Determination of Work Relative Value Units for Management of Lumbar Spinal Stenosis by Open Decompression and Interlaminar Stabilization.

Background: Effective January 1, 2017, open surgical decompression and interlaminar stabilization (ILS) received a Category I (CPT®) code 22867. The current work relative value units (wRVUs) assigned to the procedure of 13.5 are not reflective of the amount of work involved.

Guideline summary review: an evidence-based clinical guideline for the diagnosis and treatment of low back pain.

Background Context: The North American Spine Society's (NASS) Evidence Based Clinical Guideline for the Diagnosis and Treatment of Low Back Pain features evidence-based recommendations for diagnosing and treating adult patients with nonspecific low back pain. The guideline is intended to reflect contemporary treatment concepts for nonspecific low back pain as reflected in the highest quality clinical literature available on this subject as of February 2016.

Purpose: The purpose of the guideline is to provide an evidence-based educational tool to assist spine specialists when making clinical decisions for adult patients with nonspecific low back pain.

Superiority Claims for Spinal Devices: A Systematic Review of Randomized Controlled Trials.

Study Design: Systematic review.

Objectives: Superiority claims for medical devices are commonly derived from noninferiority trials, but interpretation of such claims can be challenging. This study aimed to () establish the prevalence of noninferiority and superiority designs among spinal device trials, () assess the frequency of post hoc superiority claims from noninferiority studies, and () critically evaluate the risk of bias in claims that could translate to misleading conclusions.

Three-Dimensional Printing and Tissue Engineering in Orthopaedics.

Additive manufacturing and three-dimensional printing technology may revolutionize tissue-engineering strategies. Many clinical needs, including multitissue regeneration, remain unmet among patients with orthopaedic conditions. Ongoing research efforts in three-dimensional printing, including cell-containing bioinks for bioprinting, have resulted in acellular and cellular biomaterials that may help regenerate or replace damaged or missing biologic tissues.

Applications of Three-Dimensional Printing in Orthopaedic Surgery.

Orthopaedic surgeons should be aware of the variety of applications of three-dimensional printing, which range from rough-and-ready applications, such as rapid prototyping of implant designs with the use of polymers to the fabrication of patient-specific implants and custom implants with the use of the principles of metallurgy. The local manufacture of low-cost prosthetic devices in third-world nations is the best example of the potential application of three-dimensional printing. Orthopaedic surgeons should understand the multiple applications of three-dimensional printing, including prototyping of anatomy, implants, orthotics, patient-specific instrumentation, and implants that incorporate porous structures and accommodate complex anatomy, as well as the future of biologically active three-dimensional printing.

Introduction to Additive Manufacturing and Three-Dimensional Printing in Orthopaedics.

Additive manufacturing involves the construction of devices via the layer-by-layer deposition of materials. Additive manufacturing, which also is referred to as three-dimensional printing, is different from traditional machining, which involves the subtraction of material from a workpiece. Although traditional machining methods have been used in the field of manufacturing for decades, a recent rise in the commercial use of additive manufacturing has occurred in the field of orthopaedic surgery.

Pivotal trials of orthopedic surgical devices in the United States: predominance of two-arm non-inferiority designs.

Background: The United States Food and Drug Administration (FDA) reviews class III orthopedic devices submitted for premarket approval with pivotal clinical trials. The purpose of this study was to determine the types of orthopedic devices reviewed, the design of their pivotal clinical trials, and the subjective factors affecting the interpretation of clinical trial data.

Methods: Meetings of the FDA Orthopaedic and Rehabilitation Devices Panel were identified from 2000-2016.

Spinal devices in the United States-investigational device exemption trials and premarket approval of class III devices.

Background Context: Recently, there has been increased public awareness of regulatory actions by the United States Food and Drug Administration (FDA) on spinal devices. There has also been increased scrutiny of the pivotal clinical trials of these devices.

Purpose: To investigate the premarket approval (PMA) of class III spinal devices in the United States since the turn of the century.

Does the presence of the fibronectin-aggrecan complex predict outcomes from lumbar discectomy for disc herniation?

Background Context: Protein biomarkers associated with lumbar disc disease have been studied as diagnostic indicators and therapeutic targets. Recently, a cartilage degradation product, the fibronectin-aggrecan complex (FAC) identified in the epidural space, has been shown to predict response to lumbar epidural steroid injection in patients with radiculopathy from herniated nucleus pulposus (HNP).

Purpose: Determine the ability of FAC to predict response to microdiscectomy for patients with radiculopathy due to lumbar disc herniation STUDY DESIGN/SETTING: Single-center prospective consecutive cohort study.

Does a fibronectin and aggrecan complex play a role in painful vertebral disks?

Objective: To determine the presence of a fibronectin-aggrecan complex (FAC) in the disk space of persons with chronic low back pain as relates to provocative diskography.

Design: A single-center prospective consecutive case series.

Setting: A single private practice setting.

Platelet-rich plasma increases matrix metalloproteinases in cultures of human synovial fibroblasts.

Background: The effect of platelet-rich plasma on chondrocytes has been studied in cell and tissue culture. Less attention has been given to the effect of platelet-rich plasma on nonchondrocytic cell lineages within synovial joints, such as fibroblast-like synoviocytes, which produce cytokines and matrix metalloproteinases (MMPs) that mediate cartilage catabolism. The purpose of the present study was to determine the effect of platelet-rich plasma on cytokines and proteases produced by fibroblast-like synoviocytes.

Correlation of intra-articular ankle pathology with cytokine biomarkers and matrix degradation products.

Background: Articular cartilage degeneration is mediated by inflammatory cytokines and fragments of structural matrix proteins. Few studies have examined the role of these biomarkers in intra-articular pathology of the ankle.

Methods: Four groups of patients with increasing ankle pathology were enrolled.

Failure strength of lumbar spinous processes loaded in a tension band model.

Object: There has been increasing interest in spinous process tension band devices, as distinct from spinous process spacers and plates. The purpose of this study was to load spinous processes caudally at L-4 and cranially at L-5 parallel to the long axis of the spine in a biomechanical model of tension band loading. The goal was to provide normative data for the design of a spinous process tension band device after varying degrees of surgical decompression and across varying bone mineral densities (BMDs).

The in vitro chondrotoxicity of single-dose local anesthetics.

Background: The administration of amide-type local anesthetics to cartilaginous tissues has revealed potential chondrotoxicity.

Purpose: This study evaluated whether administration of single doses of 1% lidocaine, 0.25% bupivacaine, and 0.

Effects of arm position on maximizing intra-articular visualization of the biceps tendon: a cadaveric study.

Purpose: The purpose of this study was to assess the intra-articular length of the biceps tendon in various shoulder and arm positions and identify the position in which the extra-articular portion of the tendon is maximally visualized within the glenohumeral joint.

Methods: We measured 18 positions in 4 fresh-frozen cadaveric shoulders for a total of 72 measurements. In each measurement the position of the proximal biceps tendon was measured relative to a baseline measurement in neutral position (0° shoulder flexion, 0° shoulder abduction, 0° elbow flexion, 0° shoulder rotation).

Is the fibronectin-aggrecan complex present in cervical disk disease?

Objective: To investigate the presence of inflammatory cytokines and the fibronectin-aggrecan complex (FAC) in persons undergoing surgical treatment for cervical radiculopathy caused by disk herniation.

Design: Single-center, prospective, consecutive case series.

Setting: A single large academic institution.

Prospective correlation between serum relaxin concentration and anterior cruciate ligament tears among elite collegiate female athletes.

Background: The female anterior cruciate ligament may be more susceptible to injury than the male anterior cruciate ligament because of the gender-specific expression of receptors for relaxin, a collagenolytic hormone that promotes remodeling of the anterior cruciate ligament.

Purpose: This study was undertaken to investigate whether collegiate female athletes with elevated serum relaxin concentrations (SRC) sustain anterior cruciate ligament tears at an increased rate compared with those with lower SRC.

Study Design: Cohort study (prognosis); Level of evidence, 2.

Modes of failure of knotted and knotless suture anchors in an arthroscopic bankart repair model with the capsulolabral tissues intact.

The purpose of this study was to assess failure modes of knotless and knotted anchors in a Bankart repair model with the capsulolabral soft tissues intact. Previous reports used a model stripped of soft tissues. In 8 matched pairs of cadaver shoulders, a Bankart lesion was repaired arthroscopically using either 2 Bio-SutureTak anchors (Arthrex, Naples, Florida) or 2 Bioknotless anchors (Mitek, Westwood, Massachusetts).

Bearing surfaces for total disc arthroplasty: metal-on-metal versus metal-on-polyethylene and other biomaterials.

Background Context: Concerns about the effect of metallic wear debris from metal-on-metal bearing surfaces in total hip arthroplasty have increased. Some spinal arthroplasty devices include metal-on-metal bearing surfaces.

Purpose: To review the literature for clinical reports of complications because of wear debris from metal-on-metal spinal arthroplasty devices.

Principles of biomechanics and biomaterials in orthopaedic surgery.

There are few surgical procedures within the field of orthopaedic surgery that do not entail the basis or need for understanding basic biomechanical principles. Every subspecialty field requires some aspect of biomechanics to properly understand and perform surgical procedures, patient examinations, and clinical treatment. A proper review of these principles will allow surgeons to better approach all treatment modalities used for patient care.

Are persistently symptomatic vertebral compression fractures associated with abnormal inflammatory profiles? A prospective study.

Study Design: A case-control study with prospectively collected samples for laboratory analysis in a series of patients with spinal fragility fractures and a series of patients without fracture who underwent fusion for LBP.

Objective: Was an exploratory data analysis for candidate cytokine biomarkers present in the fracture milieu of patients with persistent back pain associated with vertebral compression fracture.

Summary Of Background Data: Lumbar and thoracic compression fractures are common.

Identification of a novel fibronectin-aggrecan complex in the synovial fluid of knees with painful meniscal injury.

Background: Molecular biomarkers associated with knee pain may be useful as diagnostic modalities, prognostic indicators, and surrogate end points for therapeutic trials. The present study describes a novel complex of fibronectin and aggrecan that is present in the affected knee of patients with pain and meniscal abnormality.

Methods: The present prospective study included thirty patients with knee pain, mechanical symptoms, and magnetic resonance imaging findings that were positive for a meniscal tear who chose arthroscopic partial meniscectomy after unsuccessful nonoperative management.