J. Iannotti - Academia.edu (original) (raw)

Papers by J. Iannotti

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Introduction: Total knee arthroplasty (TKA) outcomes drive assessment of quality and reinvestment... more Introduction: Total knee arthroplasty (TKA) outcomes drive assessment of quality and reinvestment; therefore a risk stratified assessment is paramount for fair evaluation. Stratification can be affected by multiple factors including patient motivation. This study attempted to identify the correlation of patient9s preoperative confidence in their ability to return to desired activity level after TKA and improved function and outcomes. Methods: A continuous series of TKA procedures from 2008 to 2010 in a healthcare system was reviewed retrospectively. Patients included reported pre- and postoperative knee injury and osteoarthritis outcomes scores (KOOS), SF-12 scores, and responded a question regarding the desired activity level, including the level of confidence (0–10 scale) in attaining such goals, after surgery. Gender, age, body mass index, education level, smoking status, length of stay (LOS), 30-day readmission and reoperation, and 1-year infection rates were collected. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models adjusted for baseline mental and functional scores. Results: A total of 1020 primary, 18 bilateral and 177 revision TKA patients completed their postoperative questionnaires and had an average follow-up of 430, 411 and 376 days, respectively. Patients were confident in achieving treatment goals with an average score of 7.7 ± 2.1, 9.3 ± 0.5 and 6.4 ± 2.6 for primary, bilateral and revision TKA, respectively. There was direct correlation of level of confidence and shorter LOS (p = 0.005), and no correlation with readmission, reoperation and infection. Moreover, confidence was correlated with improved function and pain KOOS (p Conclusion: Patient confidence in attaining treatment goals after primary TKA has a direct correlation with shorter LOS and improved function. Patient motivation should be weighted when measuring TKA outcomes.

Background: Surgeons in the Orthopaedic and Rheumatologic Institute (ORI) at the Cleveland Clinic... more Background: Surgeons in the Orthopaedic and Rheumatologic Institute (ORI) at the Cleveland Clinic perform procedures at multiple locations across a northeast Ohio healthcare system. Prior to 2009, targeted surveillance for surgical site infection (SSI) was decentralized and geography-based. A comprehensive view of the SSI rate of each surgeon and the group as a whole was not captured. Objective: To establish an enterprise-wide ORI SSI surveillance program Methods: A multi-disciplinary project team met monthly starting 9/2008, with an Infection Preventionist (IP) serving as the project coordinator. ORI surgeons and their operating locations were identified. Using current procedural terminology (CPT) codes from a query of the Operating Room Information System (ORIS), procedures identified for surveillance included primary and revision hip, knee and shoulder arthroplasties and clean knee and shoulder arthroscopies. Case finding was done by IPs assigned to the various geographic sites. ...

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient ou... more Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient9s mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA. Methods: Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models that were adjusted for all variables, including baseline mental and functional scores. Results: A total of 804 primary and 154 revision THA patients completed their post-operative questionnaires with an average follow-up of 491 and 487 days, respectively. Patients were confident in achieving their goals, with an average score of 8.0 ± 2.2 and 7.2 ± 2.8 for primary and revision THA patients, respectively. Having greater confidence was associated with a decreased rate of 30-day readmission for primary THA patients only (p = 0.006). For both primary and revision THA patients, having greater confidence was associated with higher HOOS functional scores (primary p Conclusions: A patient9s level of confidence in their ability to achieve specific functional outcomes following either primary or revision THA does affect their post-operative outcomes. When risk-stratifying patients for THA, patient9s confidence may be as important as their medical comorbidities.

The American journal of pathology, 1977

Irreversible injury was produced in Langendorf-perfused rat hearts by 60 minutes of hypoxic, subs... more Irreversible injury was produced in Langendorf-perfused rat hearts by 60 minutes of hypoxic, substrate-free perfusion at 37 C. Upon reoxygenation, hearts suddenly released large amounts of creatine phosphokinase (CPK) and over 60% of cells contained contraction bands and appeared irreversibly injured by light and electron microscopic criteria. Ten percent polyethylene glycol (PEG) or mannitol (420 mOsmol/liter) prevented or reduced swelling of rat heart slices incubated in vitro in the cold or under anoxic conditions. Both PEG and mannitol inhibited oxygen-induced CPK release after 60 minutes of hypoxia. Cells from protected hearts contained contraction bands but remained structurally intact. The results of this study provide evidence that cell swelling may play an important role in the pathogenesis of oxygen-induced enzyme release and irreversible myocardial cell injury.

Journal of Shoulder and Elbow Surgery, 1999

Journal of Orthopaedic Research, 1984

The growth plate chondrocyte plays a central role in growth plate function. The purpose of this s... more The growth plate chondrocyte plays a central role in growth plate function. The purpose of this study was to characterize the respiratory and calcium transport properties of isolated mammalian growth plate chondrocytes and mitochondria obtained from these cells and to quantitate the mitochondrial weight and volume fraction in each zone of the growth plate. A new method was developed for isolation of mitochondria from chondrocyte suspensions. Isolated chondrocyte mitochondria demonstrated an eightfold increase in oxygen consumption in response to calcium and a two-to threefold increase in oxygen consumption in response to adenosine diphosphate. Similar responses were observed in chondrocytes treated with digitonin. The mitochondrial protein content of the growth plate and hyaline cartilage chondrocytes is significantly less than hepatocytes. Conversely, the chondrocyte mitochondrial cytochrome aa3 content is similar to mitochondria from a wide variety of sources. A zonal analysis of the growth plate demonstrates an increase in the mitochondrial weight (protein) fraction from the reserve to the hypertrophic zone whereas the mitochondrial volume fraction decreases from the reserve to the hypertrophic zone. The findings of this study emphasize the dependence of chondrocytes on glycolysis as a prime energy source and support the concept that chondrocyte mitochondria have become specialized in the process of matrix calcification.

Journal of Shoulder and Elbow Surgery, 2013

Clinical Orthopaedics and Related Research, 2004

An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices... more An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices as scaffold materials. One matrix that has been shown to promote healing and regeneration of neotissue in various applications is porcine-derived small intestinal submucosa. It was the objective of this study to investigate small intestinal submucosa for intrasynovial flexor tendon grafting in a canine model. We hypothesized that at 6 weeks small intestinal submucosa grafts would undergo host cell infiltration, neovascularization, and replacement by host neotendon. We also hypothesized that small intestinal submucosa grafts would be incorporated by the host without extensive adhesions to surrounding tissues and therefore maintain normal digit function. An intrasynovial tendon autograft was used as a gold standard. At 6 weeks the intrasynovial tendon autografts remained viable, contained normal numbers of cells along their length, and had minimal peritendinous adhesions. Four of six auto...

The Journal of Heart and Lung Transplantation

Purpose Patients are the best source of information about how they feel and how care affects them... more Purpose Patients are the best source of information about how they feel and how care affects them. Patient-reported outcome measures (PROMs) are standardized, validated questionnaires completed by patients to measure their perception of their well-being and health status. Aim: To create a cost-effective, valid, and sensitive PROMs data capture process for patients with Advanced Heart Failure (AHF) to understand to what extent a Heart Transplant (HT) affects their quality of life Methods A prospective data collection model has been designed for AHF patients eligible for HT based on the Outcomes Management and Evaluation (OME) system developed by Cleveland Clinic. Two types of data will be collected: 1) Patient condition-specific PROMs; 2) OME for HT and potential Bridge to Transplant Therapies (BTT). Patient condition-specific PROMs will be measured using the Kansas City Cardiomyopathy Questionnaire and social determinants of health (e.g., smoking habits and drug abuse). The OME data for BTT include: A)Pre-BTT details (e.g., UNOS status),B)Post-BTT details (e.g., post-transplant mechanical support). The OME data for HT include:A)Pre-transplant details (e.g., UNOS status),B)Donor characteristics (e.g., ischemic trigger greater than 4 hours),C)Post-transplant details (e.g., post-transplant mechanical support). The process for collecting PROMs is divided into 5 phases (see fig). Results Data will start to be collected approximately in November 2020 until June 2021, aiming to have the first results analyzed by July 2021 Conclusion This is one of the first PROMs processes implemented in an AHF program to the best of our knowledge. Our goal is to imbed PROMs into our workflow and create an umbrella of PROMs across the entire Heart and Vascular Institute to measure the quality of care from our patients’ perspective to improve the clinical decision-making process.

Isolated newborn rat calvarial bone cells grown in monolayer on polyurethane membranes in special... more Isolated newborn rat calvarial bone cells grown in monolayer on polyurethane membranes in specially constructed culture chambers and subjected to a cyclical biaxial mechanical strain of 0.17% at a frequency of 1 Hz for 30 min demonstrated a 16% increase in DNA synthesis during the subsequent 24 h. The metabolites of the inositol phosphate pathway, shown to be an important second messenger in many cell types, were shown to be elevated using high-performance liquid chromatography to separate and quantitate the various inositol polyphosphates. Inositol 1,4,5-trisphosphate, inositol 1,4-bisphosphate, and inositol 1,3,4,5-tetrakisphosphate reached peak accumulations after 20 s of mechanical strain. Inositol 1,3,4-trisphosphate reached a peak accumulation after 2 min, and inositol 1,2,3,4,5,6 phosphate reached a peak accumulation after 60 min of mechanical strain. Neomycin, an inhibitor of phospholipase C, a membrane-bound enzyme that hydrolyzes phosphatidyl inositol 4,5-bisphosphate to start the inositol phosphate cascade, completely inhibited accumulation of the above inositol phosphates during mechanical straining of the bone cells. Neomycin also completely abolished the increase in DNA synthesis that was seen after a mechanical strain of 0.17%. It is concluded from this study that the inositol phosphate pathway is activated by mechanical strain in bone cells and that this pathway is an important and primary mediator in the transduction of mechanical strain into cellular proliferation in these cells.

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]

Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction ... more Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass i...

The Journal of bone and joint surgery. American volume, 2001

Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) t... more Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder. We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of m...

Instructional course lectures, 1998

The Journal of bone and joint surgery. American volume, 1997

The purpose of the present study was to examine the motions of natural and prosthetically reconst... more The purpose of the present study was to examine the motions of natural and prosthetically reconstructed glenohumeral joints without capsular contracture in the laboratory to obtain a better understanding of joint motion as it may relate to failure of the implant. Seven joints from fresh-frozen human cadavera were instrumented with a six-degrees-of-freedom magnetic tracking device to study patterns of translation and rotation with and without the application of simulated muscle forces (active and passive models). The specimens were tested before and after reconstruction of the joint with use of modified operative techniques and implants that had from zero to five millimeters of radial mismatch between the humeral head and glenoid components. The natural and reconstructed joints had similar patterns of translation, with larger rotations and translations observed in the passive model. On the average, the active translations of the natural joints were best reproduced by the reconstructe...

The Orthopedic clinics of North America, 1997

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulde... more To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Introduction: Total knee arthroplasty (TKA) outcomes drive assessment of quality and reinvestment... more Introduction: Total knee arthroplasty (TKA) outcomes drive assessment of quality and reinvestment; therefore a risk stratified assessment is paramount for fair evaluation. Stratification can be affected by multiple factors including patient motivation. This study attempted to identify the correlation of patient9s preoperative confidence in their ability to return to desired activity level after TKA and improved function and outcomes. Methods: A continuous series of TKA procedures from 2008 to 2010 in a healthcare system was reviewed retrospectively. Patients included reported pre- and postoperative knee injury and osteoarthritis outcomes scores (KOOS), SF-12 scores, and responded a question regarding the desired activity level, including the level of confidence (0–10 scale) in attaining such goals, after surgery. Gender, age, body mass index, education level, smoking status, length of stay (LOS), 30-day readmission and reoperation, and 1-year infection rates were collected. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models adjusted for baseline mental and functional scores. Results: A total of 1020 primary, 18 bilateral and 177 revision TKA patients completed their postoperative questionnaires and had an average follow-up of 430, 411 and 376 days, respectively. Patients were confident in achieving treatment goals with an average score of 7.7 ± 2.1, 9.3 ± 0.5 and 6.4 ± 2.6 for primary, bilateral and revision TKA, respectively. There was direct correlation of level of confidence and shorter LOS (p = 0.005), and no correlation with readmission, reoperation and infection. Moreover, confidence was correlated with improved function and pain KOOS (p Conclusion: Patient confidence in attaining treatment goals after primary TKA has a direct correlation with shorter LOS and improved function. Patient motivation should be weighted when measuring TKA outcomes.

Background: Surgeons in the Orthopaedic and Rheumatologic Institute (ORI) at the Cleveland Clinic... more Background: Surgeons in the Orthopaedic and Rheumatologic Institute (ORI) at the Cleveland Clinic perform procedures at multiple locations across a northeast Ohio healthcare system. Prior to 2009, targeted surveillance for surgical site infection (SSI) was decentralized and geography-based. A comprehensive view of the SSI rate of each surgeon and the group as a whole was not captured. Objective: To establish an enterprise-wide ORI SSI surveillance program Methods: A multi-disciplinary project team met monthly starting 9/2008, with an Infection Preventionist (IP) serving as the project coordinator. ORI surgeons and their operating locations were identified. Using current procedural terminology (CPT) codes from a query of the Operating Room Information System (ORIS), procedures identified for surveillance included primary and revision hip, knee and shoulder arthroplasties and clean knee and shoulder arthroscopies. Case finding was done by IPs assigned to the various geographic sites. ...

Bone Joint Journal Orthopaedic Proceedings Supplement, Dec 1, 2013

Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient ou... more Introduction: Patient medical comorbidities are well-established risk modifiers of THA patient outcomes. Patient9s mental state preoperatively may influence postoperative functional outcomes though just like any medical comorbidity. This study sought to determine if patient confidence in attaining post-operative functional goals was associated with objective and subjective outcomes following THA. Methods: Patients undergoing primary or revision THA at a single institution between 2008 and 2010 were administered a questionnaire consisting of demographics, body mass index, Hip Dysfunction Osteoarthritis and Outcomes Score (HOOS), SF-12 scores, the level of functionality they hoped to gain postoperatively and their confidence in attaining that goal (0–10 scale) preoperatively and postoperatively at last follow-up (minimum 12 months). Measured outcomes included length of stay, 30-day readmission, HOOS, and SF-12 physical component scores. Correlation of patient confidence in attaining treatment goals and the outcomes collected was established using multiple linear and logistic regression models that were adjusted for all variables, including baseline mental and functional scores. Results: A total of 804 primary and 154 revision THA patients completed their post-operative questionnaires with an average follow-up of 491 and 487 days, respectively. Patients were confident in achieving their goals, with an average score of 8.0 ± 2.2 and 7.2 ± 2.8 for primary and revision THA patients, respectively. Having greater confidence was associated with a decreased rate of 30-day readmission for primary THA patients only (p = 0.006). For both primary and revision THA patients, having greater confidence was associated with higher HOOS functional scores (primary p Conclusions: A patient9s level of confidence in their ability to achieve specific functional outcomes following either primary or revision THA does affect their post-operative outcomes. When risk-stratifying patients for THA, patient9s confidence may be as important as their medical comorbidities.

The American journal of pathology, 1977

Irreversible injury was produced in Langendorf-perfused rat hearts by 60 minutes of hypoxic, subs... more Irreversible injury was produced in Langendorf-perfused rat hearts by 60 minutes of hypoxic, substrate-free perfusion at 37 C. Upon reoxygenation, hearts suddenly released large amounts of creatine phosphokinase (CPK) and over 60% of cells contained contraction bands and appeared irreversibly injured by light and electron microscopic criteria. Ten percent polyethylene glycol (PEG) or mannitol (420 mOsmol/liter) prevented or reduced swelling of rat heart slices incubated in vitro in the cold or under anoxic conditions. Both PEG and mannitol inhibited oxygen-induced CPK release after 60 minutes of hypoxia. Cells from protected hearts contained contraction bands but remained structurally intact. The results of this study provide evidence that cell swelling may play an important role in the pathogenesis of oxygen-induced enzyme release and irreversible myocardial cell injury.

Journal of Shoulder and Elbow Surgery, 1999

Journal of Orthopaedic Research, 1984

The growth plate chondrocyte plays a central role in growth plate function. The purpose of this s... more The growth plate chondrocyte plays a central role in growth plate function. The purpose of this study was to characterize the respiratory and calcium transport properties of isolated mammalian growth plate chondrocytes and mitochondria obtained from these cells and to quantitate the mitochondrial weight and volume fraction in each zone of the growth plate. A new method was developed for isolation of mitochondria from chondrocyte suspensions. Isolated chondrocyte mitochondria demonstrated an eightfold increase in oxygen consumption in response to calcium and a two-to threefold increase in oxygen consumption in response to adenosine diphosphate. Similar responses were observed in chondrocytes treated with digitonin. The mitochondrial protein content of the growth plate and hyaline cartilage chondrocytes is significantly less than hepatocytes. Conversely, the chondrocyte mitochondrial cytochrome aa3 content is similar to mitochondria from a wide variety of sources. A zonal analysis of the growth plate demonstrates an increase in the mitochondrial weight (protein) fraction from the reserve to the hypertrophic zone whereas the mitochondrial volume fraction decreases from the reserve to the hypertrophic zone. The findings of this study emphasize the dependence of chondrocytes on glycolysis as a prime energy source and support the concept that chondrocyte mitochondria have become specialized in the process of matrix calcification.

Journal of Shoulder and Elbow Surgery, 2013

Clinical Orthopaedics and Related Research, 2004

An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices... more An attractive strategy for tendon tissue engineering is the use of natural extracellular matrices as scaffold materials. One matrix that has been shown to promote healing and regeneration of neotissue in various applications is porcine-derived small intestinal submucosa. It was the objective of this study to investigate small intestinal submucosa for intrasynovial flexor tendon grafting in a canine model. We hypothesized that at 6 weeks small intestinal submucosa grafts would undergo host cell infiltration, neovascularization, and replacement by host neotendon. We also hypothesized that small intestinal submucosa grafts would be incorporated by the host without extensive adhesions to surrounding tissues and therefore maintain normal digit function. An intrasynovial tendon autograft was used as a gold standard. At 6 weeks the intrasynovial tendon autografts remained viable, contained normal numbers of cells along their length, and had minimal peritendinous adhesions. Four of six auto...

The Journal of Heart and Lung Transplantation

Purpose Patients are the best source of information about how they feel and how care affects them... more Purpose Patients are the best source of information about how they feel and how care affects them. Patient-reported outcome measures (PROMs) are standardized, validated questionnaires completed by patients to measure their perception of their well-being and health status. Aim: To create a cost-effective, valid, and sensitive PROMs data capture process for patients with Advanced Heart Failure (AHF) to understand to what extent a Heart Transplant (HT) affects their quality of life Methods A prospective data collection model has been designed for AHF patients eligible for HT based on the Outcomes Management and Evaluation (OME) system developed by Cleveland Clinic. Two types of data will be collected: 1) Patient condition-specific PROMs; 2) OME for HT and potential Bridge to Transplant Therapies (BTT). Patient condition-specific PROMs will be measured using the Kansas City Cardiomyopathy Questionnaire and social determinants of health (e.g., smoking habits and drug abuse). The OME data for BTT include: A)Pre-BTT details (e.g., UNOS status),B)Post-BTT details (e.g., post-transplant mechanical support). The OME data for HT include:A)Pre-transplant details (e.g., UNOS status),B)Donor characteristics (e.g., ischemic trigger greater than 4 hours),C)Post-transplant details (e.g., post-transplant mechanical support). The process for collecting PROMs is divided into 5 phases (see fig). Results Data will start to be collected approximately in November 2020 until June 2021, aiming to have the first results analyzed by July 2021 Conclusion This is one of the first PROMs processes implemented in an AHF program to the best of our knowledge. Our goal is to imbed PROMs into our workflow and create an umbrella of PROMs across the entire Heart and Vascular Institute to measure the quality of care from our patients’ perspective to improve the clinical decision-making process.

Isolated newborn rat calvarial bone cells grown in monolayer on polyurethane membranes in special... more Isolated newborn rat calvarial bone cells grown in monolayer on polyurethane membranes in specially constructed culture chambers and subjected to a cyclical biaxial mechanical strain of 0.17% at a frequency of 1 Hz for 30 min demonstrated a 16% increase in DNA synthesis during the subsequent 24 h. The metabolites of the inositol phosphate pathway, shown to be an important second messenger in many cell types, were shown to be elevated using high-performance liquid chromatography to separate and quantitate the various inositol polyphosphates. Inositol 1,4,5-trisphosphate, inositol 1,4-bisphosphate, and inositol 1,3,4,5-tetrakisphosphate reached peak accumulations after 20 s of mechanical strain. Inositol 1,3,4-trisphosphate reached a peak accumulation after 2 min, and inositol 1,2,3,4,5,6 phosphate reached a peak accumulation after 60 min of mechanical strain. Neomycin, an inhibitor of phospholipase C, a membrane-bound enzyme that hydrolyzes phosphatidyl inositol 4,5-bisphosphate to start the inositol phosphate cascade, completely inhibited accumulation of the above inositol phosphates during mechanical straining of the bone cells. Neomycin also completely abolished the increase in DNA synthesis that was seen after a mechanical strain of 0.17%. It is concluded from this study that the inositol phosphate pathway is activated by mechanical strain in bone cells and that this pathway is an important and primary mediator in the transduction of mechanical strain into cellular proliferation in these cells.

Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]

Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction ... more Patient satisfaction is increasingly being tied to reimbursement rates, and patient satisfaction is often associated with improving functionality and decreasing disability postoperatively. This study sought to determine if a total shoulder arthroplasty patient's preoperative confidence in his or her ability to attain the level of activity desired would influence postoperative functional scores. Patients undergoing a primary total shoulder arthroplasty at a single institution were asked to complete a preoperative questionnaire with multiple items including baseline symptom severity measures and their confidence in reaching their level of desired functionality postoperatively (scored 0-10). Patients then completed an identical postoperative questionnaire at their follow-up visits. Associations between the patient's confidence in attaining treatment goals and functional outcomes was established by multiple linear regression models that were adjusted for gender, age, body mass i...

The Journal of bone and joint surgery. American volume, 2001

Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) t... more Arthroscopic capsular release is used to treat idiopathic adhesive capsulitis (frozen shoulder) that is refractory to nonoperative treatment or manipulation under anesthesia. The role of arthroscopic capsular release in the treatment of frozen shoulder after shoulder surgery or fracture is less clearly understood. The purposes of this study were to define the outcome of arthroscopic capsular release in the management of frozen shoulder after surgery or fracture and to compare these results with those of arthroscopic capsular release in the treatment of idiopathic frozen shoulder. We evaluated the results of arthroscopic capsular release in three different groups of patients with shoulder contracture refractory to nonoperative management and manipulation under anesthesia. The three groups consisted of patients who had an idiopathic frozen shoulder, shoulder stiffness after surgery, or shoulder stiffness after fracture. We evaluated pain, function, patient satisfaction, and range of m...

Instructional course lectures, 1998

The Journal of bone and joint surgery. American volume, 1997

The purpose of the present study was to examine the motions of natural and prosthetically reconst... more The purpose of the present study was to examine the motions of natural and prosthetically reconstructed glenohumeral joints without capsular contracture in the laboratory to obtain a better understanding of joint motion as it may relate to failure of the implant. Seven joints from fresh-frozen human cadavera were instrumented with a six-degrees-of-freedom magnetic tracking device to study patterns of translation and rotation with and without the application of simulated muscle forces (active and passive models). The specimens were tested before and after reconstruction of the joint with use of modified operative techniques and implants that had from zero to five millimeters of radial mismatch between the humeral head and glenoid components. The natural and reconstructed joints had similar patterns of translation, with larger rotations and translations observed in the passive model. On the average, the active translations of the natural joints were best reproduced by the reconstructe...

The Orthopedic clinics of North America, 1997

To add clinical perspective to the articles of this two-issue collection, eight prominent shoulde... more To add clinical perspective to the articles of this two-issue collection, eight prominent shoulder surgeons discuss their approach to the treatment of rotator cuff disease. There is broad agreement in many areas, however, significant controversies remain.