it relates to glenoid erosion in the setting of bipolar bone loss. Purpose: To (1) qualitatively and quantitatively analyze the interplay between glenoid bone loss (GBL) and Hill-Sachs lesions (HSLs) in a cohort of patients with anterior instability using 3-dimensional imaging software and (2) assess the relationships between GBL and HSL characteristics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients were identified who had anterior shoulder instability with a minimum 5% GBL and evidence of HSL confirmed on computed tomography. Unilateral 3-dimensional models of the ipsilateral proximal humeral head and en face sagittal oblique view of the glenoid were reconstructed using MIMICS software (Materialise NV). GBL surface area, width, defect length, and glenoid track width were quantified...

Research paper thumbnail of Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review

Arthroscopy, Sports Medicine, and Rehabilitation

To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophiz... more To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS). Methods: Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (! 30 < 70 years old) with FSCS. Results: Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline. Conclusion: Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.

Research paper thumbnail of Primary Distal Tibia Allograft for Restoration of Glenohumeral Stability with Anterior Glenoid Bone Loss

Arthroscopy Techniques

Recurrent shoulder instability with glenoid bone deficiency remains an increasing risk for failed... more Recurrent shoulder instability with glenoid bone deficiency remains an increasing risk for failed shoulder stabilization surgery. Numerous free bone block procedures for primary treatment of anterior shoulder stability have been introduced as an alternative for the Latarjet procedure, including both autografts and allografts. Among such options is the fresh distal tibial allograft (DTA), a dense weightbearing bone without donor site morbidity and excellent conformity to the native glenoid. The aim of this Technical Note is therefore to describe our surgical technique for use of fresh DTA as a free bone block choice in the setting of primary anterior glenoid reconstruction in a patient with recurrent shoulder instability.

Research paper thumbnail of Shoulder Arthroscopy in Conjunction With an Open Latarjet Procedure Can Identify Pathology That May Not Be Accounted for With Magnetic Resonance Imaging

Arthroscopy, Sports Medicine, and Rehabilitation, 2021

To review arthroscopic findings at the time of open Latarjet procedures to determine whether preo... more To review arthroscopic findings at the time of open Latarjet procedures to determine whether preoperative magnetic resonance imaging reports (MRRs) correlate with arthroscopic findings, as well as whether the arthroscopic findings critically affected surgical interventions performed at the time of a Latarjet procedure. Methods: This was a retrospective case series of all patients who received a Latarjet procedure between 2006 and 2018. Patients were excluded if they had inadequate records or underwent revision of a bony reconstruction procedure. Both primary Latarjet procedures and Latarjet procedures for revision of a failed arthroscopic procedure were included. MRRs, arthroscopic findings, and diagnoses were collected, and differences were noted. A "critical difference" was one that affected the surgical intervention in a significantly anatomic or procedural fashion or that affected rehabilitation. Results: In total, 154 of 186 patients (83%) were included. Of these, 96 of 154 (62%) underwent revision Latarjet procedures. The average bone loss percentage reported was 20.6% (range, 0%-40%). A critical difference between MRR and arthroscopic findings was noted in 60 of 154 patients (39%), with no difference between Latarjet procedures and revision Latarjet procedures. Of 154 patients, 29 (19%) received an additional 52 intra-articular procedures for diagnoses not made on magnetic resonance imaging, with no difference between primary and revision procedures. This included biceps and/or SLAP pathology requiring a tenodesis, debridement, or repair; rotator cuff pathology requiring debridement or repair; complex (>180) labral tears requiring repair; loose bodies; and chondral damage requiring debridement or microfracture. Patients undergoing revision Latarjet procedures were less likely to have bone loss mentioned or quantified in the MRR. Conclusions: Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony perspective and a soft-tissue perspective. In this series, diagnostic arthroscopy affected the surgical plan in addition to the Latarjet

Research paper thumbnail of Treatment of Malalignment and Cartilage Injury: High Tibial Osteotomy With a Concomitant Osteochondral Allograft to the Medial Femoral Condyle and Lateral and Medial Partial Meniscectomy

Arthroscopy Techniques, 2022

In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique f... more In patients with full-thickness focal cartilage defects, osteochondral allograft is a technique for restoration of hyaline cartilage; however, in patients with genu varum, the diseased compartment of the knee is generally offloaded as well. A high tibial osteotomy presents a biomechanical solution to malalignment of the knee and offloading of the diseased compartment of the knee. The purpose of this Technical Note is to present our preferred technique to treat focal cartilage damage in a varus misaligned knee coupling a high tibial osteotomy with an osteochondral allograft to the medial femoral condyle, along with partial medial and lateral meniscectomy.

Research paper thumbnail of Open Excision of a Painful Fabella

Arthroscopy Techniques, 2022

Fabella syndrome is a relatively rare but potentially debilitating condition that causes posterol... more Fabella syndrome is a relatively rare but potentially debilitating condition that causes posterolateral knee pain and swelling, as well as issues with flexion and/or extension of the knee. Irritation, pain, and cartilage damage ensue as the capsule and fabella make contact with the posterior lateral femoral condyle. This condition should be considered in cases of posterolateral knee pain in which other more common pathologies are not readily identified and when patients present with a positive finding of tenderness on examination at the fabella. Initial treatment consists of activity modification and rest, physical therapy, and potentially cortisone injections. When these fail, surgical excision of the fabella should be considered. Surgery in the posterolateral knee, however, requires careful consideration of the immediate and surrounding anatomic structures and arthroscopy, which can be technically challenging. The objective of this technical note is to describe our open technique for symptomatic fabella excision that is easily reproducible, with pearls to minimize risk to the posterolateral structures of the knee.

Research paper thumbnail of High rate of return to sport and excellent patient-reported outcomes after an open Latarjet procedure

Journal of Shoulder and Elbow Surgery, 2022

PURPOSE To report return to sport, patient reported outcomes (PROs), subjective outcomes, and com... more PURPOSE To report return to sport, patient reported outcomes (PROs), subjective outcomes, and complications/failures in patients who underwent open Latarjet surgery. METHODS Patients who underwent open Latarjet with by two fellowship-trained surgeons between August 2006 - November 2018 were included. Prospectively collected data were reviewed. Recurrent instability and revision surgeries were recorded. Subjective outcomes included return to sport, fear of reinjury or activity modification as a result of their instability history. PROs included ASES, SF-12 PCS, SANE, QuickDASH, and satisfaction. Age, sex, sports participation, pain, primary vs. revision (prior failed arthroscopic/open Bankart) surgery, dislocation number, glenoid bone loss (GBL), glenoid track concept, and projected glenoid track were evaluated. ASES <70, recurrent dislocation, or revision instability surgery were considered failures. RESULTS 126 shoulders (125 patients) met inclusion criteria with mean age of 28.1 years (range 15-57). 7/126 (5.5%) had additional procedures prior to final follow-up and were excluded from outcomes analyses, 6 of which were failures. Mean follow-up 3.7 years (range 2-9.3 years) was attained in 86.6% (103/119) of patients. All PROs significantly improved from preoperative baseline (ASES: 69.7→90.2; SANE: 55.8→85.9; QuickDASH: 28.4→10.5). PROs did not differ with sex, sport participation type, dislocation with/without sports, primary/revision procedure, and preoperative dislocation number. No correlations existed between PROs and age, GBL, or number of previous surgeries. On-track (50/105, 47.6%) and projected on-track (90/105, 85.7%) lesions correlated with better patient satisfaction, but not PROs. Despite not suffering recurrences, 63/99 (63.6%) and 44/99 (44.4%) reported activity modifications and feared reinjury, respectively. These groups had statistically worse PROs, although did not meet the minimal clinical important difference. 97% (86/89) returned to sport, with 74% (66/89) at the same/slightly below pre-injury level. 6/126 (4.8%) required revision stabilization surgery and 6/103 (5.8%) had ASES scores <70. CONCLUSION The open Latarjet procedure leads to significant improvements in all PROs, and overall 97% of patients returned to sport. Fear of reinjury and activity modifications were common after open Latarjet procedures, but did not appear to affect clinical outcome. On-track and projected on-track measurements correlated with better patient satisfaction, but not improved PROs.

Research paper thumbnail of Arthroscopic Characterization, Treatment, and Outcomes of Glenoid Labral Articular Disruption Lesions

The American Journal of Sports Medicine, 2022

Background: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been incon... more Background: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature. Purpose/Hypothesis: The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (PROs). We hypothesized that greater degrees of bony and cartilaginous involvement would correlate with worse outcomes. Study Design: Case series; Level of evidence, 4. Methods: All patients with a diagnosis of a GLAD lesion or a reverse GLAD (RGLAD) lesion at the time of diagnostic arthroscopy (January 2006–February 2019) were included in this study. Patients with ≥13.5% bone loss or previous ipsilateral shoulder surgery were excluded. Patient charts and operative reports/photos were used to identify the location of injury, extent of injury (labral, chondral, and bony), associated injuries, demographic factors, and treatment performed. Three ...