Publications by authors named "Raffy Mirzayan"
Article Synopsis
- The study investigates the outcomes of superior capsular reconstruction (SCR) using a dermal allograft, specifically analyzing the impact of graft tears based on their location rather than treating all tears as a single group.
- Researchers hypothesized that patients with intact grafts would experience similar functional outcomes as those with tears that still covered the tuberosity.
- Results showed significant improvements in shoulder function and pain scores for patients with both intact grafts and those with specific types of tears, with a notable distinction in outcomes based on graft integrity and tear location.
Article Synopsis
- * The decision to use ABR depends on patient factors like age and activity level, as well as accurate assessments of bone loss through reliable imaging techniques; in suitable cases, ABR can yield good long-term outcomes.
- * Controversies surrounding ABR include techniques like glenoid cartilage removal, types of anchors used, and whether to close the rotator interval; for significant bone loss, several alternative surgeries like the Latarjet procedure and bone grafting options are available. *
Article Synopsis
- Osteochondritis dissecans (OCD) of the humeral capitellum is a complex and rare condition, often treated with fresh osteochondral allograft transplantation (FOCAT), which has recently gained popularity over traditional methods like debridement and microfracture due to better outcomes.* -
- This study analyzed 35 patients, mostly athletes (like baseball players and gymnasts), who underwent FOCAT from 2006 to 2022, with notable improvement in pain and function scores following the procedure.* -
- The findings indicated a successful long-term impact of FOCAT, with a significant enhancement in patients' quality of life and reduced pain over an average follow-up of nearly 93
Article Synopsis
- Bone marrow stimulation (BMS) is a proposed technique for enhancing healing during arthroscopic rotator cuff repair (ARCR) by creating vents to allow healing elements like stem cells and growth factors to access the repair site.
- A meta-analysis of 7 randomized controlled trials (RCTs) involving 576 patients was conducted to compare outcomes between BMS and control groups.
- The analysis found no significant differences in retear rates or clinical outcomes, indicating that BMS did not improve results after ARCR.
Reconstruction of chronic long head of biceps tendon tears with gracilis allograft: report of two cases.
Clin Shoulder Elb
September 2024
Article Synopsis
- Two cases of symptomatic chronic long head of the biceps tendon (LHBT) ruptures were treated using allograft reconstruction, one due to tendon shortening and the other due to total loss.
- A gracilis allograft was woven through the biceps muscle to reconstruct the tendon, allowing for sufficient length for a subpectoral tenodesis procedure.
- This method effectively relieved symptoms and corrected the appearance typically associated with ruptured biceps (often referred to as "Popeye muscle").
Article Synopsis
- Anterior glenohumeral instability combined with an irreparable subscapularis tear is a complex issue for orthopedic surgeons, with current treatments often yielding inconsistent results.
- Acellular dermal allografting has shown promise in younger patients with severe rotator cuff tears, although its effectiveness for anterior deficiencies has been less studied.
- In a report on two older patients who underwent anterior capsular reconstruction using this method, significant improvements were observed after over four years, suggesting that acellular dermal allografting is a viable option for treating massive irreparable subscapularis tears.
Article Synopsis
- - This study conducted a meta-analysis to evaluate the effectiveness of using an acellular collagen matrix patch (ACMP) during arthroscopic rotator cuff repair (ARCR) compared to standard repair methods without ACMP.
- - The analysis included five randomized controlled trials with a total of 307 patients, finding significantly lower re-tear rates (11% vs 34%) and better clinical outcomes (higher Constant scores and American Shoulder and Elbow Surgeons scores) in patients who received ACMP augmentation.
- - The results suggest that using ACMP augmentation in ARCR may lead to improved patient outcomes and reduced chances of re-tear, supporting its use in clinical practice.
Article Synopsis
- Radial head arthroplasty (RHA) is an effective treatment for complex radial head fractures, but more extensive studies are needed to identify the best implant types and sizes due to the limited existing literature.
- A study analyzing 405 RHA cases revealed that larger radial head diameters correlate with higher revision rates, especially in the first 36 months post-surgery, and that obese patients tend to have worse outcomes.
- The findings indicated no significant differences in outcomes between two specific implant types (Acumed Anatomic and Evolve), but the study highlighted a higher reoperation rate for patients with terrible triad injuries compared to isolated cases.
Article Synopsis
- This study investigates the risk of requiring additional surgery (aseptic revision) after anterior cruciate ligament reconstructions (ACLR) using different types of grafts: hamstring autograft (HA) and hybrid grafts (HY) that combine HA and allograft tendon.
- Researchers analyzed data from patients aged 25 and younger who had ACLR between 2005-2020, focusing on graft size and its impact on revision risk.
- Findings revealed that there were no significant differences in the likelihood of needing revision surgery for smaller HA grafts (less than 8 mm) compared to larger HY grafts (8 mm or more), suggesting that smaller HA grafts may be sufficient without the need for augmentation
Article Synopsis
- * A total of ten patients who underwent this procedure between 2015 and 2022 showed significant improvements in shoulder function and pain relief based on various scores, including ASES and VAS.
- * Follow-up MRI results indicated successful graft healing in all patients, highlighting the effectiveness of biologic tuberoplasty in enhancing patient outcomes.
Article Synopsis
- The study compared recurrence rates of paresthesias in patients who had primary cubital tunnel surgery with and without wrapping the ulnar nerve in human amniotic membrane (HAM).
- A total of 78 patients were analyzed, revealing that none of the 21 patients wrapped in HAM experienced recurrence of symptoms, while 19.3% of the 57 control patients did.
- The results suggest that using HAM significantly lowers the risk of recurring symptoms, prompting the need for more extensive studies to explore its effectiveness in cubital tunnel surgery.
Article Synopsis
- Several new treatments are emerging for patients with massive rotator cuff tears, including biologic tuberoplasty, which uses a dermal allograft to improve pain and function.
- Balloon arthroplasty, now FDA-approved, is also gaining popularity as a treatment option.
- Anterior cable reconstruction and lower trapezius tendon transfers have become viable solutions, especially for patients seeking to restore active external rotation.
Article Synopsis
- - A 60-year-old male underwent Achilles' tendon repair with amnion augmentation, receiving liposomal bupivacaine for nerve blocks before surgery to manage pain.
- - Post-surgery, the patient experienced an irregular anesthetic course characterized by delayed motor weakness, temporary non-weight-bearing status, and inconsistent motor block.
- - After an initial resolution of symptoms within three days, the patient faced a complete motor block on day four, which gradually improved, leading to full resolution of symptoms by day ten with no reported pain.
Background: Radial head arthroplasty (RHA) is commonly performed for isolated comminuted radial head fractures and in conjunction with traumatic elbow instability. However, there is a paucity of literature directly describing the characteristics and outcomes of patients who undergo RHA in a community-based setting. We describe a cohort of 970 RHA performed in the California regions of a US integrated health care system over a 9-year period.
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- The study focuses on superior capsule reconstruction (SCR) for treating irreparable massive rotator cuff tears (MRCT) and proposes a new classification system for assessing graft integrity and tear locations.
- Data was collected from 53 patients who underwent SCR, with an 80% follow-up rate using MRI to evaluate postoperative graft integrity.
- Results showed that 38% of grafts remained intact, while the majority of the tears occurred at various locations, emphasizing the need for further research on the clinical implications of these findings.
Article Synopsis
- Chronic distal biceps tendon ruptures are complex due to issues like tendon retraction, shortening, and muscle loss.
- Various surgical graft options and fixation methods exist, but none have been shown to be the best.
- The described technique involves using a tibialis anterior tendon allograft woven through the muscle for stronger integration with the muscle and tendon fascia.
We present the technique of biologic tuberoplasty, where an acellular dermal allograft is used to cover the tuberosity in patients with massive irreparable cuff tears to prevent bone-to-bone contact between the tuberosity and acromion when active elevation is attempted. This technique can be performed in patients with massive rotator cuff tears who are low-demand and have significant medical comorbidities, poor bone quality, or who are not candidates for a reverse shoulder arthroplasty or who cannot tolerate a lengthy rehabilitation protocol. It is less time-consuming than a superior capsule reconstruction and more bone-sparing than traditional tuberoplasty.
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- Three patients underwent ulnar nerve transposition and were treated with human amniotic membrane (HAM) wrapping to aid recovery.* -
- All patients later required reoperation for their original issues, not related to the ulnar nerve, which allowed for study of the transposed nerve.* -
- The procedure showed reduced scar formation and easy separation of the nerve from surrounding tissue, indicating that HAM wrapping is beneficial in preventing complications.*
Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking.
Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation.
Article Synopsis
- * Researchers reviewed data from 170 patients who received TEA between 2009 and 2018, noting an increase in procedures, particularly for trauma, revealing that the most common reasons for surgery were fractures and rheumatoid arthritis.
- * Results indicated that the cumulative rate of revision surgery after four years was nearly 10%, with a significant percentage (25.3%) of patients experiencing emergency department visits and 14.1% being readmitted within 90 days post-surgery, underscoring the need for further research on TEA outcomes.*
Article Synopsis
- Superior capsule reconstruction is becoming a popular treatment for massive rotator cuff tears, with initial use of the tensor fascia lata graft, but now acellular dermal matrix or dermal allograft is more common in the U.S.
- Although results have been generally positive, some studies show that graft tears can occur after surgery, prompting efforts to reduce this rate.
- One proposed solution is to use a thicker graft, as biomechanical studies indicate that thicker and stiffer grafts improve stability; the technique presented involves doubling a 3 mm dermal allograft to create a 6 mm graft.
Ulnar collateral ligament reconstruction of the elbow has evolved substantially since its introduction in 1974. Numerous variations of the surgery have been introduced, including modifications in tunnel creation, graft tensioning, and fixation. These changes have aimed to improve overall quality of the reconstruction; however, even the most commonly used techniques still present many challenges.
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- A new radiographic sign called the "Empty Merchant Sign" is introduced for diagnosing acute patellar tendon ruptures (APTR) and its accuracy, sensitivity, and specificity are evaluated.
- A study involving 50 trainees and non-trainees analyzed their ability to diagnose four knee conditions using lateral and Merchant radiographs before and after a tutorial on the Empty Merchant Sign.
- Results showed that post-tutorial, the Empty Merchant Sign had superior specificity and positive predictive value compared to lateral view, and accuracy improved significantly for all participants, indicating that even with minimal training, clinicians can effectively identify this sign.
Article Synopsis
- The study compares two methods of patellar tendon repair—transosseous technique and suture anchor repair—analyzing their clinical outcomes in 361 patients over a decade.
- Results showed that while both techniques had similar demographics and complication rates, anchor repairs had a significantly lower rerupture rate (0% vs. 7.5%).
- The findings provide evidence for the advantages of suture anchor repairs but indicate no difference in recovery time between the two methods.