Justin Purcell - Academia.edu (original) (raw)

Papers by Justin Purcell

American Journal of Sports Medicine, Apr 19, 2017

Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical trea... more Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. Purpose: To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were ''knee,'' ''microfracture,'' ''autologous chondrocyte implantation,'' and ''autologous chondrocyte transplantation.'' Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). Results: Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrixassociated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx (P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group (P = .003). Conclusion: Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.

Foot and Ankle Clinics, 2009

The Achilles tendon is formed by the two heads of the gastrocnemius muscle and the soleus muscle.... more The Achilles tendon is formed by the two heads of the gastrocnemius muscle and the soleus muscle. Its functional importance is inferred by the observation that it is the strongest and thickest tendon in the body. 1 Loss of Achilles function causes a significant loss in plantar flexion strength, which in turn can lead to an inability to run, stand on tip toes, play sports, and difficulty climbing stairs. 2 The slightly medial to midline insertion on the calcaneal tuberosity creates both an equinus and inversion force. 1 The Achilles is among the most frequently ruptured tendons. 3 Achilles tendon ruptures are usually seen in the middle-aged male who participates in athletic activities on a recreational basis. These injuries usually present with no significant warning and can cause a sharp pain in the posterior calf area. Patients will often have a sensation of having been ''kicked'' or ''hit'' in the calf area. Some patients may hear an audible snap. 4 Some of these patients, after their initial episode of discomfort, may have significant decrease in their level of pain leading to delays in them seeking medical attention. More commonly, delays in treatment are result of patients presenting for treatment and being misdiagnosed. 5-7 Scheller and colleagues 8 noted that Achilles tendon rupture was missed on the initial evaluation of 25% of their patients. Nesterson and colleagues 9 also reported 25% incidence of missed ruptures on initial evaluation. Inglis and colleagues 10 attributed the 22% of misdiagnoses in their series to physicians and patients being misled by the inconsequential nature of the trauma reported, lack of significant pain, and patient's ability to weakly plantar flex the ankle. Swelling can make a gap difficult to appreciate and action of the long toe flexor may provide enough strength to convince a physician that only a partial rupture has occurred. 8 The plantar flexion weakness seen with most ruptures may be attributed to pain rather than a complete rupture. 7 Significant fraying or shredding of the tendon can also make it difficult to appreciate a palpable gap. 5

American Journal of Sports Medicine, Jun 21, 2017

Background: Multiple studies have demonstrated a higher risk of graft failure after anterior cruc... more Background: Multiple studies have demonstrated a higher risk of graft failure after anterior cruciate ligament reconstruction with allograft, but limited data are available comparing outcomes of posterior cruciate ligament reconstruction (PCLR) with autograft versus allograft. Purpose: To compare the clinical outcomes of autograft versus allograft for primary PCLR. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to locate studies (level of evidence I-III) comparing clinical outcomes of autograft versus allograft in patients undergoing primary PCLR with the conventional transtibial technique. Search terms used were ''posterior cruciate ligament,'' ''autograft,'' and ''allograft.'' Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores (Lysholm, Tegner, subjective International Knee Documentation Committee [IKDC], and objective IKDC scores). Results: Five studies (2 level II, 3 level III) were identified that met inclusion criteria, including a total of 132 patients undergoing PCLR with autograft (semitendinosus-gracilis or bone-patellar tendon-bone) and 110 patients with allograft (tibialis anterior, Achilles tendon, or bone-patellar tendon-bone). No patients experienced graft failure. Average anteroposterior (AP) knee laxity was significantly higher in allograft patients (3.8 mm) compared with autograft patients (3.1 mm) (P \ .01). Subjective IKDC, Lysholm, and Tegner scores improved for both groups across studies, without a significant difference in improvement between groups except in one study, in which Lysholm scores improved to a significantly greater extent in the autograft group (P \ .01). Conclusion: Patients undergoing primary PCLR with either autograft or allograft can be expected to experience improvement in clinical outcomes. Autograft patients experienced less AP knee laxity postoperatively, although the clinical significance of this is unclear and subjective outcomes improved substantially and to a similar degree in both groups.

The American Journal of Sports Medicine, 2017

Background:Multiple studies have demonstrated a higher risk of graft failure after anterior cruci... more Background:Multiple studies have demonstrated a higher risk of graft failure after anterior cruciate ligament reconstruction with allograft, but limited data are available comparing outcomes of posterior cruciate ligament reconstruction (PCLR) with autograft versus allograft.Purpose:To compare the clinical outcomes of autograft versus allograft for primary PCLR.Study Design:Systematic review.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to locate studies (level of evidence I-III) comparing clinical outcomes of autograft versus allograft in patients undergoing primary PCLR with the conventional transtibial technique. Search terms used were “posterior cruciate ligament,” “autograft,” and “allograft.” Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores (Lysholm, Tegner, subjective International Knee Documentation Committee [IKDC], and objective IKDC scores).Results:Five st...

The American Journal of Sports Medicine, 2017

Background:Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treat... more Background:Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint.Purpose:To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee.Study Design:Systematic review.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were “knee,” “microfracture,” “autologous chondrocyte implantation,” and “autologous chondrocyte transplantation.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores).Results:Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion cri...

American Journal of Sports Medicine, Apr 19, 2017

Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical trea... more Background: Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint. Purpose: To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were ''knee,'' ''microfracture,'' ''autologous chondrocyte implantation,'' and ''autologous chondrocyte transplantation.'' Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores). Results: Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion criteria, including a total of 210 patients (211 lesions) undergoing MFx and 189 patients (189 lesions) undergoing ACI. The average follow-up among all studies was 7.0 years. Four studies utilized first-generation, periosteum-based ACI (P-ACI), and 1 study utilized third-generation, matrixassociated ACI (M-ACI). Treatment failure occurred in 18.5% of patients undergoing ACI and 17.1% of patients undergoing MFx (P = .70). Lysholm and KOOS scores were found to improve for both groups across studies, without a significant difference in improvement between the groups. The only significant difference in patient-reported outcome scores was found in the 1 study using M-ACI in which Tegner scores improved to a significantly greater extent in the ACI group compared with the MFx group (P = .003). Conclusion: Patients undergoing MFx or first/third-generation ACI for articular cartilage lesions in the knee can be expected to experience improvement in clinical outcomes at midterm to long-term follow-up without any significant difference between the groups.

Foot and Ankle Clinics, 2009

The Achilles tendon is formed by the two heads of the gastrocnemius muscle and the soleus muscle.... more The Achilles tendon is formed by the two heads of the gastrocnemius muscle and the soleus muscle. Its functional importance is inferred by the observation that it is the strongest and thickest tendon in the body. 1 Loss of Achilles function causes a significant loss in plantar flexion strength, which in turn can lead to an inability to run, stand on tip toes, play sports, and difficulty climbing stairs. 2 The slightly medial to midline insertion on the calcaneal tuberosity creates both an equinus and inversion force. 1 The Achilles is among the most frequently ruptured tendons. 3 Achilles tendon ruptures are usually seen in the middle-aged male who participates in athletic activities on a recreational basis. These injuries usually present with no significant warning and can cause a sharp pain in the posterior calf area. Patients will often have a sensation of having been ''kicked'' or ''hit'' in the calf area. Some patients may hear an audible snap. 4 Some of these patients, after their initial episode of discomfort, may have significant decrease in their level of pain leading to delays in them seeking medical attention. More commonly, delays in treatment are result of patients presenting for treatment and being misdiagnosed. 5-7 Scheller and colleagues 8 noted that Achilles tendon rupture was missed on the initial evaluation of 25% of their patients. Nesterson and colleagues 9 also reported 25% incidence of missed ruptures on initial evaluation. Inglis and colleagues 10 attributed the 22% of misdiagnoses in their series to physicians and patients being misled by the inconsequential nature of the trauma reported, lack of significant pain, and patient's ability to weakly plantar flex the ankle. Swelling can make a gap difficult to appreciate and action of the long toe flexor may provide enough strength to convince a physician that only a partial rupture has occurred. 8 The plantar flexion weakness seen with most ruptures may be attributed to pain rather than a complete rupture. 7 Significant fraying or shredding of the tendon can also make it difficult to appreciate a palpable gap. 5

American Journal of Sports Medicine, Jun 21, 2017

Background: Multiple studies have demonstrated a higher risk of graft failure after anterior cruc... more Background: Multiple studies have demonstrated a higher risk of graft failure after anterior cruciate ligament reconstruction with allograft, but limited data are available comparing outcomes of posterior cruciate ligament reconstruction (PCLR) with autograft versus allograft. Purpose: To compare the clinical outcomes of autograft versus allograft for primary PCLR. Study Design: Systematic review. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to locate studies (level of evidence I-III) comparing clinical outcomes of autograft versus allograft in patients undergoing primary PCLR with the conventional transtibial technique. Search terms used were ''posterior cruciate ligament,'' ''autograft,'' and ''allograft.'' Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores (Lysholm, Tegner, subjective International Knee Documentation Committee [IKDC], and objective IKDC scores). Results: Five studies (2 level II, 3 level III) were identified that met inclusion criteria, including a total of 132 patients undergoing PCLR with autograft (semitendinosus-gracilis or bone-patellar tendon-bone) and 110 patients with allograft (tibialis anterior, Achilles tendon, or bone-patellar tendon-bone). No patients experienced graft failure. Average anteroposterior (AP) knee laxity was significantly higher in allograft patients (3.8 mm) compared with autograft patients (3.1 mm) (P \ .01). Subjective IKDC, Lysholm, and Tegner scores improved for both groups across studies, without a significant difference in improvement between groups except in one study, in which Lysholm scores improved to a significantly greater extent in the autograft group (P \ .01). Conclusion: Patients undergoing primary PCLR with either autograft or allograft can be expected to experience improvement in clinical outcomes. Autograft patients experienced less AP knee laxity postoperatively, although the clinical significance of this is unclear and subjective outcomes improved substantially and to a similar degree in both groups.

The American Journal of Sports Medicine, 2017

Background:Multiple studies have demonstrated a higher risk of graft failure after anterior cruci... more Background:Multiple studies have demonstrated a higher risk of graft failure after anterior cruciate ligament reconstruction with allograft, but limited data are available comparing outcomes of posterior cruciate ligament reconstruction (PCLR) with autograft versus allograft.Purpose:To compare the clinical outcomes of autograft versus allograft for primary PCLR.Study Design:Systematic review.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and EMBASE to locate studies (level of evidence I-III) comparing clinical outcomes of autograft versus allograft in patients undergoing primary PCLR with the conventional transtibial technique. Search terms used were “posterior cruciate ligament,” “autograft,” and “allograft.” Patients were evaluated based on graft failure rate, examination of knee laxity, and patient-reported outcome scores (Lysholm, Tegner, subjective International Knee Documentation Committee [IKDC], and objective IKDC scores).Results:Five st...

The American Journal of Sports Medicine, 2017

Background:Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treat... more Background:Microfracture (MFx) and autologous chondrocyte implantation (ACI) are 2 surgical treatment options used to treat articular cartilage injuries of the knee joint.Purpose:To compare the midterm to long-term clinical outcomes of MFx versus ACI for focal chondral defects of the knee.Study Design:Systematic review.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to locate studies (level of evidence I-III) comparing the minimum average 5-year clinical outcomes of patients undergoing MFx versus ACI. Search terms used were “knee,” “microfracture,” “autologous chondrocyte implantation,” and “autologous chondrocyte transplantation.” Patients were evaluated based on treatment failure rates, magnetic resonance imaging, and patient-reported outcome scores (Lysholm, Knee Injury and Osteoarthritis Outcome Score [KOOS], and Tegner scores).Results:Five studies (3 level I evidence, 2 level II evidence) were identified that met the inclusion cri...