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Papers by Benjamin Bruce

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 25, 2016

To compare the biomechanical performance of medial row suture placement relative to the musculote... more To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model. A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system. The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RC...

Orthopaedic Journal of Sports Medicine, 2014

Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically recons... more Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ♀, 11♂) that underwent Latarjet coracoid transfer for the revision of failed previous arthroscopic instability repair. The avg. age was 32.6 yrs (16-58). All patients had recurrent symptomatic anterior instability after previous arthroscopic surgery, and avg. time from arthroscopic repair to Latarjet was 13 months (4-40 mn). All had either CT or MRI that revealed suture anchor material in the glenoid, labral and capsular stripping, and anteroinferior glenoid bone loss or erosion. Advanced bone loss percentage analysis was not per...

Journal of Shoulder and Elbow Surgery, 2014

The Journal of Bone and Joint Surgery (American), 2011

The Journal of Arthroplasty, 2014

The authors hypothesized that age, body mass index (BMI), and medical comorbidities (graded with ... more The authors hypothesized that age, body mass index (BMI), and medical comorbidities (graded with the Charleson Comorbidiy index [CCI]) could be used to predict early complications after TSA. The authors performed a retrospective review of primary TSAs with a minimum of 90-day follow-up. One hundred twenty-seven patients met the inclusion criteria. Complications occurred in 12 (9.4%) of patients. Major complications occurred in 1 patient (0.8%), medical in 8 (6.3%), and surgical in 4 (3.1%). CCI significantly correlated with complication rates and multivariate regression analysis demonstrated CCI to be the only significant determinant of overall complication rates (P = 0.005) and medical complication rates (P = 0.015). While BMI subgroup did not affect complication rates, transfusion rates, intra-operative blood loss, or operative time, our study may have been underpowered for this variable.

International Journal of Shoulder Surgery, 2014

Foot & Ankle International, 2014

Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcanea... more Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcaneal osteotomy, and since the tibial nerve has also been shown to be very sensitive to ankle position, position of the calcaneus after osteotomy and displacement was thought to likely influence the environment of the tibial nerve within the tarsal canal. The respective volume of the tarsal canal was therefore hypothesized to decrease with medial or lateral displacement osteotomies of the calcaneus. Methods: Anterior and posterior calcaneal osteotomies were made in cadaveric matched pairs and brought through sequential medial and lateral displacements. Magnetic resonance imaging was used to estimate the comparative resultant volume of the tarsal canal after each of these new positions were assumed, as compared with baseline. The proximity of the osteotomy cut to the nerve’s location was also measured. Results: The tarsal tunnel volume was calculated for all 5 displacement states and were as ...

The online version of this article can be found at: DOI: 10.1177/0363546513519950 2014 42: 973 or... more The online version of this article can be found at: DOI: 10.1177/0363546513519950 2014 42: 973 originally published online February 11, 2014Am J Sports Med

Journal of Orthopaedic Trauma, 2015

Objectives: To compare the outcomes of open reduction and internal fixation (ORIF), closed reduct... more Objectives: To compare the outcomes of open reduction and internal fixation (ORIF), closed reduction and percutaneous pinning, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA) for proximal humerus fractures. Data Sources: The search was performed on September 9, 2012 using an explicit search algorithm in the following databases: Medline, SportDiscus, CINAHL, and Cochrane Central Register of Controlled Trials. Inclusion criteria were English language studies reporting clinical outcomes after surgical treatment of 3-or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Study Selection: English language studies reporting clinical outcomes after surgical treatment of 3-or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Levels 1-4 studies were eligible for inclusion. Data Extraction: Study methodological quality and bias was evaluated using the Modified Coleman Methodology Score. Data Synthesis: Two-proportion Z test and multivariate linear regression analyses were used for group comparisons.

Shoulder Arthroscopy, 2013

The Physician and Sportsmedicine, 2012

Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. This degenerative... more Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. This degenerative condition can manifest as an acute process lasting < 3 months or a chronic process often refractory to treatment. Symptom resolution occurs in 70% to 80% of patients within the first year. A "watch-and-wait" approach can be an appropriate treatment option, although physical therapy has been shown to be an effective first-line therapy. Corticosteroids, while providing relief of pain in the acute setting, may be detrimental to recovery in the long term. Platelet-rich plasma injections, although recently well publicized, have not been proven by well-controlled clinical trials to be effective therapy. For patients with symptoms refractory to conservative management, surgical intervention has shown to be a successful treatment modality.

Operative Techniques in Sports Medicine, 2013

Journal of the American Academy of Orthopaedic Surgeons, 2012

Regional anesthesia of the upper extremity has several clinical applications and is reported to h... more Regional anesthesia of the upper extremity has several clinical applications and is reported to have several advantages over general anesthesia for orthopaedic surgery. These advantages, such as improved postoperative pain, decreased postoperative opioid administration, and reduced recovery time, have led to widespread acceptance of a variety of regional nerve blocks. Interscalene block is the most commonly used block for shoulder surgery. Other brachial plexus nerve blocks used for orthopaedic surgery of the upper extremity are supraclavicular, infraclavicular, and axillary. Several practical and theoretical aspects of regional nerve blocks must be considered to optimize the beneficial effects and minimize the risk of complications.

The Journal of Arthroplasty, 2014

➤ Total shoulder arthroplasty can be associated with a multitude of complications, the most commo... more ➤ Total shoulder arthroplasty can be associated with a multitude of complications, the most common of which include prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, infection, neural injury, and deltoid muscle dysfunction.

The American Journal of Sports Medicine, 2014

Because chondrocyte viability is imperative for successful osteochondral allograft transplantatio... more Because chondrocyte viability is imperative for successful osteochondral allograft transplantation, sterilization techniques must provide antimicrobial effects with minimal cartilage toxicity. Chlorhexidine gluconate (CHG) is an effective disinfectant; however, its use with human articular cartilage requires further investigation. To determine the maximal chlorhexidine concentration that does not affect chondrocyte viability in allografts and to determine whether this concentration effectively sterilizes contaminated osteoarticular grafts. Controlled laboratory study. Osteochondral plugs were subjected to pulse lavage with 1-L solutions of 0.002%, 0.01%, 0.05%, and 0.25% CHG and cultured for 0, 1, 2, and 7 days in media of 10% fetal bovine serum and antibiotics. Chondrocyte viability was determined via LIVE/DEAD Viability Assay. Plugs were contaminated with Staphylococcus aureus and randomized to 4 treatment groups. One group was not contaminated; the 3 others were contaminated and received no treatment, saline pulse lavage, or saline pulse lavage with 0.002% CHG. Serial dilutions were plated and colony-forming units assessed. The control group and the 0.002% CHG group showed similar cell viability, ranging from 67% ± 4% to 81% ± 22% (mean ± SD) at all time points. In the 0.01% CHG group, cell viability was reduced in comparison with control by 2-fold at day 2 and remained until day 7 (P < .01). The 0.05% and 0.25% CHG groups showed a 2-fold reduction in cell viability at day 1 (P < .01). At day 7, cell viability was reduced to 15% ± 18% (4-fold decrease) for the 0.05% CHG group and 10% ± 19% (6-fold decrease) for the 0.25% CHG group (P < .01). Contaminated grafts treated with 0.002% CHG demonstrated no colony-forming units. Pulse lavage with 0.002% CHG does not cause significant cell death within 7 days after exposure, while CHG at concentrations >0.002% significantly decreases chondrocyte viability within 1 to 2 days after exposure and should therefore not be used for disinfection of osteochondral allograft. Pulse lavage does not affect chondrocyte viability but cannot be used in isolation to sterilize contaminated fragments. Overall, 0.002% CHG was shown to effectively decontaminate osteoarticular fragments. This study offers a scientific protocol for sterilizing osteochondral fragments that does not adversely affect cartilage viability.

The American Journal of Sports Medicine, 2012

The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic ... more The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength. To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a traditional transosseous (TO) suture construct. Controlled laboratory study. Identical simulated rotator cuff tears were created on 8 matched pairs of humeri. Each matched pair underwent repair with 4 sutures using either the TOE-SB or TO technique. Initial fixation strength was tested in a custom testing jig. Each shoulder underwent 1000 cycles each of low and then high load testing. Gap displacement was measured at anterior and posterior sites of the repair with digital video tracking of paired reflective markers and recorded at predetermined cycle intervals. There were no statistically significant differences in gap formation at the repair sites under low or high load conditions between TOE-SB and TO techniques. The mean maximal gap formation of the repairs during low load testing in the TOE-SB and TO constructs was 0.93 ± 0.88 mm and 0.55 ± 0.22 mm, respectively (P = .505). The mean maximal gap formation during high load testing in the TOE-SB and TO constructs was 2.04 ± 1.10 mm and 2.28 ± 1.62 mm, respectively (P = .517). The most significant increase in gap distance occurred at the transition from low load to high load in both constructs. Most of the incremental displacement occurred within the first 100 cycles for both high and low load testing (P < .001). The arthroscopic TOE-SB technique is comparable in initial fixation strength to the traditional TO simple suture repair technique. Arthroscopic techniques can achieve initial fixation strength comparable with traditional TO techniques performed without suture anchors.

Journal of Shoulder and Elbow Surgery, 2014

Background: Body mass index (BMI) is an independent predictor of complications after hip and knee... more Background: Body mass index (BMI) is an independent predictor of complications after hip and knee arthroplasty. Whether similar trends apply to patients undergoing reverse total shoulder arthroplasty (RTSA) is unknown. Methods: A retrospective review of primary RTSAs with a minimum 90-day follow-up were included. Complications were classified as major or minor and medical or surgical. Patients were classified into 3 groups: normal BMI (BMI <25 kg/m 2 ), overweight or mildly obese (BMI 25-35 kg/m 2 ), and moderately or severely obese (BMI >35 kg/m 2 ). Results: Of the 119 patients met our inclusion criteria, 30 (25%) had a BMI of less than 25 kg/m 2 ; 65 (55%) had a BMI of 25 to 35 kg/m 2 , and 24 (20%) had BMI exceeding 35 kg/m 2 . Complications occurred in 30 patients (25%), comprising major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%). Patients with a BMI exceeding 35 kg/m 2 had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P ¼ .05) than the other groups. Patients with BMI of less than 25 kg/m 2 had a greater overall complication rate than those with a BMI of 25 to 35 kg/m 2 (P < .05). Multivariate regression analysis demonstrated BMI was the only significant determinant of overall complication rates and medical complication rates (P < .05). Conclusion: Patients with a BMI exceeding 35 kg/m 2 (severely obese) or a BMI of less than 25 kg/m 2 have higher rates of complication after RTSA. Level of evidence: Level III, Retrospective Cohort Study, Treatment Study.

Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 25, 2016

To compare the biomechanical performance of medial row suture placement relative to the musculote... more To compare the biomechanical performance of medial row suture placement relative to the musculotendinous junction (MTJ) in a cadaveric transosseous equivalent suture bridge (TOE-SB) double-row (DR) rotator cuff repair (RCR) model. A TOE-SB DR technique was used to reattach experimentally created supraspinatus tendon tears in 9 pairs of human cadaveric shoulders. The medial row sutures were passed either near the MTJ (MTJ group) or 10 mm lateral to the MTJ (rotator cuff tendon [RCT] group). After the supraspinatus repair, the specimens underwent cyclic loading and load to failure tests. The localized displacement of the markers affixed to the tendon surface was measured with an optical tracking system. The MTJ group showed a significantly higher (P = .03) medial row failure (5/9; 3 during cyclic testing and 2 during load to failure testing) compared with the RCT group (0/9). The mean number of cycles completed during cyclic testing was lower in the MTJ group (77) compared with the RC...

Orthopaedic Journal of Sports Medicine, 2014

Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically recons... more Objectives: Arthroscopic instability repair has supplanted open techniques to anatomically reconstruct anteroinferior instability pathology. Arthroscopic technique can fail for a variety of reasons. We have utilized the Latarjet as a revision option in failed arthroscopic instability repairs when there is altered surgical anatomy, capsular deficiency and/or glenoid bone compromise and recurrent glenohumeral instability. Methods: We reviewed 51 shoulders (40 ♀, 11♂) that underwent Latarjet coracoid transfer for the revision of failed previous arthroscopic instability repair. The avg. age was 32.6 yrs (16-58). All patients had recurrent symptomatic anterior instability after previous arthroscopic surgery, and avg. time from arthroscopic repair to Latarjet was 13 months (4-40 mn). All had either CT or MRI that revealed suture anchor material in the glenoid, labral and capsular stripping, and anteroinferior glenoid bone loss or erosion. Advanced bone loss percentage analysis was not per...

Journal of Shoulder and Elbow Surgery, 2014

The Journal of Bone and Joint Surgery (American), 2011

The Journal of Arthroplasty, 2014

The authors hypothesized that age, body mass index (BMI), and medical comorbidities (graded with ... more The authors hypothesized that age, body mass index (BMI), and medical comorbidities (graded with the Charleson Comorbidiy index [CCI]) could be used to predict early complications after TSA. The authors performed a retrospective review of primary TSAs with a minimum of 90-day follow-up. One hundred twenty-seven patients met the inclusion criteria. Complications occurred in 12 (9.4%) of patients. Major complications occurred in 1 patient (0.8%), medical in 8 (6.3%), and surgical in 4 (3.1%). CCI significantly correlated with complication rates and multivariate regression analysis demonstrated CCI to be the only significant determinant of overall complication rates (P = 0.005) and medical complication rates (P = 0.015). While BMI subgroup did not affect complication rates, transfusion rates, intra-operative blood loss, or operative time, our study may have been underpowered for this variable.

International Journal of Shoulder Surgery, 2014

Foot & Ankle International, 2014

Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcanea... more Background: As an entrapment phenomenon, tarsal tunnel syndrome has been described after calcaneal osteotomy, and since the tibial nerve has also been shown to be very sensitive to ankle position, position of the calcaneus after osteotomy and displacement was thought to likely influence the environment of the tibial nerve within the tarsal canal. The respective volume of the tarsal canal was therefore hypothesized to decrease with medial or lateral displacement osteotomies of the calcaneus. Methods: Anterior and posterior calcaneal osteotomies were made in cadaveric matched pairs and brought through sequential medial and lateral displacements. Magnetic resonance imaging was used to estimate the comparative resultant volume of the tarsal canal after each of these new positions were assumed, as compared with baseline. The proximity of the osteotomy cut to the nerve’s location was also measured. Results: The tarsal tunnel volume was calculated for all 5 displacement states and were as ...

The online version of this article can be found at: DOI: 10.1177/0363546513519950 2014 42: 973 or... more The online version of this article can be found at: DOI: 10.1177/0363546513519950 2014 42: 973 originally published online February 11, 2014Am J Sports Med

Journal of Orthopaedic Trauma, 2015

Objectives: To compare the outcomes of open reduction and internal fixation (ORIF), closed reduct... more Objectives: To compare the outcomes of open reduction and internal fixation (ORIF), closed reduction and percutaneous pinning, hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA) for proximal humerus fractures. Data Sources: The search was performed on September 9, 2012 using an explicit search algorithm in the following databases: Medline, SportDiscus, CINAHL, and Cochrane Central Register of Controlled Trials. Inclusion criteria were English language studies reporting clinical outcomes after surgical treatment of 3-or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Study Selection: English language studies reporting clinical outcomes after surgical treatment of 3-or 4-part proximal humerus fractures with a minimum of 1-year follow-up. Levels 1-4 studies were eligible for inclusion. Data Extraction: Study methodological quality and bias was evaluated using the Modified Coleman Methodology Score. Data Synthesis: Two-proportion Z test and multivariate linear regression analyses were used for group comparisons.

Shoulder Arthroscopy, 2013

The Physician and Sportsmedicine, 2012

Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. This degenerative... more Lateral epicondylitis, or tennis elbow, is the most common cause of elbow pain. This degenerative condition can manifest as an acute process lasting &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 3 months or a chronic process often refractory to treatment. Symptom resolution occurs in 70% to 80% of patients within the first year. A &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;watch-and-wait&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; approach can be an appropriate treatment option, although physical therapy has been shown to be an effective first-line therapy. Corticosteroids, while providing relief of pain in the acute setting, may be detrimental to recovery in the long term. Platelet-rich plasma injections, although recently well publicized, have not been proven by well-controlled clinical trials to be effective therapy. For patients with symptoms refractory to conservative management, surgical intervention has shown to be a successful treatment modality.

Operative Techniques in Sports Medicine, 2013

Journal of the American Academy of Orthopaedic Surgeons, 2012

Regional anesthesia of the upper extremity has several clinical applications and is reported to h... more Regional anesthesia of the upper extremity has several clinical applications and is reported to have several advantages over general anesthesia for orthopaedic surgery. These advantages, such as improved postoperative pain, decreased postoperative opioid administration, and reduced recovery time, have led to widespread acceptance of a variety of regional nerve blocks. Interscalene block is the most commonly used block for shoulder surgery. Other brachial plexus nerve blocks used for orthopaedic surgery of the upper extremity are supraclavicular, infraclavicular, and axillary. Several practical and theoretical aspects of regional nerve blocks must be considered to optimize the beneficial effects and minimize the risk of complications.

The Journal of Arthroplasty, 2014

➤ Total shoulder arthroplasty can be associated with a multitude of complications, the most commo... more ➤ Total shoulder arthroplasty can be associated with a multitude of complications, the most common of which include prosthetic loosening, glenohumeral instability, periprosthetic fracture, rotator cuff tears, infection, neural injury, and deltoid muscle dysfunction.

The American Journal of Sports Medicine, 2014

Because chondrocyte viability is imperative for successful osteochondral allograft transplantatio... more Because chondrocyte viability is imperative for successful osteochondral allograft transplantation, sterilization techniques must provide antimicrobial effects with minimal cartilage toxicity. Chlorhexidine gluconate (CHG) is an effective disinfectant; however, its use with human articular cartilage requires further investigation. To determine the maximal chlorhexidine concentration that does not affect chondrocyte viability in allografts and to determine whether this concentration effectively sterilizes contaminated osteoarticular grafts. Controlled laboratory study. Osteochondral plugs were subjected to pulse lavage with 1-L solutions of 0.002%, 0.01%, 0.05%, and 0.25% CHG and cultured for 0, 1, 2, and 7 days in media of 10% fetal bovine serum and antibiotics. Chondrocyte viability was determined via LIVE/DEAD Viability Assay. Plugs were contaminated with Staphylococcus aureus and randomized to 4 treatment groups. One group was not contaminated; the 3 others were contaminated and received no treatment, saline pulse lavage, or saline pulse lavage with 0.002% CHG. Serial dilutions were plated and colony-forming units assessed. The control group and the 0.002% CHG group showed similar cell viability, ranging from 67% ± 4% to 81% ± 22% (mean ± SD) at all time points. In the 0.01% CHG group, cell viability was reduced in comparison with control by 2-fold at day 2 and remained until day 7 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). The 0.05% and 0.25% CHG groups showed a 2-fold reduction in cell viability at day 1 (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). At day 7, cell viability was reduced to 15% ± 18% (4-fold decrease) for the 0.05% CHG group and 10% ± 19% (6-fold decrease) for the 0.25% CHG group (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Contaminated grafts treated with 0.002% CHG demonstrated no colony-forming units. Pulse lavage with 0.002% CHG does not cause significant cell death within 7 days after exposure, while CHG at concentrations &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.002% significantly decreases chondrocyte viability within 1 to 2 days after exposure and should therefore not be used for disinfection of osteochondral allograft. Pulse lavage does not affect chondrocyte viability but cannot be used in isolation to sterilize contaminated fragments. Overall, 0.002% CHG was shown to effectively decontaminate osteoarticular fragments. This study offers a scientific protocol for sterilizing osteochondral fragments that does not adversely affect cartilage viability.

The American Journal of Sports Medicine, 2012

The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic ... more The outcome of rotator cuff repair correlates with tendon healing. Early studies of arthroscopic rotator cuff repair demonstrate lower healing rates than traditional open techniques. Transosseous-equivalent repair techniques (suture bridge) were developed to improve the initial fixation strength. To compare the initial in vitro tensile fixation strength of a transosseous-equivalent suture bridge (TOE-SB) rotator cuff repair construct to a traditional transosseous (TO) suture construct. Controlled laboratory study. Identical simulated rotator cuff tears were created on 8 matched pairs of humeri. Each matched pair underwent repair with 4 sutures using either the TOE-SB or TO technique. Initial fixation strength was tested in a custom testing jig. Each shoulder underwent 1000 cycles each of low and then high load testing. Gap displacement was measured at anterior and posterior sites of the repair with digital video tracking of paired reflective markers and recorded at predetermined cycle intervals. There were no statistically significant differences in gap formation at the repair sites under low or high load conditions between TOE-SB and TO techniques. The mean maximal gap formation of the repairs during low load testing in the TOE-SB and TO constructs was 0.93 ± 0.88 mm and 0.55 ± 0.22 mm, respectively (P = .505). The mean maximal gap formation during high load testing in the TOE-SB and TO constructs was 2.04 ± 1.10 mm and 2.28 ± 1.62 mm, respectively (P = .517). The most significant increase in gap distance occurred at the transition from low load to high load in both constructs. Most of the incremental displacement occurred within the first 100 cycles for both high and low load testing (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The arthroscopic TOE-SB technique is comparable in initial fixation strength to the traditional TO simple suture repair technique. Arthroscopic techniques can achieve initial fixation strength comparable with traditional TO techniques performed without suture anchors.

Journal of Shoulder and Elbow Surgery, 2014

Background: Body mass index (BMI) is an independent predictor of complications after hip and knee... more Background: Body mass index (BMI) is an independent predictor of complications after hip and knee arthroplasty. Whether similar trends apply to patients undergoing reverse total shoulder arthroplasty (RTSA) is unknown. Methods: A retrospective review of primary RTSAs with a minimum 90-day follow-up were included. Complications were classified as major or minor and medical or surgical. Patients were classified into 3 groups: normal BMI (BMI <25 kg/m 2 ), overweight or mildly obese (BMI 25-35 kg/m 2 ), and moderately or severely obese (BMI >35 kg/m 2 ). Results: Of the 119 patients met our inclusion criteria, 30 (25%) had a BMI of less than 25 kg/m 2 ; 65 (55%) had a BMI of 25 to 35 kg/m 2 , and 24 (20%) had BMI exceeding 35 kg/m 2 . Complications occurred in 30 patients (25%), comprising major in 11 (9%), minor in 19 (16%), surgical in 21 (18%), and medical in 14 (12%). The most common surgical complications were acute blood loss anemia requiring transfusion (8.4%) and dislocation (4.2%). The most common medical complications were atelectasis (2.5%) and acute renal insufficiency (2.5%). Patients with a BMI exceeding 35 kg/m 2 had a significantly higher overall complication rate (P < .05) and intraoperative blood loss (P ¼ .05) than the other groups. Patients with BMI of less than 25 kg/m 2 had a greater overall complication rate than those with a BMI of 25 to 35 kg/m 2 (P < .05). Multivariate regression analysis demonstrated BMI was the only significant determinant of overall complication rates and medical complication rates (P < .05). Conclusion: Patients with a BMI exceeding 35 kg/m 2 (severely obese) or a BMI of less than 25 kg/m 2 have higher rates of complication after RTSA. Level of evidence: Level III, Retrospective Cohort Study, Treatment Study.