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https://www.readbyqxmd.com/read/27872126/multiple-ligament-reconstruction-femoral-tunnels-intertunnel-relationships-and-guidelines-to-avoid-convergence
#1
Gilbert Moatshe, Alex W Brady, Erik L Slette, Jorge Chahla, Travis Lee Turnbull, Lars Engebretsen, Robert F LaPrade
BACKGROUND: Knee dislocations often require multiple concurrent ligament reconstructions, which involve creating several tunnels in the distal femur. Therefore, the risk of tunnel convergence is increased because of the limited bone volume within the distal aspect of the femur. PURPOSE: To assess the risk of tunnel convergence and determine the optimal reconstruction tunnel orientations for multiple ligament reconstructions in the femur. STUDY DESIGN: Descriptive laboratory study...
November 21, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27871653/surgical-management-and-treatment-of-the-anterior-cruciate-ligament-posterolateral-corner-injured-knee
#2
REVIEW
Nicholas I Kennedy, Christopher M LaPrade, Robert F LaPrade
Posterolateral knee injuries occur more commonly than in the past. These injuries most commonly occur concurrent with cruciate ligament tears. The main stabilizers of the posterolateral knee are the fibular collateral ligament, the popliteus tendon, and the popliteofibular ligament. These static stabilizers function to prevent increased varus, external rotation, and coupled posterolateral rotation of the knee. The most important clinical tests to diagnose posterolateral knee injuries are the varus stress test, posterolateral drawer, and dial tests...
January 2017: Clinics in Sports Medicine
https://www.readbyqxmd.com/read/27813021/bone-marrow-aspirate-concentrate-for-the-treatment-of-osteochondral-lesions-of-the-talus-a-systematic-review-of-outcomes
#3
REVIEW
Jorge Chahla, Mark E Cinque, Jason M Shon, Daniel J Liechti, Lauren M Matheny, Robert F LaPrade, Thomas O Clanton
BACKGROUND: The goal of this perform a systematic review on the outcomes of bone marrow aspirate concentrate (BMAC) for the treatment of chondral defects and osteoarthritis (OA) of the talus. RESULTS: The systematic search performed identified 47 studies after duplicates were removed. After inclusion criteria were applied four studies were considered for insightful analysis for the treatment of focal chondral defects in the foot and ankle with the use of BMAC. Three studies were retrospective and one study was prospective in nature...
December 2016: Journal of Experimental Orthopaedics
https://www.readbyqxmd.com/read/27733556/a-3-d-ct-analysis-of-screw-and-suture-button-fixation-of-the-syndesmosis
#4
Jason M Schon, Brady T Williams, Melanie B Venderley, Grant J Dornan, Jonathon D Backus, Travis Lee Turnbull, Robert F LaPrade, Thomas O Clanton
BACKGROUND: Historically, syndesmosis injuries have been repaired with screw fixation; however, some suggest that suture-button constructs may provide a more accurate anatomic and physiologic reduction. The purpose of this study was to compare changes in the volume of the syndesmotic space following screw or suture-button fixation using a preinjury and postoperative 3-D computed tomography (CT) model. The null hypothesis was that no difference would be observed among repair techniques...
October 12, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27729320/overlap-between-anterior-cruciate-ligament-and-anterolateral-meniscal-root-insertions-a-scanning-electron-microscopy-study
#5
Brett D Steineman, Samuel G Moulton, Tammy L Haut Donahue, Cristián A Fontboté, Christopher M LaPrade, Tyler R Cram, Chase S Dean, Robert F LaPrade
BACKGROUND: The anterolateral meniscal root (ALMR) has been reported to intricately insert underneath the tibial insertion of the anterior cruciate ligament (ACL). Previous studies have begun to evaluate the relationship between the insertion areas and the risk of iatrogenic injuries; however, the overlap of the insertions has yet to be quantified in the sagittal and coronal planes. PURPOSE: To investigate the insertions of the human tibial ACL and ALMR using scanning electron microscopy (SEM) and to quantify the overlap of the ALMR insertion in the coronal and sagittal planes...
October 11, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27709059/medial-opening-wedge-proximal-tibial-osteotomy
#6
Jorge Chahla, Chase S Dean, Justin J Mitchell, Gilbert Moatshe, Raphael Serra Cruz, Robert F LaPrade
Genu varus malalignment can lead to medial compartment overload and progression of ipsilateral compartment osteoarthritis. To slow this process, a medial opening wedge proximal tibial osteotomy (PTO) can be performed. This type of PTO is indicated in patients with genu varus malalignment and isolated medial compartment osteoarthritis of the knee, prior to or concurrent with medial compartment cartilage procedures or meniscal transplants, chronic posterolateral corner deficiency, or chronic anterior cruciate ligament deficiency...
August 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/27709054/medial-meniscus-radial-tear-a-transtibial-2-tunnel-technique
#7
Marco Nitri, Jorge Chahla, David Civitarese, Sanjeev Bhatia, Samuel G Moulton, Christopher M LaPrade, Robert F LaPrade
Complete radial tears of the medial meniscus significantly decrease the meniscal tissue's ability to dissipate tibiofemoral loads and have been described as functionally similar to a total meniscectomy, predisposing patients to early osteoarthritis. At present, no consensus exists regarding the optimal surgical treatment of a radial meniscal tear. Current repair techniques have led to a reportedly high rate of incomplete healing or healing of the meniscus in a nonanatomic, gapped position, which compromises its ability to withstand hoop stresses...
August 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/27709040/varus-producing-lateral-distal-femoral-opening-wedge-osteotomy
#8
Justin J Mitchell, Chase S Dean, Jorge Chahla, Gilbert Moatshe, Tyler R Cram, Robert F LaPrade
Valgus knee alignment in excess of physiological valgus leads to excessive loading of the lateral compartment, which can potentially increase the risk of osteoarthritis and can place the medial knee structures at risk of chronic attenuation. Varus-producing distal femoral osteotomies have been proposed for correction of valgus malalignment, to relieve tension on medial-sided structures, as well as to off-load the lateral compartment. Understanding that symptomatic valgus deformity of the knee represents a complex problem that is magnified in the setting of lateral compartment arthritis or medial ligamentous incompetence, we present our preferred technique for a varus-producing distal femoral osteotomy using plate osteosynthesis and cancellous bone allograft...
August 2016: Arthroscopy Techniques
https://www.readbyqxmd.com/read/27697189/editorial-commentary-limited-data-shows-how-little-we-know
#9
Justin J Mitchell, Jorge Chahla, Robert F LaPrade
Lateral compartment osteoarthritis of the knee can be a challenging problem to address in the younger, active population. The challenge is compounded by limited treatment options and high patient expectations, with patients often desiring a return to impact high intensity activity. Distal femoral osteotomy has been reported to be one potential treatment option; however, a highly heterogeneous literature exists for both opening and closing wedge distal femoral osteotomies for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment...
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/27683660/filamentation-protects-candida-albicans-from-amphotericin-b-induced-programmed-cell-death-via-a-mechanism-involving-the-yeast-metacaspase-mca1
#10
David J Laprade, Melissa S Brown, Morgan L McCarthy, James J Ritch, Nicanor Austriaco
The budding yeast Candida albicans is one of the most significant fungal pathogens worldwide. It proliferates in two distinct cell types: blastopores and filaments. Only cells that are able to transform from one cell type into the other are virulent in mouse disease models. Programmed cell death is a controlled form of cell suicide that occurs when C. albicans cells are exposed to fungicidal drugs like amphotericin B and caspofungin, and to other stressful conditions. We now provide evidence that suggests that programmed cell death is cell-type specific in yeast: Filamentous C...
July 2016: Microbial Cell
https://www.readbyqxmd.com/read/27681857/biomechanical-analysis-of-the-individual-ligament-contributions-to-syndesmotic-stability
#11
Thomas O Clanton, Brady T Williams, Jonathon D Backus, Grant J Dornan, Daniel J Liechti, Scott R Whitlow, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Biomechanical data and contributions to ankle joint stability have been previously reported for the individual distal tibiofibular ligaments. These results have not yet been validated based on recent anatomic descriptions or using current biomechanical testing devices. METHODS: Eight matched-pair, lower leg specimens were tested using a dynamic, biaxial testing machine. The proximal tibiofibular joint and the medial and lateral ankle ligaments were left intact...
September 28, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27672016/biomechanical-comparison-of-3-current-ankle-syndesmosis-repair-techniques
#12
Thomas O Clanton, Scott R Whitlow, Brady T Williams, Daniel J Liechti, Jonathon D Backus, Grant J Dornan, Adriana J Saroki, Travis Lee Turnbull, Robert F LaPrade
BACKGROUND: Significant debate exists regarding optimal repair for unstable syndesmosis injuries. Techniques range from screw fixation, suture-button fixation, or a combination of the two. In this study, 3 common repairs were compared using a simulated weightbearing protocol with internal and external rotation of the foot. METHODS: Twenty-four lower leg specimens with mean age 54 years (range, 38-68 years) were used for testing. Following creation of a complete syndesmotic injury (AITFL, ITFL, PITFL, interosseous membrane), specimens were repaired using 1 of 3 randomly assigned techniques: (1) one 3...
September 25, 2016: Foot & Ankle International
https://www.readbyqxmd.com/read/27659939/hip-capsular-closure-a-biomechanical-analysis-of-failure-torque
#13
Jorge Chahla, Jacob D Mikula, Jason M Schon, Chase S Dean, Kimi D Dahl, Travis J Menge, Eduardo Soares, Travis Lee Turnbull, Robert F LaPrade, Marc J Philippon
BACKGROUND: Hip capsulotomy is routinely performed during arthroscopic surgery to achieve adequate exposure of the joint. Iatrogenic instability can result after hip arthroscopic surgery because of capsular insufficiency, which can be avoided with effective closure of the hip capsule. There is currently no consensus in the literature regarding the optimal quantity of sutures upon capsular closure to achieve maximal stability postoperatively. PURPOSE/HYPOTHESIS: The purpose of this study was to determine the failure torques of 1-, 2-, and 3-suture constructs for hip capsular closure to resist external rotation and extension after standard anterosuperior interportal capsulotomy (12 to 3 o'clock)...
September 22, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27631413/insights-into-the-epiphyseal-cartilage-origin-and-subsequent-osseous-manifestation-of-juvenile-osteochondritis-dissecans-with-a-modified-clinical-mr-imaging-protocol-a-pilot-study
#14
Jutta Ellermann, Casey P Johnson, Luning Wang, Jeffrey A Macalena, Bradley J Nelson, Robert F LaPrade
Purpose To retrospectively determine if a modified clinical magnetic resonance (MR) imaging protocol provides information on the origin of juvenile osteochondritis dissecans (JOCD) lesions and allows for staging on the basis of the proposed natural history of JOCD to better guide clinical management of the disease. Materials and Methods This institutional review board-approved, HIPAA-compliant, retrospective study was performed in 13 consecutive patients (mean age, 14.9 years; age range, 10-22 years; nine male and four female patients) and one additional comparative patient (a 44-year-old man), in which 19 knees with 20 JOCD lesions were imaged...
September 15, 2016: Radiology
https://www.readbyqxmd.com/read/27624178/high-load-preconditioning-of-human-soft-tissue-hamstring-grafts-an-in-vitro-biomechanical-analysis
#15
W Charles Lockwood, Daniel Cole Marchetti, Kimi D Dahl, Jacob D Mikula, Brady T Williams, Matthew M Kheir, Travis Lee Turnbull, Robert F LaPrade
PURPOSE: In order to minimize viscoelastic elongation of ACL reconstruction grafts, preconditioning protocols have been employed in clinical practice prior to final graft fixation. The purpose of this study was to evaluate two separate high-load static preconditioning protocols of double-looped semitendinosus-gracilis grafts and compare these results to both a current clinical protocol and a control group with no preconditioning protocol applied. It was hypothesized that a high-load, static preconditioning protocol would minimize graft elongation during a simulated progressive early rehabilitation compared to both the "89 N" clinical protocol and control groups...
September 13, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27613538/posteromedially-placed-plates-with-anterior-staple-reinforcement-are-not-successful-in-decreasing-tibial-slope-in-opening-wedge-proximal-tibial-osteotomy
#16
Chase S Dean, Jorge Chahla, Lauren M Matheny, Tyler R Cram, Samuel G Moulton, Grant J Dornan, Justin J Mitchell, Robert F LaPrade
PURPOSE: To document the effectiveness of a novel technique to decrease tibial slope in patients who underwent a proximal opening-wedge osteotomy with an anteriorly sloped plate placed in a posteromedial position. The hypothesis was that posteromedial placement of an anteriorly sloped osteotomy plate with an adjunctive anterior bone staple on the tibia would decrease, and maintain, the tibial slope correction at a minimum of 6 months following the osteotomy. METHODS: All patients who underwent biplanar medial opening-wedge proximal tibial osteotomy with anterior staple augmentation to decrease sagittal plane tibial slope were included, and data were collected prospectively and reviewed retrospectively...
September 9, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27562342/international-meniscus-reconstruction-experts-forum-imref-2015-consensus-statement-on-the-practice-of-meniscal-allograft-transplantation
#17
Alan Getgood, Robert F LaPrade, Peter Verdonk, Wayne Gersoff, Brian Cole, Tim Spalding
Meniscal allograft transplantation (MAT) has become relatively commonplace in specialized sport medicine practice for the treatment of patients with a symptomatic knee after the loss of a functional meniscus. The technique has evolved since the 1980s, and long-term results continue to improve. However, there still remains significant variation in how MAT is performed, and as such, there remains opportunity for outcome and graft survivorship to be optimized. The purpose of this article was to develop a consensus statement on the practice of MAT from key opinion leaders who are members of the International Meniscus Reconstruction Experts Forum so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined with the goal of ultimately improving patient outcomes...
August 25, 2016: American Journal of Sports Medicine
https://www.readbyqxmd.com/read/27535676/erratum-to-the-challenge-of-treating-complex-knee-instability
#18
V Musahl, S Zaffagnini, R LaPrade, M T Hirschmann, J Karlsson
No abstract text is available yet for this article.
August 17, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
https://www.readbyqxmd.com/read/27504467/meniscal-ramp-lesions-anatomy-incidence-diagnosis-and-treatment
#19
Jorge Chahla, Chase S Dean, Gilbert Moatshe, Justin J Mitchell, Tyler R Cram, Carlos Yacuzzi, Robert F LaPrade
Meniscal ramp lesions are more frequently associated with anterior cruciate ligament (ACL) injuries than previously recognized. Some authors suggest that this entity results from disruption of the meniscotibial ligaments of the posterior horn of the medial meniscus, whereas others support the idea that it is created by a tear of the peripheral attachment of the posterior horn of the medial meniscus. Magnetic resonance imaging (MRI) scans have been reported to have a low sensitivity, and consequently, ramp lesions often go undiagnosed...
July 2016: Orthopaedic Journal of Sports Medicine
https://www.readbyqxmd.com/read/27489757/superficial-medial-collateral-ligament-of-the-knee-anatomic-augmentation-with-semitendinosus-and-gracilis-tendon-autografts
#20
Raphael Serra Cruz, Javier Olivetto, Chase S Dean, Jorge Chahla, Robert F LaPrade
The superficial medial collateral ligament (sMCL) and associated knee structures are the most commonly injured structures of the knee. Most isolated sMCL tears are treated nonoperatively. Several studies have described different algorithms for treatment of sMCL lesions, as well as different types of techniques, both in the acute and in chronic settings. The purpose of this article was to detail our anatomic sMCL augmentation technique using semitendinosus and gracilis tendon autografts.
April 2016: Arthroscopy Techniques
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