Publications by authors named "Anthony A Essilfie"

8 Publications

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Distal posterolateral corner injury in the setting of multiligament knee injury increases risk of common peroneal palsy.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 9. Epub 2021 Feb 9.

New York University Langone Orthopedic Hospital, 333 East 38th Street, New York, NY, 10016, USA.

Purpose: The purpose of this study was to identify if the location of posterolateral corner (PLC) injury was predictive of clinical common peroneal nerve (CPN) palsy.

Methods: A retrospective chart review was conducted of patients presenting to our institution with operative PLC injuries. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. A fellowship-trained musculoskeletal radiologist reviewed the PLC injury and categorized it into distal, middle and proximal injuries with or without a biceps femoral avulsion. The CPN was evaluated for signs of displacement or neuritis.

Results: Forty-seven operatively managed patients between 2014 and 2019 (mean age-at-injury 29.5 ± 10.7 years) were included in this study. Eleven (23.4%) total patients presented with a clinical CPN palsy. Distal PLC injuries were significantly associated with CPN palsy [9 (81.8%) patients, (P = 0.041)]. Nine of 11 (81.8%) patients with CPN palsy had biceps femoral avulsion (P = 0.041). Of the patients presenting with CPN palsy, only four (36.4%) patients experienced complete neurologic recovery. Three of 7 patients (43%) with an intact CPN had full resolution of their clinically complete CPN palsy at the time of follow-up (482 ± 357 days). All patients presenting with a CPN palsy also had a complete anterior cruciate ligament (ACL) rupture in addition to a PLC injury (P = 0.009), with or without a posterior cruciate ligament (PCL) injury. No patient presenting with an isolated pattern of PCL-PLC injury (those without ACL tears) had a clinical CPN palsy.

Conclusion: Distal PLC injuries have a strong association with clinical CPN palsy, with suboptimal resolution in the initial post-operative period. Specifically, the presence of a biceps femoris avulsion injury was highly associated with a clinical CPN palsy. Additionally, CPN palsy in the context of PLC injury has a strong association with concomitant ACL injury. Furthermore, the relative rates of involvement of the ACL vs. PCL suggest that specific injury mechanism may have an important role in CPN palsy.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-021-06469-zDOI Listing
February 2021

Distal biceps femoris avulsions: Associated injuries and neurological sequelae.

Knee 2020 Dec 15;27(6):1874-1880. Epub 2020 Nov 15.

NYU Langone Health, United States of America.

Background: The aim of this study was to describe associated injuries in cases of distal biceps femoris avulsions (DBFA) as well as the incidence of neurological injury and radiographic abnormalities of the common peroneal nerve (CPN).

Methods: A retrospective chart review was conducted of patients presenting to our office or trauma center with DBFA injuries. Demographic data was obtained as well as mechanism of injury. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. The CPN was evaluated for signs of displacement or neuritis.

Results: Sixteen patients were identified (mean age-at-injury 28.6 years, 87.5% male) with DBFA. Three patients (18.8%) sustained their injuries secondary to high energy trauma while 13 (81.3%) had injuries secondary to lower energy trauma. Nine patients (56.3%) initially presented with CPN palsy. All patients presenting with CPN palsy of any kind were found to have a displaced CPN on MRI and no patient with a normal nerve course had a CPN palsy.

Conclusions: This case series demonstrates a strong association between DBFA and CPN palsy as well as multi-ligamentous knee injury (MLKI). These injuries have a higher rate of CPN palsy than that typically reported for MLKI. Furthermore, these findings suggest that CPN displacement on MRI may be a clinically significant indicator of nerve injury. LOE: IV.
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http://dx.doi.org/10.1016/j.knee.2020.07.085DOI Listing
December 2020

Resident, Fellow, and Attending Perception of E-Learning During the COVID-19 Pandemic and Implications on Future Orthopaedic Education.

J Am Acad Orthop Surg 2020 Oct;28(19):e860-e864

From the Department of Orthopaedic Surgery, New York University Langone Health, New York, NY.

Introduction: The purpose of the current study was to evaluate resident, fellow, and attending perspectives on the use of e-learning as part of orthopaedic surgery education.

Methods: A survey was created evaluating (1) overall attitudes toward e-learning, (2) multi-institutional e-learning/e-conferences, (3) national/regional e-conferences, and (4) future directions with e-learning. The survey was distributed to all the orthopaedic surgery residency program directors in the United States, and they were asked to circulate the survey to their program's faculty and trainees.

Results: A total of 268 responses were collected, including 100 attendings and 168 trainees. Overall satisfaction with e-learning compared with in-person learning was higher among trainees than attending faculty, with 51.4% of trainees favoring e-learning, as opposed to 32.2% of attendings (P = 0.006). Both groups felt they were more likely to pay attention with in-person learning (P = 0.89). During the COVID-19 pandemic, 85.7% of residents have used e-learning platforms to join a conference in their specialty of interest while off-service. Most attendings and trainees felt e-learning should play a supplemental role in standard residency/fellowship education, with a low number of respondents feeling that it should not be used (86.6% versus 84%, and 2.1% versus 0.6%, respectively, P = 0.28).

Conclusion: E-learning has been an important modality to continue academic pursuits during the disruption in usual education and training schedules during the COVID-19 pandemic. Most trainees and attendings surveyed felt that e-learning should play a supplementary role in resident and fellow education moving forward. Although e-learning does provide an opportunity to hold multi-institutional conferences and makes participation in meetings logistically easier, it cannot fully replicate the dynamic interactions and benefits of in-person learning.
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http://dx.doi.org/10.5435/JAAOS-D-20-00579DOI Listing
October 2020

Infected Hematoma After Endoscopic Sciatic Nerve Decompression.

Arthrosc Sports Med Rehabil 2020 Apr 8;2(2):e171-e174. Epub 2020 Jan 8.

New York University Langone Orthopedic Hospital, New York, New York, U.S.A.

We present a 24-year-old male who developed an infected hematoma that resulted in sciatic nerve injury after he underwent an endoscopic sciatic nerve decompression. He underwent urgent hematoma evacuation and cultures speciated as . At 4 months' follow-up, the patient's nerve had improved motor and sensory function. This case highlights the importance of obtaining appropriate hemostasis at the end of an endoscopic sciatic nerve decompression.
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http://dx.doi.org/10.1016/j.asmr.2019.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190546PMC
April 2020

Staged Bilateral Hip Arthroscopy Compared With a Matched Unilateral Hip Arthroscopy Group: Minimum 2-Year Follow-Up.

Arthroscopy 2020 07 28;36(7):1856-1861. Epub 2020 Feb 28.

NYU Langone Orthopedics, New York, York, U.S.A.

Purpose: To determine the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) at 2-year follow up in patients who underwent staged bilateral hip arthroscopy versus age-, sex-, and body mass index-matched patients who underwent unilateral hip arthroscopy.

Methods: Patients who underwent staged bilateral primary hip arthroscopy between January 2007 and December 2017 for the indication of femoroacetabular impingement (FAI) with a minimum 2-year follow-up were identified. The control group comprised patients who underwent a unilateral hip arthroscopy for FAI. The mHHS and the NAHS were analyzed.

Results: Forty-two patients (84 hips) in the bilateral group were matched with 84 patients (84 hips) in the unilateral group. Both groups had significantly improved mHHS and NAHS when comparing preoperative scores with postoperative scores (bilateral group mHHS: 45.5 ± 15.1 to 81.7 ± 17.6, P < .0001, bilateral group NAHS: 49.5 ± 13.8 to 83.6 ± 20.0, P < .0001, unilateral group mHHS 48.5 ± 13.8 to 83.6 ± 15.9, P < .0001, unilateral group NAHS 48.8 ± 12.0 to 85.0 ± 16.6, P < .0001). The patient-acceptable symptomatic state was achieved in 57 hips (68%) in the bilateral group versus 62 hips (74%) in the unilateral group, P = .4. Patients with bilateral hip arthroscopy who had <17 months between index procedure and contralateral hip arthroscopy had significantly better mHHS and NAHS (85.5 ± 18.4 vs 75.71 ± 14.4, P = .013 for mHHS and 88.1 ± 17.1 vs 76.2 ± 22.4, P = .0074 for NAHS).

Conclusions: Bilateral hip arthroscopy for the indication of FAI has improved mHHS and NAHS at 2 years of follow up compared to baseline. There was no difference in 2-year mHHS and NAHS in patients who underwent bilateral hip arthroscopy and unilateral hip arthroscopy. Patients in the bilateral hip arthroscopy group that had the contralateral surgery longer than 17 months from index procedure had lower 2 year follow up mHHS and NAHS scores than those that underwent the second surgery within 17 months of the index procedure.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2020.02.025DOI Listing
July 2020

Fresh osteochondral grafting in the United States: the current status of tissue banking processing.

Cell Tissue Bank 2019 Sep 18;20(3):331-337. Epub 2019 Jun 18.

Department of Orthopedic Surgery, USC Keck School of Medicine, 1540 Alcazar Street, CHP 207, Los Angeles, CA, 90089-9007, USA.

The use of musculoskeletal allografts has become increasingly popular among surgeons. The purpose of this review is to highlight the procurment and delievery process of fresh osteochondral allografts in the United States. The four distributors of fresh osteochondral allografts in the United States were contacted. Surveys containing quantitative and qualitative sections concerning the procurement and processing of osteochondral allograft tissue were obtained. Our results showed an average of 13 ± 4.24 years of experience with osteochondral allografts. The average donor age ranged from 13.5 ± 3 to 37.5 ± 5 years, with an average age of 27 ± 2.83 years. All donors were between ages 12 and 45 years old. The percentage of screened donors that were accepted for allograft transplant was consistent at 70-75% for 3 out of the 4 tissue banks. The percentage of grafts that expire without implantation ranged from 20% to 29%. Maximum shipping time varied between 24 and 96 hours. Each tissue bank used its own proprietary storage medium. The time from donor death to the harvest of allograft tissue was < 24 hours. The most commonly requested osteochondral allograft tissue for all banks was the medial femoral condyle. The market share of fresh allografts is as follows: Joint Restoration Foundation (JRF) 59.9%, Muskuloskeletal Transplant Foundation (MTF) 15.3%, LifeNet Health (LN) 14.5%, and Regeneration Technology Incorporated (RTI) 10.2%, with approximately 4700 fresh allografts distributed in 2018. This compiled data from the four tissue banks that supply fresh osteochondral allograft in the United States  provides important background information for patients and orthopaedic surgeons.
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http://dx.doi.org/10.1007/s10561-019-09768-5DOI Listing
September 2019

The Role for Shoulder Hemiarthroplasty in the Young, Active Patient.

Clin Sports Med 2018 Oct;37(4):527-535

Department of Orthopaedic Surgery, Keck Medical Center at University of Southern California, 1520 San Pablo Street, Suite 2000, Los Angeles, CA 90033, USA. Electronic address:

Younger patients with severe glenohumeral (GH) arthritis are a challenge to treat, as they have high physical demands, high expectations, a long lifespan, and often altered anatomy from prior surgery or congenital deformity. Nonoperative management is the cornerstone of treatment; however, when it fails, shoulder arthroplasty can be indicated. Although the literature suggests that total shoulder arthroplasty is the most appropriate for severe GH arthritis, there are a subset of patients in which a hemiarthroplasty can still be successful. This article reviews the clinical performance of hemiarthroplasty in patients with specific diagnoses while highlighting the limitations of the operation.
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http://dx.doi.org/10.1016/j.csm.2018.05.004DOI Listing
October 2018