Use of allograft bone matrix in clinical orthopedics.

Clinical orthopedics continuously aims to improve methods for bone formation. Clinical applications where bone formation is necessary include critical long bone defects in orthopedic trauma or tumor patients. Though some biomaterials combined with autologous stem cells significantly improve bone repair, critical-size damages are still challenged with the suitable implantation of biomaterials and donor cell survival.

AOA Critical Issues Symposium: Promoting Health Equity.

Promoting equitable health care is to ensure that everyone has access to high-quality medical services and appropriate treatment options. The definition of health equity often can be misinterpreted, and there are challenges in fully understanding the disparities and costs of health care and when measuring the outcomes of treatment. However, these topics play an important role in promoting health equity.

Technology-Assisted Hip and Knee Arthroplasty in Orthopaedic Residency Training: A National Survey.

Introduction: The adoption of technology-assisted total joint arthroplasty (TA-TJA) is increasing; however, the extent to which TA-TJA is used among orthopaedic trainees is unknown. The purpose of this study was to assess the current use of TA total knee arthroplasty (TKA) and total hip arthroplasty (THA) by orthopaedic residents and to evaluate resident perceptions toward TA-TJA in their surgical training.

Methods: In this cross-sectional study, an anonymous electronic survey was sent to all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency program coordinators to distribute to their PGY-2 to PGY-5 residents.

The pathophysiology and treatment of musculoskeletal fibrosis.

Fibrosis continues to challenge the regeneration and repair of the Orthopaedic tissues in states of injury or disease. The mechanism behind developmental fibrosis has been widely investigated in the last few decades. However, the current efficacy of treatment for existing fibrous scars remains insufficient from both basic research and clinical perspectives.

The Biological Use of Platelet-Rich Plasma in Skeletal Muscle Injury and Repair.

Platelet-rich plasma (PRP) is a blood product that contains several growth factors and active proteins. PRP is thought to be used autologously to assist in the repair of injured tissues as well as to treat pain at the site of injury. The mechanism behind PRP in regenerative medicine has been well investigated and includes the identification and concentration of released growth factors and exosomes.

Pediatric Supracondylar Humerus Fractures Can Be Safely Treated by Orthopaedic Surgeons With and Without Pediatric Fellowship Training.

Background: The purpose of this study was to compare the outcomes of pediatric patients who were surgically treated for a supracondylar humerus fracture by pediatric fellowship-trained orthopaedic surgeons (PFT) to the outcomes of those surgically treated by orthopaedic surgeons without pediatric fellowship training (NPFT). We hypothesized that there would be no differences in patient outcomes.

Methods: A retrospective review of pediatric patients who underwent surgical treatment for a supracondylar humerus fracture with closed reduction and percutaneous pinning (CRPP) or open reduction and percutaneous pinning (ORPP) at a regional level 1 trauma center over a 5-year period was performed.

Fibrosis following Acute Skeletal Muscle Injury: Mitigation and Reversal Potential in the Clinic.

Skeletal muscle injuries occur often in athletics and in daily life. In minor injuries, muscles are able to regenerate completely and recover their functional capabilities. However, in the case of severe injuries, the injured muscle cannot recover to a functional level because of the formation of fibrous scar tissue.

Quantifying the Impact of Patient-Specific Factors and Disease Severity on Clinical Decision Making in Cuff Tear Arthropathy: A Case-Based Survey.

Background: Rotator cuff tears are a common cause of disability. Some patients with massive and irreparable tears can develop cuff tear arthropathy (CTA), which makes management more challenging.

Questions/purposes: We sought to examine how orthopedists determine treatment for patients with CTA.

The General Orthopaedist: Going the Way of the Dinosaur or the Next Subspecialty?: AOA Critical Issues.

Orthopaedic specialization has increased substantially over the past several decades, partly due to the desire of residents to improve their clinical expertise and to increase the likelihood that they will obtain a position with better compensation and a more balanced lifestyle. The American Academy of Orthopaedic Surgeons (AAOS) census data support this trend, demonstrating a substantial rise in the percentage of practicing orthopaedic surgeons who identify themselves as specialists rather than as general orthopaedic surgeons. There is a perception that a more narrowed scope of practice may prevent the current orthopaedic workforce from being able to adequately care for populations in rural areas of the United States.

Superolateral Hoffa's Fat Pad Edema in Collegiate Volleyball Players.

Objective: Superolateral Hoffa's fat pad (SHFP) edema is a previously described magnetic resonance (MR) finding located between the patellar tendon and the lateral femoral condyle. The purpose of our study was to determine the prevalence and clinical significance of SHFP edema in female collegiate volleyball players.

Materials And Methods: Sixteen female collegiate volleyball players were consented for bilateral knee evaluations which consisted of history, physical examination and MR imaging.

Improved biomechanical and biological outcomes in the MRL/MpJ murine strain following a full-length patellar tendon injury.

Musculoskeletal injuries greatly affect the U.S. population and current clinical approaches fail to restore long-term native tissue structure and function.

Allergy/hypersensitivity reactions as a predisposing factor to complex regional pain syndrome I in orthopedic patients.

Several predisposing conditions have been associated with complex regional pain syndrome I (CRPS I). The purpose of this study was to determine the relationship between a history of allergy/hypersensitivity reactions and CRPS I in orthopedic patients. Orthopedic patients with CRPS I (n=115) who experienced pain relief after a successful sympathetic nerve blockade were identified for study inclusion; a control group (n=115) matched to the CRPS I group by age, sex, and location of injury was also included.

The trochlear cleft: initial experience in elite athletes.

Objective: The trochlear cleft is a recently described vertically oriented, low-signal cartilage lesion centered in the trough of the trochlear cartilage. The purpose of our study was to determine the incidence of clefts in an at-risk group of athletes and correlate these findings with clinical and physical examination results.

Materials And Methods: Sixteen female collegiate volleyball players consented to bilateral knee evaluations, which consisted of history, physical examination, and magnetic resonance (MR) imaging.

Murine patellar tendon biomechanical properties and regional strain patterns during natural tendon-to-bone healing after acute injury.

Tendon-to-bone healing following acute injury is generally poor and often fails to restore normal tendon biomechanical properties. In recent years, the murine patellar tendon (PT) has become an important model system for studying tendon healing and repair due to its genetic tractability and accessible location within the knee. However, the mechanical properties of native murine PT, specifically the regional differences in tissue strains during loading, and the biomechanical outcomes of natural PT-to-bone healing have not been well characterized.

Structural and biomechanical responses of osseous healing: a novel murine nonunion model.

Background: Understanding the biological mechanisms of why certain fractures are at risk for delayed healing or nonunion requires translational animal models that take advantage of transgenic and other genetic manipulation technologies. Reliable murine nonunion models can be an important tool to understand the biology of nonunion. In this study, we report the results of a recently established model for creating critical defects that lead to atrophic nonunions based on a unique fracture fixation technique.

The paratenon contributes to scleraxis-expressing cells during patellar tendon healing.

The origin of cells that contribute to tendon healing, specifically extrinsic epitenon/paratenon cells vs. internal tendon fibroblasts, is still debated. The purpose of this study is to determine the location and phenotype of cells that contribute to healing of a central patellar tendon defect injury in the mouse.

Percutaneous balloon humeroplasty for Hill-Sachs lesions: a novel technique.

Introduction: Hills-Sachs lesions are commonly associated with anterior shoulder dislocations and can be a source of recurrent instability. Studies have shown that, even after soft tissue repair of a Bankart lesion, there is still a risk for redislocation in a patient with significant bony defects. The purpose of this study is to ascertain whether balloon humeroplasty is an effective technique of reducing acute Hill-Sachs defect in a cadaveric model.

The trochlear cleft: the “black line” of the trochlear trough.

Objective: The “cartilage black line sign” is a recently described T2 dark cartilage lesion that we have identified appearing as a cleft in the trochlear trough. The purpose of our study was to define the MR imaging characteristics of a trochlear cleft, determine its incidence, and correlate the MR findings with arthroscopy.

Materials And Methods: A total of 1,300 consecutive MR examinations of the knee were retrospectively reviewed by consensus of two fellowship-trained musculoskeletal radiologists.