Bio


Dr. Seth L. Sherman is a third-generation team physician and surgeon. He is board certified and fellowship trained in Sports Medicine. Dr. Sherman is proud to serve as Orthopedic Surgeon for Stanford Cardinal Football and as the Sports Medicine fellowship director.

Dr. Sherman specializes in arthroscopic and minimally invasive surgical interventions for the knee and shoulder. He has subspecialty and research interests in knee joint preservation/cartilage restoration and the patellofemoral joint. As a tertiary care provider, Dr. Sherman offers non-surgical and salvage surgical solutions for active patients with complex problems and in cases where other surgeries have failed.

Dr. Sherman completed his residency training at the Hospital for Special Surgery in New York City and was trained by the team physicians for the NY Giants, Mets, and Knicks. During his sports medicine fellowship in Chicago , he served as assistant team physician for the Chicago Bulls and White Sox. Prior to joining the team at Stanford University in July 2019, he served as team physician for the Mizzou Tigers in the NCAA SEC conference.

Dr. Sherman is co-author on more than 100 peer reviewed articles/chapters and actively presents his research at national and international meetings. He is Chairman of the AAOS Sports Medicine/Arthroscopy committee and holds leadership positions in several other organizations (AOSSM, AANA, ISAKOS, ICRS). He is a member of the prestigious international ACL and Patellofemoral Study Groups.

He enjoys spending time with wife Sylvia and daughter Evie. He is an avid fresh and saltwater fly fisherman.

Clinical Focus


  • Orthopaedic Surgery
  • Knee Ligament Repair/Reconstruction (ACL, PCL, Posteromedial, Posterolateral, Anterolateral complex, Medial Patellofemoral Ligament)
  • Knee Meniscus Repair/Replacement (all-inside repair, inside-out repair, outside-in repair, root repair, meniscus allograft transplantation)
  • Knee Cartilage Restoration (osteochondral allograft, MACI procedure, DeNovo NT, OAT autograft, microfracture plus etc.)
  • Knee Osteotomy (Tibial Tubercle Osteotomy/Fulkerson, High Tibial Osteotomy, Distal Femoral Osteotomy)
  • Surgical Management of the Patellofemoral Joint
  • Shoulder arthroscopy (rotator cuff tendonitis, rotator cuff tear, SLAP/biceps complex, AC arthritis/separation, subacromial bursitis, labral tear, shoulder instability)
  • Open shoulder surgery (TSA, reverse TSA, open Latarjet, open distal tibial allograft)
  • Surgical tendinopathy/tear (distal biceps, distal triceps, patella tendon, quad tendon, Achilles tendon, proximal hamstring, tennis elbow, golfer's elbow)

Academic Appointments


Professional Education


  • Board Certification: American Board of Orthopaedic Surgery, Sports Medicine (2015)
  • Board Certification: American Board of Orthopaedic Surgery, Orthopaedic Surgery (2013)
  • Fellowship: Rush University Medical Center GME Office (2011) IL
  • Residency: Hospital for Special Surgery Orthopaedic Surgery Residency (2010) NY
  • Medical Education: Weill Cornell Medical College (2005) NY

Current Research and Scholarly Interests


My research focuses on ways to augment tissue healing, improve human performance, and prevent musculoskeletal injuries. Approaching these challenges through parallel basic science and clinical pathways, our team works from the “bedside to the bench and back to the bedside”, identifying areas of clinical need to deliver evidence-based solutions for patients.

We collaborates with orthopaedic surgeons, non-surgical physicians, and researchers within bioengineering, human performance, and musculoskeletal imaging across the Stanford campus. The team is developing novel methods to accurately record human movement (including wearable technology, phone-based systems), rapid MRI imaging protocols, and exploring the use of biomarkers to track injury and recovery. This research builds on my earlier work, which utilized portable, inexpensive software for Microsoft Kinect to detect knee injury risk in youth athletes performing a drop vertical jump test. The team’s multifaceted goal is: 1) develop innovative methods to screen for injury risk (i.e. youth athlete non-contact ACL), 2) create targeted intervention programs to reduce risk, 3) enhance athletic performance; and 4) improve accuracy of return to play testing following injury/surgery (i.e. clinical evaluation, biomarkers, functional tests, imaging analysis for healing).

In the laboratory,our team investigates cellular and molecular deficiencies in tissue types including tendon, ligament, articular cartilage, and meniscus. By understanding aberrant pathways leading to tissue injury, they can identify innovative therapeutic targets for intervention. In collaboration with the Genetic Engineering and Synthetic Biology laboratories, Dr. Sherman’s research has explored the role of orthobiologic agents such as platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) for tissue healing in patella tendinopathy (the breakdown of collagen in a tendon). Our lab is also investigating the use of CBD for musculoskeletal applications as an alternative to commonly used local anesthetics and cortisone derivatives. In my earlier work, we researched the cellular toxicity of such applications.

In addition to basic science research, I have helped to build a Sports Medicine clinical research team that includes several full-time clinical research coordinators, residents, fellows, and students. The team collects prospective outcomes on their patients using a novel data collection platform called Patient IQ. The group is part of the JUPITER study which is the largest, multicenter study ever assembled in patellofemoral instability. They are additionally planning to enroll in FDA-approved clinical studies investigating pioneering strategies for knee cartilage restoration, joint preservation, and orthobiologic injections for osteoarthritis. Recent clinical publications explore outcomes in meniscus preservation and transplantation, medial patellofemoral ligament reconstruction, osteochondral allograft and matrix-induced autologous chondrocyte implantation (MACI), and surgical augmentation using PRP/BMAC. The clinical research team actively reports results of non-surgical and surgical interventions to continue to introduce new knowledge to the field, with the goal of improved patient outcome.

Clinical Trials


  • Microfracture Versus Adipose Derived Stem Cells for the Treatment of Articular Cartilage Defects Recruiting

    The purpose of this study is to compare two biologic methods for the treatment of articular cartilage defects in the knee. The first method, microfracture, is the standard of care and is routinely used to recruit cells from the subchondral bone marrow to the site of cartilage loss. The second method is the application of adipose-derived stem cells (ADSCs) to the defect site. In theory, ADSCs on a collagen scaffold should enable the delivery of more specific progenitor cells to the site of injury, resulting in better regeneration and integration of articular cartilage at the site of a defect as compared to the microfracture method.

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  • Subchondroplasty® Knee RCT Recruiting

    This is a multi-center, prospective, single-blinded, two-arm study, randomized to include approximately 134 subjects treated with Subchondroplasty (SCP) + Arthroscopy and 67 subjects with arthroscopy alone. The primary objective of this study is to demonstrate superiority of Subchondroplasty with arthroscopy compared to arthroscopy alone for treatment of Bone Marrow Lesions (BMLs) in the knee.

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  • The Effect of Adipose-Derived Stem Cells for Knee Osteoarthritis Recruiting

    The purpose of this study is to compare the clinical and functional outcomes of patients with mild to moderate arthroscopically confirmed osteoarthritis between the following two groups: 1. Partial fat pad harvest with Adipose-Derived Stem Cell (ADSC) transplantation with standard arthroscopic treatment consisting of: partial meniscectomy, cartilage stabilization, loose body removal and selective synovectomy. 2. Standard arthroscopic treatment (above) with out cell transplant.

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  • The Effect of Micro Fragmented Adipose Tissue (MFAT) on Knee Osteoarthritis Recruiting

    This is a non-surgical trial comparing the clinical and functional outcomes of patients with osteoarthritis treated with Intra-articular injection of Micro Fragmented Adipose Tissue versus conventional therapy of intra-articular injection of corticosteroid.

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Graduate and Fellowship Programs


  • Sports Medicine (Fellowship Program)

All Publications


  • The Impact of COVID-19 on the Orthopaedic Sports Medicine Fellowship Application Process. Arthroscopy, sports medicine, and rehabilitation Peebles, L. A., Kraeutler, M. J., Waterman, B. R., Sherman, S. L., Mulcahey, M. K. 2021; 3 (4): e1237-e1241

    Abstract

    Over the last year, coronavirus disease 2019 (COVID-19) has spread across the world as a global pandemic, bringing unprecedented changes to the healthcare landscape for patients and physicians. Medical trainees have been similarly affected, as medical schools throughout the United States have implemented remote learning-based curriculums and withdrawn third- and fourth-year students from in-hospital clerkships. Of particular importance is the impact of COVID-19 on current orthopaedic surgery residents applying to subspecialty fellowship programs. Because of the highly transmissible nature of the virus and current social distancing restrictions, orthopaedic sports medicine fellowship interviews are being held virtually during the 2020-2021 application cycle. This transition to videoconference interviewing may de-emphasize an applicant's unique personality or interpersonal interactions that are traditionally captured in a variety of settings during the interview day. In turn, this may lead to increased prioritization of various aspects of the application, such as the applicant's residency program, letters of recommendation, and research productivity. Matching to a sports medicine fellowship program is an inherently competitive process and the COVID-19 pandemic presents novel challenges to orthopaedic residents in their efforts to successfully match. The purpose of this review is to describe the changes made to the orthopaedic sports medicine fellowship interview process resulting from COVID-19 during the 2020-2021 application cycle and discuss how these changes may impact the future fellowship application process. This review discusses the changes made to the orthopaedic sports medicine fellowship interview process caused by COVID-19 during the 2020-2021 application cycle. This review also assesses how such changes may impact the future application process and proposes potential adaptations to the current virtual interview format if it should become the new standard moving forward.

    View details for DOI 10.1016/j.asmr.2021.04.002

    View details for PubMedID 34430904

  • Single-cell transcriptomic profiling reveals distinct mechanical responses between normal and diseased tendon progenitor cells. Cell reports. Medicine Still, C. 2., Chang, W., Sherman, S. L., Sochacki, K. R., Dragoo, J. L., Qi, L. S. 2021; 2 (7): 100343

    Abstract

    Regenerative medicine approaches utilizing stem cells offer a promising strategy to address tendinopathy, a class of common tendon disorders associated with pain and impaired function. Tendon progenitor cells (TPCs) are important in healing and maintaining tendon tissues. Here we provide a comprehensive single cell transcriptomic profiling of TPCs from three normal and three clinically classified tendinopathy samples in response to mechanical stimuli. Analysis reveals seven distinct TPC subpopulations including subsets that are responsive to the mechanical stress, highly clonogenic, and specialized in cytokine or growth factor expression. The single cell transcriptomic profiling of TPCs and their subsets serves as a foundation for further investigation into the pathology and molecular hallmarks of tendinopathy in mechanical stimulation conditions.

    View details for DOI 10.1016/j.xcrm.2021.100343

    View details for PubMedID 34337559

  • ACL Study Group presents the global trends in ACL reconstruction: biennial survey of the ACL Study Group. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Sherman, S. L., Calcei, J., Ray, T., Magnussen, R. A., Musahl, V., Kaeding, C. C., Clatworthy, M., Bergfeld, J. A., Arnold, M. P. 2021

    Abstract

    OBJECTIVES: The primary objective of this survey was to gauge the current global trends in anterior cruciate ligament reconstruction (ACLR) as reported by the members of the Anterior Cruciate Ligament (ACL) Study Group (SG).METHODS: A survey was created and distributed among the members of the ACL SG consisting of 87 questions and 16 categories related to ACLR, including member demographics, preoperative management, primary ACLR techniques and graft choice, use of concomitant procedures and biological augmentation, postoperative rehabilitation, and more.RESULTS: The survey was completed by the 140 members of the ACL SG. Fifty per cent of members are from Europe, 29% from the USA, 15% from the Asia-Pacific and the remaining 6% are from Latin America, the Middle East, New Zealand and Africa. Most (92%) do not believe there is a role for non-operative management of ACL tears in higher level athletes; conversely, most agree there is a role for non-operative management in lower impact athletes (92%). A single-bundle (90%) technique with hamstring autograft (53%) were most common for primary ACLR. Tunnel position varied among respondents. Sixty-one per cent do not use allograft for primary ACLR. Fifty per cent of respondents use cortical suspensory fixation on the femur, with variable responses on the tibia. Most (79%) do not use biologics in primary ACLR, while 83% think there is a selective role for extra-articular augmentation in primary ACLR. Fifty per cent prefer bone-tendon-bone autograft for revision ACLR and extra-articular augmentation is more commonly used (13% always, 26% often) than in primary ACLR (0% always, 15% often). A majority (53%) use a brace after primary ACLR. The most common responses for minimal time to return to play after primary ACLR were 6-8 months (44%) and 8-12 months (41%).CONCLUSION: We presented the thoughts and preferences of the ACL SG on the management of ACL injuries. This survey will help to facilitate an ongoing discussion with regard to ACLR by providing global insights into the current surgical trends in ACLR.LEVEL OF EVIDENCE: Level V, Expert Opinion.

    View details for DOI 10.1136/jisakos-2020-000567

    View details for PubMedID 34272329

  • Biologics in professional and Olympic sport: a scoping review. The bone & joint journal Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103-B (7): 1189-1196

    Abstract

    AIMS: The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes.METHODS: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O'Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary.RESULTS: A total of 202 studies were initially identified, and 35 met criteria for the scoping review; 33 (94.3%) were published within the last eight years, and 18 (51.4%) originated from the USA. Platelet rich plasma was the most studied biologic therapy, being evaluated in 33 (94.3%) studies. Ulnar collateral ligament and hamstring injuries were the conditions most studied (nine (25.7%) studies and seven (20.0%) studies, respectively). Athletes most frequently participated in baseball, soccer, and American football. Only two (5.7%) studies were level 1 evidence, with interpretation and comparison between studies limited by the variations in the injury profile, biologic preparations, and rehabilitation protocols.CONCLUSION: There is diverse use of biologic therapies in the management of musculoskeletal injuries in professional and Olympic athletes. There is currently insufficient high-level evidence to support the widespread use of biologic therapies in athletes. Further research priorities include the development of condition/pathology-specific preparations of biologic therapies, and of outcome measures and imaging modalities sufficiently sensitive to detect differences in outcomes, should they exist. Cite this article: Bone Joint J2021;103-B(7):1189-1196.

    View details for DOI 10.1302/0301-620X.103B7.BJJ-2020-2282.R1

    View details for PubMedID 34192936

  • Biologics in professional and Olympic sport: a scoping review BONE & JOINT JOURNAL Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103B (7): 1189-1196
  • Infographic: Biologics in professional and Olympic sport: a scoping review. The bone & joint journal Murray, I. R., Makaram, N. S., Rodeo, S. A., Safran, M. R., Sherman, S. L., McAdams, T. R., Murray, A. D., Haddad, F. S., Abrams, G. D. 2021; 103-B (7): 1187-1188
  • Return to sport following anterior cruciate ligament reconstruction: the argument for a multimodal approach to optimise decision-making: current concepts. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Chona, D., Eriksson, K., Young, S. W., Denti, M., Sancheti, P. K., Safran, M., Sherman, S. 2021

    Abstract

    Existing literature is varied in the methods used to make this determination in the treatment of athletes who have undergone recent anterior cruciate ligament (ACL) reconstruction. Some authors report using primarily time-based criteria, while others advocate for physical measures and kinematic testing to inform decision-making. The goal of this paper is to elucidate the most current medical evidence regarding identification of the earliest point at which a patient may safely return to sport. The present review therefore seeks to examine the evidence from a critical perspective-breaking down the biology of graft maturation, effect of graft choice, potential for image-guided monitoring of progression and results associated with time-based versus functional criteria-based return to play-to justify a multifactorial approach to effectively advance athletes to return to sport. The findings of the present study reaffirm that time is a prerequisite for the biological progression that must occur for a reconstructed ligament to withstand loads demanded by athletes during sport. Modifications of surgical techniques and graft selection may positively impact the rate of graft maturation, and evidence suggests that imaging studies may offer informative data to enhance monitoring of this process. Aspects of both functional and cognitive testing have also demonstrated utility in prior studies and consequently have been factored into modern proposed methods of determining the athlete's readiness for sport. Further work is needed to definitively determine the optimal method of clearing an athlete to return to sport after ACL reconstruction. Evidence to date strongly suggests a role of a multimodal algorithmic approach that factors in time, graft biology and functional testing in return-to-play decision-making after ACL reconstruction.Level of evidence: level V.

    View details for DOI 10.1136/jisakos-2020-000597

    View details for PubMedID 34088854

  • Biologic Association Annual Summit: 2020 Report. Orthopaedic journal of sports medicine Frank, R. M., Sherman, S. L., Chahla, J., Dragoo, J. L., Mandelbaum, B., Members of the Biologic Association, Anz, A. W., Bradley, J. P., Chu, C. R., Cole, B. J., Farr, J., Flanigan, D. C., Gomoll, A. H., Halbrecht, J., Horsch, K., Lattermann, C., Leucht, P., Maloney, W. J., McIntyre, L. F., Murray, I., Muschler, G. F., Nakamura, N., Piuzzi, N. S., Rodeo, S. A., Saris, D. B., Shaffer, W. O., Shapiro, S. A., Spindler, K. P., Steinwachs, M., Tokish, J. M., Vangsness, C. T., Watson, J. T., Yanke, A. B., Zaslav, K. R. 2021; 9 (6): 23259671211015667

    Abstract

    Interest and research in biologic approaches for tissue healing are exponentially growing for a variety of musculoskeletal conditions. The recent hype concerning musculoskeletal biological therapies (including viscosupplementation, platelet-rich plasma, and cellular therapies, or "stem cells") is driven by several factors, including demand by patients promising regenerative evidence supported by substantial basic and translational work, as well as commercial endeavors that complicate the scientific and lay understanding of biological therapy outcomes. While significant improvements have been made in the field, further basic and preclinical research and well-designed randomized clinical trials are needed to better elucidate the optimal indications, processing techniques, delivery, and outcome assessment. Furthermore, biologic treatments may have potential devastating complications when proper methods or techniques are ignored. For these reasons, an association comprising several scientific societies, named the Biologic Association (BA), was created to foster coordinated efforts and speak with a unified voice, advocating for the responsible use of biologics in the musculoskeletal environment in clinical practice, spearheading the development of standards for treatment and outcomes assessment, and reporting on the safety and efficacy of biologic interventions. This article will introduce the BA and its purpose, provide a summary of the 2020 first annual Biologic Association Summit, and outline the future strategic plan for the BA.

    View details for DOI 10.1177/23259671211015667

    View details for PubMedID 34164559

  • Concomitant Osteotomy Reduces Risk of Reoperation Following Cartilage Restoration Procedures of the Knee: A Matched Cohort Analysis. Cartilage Calcei, J. G., Varshneya, K., Sochacki, K. R., Safran, M. R., Abrams, G. D., Sherman, S. L. 2021: 19476035211011515

    Abstract

    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.

    View details for DOI 10.1177/19476035211011515

    View details for PubMedID 33969740

  • Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Journal of ISAKOS : joint disorders & orthopaedic sports medicine Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., Symposium, P. 2021; 6 (3): 138-146

    Abstract

    OBJECTIVES: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS after ACL injury and description of the RTS continuum, as well as provide clinical guidance on RTS testing and decision-making.METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.RESULTS: Key points include that RTS is characterised by achievement of the preinjury level of sport and involves a criteria-based progression from return to participation to RTS, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along an RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biological assessment of healing and recovery.

    View details for DOI 10.1136/jisakos-2020-000495

    View details for PubMedID 34006577

  • High Specialization among Female Youth Soccer Players Is Associated with an Increased Likelihood of Serious Injury. Medicine and science in sports and exercise Xiao, M., Lemos, J. L., Hwang, C. E., Sherman, S. L., Safran, M. R., Abrams, G. D. 2021

    Abstract

    PURPOSE: To assess the associations between serious injury (> 3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes.METHODS: Youth, college, and professional female soccer players in the United States playing in the top league at each level were recruited to complete an anonymous online survey. The survey collected information about player demographics, soccer specialization and training patterns, history of serious injuries from soccer, and perceptions surrounding soccer specialization. Comparisons between groups were performed using 2-sample t-tests, chi-squared analyses, and multiple logistic regression models controlling for differences in age. A p-value of less than 0.05 was set as significant.RESULTS: A total of 1,018 (767 youth, 251 college/professional) athletes completed the survey. Serious injuries affected 23.6% of youth and 51.4% of college/professional athletes. Anterior cruciate ligament (ACL) tears were more prevalent in college/professional players compared to youth athletes (18.3% vs 4.0%; p < 0.001). Highly specialized youth athletes (66.5%) were more likely to have sustained a serious injury from soccer compared to athletes with low specialization (Odds Ratio (OR) = 2.28 [1.38-3.92]; p=0.008) but not moderate specialization (OR = 1.37 [0.83-2.27]; p=0.43). A higher proportion of youth athletes specialized at a young age (< 10 years) compared to college/professional players (44.2% vs 25.9%; p < 0.001).CONCLUSION: High specialization in female youth soccer players is associated with an increased likelihood of sustaining a serious injury. Current youth soccer players are specializing earlier and committing to play college soccer at a younger age compared to when current college and professional players did.

    View details for DOI 10.1249/MSS.0000000000002693

    View details for PubMedID 33927169

  • Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Fabricant, P. D., Heath, M. R., Veerkamp, M., Gruber, S., Green, D. W., Strickland, S. M., Wall, E. J., Mintz, D. N., Emery, K. H., Shubin Stein, B. E., Parikh, S. N., Brady, J. M., Ellis, H. B., Farr, J., Heyworth, B. E., Koh, J. L., Kramer, D., Magnussen, R. A., Redler, L. H., Sherman, S. L., Tompkins, M., Wilson, P. L., JUPITER Study Grp 2021; 9 (4): 2325967121991110

    Abstract

    Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient's skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy.The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability.Cohort study (diagnosis); Level of evidence, 3.Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss' kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability.Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements).Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.

    View details for DOI 10.1177/2325967121991110

    View details for Web of Science ID 000640374300001

    View details for PubMedID 33912616

    View details for PubMedCentralID PMC8047867

  • Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures. Cartilage Hinckel, B. B., Thomas, D., Vellios, E. E., Hancock, K. J., Calcei, J. G., Sherman, S. L., Eliasberg, C. D., Fernandes, T. L., Farr, J., Lattermann, C., Gomoll, A. H. 2021: 1947603521993219

    Abstract

    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 cm2) 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 cm2), 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.

    View details for DOI 10.1177/1947603521993219

    View details for PubMedID 33745340

  • Non-operative Management of Anterior Knee Pain: Patient Education. Current reviews in musculoskeletal medicine Bosshardt, L., Ray, T., Sherman, S. 2021

    Abstract

    PURPOSE OF REVIEW: Anterior knee pain is a multifactorial, often chronic condition, which can lead to long-term pain and disability. The purpose of this review is to examine the latest research on patient education for anterior knee pain. We will focus on how we might use patient education to increase the adoption of other efficacious treatment modalities and offer some suggestions for content and form of effective patient education.RECENT FINDINGS: New research suggests that patient education, alone, or in combination with targeted exercise therapy, can be effective in reducing pain and improving function in patients with patellofemoral pain. Addressing non-physical or psychological factors may also be an important component of patient education in many patients with chronic pain. Incorporation of new technologies into patient education, such as those available online, or through phone- or tablet-based apps, is likely to be helpful in the future, as we move more towards connecting with patients virtually. Patient education has been shown to be effective in decreasing pain and improving activity in patients with patellofemoral pain. Patient education should be individualized to the patient, focus on the latest effective treatments, and emphasize those treatments that can be self-managed by the patient. Emphasis should also be placed on patient understanding of risk factors and patterns of movement that may lead to, or exacerbate, anterior knee pain. Future research should continue to further characterize the elements of patient education that offer the most efficient treatment benefit.

    View details for DOI 10.1007/s12178-020-09682-4

    View details for PubMedID 33523412

  • Acute Patellofemoral Dislocation: Controversial Decision-Making. Current reviews in musculoskeletal medicine Rund, J. M., Hinckel, B. B., Sherman, S. L. 2021

    Abstract

    PURPOSE OF REVIEW: The topic of acute patella dislocations is controversial. Discussions revolve around which individuals need early surgery, identification of risk factors, and rehabilitation protocol. The purpose of this review is to discuss the current recommendations for non-operative and/or operative management of first-time dislocators.RECENT FINDINGS: Recent studies have made it clear that not all patellar dislocations are the same, not all patients do well with conservative treatment, and risk stratification can identify individuals at high risk of recurrence who would benefit from early surgical intervention. Risk factors that have been identified include younger age, skeletally immature, contralateral instability, trochlear dysplasia, patella alta, increased tibial tubercle-trochlear groove distance, and increased patella tilt. The PAPI (Pediatric and Adolescent Patellar Instability) RCT study and JUPITER (Justifying Patellar Instability Treatment by Early Results) prospective cohort study have been carefully developed, are under way, and will provide further guidance. In summary, the management of acute patellar dislocations is evolving. Surgery for patients with osteochondral loose bodies should include fixation as well as soft tissue stabilization. The standard of care for patients with an acute patellar dislocation without osteochondral loose bodies or fracture is non-operative treatment. However, imaging for all first-time dislocators is indicated to stratify risks and determine risk profile. If an individual is at high risk, soft tissue stabilization may be considered. Still, most patients will be treated non-operatively.

    View details for DOI 10.1007/s12178-020-09687-z

    View details for PubMedID 33523411

  • ACL Study Group survey reveals the evolution of anterior cruciate ligament reconstruction graft choice over the past three decades. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Arnold, M. P., Calcei, J. G., Vogel, N., Magnussen, R. A., Clatworthy, M., Spalding, T., Campbell, J. D., Bergfeld, J. A., Sherman, S. L., ACL Study Group 2021

    Abstract

    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.

    View details for DOI 10.1007/s00167-021-06443-9

    View details for PubMedID 33486558

  • Assessment and Trends of the Methodological Quality of the Top 50 Most Cited Articles on Patellar Instability. Orthopaedic journal of sports medicine Agarwalla, A. n., Yao, K. n., Darden, C. n., Gowd, A. K., Sherman, S. L., Farr, J. n., Shubin Stein, B. E., Amin, N. H., Liu, J. N. 2021; 9 (1): 2325967120972016

    Abstract

    Studies with a low level of evidence (LOE) have dominated the top cited research in many areas of orthopaedics. The wide range of treatment options for patellar instability necessitates an investigation to determine the types of studies that drive clinical practice.To determine (1) the top 50 most cited articles on patellar instability and (2) the correlation between the number of citations and LOE or methodological quality.Cross-sectional study.The Scopus and Web of Science databases were assessed to determine the top 50 most cited articles on patellar instability between 1985 and 2019. Bibliographic information, number of citations, and LOE were collected. Methodological quality was calculated using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-Randomized Studies (MINORS). Mean citations and mean citation density (citations per year) were correlated with LOE, MCMS, and MINORS scores.Most studies were cadaveric (n = 10; 20.0%), published in the American Journal of Sports Medicine (n = 13; 26.0%), published between 2000 and 2009 (n = 41; 82.0%), and conducted in the United States (n = 17; 34.0%). The mean number of citations and the citation density were 158.61 ± 59.53 (range, 95.5-400.5) and 12.74 ± 5.12, respectively. The mean MCMS and MINORS scores were 59.62 ± 12.58 and 16.24 ± 3.72, respectively. No correlation was seen between mean number of citations or citation density versus LOE. A significant difference was found in the mean LOE of articles published between 1990 and 1999 (5.0 ± 0) versus those published between 2000 and 2009 (3.12 ± 1.38; P = .03) and between 2010 and 2019 (3.00 ± 1.10; P = .01).There was a shift in research from anatomy toward outcomes in patellar instability; however, these articles demonstrated low LOE and methodological quality. Higher quality studies are necessary to establish informed standards of management of patellar instability.

    View details for DOI 10.1177/2325967120972016

    View details for PubMedID 33614793

    View details for PubMedCentralID PMC7869164

  • Clinical Outcomes of Meniscal Allograft Transplantation With Respect to the Minimal Clinically Important Difference. The American journal of sports medicine Su, L., Garcia-Mansilla, I., Kelley, B., Arshi, A., Fabricant, P., Sherman, S. L., Jones, K. J. 2021: 3635465211036116

    Abstract

    Arthroscopic-assisted meniscal allograft transplantation (MAT) has become a viable and effective treatment option for young active patients with postmeniscectomy pain. The minimal clinically important difference (MCID) of patient-reported outcome measures (PROMs) is imperative to evaluate the clinical significance of surgical interventions and inform clinical practice guidelines in orthopaedic surgery.To perform a systematic review of clinical outcome studies of patients undergoing MAT and compare postoperative improvement with established MCID thresholds.Systematic review and meta-analysis; Level of evidence, 4.A systematic review was performed using the PubMed, Web of Science, and Cochrane Library databases. A meta-analysis was performed using data obtained from studies reporting patient-reported outcomes. Subgroup analysis was performed on patients undergoing isolated lateral MAT using fresh-frozen grafts. Weighted mean postoperative improvements in the International Knee Documentation Committee (IKDC), Lysholm, and visual analog scale for pain (VAS pain) were calculated and compared with MCID values to determine if they met the MCID threshold.A total of 35 studies were identified, including 1658 unique patients. Weighted mean postoperative score improvements exceeded MCID thresholds for the VAS pain, IKDC, and Lysholm. Subgroup analysis of patients undergoing isolated lateral fresh-frozen MAT demonstrated postoperative improvements exceeding the MCID for the Lysholm and VAS pain.Evaluating postoperative PROMs with respect to the MCID is crucial to evaluate the effect of MAT on functional improvement. The results of the present meta-analysis suggest that postoperative improvements after MAT are clinically meaningful as reflected by PROMs exceeding the MCID threshold for the IKDC, Lysholm, and VAS pain.

    View details for DOI 10.1177/03635465211036116

    View details for PubMedID 34495780

  • Force-Time Waveform Shape Reveals Countermovement Jump Strategies of Collegiate Athletes. Sports (Basel, Switzerland) Guess, T. M., Gray, A. D., Willis, B. W., Guess, M. M., Sherman, S. L., Chapman, D. W., Mann, J. B. 2020; 8 (12)

    Abstract

    The purpose of this study was to relate the shape of countermovement jump (CMJ) vertical ground reaction force waveforms to discrete parameters and determine if waveform shape could enhance CMJ analysis. Vertical ground reaction forces during CMJs were collected for 394 male and female collegiate athletes competing at the National Collegiate Athletic Association (NCAA) Division 1 and National Association of Intercollegiate Athletics (NAIA) levels. Jump parameters were calculated for each athlete and principal component analysis (PCA) was performed on normalized force-time waveforms consisting of the eccentric braking and concentric phases. A K-means clustering of PCA scores placed athletes into three groups based on their waveform shape. The overall average waveforms of all athletes in each cluster produced three distinct vertical ground reaction force waveform patterns. There were significant differences across clusters for all calculated jump parameters. Athletes with a rounded single hump shape jumped highest and quickest. Athletes with a plateau at the transition between the eccentric braking and concentric phase (amortization) followed by a peak in force near the end of the concentric phase had the lowest jump height and slowest jump time. Analysis of force-time waveform shape can identify differences in CMJ strategies in collegiate athletes.

    View details for DOI 10.3390/sports8120159

    View details for PubMedID 33276573

  • Autologous Bone Grafting OPERATIVE TECHNIQUES IN SPORTS MEDICINE Robinson, P. G., Abrams, G. D., Sherman, S. L., Safran, M. R., Murray, I. R. 2020; 28 (4)
  • Superior Capsular Reconstruction: A Systematic Review of Surgical Techniques and Clinical Outcomes. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Gao, I., Sochacki, K. R., Freehill, M. T., Sherman, S. L., Abrams, G. D. 2020

    Abstract

    PURPOSE: To evaluate surgical techniques and clinical outcomes for arthroscopic superior capsular reconstruction (SCR) for treatment of massive irreparable rotator cuff tears.METHODS: A systematic review was registered with PROSPERO and performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane databases were searched. Studies investigating SCR with reported surgical technique were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. Technical aspects of surgical technique for SCR were analyzed in each article, which included: graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and post-operative rehabilitation protocol. Clinical outcomes, when available, were also analyzed.RESULTS: Three hundred sixty-five articles were screened with 29 found that described surgical technique for SCR. According to the Modified Coleman Methodology Score, 24 articles were poor (scores <55), 4 were fair (scores between 55 and 69), and 1 was good (scores between 70 and 84) with an average score of 25.8 ± 20.9. The most commonly used technique for SCR utilized: acellular dermal allograft, two biocomposite suture anchors for glenoid fixation, transosseus equivalent double-row suture anchor fixation for greater tuberosity fixation with two biocomposite medial row anchors and two biocomposite lateral row anchors, double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, performance of both anterior and posterior margin convergence, and native rotator cuff repair when possible. Only 8 of the studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder ROM, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes between the various surgical techniques.CONCLUSIONS: Many surgical techniques exist for arthroscopic SCR. However, no superior technique was demonstrated, as there were no studies comparing clinical outcomes among these various techniques.

    View details for DOI 10.1016/j.arthro.2020.09.016

    View details for PubMedID 33227320

  • The use of biologics in professional and Olympic sport: a scoping review protocol. Bone & joint open Makaram, N. S., Murray, I. R., Rodeo, S. A., Sherman, S. L., Murray, A. D., Haddad, F. S., McAdams, T. R., Abrams, G. D. 2020; 1 (11): 715–19

    Abstract

    Aims: The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport.Methods: Best-practice methodological frameworks suggested by Arksey and O'Malley, Levac et al, and the Joanna Briggs Institute will be used. This scoping review will aim to firstly map the current extent, range, and nature of evidence for biologic strategies to treat injuries in professional and Olympic sport; secondly, to summarize and disseminate existing research findings; and thirdly, to identify gaps in existing literature. A three-step search strategy will identify peer reviewed and non-peer reviewed literature, including reviews, original research, and both published and unpublished ('grey') literature. An initial limited search will identify suitable search terms, followed by a search of five electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Google Scholar) using keyword and index terms. Studies will be screened independently by two reviewers for final inclusion.Dissemination: We will chart key concepts and evidence, and disseminate existing research findings to practitioners and clinicians, through both peer reviewed and non-peer reviewed literature, online platforms (including social media), conference, and in-person communications. We will identify gaps in current literature and priorities for further study.

    View details for DOI 10.1302/2633-1462.111.BJO-2020-0159

    View details for PubMedID 33241221

  • Platelet-Rich Plasma Augmentation for Isolated Arthroscopic Meniscal Repairs Leads to Significantly Lower Failure Rates: A Systematic Review of Comparative Studies. Orthopaedic journal of sports medicine Sochacki, K. R., Safran, M. R., Abrams, G. D., Donahue, J., Chu, C., Sherman, S. L. 2020; 8 (11): 2325967120964534

    Abstract

    Background: Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing.Purpose: To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without PRP.Study Design: Systematic review; Level of evidence, 3.Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Multiple databases were searched for studies that compared outcomes of isolated arthroscopic meniscal repair augmented with PRP versus without PRP in human patients. Failures and patient-reported outcome scores were reported for each study and compared between groups. Study heterogeneity was assessed using I 2 for each outcome measure before meta-analysis. Study methodological quality was analyzed. Continuous variable data were reported as mean and standard deviation from the mean. Categorical variable data were reported as frequency with percentage. All P values were reported with significance set at P < .05.Results: Five articles were analyzed (274 patients [110 with PRP and 164 without PRP]; 65.8% male; mean age, 29.1 ± 4.6 years; mean follow-up, 29.2 ± 22.1 months). The risk of meniscal repair failure ranged from 4.4% to 26.7% for PRP-augmented repairs and 13.3% to 50.0% for repairs without PRP. Meniscal repairs augmented with PRP had significantly lower failure rates than repairs without PRP (odds ratio, 0.32; 95% CI, 0.12-0.90; P = .03). One of the 5 studies reported significantly higher outcomes in the PRP-augmented group versus the no-PRP group for the International Knee Documentation Committee (IKDC), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) (P < .05 for all). The remaining 4 studies reported no significant difference between groups with regard to outcomes for the IKDC, Lysholm knee scale, visual analog scale for pain, or Tegner activity level.Conclusion: Although the studies were of mostly of low quality, isolated arthroscopic meniscal repairs augmented with PRP led to significantly lower failure rates (10.8% vs 27.0%; odds ratio, 0.32; P = .03) as compared with repairs without PRP. However, most studies reported no significant differences in patient-reported outcomes.

    View details for DOI 10.1177/2325967120964534

    View details for PubMedID 33283008

  • Comparison of Autologous Chondrocyte Implantation and Osteochondral Allograft Transplantation of the Knee in a Large Insurance Database: Reoperation Rate, Complications, and Cost Analysis. Cartilage Sochacki, K. R., Varshneya, K., Calcei, J. G., Safran, M. R., Abrams, G. D., Donahue, J., Chu, C., Sherman, S. L. 2020: 1947603520967065

    Abstract

    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 P values were reported with significance set at P < 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%, P < 0.0001). Concomitant osteotomy at the time of index procedure significantly reduced the risk for reoperation in both groups (odds ratio [OR] 0.2, P < 0.0001 and OR 0.2, P = 0.009). The complication rates were similar between ACI (1.6%) and OCA (1.2%) groups (P = 0.24). Day of surgery payments were significantly higher after ACI compared with OCA (P = 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.

    View details for DOI 10.1177/1947603520967065

    View details for PubMedID 33106002

  • Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS Hinckel, B. B., Baumann, C. A., Ejnisman, L., Cavinatto, L. M., Martusiewicz, A., Tanaka, M. J., Tompkins, M., Sherman, S. L., Chahla, J. A., Frank, R., Yamamoto, G. L., Bicos, J., Arendt, L., Fithian, D., Farr, J. 2020; 4 (10)
  • Microfracture for the Treatment of Symptomatic Cartilage Lesions of the Knee: A Survey of International Cartilage Regeneration & Joint Preservation Society. Cartilage Medina, J., Garcia-Mansilla, I., Fabricant, P. D., Kremen, T. J., Sherman, S. L., Jones, K. 2020: 1947603520954503

    Abstract

    OBJECTIVE: The purpose of this study was to describe the current practice trends for managing symptomatic cartilage lesions of the knee with microfracture among ICRS (International Cartilage Regeneration & Joint Repair Society) members.DESIGN: A 42-item electronic questionnaire was sent to all ICRS members, which explored indications, surgical technique, postoperative management, and outcomes of the microfracture procedure for the treatment of symptomatic, full thickness chondral and osteochondral defects of the knee. Responses were compared between surgeons from different regions and years of practice.RESULTS: A total of 385 surgeons answered the questionnaire. There was a significant difference noted in the use of microfracture among surgeons by region (P < 0.001). There was no association between the number of years in practice and the self-reported proportion of microfracture cases performed (P = 0.37). Fifty-eight subjects (15%) indicated that they do not perform microfracture at all. Regarding indication for surgery, 56% of surgeons would limit their indication of microfracture to lesions measuring 2 cm2 or less. Half of the surgeons reported no upper age or body mass index limit. Regarding surgical technique, 90% of surgeons would recommend a formal debridement of the calcified layer and 91% believe it is important to create stable vertical walls. Overall, 47% of surgeons use biologic augmentation, with no significant difference between regions (P = 0.35) or years of practice (P = 0.67). Rehabilitation protocols varied widely among surgeons.CONCLUSIONS: Indications, operative technique, and rehabilitation protocols utilized for patients undergoing microfracture procedures vary widely among ICRS members. Regional differences and resources likely contribute to these practice pattern variations.

    View details for DOI 10.1177/1947603520954503

    View details for PubMedID 32911974

  • Surgeon practice patterns for pre-soaking ACL tendon grafts in vancomycin: a survey of the ACL study group. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Xiao, M., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020

    Abstract

    PURPOSE: To survey members of The ACL study group to determine the current practice patterns surrounding the technique of pre-soaking ACL grafts in vancomycin.METHODS: A web-based questionnaire was distributed to members of the ACL Study Group. Questions included the use of vancomycin solution for graft soaking during ACL reconstruction, their protocol for soaking the graft, vancomycin concentration utilized, graft choices, and concerns with the technique.RESULTS: Sixty-six (57%) ACL surgeons completed the survey. Approximately one-third (37.9%) of respondents currently pre-soak their ACL grafts in vancomycin prior to implantation, with 60% of these surgeons being from Europe. Seventy-six percent have adopted this practice within the past 5years. The majority of surgeons wrap the graft in a vancomycin-soaked gauze prior to implantation (56%), soak for a variable amount of time before implantation (56%), use a concentration of 5mg/mL (68%), and soak hamstring grafts (92%). Concerns included the mechanical properties of the graft (35%), cost of vancomycin (23%), availability (12%), and antibiotic resistance (9%).CONCLUSION: This survey demonstrates that 37.9% of ACL study group members currently utilize vancomycin to pre-soak ACL tendon grafts as a means to decrease post-operative infection risk, with the majority of surgeons having implemented this practice within the past 5years. The biggest concern towards using vancomycin was the mechanical properties of the graft after soaking.LEVEL OF EVIDENCE: IV.

    View details for DOI 10.1007/s00167-020-06265-1

    View details for PubMedID 32902684

  • Humeral Head Osteochondral Allograft Reconstruction with Arthroscopic Anterior Shoulder Stabilization at a Long-Term Follow-Up: A Case Report. JBJS case connector Sochacki, K. R., Dillingham, M. F., Abrams, G. D., Sherman, S. L., Donahue, J. n. ; 10 (2): e0555

    Abstract

    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

  • Rationale for the Use of Orthobiologics in Sports Medicine OPERATIVE TECHNIQUES IN SPORTS MEDICINE Makaram, N. S., Safran, M. R., Abrams, G. D., Sherman, S. L., Murray, I. R. 2020; 28 (3)
  • Costs, Complications, and Reoperations Associated With Primary Arthroscopic Rotator Cuff Repair With or Without Acromioplasty and/or Biceps Tenodesis. Arthroscopy, sports medicine, and rehabilitation Varshneya, K., Safran, M. R., Sherman, S. L., Abrams, G. D. 2020; 2 (4): e369–e376

    Abstract

    Purpose: To evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT.Methods: We queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into groups based on concomitant procedures (acro and/or BT) performed on the same day as index RCR. Reoperations, complications, and costs were followed for 5 years post-index procedure. Patients without laterality codes were excluded. A multivariate logistic regression analysis was used to control for confounding factors.Results: This study identified 147,838 patients (mean age, 53.1 years; standard deviation, 8.3 years) who underwent primary RCR. Patients were stratified into 4 groups: (1) RCR only, (2) RCR+ acro, (3) RCR+ BT, and (4) RCR+ acro+ BT. Patients in the RCR only group experienced the highest rate of unadjusted overall postoperative complications (17.2%) versus the other groups (RCR+ acro 16.4%, RCR+ BT 15.1%, RCR+ acro+ BT 16.2%, P < .0161). The RCR only group also experienced a significantly greater number of reoperations on the ipsilateral shoulder (P < .0001), whereas the RCR+ acro+ BT had the highest costs at all timepoints. In the regression analysis, there was no significant differences between complications and reoperations between any groups. After adjusting for covariates, the performance of a BT with an RCR and acromioplasty led to increased costs (odds ratio, 1.47, 1.37-1.59, P < .001).Conclusions: Concomitant biceps tenodesis does lead to higher total healthcare costs, both in the shorter and longer terms. When adjusting for confounding factors, the performance of concomitant biceps tenodesis with rotator cuff repair does not lead to a difference in postoperative complication rate or risk for revision surgery.Level of Evidence: Level IV, economic analysis.

    View details for DOI 10.1016/j.asmr.2020.05.010

    View details for PubMedID 32875302

  • Hop test does not correlate with neuromuscular control during drop vertical jump test: A prognostic comparative study utilizing healthy subjects CURRENT ORTHOPAEDIC PRACTICE Gulbrandsen, T. R., Willis, B. W., Guess, T. M., Gray, A. D., Sherman, S. L. 2020; 31 (4): 358–65
  • Linked Double-Row Equivalent Arthroscopic Rotator Cuff Repair Leads to Significantly Improved Patient Outcomes. Orthopaedic journal of sports medicine Endo, A., Hoogervorst, P., Safranek, C., Sochacki, K. R., Safran, M. R., Sherman, S. L., Donahue, J. 2020; 8 (7): 2325967120938311

    Abstract

    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

  • Return to sport after anterior cruciate ligament injury: Panther Symposium ACL Injury Return to Sport Consensus Group. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Meredith, S. J., Rauer, T., Chmielewski, T. L., Fink, C., Diermeier, T., Rothrauff, B. B., Svantesson, E., Hamrin Senorski, E., Hewett, T. E., Sherman, S. L., Lesniak, B. P., Panther Symposium ACL Injury Return to Sport Consensus Group 2020

    Abstract

    PURPOSE: A precise and consistent definition of return to sport (RTS) after anterior cruciate ligament (ACL) injury is lacking, and there is controversy surrounding the process of returning patients to sports and their previous activity level. The aim of the Panther Symposium ACL Injury RTS Consensus Group was to provide a clear definition of RTS and description of the RTS continuum, as well as to provide clinical guidance on RTS testing and decision-making.METHODS: An international, multidisciplinary group of ACL experts convened as part of a consensus meeting. Consensus statements were developed using a modified Delphi method. Literature review was performed to report the supporting evidence.RESULTS: Key points include that RTS is characterized by achievement of the pre-injury level of sport and involves a criteria-based progression from return to participation to return to sport, and ultimately return to performance. Purely time-based RTS decision-making should be abandoned. Progression occurs along a RTS continuum with decision-making by a multidisciplinary group that incorporates objective physical examination data and validated and peer-reviewed RTS tests, which should involve functional assessment as well as psychological readiness. Consideration should be given to biological healing, contextual factors and concomitant injuries.CONCLUSION: The resultant consensus statements and scientific rationale aim to inform the reader of the complex process of RTS after ACL injury that occurs along a dynamic continuum. Research is needed to determine the ideal RTS test battery, the best implementation of psychological readiness testing and methods for the biologic assessment of healing and recovery.LEVEL OF EVIDENCE: IV.

    View details for DOI 10.1007/s00167-020-06009-1

    View details for PubMedID 32347344

  • Failures of Realignment Osteotomy OPERATIVE TECHNIQUES IN SPORTS MEDICINE Schubert, M. F., Sidhu, R., Getgood, A. M., Sherman, S. L. 2020; 28 (1)
  • Patellofemoral Cartilage Restoration: A Systematic Review and Meta-analysis of Clinical Outcomes. The American journal of sports medicine Hinckel, B. B., Pratte, E. L., Baumann, C. A., Gowd, A. K., Farr, J. n., Liu, J. N., Yanke, A. B., Chahla, J. n., Sherman, S. L. 2020: 363546519886853

    Abstract

    Many surgical options for treating patellofemoral (PF) cartilage lesions are available but with limited evidence comparing their results.To determine and compare outcomes of PF cartilage restoration techniques.Systematic review and meta-analysis.PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, and Cochrane Library databases. Inclusion criteria were clinical studies in the English language, patient-reported outcomes after PF cartilage restoration surgery, and >12 months' follow-up. Quality assessment was performed with the Coleman Methodology Score. Techniques were grouped as osteochondral allograft transplantation (OCA), osteochondral autograft transfer (OAT), chondrocyte cell-based therapy, bone marrow-based therapy, and scaffolds.A total of 59 articles were included. The mean Coleman Methodology Score was 71.8. There were 1937 lesions (1077 patellar, 390 trochlear, and 172 bipolar; 298 unspecified). The frequency of the procedures was as follows, in descending order: chondrocyte cell-based therapy (65.7%), bone marrow-based therapy (17.2%), OAT (8%), OCA (6.6%), and scaffolds (2.2%). When compared with the overall pooled lesion size (3.9 cm2; 95% CI, 3.5-4.3 cm2), scaffold (2.2 cm2; 95% CI, 1.8-2.5 cm2) and OAT (1.5 cm2; 95% CI, 1.1-1.9 cm2) lesions were smaller (P < .001), while chondrocyte cell-based therapy lesions were larger (4.7 cm2; 95% CI, 4.1-5.3 cm2; P = .039). Overall, the instability pool was 11.9%, and the anatomic risk factors pool was 32.1%. Statistically significant improvement was observed on at least 1 patient-reported outcome in chondrocyte cell-based therapy (83%), OAT (78%), OCA (71%), bone marrow-based therapy (64%), and scaffolds (50%). There were no significant differences between any group and the overall pooled change in International Knee Documentation Committee score (30.2; 95% CI, 27.4-32.9) and Lysholm score (25.2; 95% CI, 16.9-33.5). There were no significant differences between any group and the overall pooled rate in minor complication rate (7.6%; 95% CI, 4.7%-11.9%) and major complication rate (8.3%; 95% CI, 5.7%-12.0%); however, OCA had a significantly greater failure rate (22.7%; 95% CI, 14.6%-33.4%) as compared with the overall rate (6.8%; 95% CI, 4.7%-9.5%).PF cartilage restoration leads to improved clinical outcomes, with low rates of minor and major complications. There was no difference among techniques; however, failures were higher with OCA.

    View details for DOI 10.1177/0363546519886853

    View details for PubMedID 31899868

  • Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Hinckel, B. B., Baumann, C. A., Ejnisman, L. n., Cavinatto, L. M., Martusiewicz, A. n., Tanaka, M. J., Tompkins, M. n., Sherman, S. L., Chahla, J. A., Frank, R. n., Yamamoto, G. L., Bicos, J. n., Arendt, L. n., Fithian, D. n., Farr, J. n. 2020; 4 (10): e20.00083

    Abstract

    Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.

    View details for DOI 10.5435/JAAOSGlobal-D-20-00083

    View details for PubMedID 33986224

  • Risk of Subsequent Knee Arthroplasty After Sports Medicine Procedures. Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews Enweze, L. C., Varshneya, K. n., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020; 4 (8): e2000125

    Abstract

    Approximately 10% of men and 13% of women older than the age of 60 are affected by symptomatic osteoarthritis of the knee. Anatomic repair or reconstruction after knee injury has been a central tenet of surgical treatment to reduce the risk of osteoarthritis. The purpose of this study was to examine common sports medicine procedures of the knee and determine the proportion of patients who subsequently undergo total knee arthroplasty (TKA).The MarketScan database was queried from the period of January 2007 through December 2016. Patients were identified, who underwent a procedure of the knee, as defined by Current Procedural Terminology codes relating to nonarthroplasty procedures of the knee. Patients in whom laterality could not be confirmed or underwent another ipsilateral knee procedure before TKA were excluded from this study. The primary outcome of this study was the overall rate of TKA after index knee surgery. Time from index procedure to TKA was a secondary outcome. A multivariate regression analysis was used to control for covariates such as age, sex, and comorbidity status.A total of 843,749 patients underwent one of the 13 common sports medicine procedures of the knee. The procedure with the highest unadjusted rate of subsequent TKA was arthroscopic osteochondral allograft (5.81%), whereas anterior cruciate ligament (ACL) reconstruction with meniscus repair demonstrated the lowest rate of subsequent TKA (0.01%). When adjusting for confounding factors, the regression analysis identified meniscal transplantation (odds ratio [OR] = 3.06, P < 0.0001) as having the highest risk of subsequent TKA, followed by osteochondral autograft (OR = 1.74, P = 0.0424) and arthroscopic osteochondral allograft (OR = 1.49, P < 0.0001). ACL reconstruction with meniscus repair (OR = 0.02, P < 0.0001), ACL reconstruction alone (OR = 0.17, P < 0.0001), ACL with meniscectomy (OR = 0.20, P < 0.0001), and meniscal repair (OR = 0.65, P < 0.0001) had the lowest rate of subsequent TKA. ACL reconstruction with meniscus repair had the longest period from index procedure to TKA at 2827 days.ACL reconstruction and meniscus preservation demonstrated an extremely low rate of conversion to TKA when compared with patients who needed salvage interventions such as meniscus and cartilage transplantation. None of the salvage interventions delayed the need for a TKA. Meniscal transplantation had the highest risk of all procedures of going on to a TKA.

    View details for DOI 10.5435/JAAOSGlobal-D-20-00125

    View details for PubMedID 32852917

  • The effect of silicone ankle sleeves and lace-up ankle braces on neuromuscular control, joint torque, and cutting agility. Journal of orthopaedics Cinque, M. E., Bodendorfer, B. M., Shu, H. T., Arnold, N. A., Gray, A. D., Summerhays, B. J., Guess, T. M., Sherman, S. L. 2020; 20: 359–66

    Abstract

    To evaluate the effects of silicone ankle sleeves (SASs) and lace-up ankle braces (LABs) on neuromuscular control, net joint torques, and cutting agility in healthy, active individuals.Markerless motion-capture technology tracked subjects fitted with SASs, LABs, or no brace while they performed the movements: Y-excursion, left cutting, right cutting, single-leg drop vertical jump (SLDVJ), 45-degree bound, and single-leg squat (SLS).University Laboratory.Ten healthy, active individuals (5 males and 5 females, mean ± SD 23.60 ± 1.43 years of age).Degrees of joint range of motion (ROM), Newton-meters of joint torque, time to perform a cutting maneuver.SASs and LABs resulted in significantly different knee and ankle ROM and hip internal rotation in the SLDVJ, SLS, Y-excursion, cutting maneuver, and 45-degree bound when compared to control (p < .05). Both ankle and knee torque were significantly reduced in the 45-degree bound and cutting movements with both types of PABs (p < .05). There were minimal differences between the SASs and LABs for all conditions. There were no statistically significant differences in cutting times for any of the 3 conditions.Both SAS and LAB positively impacted neuromuscular control, reduced net joint torque, and neither impaired cutting agility when compared to control.

    View details for DOI 10.1016/j.jor.2020.05.019

    View details for PubMedID 32684673

    View details for PubMedCentralID PMC7355724

  • Management of Large Focal Chondral and Osteochondral Defects in the Knee. The journal of knee surgery Calcei, J. G., Ray, T. n., Sherman, S. L., Farr, J. n. 2020; 33 (12): 1187–1200

    Abstract

    Large, focal articular cartilage defects of the knee (> 4 cm2) 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.

    View details for DOI 10.1055/s-0040-1721053

    View details for PubMedID 33260221

  • 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 Sochacki, K. R., Shea, K. G., Varshneya, K. n., Safran, M. R., Abrams, G. D., Donahue, J. n., Sherman, S. L. 2020: 363546520904685

    Abstract

    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

  • Consensus on Rehabilitation Guidelines among Orthopedic Surgeons in the United States following Use of Third-Generation Articular Cartilage Repair (MACI) for Treatment of Knee Cartilage Lesions. Cartilage Flanigan, D. C., Sherman, S. L., Chilelli, B. n., Gersoff, W. n., Jones, D. n., Lee, C. A., Toth, A. n., Cramer, C. n., Zaporojan, V. n., Carey, J. n. 2020: 1947603520968876

    Abstract

    The aim of this study was to evaluate levels of consensus in rehabilitation practices following MACI (autologous cultured chondrocytes on porcine collagen membrane) treatment based on the experience of an expert panel of U.S. orthopedic surgeons.A list of 24 questions was devised based on the current MACI rehabilitation protocol, literature review, and discussion with orthopedic surgeons. Known areas of variability were used to establish 4 consensus domains, stratified on lesion location (tibiofemoral [TF] or patellofemoral [PF]), including weightbearing (WB), range of motion (ROM), return to work/daily activities of living, and return to sports. A 3-step Delphi technique was used to establish consensus.Consensus (>75% agreement) was achieved on all 4 consensus domains. Time to full WB was agreed as immediate (with bracing) for PF patients (dependent on concomitant procedures), and 7 to 9 weeks in TF patients. A progression for ROM was agreed that allowed patients to reach 90° by week 4, with subsequent progression as tolerated. The panel estimated that the time to full ROM would be 7 to 9 weeks on average. A range of time was established for release to activities of daily living, work, and sports, dependent on lesion and patient characteristics.Good consensus was established among a panel of U.S. surgeons for rehabilitation practices following MACI treatment of knee cartilage lesions. The consensus of experts can aid surgeons and patients in the expectations and rehabilitation process as MACI surgery becomes more prevalent in the United States.

    View details for DOI 10.1177/1947603520968876

    View details for PubMedID 33124432

  • Soaking of Autologous Tendon Grafts in Vancomycin Before Implantation Does Not Lead to Tenocyte Cytotoxicity. The American journal of sports medicine Xiao, M. n., Leonardi, E. A., Sharpe, O. n., Sherman, S. L., Safran, M. R., Robinson, W. H., Abrams, G. D. 2020: 363546520951815

    Abstract

    Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity because of tenocyte toxicity.To examine the in vitro toxicity of varying doses of vancomycin on human tenocytes.Controlled laboratory study.Human patellar tenocytes were isolated and expanded in vitro. Tenocytes in culture were exposed to vancomycin at 5 different concentrations (400, 1600, 3200, 6400, and 12,800 μg/mL) and 3 time intervals (2, 6, and 24 hours). The control for all series was tenocyte exposure to only culture medium for each time interval. After treatment, a 10% Cell Counting Kit-8 solution in cellular growth medium was applied to the cells to examine cytotoxicity. A live/dead assay was used to assess tenocyte viability through fluorescence microscopy and flow cytometry. Results were analyzed statistically using multivariable logistic regression models with Tukey honest significant difference post hoc tests.Vancomycin did not cause significant changes in tenocyte viability after 2 and 6 hours of incubation at any concentration between 0 and 12,800 µg/mL. Incubation with vancomycin for 24 hours led to a significant decrease in cell viability at higher concentrations.Tenocytes derived from human patellar tendons exposed to relatively high concentrations of vancomycin for short periods of time do not demonstrate significant cell death and toxicity.Exposing tendons to vancomycin for a short period of time, such as before ACL reconstruction, is not likely to cause tenocyte toxicity because of vancomycin administration.

    View details for DOI 10.1177/0363546520951815

    View details for PubMedID 32898431

  • Significantly Lower Infection Risk For ACL Grafts Pre-Soaked in Vancomycin Compared to Un-Soaked Grafts: A Systematic Review and Meta-analysis. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Xiao, M. n., Sherman, S. L., Safran, M. R., Abrams, G. D. 2020

    Abstract

    To compare post-operative infection rates following ACL reconstruction performed with grafts pre-soaked in vancomycin versus those without vancomycin.A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for therapeutic level I-III studies that compared outcomes of pre-soaking ACL grafts with vancomycin versus without vancomycin in human patients. Included graft types were tendon autografts or allografts, and studies documenting infection with a minimum follow-up of 30 days were included. Postoperative infection rates and knee-specific patient reported outcome scores were extracted from each study and compared between groups. Study methodological quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) and Modified Coleman Methodology Score (MCMS). Infection rates and re-tear rates were pooled and weighted for meta-analysis using a random-effects model. All P values were reported with an alpha level of 0.05 set as significant.The initial search yielded 144 articles (44 duplicates, 100 screened, 29 full-text review). Ten articles (21,368 subjects [7,507 vancomycin and 13,861 no vancomycin], 67% males, mean age 29.5 + 1.5 years old) were included and analyzed. Eight of the 10 studies included only autografts, with 94.5% of grafts being hamstring autografts. Soaking grafts in vancomycin resulted in significantly fewer infections (0.013% vs 0.77%; OR 0.07 [0.03, 0.18], p < 0.001). Only two studies included patient reported outcomes, and both demonstrated no difference in International Knee Documentation Committee (IKDC) scores one year after surgery for patients with grafts pre-soaked in vancomycin compared to without vancomycin.Soaking ACL tendon grafts with vancomycin prior to implantation is associated with a nearly 15 times decrease in odds of infection compared to grafts not soaked in vancomycin. There were few studies that investigated patient reported outcomes and re-tear rates after soaking ACL grafts in vancomycin.

    View details for DOI 10.1016/j.arthro.2020.12.212

    View details for PubMedID 33359822

  • Administrative Databases Utilized for Sports Medicine Research Demonstrate Significant Differences in Underlying Patient Demographics and Resulting Surgical Trends. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association Xiao, M. n., Donahue, J. n., Safran, M. R., Sherman, S. L., Abrams, G. D. 2020

    Abstract

    To discern differences between the PearlDiver and MarketScan databases with regards to patient demographics, costs, re-operations, and complication rates for isolated meniscectomy.We queried the PearlDiver Humana Patient Records Database and the IBM® MarketScan® Commercial Claims and Encounters database for all patients who had record of meniscectomy denoted by CPT-29880 or CPT-29881 codes between January 1, 2007 and December 31, 2016. Those that had any other knee procedure at the same time as the meniscectomy were excluded, and the first instance of isolated meniscectomy was recorded. Patient demographics, Charlson Comorbidity Index (CCI), reoperations, 30- and 90-day complication rates, and costs were collected from both databases. Pearson's χ2 test with Yate's continuity correction and the student t-test were used to compare the two databases, and an alpha value of 0.05 was set as significant.We identified 441,147 patients with isolated meniscectomy from the MarketScan database (0.36% of total database), approximately 10 times the number of patients (n = 49,924; 0.20% of total database) identified from PearlDiver. The PearlDiver population was significantly older (median age: 65-69) than the MarketScan cohort, where all patients were younger than 65 (median age: 52; p < 0.001). Average CCI was significantly lower for MarketScan (0.172, SD: 0.546) compared to PearlDiver (1.43, SD: 2.05; p < 0.001), even when restricting the PearlDiver cohort to patients under 65 (1.02, SD: 1.74; p < 0.001). The PearlDiver < 65 sub-cohort also had increased 30- (RR: 1.53 (1.40-1.67)) and 90-day (RR: 1.56 (1.47-1.66)) post-operative complications compared to MarketScan. Overall, laterality coding was more prevalent in the PearlDiver database.For those undergoing isolated meniscectomy, the MarketScan database comprised an overall larger and younger cohort of patients with fewer comorbidities, even when examining only subjects under 65 years of age.Level III, retrospective comparative study.

    View details for DOI 10.1016/j.arthro.2020.09.013

    View details for PubMedID 32966865

  • Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis Utilizing a National Insurance Database. The American journal of sports medicine Sochacki, K. R., Varshneya, K. n., Calcei, J. G., Safran, M. R., Abrams, G. D., Donahue, J. n., Sherman, S. L. 2020: 363546520935453

    Abstract

    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

  • 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 Sochacki, K. R., Varshneya, K. n., Safran, M. R., Abrams, G. D., Donahue, J. n., Wang, T. n., Sherman, S. L. 2020

    Abstract

    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

  • Meniscus Injuries: A Review of Rehabilitation and Return to Play. Clinics in sports medicine Sherman, S. L., DiPaolo, Z. J., Ray, T. E., Sachs, B. M., Oladeji, L. O. 2020; 39 (1): 165–83

    Abstract

    Meniscal injury potentiates a sequence of events that leads to degenerative changes and early osteoarthritis. It is therefore imperative to preserve the meniscus whenever possible. Given the expanding indications for meniscus repair, it is important to continually analyze and advance the understanding of rehabilitation and return to play following meniscal surgery. This article presents evidence-based rehabilitation and return-to-play guidelines as well as a brief review of return-to-play outcomes following isolated meniscus repair.

    View details for DOI 10.1016/j.csm.2019.08.004

    View details for PubMedID 31767104

  • Patellofemoral Imaging and Analysis OPERATIVE TECHNIQUES IN SPORTS MEDICINE Sherman, S. L., Todd Raines, B., Benjamin Burch, M., Ray, T., Stein, B. 2019; 27 (4)
  • Enhanced subchondroplasty treatment for post-traumatic cartilage and subchondral bone marrow lesions in a canine model. Journal of orthopaedic research : official publication of the Orthopaedic Research Society Oliver, H. A., Bozynski, C. C., Cook, C. R., Kuroki, K., Sherman, S. L., Stoker, A. M., Cook, J. L. 2019

    Abstract

    This study characterizes outcomes associated with subchondroplasty (SCP) versus SCP enhanced with platelet rich plasma (PRP) or bone marrow aspirate concentrate (BMC) treatment of impact-induced subchondral bone marrow lesions (BML) using a validated pre-clinical canine model. With IACUC approval, purpose-bred research hounds (n=24) underwent arthroscopic impact injury (40N) to both medial femoral condyles. At 3 months, functional assessments, arthroscopy, and MRI were performed. One knee in each dog (n=24; n=12 per endpoint) was randomly assigned to SCP with the other knee randomly assigned to SCP+PRP, SCP+BMC or sham injection (Control) (n=8 per group; n=4 per endpoint). Dogs were evaluated at 6 and 12 months after treatment using functional assessments, radiography, arthroscopy, and MRI and humanely euthanatized at 6 or 12 months after treatment for histologic assessments. At 6 months post-treatment, comfortable range-of-motion (CROM) was higher (p<0.04) in SCP+PRP and SCP+BMC knees compared to Controls. At 1 year post-treatment, %-Total Pressure Index was higher (p=0.036) in SCP+BMC compared to Controls, pain was lower (p<0.05) in SCP+BMC and SCP+PRP compared to SCP and Controls, and CROM was higher (p<0.05) in SCP+BMC and SCP+PRP compared to SCP and Controls. Knees treated with SCP+PRP and SCP+BMC had better (p<0.05) MRI grades than SCP and Controls. No statistically significant differences in arthroscopic or histologic pathology were noted. Clinical significance: Biologics added to SCP treatment may further enhance its beneficial effects by improving range-of-motion, pain severity, and limb loading through 1 year after treatment. However, these benefits must be considered alongside cost, logistics, and treatment availability. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1002/jor.24508

    View details for PubMedID 31692048

  • Optimizing Patellofemoral Cartilage Restoration and Instability With Tibial Tubercle Osteotomy ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Sherman, S. L., Humpherys, J., Farr, J. 2019; 35 (8): 2255–56

    Abstract

    Tibial tubercle osteotomy (TTO) is a procedure that may be used to address a wide array of patellofemoral joint pathology. The most common indications for TTO include (1) patellar instability, including either a lateralized force vector or abnormal patellar alta, and (2) patellar focal cartilage defects or chondromalacia. Customization of the TTO can effectively address the patellofemoral joint pathology by modifying patellar tracking in the trochlear groove and/or altering the contact pressures experienced by the patellofemoral cartilage. TTO may be most successful when performed in conjunction with soft-tissue stabilization and/or biological augmentation of chondral injuries. Specifically, isolated anteromedialization is recommended for focal, distal lateral patellar lesions; combined anteromedialization and cartilage restoration are recommended for medial, central, and/or panpatellar cartilage pathology; medialization with soft-tissue stabilization is recommended for a lateralized tubercle position (elevated tibial tubercle-trochlear groove distance); and distalization with soft-tissue stabilization is recommended for patella alta. Clinical studies have shown good to excellent results at long-term follow-up when a TTO is performed for patellar instability, whereas TTO performed for chondral defects has shown good to excellent outcomes that correlate strongly with the size and location of the chondral defect. With appropriate patient selection, TTO is a valuable tool for the treatment of patellofemoral joint pathology.

    View details for DOI 10.1016/j.arthro.2019.05.013

    View details for Web of Science ID 000478807600002

    View details for PubMedID 31395155

  • Biomechanical Evaluation of Suture Anchor versus Transosseous Tunnel Patellar Tendon Repair Techniques. The journal of knee surgery Sherman, S. L., Black, B., Mooberry, M. A., Freeman, K. L., Gulbrandsen, T. R., Milles, J. L., Evans, L., Flood, D., Pfeiffer, F. 2019; 32 (8): 825–32

    Abstract

    The objective of this study is to compare the cyclic loading strength and ultimate failure load in suture anchor repair versus transosseous tunnel repair of patellar tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure equal bone quality among groups. All right knees were assigned to the suture anchor repair group (n=6), whereas all left knees were assigned to the transosseous bone tunnel group (n=6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 1Hz between magnitudes of 50 and 150N, 50 and 200N, 50 and 250N, and tensile load at a rate of 0.1 mm/s until failure. Failure was defined as a sharp deviation in the linear load versus displacement curve, and failure mode was recorded. DXA measurements demonstrated equivalence of bone quality between the two groups (p>0.05). During cyclic load testing, there was only a statistically significant difference between the groups with regard to cyclic loading at the 50 to 200N loading cycle (p=0.010). There was no statistically significant difference between the groups with regard to ultimate load to failure (p=0.43). Failure mode within the suture anchor cohort occurred through anchor pullout except for one, which failed through the tendon. All specimens within the transosseous cohort failed through the midsubstance of the tendon except for one, which failed through suture breakage. Suture anchor repair demonstrated a similar biomechanical profile regarding cyclic loading and ultimate load to failure when compared with "gold standard" transosseous tunnel patellar tendon repair with a trend toward less gapping in the suture anchor group. Using suture anchors for repair of the patella tendon has similar biomechanical properties to transpatellar tunnels but may provide other clinical advantages.

    View details for DOI 10.1055/s-0038-1669790

    View details for PubMedID 30189438

  • Articular Cartilage Lesion Characteristic Reporting Is Highly Variable in Clinical Outcomes Studies of the Knee CARTILAGE Jones, K. J., Sheppard, W. L., Arshi, A., Hinckel, B. B., Sherman, S. L. 2019; 10 (3): 299–304

    Abstract

    The purpose of this study was to investigate the degree of standardized evaluation and reporting of cartilage lesion characteristics in high-impact clinical studies for symptomatic lesions of the knee. We hypothesized that there are significant inconsistencies in reporting these metrics across orthopedic literature.A total of 113 clinical studies on articular cartilage restoration of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2016. Full-text review was used to evaluate sources for details on study methodology and reporting on the following variables: primary procedure, location, size, grade, and morphology of cartilage lesions.All studies reported on the type of primary cartilage procedure and precise lesion location(s). Approximately 99.1% reported lesion morphology (chondral, osteochondral, mixed). For lesion size, 32.7% of articles did not report how size was measured and 11.5% did not report units. The lesion sizing method was variable, as 27.4% used preoperative magnetic resonance imaging to measure/report lesion size, 31.0% used arthroscopy, and 8.8% used both. The majority of studies (83.2%) used area to report size, and 5.3% used diameter. Formal grading was not reported in 17.7% of studies. Only 54.8% of studies reported depth when sizing osteochondral defects.Recent literature on cartilage restoration provides adequate information on surgical technique, lesion location, and morphology. However, there is wide variation and incomplete reporting on lesion size, depth, and grading. Future clinical studies should include these important data in a consistent manner to facilitate comparison among surgical techniques.

    View details for DOI 10.1177/1947603518756464

    View details for Web of Science ID 000472034600004

    View details for PubMedID 29405742

    View details for PubMedCentralID PMC6585291

  • Do neoprene sleeves and prophylactic knee braces affect neuromuscular control and cutting agility? Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine Bodendorfer, B. M., Arnold, N. R., Shu, H. T., Leary, E. V., Cook, J. L., Gray, A. D., Guess, T. M., Sherman, S. L. 2019; 39: 23–31

    Abstract

    OBJECTIVES: To evaluate the effects of neoprene sleeves (NSs) and prophylactic knee braces (PKBs) on neuromuscular control and cutting agility.DESIGN: Markerless motion-capture technology tracked subjects (1) without a brace as a control (2) with NSs and (3) with PKBs during single-leg drop vertical jump (SLDVJ), single-leg squat (SLS), Y-excursion, and cutting movements. Movements were recorded five times per bracing condition in three different sessions.SETTING: University laboratory.PARTICIPANTS: Ten healthy, active subjects (5 male, 5 female; age range, 22-26 years).MAIN OUTCOME MEASURES: Degrees of motion and time to completion.RESULTS: Use of NSs and PKBs reduced subjects' hip internal rotation in the loading phase of SLDVJ (p = 0.026, 0.02) and SLS (p = 0.005, <0.001), reduced knee flexion in the loading phase of SLDVJ (p = 0.038, <0.001), and reduced knee frontal plane abduction (FPA) with SLS (p = 0.015, 0.024) and Y-excursion (p = 0.002, 0.005) compared to control. Use of PKBs decreased subjects' hip internal rotation in the Y-excursion (p = 0.024) and reduced knee FPA in the SLDVJ loading phase (p = 0.014) compared to control. There was no difference in cutting agility for either group (p = 0.145, 0.347).CONCLUSION: Both NSs and PKBs positively impacted neuromuscular control without impacting cutting agility.

    View details for DOI 10.1016/j.ptsp.2019.05.007

    View details for PubMedID 31203143

  • Accurate Reporting of Concomitant Procedures Is Highly Variable in Studies Investigating Knee Cartilage Restoration. Cartilage Sheppard, W. L., Hinckel, B. B., Arshi, A., Sherman, S. L., Jones, K. J. 2019: 1947603519841673

    Abstract

    OBJECTIVE: Successful clinical outcomes following cartilage restoration procedures are highly dependent on addressing concomitant pathology. The purpose of this study was to document methods for evaluating concomitant procedures of the knee when performed with articular cartilage restoration techniques, and to review their reported findings in high-impact clinical orthopedic studies. We hypothesized that there are substantial inconsistencies in reporting clinical outcomes associated with concomitant procedures relative to outcomes related to isolated cartilage repair.DESIGN: A total of 133 clinical studies on articular cartilage repair of the knee were identified from 6 high-impact orthopedic journals between 2011 and 2017. Studies were included if they were primary research articles reporting clinical outcomes data following surgical treatment of articular cartilage lesions with a minimum sample size of 5 patients. Studies were excluded if they were review articles, meta-analyses, and articles reporting only nonclinical outcomes (e.g., imaging, histology). A full-text review was then used to evaluate details regarding study methodology and reporting on the following variables: primary cartilage repair procedure, and the utilization of concomitant procedures to address additional patient comorbidities, including malalignment, meniscus pathology, and ligamentous instability. Each study was additionally reviewed to document variation in clinical outcomes reporting in patients that had these comorbidities addressed at the time of surgery.RESULTS: All studies reported on the type of primary cartilage repair procedure, with autologous chondrocyte implantation (ACI) noted in 43% of studies, microfracture (MF) reported in 16.5%, osteochondral allograft (OCA) in 15%, and osteochondral autograft transplant (OAT) in 8.2%. Regarding concomitant pathology, anterior cruciate ligament (ACL) reconstruction (24.8%) and meniscus repair (23.3%) were the most commonly addressed patient comorbidities. A total of 56 studies (42.1%) excluded patients with malalignment, meniscus injury, and ligamentous instability. For studies that addressed concomitant pathology, 72.7% reported clinical outcomes separately from the cohort treated with only cartilage repair. A total of 16.5% of studies neither excluded nor addressed concomitant pathologies. There was a significant amount of variation in the patient reported outcome scores used among the studies, with the majority of studies reporting International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcomes Score (KOOS) in 47.2% and 43.6% of articles, respectively.CONCLUSIONS: In this study on knee cartilage restoration, recognition and management of concomitant pathology is inadequately reported in approximately 28% of studies. Only 30% of articles reported adequate treatment of concomitant ailments while scoring their outcomes using one of a potential 18 different scoring systems. These findings highlight the need for more standardized methods to be applied in future research with regard to inclusion, exclusion, and scoring concomitant pathologies with regard to treatment of cartilage defects in the knee.

    View details for DOI 10.1177/1947603519841673

    View details for PubMedID 30971096

  • Isolated Complete Rupture of the Biceps Femoris Insertion: A Surgical Repair Technique Manuscript ARTHROSCOPY TECHNIQUES Todd Raines, B., Pomajzl, R. J., Ray, T. E., Bley, J. A., Sherman, S. L. 2019; 8 (4): E407–E411

    Abstract

    Isolated rupture of the distal biceps femoris insertion is rare. Current literature offers limited case reports and outcome measures after surgical management. We describe a knotless suture anchor fixation technique for this tear pattern. At surgery, the retracted biceps tendon and insertion site is debrided to healthy tissue, FiberTape suture (Arthrex) is passed in a Kracków fashion through the tendon, and the 2 ends of the suture are brought down to a SwiveLock anchor (Arthrex) at the anatomic insertion. FiberWire sutures (Arthrex) from the anchor are brought over the remnant stump, completing the repair.

    View details for DOI 10.1016/j.eats.2018.11.020

    View details for Web of Science ID 000466921200009

    View details for PubMedID 31080724

    View details for PubMedCentralID PMC6506860

  • Relationship Between 2-Dimensional Frontal Plane Measures and the Knee Abduction Angle During the Drop Vertical Jump JOURNAL OF SPORT REHABILITATION Willis, B. W., Hocker, K., Razu, S., Gray, A. D., Skubic, M., Sherman, S. L., Kurkowski, S., Guess, T. M. 2019; 28 (4): 399–402

    Abstract

    Context: Knee abduction angle (KAA), as measured by 3-dimensional marker-based motion capture systems during jump-landing tasks, has been correlated with an elevated risk of anterior cruciate ligament injury in females. Due to the high cost and inefficiency of KAA measurement with marker-based motion capture, surrogate 2-dimensional frontal plane measures have gained attention for injury risk screening. The knee-to-ankle separation ratio (KASR) and medial knee position (MKP) have been suggested as potential frontal plane surrogate measures to the KAA, but investigations into their relationship to the KAA during a bilateral drop vertical jump task are limited. Objective: To investigate the relationship between KASR and MKP to the KAA during initial contact of the bilateral drop vertical jump. Design: Descriptive. Setting: Biomechanics laboratory. Participants: A total of 18 healthy female participants (mean age: 24.1 [3.88] y, mass: 65.18 [10.34] kg, and height: 1.63 [0.06] m). Intervention: Participants completed 5 successful drop vertical jump trials measured by a Vicon marker-based motion capture system and 2 AMTI force plates. Main Outcome Measure: For each jump, KAA of the tibia relative to the femur was measured at initial contact along with the KASR and MKP calculated from planar joint center data. The coefficient of determination (r2) was used to examine the relationship between the KASR and MKP to KAA. Results: A strong linear relationship was observed between MKP and KAA (r2 = .71), as well as between KASR and KAA (r2 = .72). Conclusions: Two-dimensional frontal plane measures show strong relationships to the KAA during the bilateral drop vertical jump.

    View details for DOI 10.1123/jsr.2018-0017

    View details for Web of Science ID 000470203900001

    View details for PubMedID 30422040

  • The 50 Most-Cited Articles in Meniscal Allograft Transplantation Research: A Bibliometric Analysis CARTILAGE Chaudhry, Z. S., Fram, B., Henn, R., Sherman, S. L., Hammoud, S. 2019; 10 (2): 196–204

    Abstract

    To identify the 50 most-cited articles in meniscal allograft transplantation (MAT) research and analyze their characteristics.In September 2017, the Scopus database was queried to identify the 50 most-cited articles in MAT research. Variables analyzed include number of citations, publication year, journal, institution, country of origin, article type, study design, and level of evidence. Citation density was calculated for each article. The correlation between citation density and publication year and the correlation between level of evidence and number of citations, citation density, and publication year were computed.The 50 most-cited articles were published in 12 journals between 1986 and 2011. The number of citations ranged from 59 to 290 (109.3 ± 48.6). Citation density ranged from 2.7 to 17.6 citations per year (7.0 ± 3.3). There was a positive correlation between citation density and publication year ( r = +0.489, P < 0.001). Overall, 56% of the articles were clinical and 44% were basic science. Of the 28 clinical articles, 61% were level IV or V evidence. Level of evidence was not significantly correlated with number of citations ( r = -0.059, P = 0.766), citation density ( r = +0.030, P = 0.880), or publication year ( r = -0.0009, P = 0.996).This analysis provides the orthopedic community with a readily accessible list of the classic citations in MAT research and provides insight into the historical development of this procedure. Although there was a moderate positive correlation between citation density and publication year, articles with stronger levels of evidence were not more frequently cited despite the increasing trend toward evidence-based practice.

    View details for DOI 10.1177/1947603517749922

    View details for Web of Science ID 000461640700006

    View details for PubMedID 29291274

    View details for PubMedCentralID PMC6425545

  • Management of patellofemoral instability in the setting of multiligament knee injury ANNALS OF JOINT Sherman, S. L., Oladeji, L. O., Welsh, J., DiPaolo, Z. J. 2018; 3 (11)
  • Subchondroplasty for the treatment of post-traumatic bone marrow lesions of the medial femoral condyle in a pre-clinical canine model JOURNAL OF ORTHOPAEDIC RESEARCH Brimmo, O. A., Bozynski, C. C., Cook, C. R., Kuroki, K., Sherman, S. L., Pfeiffer, F. M., Stoker, A. M., Cook, J. L. 2018; 36 (10): 2709–17

    Abstract

    This study characterizes long-term outcomes associated with subchondroplasty (SCP) treatment for impact-induced subchondral bone marrow lesions (BML) using a validated pre-clinical canine model. With IACUC approval, purpose-bred research hounds (n = 16) underwent arthroscopic impact injury (40N) to both medial femoral condyles. At 3 months, functional assessments, arthroscopy, and MRI were performed and knees (n = 32) were randomly assigned to SCP (3 ml fluoroscopically guided percutaneous injection of AccuFill BSM into BML bone defects) or sham injection (Control). Dogs were assessed at 3, 6, 12, and 24 months after treatment using functional assessments, radiographic evaluation, arthroscopy, and MRI. Dogs were humanely euthanatized at 3, 6, 12, or 24 months after treatment for gross, microCT, and histologic assessments. All knees had focal articular cartilage defects with associated subchondral BMLs, as well as clinical dysfunction, 3 months after injury. At the 3 and 6 months, SCP knees showed more functional impairment than Control knees, however, these differences were not statistically significant. At 1- and 2-year post-treatment, function in SCP knees was better than in Control knees with range of motion being significantly (p < 0.05) better for SCP. Radiographic, arthroscopic, MRI, gross, microCT, and histologic findings matched the functional assessments well with Control being associated with better results at the two early time points and SCP being associated with better results at 1 and 2 years. Clinical significance: SCP treatment using calcium phosphate bone void filler was associated with an initial increase in pain and dysfunction followed by symptomatic benefits for up to 2 years after treatment for post-traumatic femoral condyle BMLs in a preclinical canine model. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2709-2717, 2018.

    View details for DOI 10.1002/jor.24046

    View details for Web of Science ID 000449527800016

    View details for PubMedID 29748965

  • Reconstruction of the medial patellotibial ligament results in favorable clinical outcomes: a systematic review KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY Baumann, C. A., Pratte, E. L., Sherman, S. L., Arendt, E. A., Hinckel, B. B. 2018; 26 (10): 2920–33

    Abstract

    The medial patellotibial ligament (MPTL), the medial patellofemoral ligament (MPFL), and the medial patellomeniscal ligament (MPML) support the stability of the patellofemoral joint. The purpose of this systematic review was to report the surgical techniques and clinical outcomes of the repair or reconstruction of the MPTL in isolation or concomitant with the MPFL and/or other procedures.A systematic review of the literature was conducted. Inclusion criteria were articles in the English language that reported clinical outcomes of the reconstruction of the MPTL in isolation or in combination with the MPFL and/or other procedures. Included articles were then cross-referenced to find additional journal articles not found in the initial search. The methodological quality of the articles was determined using the Coleman Methodology Score.Nineteen articles were included detailing the clinical outcomes of 403 knees. The surgical procedures described included hamstrings tenodesis with or without other major procedures, medial transfer of the medial patellar tendon with or without other major procedures and the reconstruction of the MPTL in association with the MPFL. Overall, good and excellent outcomes were achieved in > 75% of cohorts in most studies and redislocations were < 10%, with or without the association of the MPFL. An exception was one study that reported a high failure rate of 82%. Results were consistent across different techniques. The median CMS for the articles was 66 out of 100 (range 30-85).Across different techniques, the outcomes are good with low rates of recurrence, with one article reporting a high rate of recurrence. Quality of the articles is variable, from low to high. Randomized control trials are needed for a better understanding of the indications, surgical techniques, and clinical outcomes. This systematic review suggests that the reconstruction of the MPTL leads to favorable clinical outcomes and supports the role of the procedure as a valid surgical patellar stabilization procedure.IV: systematic review of level I-IV studies.

    View details for DOI 10.1007/s00167-018-4833-6

    View details for Web of Science ID 000444832000008

    View details for PubMedID 29344696

  • Meniscus Allograft Transplantation OPERATIVE TECHNIQUES IN SPORTS MEDICINE Sherman, S. L., Thomas, D. M., Gulbrandsen, T. R., Farr, J. 2018; 26 (3): 189–204
  • Evaluation of Novel Cartilage Treatment Options for Clinical Use OPERATIVE TECHNIQUES IN SPORTS MEDICINE Farr, J., Sherman, S. L. 2018; 26 (3): 218–26
  • Chondral and osteochondral lesions in the patellofemoral joint: when and how to manage ANNALS OF JOINT Sherman, S. L., Thomas, D. M., Farr, J. 2018; 3 (6)
  • Return to Play after Patellar Stabilization CURRENT REVIEWS IN MUSCULOSKELETAL MEDICINE Sherman, S. L., Deasis, D. P., Garrone, A. J., Voss, E. E., Oliver, H. A. 2018; 11 (2): 280–84

    Abstract

    The purpose of this review is to evaluate the existing literature regarding return to play (RTP) and return to prior performance (RPP) following patellar stabilization surgery. It will also discuss suggested guidelines regarding RTP, and finally, to encourage future patellofemoral instability research to report and publish results of RTP rates using standardized RTP guidelines.There is a lack of validation and universal adoption of standardized RTP guidelines. This has led to a dearth of high-quality studies on RTP and RPP after patellar stabilization. The best available studies to date would suggest high RTP rates (84%-100%), average RPP rates (33%-77%), and a highly variable timeframe for return (3-12 months). Patellofemoral instability can be a persistent and challenging problem, particularly in the young and active population for which it most often occurs. Much of the previous studies on patellofemoral instability evaluated success and failure as prevention of recurrent dislocation. However, prevention of recurrence alone may not be enough for many patients. The best available data on RTP and RPP following patellofemoral instability is based on lower quality of evidence studies, expert opinion, and published societal guidelines. Future research on this topic should include clinical validation of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS) RTP guidelines and reporting of outcomes based on these guidelines in patellofemoral instability publications.

    View details for DOI 10.1007/s12178-018-9484-1

    View details for Web of Science ID 000433204500014

    View details for PubMedID 29750318

    View details for PubMedCentralID PMC5970119

  • Radiologic and Histologic Evaluation of Proximal Bicep Pathology in Patients With Chronic Biceps Tendinopathy Undergoing Open Subpectoral Biceps Tenodesis ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Nuelle, C. W., Stokes, D. C., Kuroki, K., Crim, J. R., Sherman, S. L. 2018; 34 (6): 1790–96

    Abstract

    To correlate preoperative magnetic resonance imaging (MRI) and intraoperative anatomic findings within the proximal long head biceps tendon to histologic evaluation of 3 separate zones of the tendon in patients with chronic biceps tendinopathy.Sixteen patients with chronic biceps tendinopathy were treated with open subpectoral biceps tenodesis. Preoperative MRI tendon grading was as follows: normal tendon, increased signal, tendon splitting, incomplete/complete tear. The removed portion of the biceps tendon was split into 3 segments: zone 1, 0-3.5 cm from the labral insertion; zone 2, 3.5-6.5 cm; and zone 3, 6.5-9 cm, and was histologically evaluated using the Bonar score. Tenosynovium adjacent to the tendon was assessed histologically using the Osteoarthritis Research Society International score. CD31, CD3, and CD79a immunohistochemistries were conducted to determine vascularization, T-cell infiltrates, and B-cell infiltrates, respectively. Analysis of variance and Pearson correlations were performed for statistical analysis.Preoperative MRI showed no significant differences in tendon appearance between zones 1-3. Intraoperative findings included nonspecific degenerative SLAP tears or mild/moderate biceps tenosynovitis in all cases. Significantly (P < .001) higher Bonar scores were noted for tendon in zones 1 (7.9 ± 1.8) and 2 (7.3 ± 1.5) compared with zone 3 (5.0 ± 1.1). Cell morphology scores in zone 1 (1.9 ± 0.4) and zone 2 (1.5 ± 0.6) were significantly higher than that in zone 3 (0.8 ± 0.3) (P < .05). Inflammatory tenosynovium showed weak correlation with tendon changes in zone 1 (r = 0.08), zone 2 (r = 0.03), or zone 3 (r = 0.1).In patients with chronic long head biceps tendinopathy who underwent open subpectoral tenodesis, MRI and intraoperative assessment did not show significant structural abnormalities within the tendon despite significant histopathologic changes. Severity of tendon histopathology was more pronounced in the proximal and mid-portions of the tendon.Proximal versus distal biceps tenodesis is a subject of frequent debate. This study contributes to the ongoing evaluation of the characteristics of the proximal biceps in this type of pathologic condition.

    View details for DOI 10.1016/j.arthro.2018.01.021

    View details for Web of Science ID 000433213900013

    View details for PubMedID 29573932

  • Anterior Cruciate Ligament Injuries in Missouri High School Male and Female Soccer Athletes Gray, A. D., Miller, S., Sherman, S. L., Leary, E., Willis, B. W. LIPPINCOTT WILLIAMS & WILKINS. 2018: 575
  • Distal Femoral Varus Osteotomy for the Management of Valgus Deformity of the Knee JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Thompson, S. F., Clohisy, J. F. 2018; 26 (9): 313–24

    Abstract

    Distal femoral varus osteotomy is a well-described treatment option for patients with valgus malalignment associated with a variety of underlying conditions. This procedure may be the definitive treatment option in active patients with isolated lateral compartment osteoarthritis or posttraumatic arthritis. It may be a useful concomitant procedure in young patients with lateral meniscus deficiency, focal chondral defects, chronic medial collateral ligament insufficiency, and/or patellofemoral instability. Distal femoral varus osteotomy can be performed with medial closing wedge or lateral opening wedge techniques. Variable outcomes and complication rates have been reported. A framework for the use of distal femoral varus osteotomy can aid the orthopaedic surgeon in the evaluation and treatment of patients with symptomatic valgus malalignment.

    View details for DOI 10.5435/JAAOS-D-16-00179

    View details for Web of Science ID 000441215400006

    View details for PubMedID 29629916

  • Youth Baseball Pitching Mechanics: A Systematic Review SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Thompson, S. F., Guess, T. M., Plackis, A. C., Sherman, S. L., Gray, A. D. 2018; 10 (2): 133–40

    Abstract

    Pitching injuries in youth baseball are increasing in incidence. Poor pitching mechanics in young throwers have not been sufficiently evaluated due to the lack of a basic biomechanical understanding of the "normal" youth pitching motion.To provide a greater understanding of the kinetics and kinematics of the youth baseball pitching motion.PubMed, MEDLINE, and SPORTDiscus databases were searched from database inception through February 2017.A total of 10 biomechanical studies describing youth pitching mechanics were included.Systematic review.Level 3.Manual extraction and compilation of demographic, methodology, kinetic, and kinematic variables from the included studies were completed.In studies of healthy youth baseball pitchers, progressive external rotation of the shoulder occurs throughout the start of the pitching motion, reaching a maximum of 166° to 178.2°, before internally rotating throughout the remainder of the cycle, reaching a minimum of 13.2° to 17°. Elbow valgus torque reaches the highest level (18 ± 4 N·m) just prior to maximum shoulder external rotation and decreases throughout the remainder of the pitch cycle. Stride length is 66% to 85% of pitcher height. In comparison with a fastball, a curveball demonstrates less elbow varus torque (31.6 ± 15.3 vs 34.8 ± 15.4 N·m).Multiple studies show that maximum elbow valgus torque occurs just prior to maximum shoulder external rotation. Forces on the elbow and shoulder are greater for the fastball than the curveball.

    View details for DOI 10.1177/1941738117738189

    View details for Web of Science ID 000429947700006

    View details for PubMedID 29090988

    View details for PubMedCentralID PMC5857730

  • Patellofemoral Cartilage Restoration: Indications, Techniques, and Outcomes Foreword JOURNAL OF KNEE SURGERY Sherman, S. L. 2018; 31 (3): 205

    View details for DOI 10.1055/s-0037-1608642

    View details for Web of Science ID 000425403200001

    View details for PubMedID 29165743

  • Overuse of Magnetic Resonance Imaging in the Diagnosis and Treatment of Moderate to Severe Osteoarthritis. The Iowa orthopaedic journal Sherman, S. L., Gulbrandsen, T. R., Lewis, H. A., Gregory, M. H., Capito, N. M., Gray, A. D., Bal, B. S. 2018; 38: 33–37

    Abstract

    Background: MRI in the evaluation of end-stage knee joint osteoarthritis (OA) is usually unnecessary when radiographic and clinical evidence of gonarthrosis is clear. The purpose of this study was to assess the prevalence of MRI scans ordered in patients with radiographically obvious gonarthrosis and to examine the characteristics of health care providers who ordered these imaging studies.Methods: We retrospectively identified 164 patients diagnosed with moderate to severe OA who were referred for total knee replacement (TKA) over a one-year period. The percentage of patients who had an MRI scan with or without X-ray, within the preceding 3 months prior to referral, were calculated. Subgroups were analyzed to identify characteristics that may influence the decision to order an MRI, including K-L grade, provider type, level of training, and practice location.Results: Of 145 patients, 19 (13.1%) presented with an MRI scan. Between the number of MRI scans ordered, there was a significant difference when comparing physicians versus non-physicians, with physicians ordering less MRI scans (p=0.018). There was a significant difference when comparing non-academic versus academic, with academic providers ordering less MRI scans (p=0.044). There was no significant difference with fellowship training or provider proximity to our academic institution.Conclusions: In this study, 13.1% of patients with radiographically obvious knee OA obtained an MRI prior to referral for TKA. Non-physicians and non-academic physicians were more likely to order MRI scans. Improved education for referring providers may be necessary to decrease overuse of MRI in the diagnosis of moderate to severe arthritis.Level of Evidence: Level II.

    View details for PubMedID 30104922

  • A Novel Depth Image Analysis Method to Calculate the Anterior Reach of the Modified Star Excursion Balance Test Mishra, A. K., Skubic, M., Willis, B. W., Guess, T., Gray, A. D., Sherman, S. L., ACM ASSOC COMPUTING MACHINERY. 2018: 11-14
  • In Vivo Toxicity of Local Anesthetics and Corticosteroids on Supraspinatus Tenocyte Cell Viability and Metabolism. The Iowa orthopaedic journal Nuelle, C. W., Cook, C. R., Stoker, A. M., Cook, J. L., Sherman, S. L. 2018; 38: 107–12

    Abstract

    Background: This study was conducted to evaluate the effects of commonly used injection medication combinations on supraspinatus tenocyte cell viability and tissue metabolism.Methods: Twenty adult dogs underwent ultrasound guided injection of the canine equivalent of the subacromial space, based on random assignment to one of four treatment groups (n=5/group): normal saline, 1.0% lidocaine/methylprednisolone, 1.0% lidocaine/triamcinolone or 0.0625% bupivacaine/triamcinolone. Full-thickness sections of supraspinatus tendon were harvested under aseptic conditions and evaluated on days 1 and 7 post-harvest for cell viability and tissue metabolism. Data were analyzed for significant differences among groups.Results: Tendons exposed to 1% lidocaine/ methylprednisolone had significantly lower cell viability at day 1 as compared to all other groups and control. All local anesthetic/ corticosteroid combination groups had decreased cell viability at day 7 when compared to the control group.Conclusions: This study demonstrated significant in vivo supraspinatus tenotoxicity following a single injection of combination local anesthetic/ corticosteroid when compared to saline controls.Level of Evidence: Level II.

    View details for PubMedID 30104932

  • Development and Validation of a Portable and Inexpensive Tool to Measure the Drop Vertical Jump Using the Microsoft Kinect V2 SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Gray, A. D., Willis, B. W., Skubic, M., Huo, Z., Razu, S., Sherman, S. L., Guess, T. M. 2017; 9 (6): 537–44

    Abstract

    Noncontact anterior cruciate ligament (ACL) injury in adolescent female athletes is an increasing problem. The knee-ankle separation ratio (KASR), calculated at initial contact (IC) and peak flexion (PF) during the drop vertical jump (DVJ), is a measure of dynamic knee valgus. The Microsoft Kinect V2 has shown promise as a reliable and valid marker-less motion capture device.The Kinect V2 will demonstrate good to excellent correlation between KASR results at IC and PF during the DVJ, as compared with a "gold standard" Vicon motion analysis system.Descriptive laboratory study.Level 2.Thirty-eight healthy volunteer subjects (20 male, 18 female) performed 5 DVJ trials, simultaneously measured by a Vicon MX-T40S system, 2 AMTI force platforms, and a Kinect V2 with customized software. A total of 190 jumps were completed. The KASR was calculated at IC and PF during the DVJ. The intraclass correlation coefficient (ICC) assessed the degree of KASR agreement between the Kinect and Vicon systems.The ICCs of the Kinect V2 and Vicon KASR at IC and PF were 0.84 and 0.95, respectively, showing excellent agreement between the 2 measures. The Kinect V2 successfully identified the KASR at PF and IC frames in 182 of 190 trials, demonstrating 95.8% reliability.The Kinect V2 demonstrated excellent ICC of the KASR at IC and PF during the DVJ when compared with the Vicon system. A customized Kinect V2 software program demonstrated good reliability in identifying the KASR at IC and PF during the DVJ.Reliable, valid, inexpensive, and efficient screening tools may improve the accessibility of motion analysis assessment of adolescent female athletes.

    View details for DOI 10.1177/1941738117726323

    View details for Web of Science ID 000418307700007

    View details for PubMedID 28846505

    View details for PubMedCentralID PMC5665114

  • Management of Anterior Cruciate Ligament Injury? What's In and What's Out? INDIAN JOURNAL OF ORTHOPAEDICS Raines, B., Naclerio, E., Sherman, S. L. 2017; 51 (5): 563–75

    Abstract

    Sports medicine physicians have a keen clinical and research interest in the anterior cruciate ligament (ACL). The biomechanical, biologic, and clinical data researchers generate, help drive injury management and prevention practices globally. The current concepts in ACL injury and surgery are being shaped by technological advances, expansion in basic science research, resurging interest in ACL preservation, and expanding efforts regarding injury prevention. As new methods are being developed in this field, the primary goal of safely improving patient outcomes will be a unifying principle. With this review, we provide an overview of topics currently in controversy or debate, and we identify paradigm shifts in the understanding, management, and prevention of ACL tears.

    View details for DOI 10.4103/ortho.IJOrtho_245_17

    View details for Web of Science ID 000410233800011

    View details for PubMedID 28966380

    View details for PubMedCentralID PMC5609378

  • Osteochondral Autologous Transplantation CLINICS IN SPORTS MEDICINE Sherman, S. L., Thyssen, E., Nuelle, C. W. 2017; 36 (3): 489-+

    Abstract

    Osteochondral autologous transplantation (OAT) is a treatment strategy for small and medium sized focal articular cartilage defects in the knee. This article reviews the indications, surgical techniques, outcomes, and limitations of OAT for the management of symptomatic chondral and osteochondral lesions in the knee joint.

    View details for DOI 10.1016/j.csm.2017.02.006

    View details for Web of Science ID 000404499200008

    View details for PubMedID 28577708

  • Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy JOURNAL OF SHOULDER AND ELBOW SURGERY Capito, N. M., Cook, J. L., Yahuaca, B., Capito, M. D., Sherman, S. L., Smith, M. J. 2017; 26 (5): 745–51

    Abstract

    A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during shoulder arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for shoulder arthroscopy.A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation shoulder scores RESULTS: Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in shoulder girth (P < .05), and a significantly lower immediate postoperative visual analog scale pain score (P = .036). At 1 year postoperatively, the differences between groups for American Shoulder and Elbow Surgeons, visual analog scale pain, and Single Assessment Numeric Evaluation were not significant (P > .2).A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for shoulder arthroscopy has potential clinical benefits to surgeons and patients.

    View details for DOI 10.1016/j.jse.2017.02.021

    View details for Web of Science ID 000402464300010

    View details for PubMedID 28318850

  • In vivo bone tunnel evaluation of nanoparticle-grafts using an ACL reconstruction rabbit model JOURNAL OF BIOMEDICAL MATERIALS RESEARCH PART A Grant, S. A., Smith, S. E., Schmidt, H., Pfeiffer, F., Kuroki, K., Sherman, S., White, R., Grant, D. A. 2017; 105 (4): 1071–82

    Abstract

    Acellular human gracilis tendons conjugated with gold nanoparticles (AuNP) and hydroxyapatite nanoparticles (nano-HAp) were used as a graft in an anterior cruciate ligament (ACL) reconstruction rabbit model. The ACLs of 11 New Zealand rabbits were reconstructed using grafts conjugated without nanoparticles, with AuNP only, and with both AuNP and nano-HAp. Semi-quantitative histological scoring of bone tunnel portion of grafts was performed after 14 weeks. Bone tunnels were scored for graft degeneration, graft remodeling, percentage of new host fibrous connective, collateral connection, head-to-head connection, graft collagen fiber organization, new host fibrous connective tissue organization, and graft and interface vascularity. All grafts were intact at 14 weeks. Results of bone tunnel scoring indicate remodeling in all graft types with new organized host fibrous connective tissue, head-to-head connection to bone and mild inflammation associated with remodeling. Components of the 20 nm AuNP grafts have significantly more graft degeneration, more new host fibrous connective tissue, and more vascularity compared to crosslinked grafts. Comparison between femoral and tibial tunnel scores indicate more degeneration in femoral tunnels compared to tibial tunnels. Overall results indicated potentially enhanced remodeling from the use of 20 nm AuNP grafts. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 1071-1082, 2017.

    View details for DOI 10.1002/jbm.a.36000

    View details for Web of Science ID 000395008300012

    View details for PubMedID 28076887

  • In vitro toxicity of local anaesthetics and corticosteroids on supraspinatus tenocyte viability and metabolism JOURNAL OF ORTHOPAEDIC TRANSLATION Nuelle, C. W., Cook, C. R., Stoker, A. M., Cook, J. L., Sherman, S. L. 2017; 8: 20–24

    Abstract

    The purpose of this study was to evaluate supraspinatus tenocyte viability and metabolism in explants exposed to various local anaesthetics and corticosteroids. Our hypothesis was that the tendons exposed to these common injectates would have significantly decreased cell viability and metabolism compared with controls.Supraspinatus tendon explants were obtained from dogs, placed in a culture media, and randomly assigned to one of the following groups: culture media only (control), 1% lidocaine, 0.5% lidocaine, 0.25% bupivacaine, 0.125% bupivacaine, 0.0625% bupivacaine, betamethasone acetate (5 mg), methylprednisolone acetate (40 mg), or triamcinolone acetonide (40 mg). Cell viability was determined on Days 1 and 7 after culture treatment using calcein AM (live cell) and Sytox Blue (dead cell) stains. Tissue metabolism was assessed on Days 1 and 7 using the resazurin blue metabolic assay. Significant differences were evaluated using a one-way analysis of variance with Tukey post hoc analysis.Compared with the controls, there were significant decreases in cell viability noted at Days 1 and 7 in tenocytes exposed to 1% lidocaine, betamethasone, and methylprednisolone. Significant decreases in cell metabolism were also noted at Days 1 and 7 in those groups. Treatment with 0.125% bupivacaine, 0.0625% bupivacaine, and triamcinolone demonstrated no decrease in cell viability or metabolism when compared with controls at any time point.This data confirms that peritendinous injection of commonly used local anaesthetics and corticosteroids results in significant supraspinatus tenotoxicity in vitro. Further in vivo studies are required before making definitive clinical recommendations.

    View details for DOI 10.1016/j.jot.2016.08.002

    View details for Web of Science ID 000391086500004

    View details for PubMedID 30035090

    View details for PubMedCentralID PMC5987053

  • Development of a Micronized Meniscus Extracellular Matrix Scaffold for Potential Augmentation of Meniscal Repair and Regeneration TISSUE ENGINEERING PART C-METHODS Monibi, F. A., Bozynski, C. C., Kuroki, K., Stoker, A. M., Pfeiffer, F. M., Sherman, S. L., Cook, J. L. 2016; 22 (12): 1059–70

    Abstract

    Decellularized scaffolds composed of extracellular matrix (ECM) hold promise for repair and regeneration of the meniscus, given the potential for ECM-based biomaterials to aid in stem cell recruitment, infiltration, and differentiation. The objectives of this study were to decellularize canine menisci to fabricate a micronized, ECM-derived scaffold and to determine the cytocompatibility and repair potential of the scaffold ex vivo. Menisci were decellularized with a combination of physical agitation and chemical treatments. For scaffold fabrication, decellularized menisci were cryoground into a powder and the size and morphology of the ECM particles were evaluated using scanning electron microscopy. Histologic and biochemical analyses of the scaffold confirmed effective decellularization with loss of proteoglycan from the tissue but no significant reduction in collagen content. When washed effectively, the decellularized scaffold was cytocompatible to meniscal fibrochondrocytes, synoviocytes, and whole meniscal tissue based on the resazurin reduction assay and histologic evaluation. In an ex vivo model for meniscal repair, radial tears were augmented with the scaffold delivered with platelet-rich plasma as a carrier, and compared to nonaugmented (standard-of-care) suture techniques. Histologically, there was no evidence of cellular migration or proliferation noted in any of the untreated or standard-of-care treatment groups after 40 days of culture. Conversely, cellular infiltration and proliferation were noted in scaffold-augmented repairs. These data suggest the potential for the scaffold to promote cellular survival, migration, and proliferation ex vivo. Further investigations are necessary to examine the potential for the scaffold to induce cellular differentiation and functional meniscal fibrochondrogenesis.

    View details for DOI 10.1089/ten.tec.2016.0276

    View details for Web of Science ID 000391500100001

    View details for PubMedID 27824291

  • OSTEOCHONDRAL ALLOGRAFTS IN SHOULDER SURGICAL PROCEDURES JBJS REVIEWS Capito, N. M., Owens, B. D., Sherman, S. L., Smith, M. J. 2016; 4 (11)

    Abstract

    The use of fresh osteochondral allografts has become popular in many joint-preserving orthopaedic procedures and shows early promising results within the shoulder. Distal tibial allograft contains a stout cartilaginous layer that appears to have highly congruent curvature and concavity to the glenoid, which makes for an optimal allograft option for instability. In the setting of large Hill-Sachs lesions, the use of a humeral-head osteochondral allograft is essential to restore geometry, stability, and mechanics of the native glenohumeral joint. One must be cautious with the treatment of glenoid chondral lesions with osteoarticular grafting procedures because of the depth of the glenoid compared with the depth of subchondral bone on the graft necessary to achieve a press fit, and advanced imaging is recommended when planning an operative intervention. Optimizing joint-preservation treatment with osteochondral allografts will rely on the long-term results of these procedures, and careful patient selection, preoperative discussion, and realistic expectations are necessary.

    View details for DOI 10.2106/JBJS.RVW.16.00001

    View details for Web of Science ID 000391034100003

    View details for PubMedID 27922984

  • The 50 Most Cited Articles in Orthopedic Cartilage Surgery CARTILAGE Arshi, A., Siesener, N. J., McAllister, D. R., Williams, R. J., Sherman, S. L., Jones, K. J. 2016; 7 (3): 238–47

    Abstract

    To determine the 50 most cited articles in orthopedic cartilage surgery and their characteristics.A systematic review of the Science Citation Index Expanded was performed for articles related to cartilage surgery published in the 66 journals under the category "Orthopedics." The 50 most cited articles were determined, and the following characteristics were analyzed for each article: authors, journal and year of publication, number of citations, geographic origin, article type (basic science or clinical), article subtype by study design, and level of evidence. Citation density (total number of citations/years since publication) was also computed.The 50 most cited articles ranged from 989 to 172 citations, with citation density ranging from 71.5 to 4.1. The publication years spanned from 1968 to 2008, with the 2000s accounting for half (25) of the articles and the highest mean citation density (14.6). The 50 most cited articles were published in 11 journals. The majority of the articles (29) were clinical, with level IV representing the most common level of evidence (10). The remaining basic science articles were most commonly animal in vivo studies (14). Stronger level of evidence was correlated with overall number of citations (P = 0.044), citation density (P < 0.001), and year of publication (P = 0.003).Articles with stronger levels of evidence are more highly cited, with an increasing trend as evidence-based practice has been emphasized. This article list provides clinicians, researchers, and trainees with a group of "citation classics" in orthopedic cartilage surgery.

    View details for DOI 10.1177/1947603515621997

    View details for Web of Science ID 000384334800004

    View details for PubMedID 27375839

    View details for PubMedCentralID PMC4918068

  • Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Sherman, S. L., Copeland, M. E., Milles, J. L., Flood, D. A., Pfeiffer, F. M. 2016; 32 (6): 1117–24

    Abstract

    To evaluate the biomechanical fixation strength of suture anchor and transosseous tunnel repair of the quadriceps tendon in a standardized cadaveric repair model.Twelve "patella-only" specimens were used. Dual-energy X-ray absorptiometry measurement was performed to ensure equal bone quality amongst groups. Specimens were randomly assigned to either a suture anchor repair of quadriceps tendon group (n = 6) or a transosseous tunnel repair group (n = 6). Suture type and repair configuration were equivalent. After the respective procedures were performed, each patella was mounted into a gripping jig. Tensile load was applied at a rate of 0.1 mm/s up to 100 N after which cyclic loading was applied at a rate of 1 Hz between magnitudes of 50 to 150 N, 50 to 200 N, 50 to 250 N, and tensile load at a rate of 0.1 mm/s until failure. Outcome measures included load to failure, displacement at 1st 100 N load, and displacement after each 10th cycle of loading.The measured cyclic displacement to the first 100 N, 50 to 150 N, 50 to 200 N, and 50 to 250 N was significantly less for suture anchors than transosseous tunnels. There was no statistically significant difference in ultimate load to failure between the 2 groups (P = .40). Failure mode for all suture anchors except one was through the soft tissue. Failure mode for all transosseous specimens but one was pulling the repair through the transosseous tunnel.Suture anchor quadriceps tendon repairs had significantly decreased gapping during cyclic loading, but no statistically significant difference in ultimate load to failure when compared with transosseous tunnel repairs. Although suture anchor quadriceps tendon repair appears to be a biomechanically superior construct, a clinical study is needed to confirm this technique as a viable alternative to gold standard transosseous techniques.Although in vivo studies are needed, these results support the suture anchor technique as a viable alternative to transosseous repair of the quadriceps tendon.

    View details for DOI 10.1016/j.arthro.2015.11.038

    View details for Web of Science ID 000377563900026

    View details for PubMedID 26895785

  • Two-Stage Revision Anterior Cruciate Ligament Reconstruction ORTHOPEDICS Erickson, B. J., Cvetanovich, G., Waliullah, K., Khair, M., Smith, P., Bach, B., Sherman, S. 2016; 39 (3): E456–E464

    Abstract

    The number of primary anterior cruciate ligament (ACL) tears is rapidly increasing. In patients who wish to return to their preoperative level of function, specifically as it pertains to participation in sports, the gold standard of treatment following an ACL tear remains an anterior cruciate ligament (ACL) reconstruction. Despite a majority of good/excellent results following primary ACL reconstruction, there is a growing subset of patients with persistent or recurrent functional instability who require revision ACL reconstruction. Preoperative planning for revision ACL reconstruction requires a careful understanding of the root cause of ACL failure, including possible technical causes of primary ACL failure and the presence of combined knee pathology that was not addressed at the index ACL reconstruction. The decision to perform 2-stage revision ACL reconstruction is multifactorial and is reached by technical considerations that may make a 1-stage revision less optimal, including tunnel widening, arthrofibrosis, active infection, and others. Concomitant knee pathology such as meniscal deficiency, malalignment (including an increase in posterior tibial slope), chondral lesions, and other ligamentous laxity may also require a staged approach to treatment. This evidence-based review covers the indications for 2-stage revision ACL reconstruction, surgical techniques, evidence for and technique of bone grafting prior ACL tunnels, and outcomes of 2-stage revision stratified by initial cause of ACL reconstruction failure. With proper preoperative planning and an understanding of the cause of failure following the primary ACL reconstruction, revision ACL reconstruction can offer excellent outcomes in the motivated patient. [Orthopedics. 2016; 39(3):e456-e464.].

    View details for DOI 10.3928/01477447-20160324-01

    View details for Web of Science ID 000377519200010

    View details for PubMedID 27045480

  • Development of a Novel Canine Model for Posttraumatic Osteoarthritis of the Knee JOURNAL OF KNEE SURGERY Brimmo, O. A., Pfeiffer, F., Bozynski, C. C., Kuroki, K., Cook, C., Stoker, A., Sherman, S. L., Monibi, F., Cook, J. L. 2016; 29 (3): 235–41

    Abstract

    Translational models of posttraumatic osteoarthritis (PTOA) that accurately represent clinical pathology need to be developed. This study assessed a novel canine model for PTOA using impact injury. Impacts were delivered to the medial femoral condyle of dogs using a custom-designed impactor at 20, 40, or 60 MPa. Functional assessments and magnetic resonance imaging (MRI) were performed at 2 and 12 weeks, and arthroscopic and histologic assessments were performed at 12 weeks after injury. At 2 and 12 weeks, dogs had observable lameness, knee pain, effusion, loss in range of motion (ROM) and dysfunction in both hindlimbs with severity correlated strongly (r > 0.77) to impact level. At 12 weeks, function, pain, effusion, and ROM were significantly (p < 0.049) worse in knees impacted at 40 and 60 MPa compared with 20 MPa. MRI showed consistent cartilage and subchondral bone marrow lesions, and arthroscopy revealed synovitis and cartilage destruction in impacted knees, with increased severity for 40 and 60 MPa impacts. Histopathology was significantly (p = 0.049) more severe in 40 and 60 MPa and strongly correlated (r = 0.93) to impact level. This novel translational model appears to be valid for investigation of PTOA, including determination of temporal mechanisms of disease and preclinical testing for preventative and therapeutic strategies.

    View details for DOI 10.1055/s-0035-1549026

    View details for Web of Science ID 000373292400009

    View details for PubMedID 25892003

  • Rethinking the Standard of Care in Treating Professional Athletes CLINICS IN SPORTS MEDICINE Poma, C., Sherman, S. L., Spence, B., Brenner, L. H., Bal, B. 2016; 35 (2): 269-+

    Abstract

    There is public discussion and debate about the role of the team physician in professional sports. There is uncertainty over whether a separate legal standard of care should apply when treating professional athletes. This article advocates a single standard of care for all patients. This article also proposes that it would be useful for team physicians to develop a consensus that there should be a health policy for professional athletes. This health policy should aspire that professional athletes can complete their career, while minimizing the risk of cognitive or physical injuries that affect later quality of life.

    View details for DOI 10.1016/j.csm.2015.10.001

    View details for Web of Science ID 000372375700009

    View details for PubMedID 26832976

  • Nonligamentous Soft Tissue Pathology About the Knee: A Review ORTHOPEDICS Erickson, B. J., Campbell, K., Cvetanovich, G. L., Harris, J. D., Bach, B. R., Sherman, S. L. 2016; 39 (1): 32–42

    Abstract

    Knee pain is one of the most frequent complaints evaluated by orthopedic surgeons. It encompasses a broad range of pathology and can present in a variety of ways. Most of this pain can be attributed to essential structures of the knee, including the menisci, cruciate or collateral ligaments, and articular cartilage. However, there are underrecognized structures in and around the knee that can frequently be a cause of knee pathology and pain. Knee pain stemming from these structures may be missed or incorrectly diagnosed, and these patients often present for second and third opinions because of failure to diagnose and treat the underlying pathology. The synovial plica, suprapatellar pouch, lateral retinaculum, infrapatellar fat pad, and infrapatellar branch of the saphenous nerve are less common but still significant causes of knee pain. Although initial treatment involves various nonoperative modalities, operative treatment is often warranted. Operative and nonoperative management of these soft tissue structures may occur in isolation or with concomitant procedures, including knee ligament reconstruction, total knee arthroplasty, tibial tuberosity osteotomy, or lysis of adhesions. With proper recognition of the role of these structures in knee pain, the orthopedic surgeon can offer a valuable primary or adjunctive treatment option for patients with knee pain, especially those without localizing signs of meniscal, ligamentous, or cartilage damage.

    View details for DOI 10.3928/01477447-20151218-06

    View details for Web of Science ID 000377409200041

    View details for PubMedID 26709560

  • In Vitro Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte Viability and Metabolism CARTILAGE Sherman, S. L., Khazai, R. S., James, C. H., Stoker, A. M., Flood, D. L., Cook, J. L. 2015; 6 (4): 233–40

    Abstract

    There is growing concern that intra-articular injection of local anesthetic and/or corticosteroids may cause significant morbidity, including potential toxicity to chondrocytes and synoviocytes, after even a single exposure. We demonstrate that full thickness canine chondral and synovial samples exposed to various local anesthetics and corticosteroids exhibit decreased loss of cell viability compared with prior in vitro studies using monolayer culture, due to the protective effects of intact extracellular matrix and cell heterogeneity.Full-thickness cartilage and synovial explants were obtained from canine cadavers and exposed in culture media to the following for 24 hours: 1% lidocaine, 0.5% lidocaine, 0.25% bupivacaine, 0.125% bupvacaine, 0.0625% bupivacaine, betamethasone acetate, methylprednisolone acetate, triamcinolone acetonide, or culture media only (control). Cell viability was determined on days 1 and 7 of culture using a microscopic live-dead and alamar blue metabolic assays.Complete loss of chondrocyte and synoviocyte viability was noted in the 1% and 0.5% lidocaine group, 0.25% and 0.125% bupivacaine group, betamethasone group, and methylprednisolone groups after 1 and 7 days of culture. Treatment with 0.0625% bupivacaine and triamcinolone demonstrated no decrease in cell viability or metabolism when compared to negative control.In this canine explant model, 1% and 0.5% lidocaine, 0.25% and 0.125% bupivacaine, betamethasone acetate, and methylpresdnisolone acetate were severely chondrotoxic and synoviotoxic after a single exposure, despite intact extracellular matrix. In contrast, chondrocytes and synoviocytes exposed to 0.0625% bupivacaine and triamcinolone remained viable after treatment. Further in vivo study is needed before definitive recommendations can be made.

    View details for DOI 10.1177/1947603515594453

    View details for Web of Science ID 000361156100005

    View details for PubMedID 26425261

    View details for PubMedCentralID PMC4568732

  • Return to Play Following Anterior Cruciate Ligament Reconstruction JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Ellman, M. B., Sherman, S. L., Forsythe, B., LaPrade, R. F., Cole, B. J., Bach, B. R. 2015; 23 (5): 283–96

    Abstract

    In athletes, significant advances in anterior cruciate ligament reconstruction techniques and rehabilitation have led to improved surgical outcomes and increased expectations for return to play. Although an expeditious return to sport has become an achievable and often realistic goal, the factors that most influence safe, timely, and successful return to play remain unknown. The literature offers mainly anecdotal evidence to guide the team physician in the decision-making process, with a paucity of criteria and consensus guidelines available to help determine return to sport. Attempts have been made to introduce criteria-based progression in the rehabilitation process, but validation of subjective and objective criteria has been difficult. Nevertheless, several pertinent factors in the preoperative, intraoperative, and postoperative periods may affect return to play following anterior cruciate ligament reconstruction. Further research is warranted to validate reliable, consensus guidelines with objective criteria to facilitate the return to play process.

    View details for DOI 10.5435/JAAOS-D-13-00183

    View details for Web of Science ID 000353467800005

    View details for PubMedID 25911661

  • In Vivo Toxicity of Local Anesthetics and Corticosteroids on Chondrocyte and Synoviocyte Viability and Metabolism CARTILAGE Sherman, S. L., James, C., Stoker, A. M., Cook, C. R., Khazai, R. S., Flood, D. L., Cook, J. L. 2015; 6 (2): 106–12

    Abstract

    Intra-articular injection of local anesthetic and/or corticosteroid is an adjunct treatment for arthritic and inflammatory orthopedic conditions. Despite potential benefits, there is growing concern that these medications may cause significant morbidity, including potential toxicity to intra-articular chondrocytes and synoviocytes.Twenty dogs underwent intra-articular injection of the shoulder joint using ultrasound guidance, with the following injectates (n = 5 each): negative control (saline), methylprednisolone/1.0% lidocaine, triamcinolone/1.0% lidocaine, and triamcinolone/0.0625% bupivacaine. The dogs were euthanized 24 hours postinjection for reasons unrelated to this study. Synovium/cartilage explants were harvested under sterile conditions and assessed immediately or cultured for 7 days. Synoviocyte and chondrocyte viability was determined on day 1 and day 7 using Calcien AM and Sytox Blue live/dead fluorescent stains, and cell metabolism determined on day 2 using the alamar blue additive test. Results were compared statistically.On day 1 synovium exposed to 1%L/M demonstrated a significant decrease in cell metabolism (P = 0.0107) and subjective synoviocyte viability scores (P = 0.013) compared with the negative control. Cartilage exposed to 1%L/M demonstrated decreased chondrocyte viability and cell metabolism versus all other groups, although not significantly. After 7 days of culture, cartilage viable cell density in the 1%L/M group was significantly (P ≤ 0.001) lower than the negative control. Subjective synoviocyte viability scores was significantly lower in the 1%L/M (P = 0.013), 1%L/T (P ≤ 0.001), and 0.0625%B/T groups (P = 0.006) compared with the negative control.This study suggests potential negative effects of combination local anesthetic/corticosteroid on intra-articular cell viability and cell metabolism. Further study is needed before determining definitive clinical recommendations.

    View details for DOI 10.1177/1947603515571001

    View details for Web of Science ID 000356631400005

    View details for PubMedID 26069713

    View details for PubMedCentralID PMC4462250

  • Quantifying the Economic Impact of Provider Volume Through Adverse Events The Case of Sports Medicine ORTHOPAEDIC JOURNAL OF SPORTS MEDICINE Scott, D. J., Sherman, S., Dhawan, A., Cole, B. J., Bach, B. R., Mather, R. C. 2015; 3 (3): 2325967115574476

    Abstract

    Procedures performed by surgeons with higher provider volumes offer advantages both to the individual patient and the health system, with studies documenting fewer adverse events, shorter surgical times, and decreased reoperation rates. With workforce requirements for surgeons growing, it is increasingly necessary to establish the most efficient structure of this workforce.Substantial economic savings are realized when procedures are performed by high-volume providers as compared with low-volume providers in the areas of readmission, prolonged admission, and subsequent surgery.Economic and decision analysis; Level of evidence, 2.This study utilized decision modeling to estimate the cost savings to high-volume providers in sports medicine. Simple decision models were constructed for 3 common procedures: anterior cruciate ligament (ACL) reconstruction, rotator cuff repair, and total shoulder arthroplasty. Outcome probabilities for adverse events (readmission, prolonged admission, and subsequent surgery) and costs were taken from the literature. A Monte Carlo simulation reflecting the incidence of these procedures in the United States was performed to estimate the total nationwide cost of these procedures, and the impact of both negative and positive policies on this cost were examined using sensitivity analysis.The costs per case attributable to adverse outcomes for ACL reconstruction (in 2010 US$) were $496, $781, and $868 for high-, medium-, and low-volume providers, respectively. For rotator cuff repair, these numbers were $523, $640, and $872, and for total shoulder arthroplasty, $1692, $1876, and $2021, respectively. Sensitivity analysis revealed that a 50% increase in the number of these 3 procedures performed by high-volume surgeons could save the health system $23.1 million. If all procedures were performed by high-volume surgeons, the health system could save $72 million.The hypothesis was accepted; higher provider volumes for surgeons do convey substantial societal economic benefits. Policies to incentivize and facilitate a greater portion of procedures being performed by high-volume surgeons may increase the efficiency of resource utilization in health care delivery.

    View details for DOI 10.1177/2325967115574476

    View details for Web of Science ID 000367979000008

    View details for PubMedID 26665030

    View details for PubMedCentralID PMC4622357

  • Anterior Ankle Arthroscopy Indications, Pitfalls, and Complications FOOT AND ANKLE CLINICS Epstein, D. M., Black, B. S., Sherman, S. L. 2015; 20 (1): 41–57

    Abstract

    Anterior ankle arthroscopy is a useful, minimally invasive technique for diagnosing and treating ankle conditions. Arthroscopic treatment offers the benefit of decreased surgical morbidity, less postoperative pain, and earlier return to activities. Indications for anterior ankle arthroscopy continue to expand, including ankle instability, impingement, management of osteochondritis dissecans, synovectomy, and loose body removal. Anterior ankle arthroscopy has its own set of inherent risks and complications. Surgeons can decrease the risk of complications through mastery of ankle anatomy and biomechanics, and by careful preoperative planning and meticulous surgical technique.

    View details for DOI 10.1016/j.fcl.2014.10.001

    View details for Web of Science ID 000351810000005

    View details for PubMedID 25726482

  • Managing and recognizing complications after treatment of acromioclavicular joint repair or reconstruction CURRENT REVIEWS IN MUSCULOSKELETAL MEDICINE Ma, R., Smith, P. A., Smith, M. J., Sherman, S. L., Flood, D., Li, X. 2015; 8 (1): 75–82

    Abstract

    Complications of the acromioclavicular joint injuries can occur as a result of the injury itself, conservative management, or surgical treatment. Fortunately, the majority of acromioclavicular surgeries utilizing modern techniques and instrumentation result in successful outcomes. However, clinical failures do occur with frequency. The ability to identify the causative factor of failures makes revision surgery more likely to be successful. The purposes of this review are to highlight common problems that can occur following acromioclavicular joint surgery and discuss techniques that can be utilized in revision surgery.

    View details for DOI 10.1007/s12178-014-9255-6

    View details for Web of Science ID 000219599300009

    View details for PubMedID 25663435

    View details for PubMedCentralID PMC4596186

  • Effects on Exposed Articular Cartilage During Open Surgical Procedures: A Comparison of Various Fluids in an Animal Model ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Farr, J., Mathew, L. M., Stoker, A. M., Sherman, S. L., Cook, J. L. 2015; 31 (1): 113–17

    Abstract

    The aim of this study was to assess the potential detrimental effects of the operating room environment on exposed healthy articular cartilage and to evaluate tissue hydration treatment strategies for preserving chondrocyte viability and extracellular matrix composition in this environment.With institutional Animal Care and Use Committee approval, femoral and tibial condyles (n = 36; 6 per specimen) were harvested from canine cadavers (n = 6) immediately after euthanasia and placed on a draped operating table under standard surgical lighting for a timed 2-hour period. Each condyle was randomly assigned to one of 6 groups (n = 6 per group): no-treatment control, hyaluronic acid (HA), saline sponge, saline drip, culture media (Dulbecco's modified Eagle's medium [DMEM]) sponge, or culture media drip. Full-thickness cartilage sections were collected from each specimen immediately after harvest (time 0) and immediately after 2-hour exposure (time 2H), and processed to determine chondrocyte viability, tissue water content, and extracellular matrix composition (glycosaminoglycan [GAG] and collagen content).Chondrocyte viability was significantly lower (P = .03) after the 2-hour exposure in the control group. HA, saline sponge, and saline drip treatment groups all had significantly higher (P < .043) chondrocyte viability compared with controls at time 2H. Water content was significantly lower (P < .01) after the 2-hour exposure in the control group. Further, the water content in the control group was significantly lower than all treatment groups at time 2H (P < .001). No significant differences in tissue collagen or GAG content were observed within groups between time points or among groups at either time point.Canine articular cartilage did not demonstrate any reduction in chondrocyte viability or tissue water content at 2 hours when treated with hyaluronic acid, saline drip, saline-soaked sponge, or DMEM-soaked sponge compared with untreated exposed cartilage.Surgeons should consider the use of a hydrating solution for the treatment of exposed articular cartilage during open joint surgery of 2 hours or longer duration.

    View details for DOI 10.1016/j.arthro.2014.07.027

    View details for Web of Science ID 000347032400024

    View details for PubMedID 25260748

  • Does a Syrinx Matter for Return to Play in Contact Sports? A Case Report and Evidence-Based Review of Return-to-Play Criteria After Transient Quadriplegia SPORTS HEALTH-A MULTIDISCIPLINARY APPROACH Milles, J. L., Gallizzi, M. A., Sherman, S. L., Smith, P. A., Choma, T. J. 2014; 6 (5): 440–45

    Abstract

    Transient quadriplegia is a rare injury that can change the course of an athlete's career if misdiagnosed or managed inappropriately. The clinician should be well versed in the return-to-play criteria for this type of injury. Unfortunately, when an unknown preexisting syrinx is present in the athlete, there is less guidance on their ability to return to play. This case report and review of the current literature illustrates a National Collegiate Athletic Association (NCAA) Division I football player who suffered a transient quadriplegic event during a kickoff return that subsequently was found to have an incidental cervical syrinx on magnetic resonance imaging. The player was able to have a full neurologic recovery, but ultimately he was withheld from football.

    View details for DOI 10.1177/1941738114544674

    View details for Web of Science ID 000214873300011

    View details for PubMedID 25177422

    View details for PubMedCentralID PMC4137682

  • Tibial Tuberosity Osteotomy Indications, Techniques, and Outcomes AMERICAN JOURNAL OF SPORTS MEDICINE Sherman, S. L., Erickson, B. J., Cvetanovich, G. L., Chalmers, P. N., Farr, J., Bach, B. R., Cole, B. J. 2014; 42 (8): 2006–17

    Abstract

    Tibial tuberosity osteotomy (TTO) is a well-described treatment option for a broad range of patellofemoral joint disorders, including patellofemoral instability, patellar and trochlear focal chondral lesions, and patellofemoral arthritis. The purpose of this article is to review the evolution of the TTO procedure, from the original Hauser procedure to the current anteromedialization procedure, as well as discuss the pertinent anatomy and radiographs that accompany this procedure. The article highlights the surgical techniques for some of the more commonly performed TTO procedures and discusses the outcomes of the various TTO techniques. Complications, as well as clinical pearls to avoid these complications, are also included.

    View details for DOI 10.1177/0363546513507423

    View details for Web of Science ID 000341634900033

    View details for PubMedID 24197613

  • Patellofemoral Anatomy and Biomechanics CLINICS IN SPORTS MEDICINE Sherman, S. L., Plackis, A. C., Nuelle, C. W. 2014; 33 (3): 389-+

    Abstract

    Patellofemoral disorders are common. There is a broad spectrum of disease, ranging from patellofemoral pain and instability to focal cartilage disease and arthritis. Regardless of the specific condition, abnormal anatomy and biomechanics are often the root cause of patellofemoral dysfunction. A thorough understanding of normal patellofemoral anatomy and biomechanics is critical for the treating physician. Recognizing and addressing abnormal anatomy will optimize patellofemoral biomechanics and may ultimately translate into clinical success.

    View details for DOI 10.1016/j.csm.2014.03.008

    View details for Web of Science ID 000339463400003

    View details for PubMedID 24993406

  • Evidence-Based Approach of Treatment Options for Postoperative Knee Pain PHYSICIAN AND SPORTSMEDICINE Farr, J., Jaggers, R., Lewis, H., Plackis, A., Sim, S. B., Sherman, S. L. 2014; 42 (2): 58–70

    Abstract

    Optimal pain management is critical after knee surgery to avoid adverse events and to improve surgical outcomes. Pain may affect surgical outcomes by contributing to limitations in range of motion, strength, and functional recovery. The causes of postoperative pain are multifactorial; therefore, an appropriate pain management strategy must take into account preoperative, intraoperative, and postoperative factors to create a comprehensive and individualized plan for the patient. Preoperative assessment includes management of patient expectations, recognition of conditions and early counseling for high-risk patients (ie, opioid dependence, psychiatric comorbidities), and use of preemptive analgesia techniques (ie, preoperative IV medications, peripheral nerve blocks, incisional field blocks). Intraoperative strategies include meticulous surgical technique, limiting the use of tourniquets (ie, duration and pressure), and using preventive analgesia methods (ie, postoperative field block, continuous nerve catheters, intra-articular injection). Postoperative analgesia may be facilitated by cryotherapy, early mobilization, bracing, and rehabilitation. Certain modalities (ie, continuous passive motion devices, transcutaneous electrical nerve stimulation units, iontophoresis) may be important adjuncts in the perioperative period as well. There may be an evolving role for alternative medicine strategies. Early recognition and treatment of exaggerated postoperative pain responses may mitigate the effects of complex regional pain syndrome or the development of chronic pain.

    View details for DOI 10.3810/psm.2014.05.2058

    View details for Web of Science ID 000343399000006

    View details for PubMedID 24875973

  • Does ACL Reconstruction Alter Natural History? A Systematic Literature Review of Long-Term Outcomes JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Chalmers, P. N., Mall, N. A., Moric, M., Sherman, S. L., Paletta, G. P., Cole, B. J., Bach, B. R. 2014; 96A (4): 292–300

    Abstract

    Anterior cruciate ligament (ACL) injury can lead to tibiofemoral instability, decreased functional outcomes, and degenerative joint disease. It is unknown whether ACL reconstruction alters this progression at long-term follow-up.A systematic literature review of the long-term results (minimum follow-up, more than ten years) after operative intra-articular reconstruction of ACL injuries and after nonoperative management was performed to compare (1) knee stability on physical examination, (2) functional and patient-based outcomes, (3) the need for further surgical intervention, and (4) radiographic outcomes. After application of selection criteria, forty patient cohorts with a mean of 13.9 ± 3.1 years of postoperative follow-up were identified. Twenty-seven cohorts containing 1585 patients had undergone reconstruction, and thirteen containing 685 patients had been treated nonoperatively.Comparison of operative and nonoperative cohorts revealed no significant differences in age, sex, body mass index, or rate of initial meniscal injury (p > 0.05 for all). Operative cohorts had significantly less need for further surgery (12.4% compared with 24.9% for nonoperative, p = 0.0176), less need for subsequent meniscal surgery (13.9% compared with 29.4%, p = 0.0017), and less decline in the Tegner score (-1.9 compared with -3.1, p = 0.0215). A difference in pivot-shift test results was observed (25.5% pivot-positive compared with 46.6% for nonoperative) but did not reach significance (p = 0.09). No significant differences were seen in outcome scores (Lysholm, International Knee Documentation Committee [IKDC], or final Tegner scores) or the rate of radiographically evident degenerative joint disease (p > 0.05 for all).At a mean of 13.9 ± 3.1 years after injury, the patients who underwent ACL reconstruction had fewer subsequent meniscal injuries, less need for further surgery, and significantly greater improvement in activity level as measured with the Tegner score. There were no significant differences in the Lysholm score, IKDC score, or development of radiographically evident osteoarthritis.

    View details for DOI 10.2106/JBJS.L.01713

    View details for Web of Science ID 000331431300005

    View details for PubMedID 24553885

  • Fresh Osteochondral Allograft Transplantation for the Knee: Current Concepts JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Garrity, J., Bauer, K., Cook, J., Stannard, J., Bugbee, W. 2014; 22 (2): 121–33

    Abstract

    Fresh osteochondral allograft (OCA) transplantation has been used to manage a wide spectrum of chondral and osteochondral knee disorders. Basic science and clinical studies support the safety and efficacy of the procedure. Transplantation of viable, mature hyaline cartilage into the affected area is an advantage of the procedure, which can be used to restore bone stock in complex or salvage scenarios. Indications for OCA transplantation in the knee include primary management of large chondral or osteochondral defects and salvage of previously failed cartilage repair. The procedure also can be used for complex biologic knee reconstruction in the setting of osteonecrosis, fracture malunion, or posttraumatic arthritis. Challenges associated with OCA transplantation include allograft storage and size matching, tissue availability, chondrocyte viability, the possibility of immunologic graft response, and a demanding surgical technique. Future research should focus on optimizing allograft viability and healing and refining current surgical indications and techniques.

    View details for DOI 10.5435/JAAOS-22-02-121

    View details for Web of Science ID 000349452200007

    View details for PubMedID 24486758

  • Evaluation and Management of an Irreducible Posterolateral Knee Dislocation JOURNAL OF KNEE SURGERY Capito, N., Gregory, M. H., Volgas, D., Sherman, S. L. 2013; 26: S136–S141

    Abstract

    Irreducible posterolateral knee dislocations are rare and complex injuries that are often difficult to treat. Prompt recognition and appropriate early management are vital to the successful long-term outcome for the patient. In this case report, we highlight a single patient presenting with an irreducible posterolateral knee dislocation following a high-energy trauma. Evaluation and management included careful history and physical examination, appropriate imaging studies, and formulation of an early operative plan, leading to a safe and successful knee reduction for this patient. We review the best available evidence to guide orthopedic surgeons in their evaluation and management of the irreducible knee dislocation.

    View details for DOI 10.1055/s-0033-1341577

    View details for Web of Science ID 000346581400030

    View details for PubMedID 23512541

  • Return to High-Level Sport After Meniscal Allograft Transplantation ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Chalmers, P. N., Karas, V., Sherman, S. L., Cole, B. J. 2013; 29 (3): 539–44

    Abstract

    Our purpose was to determine the results of meniscal allograft transplantation (MAT) in high school and higher-level athletes, specifically with respect to return to their preinjury level of play.This is a retrospective case series of prospectively collected data from a single surgeon, evaluating athletes who underwent MAT. Each patient participated in either high school, collegiate, or professional athletics before injury, with a mean preinjury Tegner score of 8. In addition, patients were only included if one of their stated preoperative goals was to return to their previous level of activity. Patients completed preoperative and postoperative validated knee surveys (Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lysholm score, and Tegner score) and underwent physical examinations.The mean age of the 13 included patients was 19.8 years, with a mean follow-up of 3.3 years (range, 1.9 to 5.7 years). After MAT, 10 of 13 patients (77%) returned to sporting activity. The mean Knee Injury and Osteoarthritis Outcome Score for the sport subset was 76 (SD, 18), the mean International Knee Documentation Committee score was 77 (SD, 14), and the mean Lysholm score was 81 (SD, 13). Of the 13 patients, 3 (23%) required further surgery, comprising one revision MAT, one partial meniscectomy, and one meniscal repair.In this small retrospective series, 77% of high school and higher-level athletes with meniscal deficiency and symptomatic "post-meniscectomy syndrome" returned to their desired level of play after MAT. These athletes also had significant improvements in most outcome measures.Level IV, therapeutic case series.

    View details for DOI 10.1016/j.arthro.2012.10.027

    View details for Web of Science ID 000315584200023

    View details for PubMedID 23375179

  • An Evidenced-Based Examination of the Epidemiology and Outcomes of Traumatic Rotator Cuff Tears ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Mall, N. A., Lee, A. S., Chahal, J., Sherman, S. L., Romeo, A. A., Verma, N. N., Cole, B. J. 2013; 29 (2): 366–76

    Abstract

    The purpose of this study was to systematically review the literature to better define the epidemiology, mechanism of injury, tear characteristics, outcomes, and healing of traumatic rotator cuff tears. A secondary goal was to determine if sufficient evidence exists to recommend early surgical repair in traumatic rotator cuff tears.An independent systematic review was conducted of evidence Levels I to IV. A literature search of PubMed, Medline, Embase, and Cochrane Collaboration of Systematic Reviews was conducted, with 3 reviewers assessing studies for inclusion, methodology of individual study, and extracted data.Nine studies met the inclusion and exclusion criteria. Average patient age was 54.7 (34 to 61) years, and reported mean time to surgical intervention, 66 days (3 to 48 weeks) from the time of injury. The most common mechanism of injury was fall onto an outstretched arm. Supraspinatus was involved in 84% of tears, and infraspinatus was torn in 39% of shoulders. Subscapularis tears were present in 78% of injuries. Tear size was <3 cm in 22%, 3 to 5 cm in 36%, and >5 cm in 42%. Average active forward elevation improved from 81° to 150° postoperatively. The weighted mean postoperative UCLA score was 30, and the Constant score was 77.Traumatic rotator cuff tears are more likely to occur in relatively young (age 54.7), largely male patients who suffer a fall or trauma to an abducted, externally rotated arm. These tears are typically large and involve the subscapularis, and repair results in acceptable results. However, insufficient data prevent a firm recommendation for early surgical repair.Level IV, systematic review Levels III and IV studies.

    View details for DOI 10.1016/j.arthro.2012.06.024

    View details for Web of Science ID 000314127100027

    View details for PubMedID 23290186

  • Biomechanical Evaluation of Transosseous Rotator Cuff Repair Do Anchors Really Matter? Salata, M. J., Sherman, S. L., Lin, E. C., Sershon, R. A., Gupta, A., Shewman, E., Wang, V. M., Cole, B. J., Romeo, A. A., Verma, N. N. SAGE PUBLICATIONS INC. 2013: 283–90

    Abstract

    Suture anchor fixation has become the preferred method for arthroscopic repairs of rotator cuff tears. Recently, newer arthroscopic repair techniques including transosseous-equivalent repairs with anchors or arthroscopic transosseous suture passage have been developed.To compare the initial biomechanical performance including ultimate load to failure and localized cyclic elongation between transosseous-equivalent repair with anchors (TOE), traditional transosseous repair with a curved bone tunnel (TO), and an arthroscopic transosseous repair technique utilizing a simple (AT) or X-box suture configuration (ATX).Controlled laboratory study.Twenty-eight human cadaveric shoulders were dissected to create an isolated supraspinatus tear and randomized into 1 of 4 repair groups (TOE, TO, AT, ATX). Tensile testing was conducted to simulate the anatomic position of the supraspinatus with the arm in 60° of abduction and involved an initial preload, cyclic loading, and pull to failure. Localized elongation during testing was measured using optical tracking. Data were statistically assessed using analysis of variance with a Tukey post hoc test for multiple comparisons.The TOE repair demonstrated a significantly higher mean ± SD failure load (558.4 ± 122.9 N) compared with the TO (325.3 ± 79.9 N), AT (291.7 ± 57.9 N), and ATX (388.5 ± 92.6 N) repairs (P < .05). There was also a significantly larger amount of first-cycle excursion in the AT group (8.19 ± 1.85 mm) compared with the TOE group (5.10 ± 0.89 mm). There was no significant difference between repair groups in stiffness during maximum load to failure or in normalized cyclic elongation. Failure modes were as follows: TOE, tendon (n = 4) and bone (n = 3); TO, suture (n = 6) and bone (n = 1); AT, tendon (n = 2) and bone (n = 3) and suture (n = 1); ATX, tendon (n = 7).This study demonstrates that anchorless repair techniques using transosseous sutures result in significantly lower failure loads than a repair model utilizing anchors in a TOE construct.Suture anchor repair appears to offer superior biomechanical properties to transosseous repairs regardless of tunnel or suture configuration.

    View details for DOI 10.1177/0363546512469092

    View details for Web of Science ID 000314307500009

    View details for PubMedID 23239668

  • Recutting the distal femur to increase maximal knee extension during TKA causes coronal plane laxity in mid-flexion KNEE Cross, M. B., Nam, D., Plaskos, C., Sherman, S. L., Lyman, S., Pearle, A. D., Mayman, D. J. 2012; 19 (6): 875–79

    Abstract

    The aim of this study was to quantify the effects of distal femoral cut height on maximal knee extension and coronal plane knee laxity.Seven fresh-frozen cadaver legs from hip-to-toe underwent a posterior stabilized TKA using a measured resection technique with a computer navigation system equipped with a robotic cutting guide. After the initial femoral resections were performed, the posterior joint capsule was sutured until a 10° flexion contracture was obtained with the trial components in place. Two distal femoral recuts of +2mm each were then subsequently made and the trials were reinserted. The navigation system was used to measure the maximum extension angle achieved and overall coronal plane laxity [in degrees] at maximum extension, 30°, 60° and 90° of flexion, when applying a standardized varus/valgus load of 9.8 [Nm] across the knee.For a 10 degree flexion contracture, performing the first distal recut of +2mm increased overall coronal plane laxity by approximately 4.0° at 30° of flexion (p=0.002) and 1.9° at 60° of flexion (p=0.126). Performing the second +2mm recut of the distal femur increased mid-flexion laxity by 6.4° (p<0.0001) at 30° and 4.0° at 60° of flexion (p=0.01), compared to the 9 mm baseline resection (control). Maximum knee extension increased from 10° of flexion to 6.4° (± 2.5° SD, p<0.005) and to 1.4° (± 1.8° SD, p<0.001) of flexion with each 2mm recut of the distal femur.Recutting the distal femur not only increases the maximum knee extension achieved but also increases coronal plane laxity in midflexion.

    View details for DOI 10.1016/j.knee.2012.05.007

    View details for Web of Science ID 000311329300027

    View details for PubMedID 22727760

  • Long-term survivorship of a unicondylar knee replacement - A case report KNEE Egidy, C. C., Sherman, S. L., Macdessi, S. J., Cross, M. B., Windsor, R. E. 2012; 19 (6): 944–47

    Abstract

    Unicondylar knee arthroplasty (UKA) was introduced in the 1970s as a treatment option for isolated knee compartment gonarthrosis. Early results were discouraging secondary to poor patient selection, suboptimal surgical technique, and inferior prosthetic design. In recent years, there has been resurgence in the use of the UKA. Improvements in implant design, surgical technique, and patient selection have led to multiple studies demonstrating 94-98% survivorship of the implants at a 10 year follow-up. However, there still remains a paucity of evidence with regard to this treatment option for young, active patients. This case report presents the longest recorded follow-up (31 years) of a UKA in a young, active patient and it highlights that with appropriate patient selection and meticulous surgical technique, UKA may have a role as a long term treatment option in patients with isolated unicompartmental disease.

    View details for DOI 10.1016/j.knee.2012.03.015

    View details for Web of Science ID 000311329300040

    View details for PubMedID 22533962

  • Graft Tensioning During Knee Ligament Reconstruction: Principles and Practice JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS Sherman, S. L., Chalmers, P. N., Yanke, A. B., Bush-Joseph, C. A., Verma, N. N., Cole, B. J., Bach, B. R. 2012; 20 (10): 633–45

    Abstract

    Failure to correctly tension grafts may overconstrain or underconstrain the knee, potentially predisposing the patient to deteriorating clinical and/or radiographic results over time. Knee ligament reconstruction requires a fundamental understanding of native anatomy, ligament biomechanics, and principles of graft tensioning. A successful strategy for graft tensioning takes into account the specific biomechanics of the ligament or ligaments in question, the mechanical properties of the graft selected, the chosen fixation method, the selected tensioning method (ie, manual or mechanical), and the overall goal of the reconstruction (ie, isometry versus anisometry).

    View details for DOI 10.5435/JAAOS-20-10-633

    View details for Web of Science ID 000309489400003

    View details for PubMedID 23027693

  • Biomechanical Analysis of the Pectoralis Major Tendon and Comparison of Techniques for Tendo-osseous Repair AMERICAN JOURNAL OF SPORTS MEDICINE Sherman, S. L., Lin, E. C., Verma, N. N., Mather, R. C., Gregory, J. M., Dishkin, J., Harwood, D. P., Wang, V. M., Shewman, E. F., Cole, B. J., Romeo, A. A. 2012; 40 (8): 1887–94

    Abstract

    Various described surgical techniques exist for the repair of pectoralis major ruptures at the tendo-osseous junction. It is unclear how these techniques restore the native properties of the pectoralis major tendon because its biomechanical properties have not been described.All repairs will have lower initial biomechanical profiles than the native attachment, and transosseous sutures will demonstrate improved initial biomechanical performance compared with anchors or buttons.Controlled laboratory study.Twenty-four fresh-frozen cadaveric shoulders were randomized to 4 equal groups, including 3 experimental repair groups and 1 control group of intact pectoralis major tendons. The characteristics of the native anatomic footprint were recorded, and the experimental groups underwent pectoralis detachment, followed by subsequent repair. The restoration of the anatomic footprint was recorded. All specimens were tested with cyclic loading and load-to-failure protocols with load, displacement, and optical marker data simultaneously collected.Under cyclic loading, the intact specimens demonstrated a significantly higher secant stiffness (74.8 ± 1.6 N/mm) than the repair groups (endosteal Pec Button [PB], 46.2 ± 6.4 N/mm; suture anchor [SA], 45.9 ± 8.7 N/mm; transosseous [TO], 44.2 ± 5.5 N/mm). Measured as a percentage change, the PB and SA groups showed a significantly higher initial excursion than the intact group (PB, 24.0% ± 11.7%; SA, 17.5% ± 6.9%; intact, 2.2% ± 1.0%), and the PB group demonstrated a significantly higher cyclic elongation than the intact group (PB, 7.5% ± 2.9%; intact, 1.5% ± 1.5%). Under load-to-failure testing, the intact group showed a significantly greater maximum load (1454.8 ± 795.7 N) and linear stiffness (221.0 ± 111.7 N/mm) than the 3 repair groups (PB, 353.5 ± 88.3 N and 63.5 ± 6.9 N/mm; SA, 292.0 ± 73.3 N and 77.0 ± 7.8 N/mm; TO, 359.2 ± 110.4 N and 64.5 ± 14.1 N/mm, respectively). All repair constructs failed via suture pulling through the tendon.The biomechanical characteristics of the transosseous repair, suture anchors, or Pec Button repair were inferior to those of the native pectoralis tendon. There was no significant difference in any of the biomechanical outcomes among the repair groups. Further refinement and evaluation of suture technique and configuration in pectoralis major repair should be considered.Transosseous repair, suture anchors, and endosteal Pec Buttons appear to confer similar biomechanical integrity for pectoralis major repair. Restricting early activities to thresholds below the identified failure loads seems prudent until soft tissue healing to bone is reliably achieved.

    View details for DOI 10.1177/0363546512452849

    View details for Web of Science ID 000307175700026

    View details for PubMedID 22781500

  • A Review of Translational Animal Models for Knee Osteoarthritis ARTHRITIS Gregory, M. H., Capito, N., Kuroki, K., Stoker, A., Cook, J. L., Sherman, S. L. 2012: 764621

    Abstract

    Knee osteoarthritis remains a tremendous public health concern, both in terms of health-related quality of life and financial burden of disease. Translational research is a critical step towards understanding and mitigating the long-term effects of this disease process. Animal models provide practical and clinically relevant ways to study both the natural history and response to treatment of knee osteoarthritis. Many factors including size, cost, and method of inducing osteoarthritis are important considerations for choosing an appropriate animal model. Smaller animals are useful because of their ease of use and cost, while larger animals are advantageous because of their anatomical similarity to humans. This evidence-based review will compare and contrast several different animal models for knee osteoarthritis. Our goal is to inform the clinician about current research models, in order to facilitate the transfer of knowledge from the "bench" to the "bedside."

    View details for DOI 10.1155/2012/764621

    View details for Web of Science ID 000215117300023

    View details for PubMedID 23326663

    View details for PubMedCentralID PMC3541554