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2. Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

Author

Group, MARS, DeFroda, Steven F, Owens, Brett D, Wright, Rick W, Huston, Laura J, Pennings, Jacquelyn S, Haas, Amanda K, Allen, Christina R, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett Brick A, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Transplantation, Clinical Research, Musculoskeletal, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Cohort Studies, Humans, Osteoarthritis, Quality of Life, Reoperation, bone graft, outcomes, revision anterior cruciate ligament reconstruction, tunnel lysis, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics
Abstract

BackgroundLytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described.PurposeTo describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting.Study designCohort study; Level of evidence, 3.MethodsA total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics.ResultsA total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group.ConclusionTunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.

Published
2022

10. Minimal important clinical difference values are not uniformly valid in the active duty military population recovering from shoulder surgery

Author

Antosh, Ivan J., Bailey, James, Barlow, Brian T., Bottoni, Craig R., Bradley, Matthew W., Cameron, Kenneth L., Daner, William E., III, Dekker, Travis, Dickens, Jonathan F., Donohue, Michael A., Galvin, Joseph W., Garcia, Estephan J., Gee, Shawn, Haley, Chad A., Hurvitz, Andrew P., Kilcoyne, Kelly, Lanzi, Joseph T., Jr., LeClere, Lance, Lee, Ian E., McDonald, Lucas S., Min, Kyong S., Owens, Brett D., Pallis, Mark, Patzkowski, Jeanne C., Posner, Matthew, Potter, Benjamin K., Provencher, Matthew T., Rhon, Daniel, Roach, Christopher J., Robins, Richard Judd, Rodriguez, Marina J., Schmitz, Matthew R., Slabaugh, Mark, Sheean, Andrew J., Smith, Jennifer L., Song, Daniel J., Streets, David T., Tennent, David, Tokish, John M., Tucker, Christopher J., Wagner, Scott C., Waltz, Robert, Tenan, Matthew S., Volk, William R., DeFoor, Mikalyn T., Cognetti, Daniel J., Bedi, Asheesh, Lin, Albert, and Dekker, Travis J.

Published
2024
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11. Posterior Shoulder Instability, Part II—Glenoid Bone Grafting, Glenoid Osteotomy, and Rehabilitation/Return to Play—An International Expert Delphi Consensus Statement

Author

Athwal, George S., Bishop, Julie Y., Boache-Adjei, Yaw, Bradley, Kendall E., Brophy, Robert H., Calvo, Emilio, Camp, Christopher L., Cassidy, Tristan, Cordasco, Frank A., Danilkowicz, Richard M., Dekker, Travis A., Delaney, Ruth A., Denard, Patrick J., Duralde, Xavier A., Ernstbrunner, Lukas, Frangiamore, Salvatore J., Freehill, Michael T., Garrigues, Grant E., Goltz, Daniel E., Griffith, Timothy B., Heuberer, Philipp R., Hoy, Greg, Hoyt, Benjamin W., Hsu, Jason E., Imhoff, Andreas B., Itoi, Eiji, Jazrawi, Laith M., Kilcoyne, Kelly G., Laedermann, Alexandre, Lau, Brian C., Leclere, Lance E., Levine, William N., Martinez-Catalan, Natalia, McCarty, Eric C., Menendez, Mariano E., Millett, Peter J., Mirzayan, Raffy, Moroder, Philipp, Mullett, Hannan, Namdari, Surena, Neyton, Lionel, Nicholson, Gregory P., O'Brien, Michael J., Owens, Brett D., Parada, Stephen A., Parnes, Nata, Pasqualini, Ignacio, Pauzenberger, Leo, Provencher, Matthew T., Frank, Rachel M., Ranalletta, Maximiliano, Rodeo, Scott A., Rossi, Luciano A., Sanchez-Sotelo, Joaquin, Scanaliato, John P., Lassiter, Tally, Taylor, Dean C., Toth, Alison P., Trasolini, Nicholas A., Wagner, Eric R., Whelan, Daniel B., Wickman, John R., Wittstein, Jocelyn R., Wong, Ivan, Hurley, Eoghan T., Aman, Zachary S., Doyle, Tom R., Levin, Jay M., Matache, Bogdan A., Chalmers, Peter N., Waterman, Brian R., Erickson, Brandon J., Klifto, Christopher S., Anakwenze, Oke A., and Dickens, Jonathan F.

Published
2024
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12. Posterior Shoulder Instability, Part I—Diagnosis, Nonoperative Management, and Labral Repair for Posterior Shoulder Instability—An International Expert Delphi Consensus Statement

Author

Athwal, George S., Bishop, Julie Y., Boache-Adjei, Yaw, Bradley, Kendall E., Brophy, Robert H., Calvo, Emilio, Camp, Christopher L., Cassidy, Tristan, Chalmers, Peter N., Cordasco, Frank A., Danilkowicz, Richard M., Dekker, Travis A., Delaney, Ruth A., Denard, Patrick J., Duralde, Xavier A., Erickson, Brandon J., Ernstbrunner, Lukas, Frangiamore, Salvatore J., Freehill, Michael T., Goltz, Daniel E., Griffith, Timothy B., Heuberer, Philipp R., Hoy, Greg, Hoyt, Benjamin W., Imhoff, Andreas B., Itoi, Eiji, Kilcoyne, Kelly G., Laedermann, Alexandre, Lau, Brian C., Leclere, Lance E., Levine, William N., Martinez-Catalan, Natalia, Matache, Bogdan A., McCarty, Eric C., Menendez, Mariano E., Millett, Peter J., Mirzayan, Raffy, Moroder, Philipp, Mullett, Hannan, Neyton, Lionel, Nicholson, Gregory P., O'Brien, Michael J., Owens, Brett D., Parada, Stephen A., Parnes, Nata, Pasqualini, Ignacio, Pauzenberger, Leo, Provencher, Matthew T., Frank, Rachel M., Ranalletta, Maximiliano, Rodeo, Scott A., Rossi, Luciano A., Sanchez-Sotelo, Joaquin, Scanaliato, John P., Lassiter, Tally, Taylor, Dean C., Toth, Alison P., Trasolini, Nicholas A., Wagner, Eric R., Waterman, Brian R., Whelan, Daniel B., Wickman, John R., Wittstein, Jocelyn R., Wong, Ivan, Hurley, Eoghan T., Aman, Zachary S., Doyle, Tom R., Levin, Jay M., Jazrawi, Laith M., Garrigues, Grant E., Namdari, Surena, Hsu, Jason E., Klifto, Christopher S., Anakwenze, Oke, and Dickens, Jonathan F.

Published
2024
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15. Association Between Graft Choice and 6-Year Outcomes of Revision Anterior Cruciate Ligament Reconstruction in the MARS Cohort

Author

Group, MARS, Wright, Rick W, Huston, Laura J, Haas, Amanda K, Pennings, Jacquelyn S, Allen, Christina R, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett A, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Transplantation, Clinical Research, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Musculoskeletal, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Autografts, Bone-Patellar Tendon-Bone Grafting, Cohort Studies, Humans, Male, Reoperation, Transplantation, Autologous, anterior cruciate ligament, ACL reconstruction, revision, outcomes, graft failure, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics
Abstract

BackgroundAlthough graft choice may be limited in the revision setting based on previously used grafts, most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome.HypothesisIn the ACL revision setting, there would be no difference between autograft and allograft in rerupture rate and patient-reported outcomes (PROs) at 6-year follow-up.Study designCohort study; Level of evidence, 2.MethodsPatients who had revision surgery were identified and prospectively enrolled in this cohort study by 83 surgeons over 52 sites. Data collected included baseline characteristics, surgical technique and pathology, and a series of validated PRO measures. Patients were followed up at 6 years and asked to complete the identical set of PRO instruments. Incidence of additional surgery and reoperation because of graft failure were also recorded. Multivariable regression models were used to determine the predictors (risk factors) of PROs, graft rerupture, and reoperation at 6 years after revision surgery.ResultsA total of 1234 patients including 716 (58%) men were enrolled. A total of 325 (26%) underwent revision using a bone-patellar tendon-bone (BTB) autograft; 251 (20%), soft tissue autograft; 289 (23%), BTB allograft; 302 (25%), soft tissue allograft; and 67 (5%), other graft. Questionnaires and telephone follow-up for subsequent surgery information were obtained for 809 (66%) patients, while telephone follow-up was only obtained for an additional 128 patients for the total follow-up on 949 (77%) patients. Graft choice was a significant predictor of 6-year Marx Activity Rating Scale scores (P = .024). Specifically, patients who received a BTB autograft for revision reconstruction had higher activity levels than did patients who received a BTB allograft (odds ratio [OR], 1.92; 95% CI, 1.25-2.94). Graft rerupture was reported in 5.8% (55/949) of patients by their 6-year follow-up: 3.5% (16/455) of patients with autografts and 8.4% (37/441) of patients with allografts. Use of a BTB autograft for revision resulted in patients being 4.2 times less likely to sustain a subsequent graft rupture than if a BTB allograft were utilized (P = .011; 95% CI, 1.56-11.27). No significant differences were found in graft rerupture rates between BTB autograft and soft tissue autografts (P = .87) or between BTB autografts and soft tissue allografts (P = .36). Use of an autograft was found to be a significant predictor of having fewer reoperations within 6 years compared with using an allograft (P = .010; OR, 0.56; 95% CI, 0.36-0.87).ConclusionBTB and soft tissue autografts had a decreased risk in graft rerupture compared with BTB allografts. BTB autografts were associated with higher activity level than were BTB allografts at 6 years after revision reconstruction. Surgeons and patients should consider this information when choosing a graft for revision ACL reconstruction.

Published
2021

18. Predictors of clinical outcome following revision anterior cruciate ligament reconstruction

Author

Wright, Rick W, Huston, Laura J, Haas, Amanda K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett Brick A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Nwosu, Samuel K, Pennings, Jacquelyn S, Albright, John P, Amendola, Annunziato Ned, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush‐Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Ma, C Benjamin, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O'Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, LTC Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Physical Injury - Accidents and Adverse Effects, Patient Safety, Clinical Research, Prevention, Comparative Effectiveness Research, Adult, Anterior Cruciate Ligament Reconstruction, Female, Humans, Male, ACL, clinical outcomes, knee, ligament, osteoarthritis, MARS Group, Biomedical Engineering, Clinical Sciences, Human Movement and Sports Sciences, Orthopedics
Abstract

The underlying theme throughout this series of studies authored by the Multicenter anterior cruciate ligament (ACL) Revision Study consortium has been to determine the modifiable predictors or risk factors of long-term outcomes of revision ACL reconstruction. The observational studies described and summarized in the manuscript are both clinically relevant and of great interest in finding out the long-term consequences of the intervention and its relationship to the original injury. The successful completion of these studies has important implications for both therapy and future clinical trials. The identification of modifiable risk factors will play an important role in secondary prevention, while the identification of nonmodifiable risk factors will aid us in counseling our patients and making surgical decisions. Thus, we expect a profound clinical impact on patients' care. More importantly, this project represents an important step forward in bringing evidence to bear in clinical decision making in orthopedic surgery.

Published
2020

19. Establishing a Consensus Definition of a Knee Fracture-Dislocation (Schenck Knee Dislocation V) Using a Global Modified Delphi Method

Author

Medvecky, Michael J., Kahan, Joseph B., Richter, Dustin L., McLaughlin, William M., Moran, Jay, Islam, Wasif, Miller, Mark D., Wascher, Daniel C., Treme, Gehron P., Campos, Túlio V.O., Held, Michael, Schenck, Robert C., Jr, Abrams, Geoffrey, Alaia, Michael, Arciero, Robert A., Barenius, Björn, Brady, Jacqueline M., Ferrer, Gonzalo, Franciozi, Carlos E., Gelber, Pablo E., Getgood, Alan, Hantes, Michael, Harner, Christopher D., Jazrawi, Laith M., Krych, Aaron J., Lagae, Koen C., LaPrade, Robert F., Levy, Bruce A., Lind, Martin, Lording, Timothy, Maestu, Rodrigo, Matava, Matthew, Moatshe, Gilbert, Monllau, Joan C., Murray, Iain R., Musahl, Volker, Ooka, Nelson H.M., Owens, Brett D., Parker, David A., Percope de Andrade, Marco A., Pimenta, Frederico S., Pujol, Nicolas, Rincón, Gustavo A., Robinson, James, Safran, Marc, Saltzman, Bryan M., Stannard, James, Stuart, Michael J., Tischer, Thomas, Uchida, Soshi, Villascusa, Silvio, von Bormann, Richard PB, and Waterman, Brian R.

Published
2023
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20. Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees: Treatment and Schenck Classification Recommendations Based on a Global Delphi Method

Author

Medvecky, Michael J., Kahan, Joseph B., Richter, Dustin L., Islam, Wasif, McLaughlin, William M., Moran, Jay, Alaia, Michael J., Miller, Mark D., Wascher, Daniel C., Treme, Gehron P., Campos, Túlio V.O., Held, Michael, Schenck, Robert C., Jr., Abrams, Geoffrey D., Arciero, Robert A., Barenius, Björn, Brady, Jacqueline M., Ferrer, Gonzalo, Franciozi, Carlos E., Gelber Ghertner, Pablo E., Getgood, Alan, Hantes, Michael, Harner, Christopher D., Jazrawi, Laith M., Krych, Aaron J., Lagae, Koen C., LaPrade, Robert F., Levy, Bruce A., Lind, Martin, Lording, Timothy, Maestu, Rodrigo, Matava, Matthew, Moatshe, Gilbert, Monllau, Joan C., Murray, Iain R., Musahl, Volker, Ooka, Nelson H.M., Owens, Brett D., Parker, David A., Percope Andrade, Marco A., Pimenta, Frederico S., Pujol, Nicolas, Rincón, Gustavo A., Robinson, James, Safran, Marc R., Saltzman, Bryan M., Stannard, James, Stuart, Michael J., Tischer, Thomas, Uchida, Soshi, Villascusa, Silvio, von Bormann, Richard P.B., and Waterman, Brian R.

Published
2023
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22. Minimal Important Clinical Difference Values Are Not Uniformly Valid in the Active Duty Military Population Recovering from Shoulder Surgery

Author

Sheean, Andrew J., primary, Tenan, Matthew S., additional, DeFoor, Mikalyn T., additional, Cognetti, Daniel J., additional, Bedi, Asheesh, additional, Lin, Albert, additional, Dekker, Travis J., additional, Antosh, Ivan J., additional, Bailey, James, additional, Barlow, Brian T., additional, Bottoni, Craig R., additional, Bradley, Matthew W., additional, Cameron, Kenneth L., additional, Daner, William E., additional, Dekker, Travis, additional, Dickens, Jonathan F., additional, Donohue, Michael A., additional, Galvin, Joseph W., additional, Garcia, Estephan J., additional, Gee, Shawn, additional, Haley, Chad A., additional, Hurvitz, Andrew P., additional, Kilcoyne, Kelly, additional, Lanzi, Joseph T., additional, LeClere, Lance, additional, Lee, Ian E., additional, McDonald, Lucas S., additional, Min, Kyong S., additional, Owens, Brett D., additional, Pallis, Mark, additional, Patzkowski, Jeanne C., additional, Posner, Matthew, additional, Potter, Benjamin K., additional, Provencher, Matthew T., additional, Rhon, Daniel, additional, Roach, Christopher J., additional, Robins, Richard Judd, additional, Rodriguez, Marina J., additional, Schmitz, Matthew R., additional, Slabaugh, Mark, additional, Sheean, Andrew J., additional, Smith, Jennifer L., additional, Song, Daniel J., additional, Streets, David T., additional, Tennent, David, additional, Tokish, John M., additional, Tucker, Christopher J., additional, Wagner, Scott C., additional, Waltz, Robert, additional, and Volk, William R., additional

Published
2024
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24. Predictors of Patient-Reported Outcomes at 2 Years After Revision Anterior Cruciate Ligament Reconstruction

Author

Group, The MARS, Wright, Rick W, Huston, Laura J, Haas, Amanda K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Nwosu, Samuel K, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Arthritis, Patient Safety, Clinical Research, Musculoskeletal, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Cartilage Diseases, Cohort Studies, Female, Humans, Knee Joint, Male, Meniscectomy, Middle Aged, Patient Reported Outcome Measures, Reoperation, Surveys and Questionnaires, Young Adult, ACL reconstruction, revision, outcomes, IKDC, KOOS, Marx, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise
Abstract

BackgroundPatient-reported outcomes (PROs) are a valid measure of results after revision anterior cruciate ligament (ACL) reconstruction. Revision ACL reconstruction has been documented to have worse outcomes when compared with primary ACL reconstruction. Understanding positive and negative predictors of PROs will allow surgeons to modify and potentially improve outcome for patients.Purpose/hypothesisThe purpose was to describe PROs after revision ACL reconstruction and test the hypothesis that patient- and technique-specific variables are associated with these outcomes.Study designCohort study; Level of evidence, 2.MethodsPatients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons over 52 sites. Data included baseline demographics, surgical technique and pathology, and a series of validated PRO instruments: International Knee Documentation Committee (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale. Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Multivariate regression models were used to control for a variety of demographic and surgical factors to determine the positive and negative predictors of PRO scores at 2 years after revision surgery.ResultsA total of 1205 patients met the inclusion criteria and were successfully enrolled: 697 (58%) were male, with a median cohort age of 26 years. The median time since their most recent previous ACL reconstruction was 3.4 years. Two-year questionnaire follow-up was obtained from 989 patients (82%). The most significant positive predictors of 2-year IKDC scores were a high baseline IKDC score, high baseline Marx activity level, male sex, and having a longer time since the most recent previous ACL reconstruction, while negative predictors included having a lateral meniscectomy before the revision ACL reconstruction or having grade 3/4 chondrosis in either the trochlear groove or the medial tibial plateau at the time of the revision surgery. For KOOS, having a high baseline score and having a longer time between the most recent previous ACL reconstruction and revision surgery were significant positive predictors for having a better (ie, higher) 2-year KOOS, while having a lateral meniscectomy before the revision ACL reconstruction was a consistent predictor for having a significantly worse (ie, lower) 2-year KOOS. Statistically significant positive predictors for 2-year Marx activity levels included higher baseline Marx activity levels, younger age, male sex, and being a nonsmoker. Negative 2-year activity level predictors included having an allograft or a biologic enhancement at the time of revision surgery.ConclusionPROs after revision ACL reconstruction are associated with a variety of patient- and surgeon-related variables. Understanding positive and negative predictors of PROs will allow surgeons to guide patient expectations as well as potentially improve outcomes.

Published
2019

25. Relationship Between Sports Participation After Revision Anterior Cruciate Ligament Reconstruction and 2-Year Patient-Reported Outcome Measures

Author

Group, MARS, Bigouette, John P, Owen, Erin C, Lantz, Brett A, Hoellrich, Rudolf G, Huston, Laura J, Haas, Amanda K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Wright, Rick W, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Clinical Research, Arthritis, Physical Injury - Accidents and Adverse Effects, Musculoskeletal, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Athletic Injuries, Child, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Patient Reported Outcome Measures, Quality of Life, Reoperation, Return to Sport, Self Report, Surveys and Questionnaires, Young Adult, anterior cruciate ligament, outcomes, revision ACL, sports participation, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise
Abstract

BackgroundAnterior cruciate ligament (ACL) revision cohorts continually report lower outcome scores on validated knee questionnaires than primary ACL cohorts at similar time points after surgery. It is unclear how these outcomes are associated with physical activity after physician clearance for return to recreational or competitive sports after ACL revision surgery.HypothesesParticipants who return to either multiple sports or a singular sport after revision ACL surgery will report decreased knee symptoms, increased activity level, and improved knee function as measured by validated patient-reported outcome measures (PROMs) and compared with no sports participation. Multisport participation as compared with singular sport participation will result in similar increased PROMs and activity level.Study designCross-sectional study; Level of evidence, 3.MethodsA total of 1205 patients who underwent revision ACL reconstruction were enrolled by 83 surgeons at 52 clinical sites. At the time of revision, baseline data collected included the following: demographics, surgical characteristics, previous knee treatment and PROMs, the International Knee Documentation Committee (IKDC) questionnaire, Marx activity score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). A series of multivariate regression models were used to evaluate the association of IKDC, KOOS, WOMAC, and Marx Activity Rating Scale scores at 2 years after revision surgery by sports participation category, controlling for known significant covariates.ResultsTwo-year follow-up was obtained on 82% (986 of 1205) of the original cohort. Patients who reported not participating in sports after revision surgery had lower median PROMs both at baseline and at 2 years as compared with patients who participated in either a single sport or multiple sports. Significant differences were found in the change of scores among groups on the IKDC (P < .0001), KOOS-Symptoms (P = .01), KOOS-Sports and Recreation (P = .04), and KOOS-Quality of Life (P < .0001). Patients with no sports participation were 2.0 to 5.7 times more likely than multiple-sport participants to report significantly lower PROMs, depending on the specific outcome measure assessed, and 1.8 to 3.8 times more likely than single-sport participants (except for WOMAC-Stiffness, P = .18), after controlling for known covariates.ConclusionParticipation in either a single sport or multiple sports in the 2 years after ACL revision surgery was found to be significantly associated with higher PROMs across multiple validated self-reported assessment tools. During follow-up appointments, surgeons should continue to expect that patients who report returning to physical activity after surgery will self-report better functional outcomes, regardless of baseline activity levels.

Published
2019

26. Rehabilitation Predictors of Clinical Outcome Following Revision ACL Reconstruction in the MARS Cohort.

Author

Wright, Rick W, Huston, Laura J, Nwosu, Samuel K, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Haas, Amanda K, Lantz, Brett Brick A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Albright, John P, Amendola, Annunziato Ned, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R Jr, Baker, Champ LIII, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J Jr, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay Jr, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Ma, C Benjamin, Maiers, G Peter II, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O'Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S Jr, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Behavioral and Social Science, Patient Safety, Physical Injury - Accidents and Adverse Effects, Clinical Research, Arthritis, Physical Rehabilitation, Aging, Bioengineering, Rehabilitation, Musculoskeletal, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Braces, Cohort Studies, Early Ambulation, Female, Humans, Male, Patient Reported Outcome Measures, Range of Motion, Articular, Recovery of Function, Reoperation, Weight-Bearing, Young Adult, MARS Group, Biomedical Engineering, Clinical Sciences, Orthopedics
Abstract

BackgroundRevision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes than primary ACL reconstruction. The reasons remain varied and not completely understood.MethodsPatients undergoing revision ACL reconstruction were prospectively enrolled. Data collected included baseline demographics, surgical technique and pathological condition, prescribed rehabilitation instructions, and a series of validated patient-reported outcome instruments. Patients were followed for 2 years and asked to complete a set of outcome instruments identical to those completed at baseline. Subsequent surgical procedures on the ipsilateral knee were recorded. Regression analysis was used to control for age, sex, activity level, baseline outcome scores, and the above-mentioned rehabilitation-related variables in order to assess the factors affecting clinical outcomes 2 years after revision ACL reconstruction.ResultsA total of 843 patients met the inclusion criteria and were successfully enrolled, and 82% (695) were followed for 2 years. Two rehabilitation-related factors were found to influence outcome. First, patients who were prescribed an ACL brace for their return to sports had a significantly better Knee injury and Osteoarthritis Outcome Score (KOOS) for sports and recreational activities at 2 years (odds ratio [OR] =1.50, 95% confidence interval [CI] = 1.07 to 2.11; p = 0.019). Second, patients prescribed an ACL brace for the postoperative rehabilitation period were 2.3 times more likely to have subsequent surgery by 2 years (OR = 2.26, 95% CI = 1.11 to 4.60; p = 0.024). The odds of a graft rerupture were not affected by any type of brace wear.ConclusionsRehabilitation-related factors that the physician can control at the time of an ACL reconstruction have the ability to influence clinical outcomes at 2 years. Weight-bearing and motion can be initiated immediately postoperatively. Bracing during the early postoperative period is not helpful. Use of a functional brace early in the postoperative period was associated with an increased risk of a reoperation. Use of a functional brace for a return to sports improved the KOOS on the sports/recreation subscale.Level of evidencePrognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

Published
2019

27. Physiologic Preoperative Knee Hyperextension Is a Predictor of Failure in an Anterior Cruciate Ligament Revision Cohort: A Report From the MARS Group

Author

Group, The MARS, Cooper, Daniel E, Dunn, Warren R, Huston, Laura J, Haas, Amanda K, Spindler, Kurt P, Allen, Christina R, Anderson, Allen F, DeBerardino, Thomas M, Lantz, Brett A, Mann, Barton, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, York, James J, and Wright, Rick W

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Health Sciences, Prevention, Transplantation, Clinical Research, Adolescent, Adult, Anterior Cruciate Ligament, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Female, Humans, Knee Joint, Male, Preoperative Care, Prognosis, Prospective Studies, Range of Motion, Articular, Reoperation, Risk Factors, Rupture, Transplantation, Autologous, Young Adult, anterior cruciate ligament, knee hyperextension, graft failure, graft tensioning, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise
Abstract

BackgroundThe occurrence of physiologic knee hyperextension (HE) in the revision anterior cruciate ligament reconstruction (ACLR) population and its effect on outcomes have yet to be reported. Hypothesis/Purpose: The prevalence of knee HE in revision ACLR and its effect on 2-year outcome were studied with the hypothesis that preoperative physiologic knee HE ≥5° is a risk factor for anterior cruciate ligament (ACL) graft rupture.Study designCohort study; Level of evidence, 2.MethodsPatients undergoing revision ACLR were identified and prospectively enrolled between 2006 and 2011. Study inclusion criteria were patients undergoing single-bundle graft reconstructions. Patients were followed up at 2 years and asked to complete an identical set of outcome instruments (International Knee Documentation Committee, Knee injury and Osteoarthritis Outcome Score, WOMAC, and Marx Activity Rating Scale) as well as provide information regarding revision ACL graft failure. A regression model with graft failure as the dependent variable included age, sex, graft type at the time of the revision ACL surgery, and physiologic preoperative passive HE ≥5° (yes/no) to assess these as potential risk factors for clinical outcomes 2 years after revision ACLR.ResultsAnalyses included 1145 patients, for whom 2-year follow-up was attained for 91%. The median age was 26 years, with age being a continuous variable. Those below the median were grouped as "younger" and those above as "older" (age: interquartile range = 20, 35 years), and 42% of patients were female. There were 50% autografts, 48% allografts, and 2% that had a combination of autograft plus allograft. Passive knee HE ≥5° was present in 374 (33%) patients in the revision cohort, with 52% being female. Graft rupture at 2-year follow-up occurred in 34 cases in the entire cohort, of which 12 were in the HE ≥5° group (3.2% failure rate) and 22 in the non-HE group (2.9% failure rate). The median age of patients who failed was 19 years, as opposed to 26 years for those with intact grafts. Three variables in the regression model were significant predictors of graft failure: younger age (odds ratio [OR] = 3.6; 95% CI, 1.6-7.9; P = .002), use of allograft (OR = 3.3; 95% CI, 1.5-7.4; P = .003), and HE ≥5° (OR = 2.12; 95% CI, 1.1-4.7; P = .03).ConclusionThis study revealed that preoperative physiologic passive knee HE ≥5° is present in one-third of patients who undergo revision ACLR. HE ≥5° was an independent significant predictor of graft failure after revision ACLR with a >2-fold OR of subsequent graft rupture in revision ACL surgery. Registration: NCT00625885 ( ClinicalTrials.gov identifier).

Published
2018

30. Presentation and Surgical Management of Multiple Ligament Knee Injuries: A Multicenter Study from the Surgical Timing and Rehabilitation (STaR) Trial for MLKIs Network

Author

Poploski, Kathleen M., Lynch, Andrew D., Burns, Travis C., Harner, Christopher D., Levy, Bruce A., Owens, Brett D., Richter, Dustin L., Schenck, Robert C., Jr., Musahl, Volker, Irrgang, James J., Arciero, Robert, Black, Brandee S., Coady, Catherine M., Cooper, Jonathan M., Coyner, Katherine J., Edgar, Cory M., Getgood, Al M.J., Hart, Joe M., Hodax, Jonathan D., Hughes, Jonathan D., Jacobs, Cale A., Johnson, Darren L., Khan, Ryan M., Lesniak, Byson P., Macalena, Jeffrey A., Marx, Robert G., Miller, Mark D., Nelson, Bradley, Oostdyk, Alicia, Patterson, Charity G., Popchak, Adam J., Ranawat, Anil S., Stuart, Michael J., Taber, Caroline E., Warth, Ryan J., Whelan, Daniel B., and Wolfe, Isabel

Published
2023
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32. Anterior Shoulder Instability Part II—Latarjet, Remplissage, and Glenoid Bone-Grafting—An International Consensus Statement

Author

Alaia, Michael J., Arciero, Robert A., Bedi, Asheesh, Brophy, Robert H., Calvo, Emilio, Campbell, Kirk A., Carter, Cordelia W., Cassidy, J Tristan, Ciccotti, Michael G., Cole, Brian J., Collin, Philippe, Cordasco, Frank A., Edwards, Sara E., Erickson, Brandon J., Favard, Luc, Frank, Rachel M., Funk, Lennard, Garrigues, Grant E., Di Giacomo, Giovanni, Gonzalez-Lomas, Guillem, Heuberer, Philipp R., Imhoff, Andreas B., Kelly, John D., Khan, Moin, Krych, Aaron J., Kuhn, John E., Kwon, Young M., Lädermann, Alexandre, Levine, William N., Fat, Darren Lim, Mazzocca, Augustus D., MacDonald, Peter B., McCarty, Eric C., Meislin, Robert J., Millett, Peter J., Molony, Diarmuid C., Moran, Cathal J., Moroder, Philipp, Moya, Daniel, O’Shea, Kieran, Owens, Brett D., Provencher, Matthew T., Rhee, Yong Girl, Rodeo, Scott A., Rokito, Andrew S., Rosso, Claudio, Scheibel, Markus, Verma, Nikhil N., Virk, Mandeep S., Walch, Gilles, Warren, Russell F., Waterman, Brian R., Whelan, Daniel B., Zuckerman, Joseph D., Hurley, Eoghan T., Matache, Bogdan A., Wong, Ivan, Itoi, Eiji, Strauss, Eric J., Delaney, Ruth A., Neyton, Lionel, Athwal, George S., Pauzenberger, Leo, Mullett, Hannan, and Jazrawi, Laith M.

Published
2022
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33. Anterior Shoulder Instability Part I—Diagnosis, Nonoperative Management, and Bankart Repair—An International Consensus Statement

Author

Alaia, Michael J., Arciero, Robert A., Bedi, Asheesh, Brophy, Robert H., Calvo, Emilio, Campbell, Kirk A., Carter, Cordelia W., Cassidy, J Tristan, Ciccotti, Michael G., Cole, Brian J., Collin, Philippe, Cordasco, Frank A., Edwards, Sara E., Erickson, Brandon J., Favard, Luc, Frank, Rachel M., Funk, Lennard, Garrigues, Grant E., Di Giacomo, Giovanni, Gonzalez-Lomas, Guillem, Heuberer, Philipp R., Imhoff, Andreas B., Kelly, John D., Khan, Moin, Krych, Aaron J., Kuhn, John E., Kwon, Young M., Lädermann, Alexandre, Levine, William N., Fat, Darren Lim, Mazzocca, Augustus D., MacDonald, Peter B., McCarty, Eric C., Meislin, Robert J., Millett, Peter J., Molony, Diarmuid C., Moran, Cathal J., Moroder, Philipp, Moya, Daniel, O’Shea, Kieran, Owens, Brett D., Provencher, Matthew T., Rhee, Yong Girl, Rodeo, Scott A., Rokito, Andrew S., Rosso, Claudio, Scheibel, Markus, Verma, Nikhil N., Virk, Mandeep S., Walch, Gilles, Warren, Russell F., Waterman, Brian R., Whelan, Daniel B., Zuckerman, Joseph D., Hurley, Eoghan T., Matache, Bogdan A., Wong, Ivan, Itoi, Eiji, Strauss, Eric J., Delaney, Ruth A., Neyton, Lionel, Athwal, George S., Pauzenberger, Leo, Mullett, Hannan, and Jazrawi, Laith M.

Published
2022
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34. Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement

Author

Alaia, Michael J., Arciero, Robert A., Bedi, Asheesh, Brophy, Robert H., Calvo, Emilio, Campbell, Kirk A., Carter, Cordelia W., Cassidy, J Tristan, Ciccotti, Michael G., Cole, Brian J., Collin, Philippe, Cordasco, Frank A., Edwards, Sara E., Erickson, Brandon J., Favard, Luc, Frank, Rachel M., Funk, Lennard, Garrigues, Grant E., Di Giacomo, Giovanni, Gonzalez-Lomas, Guillem, Heuberer, Philipp R., Imhoff, Andreas B., Kelly, John D., Khan, Moin, Krych, Aaron J., Kuhn, John E., Kwon, Young M., Lädermann, Alexandre, Levine, William N., Fat, Darren Lim, Mazzocca, Augustus D., MacDonald, Peter B., McCarty, Eric C., Meislin, Robert J., Millett, Peter J., Molony, Diarmuid C., Moran, Cathal J., Moroder, Philipp, Moya, Daniel, O’Shea, Kieran, Owens, Brett D., Provencher, Matthew T., Rhee, Yong Girl, Rodeo, Scott A., Rokito, Andrew S., Rosso, Claudio, Scheibel, Markus, Verma, Nikhil N., Virk, Mandeep S., Walch, Gilles, Warren, Russell F., Waterman, Brian R., Whelan, Daniel B., Zuckerman, Joseph D., Matache, Bogdan A., Hurley, Eoghan T., Wong, Ivan, Itoi, Eiji, Strauss, Eric J., Delaney, Ruth A., Neyton, Lionel, Athwal, George S., Pauzenberger, Leo, Mullett, Hannan, and Jazrawi, Laith M.

Published
2022
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35. Risk Factors and Predictors of Significant Chondral Surface Change From Primary to Revision Anterior Cruciate Ligament Reconstruction: A MOON and MARS Cohort Study

Author

Group, The MARS, Magnussen, Robert A, Borchers, James R, Pedroza, Angela D, Huston, Laura J, Haas, Amanda K, Spindler, Kurt P, Wright, Rick W, Kaeding, Christopher C, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Lantz, Brett A, Mann, Barton, Stuart, Michael J, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Transplantation, Arthritis, Musculoskeletal, Adolescent, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Body Mass Index, Cartilage, Articular, Case-Control Studies, Female, Humans, Logistic Models, Male, Menisci, Tibial, Patellar Ligament, Prospective Studies, Reoperation, Risk Factors, Transplantation, Autologous, Transplantation, Homologous, Young Adult, ACL reconstruction, meniscus, articular cartilage, patient -reported outcomes, patellofemoral compartment, BMI, allograft, MARS Group, patient-reported outcomes, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise
Abstract

BackgroundArticular cartilage health is an important issue following anterior cruciate ligament (ACL) injury and primary ACL reconstruction. Factors present at the time of primary ACL reconstruction may influence the subsequent progression of articular cartilage damage.HypothesisLarger meniscus resection at primary ACL reconstruction, increased patient age, and increased body mass index (BMI) are associated with increased odds of worsened articular cartilage damage at the time of revision ACL reconstruction.Study designCase-control study; Level of evidence, 3.MethodsSubjects who had primary and revision data in the databases of the Multicenter Orthopaedics Outcomes Network (MOON) and Multicenter ACL Revision Study (MARS) were included. Reviewed data included chondral surface status at the time of primary and revision surgery, meniscus status at the time of primary reconstruction, primary reconstruction graft type, time from primary to revision ACL surgery, as well as demographics and Marx activity score at the time of revision. Significant progression of articular cartilage damage was defined in each compartment according to progression on the modified Outerbridge scale (increase ≥1 grade) or >25% enlargement in any area of damage. Logistic regression identified predictors of significant chondral surface change in each compartment from primary to revision surgery.ResultsA total of 134 patients were included, with a median age of 19.5 years at revision surgery. Progression of articular cartilage damage was noted in 34 patients (25.4%) in the lateral compartment, 32 (23.9%) in the medial compartment, and 31 (23.1%) in the patellofemoral compartment. For the lateral compartment, patients who had >33% of the lateral meniscus excised at primary reconstruction had 16.9-times greater odds of progression of articular cartilage injury than those with an intact lateral meniscus ( P < .001). For the medial compartment, patients who had

Published
2018

41. Surgical treatment for recurrent shoulder instability: factors influencing surgeon decision making

Author

Lau, Brian C., Hutyra, Carolyn A., Gonzalez, Juan Marcos, Mather, Richard C., III, Owens, Brett D., Levine, William N., Garrigues, Grant E., Kelly, John D., Kovacevic, David, Abrams, Jeffrey S., Cuomo, Frances, McMahon, Patrick J., Kaar, Scott, Dines, Joshua S., Miniaci, Anthony, Nagda, Sameer, Braman, Jonathan P., Harrison, Alicia K., MacDonald, Peter, and Riboh, Jonathan C.

Published
2021
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45. Surgical Predictors of Clinical Outcomes After Revision Anterior Cruciate Ligament Reconstruction

Author

Group, The MARS, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Haas, Amanda K, Huston, Laura J, Lantz, Brett A, Mann, Barton, Nwosu, Sam K, Spindler, Kurt P, Stuart, Michael J, Wright, Rick W, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Aging, Pain Research, Clinical Research, Arthritis, Rehabilitation, Patient Safety, Musculoskeletal, Activities of Daily Living, Adult, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Case-Control Studies, Female, Follow-Up Studies, Humans, Male, Osteoarthritis, Knee, Patient Reported Outcome Measures, Postoperative Complications, Quality of Life, Reoperation, Risk Factors, anterior cruciate ligament, revision ACL reconstruction, outcomes, surgical factors, surgical approach, tunnel position, ACL fixation, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics, Clinical sciences, Allied health and rehabilitation science, Sports science and exercise
Abstract

BackgroundRevision anterior cruciate ligament (ACL) reconstruction has been documented to have worse outcomes compared with primary ACL reconstruction.HypothesisCertain factors under the control of the surgeon at the time of revision surgery can both negatively and positively affect outcomes.Study designCase-control study; Level of evidence, 3.MethodsPatients undergoing revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline demographics, intraoperative surgical technique and joint disorders, and a series of validated patient-reported outcome instruments (International Knee Documentation Committee [IKDC] subjective form, Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating scale) completed before surgery. Patients were followed up for 2 years and asked to complete an identical set of outcome instruments. Regression analysis was used to control for age, sex, body mass index (BMI), activity level, baseline outcome scores, revision number, time since last ACL reconstruction, and a variety of previous and current surgical variables to assess the surgical risk factors for clinical outcomes 2 years after revision ACL reconstruction.ResultsA total of 1205 patients (697 male [58%]) met the inclusion criteria and were successfully enrolled. The median age was 26 years, and the median time since their last ACL reconstruction was 3.4 years. Two-year follow-up was obtained on 82% (989/1205). Both previous and current surgical factors were found to be significant contributors toward poorer clinical outcomes at 2 years. Having undergone previous arthrotomy (nonarthroscopic open approach) for ACL reconstruction compared with the 1-incision technique resulted in significantly poorer outcomes for the 2-year IKDC ( P = .037; odds ratio [OR], 2.43; 95% CI, 1.05-5.88) and KOOS pain, sports/recreation, and quality of life (QOL) subscales ( P ≤ .05; OR range, 2.38-4.35; 95% CI, 1.03-10.00). The use of a metal interference screw for current femoral fixation resulted in significantly better outcomes for the 2-year KOOS symptoms, pain, and QOL subscales ( P ≤ .05; OR range, 1.70-1.96; 95% CI, 1.00-3.33) as well as WOMAC stiffness subscale ( P = .041; OR, 1.75; 95% CI, 1.02-3.03). Not performing notchplasty at revision significantly improved 2-year outcomes for the IKDC ( P = .013; OR, 1.47; 95% CI, 1.08-1.99), KOOS activities of daily living (ADL) and QOL subscales ( P ≤ .04; OR range, 1.40-1.41; 95% CI, 1.03-1.93), and WOMAC stiffness and ADL subscales ( P ≤ .04; OR range, 1.41-1.49; 95% CI, 1.03-2.05). Factors before revision ACL reconstruction that increased the risk of poorer clinical outcomes at 2 years included lower baseline outcome scores, a lower Marx activity score at the time of revision, a higher BMI, female sex, and a shorter time since the patient's last ACL reconstruction. Prior femoral fixation, prior femoral tunnel aperture position, and knee flexion angle at the time of revision graft fixation were not found to affect 2-year outcomes in this revision cohort.ConclusionThere are certain surgical variables that the physician can control at the time of revision ACL reconstruction that can modify clinical outcomes at 2 years. Whenever possible, opting for an anteromedial portal or transtibial surgical exposure, choosing a metal interference screw for femoral fixation, and not performing notchplasty are associated with significantly better 2-year clinical outcomes.

Published
2017

46. Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

Author

Group, The MARS, Ding, David Y, Zhang, Alan L, Allen, Christina R, Anderson, Allen F, Cooper, Daniel E, DeBerardino, Thomas M, Dunn, Warren R, Haas, Amanda K, Huston, Laura J, Lantz, Brett A, Mann, Barton, Spindler, Kurt P, Stuart, Michael J, Wright, Rick W, Albright, John P, Amendola, Annunziato, Andrish, Jack T, Annunziata, Christopher C, Arciero, Robert A, Bach, Bernard R, Baker, Champ L, Bartolozzi, Arthur R, Baumgarten, Keith M, Bechler, Jeffery R, Berg, Jeffrey H, Bernas, Geoffrey A, Brockmeier, Stephen F, Brophy, Robert H, Bush-Joseph, Charles A, Butler, J Brad, Campbell, John D, Carey, James L, Carpenter, James E, Cole, Brian J, Cooper, Jonathan M, Cox, Charles L, Creighton, R Alexander, Dahm, Diane L, David, Tal S, Flanigan, David C, Frederick, Robert W, Ganley, Theodore J, Garofoli, Elizabeth A, Gatt, Charles J, Gecha, Steven R, Giffin, James Robert, Hame, Sharon L, Hannafin, Jo A, Harner, Christopher D, Harris, Norman Lindsay, Hechtman, Keith S, Hershman, Elliott B, Hoellrich, Rudolf G, Hosea, Timothy M, Johnson, David C, Johnson, Timothy S, Jones, Morgan H, Kaeding, Christopher C, Kamath, Ganesh V, Klootwyk, Thomas E, Levy, Bruce A, Benjamin, C, Maiers, G Peter, Marx, Robert G, Matava, Matthew J, Mathien, Gregory M, McAllister, David R, McCarty, Eric C, McCormack, Robert G, Miller, Bruce S, Nissen, Carl W, O’Neill, Daniel F, Owens, Brett D, Parker, Richard D, Purnell, Mark L, Ramappa, Arun J, Rauh, Michael A, Rettig, Arthur C, Sekiya, Jon K, Shea, Kevin G, Sherman, Orrin H, Slauterbeck, James R, Smith, Matthew V, Spang, Jeffrey T, Svoboda, Steven J, Taft, Timothy N, Tenuta, Joachim J, Tingstad, Edwin M, Vidal, Armando F, Viskontas, Darius G, White, Richard A, Williams, James S, Wolcott, Michelle L, Wolf, Brian R, and York, James J

Subjects
Arthritis, Prevention, Transplantation, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Musculoskeletal, Adult, Anterior Cruciate Ligament, Anterior Cruciate Ligament Injuries, Anterior Cruciate Ligament Reconstruction, Cartilage, Case-Control Studies, Female, Humans, Knee Injuries, Knee Joint, Male, Meniscus, Middle Aged, Patient Satisfaction, Prospective Studies, Reoperation, Risk Factors, Second-Look Surgery, Tibial Meniscus Injuries, Young Adult, revision anterior cruciate ligament reconstruction, subsequent surgery, reoperation, risk factors, outcomes, MARS Group, Biomedical Engineering, Mechanical Engineering, Human Movement and Sports Sciences, Orthopedics
Abstract

BackgroundWhile revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR.PurposeTo report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR.Study designCase-control study; Level of evidence, 3.MethodsA total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation.ResultsOf the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged

Published
2017

48. Latest Advances in Chondrocyte-Based Cartilage Repair.

Author

Yue, Li, Lim, Ryan, and Owens, Brett D.

Subjects
CARTILAGE, CARTILAGE regeneration, WNT signal transduction, CELLULAR signal transduction, CELLULAR therapy
Abstract

Chondrocyte-based cell therapy has been used for more than 30 years and is still considered to be a promising method of cartilage repair despite some limitations. This review introduces the latest developments of four generations of autologous chondrocyte implantation and current autologous chondrocyte products. The regeneration of cartilage from adult chondrocytes is limited by culture-induced dedifferentiation and patient age. Cartibeads is an innovative three-step method to produce high-quality hyaline cartilage microtissues, and it is developed from adult dedifferentiated chondrocytes with a high number of cell passages. In addition, allogeneic chondrocyte therapies using the Quantum hollow-fiber bioreactor and several signaling pathways involved in chondrocyte-based cartilage repair are mentioned, such as WNT signaling, the BMP-2/WISP1 pathway, and the FGF19 pathway. [ABSTRACT FROM AUTHOR]

Published
2024
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49. A Diagnosis of Vitamin D Deficiency Is Associated With Increased Rates of Primary Patellar Instability and Need for Recurrent Surgical Stabilization.

Author

Chang, Kenny, Albright, J. Alex, Quinn, Matthew, Khatri, Surya, Zhao, Leon, Byrne, Rory A., Daniels, Alan H., and Owens, Brett D.

Subjects
VITAMIN D deficiency, PATELLA dislocation, VITAMIN deficiency, DIAGNOSIS, ODDS ratio, LOGISTIC regression analysis
Abstract

Background: Vitamin D has been proven experimentally to affect musculoskeletal health. The purpose of this study was to identify the relationship between vitamin D deficiency and patellar instability. Hypothesis: Vitamin D deficiency is associated with an increased risk of experiencing primary patellar instability and recurrent patellar dislocation after primary surgical stabilization. Study Design: Retrospective comparative study. Level of Evidence: Level 3. Methods: A 1:1 matched retrospective study of 328,011 patients diagnosed with vitamin D deficiency was performed using the PearlDiver database. Incidence of primary patellar instability was calculated according to sex and age. Rates of primary patellar instability and surgical stabilization for recurrent dislocation were calculated with sex- and age-specific stratifications. Multivariable logistic regression was used to compare the rates of primary injury and recurrent stabilization while controlling for demographics and medical comorbidities. Results: A total of 656,022 patients were analyzed. The overall 1-year incidence rate of patellar instability in patients with vitamin D deficiency was 82.6 per 100,000 person-years (95% CI, 73.2-92.9), compared with 48.5 (95% CI, 41.4-56.5) in the matched control. Women were significantly more likely to experience primary patellar instability within 1 (adjusted odds ratio [aOR] = 1.45; 95% CI, 1.12-1.88) and 2 years (aOR, 1.31; 95% CI, 1.07-1.59) of hypovitaminosis D diagnosis. Patients aged 10 to 25 years with hypovitaminosis D were at greater risk of requiring recurrent patellar stabilization for both men (aOR, 2.48; 95% CI, 1.06-5.80) and women (aOR, 1.77; 95% CI, 1.04-3.02). Conclusion: Patients diagnosed with vitamin D deficiency experienced higher rates of primary patellar instability and have greater risk of requiring recurrent surgical stabilization for subsequent dislocations. Clinical Relevance: These results suggest that monitoring and proactively treating vitamin D deficiency in the physically active patient may lower the risk of suffering primary patellar instability or recurrence after surgical stabilization. [ABSTRACT FROM AUTHOR]

Published
2024
Full Text
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