Publications by authors named "Benjamin Miltenberg"

4 Publications

  • Page 1 of 1

Revision Soft Tissue Allograft Anterior Cruciate Ligament Reconstruction is Associated with Lower Patient Reported Outcomes Compared with Primary Anterior Cruciate Ligament Reconstruction in Patients Aged 40 and Older.

Arthroscopy 2022 Jul 12. Epub 2022 Jul 12.

Tufts Medical Center, Boston, MA;. Electronic address:

Purpose: To evaluate patient reported outcomes (PROs) and graft failure rates in revision allograft anterior cruciate ligament (ACL) reconstruction (ACLR) in patients aged 40 and older and compare them with primary ACLRs.

Methods: Patients aged 40 and older who underwent arthroscopic soft tissue allograft ACLR between 2005 and 2016 with a minimum 2-year follow-up were retrospectively reviewed. Patients were grouped based on revision versus primary ACLR. The rate of achieving an International Knee Documentation Committee (IKDC) patient acceptable symptom state (PASS) score was recorded. Patient satisfaction, PROs, and graft failure were compared between groups using chi-square test, Fisher's exact test, and Mann-Whitney U test.

Results: We identified 32 revision ACLR patients and 201 primary ACLR patients aged 40 and older who met inclusion criteria with a mean follow-up of 6.2 and 6.9 years, respectively (p=0.042). There was a lower rate of concomitant meniscal repair in the primary ACLR group (6% vs. 21.9%, p=0.007) There were no other differences in chondral injuries, mechanism of injury, or meniscal injuries between groups. The median IKDC score was higher in the primary ACLR group as compared to the revision ACLR group (83.9 vs. 70.6, p<0.001). Revision ACLR patients were less likely to achieve the IKDC PASS threshold (82.5% vs. 56.3%, p=0.001) and were less likely to report satisfaction as compared to primary ACLR patients (90.5% vs. 78.1%, p=0.038). No difference in graft failure rates was identified between groups (8% vs. 15.6%, p=0.180).

Conclusion: Revision allograft ACLR in patients aged 40 and older was associated with lower PROs compared with primary ACLR. Patients that underwent revision ACLR failed to meet the IKDC PASS threshold more often and were dissatisfied with procedure results more than twice as often as patients that underwent primary ACLR.

Study Design: Level III, retrospective cohort study.
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July 2022

Fracture Dislocations of the Proximal Humerus Treated with Open Reduction and Internal Fixation: A Systematic Review.

J Shoulder Elbow Surg 2022 May 20. Epub 2022 May 20.

Department of Orthopedic Surgery, Tufts Medical Center, Boston, MA, USA. Electronic address:

Background: The treatment of proximal humerus fracture-dislocations can be challenging given the extensive injury to the proximal humeral anatomy and increased risk of devascularization of the humeral head often seen in these injuries. The purpose of this study is to undertake a systematic review of the literature on the functional outcomes, rate of revision, and short- and long-term complications for proximal humerus fracture-dislocations treated with open reduction and internal fixation (ORIF).

Methods: The PubMed and OVID Embase databases were queried for literature reporting on proximal humerus fracture dislocations treated with ORIF. Data including study design, patient demographics, functional outcomes, and complications were recorded.

Results: Twelve studies including 294 patients with Neer type 2-, 3-, or 4-part proximal humerus fracture-dislocations met the criteria for inclusion. The mean patient age was 53.4 years (19-89 years) with an average follow-up of 2.9 years (1.15-4.9 years). At final follow-up, the mean Constant Score was 73.2 (52 - 87.3) and the mean Disabilities of the Arm Shoulder and Hand (DASH) score was 26.6 (17.5- 32). Avascular necrosis (AVN) was observed in 20.0% (0%-82.3%) and non-union was observed in 3.0% (0% - 7.7%) of patients. Conversion to arthroplasty was observed in 10.7% (5% - 20%) and a total reoperation was observed in 35.6% (11.8%-89.1%) of patients in studies explicitly reporting these outcomes. In addition to conversion to arthroplasty, common causes of reoperation were revision ORIF (5.2%) and hardware removal (22.2%).

Conclusion: Patients undergoing ORIF for proximal humerus fracture-dislocations have reasonable functional outcomes but relatively high AVN and reoperation rates. This information can be used to counsel patients and set expectations about the potential for further surgeries.
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May 2022

The Majority of Patients Aged 40 and Older Having Allograft Anterior Cruciate Ligament Reconstruction Achieve a Patient Acceptable Symptomatic State.

Arthroscopy 2022 05 1;38(5):1537-1543. Epub 2021 Oct 1.

Tufts Medical Center, Boston, Massachusetts, U.S.A.

Purpose: To evaluate patient satisfaction, retear rates, and patient-reported outcomes (PROs) in patients aged 40 and older undergoing allograft anterior cruciate ligament reconstruction (ACLR). The secondary goal was to compare these parameters between groups of patients with intact versus failed grafts, and to evaluate these in relation to a historically reported International Knee Documentation Committee (IKDC) patient-acceptable symptoms state (PASS) score.

Methods: Records of patients aged 40 and older who underwent ACLR between 2005 and 2016 at a single institution with a minimum 2-year follow-up were retrospectively reviewed. Patient-reported satisfaction, outcome scores, and failure rates were analyzed. The rate of achieving a previously defined IKDC PASS score based on younger cohorts was reported, and an updated PASS threshold for older patients was calculated.

Results: 201 patients were included with a mean age of 48.6 years (range: 40-68) and mean follow-up of 6.2 years (range: 2.8-11.2). 182 (90.5%) patients reported satisfaction following surgery. 16 (8.0%) patients experienced failure of their ACLR, 10 of which underwent revision ACLR. The median IKDC score in the intact ACLR group was 86.2, compared to 66.7 in the failure group (P < .001). In total, 134 (72.4%) patients in the intact group achieved the historical PASS score of 75.9 on IKDC compared to only 4 (25%) in the failure group (χ = 15.396, P < .001). An updated IKDC PASS threshold for older cohorts was calculated to be 66.7.

Conclusion: Patients aged 40 and older who underwent allograft ACLR had an 8.0% failure rate at a mean follow-up of 6 years. Graft failure in patients aged 40 and older was associated with worse PROs. The majority of patients achieved the historically reported IKDC PASS threshold. Additionally, an updated age-appropriate IKDC PASS score of 66.7 was calculated to aid in future ACLR studies assessing older patients.

Study Design: Level IV.
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May 2022

Imaging Active Surface Processes in Barnacle Adhesive Interfaces.

Langmuir 2016 Jan 6;32(2):541-50. Epub 2016 Jan 6.

Duke University Marine Lab , Beaufort, North Carolina 28516, United States.

Surface plasmon resonance imaging (SPRI) and voltammetry were used simultaneously to monitor Amphibalanus (=Balanus) amphitrite barnacles reattached and grown on gold-coated glass slides in artificial seawater. Upon reattachment, SPRI revealed rapid surface adsorption of material with a higher refractive index than seawater at the barnacle/gold interface. Over longer time periods, SPRI also revealed secretory activity around the perimeter of the barnacle along the seawater/gold interface extending many millimeters beyond the barnacle and varying in shape and region with time. Ex situ experiments using attenuated total reflectance infrared (ATR-IR) spectroscopy confirmed that reattachment of barnacles was accompanied by adsorption of protein to surfaces on similar time scales as those in the SPRI experiments. Barnacles were grown through multiple molting cycles. While the initial reattachment region remained largely unchanged, SPRI revealed the formation of sets of paired concentric rings having alternately darker/lighter appearance (corresponding to lower and higher refractive indices, respectively) at the barnacle/gold interface beneath the region of new growth. Ex situ experiments coupling the SPRI imaging with optical and FTIR microscopy revealed that the paired rings coincide with molt cycles, with the brighter rings associated with regions enriched in amide moieties. The brighter rings were located just beyond orifices of cement ducts, consistent with delivery of amide-rich chemistry from the ducts. The darker rings were associated with newly expanded cuticle. In situ voltammetry using the SPRI gold substrate as the working electrode revealed presence of redox active compounds (oxidation potential approx 0.2 V vs Ag/AgCl) after barnacles were reattached on surfaces. Redox activity persisted during the reattachment period. The results reveal surface adsorption processes coupled to the complex secretory and chemical activity under barnacles as they construct their adhesive interfaces.
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January 2016