Publications by authors named "Jacob G Calcei"

21 Publications

  • Page 1 of 1

Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis.

Cartilage 2021 May 8:19476035211011515. Epub 2021 May 8.

Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.

Objective: The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy.

Study Design: Retrospective cohort study, level III.

Design: Patients who underwent knee ACI (Current Procedural Terminology [CPT] 27412) or OCA (CPT 27415) with minimum 2-year follow-up were queried from a national insurance database. Resulting cohorts of patients that underwent ACI and OCA were then divided into patients who underwent isolated cartilage restoration procedure and patients who underwent concomitant osteotomy (CPT 27457, 27450, 27418). Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using ICD-9-CM codes. The cost per patient was calculated.

Results: A total of 1,113 patients (402 ACI, 67 ACI + osteotomy, 552 OCA, 92 OCA + osteotomy) were included (mean follow-up of 39.0 months). Reoperation rate was significantly higher after isolated ACI or OCA compared to ACI or OCA plus concomitant osteotomy (ACI 68.7% vs. ACI + osteotomy 23.9%; OCA 34.8% vs. OCA + osteotomy 16.3%). Overall complication rates were similar between isolated ACI (3.0%) and ACI + osteotomy (4.5%) groups and OCA (2.5%) and OCA + osteotomy (3.3%) groups. Payments were significantly higher in the osteotomy groups at day of surgery and 9 months compared to isolated ACI or OCA, but costs were similar by 2 years postoperatively.

Conclusions: Concomitant osteotomy at the time of index ACI or OCA procedure significantly reduces the risk of reoperation with a similar rate of complications and similar overall costs compared with isolated ACI or OCA.
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http://dx.doi.org/10.1177/19476035211011515DOI Listing
May 2021

Isolated Traumatic Tear of the Middle Head of the Deltoid Muscle: A Case Report.

JBJS Case Connect 2021 Jan-Mar;11(1):e20.00305

Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York.

Case: A 27-year-old male pedestrian struck presented with left shoulder pain and weakness 4 months postinjury, with an isolated middle head of the deltoid tear. The patient's pain persisted despite extensive nonoperative management. The deltoid was primarily repaired to the lateral acromion using a transosseous suture repair technique.

Conclusion: Suture repair of the deltoid to the acromion using transosseous tunnel fixation is a successful treatment for traumatic, isolated tears of the middle head of the deltoid muscle that fail conservative treatment. After surgical repair and physical therapy, our patient recovered full, pain-free range of motion and strength at 6 months.
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http://dx.doi.org/10.2106/JBJS.CC.20.00305DOI Listing
April 2021

The Science and Biomechanics of Long-Toss.

Curr Rev Musculoskelet Med 2021 Jun 8;14(3):224-231. Epub 2021 Apr 8.

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.

Purpose Of Review: Overhead throwing is a particularly violent motion that requires a complex sequence of timed muscle activations to efficiently transfer energy up the kinetic chain to throw a ball. Long-toss has long been utilized as a means of increasing shoulder range of motion, strength, and endurance, as well as an important component of rehabilitation in interval throwing programs. The purpose of this review is to assess the current literature on the science and biomechanics of long-toss.

Recent Findings: While long-toss is ubiquitously utilized in throwing programs for pitchers of all ages, the definition of long-toss, as well as its primary function in a throwing program, is debated. Throwing biomechanics in long-toss differ from that of mound pitching, although much of the variation is determined by the type of long-toss: shorter distance and on a line versus maximum distance and not on a line. Biomechanical factors including the kinematic changes of increased maximum glenohumeral external rotation, increased maximum elbow flexion, decreased trunk forward flexion at front foot contact, kinetic changes of increased shoulder internal rotation torque, increased elbow varus torque, and increased elbow extension velocity can occur with maximum distance long-toss throwing. Long-toss is a highly variable training supplement that is used in throwing programs at all levels of baseball competition. Current literature has demonstrated a number of kinetic and kinematic changes in the throwing arm and throwing motion related to increasing long-toss distances. However, the exact benefits of long-toss are difficult to quantify due to the numerous definitions and various utilizations of long-toss.
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http://dx.doi.org/10.1007/s12178-021-09706-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8137765PMC
June 2021

Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures.

Cartilage 2021 Mar 20:1947603521993219. Epub 2021 Mar 20.

Hospital for Special Surgery, New York, NY, USA.

Objective: To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques.

Design: A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons.

Results: There is a high level of evidence to support the treatment of small to medium size lesions (<2-4 cm) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions (>4 cm), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint.

Conclusions: Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.
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http://dx.doi.org/10.1177/1947603521993219DOI Listing
March 2021

Evaluation of Athletes with Hip Pain.

Clin Sports Med 2021 Apr;40(2):221-240

Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA. Electronic address:

Hip pain is a common complaint in athletes and can result in a significant amount of time lost from sport. Diagnosis of the source of hip pain can be a clinical challenge because of the deep location of the hip and the extensive surrounding soft tissue envelope. Establishing whether the source of hip pain is intra-articular or extra-articular is the first step in the process. A thorough history and a consistent and comprehensive physical examination are the foundation for the proper management of athletes with hip pain.
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http://dx.doi.org/10.1016/j.csm.2020.11.001DOI Listing
April 2021

ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 24. Epub 2021 Jan 24.

Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.

Purpose: Anterior cruciate ligament reconstruction (ACLR) aims to restore knee function and stability, allowing patients to return to the activities they enjoy and minimize further injury to the meniscus and cartilage and their ultimate progression to osteoarthritis. This study aims to present the evolution of graft choice over the last three decades according to members of the ACL Study Group (SG).

Methods: Prior to the January 2020 ACL SG biannual meeting, a survey was administered consisting of 87 questions and 16 categories, including ACLR graft choice. A similar questionnaire has been administered prior to each meeting and survey results from the past 14 meetings (1992 through 2020, excluding 1994) are included in this work. Survey responses are reported as frequencies in percentages to quantify changes in practice over the surgery period.

Results: In 1992, the most frequent graft choice for primary ACLR was bone-patellar tendon-bone (BTB) autograft, at nearly 90%. Hamstring tendon (HT) autografts have increased in popularity, currently over 50%, followed by just under 40% BTB autograft. Recently, quadriceps tendon (QT) autograft has increased in popularity since 2014.

Conclusion: Autograft (HT, BTB, QT) is an overwhelming favorite for primary ACLR over allograft. The preference for HT autograft increased over the study period relative to BTB autograft, with QT autograft gaining in popularity in recent years. Graft selection should be individualized for each patient and understanding the global trends in graft choice can help orthopaedic surgeons discuss graft options with their patients and determine the appropriate graft for each case.

Level Of Evidence: Level V, Expert Opinion.
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http://dx.doi.org/10.1007/s00167-021-06443-9DOI Listing
January 2021

Management of Large Focal Chondral and Osteochondral Defects in the Knee.

J Knee Surg 2020 Dec 1;33(12):1187-1200. Epub 2020 Dec 1.

Knee Preservation and Cartilage Restoration Center, OrthoIndy, Indianapolis, Indiana.

Large, focal articular cartilage defects of the knee (> 4 cm) can be a source of significant morbidity and often require surgical intervention. Patient- and lesion-specific factors must be identified when evaluating a patient with an articular cartilage defect. In the management of large cartilage defects, the two classically utilized cartilage restoration procedures are osteochondral allograft (OCA) transplantation and cell therapy, or autologous chondrocyte implantation (ACI). Alternative techniques that are available or currently in clinical trials include a hyaluronan-based scaffold plus bone marrow aspirate concentrate, a third-generation autologous chondrocyte implant, and an aragonite-based scaffold. In this review, we will focus on OCA and ACI as the mainstay in management of large chondral and osteochondral defects of the knee. We will discuss the techniques and associated clinical outcomes for each, while including a brief mention of alternative treatments. Overall, cartilage restoration techniques have yielded favorable clinical outcomes and can be successfully employed to treat these challenging large focal lesions.
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http://dx.doi.org/10.1055/s-0040-1721053DOI Listing
December 2020

Return to Play After Biceps Tenodesis and Transfer in a Young, Athletic Population.

Orthopedics 2021 Jan 3;44(1):e13-e18. Epub 2020 Nov 3.

The goal of this study was to investigate the level of play that can be expected in a young, athletic population after biceps tenodesis and transfer. The authors hypothesized that both return to play rates and clinical improvement would be high after biceps tenodesis and transfer among young athletes. They conducted a retrospective review of patients who underwent biceps tenodesis and transfer procedures with a minimum follow-up of 24 months. Eligible patients were contacted for consent and asked to complete a questionnaire on patient-reported, shoulder-specific outcome measure scores, level of postoperative play, and other relevant information. The study included 41 patients with a mean age of 21.3 years. Patients reported a mean Kerlan-Jobe Orthopaedic Clinic (KJOC) score of 71.7, Disabilities of the Arm, Shoulder and Hand (DASH)-Sports score of 21.3, Single Assessment Numeric Evaluation (SANE) score of 79.4, and Numeric Rating Scale (NRS) pain score of 1.8. Scores for all patient-reported outcome measures were statistically better (P<.05) for patients who underwent biceps transfer (n=24) compared with biceps tenodesis (n=17). Of the participants, 26 (63%) played a primary overhead throwing sport. Most of the patients (95%) returned to play, and of those who returned to play, 67% returned to their preoperative level or higher. Although biceps tenodesis and transfer procedures have been designated primarily for older patients with biceps-labral complex injuries, the high return to play rates and outcome scores of patients in this case series show that biceps tenodesis and transfer can provide effective surgical treatment for a younger athletic population with biceps-labral complex injuries. [Orthopedics. 2021;44(1):e13-e18.].
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http://dx.doi.org/10.3928/01477447-20201009-03DOI Listing
January 2021

Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis.

Cartilage 2020 Oct 27:1947603520967065. Epub 2020 Oct 27.

Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.

Objective: To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database.

Design: Subjects who underwent knee ACI (Current Procedural Terminology [CPT] code 27412) or OCA (CPT code 27415) with minimum 2-year follow-up were queried from a national insurance database. Reoperation was defined by ipsilateral knee procedure after index surgery. Multivariate logistic regression models were built to determine the effect of independent variables (age, sex, tobacco use, obesity, diabetes, and concomitant osteotomy) on reoperation rates. The 30-day complication rates were assessed using ICD-9-CM codes. The cost of the procedures per patient was calculated. Statistical comparisons were made. All values were reported with significance set at < 0.05.

Results: A total of 909 subjects (315 ACI and 594 OCA) were included (mean follow-up 39.2 months). There was a significantly higher reoperation rate after index ACI compared with OCA (67.6% vs. 40.4%, < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, < 0.0001 and OR 0.2, = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups ( = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA ( = 0.013).

Conclusions: Autologous chondrocyte implantation had significantly higher reoperation rates and cost with similar complication rates compared with OCA. Concomitant osteotomy significantly reduced the risk for reoperation in both groups.
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http://dx.doi.org/10.1177/1947603520967065DOI Listing
October 2020

The Orthopaedic Political Action Committee: Growth and Influence Over 20 Years.

J Am Acad Orthop Surg 2020 Jul;28(14):563-569

From the Stanford University (Dr. Calcei), Palo Alto, CA, the Rubin Institute (Dr. Delanois), Baltimore, MD, the NYU Langone Health (Dr. Lajam), New York, NY, the Dallas Sports Medicine (Dr. Gill), Dallas, TX, and the Mayo Clinic (Dr. Freedman), Rochester, MN.

The Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons, also known as the OrthoPAC, is one of the most powerful and well-respected healthcare PACs in Washington, DC. Since its inception in 1999, the OrthoPAC has advocated at the federal level for orthopaedic patients and orthopaedic surgery as a profession. This manuscript will familiarize the reader with PACs, the history and structure of the OrthoPAC, important accomplishments of the OrthoPAC, current legislative positions, and leadership/organization. We also review the various ways that orthopaedic surgeons can engage in advocacy for musculoskeletal care.
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http://dx.doi.org/10.5435/JAAOS-D-19-00823DOI Listing
July 2020

Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database.

Am J Sports Med 2020 08 15;48(10):2353-2359. Epub 2020 Jul 15.

Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, California, USA.

Background: Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series.

Purpose: To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database.

Study Design: Cohort study; Level of evidence, 3.

Methods: A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All values were reported with significance set at < .05.

Results: A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery ( < .001), meniscal transplantation ( = .005), or total knee arthroplasty ( = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; < .001).

Conclusion: Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.
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http://dx.doi.org/10.1177/0363546520935453DOI Listing
August 2020

Isolated tears of the sternocostal head of the pectoralis major muscle: surgical technique, clinical outcomes, and a modification of the Tietjen and Bak classification.

J Shoulder Elbow Surg 2020 Jul 20;29(7):1359-1367. Epub 2020 Feb 20.

Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, NY, USA. Electronic address:

Hypothesis: We aimed to describe a modified surgical technique to treat isolated sternocostal head tears using cortical button fixation while preserving the intact clavicular head tendon, to outline a new classification of pectoralis major injuries, and to present the clinical outcomes and return-to-sport data of a cohort of 21 athletes who underwent surgical repair.

Methods: We reviewed prospectively collected data of patients who underwent surgical repair with the described technique for isolated sternocostal head tears from 2008 to 2014. Two-year postoperative clinical outcomes including the Single Assessment Numeric Evaluation score, isokinetic strength, patient satisfaction, and return to sport, as well as preinjury and postoperative bench-press weight, were collected, and descriptive statistics were used for analysis.

Results: Twenty-one patients who underwent repair of isolated sternocostal head tears were included. The majority of the isolated tears of the sternocostal head of the pectoralis major (57%) occurred during the bench press. Of the ruptures, 81% were Tietjen type IIIC and 19% were type IIID. Postoperative Single Assessment Numeric Evaluation scores averaged 90.1 (standard deviation, 8.4), and patient satisfaction was 9.5 of 10 (standard deviation, 0.9). All athletes returned to sport approximately 5.5 months postoperatively. The isokinetic strength deficit averaged 8% compared with the contralateral arm, whereas the average preinjury bench-press weight of 134 kg (range 88-227 kg) was restored to 117 kg (range 61-250 kg) postoperatively.

Conclusion: We propose a new classification of pectoralis major injury. In addition, we present a biomechanically sound repair technique for isolated tears of the sternocostal head of the pectoralis with favorable outcomes. The technique takes the specific anatomy of the sternocostal and clavicular heads into account for the approach.
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http://dx.doi.org/10.1016/j.jse.2019.11.024DOI Listing
July 2020

Arthroscopic shoulder stabilization in the young athlete: return to sport and revision stabilization rates.

J Shoulder Elbow Surg 2020 May 4;29(5):946-953. Epub 2019 Dec 4.

Hospital for Special Surgery, Sports Medicine and Shoulder Service, New York, NY, USA.

Background: Shoulder instability in young athletes is a complex problem with higher recurrence, higher reoperation, and lower return to sport (RTS) rates after arthroscopic shoulder stabilization compared with adults.

Methods: This is a prospective case series of young athletes with anterior shoulder instability after arthroscopic stabilization surgery. Primary outcomes were RTS and revision surgery, minimum follow-up was 24 months. Exclusion criteria were more than 3 preoperative episodes of instability, significant bone loss, or primary posterior instability. Demographic data, recurrent instability, revision surgery, sports pre- and postsurgery, patient satisfaction, level of RTS, time to RTS, and Single Assessment Numeric Evaluation (SANE) scores were analyzed.

Results: Sixty-seven athletes met inclusion criteria, 19 females and 48 males, with a mean age of 17.5 years (range, 13-21 years). Fifty-nine (88%) athletes returned to sport at an average of 7.1 months (standard deviation, ±1.8); 50 (75%) returned to the same level or higher. Football and lacrosse were the most common sports. Four of 67 athletes (6%), all male, underwent revision stabilization at 11-36 months for recurrent instability. The overall mean SANE score was 88.

Conclusion: This study demonstrates that when the high-risk athlete, 21 years old or younger, is appropriately selected for arthroscopic shoulder stabilization by excluding those with 3 or more preoperative shoulder instability episodes and those with off-track and engaging instability patterns, excellent outcomes can be achieved with low revision surgery rates, high RTS rates, and high patient satisfaction.
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http://dx.doi.org/10.1016/j.jse.2019.09.033DOI Listing
May 2020

Operative Treatment for a Painful Nonunion Avulsion Fracture of the Femoral Attachment of the Medial Collateral Ligament in a Teenager: A Case Report.

JBJS Case Connect 2019 Apr-Jun;9(2):e0281

Department of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.

Case: A 13-year-old female gymnast presented with medial knee pain despite several months of nonoperative management for a valgus hyperextension injury resulting in a bony avulsion fracture of the medial collateral ligament (MCL) origin at the medial femoral condyle. The MCL was repaired via open reduction and internal fixation (ORIF) with a single 4.0 mm cannulated screw and washer.

Conclusions: ORIF is a successful treatment option for extra-articular bony MCL origin avulsion fractures that fail conservative treatment. Following surgical intervention and structured physical therapy, our patient had full return to sports at 10 months.
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http://dx.doi.org/10.2106/JBJS.CC.17.00281DOI Listing
June 2020

Orthobiologics for Bone Healing.

Clin Sports Med 2019 Jan;38(1):79-95

Department of Sports Medicine and Shoulder, Hospital for Special Surgery, 535 E 70th Street, New York, NY 10021, USA.

Orthobiologics are a group of biological materials and substrates that promote bone, ligament, muscle, and tendon healing. These substances include bone autograft, bone allograft, demineralized bone matrix, bone graft substitutes, bone marrow aspirate concentrate, platelet-rich plasma, bone morphogenetic proteins, platelet-derived growth factor, parathyroid hormone, and vitamin D and calcium. Properties of orthobiologics in bone healing include osteoconduction, osteoinduction, and osteogenesis. This article discusses the important properties of orthobiologics in bone healing, many of the orthobiologics currently available for bone healing, the related literature, their current clinical uses in sports medicine, and systemic factors that inhibit bone healing.
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http://dx.doi.org/10.1016/j.csm.2018.08.005DOI Listing
January 2019

The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS): Normative Data.

Am J Sports Med 2018 04 7;46(5):1228-1234. Epub 2018 Mar 7.

Hospital for Special Surgery, New York, New York, USA.

Background: Recent data have shown an increase in youth sports participation at younger ages, which may be linked to greater musculoskeletal injury risk. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) is a validated 8-item instrument designed to quantify the activity of children between 10 and 18 years old. Normative data on pediatric and adolescent activity level are unknown.

Purpose: To establish normative activity-level data for American youth and to determine if there is a natural decrease in activity level during adolescence.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A cross-sectional investigation was performed among 2002 US children and adolescents equally split by sex and age and representing census-weighted distributions of state of residency, race/ethnicity, and health insurance status. Respondents completed the HSS Pedi-FABS, as well as survey questions on demographics and sports participation. Normative data were reported with descriptive statistics. Linear regression analysis was performed to determine if there was an effect of age on activity level during adolescence.

Results: A total of 2002 respondents completed the survey; the mean age of the respondents at the time of survey completion was 14.0 ± 2.6 years. Mean weekly amount of reported physical activity was 9.3 ± 8.4 hours. HSS Pedi-FABS scores were normally distributed with a mean of 15.4 ± 8.5 points (out of 30 possible points). There was a modest but statistically significant decrease in HSS Pedi-FABS activity scores with increasing age ( r = -0.175, P < .001), corresponding to a linear decrease in activity scores by 27% on average from age 10 to 18 years.

Conclusion: The current study provides baseline normative data for activity level in a census-weighted representative population sample of 2002 American youth through the use of a validated activity score (HSS Pedi-FABS). There was a modest but statistically significant decrease in activity scores with increasing age. These results will aid future research by providing normative, representative population-level activity data and will help to quantify the natural rate of decreased activity during adolescence.
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http://dx.doi.org/10.1177/0363546518756349DOI Listing
April 2018

Biceps Tenodesis: Anatomic Tensioning.

Arthrosc Tech 2017 Aug 24;6(4):e1125-e1129. Epub 2017 Jul 24.

Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York, U.S.A.

Biceps tenodesis is a commonly employed surgical intervention for refractory symptoms related to the biceps-labral complex, those intra-articular and those within the extra-articular bicipital tunnel. While a litany of surgical techniques exists, the optimal method for ensuring an anatomic length-tension relationship during tenodesis remains elusive. Appropriate tensioning may limit undesirable outcomes such as cramping or cosmetic deformity. We describe herein our technique as a simple and efficient means to establish patient-specific, anatomic tensioning of the long head of the biceps during tenodesis.
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http://dx.doi.org/10.1016/j.eats.2017.03.033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5621850PMC
August 2017

Diagnosis and Treatment of Injuries to the Biceps and Superior Labral Complex in Overhead Athletes.

Curr Rev Musculoskelet Med 2018 Mar;11(1):63-71

Hospital for Special Surgery, Department of Sports Medicine and Shoulder, 535 E 70th St, New York, NY, 10021, USA.

Purpose Of Review: This review discusses the diagnostic and treatment challenges presented by injuries to the biceps and superior labral complex.

Recent Findings: A focused patient history, numerous physical examination maneuvers, and appropriate advanced imaging studies must be utilized to reach an accurate diagnosis. Nonoperative management, even in overhead athletes, has demonstrated relatively good outcomes, while operative outcomes have yielded mixed results. The surgeon must take into account a number of variables when choosing the appropriate surgical procedure: labral repair versus biceps tenodesis. Rehabilitation, either as nonoperative management or as a postoperative protocol, should focus on restoring glenohumeral and scapulothoracic strength, endurance, and full, pain-free range of motion, while correcting any deficiencies in balance or rhythm throughout the overhead motion. Despite the operative treatment challenges that SLAP tears present, with new techniques and proper patient selection, overhead athletes with injuries to the biceps and superior labrum complex can return to sport at a high level.
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http://dx.doi.org/10.1007/s12178-018-9460-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825341PMC
March 2018

Retrieval Analysis of Porous Titanium Glenoid Posts: An Evaluation of Osteointegration.

Orthopedics 2017 Jul 31;40(4):e703-e707. Epub 2017 May 31.

Glenoid component loosening is a commonly encountered complication of total shoulder replacements. Therefore, focus has been placed on glenoid fixation. Porous metal implants, which promote biological fixation through osteointegration, have provided an uncemented alternative to the traditional cemented implant. In this explantation study, the authors examined the bone ingrowth and ongrowth of a specific porous titanium glenoid peg. Six explanted polyethylene glenoid components with porous titanium-coated central pegs were identified in the authors' implant retrieval program via retrospective review. The retrieved implants were sectioned into thirds with a precision saw and underwent scanning electron microscopy for analysis of bone ingrowth and ongrowth. Bone ingrowth was calculated as bone volume fraction, or the fraction of available pore space filled with bone, whereas ongrowth was the percentage of the perimeter of the implant covered with bone. The 6 total shoulders included in the study were revised at an average of 16.3 months (range, 5-48 months) for instability secondary to subscapularis rupture, subscapularis rupture plus infection, or other rotator cuff tear. All glenoid components were grossly stable on retrieval and had an average of 23% bone ingrowth and 54% ongrowth. The preliminary results show that osteointegration into a porous titanium ingrowth glenoid component is possible in the short-term, even in the presence of an unfavorable biomechanical environment, such as instability and rotator cuff dysfunction, as well as infection. [Orthopedics. 2017; 40(4):e703-e707.].
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http://dx.doi.org/10.3928/01477447-20170522-04DOI Listing
July 2017

Surgical options for anterior cruciate ligament reconstruction in the young child.

Curr Opin Pediatr 2015 Feb;27(1):82-91

Division of Pediatric Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.

Purpose Of Review: To review the most recent literature on the epidemiology, diagnosis, treatment, and outcomes of pediatric anterior cruciate ligament injury.

Recent Findings: There is an increasing prevalence of anterior cruciate ligament injuries in pediatric and adolescent athletes, and nonoperative management of these injuries results in worse outcomes than surgical reconstruction. Prevention exercise protocols are cost-effective in preventing this injury in adolescent athletes. A number of techniques are currently in practice that address anterior cruciate ligament injuries in the skeletally immature, but there is no consensus on the optimal technique.

Summary: The reported clinical outcomes from anterior cruciate ligament reconstruction in young patients are favorable.
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http://dx.doi.org/10.1097/MOP.0000000000000174DOI Listing
February 2015

Iliotibial band syndrome: evaluation and management.

J Am Acad Orthop Surg 2011 Dec;19(12):728-36

Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, USA.

Iliotibial band syndrome is a common overuse injury typically seen in runners, cyclists, and military recruits. Affected patients report lateral knee pain associated with repetitive motion activities. The diagnosis is usually made based on a characteristic history and physical examination, with imaging studies reserved for cases of recalcitrant disease to rule out other pathologic entities. Several etiologies have been proposed for iliotibial band syndrome, including friction of the iliotibial band against the lateral femoral epicondyle, compression of the fat and connective tissue deep to the iliotibial band, and chronic inflammation of the iliotibial band bursa. The mainstay of treatment is nonsurgical; however, in persistent or chronic cases, surgical management is indicated.
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http://dx.doi.org/10.5435/00124635-201112000-00003DOI Listing
December 2011