Novel allograft processing methods are available from tissue banks to decrease disease transmissi... more Novel allograft processing methods are available from tissue banks to decrease disease transmission. This study evaluated the effects of 3 of these techniques on the initial mechanical properties of bone–patellar tendon–bone (BPTB) allografts: (1) aseptic harvest with low-dose radiation processing, (2) BioCleanse Tissue Processing System, and (3) Clearant Process. Ten-mm BPTB allografts were potted in an MTS 858 machine (MTS Systems Corp, Eden Prairie, Minnesota), cycled, and loaded to failure at a strain rate of 100%/s. Data were critically analyzed for graft dimensions and age and sex of donor. The 10th cycle and last cycle stiffness after 1000 cycles were measured at the toe region and at all points. The 2% yield stress (MPa), Young's modulus (MPa), elongation failure (mm), strain fracture (%), ultimate stress (MPa), and toughness (kJ) were measured. Forty-two tendons were tested (15 control, 11 BioCleanse, and 16 Clearant). No statistically significant differences were detected between the groups at their 10th cycle and last cycle stiffness ( P >.05). Yield stress ranged from 19 to 28.8 MPa without a statistically significant difference ( P >.05). Young's modulus ranged from 178.3 to 213.8 MPa without a statistically significant difference ( P >.05). Similarly, elongation to failure, strain to failure, ultimate stress, and toughness showed no statistically significant differences among the 3 groups ( P >.05). These processing techniques did not affect the time zero mechanical properties of the BPTB allograft tendons under these testing conditions. Clinical use of allografts should proceed with caution for selected patients.
Journal of Shoulder and Elbow Surgery, May 1, 2017
Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fracture... more Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humeral hemiarthroplasty (DHH) offers an alternative with multiple advantages. Methods: This is a retrospective study of 10 patients who underwent DHH for distal humeral fractures during a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Score, Disabilities of Arm, Shoulder and Hand, visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores. Average patent age at surgery was 71.9 years (range, 56-81 years); average follow-up was 73.2 months (range, 36-96 months). Results: Patients maintained improvements in Mayo Elbow Performance Scores (mean, 89.23; range, 75-100) and Disabilities of Arm, Shoulder and Hand scores (mean, 33.71; range 11.2-55.1), along with no significant decrease in range of motion compared with 1 year after surgery. Mean visual analog scale was 2.43 (range, 0-5), Single Assessment Numeric Evaluation was 74.14 (range, 50-100), and American Shoulder and Elbow Surgeons score was 72.14 (range, 48.33-100). Participants had an average flexion of 128.7°(range, 95°-142°), extension deficit of 27.1°(range, 0°-45°), supination of 79.1°(range, 45°-90°), and pronation of 73.3°(range, 50°-90°). No heterotopic ossification, elbow dislocations, or subluxations were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Two patients died, and 1 patient was lost to follow-up. Conclusion: This midterm review suggests that DHH may be an effective treatment for certain distal humeral fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. Additional studies must be conducted to further define the role of DHH for complex fractures of the distal humerus.
Journal of Shoulder and Elbow Surgery, Mar 1, 2017
Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fracture... more Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humeral hemiarthroplasty (DHH) offers an alternative with multiple advantages. Methods: This is a retrospective study of 10 patients who underwent DHH for distal humeral fractures during a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Score, Disabilities of Arm, Shoulder and Hand, visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores. Average patent age at surgery was 71.9 years (range, 56-81 years); average follow-up was 73.2 months (range, 36-96 months). Results: Patients maintained improvements in Mayo Elbow Performance Scores (mean, 89.23; range, 75-100) and Disabilities of Arm, Shoulder and Hand scores (mean, 33.71; range 11.2-55.1), along with no significant decrease in range of motion compared with 1 year after surgery. Mean visual analog scale was 2.43 (range, 0-5), Single Assessment Numeric Evaluation was 74.14 (range, 50-100), and American Shoulder and Elbow Surgeons score was 72.14 (range, 48.33-100). Participants had an average flexion of 128.7°(range, 95°-142°), extension deficit of 27.1°(range, 0°-45°), supination of 79.1°(range, 45°-90°), and pronation of 73.3°(range, 50°-90°). No heterotopic ossification, elbow dislocations, or subluxations were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Two patients died, and 1 patient was lost to follow-up. Conclusion: This midterm review suggests that DHH may be an effective treatment for certain distal humeral fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. Additional studies must be conducted to further define the role of DHH for complex fractures of the distal humerus.
Orthopaedic Journal of Sports Medicine, Jul 1, 2016
Background: Injury rates are high for collegiate football players. Few studies have evaluated the... more Background: Injury rates are high for collegiate football players. Few studies have evaluated the epidemiology of surgical procedures in National Collegiate Athletic Association (NCAA) Division I collegiate football players. Purpose: To determine the most common surgical procedures performed in collegiate football players over a 10-year period. Study Design: Descriptive epidemiological study. Methods: From the 2004-2005 season through the 2013-2014 season, all surgical procedures performed on athletes from a single NCAA Division I college football team during athletic participation were reviewed. Surgeries were categorized by anatomic location, and operative reports were used to obtain further surgical details. Data collected over this 10-season span included type of injury, primary procedures, reoperations, and cause of reoperation, all categorized by specific anatomic locations and position played.
The purpose of this study was to summarize the past 10 years of orthopaedic literature to better ... more The purpose of this study was to summarize the past 10 years of orthopaedic literature to better delineate the femoral origin of the posterior cruciate ligament (PCL). Methods: A PubMed search was conducted by 2 independent reviewers (M.P., M.V.) using the search terms "posterior cruciate ligament" or "PCL," "femur" or "femoral," and "anatomy" or "origin" or "footprint." Cadaveric and radiographic studies performed between January 1, 2003, and November 30, 2013, were analyzed. Results: Aggregate data from radiographic parameters indicate that the anatomic origin of the anterolateral bundle lies 40% of the distance from the anterior articular surface of the femur and 14.5% of the tangent distance from the Blumensaat line toward the intercondylar notch. The origin of the posteromedial bundle lies 56% from the anterior surface and 36.5% of the tangent distance toward the notch. On the basis of cadaveric data, the center of the anterolateral bundle is 8 mm from the anterior surface (27.5% of the Blumensaat line), 4.7 mm tangent from the Blumensaat line toward the notch (22.5% of the tangent distance), and 3.6 mm from the medial intercondylar ridge; the center of the posteromedial bundle is 11.9 mm from the anterior articular surface (42.5%), 10.9 mm along the tangent line (57.5%), and 3.1 mm from the medial intercondylar ridge. Conclusions: We were able to precisely delineate the femoral origin of the PCL through our systematic review. Clinical Relevance: Our systematic review may assist arthroscopic knee surgeons in placing anatomic tunnels during reconstruction of the PCL.
» Multiple opioid and non-opioid medications have proven effectiveness for pain relief after ante... more » Multiple opioid and non-opioid medications have proven effectiveness for pain relief after anterior cruciate ligament (ACL) reconstruction. » Regional anesthesia may be of value, but the evidence in support of indwelling catheters is weak. » Gabapentin, tranexamic acid, and corticosteroids may offer additional analgesic benefits. Peripheral Nerve Blocks Pain control may begin in the preoperative area with the administration of a peripheral Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A298).
Background: There has been much controversy regarding the effects of sterilization techniques and... more Background: There has been much controversy regarding the effects of sterilization techniques and graft history on the structural integrity of allograft ligaments used in reconstruction of the anterior cruciate ligament. The purpose of this review was to comprehensively examine anterior cruciate ligament allograft studies published in the last decade to evaluate the extent to which tissue source, tissue processing techniques, and donor age are reported. Methods: The authors reviewed 202 articles published from 1999 through November 2009, of which 68 retrospective, prospective, biomechanical, and histology studies evaluating 4689 allografts were included. Results: The majority of studies do not accurately report key elements of graft history including tissue bank, processing or sterilization technique, or donor age. Underreporting was particularly prominent in clinical studies as compared with basic science studies. Limited reporting of allograft processing, allograft source, and donor age raises serious questions regarding the generalizability of published studies of allograft tissue for anterior cruciate ligament reconstruction. Conclusion/Clinical Relevance: Orthopaedic surgeons who use allograft tissue must understand the tissue treatments being used (ie, preservation methods, chemical and sterilization processes) to best inform their patients regarding the risks, benefits, and long-term outcomes when such tissues are used. A complete understanding of the implanted tissue, as well as surgeon and recipient demographics, is necessary to ensure appropriate and predictable long-term outcomes.
Vitamin D is a lipophilic prohormone integral to musculoskeletal, autoimmune, oncologic, cardiova... more Vitamin D is a lipophilic prohormone integral to musculoskeletal, autoimmune, oncologic, cardiovascular, and mental health. Of particular importance to the orthopedic surgeon is the role of vitamin D in the regulation of bone mass, muscle strength, and physical performance. Although vitamin D-related skeletal pathologies are rare in industrialized nations, emerging research in the field has shown that most American adults have inadequate levels of vitamin D. Even among athletes, there is a high prevalence of vitamin D deficiency, which may place competitors at risk of stress fractures, illness, and delayed muscle recovery. Adequately identifying vitamin D-deficient individuals in need of supplementation is important to help optimize performance and prevent future injury. The goal of this review is to describe the epidemiology of vitamin D deficiency and its effects on athletic performance and musculoskeletal health. Future double-blinded studies of vitamin D supplementation in athletes are needed. We recommend treating athletes who have insufficient or deficient vitamin D levels.
above scoring scheme above was also applied. Statistical analyses were performed using JMP softwa... more above scoring scheme above was also applied. Statistical analyses were performed using JMP software system. Significance was determined at the 0.05 level. Results: Among the 26 patients, analysis were available in 25 (96%). There were 11 males and 15 females. The average age was 48 years. The average follow-up was 46 months. The average BMI was 32. The average graft size was 4.5 cm2. The 4 scores for histological and electron microscopy evaluation were combined into 2 grades. When pre-operative WOMAC and KSS were compared, there was no statistical difference between the 2 groups. No significant difference in chondrocyte viability was noted on histological or electron microscopy between refrigerated and frozen allografts at the time of implantation. A trend towards greater improvement in WOMAC, KSS was noted in the frozen allograft group, although not statistically significant (pϭ0.07) An improvement in knee range of motion was noted in frozen allograft patients compared to those with a refrigerated allograft (pϭ0.02). There was no correlation between post-op x-ray score and outcome. 24% were considered failures and were analyzed separately. All failures were refrigerated allografts. No failures were noted if the histology score was Grade 2 or if the electron microscopy score was Grade 2. The likelihood ratio for a patient to do well if the initial histological score was 2 was 8.4 and if the electron microscopy score was 2 was 1.4. Conclusions: Both refrigerated and frozen large osteochondral allografts appear to be function well clinically at 4 year follow-up. Long term follow-up is further needed.
The purpose of this pilot study was to evaluate the cytokine profile of human knee synovial fluid... more The purpose of this pilot study was to evaluate the cytokine profile of human knee synovial fluid and correlate this with the subject's degree of articular cartilage degradation, radiographic score, and synovial histology. Synovial fluid was withdrawn before knee meniscectomy in 12 subjects with varying degrees of osteoarthritis and assayed for 21 cytokines, using a multiplex cytokine assay and flow cytometry instrumentation. Articular cartilage surfaces were scored by a single orthopaedic surgeon on the basis of the International Cartilage Repair Society (ICRS) classification during the arthroscopy, and posterior-anterior knee radiographs were graded using the Kellgren-Lawrence (KL) classification. Synovial biopsies were taken in four zones at the time of surgery for histological analysis. Significant concentration differences in IL-2, IL-5, MCP-1, and MIP-1 were found between subjects with advanced arthritis and subjects with little or no arthritis on the ICRS scale (p < .05). No such differences could be appreciated using KL scores. There was no correlation between histology samples and visualized surface osteoarthritis. This data suggests a molecular basis of disease progression, with higher levels of cytokines indicative of greater degrees of osteoarthritis. These results add pilot data that can assist investigators in conducting a comparative observational study of the levels of inflammatory cytokines with radiologic and arthroscopic assessments of osteoarthritis.
Orthopaedic Journal of Sports Medicine, Oct 1, 2016
Background: Providing high-quality care while also containing cost is a paramount goal in orthopa... more Background: Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments. Hypothesis: The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers. We hypothesized that operative time, implant cost, and overall higher cost would be observed in Medicare patients.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 6, 2017
To characterize and compare the graft contact characteristics of outside-in (OI) and inside-out (... more To characterize and compare the graft contact characteristics of outside-in (OI) and inside-out (IO) femoral tunnels during single-bundle reconstruction of the anterolateral bundle of the posterior cruciate ligament in a synthetic knee model. Femoral tunnels were separately made in 16 synthetic femora (8 OI and 8 IO). Achilles tendon allografts were fixed using suspensory fixation with a pressure sensor between the allograft and femoral tunnel. Grafts were cyclically loaded; force, contact area, contact pressure, and peak pressure at the aperture were measured. This process was repeated using the same allograft to assess the other tunnel angle in a separate specimen. IO specimens showed higher mean contact pressure at all loading cycles, with significance shown at 50 N (P = .02). Peak pressure was also greater in IO specimens at all loading cycles and reached statistical significance at 100 N (P = .04). IO specimens had a lower contact area at 150 N (P = .04). No statistically signi...
Novel allograft processing methods are available from tissue banks to decrease disease transmissi... more Novel allograft processing methods are available from tissue banks to decrease disease transmission. This study evaluated the effects of 3 of these techniques on the initial mechanical properties of bone–patellar tendon–bone (BPTB) allografts: (1) aseptic harvest with low-dose radiation processing, (2) BioCleanse Tissue Processing System, and (3) Clearant Process. Ten-mm BPTB allografts were potted in an MTS 858 machine (MTS Systems Corp, Eden Prairie, Minnesota), cycled, and loaded to failure at a strain rate of 100%/s. Data were critically analyzed for graft dimensions and age and sex of donor. The 10th cycle and last cycle stiffness after 1000 cycles were measured at the toe region and at all points. The 2% yield stress (MPa), Young's modulus (MPa), elongation failure (mm), strain fracture (%), ultimate stress (MPa), and toughness (kJ) were measured. Forty-two tendons were tested (15 control, 11 BioCleanse, and 16 Clearant). No statistically significant differences were detected between the groups at their 10th cycle and last cycle stiffness ( P >.05). Yield stress ranged from 19 to 28.8 MPa without a statistically significant difference ( P >.05). Young's modulus ranged from 178.3 to 213.8 MPa without a statistically significant difference ( P >.05). Similarly, elongation to failure, strain to failure, ultimate stress, and toughness showed no statistically significant differences among the 3 groups ( P >.05). These processing techniques did not affect the time zero mechanical properties of the BPTB allograft tendons under these testing conditions. Clinical use of allografts should proceed with caution for selected patients.
Journal of Shoulder and Elbow Surgery, May 1, 2017
Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fracture... more Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humeral hemiarthroplasty (DHH) offers an alternative with multiple advantages. Methods: This is a retrospective study of 10 patients who underwent DHH for distal humeral fractures during a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Score, Disabilities of Arm, Shoulder and Hand, visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores. Average patent age at surgery was 71.9 years (range, 56-81 years); average follow-up was 73.2 months (range, 36-96 months). Results: Patients maintained improvements in Mayo Elbow Performance Scores (mean, 89.23; range, 75-100) and Disabilities of Arm, Shoulder and Hand scores (mean, 33.71; range 11.2-55.1), along with no significant decrease in range of motion compared with 1 year after surgery. Mean visual analog scale was 2.43 (range, 0-5), Single Assessment Numeric Evaluation was 74.14 (range, 50-100), and American Shoulder and Elbow Surgeons score was 72.14 (range, 48.33-100). Participants had an average flexion of 128.7°(range, 95°-142°), extension deficit of 27.1°(range, 0°-45°), supination of 79.1°(range, 45°-90°), and pronation of 73.3°(range, 50°-90°). No heterotopic ossification, elbow dislocations, or subluxations were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Two patients died, and 1 patient was lost to follow-up. Conclusion: This midterm review suggests that DHH may be an effective treatment for certain distal humeral fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. Additional studies must be conducted to further define the role of DHH for complex fractures of the distal humerus.
Journal of Shoulder and Elbow Surgery, Mar 1, 2017
Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fracture... more Background: Total elbow arthroplasty is a treatment for unreconstructable distal humeral fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humeral hemiarthroplasty (DHH) offers an alternative with multiple advantages. Methods: This is a retrospective study of 10 patients who underwent DHH for distal humeral fractures during a 4-year period (2008-2012) by a single surgeon. Patients underwent testing of range of motion, Mayo Elbow Performance Score, Disabilities of Arm, Shoulder and Hand, visual analog scale, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons scores. Average patent age at surgery was 71.9 years (range, 56-81 years); average follow-up was 73.2 months (range, 36-96 months). Results: Patients maintained improvements in Mayo Elbow Performance Scores (mean, 89.23; range, 75-100) and Disabilities of Arm, Shoulder and Hand scores (mean, 33.71; range 11.2-55.1), along with no significant decrease in range of motion compared with 1 year after surgery. Mean visual analog scale was 2.43 (range, 0-5), Single Assessment Numeric Evaluation was 74.14 (range, 50-100), and American Shoulder and Elbow Surgeons score was 72.14 (range, 48.33-100). Participants had an average flexion of 128.7°(range, 95°-142°), extension deficit of 27.1°(range, 0°-45°), supination of 79.1°(range, 45°-90°), and pronation of 73.3°(range, 50°-90°). No heterotopic ossification, elbow dislocations, or subluxations were observed. Complications included 1 fracture and 1 complaint of prominent hardware. Two patients died, and 1 patient was lost to follow-up. Conclusion: This midterm review suggests that DHH may be an effective treatment for certain distal humeral fractures. The data suggest that elbow range of motion and functional use are maintained from comparison with short-term studies. Additional studies must be conducted to further define the role of DHH for complex fractures of the distal humerus.
Orthopaedic Journal of Sports Medicine, Jul 1, 2016
Background: Injury rates are high for collegiate football players. Few studies have evaluated the... more Background: Injury rates are high for collegiate football players. Few studies have evaluated the epidemiology of surgical procedures in National Collegiate Athletic Association (NCAA) Division I collegiate football players. Purpose: To determine the most common surgical procedures performed in collegiate football players over a 10-year period. Study Design: Descriptive epidemiological study. Methods: From the 2004-2005 season through the 2013-2014 season, all surgical procedures performed on athletes from a single NCAA Division I college football team during athletic participation were reviewed. Surgeries were categorized by anatomic location, and operative reports were used to obtain further surgical details. Data collected over this 10-season span included type of injury, primary procedures, reoperations, and cause of reoperation, all categorized by specific anatomic locations and position played.
The purpose of this study was to summarize the past 10 years of orthopaedic literature to better ... more The purpose of this study was to summarize the past 10 years of orthopaedic literature to better delineate the femoral origin of the posterior cruciate ligament (PCL). Methods: A PubMed search was conducted by 2 independent reviewers (M.P., M.V.) using the search terms "posterior cruciate ligament" or "PCL," "femur" or "femoral," and "anatomy" or "origin" or "footprint." Cadaveric and radiographic studies performed between January 1, 2003, and November 30, 2013, were analyzed. Results: Aggregate data from radiographic parameters indicate that the anatomic origin of the anterolateral bundle lies 40% of the distance from the anterior articular surface of the femur and 14.5% of the tangent distance from the Blumensaat line toward the intercondylar notch. The origin of the posteromedial bundle lies 56% from the anterior surface and 36.5% of the tangent distance toward the notch. On the basis of cadaveric data, the center of the anterolateral bundle is 8 mm from the anterior surface (27.5% of the Blumensaat line), 4.7 mm tangent from the Blumensaat line toward the notch (22.5% of the tangent distance), and 3.6 mm from the medial intercondylar ridge; the center of the posteromedial bundle is 11.9 mm from the anterior articular surface (42.5%), 10.9 mm along the tangent line (57.5%), and 3.1 mm from the medial intercondylar ridge. Conclusions: We were able to precisely delineate the femoral origin of the PCL through our systematic review. Clinical Relevance: Our systematic review may assist arthroscopic knee surgeons in placing anatomic tunnels during reconstruction of the PCL.
» Multiple opioid and non-opioid medications have proven effectiveness for pain relief after ante... more » Multiple opioid and non-opioid medications have proven effectiveness for pain relief after anterior cruciate ligament (ACL) reconstruction. » Regional anesthesia may be of value, but the evidence in support of indwelling catheters is weak. » Gabapentin, tranexamic acid, and corticosteroids may offer additional analgesic benefits. Peripheral Nerve Blocks Pain control may begin in the preoperative area with the administration of a peripheral Disclosure: There was no source of external funding for this study. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/ JBJSREV/A298).
Background: There has been much controversy regarding the effects of sterilization techniques and... more Background: There has been much controversy regarding the effects of sterilization techniques and graft history on the structural integrity of allograft ligaments used in reconstruction of the anterior cruciate ligament. The purpose of this review was to comprehensively examine anterior cruciate ligament allograft studies published in the last decade to evaluate the extent to which tissue source, tissue processing techniques, and donor age are reported. Methods: The authors reviewed 202 articles published from 1999 through November 2009, of which 68 retrospective, prospective, biomechanical, and histology studies evaluating 4689 allografts were included. Results: The majority of studies do not accurately report key elements of graft history including tissue bank, processing or sterilization technique, or donor age. Underreporting was particularly prominent in clinical studies as compared with basic science studies. Limited reporting of allograft processing, allograft source, and donor age raises serious questions regarding the generalizability of published studies of allograft tissue for anterior cruciate ligament reconstruction. Conclusion/Clinical Relevance: Orthopaedic surgeons who use allograft tissue must understand the tissue treatments being used (ie, preservation methods, chemical and sterilization processes) to best inform their patients regarding the risks, benefits, and long-term outcomes when such tissues are used. A complete understanding of the implanted tissue, as well as surgeon and recipient demographics, is necessary to ensure appropriate and predictable long-term outcomes.
Vitamin D is a lipophilic prohormone integral to musculoskeletal, autoimmune, oncologic, cardiova... more Vitamin D is a lipophilic prohormone integral to musculoskeletal, autoimmune, oncologic, cardiovascular, and mental health. Of particular importance to the orthopedic surgeon is the role of vitamin D in the regulation of bone mass, muscle strength, and physical performance. Although vitamin D-related skeletal pathologies are rare in industrialized nations, emerging research in the field has shown that most American adults have inadequate levels of vitamin D. Even among athletes, there is a high prevalence of vitamin D deficiency, which may place competitors at risk of stress fractures, illness, and delayed muscle recovery. Adequately identifying vitamin D-deficient individuals in need of supplementation is important to help optimize performance and prevent future injury. The goal of this review is to describe the epidemiology of vitamin D deficiency and its effects on athletic performance and musculoskeletal health. Future double-blinded studies of vitamin D supplementation in athletes are needed. We recommend treating athletes who have insufficient or deficient vitamin D levels.
above scoring scheme above was also applied. Statistical analyses were performed using JMP softwa... more above scoring scheme above was also applied. Statistical analyses were performed using JMP software system. Significance was determined at the 0.05 level. Results: Among the 26 patients, analysis were available in 25 (96%). There were 11 males and 15 females. The average age was 48 years. The average follow-up was 46 months. The average BMI was 32. The average graft size was 4.5 cm2. The 4 scores for histological and electron microscopy evaluation were combined into 2 grades. When pre-operative WOMAC and KSS were compared, there was no statistical difference between the 2 groups. No significant difference in chondrocyte viability was noted on histological or electron microscopy between refrigerated and frozen allografts at the time of implantation. A trend towards greater improvement in WOMAC, KSS was noted in the frozen allograft group, although not statistically significant (pϭ0.07) An improvement in knee range of motion was noted in frozen allograft patients compared to those with a refrigerated allograft (pϭ0.02). There was no correlation between post-op x-ray score and outcome. 24% were considered failures and were analyzed separately. All failures were refrigerated allografts. No failures were noted if the histology score was Grade 2 or if the electron microscopy score was Grade 2. The likelihood ratio for a patient to do well if the initial histological score was 2 was 8.4 and if the electron microscopy score was 2 was 1.4. Conclusions: Both refrigerated and frozen large osteochondral allografts appear to be function well clinically at 4 year follow-up. Long term follow-up is further needed.
The purpose of this pilot study was to evaluate the cytokine profile of human knee synovial fluid... more The purpose of this pilot study was to evaluate the cytokine profile of human knee synovial fluid and correlate this with the subject's degree of articular cartilage degradation, radiographic score, and synovial histology. Synovial fluid was withdrawn before knee meniscectomy in 12 subjects with varying degrees of osteoarthritis and assayed for 21 cytokines, using a multiplex cytokine assay and flow cytometry instrumentation. Articular cartilage surfaces were scored by a single orthopaedic surgeon on the basis of the International Cartilage Repair Society (ICRS) classification during the arthroscopy, and posterior-anterior knee radiographs were graded using the Kellgren-Lawrence (KL) classification. Synovial biopsies were taken in four zones at the time of surgery for histological analysis. Significant concentration differences in IL-2, IL-5, MCP-1, and MIP-1 were found between subjects with advanced arthritis and subjects with little or no arthritis on the ICRS scale (p < .05). No such differences could be appreciated using KL scores. There was no correlation between histology samples and visualized surface osteoarthritis. This data suggests a molecular basis of disease progression, with higher levels of cytokines indicative of greater degrees of osteoarthritis. These results add pilot data that can assist investigators in conducting a comparative observational study of the levels of inflammatory cytokines with radiologic and arthroscopic assessments of osteoarthritis.
Orthopaedic Journal of Sports Medicine, Oct 1, 2016
Background: Providing high-quality care while also containing cost is a paramount goal in orthopa... more Background: Providing high-quality care while also containing cost is a paramount goal in orthopaedic surgery. Increasingly, insurance providers in the United States, including government payers, are requiring financial and performance accountability for episodes of care, including a push toward bundled payments. Hypothesis: The direct cost of outpatient arthroscopic rotator cuff repair was assessed to determine whether, due to an older population, rotator cuff surgery was more costly in Medicare-insured patients than in patients covered by other insurers. We hypothesized that operative time, implant cost, and overall higher cost would be observed in Medicare patients.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, Jan 6, 2017
To characterize and compare the graft contact characteristics of outside-in (OI) and inside-out (... more To characterize and compare the graft contact characteristics of outside-in (OI) and inside-out (IO) femoral tunnels during single-bundle reconstruction of the anterolateral bundle of the posterior cruciate ligament in a synthetic knee model. Femoral tunnels were separately made in 16 synthetic femora (8 OI and 8 IO). Achilles tendon allografts were fixed using suspensory fixation with a pressure sensor between the allograft and femoral tunnel. Grafts were cyclically loaded; force, contact area, contact pressure, and peak pressure at the aperture were measured. This process was repeated using the same allograft to assess the other tunnel angle in a separate specimen. IO specimens showed higher mean contact pressure at all loading cycles, with significance shown at 50 N (P = .02). Peak pressure was also greater in IO specimens at all loading cycles and reached statistical significance at 100 N (P = .04). IO specimens had a lower contact area at 150 N (P = .04). No statistically signi...
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Papers by Steven Narvy