Publications by authors named "Bogdan A Matache"

17 Publications

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Transosseous-Equivalent/Suture-Bridge Arthroscopic Rotator Cuff Repair in Combination with Late Post-Operative Mobilization Yield Optimal Outcomes and Retear Rate-A Network Meta-Analysis of Randomized Controlled Trials.

Arthroscopy 2021 May 31. Epub 2021 May 31.

Purpose: The purpose of this study was to perform a network meta-analysis of the randomized controlled trials (RCTs) in the literature in order to assess the evidence defining the optimal combination of surgical technique single row repair (SRR), double-row repair (DRR), or transosseous-equivalent/suture-bridge (TOE/SB) arthroscopic rotator cuff repair (ARCR) and postoperative rehabilitation (early or late) protocol for ARCR.

Methods: The literature search was performed based on the PRISMA guidelines. Randomized SSR-Early trials (RCT) comparing SRR vs DRR vs TOE/SB ARCR techniques were included, as well as early versus late postoperative ROM. Clinical outcomes were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score.

Results: 28 studies comprising 2,181 total shoulders met the inclusion criteria. TOE/SB-late (OR 0.19 [0.08;0.46) and DRR-late (OR 0.25 [0.12;0.52) were found to significantly reduce the rate of re-tear, with TOE/SB-late resulting in the highest P-score for the American Shoulder & Elbow Surgeons (ASES) (P Score: 0.7911) score and re-tear rate (P Score: 0.8725). DRR-early did not result in any significant improvements over the SRR-early group, except in internal rotation. There was no significant difference in forward flexion between groups, with almost equivalent P-Scores. Furthermore, TOE/SB-early and TOE/SB-late trended toward worsening external rotation compared to the control.

Conclusion: The current study suggests that rotator cuff repair using the transosseous-equivalent/suture-bridge technique and late postoperative mobilization yields the highest functional outcomes and lowest re-tear rate in the arthroscopic management of symptomatic rotator cuff tears.
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http://dx.doi.org/10.1016/j.arthro.2021.05.050DOI Listing
May 2021

Improved Functional Outcome Scores Associated with Greater Reduction in Cam Height Using the Femoroacetabular Impingement Resection Arc During Hip Arthroscopy.

Arthroscopy 2021 May 27. Epub 2021 May 27.

New York Langone Medical University, Department of Orthopaedic Surgery.

Purpose: To evaluate the association between postoperative cam lesion measured by the "femoroacetabular impingement resection (FAIR) arc" and 2-year patient outcomes following hip arthroscopy.

Methods: A retrospective review of prospectively gathered data from 2013-2017 was performed. All patients who underwent hip arthroscopy for FAI with ≥ 2-year follow-up were included. Cam FAIR arc measurements were made pre and postoperatively on a 45° Dunn view radiograph. The clinical effect of postoperative cam maximal radial distance (MRD) was assessed using the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS). Patients were divided into subgroups based on relationship to the mean and standard deviations for cam MRD. One half standard deviation above the mean was found to be 3.15 mm.

Results: Sixty-one hips in 59 consecutive patients (age 38.1+/-13.1; BMI: 25.5+/-4.3; 36 females) were included. Mean pre- and postoperative cam maximal radial distances (MRD) were 4.5 ± 1.7mm and 2.3 ± 1.7mm(p<0.001), respectively. The interclass correlation coefficient was excellent (>0.9) for all measurements. There were no differences in age, sex, BMI or preoperative mHHS/NAHS between <3.15 mm and >3.15 mm cam MRD groups (p>0.05). Using linear regression, cam MRD was found to be significantly associated with 2-year outcomes for both mHHS (R=0.21, p<0.001) and NAHS (R=0.004). Subgroup analysis demonstrated that patients in the cam MRD < 3.15 mm group had significantly higher mHHS (89.7 vs 70.0 p<0.001) and NAHS scores (90.5 vs 72.9, p<0.001) than those in the >3.15 mm group. Additionally, more patients in the <3.15 mm group reached the minimal clinically important difference (MCID) (95.2% vs 78.9%, p=0.048) and were above patient acceptable symptomatic state (PASS) (95.2% vs 52.6%, p<0.001) compared to the >3.15 mm group.

Conclusion: Patients with a lower postoperative cam MRD relative to the FAIR arc demonstrated significantly improved outcomes as compared to those with higher postoperative MRD at two-year follow-up.
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http://dx.doi.org/10.1016/j.arthro.2021.05.014DOI Listing
May 2021

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis.

J Shoulder Elbow Surg 2021 Apr 20. Epub 2021 Apr 20.

The Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada. Electronic address:

Background: Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies.

Methods: A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score.

Results: The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies.

Conclusion: CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.
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http://dx.doi.org/10.1016/j.jse.2021.04.001DOI Listing
April 2021

Immobilisation in external rotation after first-time traumatic anterior shoulder instability reduces recurrent instability: a meta-analysis.

J ISAKOS 2021 01 23;6(1):22-27. Epub 2020 Dec 23.

Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.

Importance: Cadaveric and MRI findings have demonstrated significantly less labral separation and displacement when the shoulder is placed in external rotation as compared with internal rotation.

Objective: The purpose of the current study is to meta-analyse the randomised controlled trials in the literature to compare immobilisation in external versus internal rotation after first-time anterior shoulder dislocation.

Evidence Review: A literature search of MEDLINE, EMBASE and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials comparing immobilisation in external rotation versus internal rotation for first-time anterior shoulder dislocation were included.

Findings: Nine randomised controlled trials with 795 patients were included. The mean age of included patients was 29 years, 82.4% were male and the mean follow-up was 25.5 months. As compared with immobilisation in internal rotation, compliance was significantly higher (74.5% vs 67.4%, p=0.01), and the rate of recurrent dislocations was significantly lower (22.2% vs 33.4%, p=0.02) with immobilisation in external rotation. Additionally, in patients 20-40 years old the rate of recurrent dislocations was significantly lower in those treated with immobilisation in external rotation than internal rotation (12.1% vs 31.4%, p=0.006). Immobilisation in external rotation also resulted in a higher rate of return to preinjury level of play (60.1% vs 42.6%, p=0.0001).

Conclusions And Relevance: Immobilisation of the shoulder in external rotation after a traumatic first-time anterior shoulder dislocation results in a higher compliance rate, a lower recurrent dislocation rate and a higher rate of return to play as compared with immobilisation in internal rotation.

Level Of Evidence: Level I.
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http://dx.doi.org/10.1136/jisakos-2020-000511DOI Listing
January 2021

Arthroscopic Latarjet Procedure: Indications, Techniques, and Outcomes.

JBJS Rev 2021 03 10;9(3). Epub 2021 Mar 10.

Department of Orthopedic Surgery, New York University Langone Health, New York, NY.

»: The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure.

»: Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure.

»: Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
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http://dx.doi.org/10.2106/JBJS.RVW.20.00071DOI Listing
March 2021

Return to play criteria among shoulder surgeons following shoulder stabilization.

J Shoulder Elbow Surg 2021 Jun 19;30(6):e317-e321. Epub 2021 Feb 19.

Division of Sports Medicine, Department of Orthopaedic Surgery, New York University Langone Health, New York, NY, USA.

Purpose: The purpose of this study was to survey the members of North American and European shoulder surgery and sports medicine societies to evaluate their criteria for deciding when an athlete can safely return to play (RTP) following shoulder stabilization surgery.

Methods: A survey was sent to the members of the American Shoulder and Elbow Surgeons (ASES), American Orthopaedic Society for Sports Medicine (AOSSM), European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), and European Society for Surgery of the Shoulder and the Elbow (SECEC). Surgeons were asked which criteria they used to determine when an athlete can return to play following the arthroscopic Bankart repair and Latarjet procedures, with additional questions on how time from surgery and participation in collision sports affect return.

Results: Overall, 317 surgeons responded to the survey. Following arthroscopic Bankart repair, the most common criteria used were time (98.7%), strength (74.8%), and range of motion (70%). The most commonly reported time point was 4 months (43.8%), and the majority used an additional time period, most commonly 2 months (38.2%), before allowing a collision athlete to return to play (75.4%). Interestingly, the addition of a remplissage procedure did not affect decision making regarding RTP in most cases (92.1%). Following the Latarjet procedure, the most common criteria used were time (98.4%), strength (67.5%), and range of motion (65.9%). Less than half reported using imaging to assess for radiographic union before allowing patients to return to play (47%), and the most common modality was plain radiography (80%). The most common time point was 4 months (33.1%), and the majority reported waiting an additional period of time, most commonly by 2 months (25.9%), before allowing a collision athlete to return to play (59.6%).

Conclusion: Despite the absence of evidence-based guidelines on when athletes can safely return to play following shoulder stabilization surgery, there exists minimal variability in recommendations between North American and European shoulder surgeons. Further research is required to better define criteria for RTP after the arthroscopic Bankart repair and Latarjet procedures.
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http://dx.doi.org/10.1016/j.jse.2021.01.026DOI Listing
June 2021

Short-term complications of the Latarjet procedure: a systematic review.

J Shoulder Elbow Surg 2021 Feb 16. Epub 2021 Feb 16.

NYU Langone Health, Division of Sports Medicine, Department of Orthopaedic Surgery, New York, NY, USA.

Purpose: The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches.

Methods: PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant.

Results: Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81).

Conclusion: Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
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http://dx.doi.org/10.1016/j.jse.2021.01.024DOI Listing
February 2021

Humeral head subluxation in Walch type B shoulders varies across imaging modalities.

JSES Int 2021 Jan 10;5(1):98-101. Epub 2020 Oct 10.

Roth|McFarlane Hand & Upper Limb Centre, St. Joseph's Healthcare London, London, ON, Canada.

Background: The Walch type B pattern of glenohumeral osteoarthritis is characterized by posterior humeral head subluxation (PHHS). At present, it is unknown whether the percentage of subluxation measured on axillary radiographs is consistent with measurements on 2-dimensional (2D) axial or 3-dimensional (3D) volumetric computed tomography (CT). The purpose of this study was to evaluate PHHS across imaging modalities (radiographs, 2D CT, and 3D CT).

Methods: A cohort of 30 patients with Walch type B shoulders underwent radiography and standardized CT scans. The cohort comprised 10 type B1, 10 type B2, and 10 type B3 glenoids. PHHS was measured using the scapulohumeral subluxation method on axillary radiographs and 2D CT. On 3D CT, PHHS was measured volumetrically. PHHS was statistically compared between imaging modalities, with ≤ .05 considered significant.

Results: The mean PHHS value for the entire group was 69% ± 24% on radiographs, 65% ± 23% with 2D CT, and 74% ± 24% with 3D volumetric CT. PHHS as measured on complete axillary radiographs was not significantly different than that measured on 2D CT ( = .941). Additionally, PHHS on 3D volumetric CT was 9.5% greater than that on 2D CT ( < .001). There were no significant differences in PHHS between the type B1, B2, and B3 groups with 2D or 3D CT measurement techniques ( > .102).

Conclusion: Significant differences in PHHS were found between measurement techniques ( < .035). A 9.5% difference in PHHS between 2D and 3D CT can be mostly accounted for by the linear (2D) vs. volumetric (3D) measurement techniques (a linear 80% PHHS value is mathematically equivalent to a volumetric PHHS value of 89.6%). Surgeons should be aware that subluxation values and therefore thresholds vary across different imaging modalities and measurement techniques.
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http://dx.doi.org/10.1016/j.jseint.2020.08.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7846694PMC
January 2021

Knotted Versus Knotless Anchors for Labral Repair in the Shoulder: A Systematic Review.

Arthroscopy 2021 04 9;37(4):1314-1321. Epub 2020 Dec 9.

Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A.

Purpose: To compare biomechanical and clinical outcomes between knotless and knotted anchors in arthroscopic labral repair, specifically in (1) Bankart repair, (2) SLAP repair, (3) posterior labral repair, and (4) remplissage augmentation of Bankart repair.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find biomechanical and clinical studies comparing knotted and knotless anchors using the search term "knotless anchor."

Results: Overall, 17 studies met inclusion criteria. There were 7 studies evaluating the biomechanical outcomes, of which 5 found mixed results between knotted and knotless anchors for arthroscopic Bankart repair, 1 demonstrated a difference for SLAP repair favoring knotless anchors, and 2 showed no significant difference for Remplissage in terms of ultimate load-to-failure. Four studies evaluated knotless labral anchors compared with knotted anchors in patients undergoing arthroscopic Bankart repair with no significant differences in outcomes reported between the 2 anchor types, except in one study that found an improved visual analog scale score and a lower recurrence and revision rate with knotted anchors. Five studies evaluated knotless anchors compared with knotted anchors in patients undergoing SLAP repair, and none of the included studies found any significant differences in the patient reported outcome measures or revision rates. Of the 5 studies comparing operative time, 4 found a reduced time with knotless anchors.

Conclusions: The clinical results show no significant differences in outcomes between knotless and knotted anchors for labral repair in the shoulder, including Bankart repair, SLAP repair, and posterior labral repair. However, there was conflicting evidence supporting knotless or knotted anchors in the biomechanical studies. However, operative times may be reduced with the use of knotless anchors.

Level Of Evidence: III, A Systematic Review of Level II and III studies.
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http://dx.doi.org/10.1016/j.arthro.2020.11.056DOI Listing
April 2021

Treatment of Stages IIIA and IIIB in Kienbock's Disease: A Systematic Review.

J Wrist Surg 2020 Dec 14;9(6):535-548. Epub 2020 Sep 14.

Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada.

 Despite numerous proposed surgical interventions, there is a lack of consensus in the optimal treatment of advanced Kienbock's disease.  This study aims to perform a systematic review of the current evidence in the management of Lichtman's stages IIIA and IIIB of the disease.  A literature search was performed using the MEDLINE, EMBASE, and COCHRANE databases to identify studies between 2008 and 2018 evaluating stage-specific outcomes in Lichtman's stages IIIA and IIIB. The quality of each included paper was evaluated using the Structured Effectiveness Quality Evaluation Scale (SEQES). Data extracted were stage-specificity, clinical and functional outcomes, and radiographic progression of Lichtman's staging.  A total of 1,489 titles were identified. Eighty-three papers were fully reviewed, and 30 articles met eligibility criteria for inclusion. There were 3 low-quality and 27 moderate-quality papers. Surgical techniques reported included decompression surgeries, joint-levelling, and radial wedge osteotomies, revascularization techniques, intracarpal arthrodesis, proximal row carpectomy, arthroplasty, and balloon kyphoplasty. All treatment modalities offered pain relief and improvement in functional outcomes. Compared with proximal row carpectomy, intracarpal arthrodesis, and arthroplasty, nonsalvage procedures provided similar clinical and functional outcomes in both stages, with joint-levelling and radial wedge osteotomies preserving greater range of motion.  In this systematic review of Kienbock's disease stages IIIA and IIIB, all treatment modalities provided positive outcomes. In stage IIIB, there is evidence to support nonsalvage procedures, as they produced similar clinical outcomes to salvage procedures that have the advantage of not precluding future treatment options if needed and preserving greater range of motion.
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http://dx.doi.org/10.1055/s-0040-1716353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7708034PMC
December 2020

Development of an Swan Neck Deformity Biomechanical Model.

Hand (N Y) 2020 Oct 28:1558944720966736. Epub 2020 Oct 28.

Western University, London, Ontario, Canada.

Background: Injury to the finger's extensor mechanism is a common cause of swan neck deformity (SND). Progression of extensor and flexor tendon imbalance negatively affects laxity of the volar plate, resulting in the inhibition of proper finger motion. The complexity of finger anatomy, however, makes understanding the pathomechanics of these deformities challenging. Therefore, development of an SND model is imperative to understand its influence on finger biomechanics and to provide an in vitro model to evaluate the various treatment options.

Methods: The index, middle, and ring fingers from 8 cadaveric specimens were used in an in vitro active motion simulator to replicate finger flexion/extension. An SND model was developed through sectioning of the terminal extensor tendon at the distal insertion (creating a mallet finger) and transverse retinacular ligament (TRL). A strain gauge inserted under the volar plate measured laxity of the plate, and electromagnetic trackers recorded proximal interphalangeal joint (PIPJ) angles.

Results: Strain in the volar plate increased progressively with creation of the mallet and SND conditions ( = .015). Although not statistically significant, the mallet finger condition accounted for 26% of the increase, whereas sectioning of the TRL accounted for 74% ( = .031). As predicted, PIPJ hyperextension was not detectable by joint angle measurement; however, the PIPJ angle had a strong positive correlation with volar plate strain ( = 1.0, < .001).

Conclusion: Volar plate strain measurement, in an in vitro model, can detect an induced SND. Moreover, as a surrogate for PIPJ hyperextension, volar plate strain may be useful to evaluate the time-zero effectiveness of various surgical interventions.
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http://dx.doi.org/10.1177/1558944720966736DOI Listing
October 2020

No difference in 90-day complication rate following open versus arthroscopic Latarjet procedure.

Knee Surg Sports Traumatol Arthrosc 2020 Oct 6. Epub 2020 Oct 6.

New York University Langone Health, New York, NY, USA.

The purpose of this study was to compare the 90-day complication rate between the open and arthroscopic Latarjet procedure. A retrospective review of patients who underwent an open or arthroscopic Latarjet procedure at NYU Langone Health between 2012 and 2019 was performed. The complications, readmissions, and reoperations within 90 days were assessed. Outcomes were compared between the two approaches, and a p value of < 0.05 was considered to be statistically significant. The study included 150 patients (open: 110; arthroscopic: 40), with no patients lost to follow-up within the first 90 days. Both cohorts were similar in terms of patient demographics. No intra-operative complications were observed in either group. Overall, there were 4 post-operative complications with the open approach and 2 with the arthroscopic approach (3.6% and 5.0%, respectively; n.s.) during the study period. Three patients required a readmission within the 90-day period; one patient in both groups required a revision Latarjet for graft fracture, and one patient in the open Latarjet required irrigation and debridement for deep infection (n.s.). With the open approach, there were 2 (2.3%) wound complications, 1 graft complication, and 1 (1.1%) nerve injury. With the arthroscopic approach, there was 1 (2.8%) wound complication and 1 (2.8%) hardware complication. The safety, and 90-day complication and readmission profile of arthroscopic Latarjet is similar to open Latarjet procedure. LEVEL OF EVIDENCE: Level III.
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http://dx.doi.org/10.1007/s00167-020-06301-0DOI Listing
October 2020

Lateral Trochlear Ridge: A Non-Articulating Zone for Anterior-to-Posterior Screw Placement in Fractures Involving the Capitellum and Trochlea.

J Bone Joint Surg Am 2019 Aug;101(15):e75

University of Ottawa, Ottawa, Ontario, Canada.

Background: Coronal shear fractures of the distal aspect of the humerus that involve the capitellum and the trochlea are rare; nevertheless, they are difficult to treat because of the complex fracture patterns and osteochondral nature of the fragments, limiting optimal screw placement. The use of anterior-to-posterior screw fixation by a lag technique (without countersinking) could potentially improve the strength of the construct. Our primary research question was to anatomically determine if there is a non-articulating zone for screw placement along the anterior aspect of the lateral trochlear ridge (aLTR) throughout normal elbow range of motion.

Methods: Eight fresh-frozen cadaveric elbows were used. The region of interest was defined with 3 polymeric pins inserted in the inferior, middle, and superior-most aspects of the aLTR of each elbow, with use of an extensor digitorum communis (EDC) split approach. The elbows were then mounted on a magnetic resonance imaging (MRI)-compatible compression frame and subjected to high-resolution 7-T MRI at 90°, 120°, and 145° of flexion (positions of potential impingement), and at neutral and maximal pronation and maximal supination for each position of flexion. Portions of the aLTR that had free adjacent space were identified using the sagittal and coronal scans. This non-articulating region was identified as the "non-articulating zone" (NAZ).

Results: The NAZ was found to encompass the proximal 38.2% (range, 30.2% to 48.9%) of the aLTR, measuring, on average, 5.2 mm in width. It was consistently located either directly adjacent to the apex of the ridge or just medial to it. The distal 61.8% of the aLTR articulated with either the ulna or the radial head in some of the elbows.

Conclusions: Our results suggest that there is a portion of the aLTR that, despite being covered with articular cartilage, is non-articulating throughout normal elbow range of motion.

Clinical Relevance: In situations in which headless anterior-to-posterior and posterior-to-anterior screw insertion results in inadequate fixation of capitellar-trochlear fractures, anterior-to-posterior lag screw instrumentation along the non-articulating portion of the aLTR may provide a location for additional fixation in some patients. However, because of variation between patients, each case must be individualized.
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http://dx.doi.org/10.2106/JBJS.18.01270DOI Listing
August 2019

Anatomic Shoulder Arthroplasty: Technical Considerations.

Open Orthop J 2017 30;11:1115-1125. Epub 2017 Sep 30.

Associate Professor of Surgery, Division of Orthopaedic Surgery, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Osteoarthritis of the shoulder is a common condition in the aging population, and it can have profound effects on patients' quality of life. The anatomic total shoulder arthroplasty is a well-described treatment modality resulting generally excellent outcomes. The objective of this review is to discuss the technical aspects of primary anatomic total shoulder arthroplasty, and to provide a framework to follow to achieve a successful surgical result. The topics covered include preoperative planning, surgical considerations, and approaches, humeral preparation, glenoid bone loss and the emerging concept of using the reverse total shoulder arthroplasty for the type B2 glenoid.
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http://dx.doi.org/10.2174/1874325001711011115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5676003PMC
September 2017

A randomized, double-blind sham-controlled trial on the efficacy of arthroscopic tennis elbow release for the management of chronic lateral epicondylitis.

BMC Musculoskelet Disord 2016 06 1;17:239. Epub 2016 Jun 1.

Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada.

Background: Tennis elbow is a common elbow pathology typically affecting middle-aged individuals that can lead to significant disability. Most cases resolve within 2 years of symptom onset, but a subset of patients will develop persistent symptoms despite appropriate conservative management. There are several surgical approaches used to treat chronic tennis elbow, with arthroscopic surgery becoming an increasingly popular approach to address this pathology in North America. This procedure involves the arthroscopic release of the extensor carpi radialis brevis tendon (ECRB) origin at the elbow. The potential benefit of arthroscopic treatment of this condition is improved patient outcomes and shorter recovery time following surgery. The results of this technique have been reported only in the context of case series, which have shown positive results. However, in order to justify its widespread use and growing popularity, a high level of evidence study is required. The purpose of this prospective, randomized sham-controlled trial is to determine whether arthroscopic tennis elbow release is effective at treating chronic lateral epicondylitis.

Methods: We will conduct a prospective single center, double-blind, randomized sham-controlled parallel arm trial evaluating the efficacy of arthroscopic tennis elbow release in adult patients with symptoms for at least 6 months. Patients will undergo intraoperative randomization after diagnostic arthroscopy of the elbow to receive either ECRB release (through the creation of a lateral portal) or a sham lateral portal and no ECRB release. The primary outcome will be the Mayo Elbow Performance Score (MEPS) at 1 year follow-up. Secondary outcomes will be the abbreviated Disability of the Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons elbow (ASES-e) score and grip strength at 3, 6, 12 and 24 months as well as return-to-work time, ability to return to full duty and adverse outcomes.

Discussion: Results of this study will provide empirical high quality evidence to guide clinical decision-making in patients with chronic tennis elbow.

Trial Registration: NCT02236689 (September 8, 2014).
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http://dx.doi.org/10.1186/s12891-016-1093-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4888299PMC
June 2016

Circumferential Casting of Distal Radius Fractures.

J Orthop Trauma 2014 Aug;28(8):e186-90

*Division of Orthopedic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Canada; and †Faculty of Medicine, McGill University, Montreal, Canada.

Objectives: To determine the prevalence and predictive factors for the early cast alteration (splitting, trimming, and complete replacement) in patients with distal radius fractures (DRFs) treated in circumferential cast. To determine whether performing early cast alterations affects the fracture alignment.

Design: Retrospective Cohort Study.

Setting: Level 1 Trauma Center.

Patients: All adult patients who presented with a DRF to a tertiary care hospital over a 3-year period.

Intervention: All DRFs without immediate surgical indications are initially treated with circumferential casts at this center.

Outcome Measurements: The following variables were analyzed: patient demographics, polytrauma at the time of injury, physician subspecialty performing reduction, and type of cast alteration. Radiographs were used to assess initial fracture characteristics and secondary displacement of reduction over time. Analysis was performed primarily to identify predictive variables for the early cast alteration and secondarily to determine the effect of these alterations on fracture alignment.

Results: 296 patients were included in the study. One of every 4-5 patients had their cast altered within the first 10 days of treatment. One of 3 polytrauma patients had their cast altered. No type of cast alteration was found to be significantly predictive of loss of fracture alignment at 2 or 6 weeks.

Conclusions: Cast alteration is commonplace after casting of DRFs but is not associated with the loss of alignment. Patients with polytrauma may benefit from immediate cast splitting.

Level Of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000000045DOI Listing
August 2014

A ten-year analysis of the research funding program of the orthopaedic trauma association.

J Bone Joint Surg Am 2013 Oct;95(19):e1421-6

Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, 325 9th Avenue, Seattle, WA 98104. E-mail address:

Background: The Orthopaedic Trauma Association (OTA) awarded over $3 million in research grants during 2000 through 2009. However, little is known regarding the outcomes of this funding program. Given the continued constraints in securing research dollars, we evaluated the research funding program of the OTA over this ten-year period. We studied the association of grant funding with (1) the publication rate, (2) the cost per publication, (3) the journal impact factor for published manuscripts, and (4) the dollar amount of extramural funding secured.

Methods: Grants from the target period were identified with use of the OTA online archive. The title of each grant and the name of the principal investigator were used to search across seven scientific databases for associated publications.

Results: Over the study period, $3,507,050 was awarded through 131 grants (thirty-three clinical, thirty-nine basic science, and fifty-nine resident). A total of 202 associated publications (seventy-three for the clinical grants, eighty-four for the basic science grants, and forty-five for the resident grants) were identified. Twenty-two (67%) of the clinical grants led to at least one publication compared with thirty-one (79%) of the basic science grants and twenty-four (41%) of the resident grants. The cost per publication was $26,892 for the clinical grants compared with $11,357 for the basic science grants and $13,111 for the resident grants. The mean impact factor of the journals containing the publications was 2.58.

Conclusions: Over the study period, the publication output for the funded projects was substantial. Basic science grants had the highest publication rate. The three types of grants resulted in publication in peer-reviewed journals with similar impact factors.
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Source
http://dx.doi.org/10.2106/JBJS.L.01627DOI Listing
October 2013