5 results on '"Brian J Mannino"'
Search Results
2. Tibial Tubercle–Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope
- Author
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CPT Christian A. Cruz, M.D., CPT Mitchell C. Harris, M.D., CPT Jeffery L. Wake, D.O., CPT Gregory E. Lause, L.C.D.R., Brian J. Mannino, M.D., and Craig R. Bottoni, M.D.
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
Anterior cruciate ligament reconstruction failure remains a commonly seen outcome despite advances in technique and graft options. Recent studies have shown that the declination of the tibial plateau slope in the sagittal plane affects the in situ stress on the anterior cruciate ligament. The native posterior tibial slope has been described to range from 7° to 10°. However, several authors have suggested that a posterior tibial slope >12° should be considered pathologic. Given the recent evidence, our institution has begun performing a tibial tubercle–sparing anterior closing wedge proximal tibial osteotomy with cross screw fixation to decrease sagittal plane tibial slope.
- Published
- 2021
- Full Text
- View/download PDF
3. Bone-Tendon-Autograft Anterior Cruciate Ligament Reconstruction: A New Anterior Cruciate Ligament Graft Option
- Author
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CPT. Steven R. Wilding, M.D., CPT. Christian A. Cruz, M.D., LCDR. Brian J. Mannino, M.D., CPT. James B. Deal, M.D., CPT Jeffrey Wake, D.O., A.T.C., and Craig R. Bottoni, M.D.
- Subjects
Orthopedic surgery ,RD701-811 - Abstract
The bone-tendon-bone (BTB) autograft is widely used for anterior cruciate ligament (ACL) reconstruction. However, the primary disadvantages of this technique include postoperative kneeling pain, the risk of perioperative patellar fracture, and graft-tunnel mismatch. Therefore, a single bone plug technique for ACL reconstructions was developed to mitigate the disadvantages of the BTB technique. To differentiate this graft, we have coined the term BTA, for bone-tendon-autograft. The middle third of the patellar tendon is used with a typical width of 10 to 11 mm. A standard tibial tubercle bone plug is harvested. The length of the patellar tendon and graft construct is then measured. If the tendon is >45 mm and the construct at least 70 mm, then we proceed with the BTA technique. At the inferior pole of the patella, electrocautery is used to harvest the tendon from the patella. The advantages of this technique include faster graft harvest and preparation. Obviating the patellar bone plug harvest should eliminate the risk of perioperative patellar fracture and theoretically will mitigate donor site morbidity and kneeling pain, 2 of the most commonly cited complications of the use of BTB autografts for ACL reconstruction. In conclusion, the BTA technique is a reliable technique for ACL reconstruction.
- Published
- 2020
- Full Text
- View/download PDF
4. Bone-Tendon-Autograft Anterior Cruciate Ligament Reconstruction: A New Anterior Cruciate Ligament Graft Option
- Author
-
Lcdr. Brian J. Mannino, Craig R. Bottoni, Cpt. Christian A. Cruz, Cpt. Steven R. Wilding, Cpt. James B. Deal, and Cpt Jeffrey Wake
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Anterior cruciate ligament reconstruction ,Anterior cruciate ligament ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Bone plug ,Technical Note ,medicine ,Orthopedics and Sports Medicine ,Orthopedic surgery ,030222 orthopedics ,business.industry ,030229 sport sciences ,Perioperative ,musculoskeletal system ,medicine.disease ,Patellar tendon ,Surgery ,Tendon ,surgical procedures, operative ,medicine.anatomical_structure ,Patella ,Patella fracture ,business ,human activities ,RD701-811 - Abstract
The bone-tendon-bone (BTB) autograft is widely used for anterior cruciate ligament (ACL) reconstruction. However, the primary disadvantages of this technique include postoperative kneeling pain, the risk of perioperative patellar fracture, and graft-tunnel mismatch. Therefore, a single bone plug technique for ACL reconstructions was developed to mitigate the disadvantages of the BTB technique. To differentiate this graft, we have coined the term BTA, for bone-tendon-autograft. The middle third of the patellar tendon is used with a typical width of 10 to 11 mm. A standard tibial tubercle bone plug is harvested. The length of the patellar tendon and graft construct is then measured. If the tendon is >45 mm and the construct at least 70 mm, then we proceed with the BTA technique. At the inferior pole of the patella, electrocautery is used to harvest the tendon from the patella. The advantages of this technique include faster graft harvest and preparation. Obviating the patellar bone plug harvest should eliminate the risk of perioperative patellar fracture and theoretically will mitigate donor site morbidity and kneeling pain, 2 of the most commonly cited complications of the use of BTB autografts for ACL reconstruction. In conclusion, the BTA technique is a reliable technique for ACL reconstruction.
- Published
- 2020
5. Tibial Tubercle-Sparing Anterior Closing Wedge Osteotomy With Cross-Screw Fixation to Correct Pathologic Posterior Tibial Slope
- Author
-
Brian J. Mannino, Craig R. Bottoni, Cpt. Christian A. Cruz, Cpt Mitchell C. Harris, Cpt Gregory E. Lause, and Cpt Jeffery L. Wake
- Subjects
musculoskeletal diseases ,medicine.medical_specialty ,Anterior cruciate ligament reconstruction ,medicine.medical_treatment ,Anterior cruciate ligament ,Osteotomy ,Screw fixation ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Technical Note ,Orthopedics and Sports Medicine ,Closing wedge ,Orthopedic surgery ,Orthodontics ,030222 orthopedics ,business.industry ,030229 sport sciences ,In situ stress ,Proximal tibial osteotomy ,musculoskeletal system ,Sagittal plane ,Surgery ,medicine.anatomical_structure ,business ,RD701-811 - Abstract
Anterior cruciate ligament reconstruction failure remains a commonly seen outcome despite advances in technique and graft options. Recent studies have shown that the declination of the tibial plateau slope in the sagittal plane affects the in situ stress on the anterior cruciate ligament. The native posterior tibial slope has been described to range from 7° to 10°. However, several authors have suggested that a posterior tibial slope >12° should be considered pathologic. Given the recent evidence, our institution has begun performing a tibial tubercle–sparing anterior closing wedge proximal tibial osteotomy with cross screw fixation to decrease sagittal plane tibial slope., Technique Video Video 1 This video details a tibial tubercle anterior wedge osteotomy to correct a pathologic posterior tibial slope with cross-screw fixation. The patient should be positioned supine on a radiolucent flat top table. The C-arm should be placed on the contralateral side of the operative extremity. Radiolucent triangles are helpful for positioning. The incision is typically 6 to 8 cm beginning at the tibial tubercle and proceeds distally. The osteotomy start point is just distal to the tibial tubercle aiming toward the proximal tibiofibular joint on the lateral radiograph. Breakaway pins and a parallel guide are used to guide the trajectory of the proximal and distal pins. The use of fluoroscopy is recommended to ensure the pins are coplanar on the lateral view. The distal pins are then inserted in a similar fashion to the proximal pins based on preoperative measurements of the necessary osteotomy size. The tips of the distal pins should intersect the proximal pins. The posterior cortex should not be violated. The breakaway pins are then broken off and the pins are used as a cutting guide for the osteotomy. After the bone wedge is removed, the knee should be extended to close the osteotomy gap. K-wires are then used to guide the trajectory of the 4.5mm cannulated crossing screws for fixation. A 3.2-mm drill is used to drill bicortically, followed by a 4.5-mm tap to facilitate screw passage. An anterior trajectory of the screws is recommended.
- Published
- 2020
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