Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 472 | Issue 9 | Sep, 2014

Editorial: Words Hurt – Avoiding Dehumanizing Language in Orthopaedic Research and Practice

Seth S. Leopold MD, Lee Beadling BS, Mark C. Gebhardt MD, Terence J. Gioe MD, Benjamin K. Potter MD, Clare M. Rimnac PhD, Montri D. Wongworawat MD

CORR® ORS Richard A. Brand Award for Outstanding Orthopaedic Research: Engineering Flexor Tendon Repair With Lubricant, Cells, and Cytokines in a Canine Model

Chunfeng Zhao MD, Yasuhiro Ozasa MD, PhD, Ramona L. Reisdorf BS, Andrew R. Thoreson MS, Gregory D. Jay MD, PhD, Kai-Nan An PhD, Peter C. Amadio MD

Adhesions and poor healing are complications of flexor tendon repair.

Epidemiology of Multiligament Knee Reconstruction

Sean M. Wilson BA, Nabil Mehta BSE, Huong T. Do MA, Hassan Ghomrawi PhD, Stephen Lyman PhD, Robert G. Marx MD, MSc, FRCSC

The multiple-ligament-injured knee represents a special challenge, being an uncommon injury that is both severe and complicated to treat. Many studies have evaluated patients treated for this injury, but most are limited in their scope. The evaluation of this injury and its treatment using an administrative database might provide a different perspective.

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

Gabriel A. Arom BS, Michael G. Yeranosian MD, Frank A. Petrigliano MD, Rodney D. Terrell MD, David R. McAllister MD

Knee dislocations are uncommon but devastating orthopaedic injuries. Little is known about their frequency and the types of patients who are affected.

What Is the Frequency of Vascular Injury After Knee Dislocation?

Kyle M. Natsuhara BS, Michael G. Yeranosian MD, Jeremiah R. Cohen BS, Jeffrey C. Wang MD, David R. McAllister MD, Frank A. Petrigliano MD

Vascular injury secondary to an acute knee dislocation is a known complication. However, there exist wide discrepancies in the reported rate of vascular injury in this setting.

Vascular and Nerve Injury After Knee Dislocation: A Systematic Review

Omar Medina BS, Gabriel A. Arom BS, Michael G. Yeranosian MD, Frank A. Petrigliano MD, David R. McAllister MD

Vascular injury is a devastating complication of acute knee dislocation. However, there are wide discrepancies in the reported frequency of vascular injury after knee dislocations, as well as important differences among approaches for diagnosis of this potentially limb-threatening problem.

Is Peroneal Nerve Injury Associated With Worse Function After Knee Dislocation?

Aaron J. Krych MD, Steven A. Giuseffi MD, Scott A. Kuzma MD, Michael J. Stuart MD, Bruce A. Levy MD

Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury–with or without complete recovery–is a predictor of inferior patient-reported outcome scores.

Posterior Tibial Tendon Transfer Improves Function for Foot Drop After Knee Dislocation

Marius Molund MD, Lars Engebretsen MD, PhD, Kjetil Hvaal MD, PhD, Jan Hellesnes PT, Elisabeth Ellingsen Husebye MD, PhD

Knee dislocation may be associated with an injury to the common peroneal nerve with a subsequent foot drop. Previous studies have demonstrated good functional results after posterior tibial tendon transfer in patients with foot drop. No studies, to our knowledge, have focused exclusively on knee dislocation as the cause of common peroneal nerve injury leading to foot drop.

Stress Radiography for the Diagnosis of Knee Ligament Injuries: A Systematic Review

Evan W. James BS, Brady T. Williams BS, Robert F. LaPrade MD, PhD

Stress radiography is a widely used diagnostic tool to assess injury to the anterior and posterior cruciate ligaments and the medial and lateral structures of the knee. However, to date, numerous techniques have been reported in the literature with no clear consensus as to which methodology is best for assessing ligament stability.

Medial Injury in Knee Dislocations: What Are the Common Injury Patterns and Surgical Outcomes?

Brian C. Werner MD, Michael M. Hadeed BS, F. Winston Gwathmey MD, Cree M. Gaskin MD, Joseph M. Hart PhD, ATC, Mark D. Miller MD

When associated with a knee dislocation, management of the medial ligamentous injury is challenging, with little literature available to guide treatment.

Is the All-arthroscopic Tibial Inlay Double-bundle PCL Reconstruction a Viable Option in Multiligament Knee Injuries?

Alexander E. Weber MD, Benjamin Bissell MD, Edward M. Wojtys MD, Jon K. Sekiya MD

All-arthroscopic tibial inlay double-bundle (DB) posterior cruciate ligament (PCL) reconstruction avoids an open dissection and the “killer turn” while maintaining the advantage of an anatomic graft. However, clinical data on the viability of this surgical technique in multiligamentous knee injuries are lacking.

A Novel Posteromedial Approach for Tibial Inlay PCL Reconstruction in KDIIIM Injuries: Avoiding Prone Patient Positioning

Dustin Richter MD, Daniel C. Wascher MD, Robert C. Schenck MD

Treatment of traumatic knee dislocations remains controversial and challenging. Current techniques for PCL reconstruction utilize either a transtibial approach with potential risk of vascular injury from drilling toward the popliteal artery or a tibial inlay technique with prone patient positioning, which is cumbersome and adds operative time. We therefore developed a surgical technique using a supine posteromedial approach for PCL tibial inlay reconstruction for the treatment of Schenck KDIIIM (ACL/PCL/medial collateral ligament) knee dislocations. In patients undergoing this technique, we evaluated patient-reported outcome scores, ROM, stability, and complications.

Is Stability of the Proximal Tibiofibular Joint Important in the Multiligament-injured Knee?

Michael Jabara MD, Jeffrey Bradley MD, Michael Merrick MD

The incidence of proximal tibiofibular joint instability in the setting of the multiligament-injured knee has not been previously reported. The integrity of the proximal tibiofibular joint is required to perform a fibular-based, lateral-sided knee reconstruction.

Risk Factors for the Development of Heterotopic Ossification After Knee Dislocation

Daniel B. Whelan MD, Andrew P. Dold MD, Tomce Trajkovski MD, Jas Chahal MD

Results of treatment for acute knee dislocations and multiligament knee injuries may be influenced by a multitude of patient- and injury-related factors, including neurologic function, vascular status, ipsilateral fractures, and joint stability. The development of heterotopic ossification (HO) may nullify any benefits of reconstruction, because it can cause stiffness and discomfort. Identifying factors associated with HO after knee dislocation may help identify patients who might benefit from prophylaxis.

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Trevor R. Born MD, William M. Engasser MD, Alexander H. King, Aaron J. Krych MD, Diane L. Dahm MD, Bruce A. Levy MD, Michael J. Stuart MD

Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction.

Long-term Followup of Surgically Treated Knee Dislocations: Stability Restored, but Arthritis Is Common

Gregory C. Fanelli MD, Paul L. Sousa MBA, Craig J. Edson MS

Surgical treatment of knee dislocations is intended to correct the anatomic injury and restore knee stability and patient function. Several studies have shown successful results with surgical treatment of knee dislocations with up to 10 years of followup, but longer-term studies are uncommon.

Can Fluoroscopy-based Computer Navigation Improve Entry Point Selection for Intramedullary Nailing of Femur Fractures?

Meghan C. Crookshank PhD, Max R. Edwards MD, FRCS(Tr&Ortho), Michael Sellan MSc, Cari M. Whyne PhD, Emil H. Schemitsch MD, FRCS(C)

The entry point is crucial to an accurate reduction in femoral nailing. Fluoroscopy-based navigation was developed to aid in reducing femur fractures and selecting entry points.

Healing Delayed But Generally Reliable After Bisphosphonate-associated Complete Femur Fractures Treated with IM Nails

Kenneth A. Egol MD, Ji Hae Park BS, Zehava Sadka Rosenberg MD, Valerie Peck MD, Nirmal C. Tejwani MD

Bisphosphonate therapy for osteoporosis has been associated with atypical femoral fractures. To date, there have been few reports in the literature regarding the preoperative and postoperative courses of patients who have sustained bisphosphonate-associated complete atypical femur fractures.

Elastic Nailing for Pediatric Subtrochanteric and Supracondylar Femur Fractures

Shital N. Parikh MD, Senthil T. Nathan MD, Michael J. Priola MD, Emily A. Eismann MS

Subtrochanteric and supracondylar femur fractures are difficult injuries to treat in children. Although elastic stable intramedullary nails are commonly used for pediatric femur shaft fractures, there is little information on their effectiveness for managing pediatric subtrochanteric and supracondylar femur fractures.

Assessing Leg Length After Fixation of Comminuted Femur Fractures

Dolfi Herscovici DO, Julia M. Scaduto ARNP

Nailing comminuted femur fractures may result in leg shortening, producing significant complications including pelvic tilt, narrowing of the hip joint space, mechanical and functional changes in gait, an increase in energy expenditures, and strains on spinal ligaments, leading to spinal deformities. The frequency of this complication in patients managed with an intramedullary (IM) nail for comminuted diaphyseal fractures is unknown.

Ipsilateral Proximal Femur and Shaft Fractures Treated With Hip Screws and a Reamed Retrograde Intramedullary Nail

Robert F. Ostrum MD, Paul Tornetta MD, J. Tracy Watson MD, Anthony Christiano BA, Emily Vafek MD

Although not common, proximal femoral fractures associated with ipsilateral shaft fractures present a difficult management problem. A variety of surgical options have been employed with varying results.

No Difference in Postoperative Pain After Arthroscopic versus Open Rotator Cuff Repair

Gerald Williams MD, Matthew J. Kraeutler BS, Benjamin Zmistowski BS, John M. Fenlin MD

Rotator cuff repair is a successful treatment in terms of patient satisfaction and pain relief regardless of the repair method. Although arthroscopic repair is commonly thought to be less painful than open or miniopen repair, studies disagree on this point.

Confirmation of Long-term In Vivo Bearing Mobility in Eight Rotating-platform TKAs

Michael T. LaCour BS, Adrija Sharma PhD, Christopher B. Carr PhD, Richard D. Komistek PhD, Douglas A. Dennis MD

Posterior-stabilized rotating-platform prostheses for TKAs were designed to improve contact mechanics at the femoral-polyethylene (PE) interface. Short-term followup studies have shown that the PE bearings rotate with respect to the tibia but might not necessarily track with the femur. It is important to know how kinematics in these designs change owing to long-term in vivo use.

Increased Complication Rates After Hip and Knee Arthroplasty in Patients With Cirrhosis of the Liver

John V. Tiberi MD, Viktor Hansen MD, Naglaa El-Abbadi MS, MPH, Hany Bedair MD

Risk stratification is critical in patients with cirrhosis undergoing THAs and TKAs, as they may be more likely to have serious medical and surgical complications. As opposed to the Child-Pugh scoring system, which has limited use for orthopaedic surgeons inexperienced in assessing ascites and hepatic encephalopathy, the Model for End-stage Liver Disease (MELD) is an easily calculated, validated scoring system for severity of liver disease based on common laboratory values; however, its usefulness for predicting complications after elective arthroplasty has not been studied.

High Early Failure Rate After Cementless Hip Replacement in the Octogenarian

Esa Jämsen MD, PhD, Antti Eskelinen MD, PhD, Mikko Peltola MSc, Keijo Mäkelä MD, PhD

Use of cementless hip replacements is increasing in many countries, but the best method for fixation for octogenarian patients remains unknown.

Do Jumbo Cups Cause Hip Center Elevation in Revision THA? A Radiographic Evaluation

Chima D. Nwankwo BSc, Michael D. Ries MD

Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, hip center elevation may occur with use of a jumbo cup owing to reaming superiorly and/or because of the increased diameter of the jumbo cup compared with the native acetabulum.

Obesity Does Not Affect Survival Outcomes in Extremity Soft Tissue Sarcoma

Vignesh K. Alamanda BS, David C. Moore MD, Yanna Song MS, Herbert S. Schwartz MD, Ginger E. Holt MD

Obesity is a growing epidemic and has been associated with an increased frequency of complications after various surgical procedures. Studies also have shown adipose tissue to promote a microenvironment favorable for tumor growth. Additionally, the relationship between obesity and prognosis of soft tissue sarcomas has yet to be evaluated.

Patient and Procedure-specific Risk Factors for Deep Infection After Primary Shoulder Arthroplasty

Jason Richards MD, Maria C. S. Inacio PhD, Michael Beckett MD, Ronald A. Navarro MD, Anshuman Singh MD, Mark T. Dillon MD, Jeff F. Sodl MD, Edward H. Yian MD

Deep infection after shoulder arthroplasty is a diagnostic and therapeutic challenge. The current literature on this topic is from single institutions or Medicare samples, lacking generalizability to the larger shoulder arthroplasty population.

High-energy Versus Low-energy Extracorporeal Shock Wave Therapy for Calcifying Tendinitis of the Shoulder: Which is Superior? A Meta-analysis

F. U. Verstraelen MD, N. J. H. M. Kleef MD, L. Jansen PhD, J. W. Morrenhof PhD, MD

There are several treatment options for calcifying tendinitis of the shoulder. The next step treatment after conservative treatment fails is still a matter of dispute. Extracorporeal shock wave therapy (ESWT) has been shown to be a good alternative to surgery, but the best treatment intensity remains unknown. High-energy ESWT is much more painful, more expensive, and usually is done in an inpatient setting, whereas low-energy ESWT can be performed in an outpatient setting by a physical therapist.

How Does a Novel Monoplanar Pedicle Screw Perform Biomechanically Relative to Monoaxial and Polyaxial Designs?

Samuel R. Schroerlucke MD, Nikolai Steklov BS, Gregory M. Mundis MD, James F. Marino MD, Behrooz A. Akbarnia MD, Robert K. Eastlack MD

Minimally invasive spinal fusions frequently require placement of pedicle screws through small incisions with limited visualization. Polyaxial pedicle screws are favored due to the difficulty of rod insertion with fixed monoaxial screws. Recently, a novel monoplanar screw became available that is mobile in the coronal plane to ease rod insertion but fixed in the sagittal plane to eliminate head slippage during flexion loads; however, the strength of this screw has not been established relative to other available screw designs.

Is Unilateral Kyphoplasty as Effective and Safe as Bilateral Kyphoplasties for Osteoporotic Vertebral Compression Fractures? A Meta-analysis

Zhaobo Huang MD, Shuanglin Wan MD, Lei Ning MD, Shiliang Han MD

An osteoporotic vertebral compression fracture is a common condition in elderly people, especially women. The percutaneous kyphoplasty is an effective treatment for osteoporotic vertebral compression fractures. Controversy remains regarding whether a unilateral or a bilateral approach is superior, and to our knowledge, there have been no large studies comparing these two approaches, therefore a meta-analysis synthesizing the data on this question is warranted.

Do Inflammatory Markers Portend Heterotopic Ossification and Wound Failure in Combat Wounds?

Jonathan A. Forsberg MD, Benjamin K. Potter MD, Elizabeth M. Polfer MD, Shawn D. Safford MD, Eric A. Elster MD

After a decade of war in Iraq and Afghanistan, we have observed an increase in combat-related injury survival and a paradoxical increase in injury severity, mainly because of the effects of blasts. These severe injuries have a devastating effect on each patient’s immune system resulting in massive upregulation of the systemic inflammatory response. By examining inflammatory mediators, preliminary data suggest that it may be possible to correlate complications such as wound failure and heterotopic ossification (HO) with distinct systemic and local inflammatory profiles, but this is a relatively new topic.

What Factors Influence Applicants’ Rankings of Orthopaedic Surgery Residency Programs in the National Resident Matching Program?

William P. Huntington MD, Nikkole Haines MD, Joshua C. Patt MD, MPH

In accordance with the American Academy of Orthopaedic Surgeons’ strategic goal of enriching our field by building a more diverse orthopaedic workforce, the specialty needs further information delineating the factors important to the applicant pool as a whole and more specifically to women and other underrepresented minority groups.

Surgical Revascularization in Structural Orthotopic Bone Allograft Increases Bone Remodeling

Wouter F. Willems MD, Thomas Kremer MD, Patricia Friedrich AAS, Allen T. Bishop MD

Osseous defects reconstructed with cryopreserved structural allografts are poorly revascularized and therefore are prone to nonunion, infection, deterioration of mechanical properties, and fracture. Whether this can be mitigated by specific interventions such as intramedullary surgical revascularization has been incompletely evaluated.

The Elixhauser Comorbidity Method Outperforms the Charlson Index in Predicting Inpatient Death After Orthopaedic Surgery

Mariano E. Menendez MD, Valentin Neuhaus MD, C. Niek Dijk MD, PhD, David Ring MD, PhD

Scores derived from comorbidities can help with risk adjustment of quality and safety data. The Charlson and Elixhauser comorbidity measures are well-known risk adjustment models, yet the optimal score for orthopaedic patients remains unclear.

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