58 results on '"Robert J, Gillespie"'
Search Results
2. Reliability of the modified Walch classification for advanced glenohumeral osteoarthritis using 3-dimensional computed tomography analysis: a study of the ASES B2 Glenoid Multicenter Research Group
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Anthony Miniaci, Grant E. Garrigues, David M. Dines, Armodios M. Hatzidakis, Patrick J. Denard, Surena Namdari, Brian M. Grawe, Joseph P. Iannotti, Richard J. Friedman, Peter S. Johnston, Bong Jae Jun, Brent J. Morris, T. Bradley Edwards, J. Gabriel Horneff, Edwin E. Spencer, Gerald R. Williams, Andrew Green, Andrew Jawa, James D. Kelly, Young W. Kwon, Robert J. Gillespie, Gregory Strnad, Jason E. Hsu, Yuxuan Jin, Eric T. Ricchetti, Jay D. Keener, Vahid Entezari, and Michael S Khazzam
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Glenoid Cavity ,medicine.medical_treatment ,Computed tomography ,03 medical and health sciences ,0302 clinical medicine ,Osteoarthritis ,Deformity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Reliability (statistics) ,030222 orthopedics ,medicine.diagnostic_test ,Shoulder Joint ,business.industry ,Reproducibility of Results ,030229 sport sciences ,General Medicine ,Arthroplasty ,Confidence interval ,Scapula ,Glenohumeral osteoarthritis ,Surgery ,Glenoid morphology ,medicine.symptom ,Tomography, X-Ray Computed ,Nuclear medicine ,business ,Kappa - Abstract
Background Variations in glenoid morphology affect surgical treatment and outcome of advanced glenohumeral osteoarthritis (OA). The purpose of this study was to assess the inter- and intraobserver reliability of the modified Walch classification using 3-dimensional (3D) computed tomography (CT) imaging in a multicenter research group. Methods Deidentified preoperative CTs of patients with primary glenohumeral OA undergoing anatomic or reverse total shoulder arthroplasty (TSA) were reviewed with 3D imaging software by 23 experienced shoulder surgeons across 19 institutions. CTs were separated into 2 groups for review: group 1 (96 cases involving all modified Walch classification categories evaluated by 12 readers) and group 2 (98 cases involving posterior glenoid deformity categories [B2, B3, C1, C2] evaluated by 11 readers other than the first 12). Each case group was reviewed by the same set of readers 4 different times (with and without the glenoid vault model present), blindly and in random order. Inter- and intraobserver reliabilities were calculated to assess agreement (slight, fair, moderate, substantial, almost perfect) within groups and by modified Walch classification categories. Results Interobserver reliability showed fair to moderate agreement for both groups. Group 1 had a kappa of 0.43 (95% confidence interval [CI]: 0.38, 0.48) with the glenoid vault model absent and 0.41 (95% CI: 0.37, 0.46) with it present. Group 2 had a kappa of 0.38 (95% CI: 0.33, 0.43) with the glenoid vault model absent and 0.37 (95% CI: 0.32, 0.43) with it present. Intraobserver reliability showed substantial agreement for group 1 with (0.63, range 0.47-0.71) and without (0.61, range 0.52-0.69) the glenoid vault model present. For group 2, intraobserver reliability showed moderate agreement with the glenoid vault model absent (0.51, range 0.30-0.72), which improved to substantial agreement with the glenoid vault model present (0.61, range 0.34-0.87). Discussion Inter- and intraobserver reliability of the modified Walch classification were fair to moderate and moderate to substantial, respectively, using standardized 3D CT imaging analysis in a large multicenter study. The findings potentially suggest that cases with a spectrum of posterior glenoid bone loss and/or dysplasia can be harder to distinguish by modified Walch type because of a lack of defined thresholds, and the glenoid vault model may be beneficial in determining Walch type in certain scenarios. The ability to reproducibly separate patients into groups based on preoperative pathology, including Walch type, is important for future studies to accurately evaluate postoperative outcomes in TSA patient cohorts.
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- 2021
3. Subacromial Decompression in Patients With Shoulder Impingement With an Intact Rotator Cuff: An Expert Consensus Statement Using the Modified Delphi Technique Comparing North American to European Shoulder Surgeons
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Francesco Franceschi, Felix ' Buddy' Savoie, Joaquin Sanchez-Sotelo, Robert J. Gillespie, William N. Levine, Knut Beitzel, Kevin Tetsworth, Brian R. Wolf, Kevin P. Shea, Robert T. Burks, Tom C. Ludvigsen, Klaus Bak, George S. Athwal, Andreas B. Imhoff, Vaida Glatt, Emilio Calvo, Michael C. Glanzmann, Marc R. Safran, Robert A. Arciero, Philipp Moroder, Erik Hohmann, Giuseppe Milano, Ofer Levy, Sebastian Siebenlist, Alexandre Lädermann, Peter J. Millett, Berte Bøe, Stephen C. Weber, Paul M. Sethi, Nikhil N. Verma, Jon J.P. Warner, Ben Kibler, Giovanni Di Giacomo, Claudio Rosso, Augustus D. Mazzocca, Eduard Alentorn-Geli, Richard K.N. Ryu, Luc Favard, Jeffrey S. Abrams, and Lennard Funk
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medicine.medical_specialty ,business.industry ,Radiography ,Modified delphi ,Shoulder Impingement ,Delphi method ,Subacromial decompression ,Work-up ,medicine.anatomical_structure ,medicine ,Physical therapy ,Orthopedics and Sports Medicine ,Rotator cuff ,In patient ,business - Abstract
Purpose The purpose of this study was to perform a Delphi consensus for the treatment of patients with shoulder impingement with intact rotator cuff tendons, comparing North American to European shoulder surgeon preferences. Methods Nineteen surgeons from North America [NAP] and 18 surgeons from Europe [EP] agreed to participate and answered 10 open-ended questions in rounds 1 and 2. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. If agreement at round 3 was 60% for an item, the results were carried forward into round 4. For round 4 the panel members outside consensus >60%, Results There was agreement on the following items: impingement is a clinical diagnosis; a combination of clinical tests should be used; other pain generators must be excluded; radiographs must be part of the work up; MR imaging is helpful; the first line of treatment should always be physiotherapy; a corticosteroid injection is helpful in reducing symptoms; indication for surgery is failure of non-operative treatment for a minimum of 6 months. The NAP were likely to routinely prescribe NSAIDs [NA 89%; EU 35%] and consider steroids for impingement [NA 89%. EU 65%]. Conclusion Consensus was achieved for 16 of the 71 Likert items: impingement is a clinical diagnosis and a combination of clinical tests should be used. The first line of treatment should always be physiotherapy, and a corticosteroid injection can be helpful in reducing symptoms. The indication for surgery is failure of non-operative treatment for a minimum of 6 months. The panel also agreed that SAD is a good choice for shoulder impingement if there is evidence of mechanical impingement with pain not responding to non-surgical measures.
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- 2022
4. Immunologic Contributions Following Rotator Cuff Injury and Development of Cuff Tear Arthropathy
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Jensen G. Kolaczko, Charles A Su, Grant B. Nelson, Robert J. Gillespie, Christopher J. McMellen, and Peter J. Millett
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medicine.medical_specialty ,business.industry ,Shoulder Joint ,Rotator cuff injury ,medicine.disease ,Surgery ,Rotator Cuff Injuries ,Rotator Cuff ,medicine.anatomical_structure ,Glenohumeral arthritis ,Humeral Head ,Medicine ,Tears ,Animals ,Humans ,Orthopedics and Sports Medicine ,Rotator cuff ,sense organs ,Rotator Cuff Tear Arthropathy ,Cuff Tear Arthropathy ,business ,Cartilage damage ,Muscle fibrosis ,Greater Tuberosity - Abstract
» Rotator cuff tear arthropathy (RCTA) describes a pattern of glenohumeral degenerative changes following chronic rotator cuff tears that is characterized by superior humeral head migration, erosion of the greater tuberosity of the humeral head, contouring of the coracoacromial arch to create a socket for the humeral head, and eventual glenohumeral arthritis. » Acute and chronic inflammatory changes following rotator cuff tears are thought to contribute to cartilage damage, muscle fibrosis, and fatty infiltration in the glenohumeral joint. » In vitro animal studies targeting various inflammatory modulators, including macrophages, insulin-like growth factor-I, and transforming growth factor-beta pathways, provide promising therapeutic targets to improve healing after rotator cuff tears. » The role of platelet-rich plasma in the treatment and prevention of RCTA has been investigated, with conflicting results.
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- 2021
5. Clinical Outcomes of the Traditional Latarjet Versus the Congruent Arc Modification for the Treatment of Recurrent Anterior Shoulder Instability: A Meta-analysis
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Sunita Mengers, Derrick M. Knapik, Michael R. Karns, Matthew W Kaufman, James E. Voos, Gary Edwards, and Robert J. Gillespie
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Orthodontics ,business.industry ,shoulder instability ,Anterior shoulder ,Latarjet procedure ,Instability ,Article ,congruent arc ,Arc (geometry) ,Meta-analysis ,Shoulder instability ,Medicine ,Orthopedics and Sports Medicine ,business ,traditional Latarjet - Abstract
Background: Few studies have compared clinical outcomes between the traditional Latarjet procedure for anterior shoulder instability and the congruent arc modification to the Latarjet procedure. Purpose: To systematically evaluate the literature for the incidence of recurrent instability, clinical outcomes, radiographic findings, and complications for the traditional Latarjet procedure and the congruent arc modification and to compare results of each search. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review and meta-analysis was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies published between January 1990 and October 2020 that described clinical outcomes of the traditional Latarjet and the congruent arc modification with a follow-up range of 2 to 10 years. The difference in surgical technique was analyzed using a chi-square test for categorical variables, while continuous variables were evaluated using a Student t test. Results: In total, 26 studies met the inclusion criteria: 20 studies describing the traditional Latarjet procedure in 1412 shoulders, and 6 studies describing the congruent arc modification in 289 shoulders. No difference between procedures was found regarding patient age at surgery, follow-up time, Rowe or postoperative visual analog scores, early or late complications, return-to-sport timing, or incidence of improper graft placement or graft fracture. A significantly greater proportion of male patients underwent glenoid augmentation using the congruent arc modification versus traditional Latarjet ( P < .001). When comparing outcomes, the traditional Latarjet procedure demonstrated a lower incidence of fibrous union or nonunion ( P = .047) and broken, loose, or improperly placed screws ( P < .001), and the congruent arc modification demonstrated improved outcomes with regard to overall return to sport ( P < .001), return to sport at the same level ( P < .001), incidence of subluxation ( P = .003) or positive apprehension ( P = .002), and revision surgery for recurrent instability ( P = .027). Conclusion: Outcomes after the congruent arc modification proved at least equivalent to the traditional Latarjet procedure in terms of recurrent instability and return to sport, although early and late complications were equivalent. The congruent arc procedure may be an acceptable alternative to traditional Latarjet for the treatment of anterior shoulder instability with glenoid bone loss; however, long-term outcomes of this procedure are needed.
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- 2021
6. Effects of opioid-limiting legislation on postoperative opioid use in shoulder arthroplasty in an epidemic epicenter
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Elisabeth Kroneberger, Nikunj N. Trivedi, Jiao Yu, John Strony, Robert J. Gillespie, James E. Voos, Yazdan Raji, and Jacob G. Calcei
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medicine.medical_specialty ,Narcotic ,medicine.medical_treatment ,Legislation ,medicine ,Humans ,Orthopedics and Sports Medicine ,Dosing ,Postoperative Period ,Medical prescription ,Practice Patterns, Physicians' ,Retrospective Studies ,Pain, Postoperative ,business.industry ,Opioid use ,Public health ,General Medicine ,Drug Tolerance ,Arthroplasty ,United States ,Analgesics, Opioid ,Opioid ,Arthroplasty, Replacement, Shoulder ,Anesthesia ,Surgery ,business ,medicine.drug - Abstract
The current opioid epidemic in the United States has become a public health crisis with an estimated 150 daily deaths and nearly 47,000 opioid-related deaths in the United States in 2017 alone. Sensible prescriber practice changes have been a focus of policymakers to decrease the total number of narcotic pain medications in circulation. In the state of Ohio, opioid prescription limits for acute pain were enacted in August 2017. However, given the association of acute opioid exposure with long-term use and lack of assessment of these policies, there is an unmet need to evaluate the effects of similar legislation in Ohio on postoperative opioid dosing after shoulder arthroplasty. This study evaluates the effects of opioid prescription-limiting legislation in Ohio on postoperative opioid dosing in shoulder arthroplasty and assesses risk factors related to long-term opioid use.All patients undergoing primary and revision shoulder arthroplasty over a 5-year period performed by a single surgeon were included. The pre-legislation (PRE) and post-legislation (POST) groups were defined as patients undergoing shoulder arthroplasty before August 31, 2017 and on or after August 31, 2017, respectively. The Ohio Automated Rx Reporting System was queried for controlled-substance prescriptions from 30 days preoperatively to 90 days postoperatively. Patients were designated as opioid tolerant if they had filled an opioid prescription within 30 days of surgery. A binary logistic regression analysis was applied to assess factors related to long-term opioid use.A total of 334 patients were categorized into 2 cohorts: PRE (n = 99) and POST (n = 235). Accounting for legislative effects, we observed significant reductions in cumulative morphine milligram equivalent (MME) dosing in the opioid-naive patients in the 7-day and 30-day postoperative periods (450.0 MMEs in PRE group vs. 210.0 MMEs in POST group, P.001) and in the opioid-tolerant patients in the 7-day postoperative period (450.0 MMEs in PRE group vs. 250.0 MMEs in POST group, P = .001). Among the opioid-naive patients, the POST group had a significant MME reduction in the 90-day postoperative period relative to the PRE cohort (P.001). Preoperative opioid tolerance and benzodiazepine tolerance were independent risk factors for increased MME dosing at 90 days postoperatively (P.001 and P = .02, respectively).Opioid prescription-limiting legislation for acute pain in the state of Ohio is associated with a notable reduction in opioid MME dosing in the 90-day postoperative period after shoulder arthroplasty, particularly in opioid-naive patients in the first 30 days postoperatively. Preoperative opioid tolerance is correlated with significantly higher MME dosing postoperatively after shoulder arthroplasty.
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- 2021
7. Woven collagen biotextiles enable mechanically functional rotator cuff tendon regeneration during repair of segmental tendon defects in vivo
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James M. Anderson, Ozan Akkus, Derrick M. Knapik, Greg D. Learn, Victoria A. Webster-Wood, Robert J. Gillespie, Jameson Cumsky, and Phillip McClellan
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Scaffold ,Pathology ,medicine.medical_specialty ,Materials science ,Biomedical Engineering ,02 engineering and technology ,Article ,Rotator Cuff Injuries ,Biomaterials ,Rotator Cuff ,03 medical and health sciences ,0302 clinical medicine ,Tissue engineering ,Materials Testing ,medicine ,Animals ,Regeneration ,Rotator cuff ,030222 orthopedics ,Tissue Scaffolds ,Textiles ,Regeneration (biology) ,Mesenchymal stem cell ,Mesenchymal Stem Cells ,021001 nanoscience & nanotechnology ,Tenomodulin ,Tendon ,medicine.anatomical_structure ,Biotextile ,Collagen ,Rabbits ,0210 nano-technology - Abstract
Despite advancements in surgical techniques and materials for rotator cuff repair procedures, primary repair failures remain common. This study examines the use of electrochemically aligned collagen (ELAC) threads woven into biotextile scaffolds as grafts to repair critical infraspinatus tendon defects in New Zealand White rabbits. Three surgical treatment groups were evaluated: rabbits undergoing direct repair as operative controls, rabbits receiving ELAC scaffolds alone, and rabbits treated with mesenchymal stem cell (MSC)-seeded ELAC scaffolds. In each animal, the intact, contralateral infraspinatus served as an internal positive control. Tendon-bone constructs were harvested after 3 months in vivo and outcome measures included biomechanical testing, histological staining, and immunohistochemical staining. Biomechanical testing revealed that maximum load-bearing capacity was comparable between all groups, while MSC-seeded scaffold repairs exhibited increased stiffness relative to non-seeded scaffold repairs. Histological staining revealed robust collagen deposition around ELAC fibers and increased cellularity within the continuum of woven scaffolds as compared to native tendon. Immunohistochemical staining revealed presence of collagens I and III in all groups, but procollagen I and the tendon-specific marker tenomodulin were only observed in seeded and non-seeded ELAC scaffold repairs. Findings of this pilot study warrant continued investigation of ELAC biotextile scaffolds for repair of critically-sized rotator cuff tendon defects. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 1864-1876, 2019.
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- 2018
8. Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Controlled Study
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Lakshmanan Sivasundaram, Brian N. Victoroff, Michael J. Salata, Robert J Gillespie, Nikunj N. Trivedi, Michael R. Karns, John Strony, James E. Voos, and Sunita Mengers
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Adult ,Male ,Gastrointestinal bleeding ,Narcotic ,medicine.medical_treatment ,Analgesic ,law.invention ,Rotator Cuff Injuries ,03 medical and health sciences ,Arthroscopy ,Rotator Cuff ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Humans ,Orthopedics and Sports Medicine ,Rotator cuff ,Prospective Studies ,Adverse effect ,Aged ,030222 orthopedics ,Pain, Postoperative ,business.industry ,030229 sport sciences ,Middle Aged ,medicine.disease ,Ketorolac ,medicine.anatomical_structure ,Treatment Outcome ,Anesthesia ,Cuff ,Surgery ,business ,medicine.drug - Abstract
BACKGROUND Arthroscopic rotator cuff repair (RCR) is associated with substantial postoperative pain. Oral narcotic agents are the preferred analgesic postoperatively. However, these agents are associated with several side effects and a potential for abuse. This study evaluates the efficacy of ketorolac as an adjunctive agent for postoperative pain control after arthroscopic RCR. METHODS Adult patients undergoing arthroscopic RCR were prospectively enrolled and randomized to one of two groups. The control received our institution's standard-of-care pain protocol, including oxycodone-acetaminophen 5 to 325 mg on discharge. The ketorolac group received the standard-of-care protocol, intravenous ketorolac at the completion of the procedure, and oral ketorolac on discharge. Pain and functional outcome scores and narcotic utilization were recorded three times per day for the first 5 days after surgery. Repeat magnetic resonance imaging was done at least 6 months postoperatively. RESULTS In our study, 39 patients were included for final analysis; the mean age of the cohort was 55.7 ± 10.6 years, and 66.7% of patients were male. No differences were observed in preoperative demographics, comorbidities, cuff tear morphology, and functional scores between the two groups. Over the first 5 days after surgery, patients in the ketorolac group consumed a mean of 10.6 fewer narcotic pills, a consumption reduction of 54.6% (19.42 versus 8.82, P < 0.001). No difference was observed in functional outcome scores at up to 6 weeks postoperatively between the two groups. No difference was observed in adverse events between the two groups with no reported cases of gastritis or gastrointestinal bleeding. Twenty-two of 39 patients underwent repeat magnetic resonance imaging at a mean of 7.9 months postoperatively, of which 5 (22%) demonstrated a retear of their rotator cuff. No significant difference was observed between the ketorolac and control groups in the rate of retear (P = 1.00). DISCUSSION Adjunctive ketorolac substantially reduces narcotic utilization after arthroscopic RCR.
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- 2020
9. Comparison Study of Patient Demographics, Causes, Costs, and Risk-Factors Associated with Ninety-Day Readmissions Following Primary Reverse Shoulder Arthroplasty
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Ajit M. Vakharia, Jason Ina, Robert J Gillespie, Nikunj N. Trivedi, and Lakshmanan Sivasundaram
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Patient demographics ,Emergency medicine ,medicine ,Comparison study ,Orthopedics and Sports Medicine ,Surgery ,Reverse shoulder ,General Medicine ,business ,Arthroplasty - Published
- 2021
10. Advances in Glenoid Design in Anatomic Total Shoulder Arthroplasty
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Robert J. Gillespie, Jilan L Shimberg, Sunita Mengers, Nikunj N. Trivedi, Lakshmanan Sivasundaram, James E. Voos, and Michael J. Salata
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medicine.medical_specialty ,Glenoid Cavity ,business.industry ,Shoulder Joint ,medicine.medical_treatment ,MEDLINE ,Shoulder Prosthesis ,General Medicine ,Prosthesis Design ,Arthroplasty ,Surgery ,Arthroplasty, Replacement, Shoulder ,Medicine ,Humans ,Orthopedics and Sports Medicine ,business - Published
- 2020
11. Opioid-prescribing patterns among shoulder and elbow surgeons: considerations for future prescription guidelines
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James E. Voos, Jessica L. Janes, Sunita Mengers, Yazdan Raji, Alexander J. Acuña, Robert J. Gillespie, and Michael R. Karns
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medicine.medical_specialty ,Shoulder ,Narcotic ,medicine.medical_treatment ,Elbow ,Drug Prescriptions ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Oxycodone hydrochloride ,Humans ,Orthopedics and Sports Medicine ,Medical prescription ,Practice Patterns, Physicians' ,Surgeons ,030222 orthopedics ,Pain, Postoperative ,business.industry ,030229 sport sciences ,General Medicine ,United States ,Acetaminophen ,Analgesics, Opioid ,medicine.anatomical_structure ,Opioid ,Family medicine ,Orthopedic surgery ,Surgery ,business ,Orthopedic Procedures ,medicine.drug - Abstract
Background Although the achievement of adequate analgesia is critical to patient comfort and recovery following orthopedic procedures, no standard protocol exists to dictate the appropriate duration and quantity of narcotic prescription in the postoperative period. Therefore, the purpose of this survey was to determine patterns of opioid prescribing among orthopedic shoulder and elbow providers. Methods In March 2020, a survey was distributed through a LISTSERV to 989 members of the American Shoulder and Elbow Surgeons orthopedic society. Survey recipients were asked to describe their personal and practice characteristics. Additionally, they were asked to list their 3 most commonly performed procedures and, for each operation, to list which narcotic pain medication they most commonly prescribe postoperatively, along with the corresponding number of tablets typically given. Similarly, respondents were asked to record frequently recommended alternative strategies for postoperative pain control, factors influencing the respondents’ prescribing practices, and methods of patient counseling regarding opioid use and disposal. Results A total of 177 providers responded to the survey. Across all selected procedures, Percocet (5 mg of oxycodone hydrochloride and 325 mg of acetaminophen) was the most commonly prescribed drug, with 21-30 tablets being the most commonly prescribed amount. The majority of surgeons (82%) indicated that previous opioid prescriptions influence their decision to prescribe opioids. Respondents most frequently reported patient age (48%) and duration of the patient’s symptoms (32%) as additional influential factors. Most surgeons (93%) reported counseling their patients regarding the use of opioid medications. However, only 30% of surgeons reported providing information regarding how to dispose of unused opioids. In lieu of opioids, nearly all investigators reported the use of ice as a pain-relief strategy, with rest and the use of nonsteroidal anti-inflammatory drugs reported as other commonly recommended alternatives. Of 137 respondents who were aware of prescription guidelines, 21% reported using recommendations from the American Academy of Orthopaedic Surgeons, 21% used institutional policies, and 20% used personal guidelines, whereas the remaining respondents used other literature findings in their prescription decisions. Of particular concern, 21% of overall respondents were unaware of any type of guidelines. Discussion To prevent both misuse and abuse of opioid prescribing, this analysis serves as a starting point for the establishment of more consistent, evidence-based opioid prescription guidelines for surgical procedures on the shoulder and elbow. In addition to recommending safe, procedure-specific opioid dosages and standardizing pain management strategies, these guidelines should include effective methods of educating both providers and patients regarding the use of opioid medication.
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- 2020
12. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative
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Kathryn Janies, Laura DeStigter, Darcy Steinberg, Kori B. Flower, Jennifer Zubler, Tumaini R. Coker, Marian F. Earls, Robert J. Gillespie, Toni M. Whitaker, Sara Massie, Jane Bassewitz, and Michelle M. Macias
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Male ,medicine.medical_specialty ,Quality management ,Primary Health Care ,Referral ,business.industry ,MEDLINE ,medicine.disease ,Quality Improvement ,Resource (project management) ,Autism spectrum disorder ,Child, Preschool ,Surveys and Questionnaires ,Family medicine ,Pediatrics, Perinatology and Child Health ,Community health ,medicine ,Humans ,Mass Screening ,Female ,Social determinants of health ,Early childhood ,business ,Intersectoral Collaboration - Abstract
OBJECTIVES: Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
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- 2020
13. Evaluating the role of graft integrity on outcomes: clinical and imaging results following superior capsular reconstruction
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Robert J. Gillespie, Matthew R. Peck, John Strony, Sunita Mengers, Mark W. LaBelle, Michael J. Salata, Sean A. Cupp, Eric M. Parsons, and Robert Flannery
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medicine.medical_specialty ,Shoulders ,Visual analogue scale ,Radiography ,Elbow ,Biceps ,Rotator Cuff Injuries ,03 medical and health sciences ,Arthroscopy ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Rotator cuff ,Range of Motion, Articular ,Retrospective Studies ,030222 orthopedics ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,030229 sport sciences ,General Medicine ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Tears ,business - Abstract
Background Superior capsular reconstruction (SCR) addresses massive, irreparable rotator cuff tears in young patients. The purpose of this study was to retrospectively evaluate clinical outcomes and graft integrity in patients following SCR. Methods Thirty-four consecutive patients undergoing SCR by 2 surgeons with minimum 2-year follow-up were identified. Functional outcomes were obtained, including Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), visual analog scale (VAS), and Single Assessment Numeric Evaluation (SANE) scores. Graft integrity was evaluated on magnetic resonance images (MRIs). Results Thirty-five shoulders in 34 patients were identified. Four patients underwent subsequent surgery. The mean preoperative scores were SST 21.6 ± 17.6, ASES 28.3 ± 10.1, SANE 50.6 ± 22.1, and VAS 6.6 ± 1.7. The mean postoperative outcomes were SST 79.1 ± 19.6, ASES 79.9 ± 17.4, SANE 74.3 ± 18.7, and VAS 1.5 ± 2.2. There was statistically significant improvement in SST, ASES, and VAS following SCR. MRI revealed graft failure in 62% (n = 13 of 21) of shoulders. Radiographic evidence of graft healing did not have any effect on SST, ASES, SANE, or VAS scores. Conclusion Given the high rate of graft failure without a significant difference in clinical outcomes, graft healing after SCR might not be an independent predictor of success. The improved clinical improvement in patients undergoing SCR may be due to other known beneficial aspects of the procedure, including partial rotator cuff repair, debridement, and biceps management.
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- 2020
14. Volumetric MicroCT Intensity Histograms of Fatty Infiltration Correlate with the Mechanical Strength of Rotator Cuff Repairs: An Ex Vivo Rabbit Model
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Derrick M. Knapik, Phillip E McClellan, Robert J. Gillespie, Ozan Akkus, Lekha Kesavan, Jason Ina, Yujing Wen, and Victoria A. Webster-Wood
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Rotator Cuff Injuries ,Correlation ,03 medical and health sciences ,symbols.namesake ,0302 clinical medicine ,Imaging, Three-Dimensional ,Histogram ,medicine ,Animals ,Orthopedics and Sports Medicine ,Rotator cuff ,Clinical significance ,030212 general & internal medicine ,030222 orthopedics ,business.industry ,General Medicine ,X-Ray Microtomography ,Pearson product-moment correlation coefficient ,Intensity (physics) ,Tendon ,medicine.anatomical_structure ,Basic Research ,Adipose Tissue ,symbols ,Surgery ,Female ,Rabbits ,business ,Ex vivo ,Biomedical engineering - Abstract
BACKGROUND: Fatty infiltration of the rotator cuff occurs after injury to the tendon and results in a buildup of adipose in the muscle. Fatty infiltration may be a biomarker for predicting future injuries and mechanical properties after tendon repair. As such, quantifying fatty infiltration accurately could be a relevant metric for determining the success of tendon repairs. Currently, fatty infiltration is quantified by an experienced observer using the Goutallier or Fuchs staging system, but because such score-based quantification systems rely on subjective assessments, newer techniques using semiautomated analyses in CT and MRI were developed and have met with varying degrees of success. However, semiautomated analyses of CT and MRI results remain limited in cases where only a few two-dimensional slices of tissue are examined and applied to the three-dimensional (3-D) tissue structure. We propose that it is feasible to assess fatty infiltration within the 3-D volume of muscle and tendon in a semiautomated fashion by selecting anatomic features and examining descriptive metrics of intensity histograms collected from a cylinder placed within the central volume of the muscle and tendon of interest. QUESTIONS/PURPOSES: (1) Do descriptive metrics (mean and SD) of intensity histograms from microCT images correlate with the percentage of fat present in muscle after rotator cuff repair? (2) Do descriptive metrics of intensity histograms correlate with the maximum load during mechanical testing of rotator cuff repairs? METHODS: We developed a custom semiautomated program to generate intensity histograms based on user-selected anatomic features. MicroCT images were obtained from 12 adult female New Zealand White rabbits (age 8 to 12 months, weight 3.7 kg ± 5 kg) that were randomized to surgical repair or sham repair of an induced infraspinatus defect. Intensity histograms were generated from images of the operative and contralateral intact shoulder in these rabbits which were presented to the user in a random order without identifying information to minimize sources of bias. The mean and SD of the intensity histograms were calculated and compared with the total percentage of the volume threshold as fat. Patterns of fat identified were qualitatively compared with histologic samples to confirm that thresholding was detecting fat. We conducted monotonic tensile strength-to-failure tests of the humeral-infraspinatus bone-tendon-muscle complex, and evaluated associations between histogram mean and SDs and maximum load. RESULTS: The total percentage of fat was negatively correlated with the intensity histogram mean (Pearson correlation coefficient -0.92; p < 0.001) and positively with intensity histogram SD (Pearson correlation coefficient 0.88; p < 0.001), suggesting that the increase in fat leads to a reduction and wider variability in volumetric tissue density. The percentage of fat content was also negatively correlated with the maximum load during mechanical testing (Pearson correlation coefficient -78; p = 0.001), indicating that as the percentage of fat in the volume increases, the mechanical strength of the repair decreases. Furthermore, the intensity histogram mean was positively correlated with maximum load (Pearson correlation coefficient 0.77; p = 0.001) and histogram SD was negatively correlated with maximum load (Pearson correlation coefficient -0.72; p = 0.004). These correlations were strengthened by normalizing maximum load to account for animal size (Pearson correlation coefficient 0.86 and -0.9, respectively), indicating that as histogram mean decreases, the maximum load of the repair decreases and as histogram spread increases, the maximum load decreases. CONCLUSION: In this ex vivo rabbit model, a semiautomated approach to quantifying fat on microCT images was a noninvasive way of quantifying fatty infiltration associated with the strength of tendon healing. CLINICAL RELEVANCE: Histogram-derived variables may be useful as surrogate measures of repair strength after rotator cuff repair. The preclinical results presented here provide a foundation for future studies to translate this technique to patient studies and additional imaging modalities. This semiautomated method provides an accessible approach to quantification of fatty infiltration by users of varying experience and can be easily adapted to any intensity-based imaging approach. To translate this approach to clinical practice, this technique should be calibrated for MRI or conventional CT imaging and applied to patient scans. Further investigations are needed to assess the correlation of volumetric intensity histogram descriptive metrics to clinical mechanical outcomes.
- Published
- 2020
15. Complications and Return to Activity After Arthroscopic Repair of Isolated Type II SLAP Lesions: A Systematic Review Comparing Knotted Versus Knotless Suture Anchors
- Author
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Derrick M. Knapik, Robert J. Gillespie, Michael J. Salata, James E. Voos, and Jensen G. Kolaczko
- Subjects
Labrum ,medicine.medical_specialty ,labrum ,arthroscopic surgery ,tear ,business.industry ,anchor ,shoulder ,Return to activity ,Biceps ,Article ,Surgery ,repair ,Tears ,Medicine ,Orthopedics and Sports Medicine ,business ,biceps ,Suture anchors - Abstract
Background: Superior labral anterior to posterior (SLAP) tears are one of the most common injuries to the shoulder, with the type II variant representing the most frequently encountered subtype. Purpose: To systematically review the literature to better understand outcomes after arthroscopic repair of isolated type II SLAP lesions using knotted versus knotless anchors based on implant number, implant location, patient position, and portal position. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review investigating all studies in the literature between January 2000 and June 2019 reporting on patients undergoing arthroscopic repair for isolated type II SLAP lesions using knotted versus knotless suture anchors was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the PubMed, BIOSIS Previews, SPORTDiscus, PEDro, and Embase databases. Results: A total of 234 patients undergoing isolated arthroscopic repair of type II SLAP lesions using suture anchors were identified, with 76% (179/234) treated using knotted anchors versus 24% (55/234) treated using knotless anchors. Complications were reported in 12% of patients treated using knotted anchors versus no patients treated using knotless anchors ( P = .008). The incidence of complications for knotted anchor repair was not significantly affected by patient position ( P = .22) or portal position ( P = .19). Using multiple regression analysis, we found no significant association with the incidence of complications when analyzing for anchor design ( R 2 = 0.02; P = .06) or anchor position ( R 2 = 0.02; P = .92). No significant difference in return-to-activity timing was appreciated based on anchor type ( P = .28), patient position ( P = .98), or portal position ( P = .97) in patients treated using knotted anchors. Conclusion: Patients treated using knotted anchors were significantly more likely to experience a postoperative complication compared with patients treated using knotless anchors after arthroscopic repair of isolated type II SLAP lesions. Despite the increased incidence of a postoperative complication after knotted anchor fixation compared with knotless anchor fixation, multiple regression analysis showed that anchor design and anchor position were not significantly predictive of the incidence of complications. Given the increasing popularity of knotless anchor fixation, further study on the long-term outcomes after knotless repair for isolated type II SLAP lesions is warranted.
- Published
- 2020
16. Investigating the International Normalized Ratio Thresholds for Complication in Shoulder Arthroplasty
- Author
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Nikunj N. Trivedi, James E. Voos, Sunita Mengers, Lakshmanan Sivasundaram, Adrienne Lee, Jerry Y. Du, Robert J Gillespie, Yazdan Raji, and Michael R. Karns
- Subjects
endocrine system ,medicine.medical_specialty ,medicine.medical_treatment ,Arthroplasty, Replacement, Hip ,03 medical and health sciences ,0302 clinical medicine ,health services administration ,medicine ,Humans ,heterocyclic compounds ,Orthopedics and Sports Medicine ,In patient ,cardiovascular diseases ,Significant risk ,International Normalized Ratio ,Elective surgery ,Arthroplasty, Replacement, Knee ,Aged ,Retrospective Studies ,030222 orthopedics ,business.industry ,fungi ,030229 sport sciences ,Perioperative ,Arthroplasty ,Surgery ,Increased risk ,Arthroplasty, Replacement, Shoulder ,Cohort ,Female ,Warfarin ,business ,Complication - Abstract
BACKGROUND In patients on warfarin anticoagulation therapy, elective shoulder arthroplasty surgeons must carefully balance bleeding and embolic risks. Currently, an international normalized ratio (INR) threshold of 1.5 is supported in the setting of elective surgery. However, no previous study has investigated the optimal preoperative INR target specifically in shoulder arthroplasty. The purpose of this study was to evaluate the association of preoperative INR with rates of transfusion, complication, and readmission/revision surgery in shoulder arthroplasty. METHODS Patients who underwent elective shoulder arthroplasty were identified in a national database. The primary outcome of interest was the risk for all-cause complication at 30 days postoperatively. Major and minor complication, revision surgery, and readmission rates were also investigated. RESULTS From 2006 to 2016, 1,014 procedures were identified who had undergone elective shoulder arthroplasty with a perioperative INR lab result within 24 hours of surgery. In our cohort, 550 patients (54.2%) were women, with an average age of 71.0 ± 9.8 years. After controlling for confounders, patients with a preoperative INR > 1.5 were 18.9 times as likely to have a major complication as those with a preoperative INR ≤ 1.0 (P = 0.003). Patients with an INR of 1.25 < INR ≤ 1.5 did not have a statistically significant risk of minor or major complication in comparison with those with an INR ≤ 1.0 (P = 0.23, P = 0.67). DISCUSSION Although recent hip and knee arthroplasty literature has found that an INR < 1.25 may be an optimal preoperative INR goal, our results did not find an increased risk for bleeding and complication with an INR ≤ 1.5 for shoulder arthroplasty. These results support current guidelines recommending a preoperative INR ≤ 1.5 for shoulder arthroplasty.
- Published
- 2020
17. Operationalizing SDoH Into a Broader Screening Context
- Author
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Robert J. Gillespie
- Subjects
Operationalization ,business.industry ,education ,Social environment ,Context (language use) ,Child health ,Developmental psychology ,03 medical and health sciences ,0302 clinical medicine ,030225 pediatrics ,Pediatrics, Perinatology and Child Health ,Health care ,Medicine ,Social determinants of health ,business ,Adverse Childhood Experiences - Abstract
Sokol et al1 have provided an excellent review of the current state of existing screeners for social determinants of health (SDoH). We have previously published on the correlations of parental Adverse Childhood Experiences (ACEs) and child developmental screening results,2 which illustrates an example of the inextricable links between factors in the social milieu and child health outcomes. It is believed that social determinants also create real-world barriers to families engaging in necessary services within the health care system. Given the … E-mail: rgillespie{at}childrens-clinic.com
- Published
- 2020
18. Differences in Coracoid and Glenoid Dimensions Based on Sex, Race, and Age: Implications for Use of the Latarjet Technique in Glenoid Reconstruction
- Author
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Joseph E. Tanenbaum, Derrick M. Knapik, James E. Voos, Robert J. Gillespie, and Jameson Cumsky
- Subjects
musculoskeletal diseases ,Orthodontics ,030222 orthopedics ,medicine.medical_specialty ,business.industry ,Modified technique ,030229 sport sciences ,Latarjet procedure ,musculoskeletal system ,Time of death ,Coracoid ,03 medical and health sciences ,0302 clinical medicine ,Cadaver ,Orthopedic surgery ,Medicine ,Original Article ,Orthopedics and Sports Medicine ,Surgery ,Statistical analysis ,business ,Cadaveric spasm - Abstract
BACKGROUND: The Latarjet procedure restores shoulder stability through reconstruction of the glenoid arc. Prior investigations of glenoid and coracoid dimensions have been underpowered to detect differences based on sex and race. QUESTIONS/PURPOSES: We sought to establish normative values for glenoid width and coracoid dimensions based on sex, race, and age. In addition, we assessed the restoration of glenoid dimensions using the classic and modified Latarjet techniques (classic technique: placing lateral surface of the coracoid to the glenoid; modified technique: placing inferior surface of the coracoid to the glenoid). METHODS: A total of 993 cadaveric specimens (n = 1986 scapulae) from people over 18 years of age at the time of death were analyzed. Measurements of maximal glenoid width, coracoid width, thickness, and length were recorded. Statistical analysis was performed to detect differences based on sex and race, while univariable linear regression was used to determine the association of increasing age on measured dimensions. RESULTS: All dimensions of specimens were significantly larger in males than in females. Caucasians possessed larger mean glenoid width, coracoid width, and coracoid length, while coracoid thickness was significantly larger in African Americans. Linear regression analysis found that increasing age was associated with increased glenoid width and coracoid dimensions. Coracoid positioning restored glenoid width in defects measuring 20% of glenoid width using both classic and modified Latarjet techniques, while defects measuring up to 25% were more accurately reproduced using the modified technique. CONCLUSION: Dimensions were significantly larger in males and in Caucasians, aside from coracoid thickness. Mean dimensions increased with advancing age. Coracoid positioning using classic or modified Latarjet techniques restored glenoid width defects measuring 20% of the glenoid width, while the modified technique allowed for restoration of larger defects. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11420-018-9618-4) contains supplementary material, which is available to authorized users.
- Published
- 2018
19. Oral Ketorolac as an Adjuvant Agent for Postoperative Pain Control following Arthroscopic Rotator Cuff Repair: A Prospective, Randomized, Controlled Study. (113)
- Author
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Nikunj N. Trivedi, Brian N. Victoroff, Joseph E. Tanenbaum, Michael R. Karns, Michael J. Salata, Robert J Gillespie, Sunita Mengers, James E. Voos, Lakshmanan Sivasundaram, and John Strony
- Subjects
medicine.medical_specialty ,business.industry ,Narcotic ,Postoperative pain ,medicine.medical_treatment ,Analgesic ,Article ,Surgery ,law.invention ,Ketorolac ,medicine.anatomical_structure ,Randomized controlled trial ,law ,medicine ,Orthopedics and Sports Medicine ,Rotator cuff ,business ,Adjuvant ,medicine.drug - Abstract
Objectives: Arthroscopic rotator cuff repairs are associated with substantial postoperative pain. Traditionally, oral narcotic agents have been the preferred analgesic postoperatively in orthopaedic surgery. However, these agents are associated with several side effects and a significant potential for abuse. This study evaluates the efficacy of ketorolac, a non-steroidal anti-inflammatory drug with analgesic properties, as an adjunctive agent for postoperative pain control following arthroscopic rotator cuff repair. Methods: Adult patients undergoing an arthroscopic rotator cuff repair were prospectively enrolled. Patients who met inclusion and exclusion criteria were randomized into one of two groups. The control group received our standard of care pain protocol, including oxycodone-acetaminophen 5-325 on discharge. Patients in the ketorolac group additionally received a dose of IV ketorolac intraoperatively and were prescribed a scheduled dose of oral ketorolac (10mg by mouth every six hours for three days) along with omeprazole (20mg by mouth every day for three days) for acid reflux. Visual Analogue Scale (VAS), functional outcome scores, and total narcotic utilization were recorded three times per day for the first five days after surgery. Statistically significant differences in patient demographics and comorbidities between groups were determined initially with univariate analysis. Linear mixed-effect models were then fitted for each outcome variable to evaluate the main effects of treatment group and follow-up times. Results: In our study, 39 patients were included for final analysis; the mean age of the cohort was 55.7±10.6 years and 66.7% of patients were male. There were no differences in preoperative demographics, comorbidities, cuff tear morphology, and functional scores between the two groups. (Table 1) Patients in the Ketorolac group had lower mean VAS scores and opioid utilization at all time points. (Figure 1, 2) On multivariate analysis that controls for confounding variables, patients in the ketorolac group had a mean 9.67 decrease in VAS scores in comparison to the control group, though these results were not statistically or clinically significant (Coefficient estimate= -9.67, 95% CI -25.13-5.79, p=.2202; MCID 13). (Table 3) Patients in the ketorolac group utilized significantly less narcotics, with a mean of 0.7 fewer pills of oxycodone-acetaminophen per time interval in comparison to the control group (Coefficient estimate=-0.70, 95% CI -1.005 -0.389, pConclusions: In this prospective, randomized, controlled study, the use of adjunctive intravenous and short-term oral ketorolac substantially reduced narcotic utilization following arthroscopic rotator cuff repair.
- Published
- 2021
20. Feasibility of Assessing Parental ACEs in Pediatric Primary Care: Implications for Practice-Based Implementation
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Alonzo T. Folger and Robert J. Gillespie
- Subjects
medicine.medical_specialty ,Social work ,business.industry ,Public health ,media_common.quotation_subject ,Context (language use) ,Resistance (psychoanalysis) ,Primary care ,Critical Care and Intensive Care Medicine ,Qualitative survey ,Pediatric clinic ,03 medical and health sciences ,0302 clinical medicine ,Nursing ,030225 pediatrics ,Emergency Medicine ,medicine ,030212 general & internal medicine ,Psychological resilience ,business ,media_common - Abstract
To determine the feasibility and provider acceptability of implementing assessments for parental ACEs within the context of an outpatient pediatric clinic, and to compare parental ACE detection rates between an item-level response tool and an aggregate-level response tool. A convenience sample of parents completed one of two assessment tools during their child’s four month well visit. Detection of ACE scores ≥4 was compared between the two tools. Providers conducting the assessments completed a qualitative survey describing their experiences. Detection rates were significantly higher with the use of an aggregate-level reporting tool compared to item-level tool (11.2% versus 8.1%, p = 0.013). Provider feedback on the assessment process was positive; providers reported improved clinic visits without undue burden in terms of time constraints or parental resistance to ACE assessments. Implementing parental ACE assessments is feasible with limited resources in an outpatient setting. Providers and parents appear receptive to the conversations about past trauma, and find value in including this information in their counseling during well visits. Parents appear to be more likely to disclose ACEs when a degree of privacy is given through aggregate-level versus item-level reporting.
- Published
- 2017
21. Screening for Adverse Childhood Experiences in Pediatric Primary Care: Pitfalls and Possibilities
- Author
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Robert J Gillespie
- Subjects
Parents ,Stress Disorders, Traumatic ,medicine.medical_specialty ,MEDLINE ,Historical Trauma ,Primary care ,Pediatrics ,03 medical and health sciences ,0302 clinical medicine ,Adverse Childhood Experiences ,Professional-Family Relations ,030225 pediatrics ,Humans ,Medicine ,030212 general & internal medicine ,Child ,Referral and Consultation ,Intergenerational transmission ,Pediatric practice ,Parenting ,Primary Health Care ,business.industry ,Caregivers ,Family medicine ,Pediatrics, Perinatology and Child Health ,Stress disorders ,business - Abstract
Addressing adverse childhood experiences (ACEs) in primary care pediatric practice is riddled with potential pitfalls that prevent most providers from implementing ACE or toxic stress screening in their practices. However, the growing body of literature and clinician experience about ACE screening shows how this practice is also ripe with possibilities beyond just the treatment of trauma-related diagnoses and for the prevention of intergenerational transmission of toxic stress. This article reviews the current state of screening for ACEs and toxic stress in practice, describes how pediatricians and clinics have overcome pitfalls during implementation of practice-based screening initiatives, and discusses possibilities for the future of primary care-based screening. [ Pediatr Ann. 2019;48(7):e257–e261.]
- Published
- 2019
22. A 46-year Analysis of Gender Trends in Academic Authorship in Orthopaedic Sports Medicine
- Author
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Michael J. Salata, Lakshmanan Sivasundaram, Allison Gilmore, James E. Voos, Nikunj N. Trivedi, Chang-Yeon Kim, Raymond W. Liu, and Robert J Gillespie
- Subjects
Male ,medicine.medical_specialty ,Academic authorship ,Sports medicine ,Sports Medicine ,03 medical and health sciences ,Physicians, Women ,0302 clinical medicine ,Sex Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Publishing ,030222 orthopedics ,business.industry ,Retrospective cohort study ,030229 sport sciences ,Evidence-based medicine ,Authorship ,Test (assessment) ,Trend analysis ,Orthopedics ,Bibliometrics ,Surgery ,Observational study ,Female ,Level iii ,Periodicals as Topic ,business ,Demography - Abstract
INTRODUCTION Participation of women in medicine has increased markedly in recent decades, but gender disparities still exist, particularly in academic medicine. To provide insight into the gender gap, specifically in academic orthopaedic sports medicine, we investigated the relationship between gender and authorship in orthopaedic sports literature from 1972 to 2018. METHODS Information about every original article in four prominent orthopaedic sports medicine journals between 1972 and 2018 was extracted from PubMed. The proportions of female first, second, middle, and senior authors over time were determined. Gender influences on level of evidence, academic degrees, and academic productivity and longevity were also studied. Student t-test, multiple linear regression, chi-square test, Cochran-Armitage trend test, and Kaplan-Meier analysis were used to determine significance between groups. RESULTS In our sample, 16.6% of all authors were female. The proportion of female authors increased from 2.6% (1972 to 1979) to 14.7% (2010 to 2018). Female authors averaged fewer publications (1.9 versus 2.8 articles for male authors) and were more likely to be attributed middle authorship (45.9% versus 37.1%) than senior authorship (14.7% versus 22.1%, P < 0.001). Female authors were more likely to be full-time research staff, such as a PhD (18.2% versus 9.0%, P < 0.001), which correlated with a higher level of evidence (B = -0.162, P < 0.001). Gender differences in academic longevity decreased over decades (1972 to 1989, 1990 to 1999, 2000 to 2008), demonstrated by decreasing significance of Kaplan-Meier log-rank tests (
- Published
- 2019
23. Parental Adverse Childhood Experiences and Pediatric Healthcare Use by 2 Years of Age
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Robert A. Shapiro, Emily A. Eismann, Alonzo T. Folger, Maurizio Macaluso, Maggie E. Brownrigg, Robert J. Gillespie, and Nicole B. Stephenson
- Subjects
Male ,Parents ,Pediatrics ,medicine.medical_specialty ,Healthcare use ,Offspring ,Office Visits ,Cohort Studies ,03 medical and health sciences ,Oregon ,0302 clinical medicine ,030225 pediatrics ,Intervention (counseling) ,Medicine ,Humans ,030212 general & internal medicine ,Adverse Childhood Experiences ,Preventive healthcare ,Retrospective Studies ,Primary Health Care ,business.industry ,Vaccination ,Infant ,Retrospective cohort study ,Paternal Exposure ,Adult Survivors of Child Adverse Events ,Relative risk ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Patient Compliance ,Female ,business - Abstract
Objective To determine whether maternal and paternal exposure to adverse childhood experiences (ACEs) has an association with offspring healthcare use by 2 years of age. Study design A retrospective cohort study was performed on 454 patients at a large suburban pediatric primary care practice whose mother (n = 374) or father (n = 156) or both (n = 123) completed an ACE survey between October 2012 and June 2014. The association between self-reported parental ACEs and healthcare use by 2 years of age, including number of missed well-child visits, sick visits, and delayed or missed immunizations, was modeled using multivariable negative binomial regression. All analyses adjusted for child sex, payer source, and preterm birth. Results Maternal, but not paternal, ACE exposure was significantly associated with missed well-child visits by 2 years of age. For each additional maternal ACE, there was a significant 12% increase in the incidence rate of missed well-child visits (relative risk, 1.12; 95% CI, 1.03-1.22; P = .010). Maternal and paternal ACE scores were not significantly associated with increased sick visits or delayed or missed immunizations. Conclusions The ACE exposure of mothers is negatively associated with adherence to preventive healthcare visits among their children early in life. Future research is needed to elucidate the mechanisms of this association and to develop and implement family-based intervention strategies.
- Published
- 2018
24. Predicting Discharge Disposition After Shoulder Arthroplasty in the United States
- Author
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Chang-Yeon Kim, Harry A. Hoyen, Joseph E. Tanenbaum, Robert J Gillespie, Glenn D. Wera, Blaine T. Bafus, Nikunj N. Trivedi, and Lakshmanan Sivasundaram
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Orthopedics and Sports Medicine ,Aged ,Retrospective Studies ,Aged, 80 and over ,030222 orthopedics ,business.industry ,Racial Groups ,Age Factors ,Retrospective cohort study ,030229 sport sciences ,Nomogram ,Middle Aged ,Arthroplasty ,Patient Discharge ,United States ,Logistic Models ,Arthroplasty, Replacement, Shoulder ,Elective Surgical Procedures ,Predictive value of tests ,Cohort ,Physical therapy ,Surgery ,Observational study ,Female ,business ,Shoulder replacement ,Cohort study - Abstract
Introduction Postdischarge management for shoulder replacement continues to be performed on a case-by-case basis, with no uniform guidelines dictating management. The goal of this study was to develop a nomogram to preoperatively predict a patient's discharge disposition after elective shoulder arthroplasty. Methods Patients who underwent elective shoulder arthroplasty between 2012 and 2015 were identified in the National Surgical Quality Improvement Program database. A multivariable logistic regression model was used to identify risk factors for discharge to a postacute care facility, and these results were used to create a predictive nomogram. Results From 2012 to 2015, 8,363 procedures were identified. In our cohort, 962 patients (11.5%) were discharged to a postacute care facility, and 7,492 patients (88.5%) were discharged home. Preoperative functional status, followed by American Society of Anesthesiologists Class and age, had the strongest predictive value for discharge disposition after shoulder arthroplasty. Discussion Discharge disposition can be predicted using a nomogram with commonly identified preoperative and intraoperative variables. Level of evidence Level III, retrospective cohort design, observational study.
- Published
- 2018
25. Operative duration-based learning period analysis for reverse and total shoulder arthroplasty: A multicenter study
- Author
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Surena Namdari, Andrew Jawa, Robert J. Gillespie, Jeremiah T. Lowe, Peter S. Johnston, Benjamin W. Sears, and Edward J Testa
- Subjects
musculoskeletal diseases ,030222 orthopedics ,medicine.medical_specialty ,Shoulder ,business.industry ,medicine.medical_treatment ,Rehabilitation ,education ,Physical Therapy, Sports Therapy and Rehabilitation ,030229 sport sciences ,Arthroplasty ,Learning experience ,03 medical and health sciences ,0302 clinical medicine ,Multicenter study ,Physical therapy ,medicine ,Period Analysis ,Orthopedics and Sports Medicine ,Surgery ,Duration (project management) ,business ,human activities - Abstract
Background A surgical learning period may be quantified after which operative duration is significantly reduced. We sought to retrospectively quantify and compare surgeon’s learning experience for total shoulder arthroplasty and reverse shoulder arthroplasty. Methods We reviewed 2055 shoulder arthroplasty cases from 2011 to 2015 for four early-career and four later-career fellowship-trained shoulder surgeons from four institutions. We plotted consecutive case number versus operative time for each surgeon separately for total shoulder arthroplasty or reverse shoulder arthroplasty. Two-step regression approach was used to determine a plateau point or end of the learning period. Additionally, the mean annual volume of reverse shoulder arthroplasty and total shoulder arthroplasty for each surgeon was plotted against mean surgery duration. Early- and later-career surgeons were compared with regression analysis. Results Early-career surgeons demonstrated a significant decrease in operative time with increasing annual case volume for reverse shoulder arthroplasty ( p = 0.01; m = −1.1) and total shoulder arthroplasty ( p = 0.02; m = −0.8). Three of four early-career surgeons reached a plateau point for either reverse shoulder arthroplasty or total shoulder arthroplasty between 12 and 86 cases. Conclusion For only early-career surgeons, higher case volume yields decreased operative duration, with improvement more pronounced for reverse shoulder arthroplasty compared to total shoulder arthroplasty. Though the learning period varies, it may be fewer than 90 cases.
- Published
- 2018
26. Role of the Remaining Rotator Cuff Following Reverse Total Shoulder Arthroplasty
- Author
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James E. Voos, Derrick M. Knapik, Michael J. Salata, and Robert J. Gillespie
- Subjects
030222 orthopedics ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,030229 sport sciences ,Arthroplasty ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,medicine ,Orthopedics and Sports Medicine ,Rotator cuff ,business - Published
- 2016
27. Neer Award 2015: A randomized, prospective evaluation on the effectiveness of tranexamic acid in reducing blood loss after total shoulder arthroplasty
- Author
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Jonathan J. Streit, Yousef Shishani, Sheeba Joseph, Robert J. Gillespie, and Reuben Gobezie
- Subjects
Male ,medicine.medical_specialty ,Administration, Topical ,medicine.medical_treatment ,Blood Loss, Surgical ,Hematocrit ,Placebo ,law.invention ,Hemoglobins ,Double-Blind Method ,Randomized controlled trial ,law ,Antifibrinolytic agent ,medicine ,Humans ,Orthopedics and Sports Medicine ,Prospective Studies ,Arthroplasty, Replacement ,Prospective cohort study ,Saline ,Aged ,Aged, 80 and over ,medicine.diagnostic_test ,Shoulder Joint ,business.industry ,General Medicine ,Middle Aged ,Arthroplasty ,Antifibrinolytic Agents ,Surgery ,Tranexamic Acid ,Anesthesia ,Female ,business ,Tranexamic acid ,medicine.drug - Abstract
Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to significantly reduce blood loss and transfusion requirements after total knee and hip arthroplasty. The purpose of this study was to evaluate the effect of TXA on postoperative blood loss after shoulder arthroplasty.A total of 111 patients (62 women; average age, 67 years) who underwent shoulder arthroplasty were prospectively randomized in double-blinded fashion to receive either 100 mL of normal saline or 100 mL of normal saline with 2 g TXA by topical application into the wound at the completion of the case. All patients received a postoperative drain. Drain output representing postoperative blood loss, transfusion requirements, and change in hemoglobin level were recorded. All postoperative complications were noted.The average blood loss recorded after surgery was 170 mL in the placebo group and 108 mL in the TXA group (P = .017). The average change in hemoglobin level was 2.6 g/dL in the placebo group and 1.7 g/dL in the TXA group (P.001). There were no transfusion requirements or postoperative complications noted in either group.In this cohort of patients, those treated with TXA experienced a significantly lower amount of postoperative blood loss and a significantly smaller change in hemoglobin level compared with those treated with placebo. Further work is required to determine the effectiveness and clinical significance of TXA in reducing transfusion requirements in shoulder arthroplasty and, more specifically, shoulder arthroplasty performed for complicated patients or for trauma and fracture patients.
- Published
- 2015
28. Response to Mohammadi et al regarding: 'Predicting adverse events, length of stay, and discharge disposition following shoulder arthroplasty: a comparison of the Elixhauser Comorbidity Measure and Charlson Comorbidity Index'
- Author
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Nikunj N. Trivedi, Robert J. Gillespie, Raymond W. Liu, Chang-Yeon Kim, Lakshmanan Sivasundaram, and Mark W. LaBelle
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Measure (physics) ,Discharge disposition ,General Medicine ,Comorbidity ,Length of Stay ,medicine.disease ,Arthroplasty ,Patient Discharge ,Arthroplasty, Replacement, Shoulder ,Charlson comorbidity index ,Emergency medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Surgery ,Hospital Mortality ,business ,Adverse effect - Published
- 2018
29. Parental Adverse Childhood Experiences and Offspring Development at 2 Years of Age
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Robert A. Shapiro, Maggie E. Brownrigg, Robert J. Gillespie, Emily A. Eismann, Nicole B. Stephenson, Maurizio Macaluso, and Alonzo T. Folger
- Subjects
Adult ,Male ,Patient Transfer ,Population ,Poison control ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Child Development ,Adverse Childhood Experiences ,030225 pediatrics ,Surveys and Questionnaires ,Adaptation, Psychological ,Medicine ,Humans ,0501 psychology and cognitive sciences ,Prospective Studies ,Parent-Child Relations ,education ,education.field_of_study ,business.industry ,05 social sciences ,Retrospective cohort study ,Child development ,Confidence interval ,Patient Discharge ,Adult Survivors of Child Adverse Events ,Relative risk ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,Psychosocial ,050104 developmental & child psychology ,Cohort study ,Demography - Abstract
OBJECTIVES: The study objective was to determine if maternal and paternal exposure to adverse childhood experiences (ACEs) have a significant association with negative offspring development at 24 months of age in a suburban pediatric primary care population. METHODS: A retrospective cohort study was conducted of 311 mother-child and 122 father-child dyads who attended a large pediatric primary care practice. Children were born from October 2012 to June 2014, and data were collected at the 2-, 4-, and 24-month well-child visits. Multivariable Poisson regression with robust error variance was used to model the relationship between self-reported parental ACEs and the outcomes of suspected developmental delay at 24 months and eligibility for early intervention services. RESULTS: For each additional maternal ACE, there was an 18% increase in the risk for a suspected developmental delay (relative risk: 1.18, 95% confidence interval: 1.08–1.29). A similar trend was observed for paternal ACEs (relative risk: 1.34, 95% confidence interval: 1.07–1.67). Three or more maternal ACEs (versus CONCLUSIONS: Parental ACE exposures can negatively impact child development in multiple domains, including problem solving, communication, personal-social, and motor skills. Research is needed to elucidate the psychosocial and biological mechanisms of intergenerational risk. This research has implications for the value of parental ACE screening in the context of pediatric primary care.
- Published
- 2018
30. Biomechanical evaluation of a novel suturing scheme for grafting load-bearing collagen scaffolds for rotator cuff repair
- Author
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Mousa Younesi, Anowarul Islam, Andrew G. Tsai, Michael S. Bohl, Robert J. Gillespie, and Ozan Akkus
- Subjects
Infraspinatus tendon ,Scaffold ,Biophysics ,Article ,Load bearing ,Rotator Cuff Injuries ,Weight-Bearing ,Rotator Cuff ,Suture (anatomy) ,Tendon Injuries ,Animals ,Medicine ,Orthopedics and Sports Medicine ,Rotator cuff ,Displacement (orthopedic surgery) ,Wound Healing ,Tissue Scaffolds ,business.industry ,Suture Techniques ,Stiffness ,Biomechanical Phenomena ,Tendon ,Disease Models, Animal ,medicine.anatomical_structure ,Female ,Collagen ,Rabbits ,medicine.symptom ,business ,Biomedical engineering - Abstract
Background Currently, there are no well-established suture protocols to attach fully load-bearing scaffolds which span tendon defects between bone and muscle for repair of critical sized tendon tears. Methods to attach load-bearing tissue repair scaffolds could enable functional repair of tendon injuries. Methods Sixteen rabbit shoulders were dissected (New Zealand white rabbits, 1 yr. old, female) to isolate the humeral–infraspinatus muscle complex. A unique suture technique was developed to allow for a 5 mm segmental defect in infraspinatus tendon to be replaced with a mechanically strong bioscaffold woven from pure collagen threads. The suturing pattern resulted in a fully load-bearing scaffold. The tensile stiffness and strength of scaffold repair were compared with intact infraspinatus and regular direct repair. Findings The failure load and displacement at failure of the scaffold repair group were 59.9 N (standard deviation, SD = 10.7) and 10.3 mm (SD = 2.9), respectively and matched those obtained by direct repair group which were 57.5 N (SD = 15.3) and 8.6 mm (SD = 1.5), ( p > 0.05). Failure load, displacement at failure and stiffness of both of the repair groups were half of the intact infraspinatus shoulder group. Interpretation With the developed suture technique, scaffold repair showed similar failure load, displacement at failure and stiffness to the direct repair. This novel suturing pattern and the mechanical robustness of the scaffold at time zero indicates that the proposed model is mechanically viable for future in vivo studies which has a higher potential to translate into clinical uses.
- Published
- 2015
31. Treatment of massive and recurrent rotator cuff tears augmented with a poly-l-lactide graft, a preliminary study
- Author
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Kenneth A. Kearns, Kelly Martens, Adam C. Zoga, Brett A. Lenart, Gerald R. Williams, and Robert J. Gillespie
- Subjects
Adult ,Male ,Reoperation ,medicine.medical_specialty ,Polyesters ,Elbow ,Population ,Rotator Cuff Injuries ,Vehicle accident ,Rotator Cuff ,Absorbable Implants ,Poly-L-lactide ,medicine ,Humans ,Orthopedics and Sports Medicine ,Rotator cuff ,education ,Aged ,Retrospective Studies ,education.field_of_study ,Trauma Severity Indices ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,Middle Aged ,Magnetic Resonance Imaging ,Synthetic polymer ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Tears ,Female ,business ,Follow-Up Studies - Abstract
The incidence of failed rotator cuff repairs remains high, especially in the setting of massive tears or revision repairs. The purpose of this study was to evaluate patient outcomes and repair integrity after augmentation with the repair patch, a poly-l-lactide synthetic polymer.Sixteen consecutive patients with massive or recurrent rotator cuff tears underwent open repair with synthetic poly-l-lactide patch augmentation. Two patients required the patch to bridge defects, and 1 patient retore after a motor vehicle accident and had revision surgery at another institution. The 13 remaining patients were retrospectively evaluated from 1.2 to 1.7 years (average, 1.5 years) after surgery by PENN, American Shoulder and Elbow Surgeons, and Single Assessment Numeric Evaluation scores. Magnetic resonance imaging was used to examine the integrity of the repair at a minimum of 1 year of follow-up.The mean age was 57.3 years (42-68 years). Five patients (38%) had an intact rotator cuff at the time of follow-up. The remaining patients (62%) had full-thickness tears. PENN scores significantly improved from a preoperative score of 50.9 to 77.6 (P.005). American Shoulder and Elbow Surgeons scores significantly improved from 32.8 to 74.2 (P = .0001). Single Assessment Numeric Evaluation scores at latest follow-up were 76.2.Poly-l-lactide repair patch augmentation of massive and recurrent large to massive rotator cuff tears demonstrates significant improvement in shoulder outcome measures for this difficult population, despite a retear rate of 62%. Further investigation with larger, prospective long-term studies is needed to determine whether this technique provides a true benefit compared with traditional, nonaugmented repair.
- Published
- 2015
32. Effects of PDGF-BB delivery from heparinized collagen sutures on the healing of lacerated chicken flexor tendon in vivo
- Author
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Baris Ozgur Donmez, Derrick M. Knapik, Michael S. Bohl, Mousa Younesi, Anowarul Islam, Ping He, Philip McClellan, Jameson Cumsky, Greg D. Learn, Robert J. Gillespie, and Ozan Akkus
- Subjects
0301 basic medicine ,medicine.medical_specialty ,Materials science ,Flexor tendon repair ,Biomedical Engineering ,Becaplermin ,Strain (injury) ,02 engineering and technology ,Biochemistry ,Lacerations ,Article ,Biomaterials ,Tendons ,03 medical and health sciences ,Vascularity ,Drug Delivery Systems ,Suture (anatomy) ,In vivo ,medicine ,Animals ,Molecular Biology ,Wound Healing ,biology ,Flexor tendon ,Sutures ,Heparin ,General Medicine ,Anatomy ,Proto-Oncogene Proteins c-sis ,021001 nanoscience & nanotechnology ,medicine.disease ,musculoskeletal system ,Tendon ,Surgery ,Biomechanical Phenomena ,030104 developmental biology ,medicine.anatomical_structure ,biology.protein ,Cattle ,Collagen ,medicine.symptom ,0210 nano-technology ,Chickens ,Platelet-derived growth factor receptor ,Biotechnology - Abstract
Flexor tendon lacerations are traditionally repaired by using non-absorbable monofilament sutures. Recent investigations have explored to improve the healing process by growth factor delivery from the sutures. However, it is difficult to conjugate growth factors to nylon or other synthetic sutures. This study explores the performance of a novel electrochemically aligned collagen suture in a flexor tendon repair model with and without platelet derived growth factor following complete tendon laceration in vivo. Collagen suture was fabricated via electrochemical alignment process. Heparin was covalently bound to electrochemically aligned collagen sutures (ELAS) to facilitate affinity bound delivery of platelet-derived growth factor-BB (PDGF-BB). Complete laceration of the flexor digitorum profundus in the third digit of the foot was performed in 36 skeletally mature White Leghorn chickens. The left foot was used as the positive control. Animals were randomly divided into three groups: control specimens treated with standard nylon suture (n=12), specimens repaired with heparinated ELAS suture without PDGF-BB (n=12) and specimens repaired with heparinated ELAS suture with affinity bound PDGF-BB (n=12). Specimens were harvested at either 4weeks or 12weeks following tendon repair. Differences between groups were evaluated by the degree of gross tendon excursion, failure load/stress, stiffness/modulus, absorbed energy at failure, elongation/strain at failure. Quantitative histological scoring was performed to assess cellularity and vascularity. Closed flexion angle measurements demonstrated no significant differences in tendon excursion between the study groups at 4 or 12weeks. Biomechanical testing showed that the group treated with PDGF-BB bound heparinated ELAS suture had significantly higher stiffness and failure load (p0.05) at 12-weeks relative to both heparinated ELAS suture and nylon suture. Similarly, the group treated with PDGF-BB bound suture had significantly higher ultimate tensile strength and Young's modulus (p0.05) at 12-weeks relative to both ELAS suture and nylon suture. Compared to nylon controls, heparinized ELAS with PDGF-BB improved biomechanics and vascularity during tendon healing by 12-weeks following primary repair. The ability of ELAS to deliver PDGF-BB to the lacerated area of tendon presents investigators with a functional bioinductive platform to improve repair outcomes following flexor tendon repair.A high strength aligned collagen suture was fabricated via linear electrocompaction and heparinized for prolonged delivery of PDFG-BB. When it was used to suture a complete lacerated flexor tendon in a chicken model controlled release of the PDGF-BB improved the strength of treated tendon after 12 weeks compared to tendon sutured with commercial nylon suture. Furthermore, Collagen suture with affinity bound PDGF-BB enhanced the vascularization and remodeling of lacerated tendon when it compare to synthetic nylon suture. Overall, electrocompacted collagen sutures holds potential to improve repair outcome in flexor tendon surgeries by improving repair strength and stiffness, vascularity, and remodeling via sustained delivery of the PDGF-BB. The bioinductive collagen suture introduces a platform for sustained delivery of other growth factors for a wide-array of applications.
- Published
- 2016
33. Biologic and Synthetic Grafts in the Reconstruction of Large to Massive Rotator Cuff Tears
- Author
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Derrick M. Knapik, Ozan Akkus, and Robert J. Gillespie
- Subjects
Scaffold ,medicine.medical_specialty ,Combined use ,Transplantation, Heterologous ,Tendon reconstruction ,Article ,Rotator Cuff Injuries ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Transplantation, Homologous ,Orthopedics and Sports Medicine ,Rotator cuff ,Orthopedic Procedures ,030222 orthopedics ,Tissue Scaffolds ,business.industry ,Guided Tissue Regeneration ,Rotator cuff injury ,030229 sport sciences ,medicine.disease ,musculoskeletal system ,Tendon ,Surgery ,Extracellular Matrix ,Transplantation ,medicine.anatomical_structure ,Tears ,Collagen ,business - Abstract
Rotator cuff injuries are common in both young and elderly patients. Despite improvements in instrumentation and surgical techniques, the failure rates following tendon reconstruction remain unacceptably high. To improve outcomes, graft patches have been developed to provide mechanical strength and to furnish a scaffold for biologic growth across the delicate tendon-bone junction. Although no patch effectively re-creates the structured, highly organized system of prenatal tendon development, augmenting rotator cuff repair may help restore native tendon-to-bone attachment while reproducing the mechanical and biologic properties of native tendon. An understanding of biologically and synthetically derived grafts, along with knowledge of the preliminary data available regarding their combined use with growth factors and stem cells, is needed to improve management and treatment outcomes. The current literature has not been consistent in showing patch augmentation to be beneficial over traditional repair, but novel scaffolding materials may help facilitate rotator cuff tendon repair that is histologically and biomechanically comparable to native tendon.
- Published
- 2016
34. Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty
- Author
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Michael R. Karns, Maxwell E Cooper, Lakshmanan Sivasundaram, Robert J. Gillespie, James E. Voos, and Nikunj N. Trivedi
- Subjects
medicine.medical_specialty ,Prosthesis-Related Infections ,business.industry ,medicine.medical_treatment ,MEDLINE ,Shoulder Prosthesis ,Periprosthetic ,Arthroplasty ,Surgery ,Arthroplasty, Replacement, Shoulder ,Humans ,Medicine ,Orthopedics and Sports Medicine ,business ,Joint (geology) - Published
- 2019
35. The Safety of Controlled Hypotension for Shoulder Arthroscopy in the Beach-Chair Position
- Author
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Reuben Gobezie, Jonathan J. Streit, Robert J. Gillespie, Tanvir U. Syed, Adam Haas, John Paul Wanner, Yousef Shishani, and Christopher L. McCrum
- Subjects
Adult ,Male ,Mean arterial pressure ,medicine.medical_specialty ,Posture ,Hypotension, Controlled ,Electroencephalography ,Brain Ischemia ,Arthroscopy ,Monitoring, Intraoperative ,medicine ,Humans ,Orthopedics and Sports Medicine ,Cerebral perfusion pressure ,medicine.diagnostic_test ,Shoulder Joint ,business.industry ,General Medicine ,Middle Aged ,Endoscopy ,Surgery ,Blood pressure ,Cerebrovascular Circulation ,Anesthesia ,Practice Guidelines as Topic ,Orthopedic surgery ,Female ,Safety ,business ,human activities ,Controlled hypotension - Abstract
Background: The safety of controlled hypotension during arthroscopic shoulder procedures with the patient in the beach-chair position is controversial. Current practice for the management of intraoperative blood pressure is derived from expert opinion among anesthesiologists, but there is a paucity of clinical data validating their practice. The purpose of this study was to evaluate the effect of controlled hypotension on cerebral perfusion with use of continuous electroencephalographic monitoring in patients undergoing shoulder arthroscopy in the beach-chair position. Methods: Fifty-two consecutive patients who had undergone shoulder arthroscopy in the beach-chair position were enrolled prospectively in this study. All patients underwent preoperative blood pressure measurements, assignment of an American Society of Anesthesiologists (ASA) grade, and a preoperative and postoperative neurological and Mini-Mental State Examination (MMSE). The target systolic blood pressure for all patients was 90 to 100 mm Hg during surgery. Continuous intraoperative monitoring was performed with standard ASA monitors and a ten-lead portable electroencephalography monitor. Real-time electroencephalographic monitoring was performed by an attending-level neurophysiologist. Results: All patients violated at least one recommended limit for blood pressure reduction. The average decrease in systolic blood pressure and mean arterial pressure from baseline was 36% and 42%, respectively. Three patients demonstrated ischemic changes on electroencephalography that resolved with an increase in blood pressure. No adverse neurological sequelae were observed in any patient on the basis of the MMSE. Conclusions: This study provides the first prospective data on global cerebral perfusion during shoulder arthroscopy in the beach-chair position with use of controlled hypotension. Our study suggests that patients may be able to safely tolerate a reduction in blood pressure greater than current recommendations. In the future, intraoperative cerebral monitoring may play a role in preventing neurological injury in patients undergoing shoulder arthroscopy in the beach-chair position.
- Published
- 2012
36. Antibiotic-loaded bone cement reduces deep infection rates for primary reverse total shoulder arthroplasty: a retrospective, cohort study of 501 shoulders
- Author
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Yousef Shishani, Reuben Gobezie, Robert J. Nowinski, Robert J. Gillespie, Gilles Walch, and Brian S. Cohen
- Subjects
Male ,Reoperation ,musculoskeletal diseases ,medicine.medical_specialty ,Prosthesis-Related Infections ,Time Factors ,Shoulders ,Joint Prosthesis ,medicine.medical_treatment ,Risk Assessment ,Cohort Studies ,Drug Delivery Systems ,Reference Values ,Tobramycin ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Arthroplasty, Replacement ,Aged ,Retrospective Studies ,Fixation (histology) ,Aged, 80 and over ,Shoulder Joint ,business.industry ,Incidence (epidemiology) ,Bone Cements ,Retrospective cohort study ,General Medicine ,Antibiotic Prophylaxis ,Bone cement ,Arthroplasty ,Anti-Bacterial Agents ,Prosthesis Failure ,Surgery ,Treatment Outcome ,Female ,business ,Follow-Up Studies ,Cohort study ,medicine.drug - Abstract
Background: Deep infection after primary reverse total shoulder arthroplasty is a devastating event and has an increased incidence compared with anatomic total shoulder arthroplasty. Recent reports in the hip and knee arthroplasty literature suggest that antibiotic-loaded bone cement may lower infection rates for primary arthroplasties. We conducted a retrospective cohort study to evaluate the effect of antibiotic-loaded bone cement vs plain bone cement on the prevention of deep infection after primary reverse total shoulder arthroplasty. Materials and methods: Four surgeons from their respective facilities participated in the retrospective cohort data collection. From 1999 to 2008, 501 consecutive primary reverse total shoulder arthroplasties were performed. Patients with revision of failed previous arthroplasties were excluded, and patients with any other previous shoulder procedure were included. Two groups were examined in this retrospective cohort: In group 1 (265 shoulders), the cement used for humeral fixation did not have antibiotics; in group 2 (236 shoulders), antibiotic-impregnated bone cement containing tobramycin, gentamycin, or vancomycin/tobramycin was used for fixation. Results: At an average postoperative follow-up of 37 months, no deep infection had developed in the 236 shoulders in group 2, whereas a deep infection had developed in 8 of the 265 shoulders (3.0%) in group 1. This difference between the groups was significant (P < .001). Conclusions: Antibiotic-impregnated bone cement was effective in the prevention of postoperative deep infection after primary reverse total shoulder arthroplasty during short-term follow-up. Level of evidence: Level III, Retrospective Case Control Design, Treatment Study. 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
- Published
- 2012
37. Gender differences in the anatomy of the distal femur
- Author
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Randall E. Marcus, Robert J. Gillespie, A. Levine, S. J. Fitzgerald, Daniel R. Cooperman, J. Kolaczko, and M. DeMaio
- Subjects
Adult ,Male ,musculoskeletal diseases ,medicine.medical_specialty ,Aspect ratio ,Total knee replacement ,Flange ,White People ,Young Adult ,Distal femur ,Reference Values ,Cadaver ,Humans ,Medicine ,Orthopedics and Sports Medicine ,Femur ,Observer Variation ,Sex Characteristics ,Anthropometry ,business.industry ,Significant difference ,Anatomy ,Middle Aged ,musculoskeletal system ,Body Height ,Black or African American ,Orthopedic surgery ,Female ,Surgery ,business - Abstract
Recently, gender-specific designs of total knee replacement have been developed to accommodate anatomical differences between males and females. We examined a group of male and female distal femora matched for age and height, to determine if there was a difference in the aspect ratio (mediolateral distance versus anteroposterior distance) and the height of the anterior flange between the genders. The Hamann-Todd Collection provided 1207 skeletally mature cadaver femora. The femoral length, the anteroposterior height, height of the lateral and medial flanges and the mediolateral width were measured in all the specimens. The mechanical axis of the femur, the cut articular width and the aspect ratio were assessed. Statistical analysis of the effect of gender upon the aspect ratio and the lateral and medial flanges was undertaken, controlling for age, height and race. The mean aspect ratio of male femora was 1.21 (sd 0.07) and of female femora it was 1.16 (sd 0.06) (p < 0.001). There was no significant difference between male and female specimens in the mean size of the lateral flange (6.57 mm (sd 2.57) and 7.02 mm (sd 2.36), respectively; p = 0.099) or of the medial flange (3.03 mm (sd 2.47) and 3.56 mm (sd 2.32), respectively; p = 0.67). Future work in the design of knee prostheses should take into account the overall variability of the anatomy of the distal femur.
- Published
- 2011
38. Radiographic Location of the Lateral Intercondylar Ridge
- Author
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Lutul D. Farrow, Brian N. Victoroff, Daniel R. Cooperman, and Robert J. Gillespie
- Subjects
Adult ,Knee Joint ,Anterior cruciate ligament reconstruction ,business.industry ,medicine.medical_treatment ,Anterior cruciate ligament ,Radiography ,Plain film ,Physical Therapy, Sports Therapy and Rehabilitation ,Anatomy ,Ridge (differential geometry) ,Blumensaat's line ,Young Adult ,medicine.anatomical_structure ,Cadaver ,medicine ,Humans ,Orthopedics and Sports Medicine ,Femur ,business - Abstract
Background The lateral intercondylar ridge (resident's ridge) is considered to be an important landmark during anterior cruciate ligament reconstruction. Presently, no study exists describing the location of this vital landmark on plain radiographic images. Hypothesis Lateral intercondylar ridge location can be estimated on lateral plain film images. Study Design Descriptive laboratory study. Methods Lateral radiographic images were taken of 20 distal femora with metallic markers overlying the lateral intercondylar ridge. The length of Blumensaat's line and the distance from the anterior extent of Blumensaat's line to the point where the lateral intercondylar ridge intersects Blumensaat's line were measured. The ratio of these measurements was then determined (Blumensaat's-ridge ratio). The angle of the lateral intercondylar ridge with respect to Blumensaat's line (Blumensaat's-ridge angle) was also determined. Results The mean length of Blumensaat's line was 32.1 mm (95% confidence interval, 31.0–33.2 mm). The mean distance from the anterior extent of Blumensaat's line to the point where the lateral intercondylar ridge intersects Blumensaat's line was 25.3 mm (95% confidence interval, 24.3–26.3 mm). The mean Blumensaat's-ridge ratio was 0.79 (95% confidence interval, 0.77–0.81). The mean Blumensaat's-ridge angle was 75.5° (95% confidence interval, 72.0°–79.1°). Conclusion The lateral intercondylar ridge intersects Blumensaat's line at a point defined by multiplying the Blumensaat's line length by 0.79. From this point, the ridge runs at a 75.5° angle with respect to Blumensaat's line. Clinical Relevance Awareness of the radiographic location of the lateral intercondylar ridge may help confirm accurate tunnel placement when arthroscopic positioning is in doubt. Furthermore, femoral tunnel position can be quickly and accurately assessed in the outpatient setting in patients with unsatisfactory outcomes after anterior cruciate ligament reconstruction.
- Published
- 2008
39. Cost Analysis of Hemiarthroplasty Versus Reverse Shoulder Arthroplasty for Fractures
- Author
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Reuben Gobezie, Sheeba Joseph, Brian N. Victoroff, Jason A. Solomon, Robert J. Gillespie, John H. Wilber, and Yousef Shishani
- Subjects
Male ,medicine.medical_specialty ,Shoulder surgery ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Orthopedics and Sports Medicine ,Range of Motion, Articular ,Aged ,Aged, 80 and over ,030222 orthopedics ,Rehabilitation ,Shoulder Fracture ,business.industry ,Shoulder Joint ,030229 sport sciences ,Arthroplasty ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Arthroplasty, Replacement, Shoulder ,Orthopedic surgery ,Costs and Cost Analysis ,Shoulder Fractures ,Shoulder joint ,Female ,Implant ,Hemiarthroplasty ,Range of motion ,business - Abstract
Complex proximal humerus fractures in older patients can be treated with hemiarthroplasty (HA) or reverse shoulder arthroplasty (RSA), with both providing good pain relief and function. This study compared the costs, complications, and outcomes of HA vs RSA after proximal humerus fracture in older patients. Patients 65 years or older who were admitted between January 2007 and August 2011 with a 3- or 4-part proximal humerus fracture and treated with HA or RSA were identified. Surgeries were performed at the same institution by 1 of 3 surgeons trained in trauma or shoulder surgery. Operating room costs, implant costs, total costs to the patient and hospital, and range of motion were compared. In the study group, 8 patients (7 women and 1 man; mean age, 77 years) received HA and 16 patients (13 women and 3 men; mean age, 77 years) received RSA. Hemiarthroplasty implant cost and operating room cost were $9140 and $8900 less than those of RSA, respectively ( P P Orthopedics. 2016; 39(4):230–234.]
- Published
- 2015
40. Scapular neck length and implications for reverse total shoulder arthroplasty: An anatomic study of 442 cadaveric specimens
- Author
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Reuben Gobezie, Robert J. Gillespie, Stephanie J Muh, Steven A Horton, Jonathan J. Streit, and Chad M. Fortun
- Subjects
musculoskeletal diseases ,Fossa ,medicine.medical_treatment ,Population ,Infraglenoid tubercle ,Notching ,scapular neck angle ,Medicine ,Orthopedics and Sports Medicine ,Clinical significance ,education ,Reduction (orthopedic surgery) ,education.field_of_study ,biology ,business.industry ,Anatomy ,biology.organism_classification ,musculoskeletal system ,Arthroplasty ,medicine.anatomical_structure ,scapular neck length ,reverse total shoulder arthroplasty ,Surgery ,Original Article ,business ,Cadaveric spasm - Abstract
Purpose: Reverse total shoulder arthroplasty (RTSA) may be used to treat a variety of pathologic shoulder conditions, but complications such as scapular notching continue raise concerns. Variable anatomy surrounding the glenoid may have implications for future RTSA design, but at present the anatomy of the scapular neck in the human population has not been clearly defined. Materials and Methods: 442 human scapulae from the Hamann-Todd Osteological Collection were measured for scapular neck length (SNL) and scapular neck angle (SNA). SNL was defined as the distance from the most lateral portion of the infraglenoid tubercle to the most inferolateral portion of the glenoid fossa. The SNA was measured according to Gerber et al. previously. The mean, standard deviation and ranges for SNL and SNA were calculated and compared based on sex and race, and interobserver variability was calculated. Results: The mean SNL was 1.06 cm ± 0.33 cm (0.37-2.43 cm). Males demonstrated a larger SNL (1.08 cm ± 0.33 cm) than females (1.01 cm ± 0.32 cm) (P < 0.12), and Caucasians (1.09 cm ± 0.33 cm) demonstrated a significantly larger SNL than African-Americans (1.00 cm ± 0.32) (P < 0.01). The mean SNA was 106.7° ± 11.0° (76.9-139.4°). No significant correlation was found between SNL and SNA (Pearson Correlation Coefficient = 0.018) (P < 0.702). Conclusion: Scapular neck length and SNA vary widely within the population but there appears to be a tendency towards increased SNL in males and Caucasians. Clinical Relevance: The anatomy of the scapular neck may have significant implications for RTSA design, surgical planning, and reduction of associated complications.
- Published
- 2015
41. Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine
- Author
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Derrick M. Knapik, Robert J. Gillespie, Michael J. Salata, and James E. Voos
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,American football ,Football ,League ,coracoid ,Coracoid ,glenoid ,03 medical and health sciences ,0302 clinical medicine ,augmentation ,medicine ,Orthopedics and Sports Medicine ,030222 orthopedics ,biology ,Athletes ,business.industry ,shoulder instability ,030229 sport sciences ,biology.organism_classification ,Shoulder instability ,Physical therapy ,business - Abstract
Background: Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. Purpose: To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Study Design: Case series; Level of evidence, 4. Methods: A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes’ first season in the NFL were gathered using publicly available databases. Results: Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Conclusion: Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.
- Published
- 2017
42. Arthroscopic Treatment of Anterosuperior Rotator Cuff Tears
- Author
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Erik Schnaser, Yves Lefebvre, Robert J. Gillespie, Bruno Toussaint, and Reuben Gobezie
- Subjects
Male ,medicine.medical_specialty ,Radiography ,Rotator Cuff Injuries ,Arthroscopy ,Rotator Cuff ,medicine ,Humans ,Orthopedics and Sports Medicine ,Rotator cuff ,Range of Motion, Articular ,Retrospective Studies ,Arm Injuries ,medicine.diagnostic_test ,business.industry ,Rotator cuff injury ,Magnetic resonance imaging ,musculoskeletal system ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Tears ,Female ,Arthrogram ,business ,Range of motion - Abstract
This study evaluated pre- and postoperative clinical and structural outcome data on anterosuperior rotator cuff tears involving the supraspinatus and subscapularis treated by arthroscopic methods. Between June 2006 and October 2007, a total of 155 consecutive patients underwent an arthroscopic repair for a supraspinatus or supraspinatus and infraspinatus (superior) rotator cuff tear. Of these, 44 (28%) were identified on preoperative imaging to have involvement of the subscapularis. Confirmation of subscapularis tears occurred during arthroscopic repair of the superior rotator cuff. If the subscapularis was found to be torn, it was documented, and an arthroscopic repair was performed. Postoperative clinical and radiographic outcomes were assessed with the belly press and lift-off tests, range of motion, strength, pain score, Constant score, and either a magnetic resonance imaging arthrogram or a computed tomography arthrogram at an average of 15 months postoperatively. Failure was determined based on rotator cuff integrity on radiologic studies. Sixteen of the 44 anterosuperior rotator cuff tears identified on preoperative imaging were found to have a full-thickness subscapularis tear requiring repair on arthroscopic examination. On preoperative imaging, subscapularis tears were all either grade 1 or grade 2 (no complete grade 3 tears). Mean follow-up was 16.9 months (range, 13–24 months). Compared with preoperative values, significant postoperative improvements occurred in Constant scores, forward flexion, strength, and pain scores ( P P
- Published
- 2013
43. [Untitled]
- Author
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Robert J Gillespie and Daniel J. Sucato
- Subjects
medicine.medical_specialty ,Salmonella ,Bone disease ,business.industry ,Osteomyelitis ,General Medicine ,medicine.disease_cause ,medicine.disease ,Gallium 67 scan ,Surgery ,medicine.anatomical_structure ,El Niño ,Pediatrics, Perinatology and Child Health ,medicine ,Orthopedics and Sports Medicine ,Osteitis ,Presentation (obstetrics) ,business ,Pelvis - Abstract
We report two cases of salmonella osteomyelitis isolated to the pelvis in white adolescents aged 12 and 16 years. No underlying medical condition predisposed these children to salmonella osteomyelitis, and the clinical course was prolonged before definitive diagnosis. The key to diagnosis and the localization of the site of the pathologic condition was made from radionuclide studies performed 2-3 weeks from the onset of symptoms. Clinicians should be aware of isolated salmonella osteomyelitis of the pelvis in normal children, especially when imaging studies are normal at initial presentation. Technetium-labeled bone scans may be normal
- Published
- 1997
44. Repair of Pectoralis Major Ruptures: Single-surgeon Case Series
- Author
-
Daniel F. O'Brien, Robert J. Gillespie, Grant E. Garrigues, Matthew J. Kraeutler, and Mark D. Lazarus
- Subjects
Adult ,Male ,medicine.medical_specialty ,Adolescent ,Elbow ,Bench press ,Pectoralis Muscles ,Young Adult ,Patient satisfaction ,Deformity ,medicine ,Humans ,Orthopedics and Sports Medicine ,Retrospective Studies ,Rupture ,business.industry ,Cosmesis ,Middle Aged ,Plastic Surgery Procedures ,Single surgeon ,Surgery ,Bench pressing ,Treatment Outcome ,medicine.anatomical_structure ,medicine.symptom ,Range of motion ,business - Abstract
Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon. Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145–525 lb) was restored to an average of 264 lb (range, 100–500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33–77 points), improving to 94 points (range, 64–100 points) at last follow-up ( P =.011). Average postoperative ASES and SANE scores were 96 points (range, 60–100 points) and 93 points (range, 50–100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria. Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.
- Published
- 2012
45. Three siblings with Chance fractures: the importance of 3-point restraints
- Author
-
Edward M. Barksdale, Todd A. Ponsky, George H. Thompson, Robert J Gillespie, and Zachary L. Gordon
- Subjects
Male ,medicine.medical_specialty ,Adolescent ,Chance fracture ,Poison control ,Abdominal Injuries ,Suicide prevention ,Occupational safety and health ,Injury prevention ,medicine ,Humans ,Orthopedics and Sports Medicine ,Child ,Surgical repair ,business.industry ,Multiple Trauma ,Accidents, Traffic ,Human factors and ergonomics ,General Medicine ,Equipment Design ,Seat Belts ,medicine.disease ,Surgery ,Casts, Surgical ,Pediatrics, Perinatology and Child Health ,Orthopedic surgery ,Physical therapy ,Spinal Fractures ,Female ,business ,human activities - Abstract
Pediatric Chance fractures are uncommon injuries. They are the result of a flexion-distraction force applied to the spine, and most commonly occur from motor vehicle accidents in which passengers are wearing lap seat belts as opposed to 3-point restraints with a chest strap. Neurologic injuries are rarely associated with Chance fractures in children, but accompanying intraabdominal injuries are often found and carry a potential for significant morbidity. We present 3 siblings in a minivan who were involved in a high-speed motor vehicle accident and as a result of wearing their 3-point restraints improperly, suffered Chance fractures. None had neurologic dysfunction, but 2 had serious intra-abdominal injuries requiring surgical repair. All 3 Chance fractures were treated with cast immobilization. This case report shows the importance of wearing 3-point restraints properly while traveling in a motor vehicle.
- Published
- 2009
46. Biomechanical evaluation of 3-part proximal humerus fractures: a cadaveric study
- Author
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Robert J. Gillespie, Ethan S Lea, Vimala Ramachandran, and Heather A. Vallier
- Subjects
musculoskeletal diseases ,animal structures ,Proximal humerus ,Fixation (surgical) ,Absorptiometry, Photon ,Fracture Fixation ,Materials Testing ,Cadaver ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Orthodontics ,Universal testing machine ,business.industry ,Stiffness ,Equipment Design ,Compression (physics) ,Biomechanical Phenomena ,Equipment Failure Analysis ,Shoulder Fractures ,Surgery ,medicine.symptom ,Cadaveric spasm ,business ,Cost of care ,Bone Plates ,Greater Tuberosity - Abstract
Proximal humerus fractures occur frequently, and treatment remains controversial. This study compares stiffness in axial loading for 3 methods of fixation (locking compression plate, standard (nonlocking) proximal humerus plate, and blade plate) in a 3-part proximal humerus fracture model. Twelve paired proximal humeri were obtained from embalmed human cadavers and separated into 3 groups. Osteotomies of the surgical neck and greater tuberosity were created to simulate a 3-part proximal humerus fracture. After fixation, constructs were axially loaded in 20 degrees of abduction for 200 cycles in an Instron materials testing machine (Norwood, Massachusetts). The blade plate (mean, 146.87+/-28.9 N/mm) demonstrated 29% more mean stiffness than the standard plate (mean, 113.0+/-22.3 N/mm; P=.19). The locking compression plate (mean, 130.71+/-39.2 N/mm) exhibited 15% greater stiffness compared to the standard plate in our 3-part model (P=.58). The blade plate demonstrated 12% greater stiffness than the locking compression plate (P=.64). There was no significant difference in mean stiffness between the fixed-angle devices and the standard plate. Future in vitro and clinical studies of plate devices for proximal humerus fractures would be worthwhile to determine the benefits and limitations of various implants for specific types of fractures, including clinical performance and cost of care.
- Published
- 2009
47. Eccentric reaming in total shoulder arthroplasty: a cadaveric study
- Author
-
Robert J. Gillespie, Robert Lyons, and Mark D. Lazarus
- Subjects
musculoskeletal diseases ,Orthodontics ,medicine.medical_specialty ,Preoperative planning ,business.industry ,Shoulder Joint ,medicine.medical_treatment ,musculoskeletal system ,Prosthesis ,Arthroplasty ,Osteotomy ,Scapula ,Orthopedic surgery ,medicine ,Deformity ,Cadaver ,Eccentric ,Humans ,Orthopedics and Sports Medicine ,Surgery ,medicine.symptom ,business ,Cadaveric spasm - Abstract
Posterior glenoid bone loss often is seen in association with glenohumeral osteoarthritis. Many different techniques have been proposed to account for this bone loss during total shoulder arthroplasty, the most popular being eccentric anterior reaming. However, the amount of correction that can be achieved has not been been well quantified. The purpose of this study was to define the amount of eccentric posterior glenoid wear that can be corrected by anterior glenoid reaming. Eight cadaveric scapulae were studied. Simulations of posterior glenoid wear in 5 degrees increments were performed on each scapula. The specimens were then eccentrically reamed to correct the deformity. Anteroposterior width, superior-inferior height, and the best-fit pegged glenoid prosthesis size were measured. Anterior reaming to correct a 10 degrees posterior defect resulted in a decrease in anteroposterior glenoid diameter from 26.7+/-2.5 mm to 23.8+/-3.1 mm (P=.006). In 4 of 8 specimens, placing a glenoid prosthesis was not possible after correcting a 15 degrees deformity because of inadequate bony support (N=2), peg penetration (N=1) or both (N=1). A 20 degrees deformity was correctable in 2 of 8 specimens and only after downsizing the glenoid component. Anterior glenoid reaming to correct eccentric posterior wear of >10 degrees results in significant narrowing of the anteroposterior glenoid width. A 15 degrees deformity has only a 50% chance of successful correction by anterior, eccentric reaming. Orthopedic surgeons need to be cognizant of this in their preoperative planning for total shoulder arthroplasty.
- Published
- 2009
48. A Randomized, Prospective Evaluation on the Effectiveness of Tranexamic Acid in Reducing Blood Loss after Total Shoulder Arthroplasty
- Author
-
Reuben Gobezie, Shane Hanzlik, Robert J. Gillespie, Yousef Shishani, and Jonathan J. Streit
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,General Medicine ,Arthroplasty ,Prospective evaluation ,Surgery ,Blood loss ,medicine ,Orthopedics and Sports Medicine ,business ,Tranexamic acid ,medicine.drug - Published
- 2015
49. Septic Arthritis of the Hip in Children
- Author
-
Richard M. Schwend, Robert J Gillespie, and Daniel J. Sucato
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Diagnostic test ,Articular cartilage ,medicine.disease ,Surgery ,Antibiotic therapy ,Erythrocyte sedimentation rate ,Oral antibiotic therapy ,medicine ,Orthopedics and Sports Medicine ,Septic arthritis ,Ultrasonography ,business ,Surgical treatment - Abstract
Recent advances in the management of septic arthritis of the hip in children include a better understanding of the effects of infection on articular cartilage; improvements in diagnostic tests, including erythrocyte sedimentation rate, C-reactive protein analysis, and ultrasonography; and more efficacious home intravenous and oral antibiotic therapy. Early diagnosis is essential to successful treatment. Needle aspiration is the most specific diagnostic test; however, false-negative results are possible. Prompt surgical drainage and postoperative antibiotic therapy until signs of infection resolve are necessary to prevent late sequelae. Surgical treatment of limb-length inequality is more useful than attempts to salvage the destroyed or incongruent joint.
- Published
- 2000
50. Proteomic profiling and functional characterization of early and late shoulder osteoarthritis
- Author
-
Roopashree Subbaiah, Reuben Gobezie, Yelenna Skomorovska-Prokvolit, John Paul Wanner, Masaru Miyagi, Robert J. Gillespie, Yousef Shishani, Eric Boilard, and Subburaman Mohan
- Subjects
Adult ,Male ,Proteomics ,Shoulder ,Blotting, Western ,Immunology ,Enzyme-Linked Immunosorbent Assay ,Osteoarthritis ,Proinflammatory cytokine ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Tandem Mass Spectrometry ,Synovial Fluid ,Humans ,Immunology and Allergy ,Medicine ,Synovial fluid ,Liver X receptor ,Aged ,030304 developmental biology ,030203 arthritis & rheumatology ,0303 health sciences ,business.industry ,Acute-phase protein ,Interleukin ,Middle Aged ,medicine.disease ,Complement system ,Female ,Interleukin 18 ,business ,Chromatography, Liquid ,Research Article - Abstract
Introduction: The development of effective treatments for osteoarthritis (OA) has been hampered by a poor understanding of OA at the cellular and molecular levels. Emerging as a disease of the ‘whole joint’, the importance of the biochemical contribution of various tissues, including synovium, bone and articular cartilage, has become increasingly significant. Bathing the entire joint structure, the proteomic analysis of synovial fluid (SF) from osteoarthritic shoulders offers a valuable ‘snapshot’ of the biologic environment throughout disease progression. The purpose of this study was to identify differentially expressed proteins in early and late shoulder osteoarthritic SF in comparison to healthy SF. Methods: A quantitative 18 O labeling proteomic approach was employed to identify the dysregulated SF proteins in early (n = 5) and late (n = 4) OA patients compared to control individuals (n = 5). In addition, ELISA was used to quantify six pro-inflammatory and two anti-inflammatory cytokines. Results: Key results include a greater relative abundance of proteins related to the complement system and the extracellular matrix in SF from both early and late OA. Pathway analyses suggests dysregulation of the acute phase response, liver x receptor/retinoid x receptor (LXR/RXR), complement system and coagulation pathways in both early and late OA. The network related to lipid metabolism was down-regulated in both early and late OA. Inflammatory cytokines including interleukin (IL) 6, IL 8 and IL 18 were up-regulated in early and late OA. Conclusions: The results suggest a dysregulation of wound repair pathways in shoulder OA contributing to the presence of a ‘chronic wound’ that progresses irreversibly from early to later stages of OA. Protease inhibitors were downregulated in late OA suggesting uncontrolled proteolytic activity occurring in late OA. These results contribute to the theory that protease inhibitors represent promising therapeutic agents which could limit proteolytic activity that ultimately leads to cartilage destruction.
- Published
- 2013
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