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    ajstoner@stanford.edu
    University - Student Department: School of Medicine Position: Graduate, Medicine

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  • Mail Code: 5717

All Publications

  • Segmental trans-endplate pedicle screws do not induce spinal deformity in a porcine model. Spine deformity Johnson, T. R., Generoso, T. O., Farnsworth, C., Jobanputra, A., Wen, J. H., Stoner, A. J., Salunga, A., Ho, V., Guzman, M., Berry, D., Upasani, V., Vorhies, J. S. 2026

    Abstract

    Growth modulation is an established technique for limb deformity correction and is increasingly applied to spinal deformities. While distraction-based posterior and anterior compressive methods have been explored, spinal growth modulation through fixation across vertebral growth centers remains unstudied. We hypothesized that unilateral trans-endplate screws-spinal epiphysiodesis trajectory (SET) screws-could induce partial anterior growth arrest and promote scoliotic deformity in a porcine model.Four male piglets (two experimental, two control) underwent unilateral posterior spinal instrumentation at four lower thoracic levels at eight weeks of age. Experimental animals received trans-endplate SET screws; controls received pedicle screws. Radiographs obtained three months postoperatively assessed vertebral height and Cobb angles. MRI and CT were also used to evaluate vertebral wedging, disc and facet health, physeal bars, and endplate changes.After three months, no significant differences in coronal or sagittal Cobb angles were observed between SET and pedicle screw groups (p > 0.05). No vertebral wedging or restriction of vertical growth was seen in either group. Disc and facet health remained unchanged by Pfirrmann and Fujiwara grading. No physeal bars were identified; one SET specimen showed endplate irregularities.In this pilot porcine model, SET screws did not produce scoliotic or kyphotic deformity. Further research is necessary to clarify the mechanisms and timing required for effective anterior spinal growth modulation.IV.

    View details for DOI 10.1007/s43390-026-01313-1

    View details for PubMedID 41910710

    View details for PubMedCentralID 5686794

  • The Anatomy of the Anterior Intermeniscal Ligament in Children: Implications for Tibial Spine Fractures, Meniscal Injuries, and Anterior Cruciate Ligament Reconstruction ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Alayleh, A. M., Hollyer, I., Johnstone, T., Obilo, C., McFarlane, K., Cruz, J., Stoner, A., Duru, N., Pham, N., Chan, C., Ellis, H. B., Schmitz, M. R., Tompkins, M., Yen, Y., Ganley, T., Shea, K. G. 2026; 14 (3): 23259671251412407

    Abstract

    The anterior intermeniscal ligament (AIML) footprint and dimensions in skeletally immature knees have not been well documented. The AIML may play an important role in tibial spine fracture (TSF) reduction and meniscal repair/stability. The AIML is vulnerable to injuries during drill hole placement in anterior cruciate ligament (ACL) reconstruction. Therefore, it is necessary to characterize the anatomy of the AIML in skeletally immature knees to prevent iatrogenic injuries.To evaluate AIML dimensions, its meniscal attachment patterns, and its relationship to the ACL.Descriptive laboratory study.A total of 12 fresh-frozen cadaveric knees, 6 male and 6 female, were dissected (mean age, 9.8 years [range, 9-11 years]). The distal aspect of the quadriceps tendon was transected, and the joint capsule was opened. The infrapatellar fat pad was dissected and the AIML identified. Photographs were taken with an in-frame ruler, and the AIML length and distance to the anterior aspect of the ACL were measured. The AIML insertion type was determined according to the classification system reported by Nelson and LaPrade.The mean length of the AIML was 23.6 mm (range, 19.8-31.9 mm). In 11 specimens, the mean distance between the AIML and the most anterior aspect of the ACL was 3.7 mm (range, 2.5-4.6 mm). In the remaining knee, the footprint of the anterior root of the medial meniscus, ACL, and AIML were nearly indistinguishable. The AIML was found with a type I insertion in 7 cases and a type II insertion in 5 cases.This study demonstrated the smaller dimensions of the AIML in skeletally immature patients and its relationship to key adjacent structures compared with previously reported adult data. These anatomic relationships highlight the AIML's vulnerability during ACL reconstruction, TSF reduction, and meniscal repair. Although the biomechanical consequences of the AIML remain unclear, we recommend avoiding injuries to this structure during procedures that may place it at risk.This study characterized the anatomy of the AIML in pediatric knees, highlighting its consistent presence, smaller dimensions, and proximity to critical structures. Understanding the AIML's anatomy will help to minimize iatrogenic injuries during surgery, particularly in ACL reconstruction, TSF reduction, and meniscal repair.

    View details for DOI 10.1177/23259671251412407

    View details for Web of Science ID 001719098000001

    View details for PubMedID 41884687

    View details for PubMedCentralID PMC13009989

  • Can Suture Tape Improve Radial Meniscal Tear Repair Over Traditional Suture? A Biomechanical Cadaveric Study. The American journal of sports medicine Stoner, A. J., Huang, A., Alayleh, A. M., Duru, N. O., Anaya Gallegos, A., Chan, C., Chan, C., Ellis, H. B., Ganley, T., Meadows, M. C., Schmitz, M. R., Sherman, S. L., Tompkins, M. A., Yen, Y. M., Shea, K. G. 2026: 3635465261422715

    Abstract

    While studies have demonstrated that the "hashtag" suture pattern may improve biomechanical repair properties in radial meniscal tears, the effect of the type of suture within the hashtag is unknown.The purpose of this study was to evaluate the repair strength of the hashtag repair using suture tape compared to traditional 2-0 suture. It was hypothesized that suture tape, particularly in the "rebar" portion of the hashtag repair, would significantly increase construct strength compared to traditional 2-0 suture.Controlled laboratory study.Complete radial tears were made at the midbody of 28 fresh-frozen adult lateral menisci. Specimens underwent hashtag repair with 1 of 4 different suture configurations: all 2-0 suture (2-0), all suture tape (tape), suture tape as the rebar and 2-0 suture as the horizontal component (hybrid v1), or 2-0 suture as the rebar and suture tape as the horizontal component (hybrid v2). Specimens were loaded in a tensile testing system and cyclically loaded for 500 cycles before load-to-failure testing. Load-to-failure (N), stiffness (N/mm), and mechanism of failure were recorded. Data were analyzed using analysis of variance with the Tukey multiple comparisons test.Tape constructs demonstrated significantly higher load-to-failure compared to 2-0 constructs (189.8 ± 16.1 N vs 145.6 ± 39.6 N; P = .0357). There was no significant difference between tape and hybrid v1 constructs (189.8 ± 16.1 N vs 191.2 ± 31.8 N; P = .9997). Hybrid v2 constructs failed at significantly lower loads (141.9 ± 19.7 N) compared to both tape and hybrid v1 repairs (P = .0205 and P = .0167, respectively). Hybrid v1 constructs also showed significantly higher stiffness (16.4 ± 2.3 N/mm) compared to 2-0 (13.2 ± 2.8 N/mm) and hybrid v2 (12.7 ± 1.7 N/mm) constructs (P = .0497 and P = .0182, respectively).Suture tape increased the hashtag repair strength and stiffness in radial meniscal tears in cadaveric menisci, with the improved strength attributed to suture tape in the rebar limb. The horizontal suture type did not significantly affect construct strength or stiffness. These data suggest that suture tape may significantly improve the biomechanical repair strength of hashtag radial meniscal tear repairs.Radial meniscal tears are difficult to repair and are associated with poor prognosis, necessitating further research into optimal repair constructs.

    View details for DOI 10.1177/03635465261422715

    View details for PubMedID 41731314

  • Comparative Analysis of Iliotibial Band Graft Length in Pediatric Anterior Cruciate Ligament Reconstruction: MacIntosh Versus All-Epiphyseal Femoral Drilling Technique. The American journal of sports medicine Duru, N. O., Stoner, A. J., Alayleh, A. M., Lind, D. R., Schultz, C., Pham, N. S., Ellis, H. B., Schmitz, M. R., Yen, Y. M., Tompkins, M. A., Ganley, T., Meadows, M. C., Chan, C., Shea, K. G. 2025: 3635465251371321

    Abstract

    Iliotibial band (ITB) grafts yield excellent outcomes for anterior cruciate ligament reconstruction (ACLR) in skeletally immature patients. Because closure of the ITB harvest interval is often not feasible, techniques that allow for shorter ITB grafts may be beneficial.That the all-epiphyseal femur ITB graft would be significantly shorter than the over-the-top ITB graft.Controlled laboratory study.Six fresh-frozen pediatric knees (mean age, 9.7 years; range, 9-11 years) were used. Surgeons simulated the modified MacIntosh and all-epiphyseal ITB ACLRs using No. 2 suture as a proxy for the ITB graft. A suture was attached at the ITB origin on the Gerdy tubercle and then passed over-the-top on the femur, under the transverse meniscal ligament, and to the metaphyseal anchor point. The length of the suture was measured. The suture was then placed through the all-epiphyseal femoral drill hole, under the transverse meniscal ligament to the same tibial metaphyseal anchor point. Femoral condyle width was recorded, and the relationship between graft length and technique was analyzed using analysis of covariance to adjust for femoral condyle widths.Graft length for the all-epiphyseal ITB ACLR was significantly shorter than that for the modified MacIntosh ITB ACLR, with a mean difference of 26.0 ± 6.0 mm (P < .001). Across both groups, each additional millimeter of condyle width was associated with an increase in graft length by 2.3 mm (P < .001). Mean graft lengths for the modified MacIntosh and all-epiphyseal femur were 173.3 ± 16.5 mm and 147.3 ± 16.0 mm, respectively.The all-epiphyseal femoral technique requires a significantly shorter ITB graft length compared with the modified MacIntosh technique. A nomogram was developed to estimate graft length differences adjusted for condyle width. Future pediatric studies should continue to explore the biomechanics of both graft techniques, as they may provide lateral extra-articular stabilization and reduce ACL reinjury rates.Shortened ITB autograft length may reduce symptoms associated with muscle herniation.

    View details for DOI 10.1177/03635465251371321

    View details for PubMedID 40971308

  • Impact of Pediatric Knee Anatomy on ACL Reconstruction: Lessons Learned From Cadaveric Dissections-A Review. Sports medicine and arthroscopy review Alayleh, A. M., Alawa, J., Stoner, A., Bryant, S., Troyer, S., Ganley, T. J., Ellis, H., Tompkins, M., Shea, K. G. 2025; 33 (1): 14-23

    Abstract

    Anterior Cruciate Ligament (ACL) injuries in pediatric patients are rising and present unique challenges for orthopedic surgeons due to skeletal immaturity and risk for physeal damage during ACL reconstruction. This review aims to share insights from pediatric cadaveric anatomic studies and related research to inform surgical management of ACL injuries in skeletally immature patients. We highlight age-dependent variations in the distances between the ACL and medial collateral ligament and their respective physes, developmental variability in the anterolateral structures of the pediatric knee, and variability in the proximity of the neurovascular bundle's proximity to the iliotibial band graft pathway during ACL reconstruction. In addition, we review biomechanical properties of different grafts to assess their strength and suitability for ACL reconstruction. Our findings emphasize the importance of age-specific surgical approaches that consider individual anatomic differences of pediatric patients, collectively advancing our understanding of pediatric knee anatomy and its relevance to successful ACL reconstruction.

    View details for DOI 10.1097/JSA.0000000000000418

    View details for PubMedID 40145602

  • How can we better engage female athletes? A novel approach to health and performance education in adolescent athletes BMJ OPEN SPORT & EXERCISE MEDICINE Roche, M., Mcintyre, A., Oliver, C., Sainani, K., Boyd, T., Stoner, A., Kraus, E. 2024; 10 (3): e001901

    Abstract

    To evaluate the impact of a video series versus online pamphlets/blog posts on Female Athlete Triad (Triad) and Relative Energy Deficiency in Sport (REDs) knowledge in high school female runners.Runners from 10 US schools were cluster-randomised into groups to either watch videos or read pamphlets on Triad/REDs, nutrition, menstrual cycle, bone health and mental health. Changes in knowledge and interest were assessed using generalised estimating equations.Forty-five runners were in the video intervention group (mean age=16.0) and 39 in the control (mean age=15.7). Both groups showed knowledge gains for all topics, except for mental health, where knowledge was already high. The intervention group's knowledge increase (means=75.7 and 93.3) was not significantly higher than the control's (means=77.9 and 93.6) (p=0.149). However, the intervention group had stronger scores on behavioural impact, information novelty and interest (means=3.77, 3.93 and 4.14) compared with the control's (means=3.36, 3.48 and 3.52) (p≤0.05, p≤0.05 and p≤0.001).Both videos and pamphlets improved knowledge of Triad/REDs and female athlete science, however videos had a greater influence on athletes' engagement and behavioural intentions.

    View details for DOI 10.1136/bmjsem-2024-001901

    View details for Web of Science ID 001311554800001

    View details for PubMedID 39290377

    View details for PubMedCentralID PMC11407224

  • Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. The American surgeon Gomez, G. I., Li, G. Q., Valido, A. A., Stoner, A. J., Bromley-Dulfano, R. A., Sheira, D., Gonzalez, C. A., Khan, S. I., Choi, J., Zygourakis, C. C., Weiser, T. G. 2023: 31348231216479

    Abstract

    Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients.This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded.A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury.In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.

    View details for DOI 10.1177/00031348231216479

    View details for PubMedID 37983195