Dr. Donahue is a Board Certified Orthopaedic Surgeon with Subspecialty Certification in Orthopaedic Sports Medicine. He is fellowship trained and specializes in Arthroscopic and Minimally Invasive Reconstructive Surgery of the Shoulder and Knee, and Sports Medicine.
Dr. Donahue received his undergraduate degree from Stanford University and his Doctor of Medicine from Columbia University College of Physicians and Surgeons. He completed his residency in Orthopedic Surgery at St. Luke’s-Roosevelt Hospital Center (NYC), Memorial Sloan-Kettering Cancer Center (NYC), and the Alfred I. duPont Institute (DE), and went on to a fellowship in Orthopedic Sports Medicine at the Stanford/SOAR Sports Medicine Fellowship Program.
Dr. Donahue’s interests include arthroscopic surgery of the shoulder and knee. He specializes in anterior cruciate ligament injuries, shoulder instability, and rotator cuff tears. He has done research on both shoulder instability and rotator cuff tears and has developed new techniques and medical devices for rotator cuff and all soft tissue repairs. He has started and actively serves on the medical advisory board for several surgical device companies and continues to design new surgical devices for arthroscopic procedures. He has authored several device patents and journal articles.
Dr. Donahue has been a member of the American Academy of Orthopedic Surgeons and a Diplomat of the American Board of Orthopedic Surgery. He is also member of the Arthroscopy Association of North America, the American Orthopedic Society of Sports Medicine, the California Orthopedic Association, The International Knee Society, the California Medical Association, and the Santa Clara Medical Society.
Dr. Donahue has served as the Program Director of the SOAR Orthopedic Sports Medicine Fellowship Program. He has served as the Director of Santa Clara University’s Sports Medicine Program and the Head Team Physician for all of Santa Clara University’s athletic teams, a team physician for the San Francisco 49ers, the San Francisco Giants, the Stanford Athletic Department, and many other area collegiate and high school teams.
- Orthopaedic Surgery
Clinical Assistant Professor, Orthopaedic Surgery
Team Physician, Stanford Athletic Department (2019 - Present)
Team Physician, Menlo Atherton High School (2017 - Present)
Consultant, San Francisco Giants (2011 - 2016)
Head Team Physician All Sports, Santa Clara University (2005 - 2019)
Program Director, SOAR Orthopedic Sports Medicine Fellowship Program (ACGME Accredited) (2005 - 2019)
Sports Medicine Program Director, Santa Clara University Musculoskeletal Medicine (2005 - 2019)
Team Physician, Foothill College (2004 - Present)
Team Physician, DeAnza College (2004 - 2017)
Team Physician, San Francisco 49ers (2004 - 2007)
Team Physician, Team Physician (2004 - 2007)
Honors & Awards
Chief Resident, St.Luke’s-Roosevelt Hospital,University Hospital of Columbia College of Physicians and Surgeons,NY (2004-2005)
AOA-OREF-Zimmer Resident Leadership Forum Recipient, NY (2004)
Resident’s Research Award, St.Luke’s-Roosevelt Hospital,University Hospital of Columbia College of Physicians and Surgeons,NY (2003-2004)
Marie Nercessian Memorial Award, Columbia College of Physicians and Surgeons (1999)
Research Grant, National Institute of Health, Columbia College of Physicians and Surgeons, New York, NY (1995-1999)
Research Grant, National Institute of Health,Columbia College of Physicians and Surgeons,NY (1995-1999)
Residency: Icahn School of Medicine at Mount Sinai Orthopaedic Surgery (2004) NY
Board Certification, Sports Medicine, American Board of Orthopaedic Surgery (2008)
Board Certification, Orthopaedic Surgery, American Board of Orthopaedic Surgery (2007)
Fellowship, Stanford/ SOAR, Sports Medicine and Orthopedic Surgery (2005)
Residency, St. Luke’s-Roosevelt Hospital, University Hospital of Columbia College of Physicians & Surgeons, NY (2004)
Residency, Alfred I. duPont Hospital for Children, DE (2003)
Residency, Memorial Sloan Kettering Cancer Center, NY (2001)
Internship, St. Luke’s-Roosevelt Hospital, University Hospital of Columbia College of Physicians & Surgeons, NY (2000)
Medical School, Medical School, NY (1999)
Undergraduate, Stanford University, Biological Sciences, CA (1993)
Feezor; Christopher, Rosenthal; Michael, Donahue; Joseph P.. "United States Patent 9861353 Devices, systems, and methods for attaching soft tissue to bone tissue", Stabilynx, Inc, Feb 15, 2015
Graduate and Fellowship Programs
Sports Medicine (Fellowship Program)
Humeral Head Osteochondral Allograft Reconstruction with Arthroscopic Anterior Shoulder Stabilization at a Long-Term Follow-Up: A Case Report.
JBJS case connector
; 10 (2): e0555
The authors report a case of recurrent anterior shoulder instability in a 19-year-old man. Intraoperative arthroscopic examination identified Bankart and engaging Hill-Sachs lesions. The patient was treated with humeral head osteochondral allograft reconstruction and concomitant arthroscopic anterior stabilization. At the 14-year follow-up, there was no recurrent instability.Humeral head osteochondral allograft reconstruction combined with an arthroscopic anterior stabilization procedure can be successful for recurrent shoulder instability and engaging Hill-Sachs lesion.
View details for DOI 10.2106/JBJS.CC.19.00555
View details for PubMedID 32649125
Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes.
Orthopaedic journal of sports medicine
2020; 8 (7): 2325967120938311
Background: Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs.Purpose: To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates after linked double-row equivalent rotator cuff repair for full-thickness rotator cuff tears.Study Design: Case series; Level of evidence, 4.Methods: Consecutive patients who underwent linked double-row equivalent arthroscopic rotator cuff repair with minimum 2-year follow-up were included. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) score at final follow-up. Secondary outcomes included the Simple Shoulder Test (SST), shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, visual analog scale (VAS), reoperations, and complications. Clinical relevance was defined by the minimally clinically important difference (MCID). Comparisons on an individual level that exceeded MCID (individual-level scores) were deemed clinically relevant. Comparisons between preoperative and postoperative scores were completed using the Student t test. All P values were reported with significance set at P < .05.Results: A total of 42 shoulders in 41 consecutive patients were included in this study (21 male patients [51.2%]; mean age, 64.5 ± 11.9 years; mean follow-up, 29.7 ± 4.5 months). All patients (100%) completed the minimum 2-year follow-up. The rotator cuff tear measured on average 15.2 ± 8.9 mm in the coronal plane and 14.6 ± 9.8 mm in the sagittal plane. The ASES score improved significantly from 35.5 ± 18.2 preoperatively to 93.4 ± 10.6 postoperatively (P < .001). The QuickDASH (P < .001), SST (P < .001), and VAS (P < .001) scores also significantly improved after surgery. All patients (42/42 shoulders; 100%) achieved clinically relevant improvement (met or exceeded MCID) on ASES and SST scores postoperatively. There were no postoperative complications (0.0%) or reoperations (0.0%) at final follow-up.Conclusion: Arthroscopic repair of full-thickness rotator cuff tears with the linked double-row equivalent construct results in statistically significant and clinically relevant improvements in PRO scores with low complication rates (0.0%) and reoperation rates (0.0%) at short-term follow-up.
View details for DOI 10.1177/2325967120938311
View details for PubMedID 32728593
Reoperation Rates following Meniscus Transplantation using the Truven Database.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association
The purpose of this study was to determine the (1) reoperation rate and (2) 30-day complication rate in a large insurance database.The Truven Database was queried for subjects that underwent meniscus allograft transplantation (CPT code 29868) in the outpatient setting with minimal two year follow up. Patients without confirmed laterality and patients that 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 ICD-9-CM codes.284 patients (mean age of 26.2 ± 10.4 years old and 49.6% females) were included in this study with mean follow up of 43.2 ± 19.2 months. One hundred and sixty seven subjects (58.8%) undergoing meniscus allograft transplantation underwent reoperation at an average of 11.9 ± 12.2 months postoperatively. There was a low number of subjects that required ipsilateral unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) postoperatively (0.7% and 1.1%, respectively). The overall 30-day complication rate following meniscus allograft transplantation was 1.4%.Patients undergoing meniscus allograft transplantation have a 58.8% reoperation rate at final follow up with low (1.4%) 30-day complication rates in a large insurance database.
View details for DOI 10.1016/j.arthro.2020.06.031
View details for PubMedID 32645340
Relationship of the Medial Patellofemoral Ligament Origin on the Distal Femur to the Distal Femoral Physis: A Systematic Review.
The American journal of sports medicine
The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies.To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants.Systematic review.A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched for studies investigating the anatomic origin of the MPFL on the distal femur and its relationship to the medial distal femoral physis in skeletally immature participants. Study methodological quality was analyzed with the Anatomical Quality Assessment tool, with studies categorized as low risk, high risk, or unclear risk of bias. Continuous variable data were reported as mean ± SD. Categorical variable data were reported as frequency with percentage.Seven articles were analyzed (298 femurs, 53.7% male patients; mean age, 11.7 ± 3.4 years). There was low risk of bias based on the Anatomical Quality Assessment tool. The distance from the MPFL origin to the distal femoral physis ranged from 3.7 mm proximal to the physis to 10.0 mm distal to the physis in individual studies. Six of 7 studies reported that the MPFL origin on the distal femur lies distal to the medial distal femoral physis in the majority of specimens. The MPFL originated distal to the medial distal femoral physis in 92.8% of participants at a mean distance of 6.9 ± 2.4 mm.The medial patellofemoral ligament originates distal to the medial distal femoral physis in the majority of cases at a mean proximal-to-distal distance of 7 mm distal to the physis. However, this is variable in the literature owing to study design and patient age and sex.
View details for DOI 10.1177/0363546520904685
View details for PubMedID 32109145
Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database.
The American journal of sports medicine
Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series.To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database.Cohort study; Level of evidence, 3.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 P values were reported with significance set at P < .05.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%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery (P < .001), meniscal transplantation (P = .005), or total knee arthroplasty (P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001).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.
View details for DOI 10.1177/0363546520935453
View details for PubMedID 32667826
Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique
JOURNAL OF ORTHOPAEDICS
2018; 15 (2): 426–31
There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques.Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated.The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques.This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting.Basic science biomechanical study.
View details for DOI 10.1016/j.jor.2018.03.006
View details for Web of Science ID 000433372300033
View details for PubMedID 29881170
View details for PubMedCentralID PMC5990346
The in vivo relationship between anterior neutral tibial position and loss of knee extension after transtibial ACL reconstruction
2014; 21 (1): 74-79
Restoration of anterior tibial stability while avoiding knee extension deficit are a common goal of anterior cruciate ligament (ACL) reconstruction. However, achieving this goal can be challenging. The purpose of this study was to determine whether side-to-side differences in anterior tibial neutral position and laxity are correlated with knee extension deficit in subjects 2years after ACL reconstruction.In the reconstructed and contralateral knees of 29 subjects with transtibial reconstruction, anterior tibiofemoral neutral position was measured with MRI and three-dimensional modeling techniques; terminal knee extension at heel strike of walking and during a seated knee extension were measured via gait analysis; and anterior laxity was measured using the KT-1000.Knees that approached normal anterior stability and anterior tibial position had increased extension deficit relative to the contralateral knee. On average the reconstructed knee had significantly less (2.1±4.4°) extension during active extension and during heel strike of walking (3.0±4.3º), with increased anterior neutral tibial position (2.5±1.7mm) and anterior laxity (1.8±1.0mm). There was a significant correlation between side-to-side difference in anterior neutral tibial position with both measures of knee extension (walking, r=-0.711, p<0.001); active knee extension, r=-0.544, p=0.002).The results indicate a relationship between the loss of active knee extension and a change in anterior neutral tibial position following non-anatomic transtibial ACL reconstruction. Given the increasing evidence of a link between altered kinematics and premature osteoarthritis, these findings provide important information to improve our understanding of in vivo knee function after ACL reconstruction.
View details for DOI 10.1016/j.knee.2013.06.003
View details for PubMedID 23830645
Three-dimensional knee moments of ACL reconstructed and control subjects during gait, stair ascent, and stair descent
JOURNAL OF BIOMECHANICS
2013; 46 (3): 515-520
Changes in knee mechanics following anterior cruciate ligament reconstruction (ACLR) have been implicated as a contributor to the development of premature osteoarthritis (OA). However, changes in ambulatory loading in this population have not been well documented. While the magnitude of the external knee moment vector is a major factor in loading at the knee, there is not a comprehensive understanding of the changes in the individual components of the vector following ACL reconstruction. The purpose of this study was to test for differences in the three components of the external knee moment during walking and stair locomotion between ACLR, contralateral and healthy control knees. Forty-five ACLR and 45 healthy control subjects were tested during walking, stair ascent and descent. ACLR knees had a lower first peak adduction moment than contralateral knees during all three activities. Similarly, additional cases of significant differences between ACLR and contralateral knees consisted of lower peak moments for the ACLR than the contralateral knees. These differences were due to both ACLR and contralateral knees as the ACLR knees indicated lower and the contralateral knees greater peak moments compared to healthy control knees. The results suggest a compensatory change involving greater loading in the contralateral knee, perhaps due to lower loading of the ACLR knee. Further, lower knee moments of the ACLR knee suggest that increased joint loading may not be the initiating factor in the development of OA following ACL reconstruction; but rather previous described kinematic or biological changes might initiate the pathway to knee OA.
View details for DOI 10.1016/j.jbiomech.2012.10.010
View details for PubMedID 23141637
Variations in the three-dimensional location and orientation of the ACL in healthy subjects relative to patients after transtibial ACL reconstruction
JOURNAL OF ORTHOPAEDIC RESEARCH
2012; 30 (6): 910-918
Recent reports have indicated that anatomical placement of the anterior cruciate ligament (ACL) graft is an important factor for restoration of joint function following ACL reconstruction. The objective of this study was to address a need for a better understanding of anatomical variations in ACL position and orientation within the joint. Specifically, variations in the ACL anatomy were assessed by testing for side-to-side ACL footprint location symmetry in a healthy population relative to the operative and contralateral knee in a patient population after traditional transtibial single-bundle ACL reconstruction. MRI and three-dimensional modeling techniques were used to determine the in vivo tibiofemoral ACL footprint centers and the resulting ACL orientations in both knees of 30 healthy subjects and 30 subjects after transtibial ACL reconstruction. While there were substantial inter-subject variations in ACL anatomy, the side-to-side RMS differences in the ACL footprint center were 1.20 and 1.34 mm for the femur and tibia, respectively, for the healthy subjects and no clinically meaningful intra-subject differences were measured. However, there were large intra-subject side-to-side differences after transtibial ACL reconstruction, with ACL grafts placed 5.63 and 7.64 mm from the center of the contralateral femoral and tibial ACL footprint centers, respectively. Grafts were placed more medial, anterior, and superior on the femur and more posterior on the tibia; producing grafts that were more vertical in the sagittal and coronal planes. Given the large variation among subjects, these findings advocate the use of the contralateral ACL morphology for retrospectively evaluating patient-specific anatomic graft placement.
View details for DOI 10.1002/jor.22011
View details for PubMedID 22105556
Coracoclavicular stabilization using a suture anchor technique.
American journal of orthopedics (Belle Mead, N.J.)
2008; 37 (6): 294–300
Multiple fixation options exist for coracoclavicular stabilization, but many are technically demanding and require hardware removal. In the study reported here, we reviewed a specific fixation technique that includes suture anchors moored in the base of the coracoid process. We retrospectively reviewed 24 consecutive cases of patients who underwent coracoclavicular stabilization with a suture anchor for a type III or type V acromioclavicular (AC) joint separation or a group II, type II or type V distal clavicle fracture. Eighteen of the 22 patients had full strength and painless range of motion (ROM) in the affected extremity by 3 months and at final follow-up (minimum, 24 months; mean, 39 months). Two patients were lost to follow-up. Four patients had early complications likely secondary to documented noncompliance. Two of these 4 patients underwent reoperation with a similar procedure and remained asymptomatic at a minimum follow-up of 15 months. One patient underwent osteophyte and knot excision 7 months after surgery and remained asymptomatic at 30 months. Our results suggest that coracoclavicular stabilization using a suture anchor technique is a safe and reliable method of treating acromioclavicular joint separations and certain distal clavicle fractures in the compliant patient.
View details for PubMedID 18716693
Vesicant characteristics of oxapliplatin following antecubital extravasation
2003; 15 (5): 237–39
Oxaliplatin is a novel class of platinum chermotherapeutic agent used in refractory adenocarcinoma. It has previously been regarded as a non-vesicant, and as such was considered safe to administer through peripheral veins. This report documents severe muscle and subcutaneous reaction with a single dose of oxaliplatin at the site of extravasation in a patient aged 58 years. Conventional therapeutic modalities were employed to reduce the effect of the soft tissue infiltrate. Despite that, significant muscle necrosis and fibrosis occurred. Surgery was deferred secondary to patient choice, and eventual extensive physical therapy restored function to the elbow joint. This case shows that oxaliplatin may not be an appropriate cytotoxic agent to be administered through a peripheral line and consideration must be made for central access when this drug is used. In addition, when extravasation does occur, the current report indicates that non-surgical management can be successful.
View details for DOI 10.1016/S0936-6555(02)00338-2
View details for Web of Science ID 000184594800004
View details for PubMedID 12924452
Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans
SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES
2003; 17 (6): 972–78
Animal studies have documented significantly better preserved postoperative cell-mediated immune function, as measured by serial delayed-type hypersensitivity (DTH) challenges, after laparoscopic-assisted than after open bowel resection. Similarly, in humans, the DTH responses after open cholecystectomy have been shown to be significantly smaller than preoperative responses; whereas after laparoscopic cholecystectomy, no significant change in DTH response has been noted. The purpose of this study was to assess cell-mediated immune function via serial DTH skin testing in patients undergoing laparoscopic or open colectomy.A total of 35 subjects underwent either laparoscopic (n = 18) or open colectomy (n = 17) in this prospective but not randomized study. Only patients who were judged to be immunoresponsive by virtue of having responded successfully to a preoperative DTH challenge were eligible for entry in the study. DTH challenges were carried out at three time points in all patients: preoperatively, immediately following surgery, and on the third postoperative day (POD 3). Responses were measured 48 h after each challenge and the area of induration calculated. There were no significant differences between the laparoscopic (LC) and open (OC) colorectal resection groups in regard to demographics, indications for surgery, or type of resection carried out. The percentage of patients transfused was similar in both groups (17%, LC; 12% OC; p = NS). In the LC group, all cases were completed without conversion using minimally invasive methods. There were no perioperative deaths, and the rate of postoperative complications was similar in both groups. The preoperative and postoperative DTH results were analyzed and compared within each surgical group using several methods.In regards to the OC group results, the median sum-total DTH responses for the day of surgery challenges (0.44 +/- 69 cm2) and the POD 3 challenges (0.72 +/- 3.37 cm2) were significantly smaller than the preoperative results (3.61 +/- 3.83 cm2, p <0.0005 vs op day and p <0.0003 vs POD 3 results). When the LC group results were similarly analyzed, no significant difference in DTH response was noted between the pre- and the postoperative challenge results. Additionally, when the median percent change from baseline was calculated and considered for the OC group's DTH results, both postoperative challenge time points demonstrated significantly decreased responses when compared to their preoperative results (vs day of surgery, p <0.007; vs POD 3, p <0.006). Similar analysis of the LC group's results yielded nonsignificant differences between the pre- and postoperative responses. Lastly, when the LC and the OC groups median percent change from baseline results were directly compared for each of the postoperative challenges, a significant difference was noted for the POD 0 challenge (LC, -21%; OC 88%; p <0.004) but not for the POD 3 challenge.The postoperative DTH responses of the open surgery patients were significantly smaller than their preoperative responses. This was not the case for the laparoscopic group (a combination of fully laparoscopic and laparoscopic-assisted resections). When the open and laparoscopic groups results are directly compared, regarding the results of the day of surgery DTH challenges, the LC groups median percent change from baseline was significantly less than that observed in the OC group. These results imply that open colorectal resection is associated with a significant suppression of cell-mediated immune response postoperatively, whereas in this study laparoscopic colorectal resection was not. Further human studies are needed to verify these findings and to determine the clinical significance, if any, of this temporary difference in immune function following colon resection.
View details for DOI 10.1007/s00464-001-8263-y
View details for Web of Science ID 000183558600029
View details for PubMedID 12640542
Metastatic breast carcinoma to bone disguised by osteopoikilosis
2003; 32 (4): 240–43
A case of metastatic lobular carcinoma of the breast in conjunction with osteopoikilosis is described. Widespread diffuse sclerotic bone lesions were identified on radiographs in a patient with breast carcinoma. In addition computed tomography demonstrated discrete spherical areas of increased density throughout the skeleton manifest typically by osteopoikilosis. No systemic symptoms were evident, blood parameters were normal and the lesions did not demonstrate any increased uptake of technetium on bone scan. An iliac crest bone biopsy, however, revealed metastatic disease in addition to osteopoikilosis. Conventional radiological investigations may not delineate metastasis on a background of bone dysplasia.
View details for DOI 10.1007/s00256-002-0605-x
View details for Web of Science ID 000182469400008
View details for PubMedID 12652341
Combined physeal/apophyseal fracture of the proximal tibia with anterior angulation from an indirect force: report of 2 cases.
American journal of orthopedics (Belle Mead, N.J.)
2003; 32 (12): 604–7
Physeal fracture of the proximal tibia is a rare injury, comprising less than 2% of all physeal injuries. The literature distinguishes between tibial tubercle avulsions (apophyseal injuries) classified by Ogden, Tross, and Murphy as type I, II, and III and Salter-Harris II fractures. An extensive review of the literature located only 5 cases in which patients sustained a combined fracture of the proximal tibial physis and tibial tubercle. We report 2 such cases, which are not amenable to classification by current systems, and agree with Ryu and Debenham's suggestion to add a fourth type, avulsion hinge fracture of the proximal tibial epiphysis, to the Watson-Jones/Ogden classification.
View details for PubMedID 14713068
Wound tensile strength and contraction rate are not affected by laparotomy or pneumoperitoneum
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
1998; 12 (9): 1166–70
Many cellular elements responsible for wound healing are affected by laparotomy. The aim of this study was to evaluate the effects of laparotomy and CO2 pneumoperitoneum on wound healing.Male Sprague Dawley rats were randomly assigned to one of three experimental groups. Anesthesia control rats underwent no procedure. Pneumoperitoneum group rats were insufflated with CO2 gas. Laparotomy group rats underwent a 7-cm midline laparotomy incision. The interventions were 30 min long. For the incisional study (n = 30), a 4-cm dorsal full-thickness skin incision was made on each rat and then closed with staples. On postoperative days 7 and 14, an equal number of rats were sacrificed from each group, and wound tensile strength measurements were performed. For the excisional study (n = 45), each group of 15 rats underwent a 2-cm diameter circular dorsal full-thickness skin excision. Blinded measurements of wound area were performed every other day until wounds closed.Wound tensile strength values were not significantly different among experimental groups at either time point. The study had a power of 80% to find a 30% difference at POD 7 and a power of 80% to find a 23% difference at POD 14 to a confidence level of p < 0.05. Wound contraction data from the excisional model were analyzed with the Generalized Estimation Equations statistical approach. When we modeled the treatment group as a covariate, no statistical difference was found between groups, demonstrating equal slopes across time.From the results of these studies, we conclude that wound healing in this model is not significantly diminished following laparotomy or peritoneal insufflation, as compared to anesthesia control.
View details for DOI 10.1007/s004649900808
View details for Web of Science ID 000075674100015
View details for PubMedID 9716775
An in vitro model fails to demonstrate aerosolization of tumor cells
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
1998; 12 (5): 436–39
We investigated the ability of pressurized CO2 gas to aerosolize B16 melanoma (B16) tumor cells in an in vitro model.The experimental apparatus consisted of an 18.9-L plastic cylindrical vessel and a compliant latex pouch was attached to the top. Two 5-mm ports penetrated the vessel; insufflation and desufflation were carried out through them. A culture dish containing 20 million B16 cells in liquid culture media was placed at the base within the container. In the first experiment, the vessel was insufflated with CO2 gas to a static pressure of 15 or 30 mm Hg with the outflow port closed. After 10 min, the outflow port was opened and the gas was desufflated through a collecting device containing sterile culture medium. In a second experiment, a continuous flow of CO2 through the vessel was maintained after a pressure of 15 or 30 mm Hg was established. A total of 10 L CO2 was cycled through the vessel. In both experiments, 24 determinations were carried out at each pressure. Each experimental culture dish was microscopically scanned for 2 weeks for the presence of tumor cells. The third and fourth experiments tested for the presence of aerosolized nonviable tumor cells in the expelled gas. Using the model described above, after 10 mins of 30 mm Hg static pressure, the CO2 gas was expelled directly onto a glass slide and cytofixed. Alternately, after 10 mins at 30 mm Hg static pressure, the gas was expelled through a saline-filled Soluset (Abbott Laboratories), centrifuged, and the residue cytofixed onto a glass slide. Each of the five slides per experiment were examined microscopically for the presence of cells.In the first and second experiments, no cells or growth were observed in any of the 96 experimental dishes. In experiments three and four, no cells were detected on any of the slides.It was not possible with this model to aerosolize tumor cells in a pressurized CO2 environment. Our results suggest that aerosolization of tumor cells is not the mechanism of port site recurrences after laparoscopic surgery for malignant disease.
View details for DOI 10.1007/s004649900698
View details for Web of Science ID 000073369400014
View details for PubMedID 9569365