85 results on '"Mirzayan R"'
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2. Quantitation of intrathecal measles virus IgG antibody synthesis rate: Subacute sclerosing panencephalitis and multiple sclerosis
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Conrad, A.J., primary, Chiang, E.Y., additional, Andeen, L.E., additional, Avolio, C., additional, Walker, S.M., additional, Baumhefner, R.W., additional, Mirzayan, R., additional, and Tourtellotte, W.W., additional
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- 1994
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3. Luminal glucose concentrations in the gut under normal conditions
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Ferraris, R. P., primary, Yasharpour, S., additional, Lloyd, K. C., additional, Mirzayan, R., additional, and Diamond, J. M., additional
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- 1990
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4. The use of calcium sulfate in the treatment of benign bone lesions. A preliminary report.
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Mirzayan, Raffy, Panossian, Vahe, Avedian, Raffi, Forrester, Deborah M., Menendez, Lawrence R., Mirzayan, R, Panossian, V, Avedian, R, Forrester, D M, and Menendez, L R
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CALCIUM sulfate ,BONE substitutes ,BONE grafting ,BONE resorption ,BONE growth ,THERAPEUTICS ,CALCIUM compounds ,BONE diseases ,CRYOSURGERY ,OSTEOMYELITIS ,RETROSPECTIVE studies ,BONE cysts - Abstract
Assesses the efficacy of calcium sulfate as a bone graft substitute in patients undergoing operative treatment of a benign bone lesion. Complications associated with harvesting autogenous bone grafts; Radiographic analysis of calcium sulfate resorption and bone healing; Rate of bone growth.
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- 2001
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5. A technique to determine proper pin placement of crossed pins in supracondylar fractures of the elbow.
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Reynolds, Richard A.K., Mirzayan, Raffy, Reynolds, R A, and Mirzayan, R
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- 2000
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6. Gunshot wound to the thoracic aorta with peripheral arterial bullet embolization: case report and literature review.
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Shen P, Mirzayan R, Jain T, McPherson J, and Cornwell EE III
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- 1998
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7. Undetected iatrogenic lesions of the anterior femoral shaft during intramedullary nailing: a cadaveric study
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Shepherd Lane, Mirzayan Raffy, Zalavras Charalampos, and Papadakis Stamatios A
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Orthopedic surgery ,RD701-811 ,Diseases of the musculoskeletal system ,RC925-935 - Abstract
Abstract Background The incidence of undetected radiographically iatrogenic longitudinal splitting in the anterior cortex during intramedullary nailing of the femur has not been well documented. Methods Cadaveric study using nine pairs of fresh-frozen femora from adult cadavers. The nine pairs of femora underwent a standardized antegrade intramedullary nailing and the detection of iatrogenic lesions, if any, was performed macroscopically and by radiographic control. Results Longitudinal splitting in the anterior cortex was revealed in 5 of 18 cadaver femora macroscopically. Anterior splitting was not detectable in radiographic control. Conclusion Longitudinal splitting in the anterior cortex during intramedullary nailing of the femur cannot be detected radiographically.
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- 2008
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8. Patients With Graft Tears Leaving the Tuberosity Covered Have Similar Functional Outcomes to Those With an Intact Graft After Superior Capsular Reconstruction.
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Mirzayan R, Acevedo DC, Yao JF, Otarodifard KA, Hall M, Suh BD, and Singh A
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- Humans, Middle Aged, Female, Male, Aged, Magnetic Resonance Imaging, Rotator Cuff Injuries surgery, Treatment Outcome, Plastic Surgery Procedures methods, Acellular Dermis, Retrospective Studies, Shoulder Joint surgery
- Abstract
Background: Studies to date of superior capsular reconstruction (SCR) comparing outcomes of healed grafts versus torn grafts do not separate graft tears based on location of the tear, rather they combine and report all tears as a single group., Purpose/hypothesis: The purpose of this study was to correlate functional outcome with graft integrity and graft tear location after SCR with a dermal allograft. It was hypothesized that the functional outcomes of patients with an intact graft would be equivalent to those with graft tears leaving the tuberosity covered., Study Design: Cohort study; Level of evidence, 3., Methods: Patients who underwent SCR with an acellular dermal allograft at a single institution were included. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Oxford Shoulder Score, visual analog scale (VAS) for pain, and postoperative Single Assessment Numeric Evaluation (SANE) scores were recorded. A magnetic resonance imaging scan was performed postoperatively to assess graft integrity., Results: A total of 39 patients met inclusion criteria. Mean age of patients was 60.4 ± 8.7 years; mean follow-up was 53.3 ± 25 months (range, 14-98 months). Magnetic resonance imaging performed at a mean of 17.5 months (range, 6-66 months) demonstrated an intact graft in 14 (36%); tear from the glenoid in 11 (28%), from midsubstance in 4 (10%), and from the tuberosity in 8 (21%); and complete graft absence in 2 (5%). Patients were divided into group 1 (intact graft), group 2 (tuberosity covered: tears from glenoid and midsubstance tears), and group 3 (tuberosity bare: tears from the tuberosity and dissolved or absent grafts). In group 1, there was significant improvement in ASES (37.9 to 88.5; P < .001), Oxford (25.2 to 46.2; P < .001), and VAS (6.8 to 0.9; P < .001). In group 2, there was significant improvement in ASES (32.2 to 86.1; P < .001), Oxford (23.4 to 44.2; P < .001), and VAS (7.3 to 1.3; P < .001). In group 3, there was no significant improvement in ASES (40.3 to 45.8; P = .50) or Oxford (33.5 to 31.4; P = .81), but there was a significant reduction in VAS (7.1 to 5.4; P = .03). There was no significant difference between group 1 and 2 in postoperative ASES (88.5 vs 86.1; P = .59), Oxford (46.2 vs 44.2; P = .07), VAS (0.9 vs 1.3, P = .42) and SANE (85.4 vs 83.2; P = .92) scores. However, group 3 had significantly lower ASES (45.8; P < .001), lower Oxford (31.4; P < .001), lower SANE (45.4; P < .001), and higher VAS (5.4; P < .001) scores than groups 1 and 2. There were no differences in outcomes based on sex ( P = .72), previous surgery ( P = .06), preoperative acromiohumeral distance ( P = .57), and preoperative Goutallier stage of the supraspinatus ( P = .16)., Conclusion: Patients who underwent SCR with a dermal allograft and developed a graft tear leaving the tuberosity covered had equivalent functional outcomes to those with an intact graft., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M. has received honoraria from Arthrex not related to this manuscript, consulting fees from Arthrex, and speaking fees from Empire Medical. A.S. has received compensation from Arthrex for services other than consulting, support for education from Arthrex, and support for education from ImpactOrtho. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. This study was approved by the Kaiser Permanente Southern California institutional review board (No. 11147).
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- 2024
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9. Bone Marrow Stimulation for Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials.
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Hurley ET, Crook BS, Danilkowicz RM, Jazrawi LM, Mirzayan R, Dickens JF, Anakwenze O, and Klifto CS
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- Humans, Randomized Controlled Trials as Topic, Rotator Cuff surgery, Arthroscopy methods, Rotator Cuff Injuries surgery
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Background: Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet.", Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR., Study Design: Meta-analysis; Level of evidence, 1., Methods: A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant., Results: A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear ( I
2 = 43%; P = .61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 ( P = .12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P = .31) or visual analog scale score (0.9 vs 0.9, respectively; P = .89)., Conclusion: The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.D. has received support for education from SouthTech Orthopedics. L.M.J. has received support for education from Suvon Surgical, Gotham Surgical, and Arthrex and consulting fees from Flexion Therapeutics. R.M. has received consulting fees from Arthrex and compensation for services other than consulting from Empire Medical. J.F.D. has received support for education from SouthTech Orthopedics and Supreme Orthopedic Systems and compensation for services other than consulting from Arthrex. O.A. has received consulting fees from Exactech, Smith & Nephew, Medical Device Business Services, Bioventus, Lima, Responsive Arthroscopy, Encore Medical, and Stryker; support for education from Arthrex and SouthTech Orthopedics; and travel expenses from Wright Medical and Zimmer Biomet. C.K. has received consulting fees from Acumed, restor3d, and Smith & Nephew and holds stock or stock options in GE HealthCare, Johnson & Johnson, Merck, and Pfizer. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.- Published
- 2024
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10. Reconstruction of chronic long head of biceps tendon tears with gracilis allograft: report of two cases.
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Mirzayan R and Vega A
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We present two cases of symptomatic chronic long head of the biceps tendon (LHBT) ruptures treated with reconstruction of the tendon with an allograft due to native tendon shortening in one case and complete native tendon loss in the other. A gracilis allograft was Pulver-Taft weaved through the biceps muscle belly to reconstruct the LHBT and provide sufficient working length to perform a subpectoral tenodesis. In cases of chronic, symptomatic LHBT rupture with a shortened or absent tendon, a gracilis allograft can be used to reconstruct the biceps tendon and to perform a subpectoral tenodesis, providing symptom relief and reversing a Popeye muscle.
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- 2024
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11. Fresh Osteochondral Allograft Transplantation of the Capitellum for the Treatment of Osteochondritis Dissecans.
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Mirzayan R, Ragheb JM, Jeshion-Nelson K, DeWitt DO, and Cruz CA
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- Humans, Male, Adolescent, Female, Child, Adult, Young Adult, Retrospective Studies, Bone Transplantation methods, Humerus surgery, Transplantation, Homologous, Arthroscopy methods, Allografts, Elbow Joint surgery, Treatment Outcome, Osteochondritis Dissecans surgery
- Abstract
Background: Osteochondritis dissecans (OCD) of the humeral capitellum is a rare and challenging condition to treat. Several surgical options exist, but in the last few years, the pendulum has swung from debridement and microfracture to restoration of the articular surface. Osteochondral autografts from the rib and knee have been described, but donor-site morbidity is a concern., Purpose: To expand the results of fresh osteochondral allograft transplantation (FOCAT) in a previously published report with inclusion of additional patients and a longer follow-up period., Study Design: Case series; Level of evidence, 4., Methods: After institutional review board approval, the charts of patients who underwent FOCAT for OCD of the capitellum between 2006 and 2022 by a single surgeon were reviewed. The majority of cases (94%) had unstable lesions (Minami grades 2 and 3). A trial of nonoperative treatment had failed in all. All patients underwent diagnostic arthroscopy, followed by a mini-open, ligament-sparing approach with grafting using commercially available guides and instruments., Results: A total of 35 patients were identified, of whom 25 were male. The mean age was 16 ± 3.9 years (range, 11-32 years). There were 24 baseball players (19 pitchers and 5 position players), 5 gymnasts, 3 cheerleaders/tumblers, 1 tennis player, 1 student (who did not participate in athletics), and 1 patient with avascular necrosis from chemotherapy. Eighteen patients had a mean flexion contracture of 14.1°± 11.9°. A single osteochondral allograft plug was used in 23 patients (mean diameter, 11.3 ± 2.8 mm), and 12 patients required 2 plugs (Mastercard technique). The mean follow-up was 92.6 ± 54.5 months (range, 24-204 months). There was significant improvement in Oxford (from 25.5 ± 4.9 to 46.7 ± 3.5; P < .00001) and visual analog scale for pain (from 7.5 ± 2 to 0.3 ± 1.0; P < .0001) scores. The mean Single Assessment Numeric Evaluation score at the time of follow-up was 90.6 ± 10.8 (range, 60-100). In overhead athletes, there was significant improvement in the Kerlan-Jobe Orthopaedic Clinic score (from 40.8 ± 11.8 to 90.6 ± 10.8; P < .00001). A postoperative magnetic resonance imaging scan was obtained in 16 (46%) patients at a mean of 32.6 months. In all cases, the graft was incorporated. All overhead athletes were able to return to their sport and perform at the same level or higher for >2 years. Two elbows required a subsequent arthroscopy for loose-body removal; otherwise, there were no other complications., Conclusion: FOCAT is an excellent option for treating OCD lesions of the humeral capitellum. Excellent outcomes and high return-to-sport rates were observed, with midterm follow-up showing no graft failures. FOCAT eliminates donor-site morbidity., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M. has received honoraria from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
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- 2024
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12. Controversies in surgical management of anterior shoulder instability. State of the Art.
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Mirzayan R, Itoi E, Karpyshyn J, Wong IH, and Di Giacomo G
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- Humans, Bankart Lesions surgery, Treatment Outcome, Joint Instability surgery, Arthroscopy methods, Shoulder Joint surgery, Shoulder Dislocation surgery, Bone Transplantation methods
- Abstract
Arthroscopic Bankart repair (ABR) has been accepted as a standard procedure for anterior shoulder instability with a minimum or no glenoid bone loss and an on-track Hill-Sachs lesion if present. However, several controversies exist in the surgical treatment of anterior shoulder instability. This article will discuss some of these controversies in, "simple," dislocations (without bone loss) as well as, "complex," (with critical bone loss). Determining which patients will benefit from an arthroscopic procedure depends on multiple factors including age, activity level, adequate determination of bone loss, performed with feasible and reliable imaging techniques. In the absence of concomitant significant bony and soft tissue pathology, ABR alone can provide satisfactory clinical results on a long-term basis. Controversies, including whether to remove cartilage from the edge of the glenoid, knotted versus knotless anchors, and routine rotator interval closure, still exist. In cases with significant bone loss, several bone restoring procedures have been described, such as, the Latarjet procedure, iliac crest bone graft, arthroscopic anatomic glenoid reconstruction with a frozen distal tibial allograft, and fresh distal tibial allograft reconstruction. This article will address these controversies and provide guidance based on available published data., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Raffy Mirzayan, MD reports a relationship with Arthrex Inc that includes: speaking and lecture fees. Ivan Wong reports a relationship with DePuy Mitek Inc that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Smith and Nephew Inc that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with CONMED Corp that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Stryker Orthopaedics that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Arthrex Inc that includes: consulting or advisory. Ivan Wong reports a relationship with Bioventus LLC that includes: speaking and lecture fees., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)
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- 2024
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13. Anterior capsular reconstruction with acellular dermal allograft for subscapularis deficiency: a report of two cases.
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Mirzayan R and Korber S
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Anterior glenohumeral instability with an irreparable subscapularis tear is a challenging problem for the orthopedic shoulder surgeon. Current techniques, including tendon transfers, yield inconsistent results with high rates of recurrent instability. Acellular dermal allografting has been used in young patients with massive superior rotator cuff tears with early success, but acellular dermal allografting is comparatively unstudied in anterior deficiency. We present two cases of anterior capsular reconstruction with an acellular dermal allograft in patients ages 66 and 58 years with irreparable subscapularis tendon tears. Follow-up for both patients exceeded 4 years, with forward flexion >140°, external rotation exceeding 60°, a Single Assessment Numeric Evaluation score >90 points, a visual analog scale score of 0 points, and an American Shoulder and Elbow Score of 98 points. In conclusion, acellular dermal allografting can be used to reconstruct the anterior capsule in patients with massive irreparable subscapularis tears, similar to its use in superior capsular reconstruction in patients with massive posterosuperior rotator cuff tears.
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- 2024
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14. Acellular Collagen Matrix Patch Augmentation of Arthroscopic Rotator Cuff Repair Reduces Re-Tear Rates: A Meta-analysis of Randomized Control Trials.
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Hurley ET, Crook BS, Danilkowicz RM, Buldo-Licciardi M, Anakwenze O, Mirzayan R, Klifto CS, and Jazrawi LM
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- Humans, Collagen therapeutic use, Rotator Cuff surgery, Rupture, Treatment Outcome, Randomized Controlled Trials as Topic, Aminopyridines, Lacerations, Rotator Cuff Injuries surgery
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Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation., Methods: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant., Results: Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P = .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P = .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P = .01)., Conclusions: The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR., Level of Evidence: Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
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- 2024
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15. No difference in revision risk between autologous hamstring graft less than 8 mm versus hybrid graft 8 mm or larger in anterior cruciate ligament reconstruction.
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Mirzayan R, Chang RN, Royse KE, Prentice HA, and Maletis GB
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- Humans, Adult, Retrospective Studies, Transplantation, Homologous, Transplantation, Autologous adverse effects, Reoperation, Autografts surgery, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction adverse effects, Hamstring Tendons transplantation
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Purpose: Hamstring autograft (HA) is commonly used for primary anterior cruciate ligament reconstruction (ACLR). However, if the harvested HA is inadequate in diameter, it is often augmented with an allograft tendon, forming a hybrid graft (HY). This study sought to evaluate aseptic revision risk following HA versus HY ACLR., Methods: A retrospective cohort study was performed using data obtained from our healthcare system's ACLR registry. Patients ≤ 25 years of age who underwent primary isolated ACLR were identified (2005-2020). Graft type and diameter size was the primary exposure of interest: < 8 mm HA and ≥ 8 mm HY. A secondary analysis was performed to examine 7 mm HA and 7.5 mm HA vs ≥ 8 mm HY. Propensity score-weighted Cox proportional hazard regression was used to evaluate the risk of aseptic revision., Results: The study sample included 1,945 ACLR: 548 ≥ 8 mm HY, 651 7 mm HA, and 672 7.5 mm HA. The crude cumulative aseptic revision probability at 8-years for ≥ 8 mm HY was 9.1%, 11.1% for 7 mm HA, and 11.2% for 7.5 mm HA. In adjusted analysis, no difference in revision risk was observed for < 8 mm HA (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.72-1.82), 7 mm HA (HR 1.23, 95% CI 0.71-2.11), or 7.5 mm HA (HR 1.16, 95% CI 0.74-1.82) compared to ≥ 8 mm HY., Conclusion: In a US-based cohort of ACLR patients aged ≤ 25 years, we failed to observe any differences in aseptic revision risk for HA < 8 mm compared to HY ≥ 8 mm. Augmentation of a HA as small as 7 mm is not necessary to prevent a revision surgery., Level of Evidence: Level III., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)
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- 2023
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16. Risk of radial head arthroplasty revision is correlated with radial head diameter: a multicenter analysis of 405 cases.
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Mirzayan R, Lowe N, Lin B, Acevedo DC, and Singh A
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- Female, Humans, Adolescent, Young Adult, Adult, Middle Aged, Aged, Aged, 80 and over, Retrospective Studies, Treatment Outcome, Radius surgery, Radius injuries, Arthroplasty, Range of Motion, Articular, Elbow Joint surgery, Radius Fractures surgery
- Abstract
Background: Radial head arthroplasty (RHA) is commonly used for the treatment of comminuted radial head fractures. Indications as well as implant types continue to evolve. RHA has had good outcomes with midterm longevity. The literature is limited to small case series with varying implant types, and larger studies are needed to determine the optimal implant type and radial head diameter., Methods: A retrospective analysis of RHA cases performed by 75 surgeons at 14 medical centers in an integrated health care system between 2006 and 2017 was completed. Patient demographics, comorbidities, implant type and head diameter, and indications for revision were recorded. Patients' in-person clinical visit data were recorded. Patients were also contacted via telephone at a minimum of 2 years to obtain abbreviated Disabilities of the Arm, Shoulder, and Hand questionnaire and Oxford scores. Implant survivorship was also captured within our integrated system., Results: 405 cases met our inclusion criteria. Mean age was 51.5 ± 15.5 years (range 16-88 years) and more common in females (62%). Chart review and telephone follow-up was performed at a mean of 68.9 ± 31.5 months (range 24-146 months). Our study found that revision rate was positively correlated with increasing radial head diameter. A 26-mm head had 7.7 odds of revision compared to a size 18-mm head (95% confidence interval 1.2-150.1). More than 95% of revision cases were performed within the first 36 months of the index procedure. Obese patients had a significantly lower mean postoperative Oxford score (35.5) compared to controls (38.3) (P = .02). There was a significantly higher overall reoperation rate for terrible triad (18.4%) vs. isolated injuries (10.4%) (P = .04). There was no difference between Acumed Anatomic and Evolve radial head implants in overall reoperation, implant revision, postoperative range of motion, or patient-reported outcomes., Conclusions: Risk of revision is directly correlated with implanted radial head diameter. There were no differences in outcomes and complications between the 2 main implants used. Individuals who did not undergo a revision by 3 years' time tend to retain the implant. Terrible triad injuries had a higher all-cause reoperation rate than isolated radial head fractures, but no difference in the rate of RHA revision. These data reinforce the practice of downsizing radial head implant diameter., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2023
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17. Preliminary Outcomes of Arthroscopic Biologic Tuberoplasty in the Treatment of Massive Irreparable Rotator Cuff Tears.
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Mirzayan R
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Introduction: Several treatment options exist for the treatment of massive, irreparable rotator cuff tears. A novel technique has been described whereby an acellular dermal allograft is secured to the greater tuberosity which acts as an interpositional tissue preventing bone-to-bone contact between the greater tuberosity and acromion. The preliminary results of this arthroscopic procedure are being presented., Methods: Patients who underwent a biologic tuberoplasty procedure between 2015 and 2022, by a single surgeon, were included in this study. Pre- and postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and visual analogue pain scores (VAS) were prospectively recorded and retrospectively reviewed. Postoperative MRI was obtained in some cases. Paired t-test was used to calculate significance set at <0.05., Results: Ten patients met the inclusion criteria. The mean age was 70.4+4.7 years (range 65-78). There were five males. The mean length of follow-up was 21+27 months (range six to 95 months). There was significant improvement in ASES (24.3+4 to 91.5+10.3, P<0.00001), SANE (22.5+10.3 to 88+11.6, P<0.00001), and VAS (8.8+0.6 to 1.1+2.5, P<0.00001). MRI was obtained in seven patients at a mean of 5.3+2.9 months and showed a healed graft to the tuberosity in all cases., Conclusion: Biologic tuberoplasty is an effective procedure in improving pain and functional outcomes in patients with massive, irreparable rotator cuff tears., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Mirzayan et al.)
- Published
- 2023
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18. Emerging Treatment Options for Massive Rotator Cuff Tears: Biologic Tuberoplasty, Balloon Arthroplasty, Anterior Cable Reconstruction, Lower Trapezius Transfer.
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Mirzayan R, Abboud JA, Sethi PM, Khan AZ, Lohre R, Talamo M, Quintana JO, and Elhassan B
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- Humans, Rotator Cuff surgery, Arthroplasty methods, Rotator Cuff Injuries surgery, Superficial Back Muscles surgery, Biological Products
- Abstract
There are several emerging treatments for patients with massive rotator cuff tears. Biologic tuberoplasty is still in its infancy but holds promise for improving pain and function by biologically covering a bare tuberosity with a dermal allograft to prevent bone-to-bone contact between the tuberosity and the undersurface of the acromion. Balloon arthroplasty is a technique of widespread interest, with the device recently gaining FDA approval. Anterior cable reconstruction uses the autologous long head of the biceps tendon to reconstruct the anterior cable of the rotator cuff. Tendon transfers, specifically lower trapezius tendon transfer, have now been established as a viable option especially in patients who want to regain active external rotation.
- Published
- 2023
19. Human Amniotic Membrane Wrapping of the Ulnar Nerve During Cubital Tunnel Surgery Reduces Recurrence of Symptoms.
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Mirzayan R, Russo F, Yang ST, Lowe N, Shean CJ, and Harness NG
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Background: Compare the recurrence rate of paresthesias in patients undergoing primary cubital tunnel surgery in those with and without wrapping of the ulnar nerve with the human amniotic membrane (HAM)., Methods: A retrospective investigation of patients undergoing primary cubital tunnel surgery with a minimum 90-day follow-up was performed. Patients were excluded if the nerve was wrapped using another material, associated traumatic injury, simultaneous Guyon's canal release, or revision procedures. Failure was defined as those patients who experienced initial complete resolution of symptoms (paresthesias) but then developed recurrence of paresthesias., Results: A total of 57 controls (CON) and 21 treated with HAM met our inclusion criteria. There was a difference in the mean age of CON (48.4 ± 13.5 years) and HAM (30.6 ± 15) ( P< 0.0001 ). There was no difference in gender mix ( P=0.4 ), the severity of symptoms ( P=0.13 ), and length of follow-up ( P=0.084 ). None of 21 (0%) treated with HAM developed recurrence of symptoms compared to 11 of 57 (19.3%) ( P=0.03 ) (CON). Using a multivariate regression model adjusted for age and procedure type, CON was 24.4 (95% CI=1.26-500, P=0.0348 ) times higher risk than HAM of developing a recurrence of symptoms., Conclusion: The HAM wrapping used in primary cubital tunnel surgery significantly reduced recurrence rates of paresthesias. Further prospective studies with randomization should be carried out to better understand the role HAM can play in cubital tunnel surgery.
- Published
- 2022
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20. Radial head arthroplasty: a descriptive study of 970 patients in an integrated health care system.
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Foroohar A, Prentice HA, Burfeind WE, Navarro RA, Mirzayan R, and Zeltser DW
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- Adolescent, Adult, Arthroplasty, Female, Humans, Male, Reoperation adverse effects, Retrospective Studies, Risk Factors, Treatment Outcome, Delivery of Health Care, Integrated, Elbow Joint surgery, Joint Instability surgery
- Abstract
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. Patient demographics, implant selection, 90-day acute postoperative events, and cumulative reoperation/revision rates are included., Methods: Patients aged ≥18 years who underwent primary RHA were identified (2009-2017). Patient characteristics and demographics, including age, body mass index, gender, diabetes status, American Society of Anesthesiologists (ASA) classification, primary diagnosis, and concomitant procedures were described. Crude cumulative revision and reoperation probabilities were calculated as 1 minus the Kaplan-Meier estimator, with follow-up time calculated as the time from the index RHA to revision/reoperation date for those with the outcome of interest and time from index RHA to censoring date (eg, date of death, health care termination, study end date [March 31, 2018]) for those without the outcome. Ninety-day postoperative incidence of emergency department (ED) visit, readmission, and mortality was calculated as the number of patients with the event of interest over the number of patients at risk., Results: A total of 970 patients underwent primary unilateral RHA by 205 surgeons during the study period. Annual procedure volume increased from 53 procedures in 2009 to 157 procedures in 2017. More patients were female, without diabetes, and had an ASA classification of 1 or 2. Fracture was the predominant indication for RHA (98.4%) and more than half (54.3%) had concomitant procedures performed. Most implants were press fit (63.2%) over loose fit, and >90% were monopolar. Three-year cumulative revision and reoperation probabilities following RHA were 6.5% (95% confidence interval [CI] = 5.0%-8.5%) and 8.2% (95% CI = 6.5%-10.3%), respectively. Revisions and reoperations tended to occur within the first postoperative year. Of the 970 RHA patients, 83 (8.5%) had a 90-day ED visit, 58 (6.0%) had a 90-day readmission, and 1 (0.1%) died within a 90-day postoperative period., Conclusion: This large cohort of RHA patients provides information about the practice of RHA at large and in the community. Surgeons are performing more RHA over time and choosing press fit stems more often. Revisions and reoperations tended to occur early. Readmission and ED visits were low but not negligible, with pain being the most common reason for ED visit., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2022
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21. Delayed Onset of Motor Blockade After Liposomal Bupivacaine Use for a Perioperative Popliteal Nerve Block: A Case Report.
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Shah S, Mirzayan R, Bernbeck J, Italia Y, Morkos A, Qiu C, and Desai V
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We present a case of a 60-year-old male who has undergone Achilles' tendon repair with amnion augmentation on the right side. Before the surgery, liposomal bupivacaine was requested by the patient, and this was used to block the popliteal and adductor canal nerves for intraoperative anesthetic and postoperative pain control. The patient understood the benefits and risks of the regional nerve block with this medication and its off-label use. After the surgery, the patient underwent an irregular course of anesthetic, including delayed motor weakness, and became non-weight-bearing temporarily. The motor block was inconsistent and non-linear. Initially, the motor block completely resolved with a return to the sensation after three days. Then, on day four, a complete motor block developed, which resolved gradually over the next four days. After 10 days, the patient had full resolution of symptoms. He denies any pain since the surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Shah et al.)
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- 2022
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22. Classification system of graft tears following superior capsule reconstruction.
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Mirzayan R, Acevedo DC, Sidell MA, Otarodi KA, Hall MP, Suh BD, and Singh A
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- Aged, Arthroscopy, Humans, Middle Aged, Range of Motion, Articular, Treatment Outcome, Rotator Cuff Injuries surgery, Shoulder Joint surgery
- Abstract
Objective: Superior capsule reconstruction (SCR) is a treatment option for irreparable massive rotator cuff tears (MRCT). The purpose of this study is to describe a classification system for graft integrity and tear location., Methods: Patients who underwent SCR at a single institution were included. Pre-operative age, gender, prior surgery, Hamada grade, and Goutallier stage were recorded. An MRI was performed postoperatively to assess graft integrity and tear location., Results: 53 patients met inclusion criteria. Mean age was 60.1 ± 7.9 years. A post-operative MRI was performed in 42 (80%) patients at a mean of 14 ± 7 months (range, 6-40 months). MRIs demonstrated an intact graft in 16 (38%) shoulders. Of the 26 graft tears, 14 (54%) were from the glenoid, 5 (19%) mid-substance, 6 (23%) from the tuberosity, and 1 (3.8%) had complete graft absence., Conclusion: Graft tears are common following SCR. We describe four different graft tear locations and submit a classification system that can be used in future studies to better compare outcomes based on graft integrity and tear location. Clinical correlation with graft integrity and graft tear location needs to be further investigated., (Copyright © 2021. Published by Elsevier Inc.)
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- 2022
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23. Interposition of human amniotic membrane at the bone-tendon interface of a full-thickness rotator cuff repair.
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Mirzayan R and Suh BD
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- 2021
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24. Dissection of an Ulnar Nerve Previously Transposed and Wrapped with Human Amniotic Membrane: A Report of 3 Cases.
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Mirzayan R, Syed SP, and Shean CJ
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- Amnion pathology, Amnion surgery, Humans, Neurosurgical Procedures, Reoperation, Cubital Tunnel Syndrome pathology, Cubital Tunnel Syndrome surgery, Ulnar Nerve pathology, Ulnar Nerve surgery
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Cases: We present 3 patients who underwent ulnar nerve transposition and wrapping of the nerve with human amniotic membrane (HAM). All 3 patients subsequently required a reoperation for the original pathologic condition (not for ulnar nerve symptoms), necessitating the exploration and dissection of the transposed ulnar nerve. We demonstrate the lack of scar formation and ease of separation between nerve and surrounding tissue, as well as histology in one case taken from the perineural tissues (previous amniotic membrane), demonstrating no inflammatory cells or absence of scar tissue formation., Conclusion: Exploration and dissection of a previously transposed ulnar nerve can be facilitated by wrapping the nerve with HAM to prevent scarring and perineural fibrosis., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B587)., (Copyright © 2021 by The Journal of Bone and Joint Surgery, Incorporated.)
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- 2021
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25. Chronic Distal Biceps Tendon Tear Reconstruction With Tibialis Anterior Allograft.
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Mirzayan R and Mills ES
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Chronic distal biceps tendon ruptures present a unique surgical challenge due to tendon retraction and shortening as well as muscle atrophy. Several graft choices and fixation methods have been described, with no one technique proving superior to date. We describe a technique wherein a tibialis anterior tendon allograft is Pulver-Taft weaved through the muscle belly to achieve incorporation with the muscle and tendonous fascia to achieve superior pull-out strength., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)
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- 2021
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26. Total Elbow Arthroplasty: A Descriptive Analysis of 170 Patients From a United States Integrated Health Care System.
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Zeltser DW, Prentice HA, Navarro RA, Mirzayan R, Dillon MT, and Foroohar A
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- Aged, Elbow, Humans, Reoperation, Retrospective Studies, Treatment Outcome, United States epidemiology, Arthroplasty, Replacement, Elbow, Delivery of Health Care, Integrated, Elbow Joint surgery
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Purpose: Total elbow arthroplasty (TEA) can be used, with varying degrees of success, for the treatment of rheumatoid arthritis, osteoarthritis, and distal humerus fractures and their sequelae in elderly patients. Some of the largest studies of TEA have included data from more than 20 years ago and may not reflect the current practice of TEA. We sought to describe a modern cohort of patients who underwent TEA in a United States integrated health care system., Methods: All patients aged 18 years and older who underwent primary unilateral TEA from January 1, 2009, through March 31, 2018, were identified to conduct a descriptive study. The patients' characteristics and demographics, including age, body mass index, sex, diabetes status, American Society of Anesthesiologists classification, and surgical indication, were recorded. The crude cumulative revision probability as well as the 90-day postoperative incidence rate of emergency department visit, readmission, and mortality was calculated., Results: A total of 170 patients met our inclusion criteria. The annual procedure volume nearly doubled, from 11 procedures in 2009 to 21 procedures in 2017. The most common indication for TEA was fracture (40.6%), followed by rheumatoid arthritis (36.5%). At 4-year follow up, the crude cumulative revision probability was 9.8% (95% confidence interval, 5.6%-16.9%). Of the 170 patients who underwent TEA, 43 (25.3%) experienced a 90-day emergency department visit, 24 (14.1%) experienced a 90-day readmission, and 2 (1.2%) died within 90 days postoperatively., Conclusions: This cohort of patients who underwent TEA using modern implants showed a notable increase in the volume of TEA over the study period, with more TEAs performed for trauma. The incidence of readmission and emergency department visits following TEA were high in this study. Further studies are needed to better define the current practice of TEA in the community at large., Type of Study/level of Evidence: Therapeutic IV., (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
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- 2021
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27. Biologic Tuberoplasty With an Acellular Dermal Allograft for Massive Rotator Cuff Tears.
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Mirzayan R and Bouz G
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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. Patients with massive rotator cuff tears involving the supraspinatus and a portion of the infraspinatus lose their force couple, leading to superior humeral head migration with abutment of the tuberosity against the acromion upon deltoid activation. The center of rotation moves superiorly with deltoid contraction, developing an acromiohumeral articulation. This results in bone-to-bone contact between the acromion and humerus, leading to pain and acetabularization of the acromion over time. Coverage of the tuberosity with the acellular dermal allograft acts as an interpositional tissue and prevents bone-to-bone contact between the tuberosity and acromion., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier.)
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- 2021
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28. Metrics of OsteoChondral Allografts (MOCA) Group Consensus Statements on the Use of Viable Osteochondral Allograft.
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Görtz S, Tabbaa SM, Jones DG, Polousky JD, Crawford DC, Bugbee WD, Cole BJ, Farr J, Fleischli JE, Getgood A, Gomoll AH, Gross AE, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Mirzayan R, Mologne TS, Provencher MT, Rodeo SA, Safir O, Strauss ED, Wahl CJ, Williams RJ, and Yanke AB
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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., Study Design: Consensus statement., Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement., Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement., Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.G. has received education payments from Arthrex and Goode Surgical, consulting fees from JRF, and honoraria from JRF and Vericel. D.G.J. has received education payments from Arthrex; consulting fees from Acumed, Amniox Medical, Aastrom BioSciences, and Medical Device Business Services; speaking fees from Aastrom BioSciences and Linvatec; honoraria from Flexion, Musculoskeletal Transplant Foundation, and Vericel; and hospitality payments form Aesculap and Zimmer Biomet. J.D.P. has received education payments from Pylant Medical. D.C.C. has received consulting fees from Arthrosurface and DePuy, honoraria from JRF, and hospitality payments from Steelhead Surgical. W.D.B. has received consulting fees from Arthrex, Encore Medical, JRF, DePuy/Medical Device Business Services, and Orthalign; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Orthalign. B.J.C. has received education payments from Medwest; consulting fees from Acumed, Aesculap Biologics, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Smith & Nephew, Vericel, and Zimmer Biomet; speaking fees from Arthrex and Lifenet Health; hospitality payments from GE Healthcare; honoraria from Vericel; and royalties from Arthrex and DJO. J.F. has received education payments from Crossroads Orthopedics; consulting fees from Aastrom Biosciences, Aesculap, Arthrex, Collagen Matrix, Exactech, DePuy, Organogenesis, and RTI Surgical; nonconsulting fees from Arthrex and Vericel; honoraria from JRF and Vericel; royalties from DePuy and Organogenesis; and hospitality payments from Skeletal Kinetics. J.E.F. has received education payments from Peerless Surgical, Linvatec, and Zimmer Biomet and consulting and nonconsulting fees from Smith & Nephew. A.H.G. has received consulting fees from Aastrom, Flexion, JRF, Smith & Nephew, and Vericel; nonconsulting fees from Aastrom and LifeNet Health; honoraria from Fidia Pharma, JRF, and Vericel; and royalties from Organogenesis. A.J.K. has received grant support from Exactech; consulting fees from Arthrex, JRF, and Responsive Arthroscopy; honoraria from JRF, MTF, and Vericel; and royalties from Arthrex. C.L. has received consulting fees from Aastrom, Sanofi-Aventis, Vericel, and Zimmer Biomet; nonconsulting fees from Aesculap, Arthrosurface, and Vericel; and honoraria from Arthrosurface, JRF, and Vericel. B.R.M. has received education payments from Arthrex; consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; and nonconsulting fees from Arthrex. P.R.M. has received hospitality payments from Arthrex. R.M. has received education payments from Arthrex and SportsTek Medical, nonconsulting fees from Arthrex, and royalties from Zimmer Biomet. T.S.M. has received education support from Arthrex and consulting fees and honoraria from JRF. M.T.P. has received consulting fees, speaking fees, and royalties from Arthrex; royalties from Arthrosurface; honoraria from Flexion; and consulting fees and honoraria from JRF. S.A.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet. E.D.S. has received education payments from Arthrex and hospitality payments from Axogen and Liberty Surgical. C.J.W. has received consulting fees and nonconsulting fees from Smith & Nephew, royalties from Arthrosurface, and hospitality payments from Arthrex and Stryker. R.J.W. has received education payments, nonconsulting fees, consulting fees, and royalties from Arthrex. A.B.Y. has received education payments from Arthrex and Medwest, consulting fees from Aastrom Biosciences and Olympus, and honoraria from JRF. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)
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- 2021
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29. The "Empty Merchant Sign" in acute patellar tendon ruptures.
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Mirzayan R, Hill PS, Batech M, Suh BD, DeWitt DO, and Heckmann N
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- Humans, Knee, Rupture diagnostic imaging, Joint Instability, Knee Injuries diagnostic imaging, Patellar Ligament diagnostic imaging, Tendon Injuries diagnostic imaging
- Abstract
Introduction: We introduce a new sign on a Merchant view present in acute patellar tendon ruptures (APTR). We aim to determine the accuracy, sensitivity, and specificity of this new radiographic sign and measure the effect of a tutorial on these measures between trainees and non-trainees., Methods: Lateral and Merchant radiographs (22 images) of knees with four conditions (patellar instability, APTR, quadriceps tendon rupture, and controls) were randomly shown to 50 trainees and non-trainees who were asked to make a diagnosis based on radiographs. A brief tutorial was administered describing the "Empty Merchant Sign" and the same 22 images were randomly shown after the tutorial. Accuracy, sensitivity, specificity, and positive predictive value were calculated between the two image types and the effect of tutorial on these measures was assessed., Results: After the tutorial: 1. the "Empty Merchant Sign" had a higher specificity (100%) and positive predictive value (99%) compared to the lateral radiograph (81% and 64% respectively, P < 0.001), 2. There was significant improvement (from 56% to 95.3%; P < 0.001) in the accuracy of the Merchant view, making it as accurate as the lateral view (95.3% vs. 90.7%, respectively; P = 0.113). There was no difference in the accuracy of the Merchant view between trainees (97.2%) and non-trainees (90.5%) (P = 0.079)., Conclusion: The "Empty Merchant Sign" is a highly sensitive and specific diagnostic sign in cases of APTR. With very little training, physicians can identify this sign to diagnose APTRs on a Merchant view., (Copyright © 2020 Elsevier Inc. All rights reserved.)
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- 2021
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30. Arthroscopic Superior Capsule Reconstruction with a Doubled-Over (6 mm) Dermal Allograft.
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Mirzayan R, Otarodifard KA, and Singh A
- Abstract
Superior capsule reconstruction has gained popularity as a treatment option for massive rotator cuff tears. The initial graft described was a tensor fascia lata. In the United States, acellular dermal matrix or dermal allograft has gained popularity. The results from published reports have been promising, but graft tear on postoperative imaging has been reported in several studies. Strives are being made to reduce the graft tear rate. One such way is to increase the thickness of the graft. Biomechanical studies have shown that thicker and stiffer grafts perform better in restoring superior stability. We present a technique of doubling a commercially available 3 mm dermal allograft and making it into a 6 mm graft for superior capsule reconstruction., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)
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- 2021
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31. Ulnar Collateral Ligament Reconstruction of the Elbow With Double Suspensory Fixation.
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Mirzayan R, Schoell K, Acevedo DC, and Singh A
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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. We describe a technique for ulnar collateral ligament (UCL) reconstruction using bisuspensory button fixation and a single tunnel on both the ulnar and humeral sides. This technique avoids many of the most common complications and methods of failure of UCL reconstruction, provides immediate strong graft fixation, and offers the surgeon a technically less demanding procedure., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)
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- 2021
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32. Bipolar Osteochondral Allograft Transplantation of the Patella and Trochlea.
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Mirzayan R, Charles MD, Batech M, Suh BD, and DeWitt D
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- Adolescent, Adult, Female, Follow-Up Studies, Functional Status, Humans, Male, Middle Aged, Prospective Studies, Recovery of Function, Treatment Outcome, Young Adult, Allografts transplantation, Cartilage transplantation, Joint Dislocations surgery, Joint Instability surgery, Patellofemoral Joint surgery
- Abstract
Objective: To evaluate clinical, functional, and radiographic outcomes of patients who underwent bipolar osteochondral allograft transplantation (OCAT) of the patellofemoral joint (PFJ)., Design: Prospectively collected data on 18 knees who underwent fresh osteochondral allograft transplantation of the patella and trochlea by a single surgeon were reviewed. Inclusion criteria were: high-grade chondral lesions of PFJ (5 knees), or recurrent patella dislocations with trochlear dysplasia and chondral injury to the patella and/or trochlea (13 knees). Functional scores were obtained preoperatively and at follow-up appointments included Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), Oxford, Cincinnati, Tenger-Lysholm, visual analogue scale (VAS)-pain, and Single Assessment Numeric Evaluation (SANE). Grafts were also evaluated using Osteochondral Allograft MRI Scoring System (OCAMRISS)., Results: Three patients were lost to follow-up, leaving 4 knees in group 1, and 11 knees in group 2. Average age was 28.9 years (range 16-52 years). The average follow-up was 33.2 months (range 12-64 months). There was significant improvement of KOOS (from 38.7 to 83.1), IKDC (from 28.2 to 76.6), Tegner-Lysholm (from 38.3 to 88.3), Oxford (from 22.7 to 42.9), Cincinnati (from 35.1 to 83.6), VAS (from 71 to 17.9.), and SANE (from 43.3 to 83) ( P < 0.0001). The OCAMRISS score for patella was 2.23 and for trochlea 4.69. There were no revisions or conversions to arthroplasty., Conclusion: Bipolar OCAT of the patella and trochlea provide significant improvement in functional outcomes, relief from pain, activity level, and prevent recurrent instability.
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- 2020
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33. Operative Treatment of Acute Patellar Tendon Ruptures.
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O'Dowd JA, Lehoang DM, Butler RR, Dewitt DO, and Mirzayan R
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- Adolescent, Adult, Aged, Aged, 80 and over, Biomechanical Phenomena, Child, Cohort Studies, Female, Humans, Male, Middle Aged, Retrospective Studies, Rupture surgery, Suture Anchors, Suture Techniques, Young Adult, Patellar Ligament surgery
- Abstract
Background: The gold standard for patellar tendon repair is a transosseous technique. Suture anchor repair has gained popularity, with recent biomechanical studies demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads as compared with transosseous repair. These findings have not been substantiated in a large clinical cohort., Purpose: To report demographic and epidemiologic data, clinical and surgical findings, and outcomes and complications of anchor and transosseous suture repairs of acute patellar tendon ruptures., Study Design: Cohort study; Level of evidence, 3., Methods: All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury between 2006 and 2016 were retrospectively reviewed. Surgery was performed at a multisurgeon (120 surgeons) multicenter (14 centers) community-based integrated health care system. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded., Results: A total of 361 patients (374 knees) met our inclusion criteria. The mean age was 39.8 years (range, 9-86 years), and 91.7% were male. There were 321 transosseous and 53 anchor repairs. There was no significant difference in the mean age ( P = .27), sex ( P = .79), tourniquet time ( P = .93), or body mass index ( P = .78) between the groups. There was a significant difference in rerupture rate between transosseous and anchor repairs (7.5% vs 0%, respectively; P = .034). Based on logistic regression, transosseous repair had 3.24 times the odds of reoperation verseus anchor repair (95% CI, 0.757-13.895; P = .1129). The infection rate was 1.6% for transosseous repair and 7.5% for anchor repair ( P = .160). There was no difference in time to release from medical care: 18.4 weeks for anchor and 17.1 weeks for transosseous repairs ( P = .92)., Conclusion: Anchor repair demonstrated a significant decrease in rerupture rate when compared with transosseous repair. There was no difference in reoperation rate, infection rate, or time to release from medical care.
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- 2020
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34. Functional outcomes of ulnar collateral ligament reconstruction with a novel double suspensory fixation.
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Mirzayan R, Benvegnu N, Sidell M, Acevedo DC, DeWitt DO, Lowe N, and Singh A
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- Adolescent, Adult, Collateral Ligament, Ulnar injuries, Elbow Joint diagnostic imaging, Elbow Joint physiopathology, Humans, Magnetic Resonance Imaging, Male, Postoperative Period, Reoperation, Young Adult, Baseball injuries, Collateral Ligament, Ulnar surgery, Elbow Joint surgery, Return to Sport, Ulnar Collateral Ligament Reconstruction methods
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Background: Ulnar collateral ligament reconstruction (UCLR) has allowed the return of overhead athletes to throwing sports. We describe a new double suspensory (DS) technique using a single tunnel in the ulna and humerus, achieving fixation with adjustable loop buttons., Methods: Inclusion criteria included skeletally mature baseball players with clinical and magnetic resonance imaging diagnosis of UCL insufficiency who failed a trial of structured nonoperative treatment. A total of 36 baseball players underwent DS UCLR, between 2011 and 2017, by 1 surgeon with minimum 2-year follow-up. The graft was fixated with an adjustable button loop on the humeral side and a tension slide technique with a button on the ulnar side. Pre- and postoperative Kerlan-Jobe Orthopaedic Clinic and Single Assessment Numerical Evaluation and postoperative Conway scores were obtained., Results: The mean age was 19.8 ± 4.6 years (range, 14-35 years). All were male. Mean years played before surgery was 14.3 ± 4.6 years (range, 8-28 years). There were 32 (89%) pitchers and 4 (11%) position players. There were 13 (36%) high school, 20 (55%) college, 2 (6%) minor league, and 1 (3%) adult league athletes. The mean follow-up was 55.3 ± 23.7 months (range, 26-97 months). There was significant improvement in Kerlan-Jobe Orthopaedic Clinic (33.2 ± 19.9 to 89.7 ± 15.1, P < .0001) and Single Assessment Numerical Evaluation (20.7 ± 16.7 to 93.6 ± 11.9, P < .0001) scores. Using Conway scoring, 25 (69%) had excellent, 5 (14%) good, 3 (8%) fair, and 3 (8%) poor scores. Mean return to play was 9 ± 1.5 months (range, 6-16 months). Only 1 (3%) athlete required a revision surgery and ultimately returned to play and 1 (3%) hardware removal. None developed ulnar nerve symptoms., Conclusion: DS fixation for UCLR in baseball players can lead to excellent clinical results and early return to play., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2020
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35. Is there a difference in the acromiohumeral distances measured on radiographic and magnetic resonance images of the same shoulder with a massive rotator cuff tear?
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Mirzayan R, Donohoe S, Batech M, Suh BD, Acevedo DC, and Singh A
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- Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Retrospective Studies, Rotator Cuff Injuries diagnostic imaging, Acromion diagnostic imaging, Humerus diagnostic imaging, Magnetic Resonance Imaging, Radiography, Rotator Cuff Injuries classification
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Background: The purpose of our study was to compare the acromiohumeral distance (AHD) between radiographic and magnetic resonance images (MRIs) of the same shoulder with massive rotator cuff tears (MRCTs)., Methods: Thirty-four shoulders with MRCTs that had an MRI and radiograph of the same shoulder within an average of 40.3 days (range: 8-109 days) were identified. AHD was measured digitally on radiograph and MRI by 3 examiners. Shoulders were grouped into Hamada grades <3 (group 1) and Hamada grades ≥3 (group 2)., Results: The mean age was 66.4 years (range: 51-89). There were 19 men (59%). The Kappa for inter-rater reliability was 0.982 (95% confidence interval [CI] 0.975, 0.988) for radiographs and 0.88 (95% CI 0.75, 0.94) for MRI. There was a significant difference in the mean AHD of group 1 on radiograph vs. MRI (7.9 mm vs. 2.5 mm, respectively; P < .0001), but no difference in group 2 (1.8 mm vs. 2.2 mm, respectively; P = .45). There was no difference in AHD in group 1 between shoulders with Goutallier stage <3 (8.1 ± 1.9 mm) and those with Goutallier stage ≥3 (7.3 ± 2.1 mm) (P = .3479). There was no difference in AHD in group 2 between shoulders with Goutallier stage <3 (3.0 ± 0.1 mm) and those with Goutallier stage ≥3 (1.5 ± 1.0 mm) (P = .079)., Conclusion: There is a significant difference in AHD measurements between radiograph and MRI of the same shoulder with MRCT in early Hamada grades. AHDs measured on radiograph and MRI should not be used interchangeably in early Hamada grades to assess outcomes of superior capsule reconstruction and similar procedures., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2020
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36. Complications of Elbow Arthroscopy in a Community-Based Practice.
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Intravia J, Acevedo DC, Chung WJ, and Mirzayan R
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- Adolescent, Adult, Aged, Aged, 80 and over, Child, Child, Preschool, Female, Humans, Incidence, Male, Middle Aged, Odds Ratio, Postoperative Complications etiology, Retrospective Studies, Risk Factors, United States epidemiology, Vascular System Injuries etiology, Young Adult, Arthroscopy adverse effects, Elbow Joint surgery, Postoperative Complications epidemiology, Vascular System Injuries epidemiology
- Abstract
Purpose: The purpose of this study was to report the complications of elbow arthroscopy in a large community practice with multiple surgeons and to analyze potential risk factors for these complications., Methods: Patient demographic information, surgical variables, surgeon variables, and complications were retrospectively reviewed for all elbow arthroscopies performed within the health network from 2006 to 2014. Inclusion criteria included patients of any age undergoing a primary and revision elbow arthroscopy, which may have been performed in conjunction with other procedures. Exclusion criteria included incorrectly coded procedures where arthroscopy was not performed and no postoperative follow-up. Statistical calculations were performed using a binary logistic regression analysis to fit a logistic regression model., Results: 560 consecutive elbow arthroscopies in 528 patients performed between 2006 and 2014, by 42 surgeons at 14 facilities, were reviewed. 113 procedures were performed in pediatric patients under the age of 18. The average age was 38.6 years (range: 5-88). There were 444 males. The average length of follow-up was 375.8 days (2 to 2,739 days). Overall, heterotopic ossification occurred in 14 of 560 cases (2.5%) (all males), and 20 of 560 (3.5%) cases developed transient nerve palsies (8 ulnar, 8 radial, 1 median, 3 medial antebrachial cutaneous). There were 3 (0.5%) deep and 11 (2%) superficial infections. There were no vascular injuries, compartment syndrome, deep vein thrombosis, or pulmonary embolism. Elevated blood sugar was a significantly higher risk for infection (odds ratio [OR] 4.11, 95% confidence interval [CI] 1.337 to 12.645; P = .0136). Previous elbow surgery (OR 3.57, 95% CI 1.440 to 8.938; P = .006) and female sex (OR 4.05; 95% CI 1.642 to 9.970; P = .002) had a significantly higher risk for nerve injury. Relative to pediatric patients, there were higher odds in adults for nerve injury, infection, and heterotopic ossification, but none reached significance., Conclusions: Elbow arthroscopy is a safe procedure with low complication rates. Diabetes is a risk factor for infection. Prior surgery and female sex are risk factors for nerve injury., Level of Evidence: Case series, level 4., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
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- 2020
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37. Do Corticosteroid Injections Before or After Primary Rotator Cuff Repair Influence the Incidence of Adverse Events? A Subjective Synthesis.
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Kunze KN, Mirzayan R, Beletsky A, Cregar W, Skallerud W, Williams BT, Verma NN, Cole BJ, and Chahla J
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- Adrenal Cortex Hormones administration & dosage, Arthroscopy, Humans, Injections, Intra-Articular adverse effects, Postoperative Period, Rotator Cuff, Adrenal Cortex Hormones adverse effects, Rotator Cuff Injuries therapy
- Abstract
Purpose: To determine the influence of corticosteroid injections (CSIs) before or after primary rotator cuff repair (RCR) on the risk of (1) revision RCR, (2) retears, and (3) infections., Methods: The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and MEDLINE databases were queried in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data pertaining to the use of CSIs before or after primary RCR and adverse events were extracted. A subjective synthesis of these outcomes and bias was performed., Results: A total of 10 studies including 240,976 patients were identified; 20.0% received a perioperative CSI. Of the 48,235 patients who received a CSI, 66.2% did so preoperatively whereas 33.8% did so postoperatively. A total of 78 patients received both preoperative and postoperative CSIs. Three studies examined the influence of preoperative CSIs on revision RCR; the incidence ranged from 3.8% to 10.5% with preoperative CSIs and from 3.2% to 3.4% for controls. Two of these studies analyzed outcomes of patients from the same databases over the same period. Five studies examined the influence of postoperative CSI use on retears; the incidence ranged from 5.7% to 19.0% in patients who received postoperative CSIs and from 10.0% to 18.4% for controls. Three studies examined the influence of CSI use on infection; 2 studies examined the risk of infection after postoperative CSI use, which ranged from 0.0% to 6.7% with CSIs and from 0.0% to 0.5% for controls., Conclusions: The use of preoperative CSIs could be associated with an increased risk of revision RCR. There were no conclusive data to suggest an increased risk of retear or infection with CSI use based on a subjective synthesis of ranges. There is currently poor-quality literature surrounding this topic. Given that the current literature is limited and heterogeneous, no definitive recommendations can be made on perioperative CSI use for RCR., Level of Evidence: Level III, systematic review of Level I and III studies., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
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- 2020
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38. Acellular dermal matrix augmentation significantly increases ultimate load to failure of pectoralis major tendon repair: a biomechanical study.
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Mirzayan R, Andelman SM, Sethi PM, Baldino JB, Comer BJ, Obopilwe E, Morikawa D, Otto A, Mehl J, Murphy M, and Mazzocca AD
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- Aged, Biomechanical Phenomena, Cadaver, Elasticity, Humans, Humerus, Male, Middle Aged, Pectoralis Muscles, Suture Anchors, Suture Techniques, Sutures, Tendons surgery, Upper Extremity surgery, Acellular Dermis, Tendon Injuries surgery, Tendons physiopathology
- Abstract
Background: Biomechanical studies have demonstrated that standard pectoralis major tendon (PMT) repairs have inferior strength compared with native tendon., Hypothesis: Augmentation of PMT repair with an acellular dermal matrix (ADM) will increase the ultimate load to failure., Methods: Eighteen cadaveric specimens were allocated to 3 repair groups: standard repair (SR); augmented repair (AR) with ADM; and intact, native tendon (NT). Specimens were tested for cyclic elongation, linear stiffness, load to 5 mm displacement, maximum load to failure, and method of failure., Results: Maximum load to failure in AR (1450 ± 295 N) was significantly higher than SR (921 ± 159 N; P = .0042) and equivalent to NT (1289 ± 240 N; P = .49). NT required the highest load to displace 5 mm (709 ± 202 N), which was higher than AR (346 ± 95 N; P < .001) and SR (375 ± 55; P = .0015). NT stiffness (125 ± 42 N/mm) was greater than the AR (69 ± 19 N/mm; P = .0073) or SR (75 ± 11 N/mm; P = .015). The mode of failure for SR was suture pullout from the PMT as opposed to button pullout from the humerus (fracture) for AR., Conclusion: ADM augmentation of PMT repair significantly increases ultimate load to failure., (Copyright © 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2020
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39. An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint.
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Chahla J, Hinckel BB, Yanke AB, Farr J, Bugbee WD, Carey JL, Cole BJ, Crawford DC, Fleischli JE, Getgood A, Gomoll AH, Gortz S, Gross AE, Jones DG, Krych AJ, Lattermann C, Mandelbaum BR, Mandt PR, Minas T, Mirzayan R, Mologne TS, Polousky JD, Provencher MT, Rodeo SA, Safir O, Sherman SL, Strauss ED, Strickland SM, Wahl CJ, and Williams RJ 3rd
- Abstract
Background: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology., Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique., Study Design: Consensus statement., Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document., Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%., Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.C. has received research support and consulting fees from Arthrex, Conmed, and Smith & Nephew. B.B.H. has received research support from Arthrex and educational support from Arthrex and Elite Orthopaedics. A.B.Y. has received research support from Arthrex, Orthogenesis, Medwest, and Vericel; educational support from Arthrex, Medwest, and Smith & Nephew; and consulting fees from Aastrom Biosciences, JRF Ortho, Olympus, PatientIQ, Smith & Nephew, and Sparta Biomedical. J.F. has received consulting fees from Osiris Therapeutics, Zimmer Biomet, ISTO Technologies, Ceterix Orthopaedics, Biomet, Genzyme, MedShape, and Sanofi-Aventis; has received speaking fees from Arthrex and Zimmer Biomet; has received royalties from Arthrex, DePuy, Organogenesis, Springer, and Thieme Medical Publishers; and has stock/stock options in MedShape and Ortho Regenerative Technologies. W.D.B. has received consulting fees from Arthrex, DePuy, Insight Medical, JRF Ortho, OrthAlign, and Smith & Nephew; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Insight Medical, Moximed, and OrthAlign. B.J.C. has received research support from Aesculap/B. Braun, Arthrex, and Regentis Biomaterials; has received educational support from Medwest; has received consulting fees from Acumed, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Genzyme, Pacira Pharmaceuticals, Regentis Biomaterials, Smith & Nephew, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Carticept Medical, LifeNet Health, and Pacira Pharmaceuticals; has received hospitality payments from GE Healthcare; has received royalties from Arthrex, DJO, Elsevier, and Operative Techniques in Sports Medicine; and has stock/stock options in BandGrip, Ossio, and Regentis Biomaterials. D.C.C. has received research support from Histogenics, JRF Ortho, Moximed, and Zimmer Biologics and consulting fees from Arthrosurface, DePuy, Histogenics, JRF Ortho, and Moximed. J.E.F. has received research support from Arthrex and Smith & Nephew; educational support from Linvatec, Peerless Surgical, and Zimmer Biomet; and consulting fees and speaking fees from Smith & Nephew. A.G. has received research support from Aesculap/B. Braun, Arthrex, DePuy, Eupraxia Pharmaceuticals, Musculoskeletal Transplant Foundation, Ossur, and Smith & Nephew; consulting fees from Collagen Solutions, Olympus, Ossur, and Smith & Nephew; speaking fees from Conmed Linvatec, Ossur, and Smith & Nephew; and royalties from Smith & Nephew. A.H.G. has received research support from JRF Ortho and Vericel; consulting fees from Aesculap, Geistlich Pharma, Genzyme, JRF Ortho, Moximed, Smith & Nephew, and Vericel; speaking fees from Aastrom Biosciences, LifeNet Health, and Vericel; and royalties from Organogenesis. S.G. has received educational support from Arthrex and Goode Surgical and honoraria from Vericel. A.E.G. has received consulting fees, speaking fees, and royalties from Zimmer Biomet and has stock/stock options in Intellijoint Surgical. D.G.J. has received research support from Genzyme and Sanofi-Aventis; has received educational support from Arthrex; has received consulting fees from Aastrom Biosciences, Acumed, Amniox Medical, DePuy/Medical Device Business Services, Flexion, Genzyme, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Conmed Linvatec, Flexion, Genzyme, Mitek, Musculoskeletal Transplant Foundation, TissueTech, Vericel, and Zimmer Biomet; and is a board or committee member of the Musculoskeletal Transplant Foundation. A.J.K. has received research support from Aesculap/B. Braun, Arthrex, Ceterix Orthopaedics, and Histogenics; has received consulting fees from Arthrex, DePuy, JRF Ortho, and Vericel; has received speaking fees from Arthrex; and is a board or committee member of the Musculoskeletal Transplant Foundation. C.L. has received honoraria from Arthrosurface; consulting fees from Aastrom Biosciences, Genzyme, JRF Ortho, Samumed, Sanofi-Aventis, Vericel, and Zimmer Biomet; and speaking fees from Vericel. B.R.M. has received consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; speaking fees from Arthrex; and royalties from Arthrex. R.M. has received research support from Arthrex and DJO, has received educational support from Arthrex, has received speaking fees from Arthrex, has received royalties from Zimmer Biomet, and has stock/stock options in AlignMed. T.S.M. has received research support from JRF Ortho, educational support from Arthrex, consulting fees from JRF Ortho and MicroAire Surgical Instruments, and speaking fees from JRF Ortho. J.D.P. has received research support from Ossur, Sanofi-Aventis, and Vericel; consulting fees from JRF Ortho; and speaking fees from DePuy. M.T.P. has received consulting fees from Arthrex and JRF Ortho (AlloSource), speaking fees from Arthrex, and royalties from Arthrex and SLACK. S.A.R. has received consulting fees from Flexion, has received speaking fees from Smith & Nephew, has received honoraria from Fidia Pharma, has received royalties from Zimmer Biomet, and has stock/stock options in Ortho Regenerative Technologies. O.S. has received research support from DePuy and consulting fees from Zimmer Biomet. S.L.S. has received consulting fees and research support from Arthrex Inc; is a paid consultant for Ceterix Orthopaedics, CONMED Linvatec, Flexion Therapeutics, GLG Consulting, JRF Ortho, Moximed, Olympus, Vericel, Linvatec, and RTI Surgical; has received hospitality payments from Linvatec and Smith & Nephew; and has received a grant (indirect) from DJO. E.D.S. has received research support from CartiHeal, Fidia Pharma, and NuTech; consulting fees from Arthrex, Fidia Pharma, Flexion, JRF Ortho, Organogenesis, Smith & Nephew, and Vericel; speaking fees from Arthrex, Organogenesis, and Vericel; and royalties from Jaypee Brothers Medical Publishers. C.J.W. has received consulting fees from Arthrosurface and Smith & Nephew and speaking fees from Arthrex, Arthrosurface, and Smith & Nephew. R.J.W. has received research support from Histogenics; has received consulting fees from Arthrex, JRF Ortho, and Lipogems; has received speaking fees from Arthrex; has received royalties from Arthrex; and has stock/stock options in CyMedica Orthopedics, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)
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- 2020
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40. Revision Risk of Soft Tissue Allograft Versus Hybrid Graft After Anterior Cruciate Ligament Reconstruction.
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Mirzayan R, Prentice HA, Essilfie A, Burfeind WE, Ding DY, and Maletis GB
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- Adult, Allografts, Cohort Studies, Humans, Risk Factors, Transplantation, Autologous, Young Adult, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction, Reoperation
- Abstract
Background: When a harvested hamstring autograft is deemed by the surgeon to be of inadequate diameter, the options include using the small graft, using another autograft from a different site, augmenting with an allograft (hybrid graft), using a different configuration of the graft (eg, 5- or 6-stranded), or abandoning the autograft and using allograft alone. A small graft diameter is associated with a higher revision risk, and using another autograft site includes added harvest-site morbidity; therefore, use of a hybrid graft or an allograft alone may be appealing alternative options. Revision risk for hybrid graft compared with soft tissue allograft is not known., Purpose: To evaluate the risk for aseptic revision surgery after primary anterior cruciate ligament reconstruction (ACLR) using a soft tissue allograft compared with ACLR using a hybrid graft in patients 25 years and younger., Study Design: Cohort study; Level of evidence, 3., Methods: Data from a health care system's ACLR registry were used to identify primary isolated unilateral ACLRs between 2009 and 2016 using either a hybrid graft (hamstring autograft with soft tissue allograft) or a soft tissue allograft alone. Multivariable Cox proportional hazards regression was used to evaluate risk for aseptic revision after ACLR according to graft used after adjustment for age, allograft processing, tunnel drilling technique, and region where the primary ACLR was performed., Results: The cohort included 2080 ACLR procedures; a hybrid graft was used for 479 (23.0%) ACLRs. Median follow-up time was 3.4 years (interquartile range, 1.8-5.1 years). The crude 2-year aseptic revision probability was 5.4% (95% CI, 4.3%-6.7%) for soft tissue allograft ACLR and 3.8% (95% CI, 2.3%-6.4%) for hybrid graft ACLR. After adjustment for covariates, soft tissue allograft ACLR had a higher risk of aseptic revision during follow-up compared with hybrid graft ACLR (hazard ratio, 2.00; 95% CI, 1.21-3.31; P = .007)., Conclusion: Soft tissue allografts had a 2-fold higher risk of aseptic revision compared with hybrid graft after ACLR. Future studies evaluating the indications for using hybrid grafts and the optimal hybrid graft diameter is needed.
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- 2020
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41. Risk Factors and Complications Following Arthroscopic Tenotomy of the Long Head of the Biceps Tendon.
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Mirzayan R, McCrum C, Butler RK, and Alluri RK
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Background: Controversy exits regarding performing a tenotomy versus a tenodesis of the long head of the biceps tendon (LHBT)., Purpose: To evaluate the complications after arthroscopic tenotomy of the LHBT and characterize the incidence of cosmetic deformity, cramping, subjective weakness, and continued anterior shoulder pain (ASP). Additionally, to identify patient-related factors that may predispose a patient to these complications., Study Design: Case-control study; Level of evidence, 3., Methods: Records of patients who underwent an arthroscopic LHBT tenotomy at an integrated health care system under the care of 55 surgeons were retrospectively reviewed. Exclusion criteria included LHBT tenodesis, arthroplasty, neoplastic, or fracture surgery; age younger than 18 years; incomplete documentation of physical examination; or incomplete operative reports. Characteristic data, concomitant procedures, LHBT morphology, and postoperative complications were recorded. Patients with and without postoperative complications-including cosmetic deformity, subjective weakness, continued ASP, and cramping-were analyzed by age, sex, dominant arm, body mass index (BMI), smoking status, workers' compensation status, and intraoperative LHBT morphology to identify risk factors for developing these postoperative complications., Results: A total of 192 patients who underwent LHBT tenotomy were included in the final analysis. Tenotomy was performed with concomitant shoulder procedures in all but 1 individual. The mean ± SD patient age was 60.6 ± 9.5 years, and 55% were male. The overall complication rate was 37%. The most common postoperative complications include cosmetic (Popeye) deformity (14.1%), subjective weakness (10.4%), cramping (10.4%), and continued postoperative ASP over the bicipital groove (7.8%). Every 10-year increase in age was associated with 0.52 (95% CI, 0.28-0.94) times the odds of continued ASP and 0.59 (95% CI, 0.36-0.98) times the odds of cramping pain. Male patients had 3.9 (95% CI, 1.4-10.8) times the odds of cosmetic (Popeye) deformity. Patients who had active workers' compensation claims had 12.5 (95% CI, 2.4-63.4) times the odds of having continued postoperative ASP. Tenotomy on the dominant arm, BMI, and active smoking status demonstrated no statistically significant association with postoperative complications., Conclusion: Patients experiencing complications after tenotomy were significantly younger and more likely to be male and to have a workers' compensation injury. LHBT tenotomy may best be indicated for elderly patients, female patients, and those without active workers' compensation claims., Competing Interests: One or more of the authors declared the following potential conflict of interest or source of funding: R.M. has received research support from Arthrex and the Joint Restoration Foundation; grant support from DJO; educational support from Arthrex; royalties from Zimmer Biomet, Thieme, and Wolters Kluwer; and honoraria from Arthrex. C.M. has received grant support from Arthrex and educational support from Smith & Nephew and Pylant Medical. R.K.A. has received research support from Accumed, Trimmed, and Arthrex and has stock/stock options in Zimmer Biomet, Stryker, Medtronic, and Axogen. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)
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- 2020
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42. Failed Dermal Allograft Procedures for Irreparable Rotator Cuff Tears Can Still Improve Pain and Function: The "Biologic Tuberoplasty Effect".
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Mirzayan R, Stone MA, Batech M, Acevedo DC, and Singh A
- Abstract
Background: Acellular dermal matrices (ADMs) have been used in the treatment of shoulders with massive rotator cuff tears (MRCTs). Despite clinical improvement, correlation of clinical findings with ADM integrity on imaging has not been investigated., Hypothesis: The pain in shoulders with MRCTs is partially due to bone-to-bone contact between the tuberosity and acromion. Coverage of the tuberosity with an intact graft or a graft that is torn in a way that the tuberosity remains covered will act as an interpositional tissue, preventing bone-to-bone contact and leading to clinical improvement., Study Design: Case series; Level of evidence, 4., Methods: Between 2006 and 2016, a total of 25 shoulders with MRCTs underwent a procedure with an ADM. Pre- and postoperative visual analog scale (VAS) results, American Shoulder and Elbow Surgeons (ASES) score, Hamada grade, and Goutallier classification were reviewed. A postoperative magnetic resonance imaging (MRI) was obtained in 22 (88%) shoulders. The status of the graft was divided into the following categories: type I, intact graft; type II, graft tear with tuberosity covered; and type III, graft tear with tuberosity uncovered (bare)., Results: The mean patient age was 61 years (range, 49-73 years), and the mean follow-up was 25.6 months (range, 10-80 months). Mean length from surgery to postoperative MRI was 13.9 months (range, 6-80 months). The graft was torn in 59% (13/22 shoulders). Significant improvements were found in VAS and ASES scores (7 vs 0.7 and 32.6 vs 91.2, respectively; P < .01) for type I grafts and in VAS and ASES scores (8.1 vs 1.3 and 26.3 vs 84.6, respectively; P < .01) for type II grafts. No difference was found in postoperative VAS and ASES (0.7 vs 1.3 and 91.2 vs 84.6, respectively; P = .8) between type I and type II grafts. No improvement was seen in VAS (7.3 vs 5.7; P = .2) or ASES (30.6 vs 37.2; P = .5) for type III grafts., Conclusion: MRI appearance of the graft has a significant impact on functional outcomes. Patients with an intact graft or a graft tear leaving the tuberosity covered have lower pain and higher functional scores than those in whom the torn graft leaves the tuberosity uncovered., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M. has received royalties from Wolters Kluwer, Thieme, and Zimmer Biomet; honoraria from Arthrex; research support from Arthrex, the Joint Restoration Foundation, and DJO Global; and has stock/stock options in Alignmed. M.A.S. has received educational support from DePuy/Synthes and hospitality payments from Acumed. A.S. has received consulting fees from Tornier. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
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- 2019
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43. Rationale for Biologic Augmentation of Rotator Cuff Repairs.
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Mirzayan R, Weber AE, Petrigliano FA, and Chahla J
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- Combined Modality Therapy, Humans, Retreatment, Treatment Failure, Biological Therapy methods, Plastic Surgery Procedures methods, Rotator Cuff Injuries surgery, Rotator Cuff Injuries therapy, Wound Healing
- Abstract
The structural integrity of rotator cuff repair (RCR) has been a primary focus for shoulder surgeons seeking long-term clinical and functional success. Improvements in surgical techniques have allowed for superior initial biomechanical fixation. However, tendon healing remains a significant clinical problem even after rigid time-zero repair. The lack of long-term healing has led to increased interest in biologic augmentation to improve tendon-to-bone healing. This interest has led to a rise in the investigation of small molecular therapies, cell-based strategies, and tissue-derived treatments offering surgeons a new therapeutic toolbox for potentially improving RCR long-term outcomes. However, the delivery, efficacy, and safety of these treatments remain under investigation. Additional well-designed, high-level studies are of paramount importance in creating evidence-based guidelines for the implementation of new biologic solutions. This review article discusses the current preclinical, translational, and clinical experience with and rationale for biologic augmentation in RCR.
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- 2019
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44. Complications of biceps tenodesis based on location, fixation, and indication: a review of 1526 shoulders.
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McCrum CL, Alluri RK, Batech M, and Mirzayan R
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- Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Muscle Cramp etiology, Muscle Weakness etiology, Prostheses and Implants, Reoperation statistics & numerical data, Retrospective Studies, Shoulder surgery, Shoulder Dislocation surgery, Shoulder Pain surgery, Tendon Injuries surgery, Tenodesis instrumentation, Young Adult, Muscle, Skeletal surgery, Postoperative Complications etiology, Shoulder Pain etiology, Tendons surgery, Tenodesis adverse effects, Tenodesis methods
- Abstract
Background: Long head of the biceps tendon (LHBT) tenodesis is predominantly performed for 2 reasons: anterior shoulder pain (ASP) or structural reasons (partial tear, dislocation)., Methods: Between 2006 and 2014, all cases of primary LHBT tenodesis performed at an integrated health care system were retrospectively reviewed. Complications were analyzed by tenodesis location (below or out of the groove [OOG] vs leaving tendon in the groove [ITG]), fixation method (soft tissue vs implant), and indication (preoperative ASP vs structural)., Results: Among 1526 shoulders, persistent ASP did not differ by fixation method (11.0% for implant vs 12.8% for soft tissue, P = .550) or location (10.8% for OOG vs 12.9% for ITG, P = .472). Soft-tissue tenodesis cases had more frequent new-onset ASP (11.9% vs 2.6%, P < .001) and subjective weakness (8.50% vs 3.92%, P < .001) but less frequent revisions (0% vs 1.19%, P = .03) than implant tenodesis cases. No difference was found between ITG and OOG for persistent ASP (12.9% vs 10.8%, P = .550), new-onset ASP (6.5% vs 2.8%, P = .339), cramping (1.70% vs 2.31%, P = .737), deformity (4.72% vs 4.62%, P = .532), or subjective weakness (6.23% vs 4.32%, P = .334), but ITG cases had more revisions (1.51% vs 0.60%, P = .001). Among implant tenodesis cases, 1 shoulder (0.085%) sustained a fracture., Conclusion: The overall complication rate of LHBT tenodesis was low. Of the shoulders, 10.8% to 12.9% continued to have ASP, regardless of whether the LHBT was left ITG. Soft-tissue tenodesis cases had higher rates of new-onset ASP and subjective weakness. No significant difference for tenodesis ITG or OOG was found in biceps-related complications., (Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)
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- 2019
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45. Chronic Medial Epicondyle Avulsion: Technique of Fragment Excision and Ligament Reconstruction With Internal Brace Augmentation.
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Mirzayan R and Cooper JD
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- Allografts, Athletic Injuries surgery, Fracture Fixation, Internal instrumentation, Gracilis Muscle, Humans, Suture Techniques, Collateral Ligament, Ulnar injuries, Collateral Ligament, Ulnar surgery, Fracture Fixation, Internal methods, Fractures, Ununited surgery, Humeral Fractures surgery, Tendons transplantation
- Abstract
Medial epicondyle fracture nonunions of the elbow may lead to symptomatic instability in the high-demand or overhead athlete. These injuries are challenging to treat surgically because of the small residual bony fragment, the scarred and shortened chronically injured ulnar collateral ligament (UCL), which prevents it from being mobilized and reduced to its native position. To date, most described methods aim at reducing the displaced fragment and achieving union with the humerus. This usually can only be accomplished by releasing of the scarred UCL to mobilize the fragment. The scarred and attenuated residual ligament is then repaired to restore stability but is often inadequate to sustain high-level valgus loads. We describe a technique of excision of the bony fragment and UCL reconstruction with allograft, augmented with internal brace to provide medial stability to the elbow. The described method allows proper tensioning of the graft and provides immediate and secure fixation.
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- 2019
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46. Cryopreserved, Viable Osteochondral Allograft for the Treatment of a Full-Thickness Cartilage Defect of the Glenoid.
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Mirzayan R, Sherman B, and Chahla J
- Abstract
Glenoid chondral injuries constitute challenging injuries to treat because of the limited access and the limited options and evidence available for their resolution. The purpose of this Technical Note is to describe the procedure, pearls, and pitfalls of implantation of a cryopreserved osteochondral allograft (Cartiform) for the treatment of full-thickness cartilage defects of the shoulder. Cartiform is a cryopreserved osteochondral allograft composed of chondrocytes, chondrogenic growth factors, and extracellular matrix proteins that can be implanted through a single-stage procedure.
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- 2018
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47. Carbon Dioxide Insufflation of the Knee in the Treatment of Full-Thickness Chondral Defects With Micronized Human Articular Cartilage.
- Author
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Mirzayan R, Cooper JD, and Chahla J
- Abstract
BioCartilage (BC) is dehydrated, minced human hyaline articular cartilage that was developed as an adjunct to microfracture surgery to help stimulate the bone marrow and stem cells to form hyaline-like tissue in full-thickness chondral defects. The minced pieces of BC require a dry environment for application and can easily be disrupted by residual moisture of saline solution in the surrounding tissues. We present a technique of carbon dioxide insufflation during knee arthroscopy as a means of maintaining a dry environment for preparation of the bony bed during BC augmentation of microfracture surgery. This technique is safe and provides more than adequate visualization, as well as a dry environment, to make the arthroscopic application of BC significantly more efficient.
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- 2018
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48. Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases.
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Mirzayan R, Acevedo DC, Sodl JF, Yian EH, Navarro RA, Anakwenze O, and Singh A
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- Adolescent, Adult, Aged, Aged, 80 and over, Cohort Studies, Female, Humans, Male, Middle Aged, Recurrence, Reoperation statistics & numerical data, Retrospective Studies, Rupture surgery, Time-to-Treatment, Upper Extremity injuries, Young Adult, Suture Anchors, Sutures, Tendon Injuries surgery, Upper Extremity surgery
- Abstract
Background: Distal triceps tendon ruptures are rare. The authors present a series of 184 surgically treated, acute, traumatic triceps tendon avulsions and compare the complications between those treated with anchors (A) versus transosseous (TO) suture repair., Hypothesis: No difference exists in the retear rate between TO and A repairs. Study Designed: Cohort study; Level of evidence, 3., Methods: All patients who underwent an open primary repair of a traumatic triceps tendon avulsion within 90 days of injury, between 2007 and 2015, were retrospectively reviewed. Surgeries were performed within a multisurgeon (75 surgeons), multicenter (14 centers), community-based integrated health care system. Patient demographic information, type of repair, complications, and time from surgery to release from medical care were recorded., Results: 184 triceps tears in 181 patients met the inclusion criteria. The mean age was 49 years (range, 15-83 years). There were 169 males. The most common mechanisms of injury were fall (56.5%) and weight lifting (19%). Mean time from injury to surgery was 19 days (range, 1-90 days); in 74.5% of cases, surgery was performed in 3 weeks or less. There were 105 TO and 73 A repairs. No significant difference was found between the two groups in the mean age ( P = .18), sex ( P = .51), completeness of tears ( P = .74), tourniquet time ( P = .455), and prevalence of smokers ( P = .64). Significant differences were noted between TO and A repairs in terms of reruptures (6.7% vs 0%, respectively; P = .0244), overall reoperation rate (9.5% vs 1.4%; P = .026), and release from medical care (4.3 vs 3.4 months; P = .0014), but no difference was seen in infection rate (3.8% vs 0%; P = .092). No difference was noted in release from medical care in patients who underwent surgery 3 weeks or less after injury compared with those undergoing surgery more than 3 weeks after injury (3.90 vs 4.09 months, respectively; P = .911)., Conclusion: Primary repair of triceps ruptures with TO fixation has a significantly higher rerupture rate, higher reoperation rate, and longer release from medical care than does repair with A fixation. Implementation of suture anchors in triceps repairs offers a lower complication rate and earlier release from medical care.
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- 2018
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49. Surgical Treatment of Distal Biceps Tendon Ruptures: An Analysis of Complications in 784 Surgical Repairs.
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Dunphy TR, Hudson J, Batech M, Acevedo DC, and Mirzayan R
- Subjects
- Adult, Aged, Aged, 80 and over, Bone Screws, Female, Humans, Male, Middle Aged, Muscle Strength physiology, Orthopedic Procedures methods, Range of Motion, Articular, Retrospective Studies, Rupture physiopathology, Suture Anchors, Sutures, Tendon Injuries physiopathology, Elbow surgery, Orthopedic Procedures adverse effects, Postoperative Complications, Rupture surgery, Tendon Injuries surgery
- Abstract
Background: Distal biceps brachii tendon ruptures lead to substantial deficits in elbow flexion and supination; surgical repair restores muscle strength and endurance., Purpose: To examine clinical and surgical outcomes for distal biceps tendon repairs in a large, multispecialty, integrated health care system., Study Design: Cohort study; Level of evidence, 3., Methods: Retrospective cohort study of distal biceps tendon repairs performed between January 1, 2008, and December 31, 2015. The repair methods were classified as double-incision approach using bone tunnel-suture fixation or anterior single-incision approach. Anterior single incisions were further classified according to the fixation method: cortical button alone, cortical button and interference screw, or suture anchors alone. Patient demographics, surgeon characteristics, range of motion, and complications were analyzed for all repair types., Results: Of the 784 repairs that met the inclusion criteria, 639 (81.5%) were single-incision approaches. When comparing double-incision and single-incision repairs, there was a significantly higher rate of posterior interosseous nerve palsy (3.4% vs 0.8%, P = .010), heterotopic bone formation (7.6% vs 2.7%, P = .004), and reoperation (8.3% vs 2.3%, P < .001). The most common nerve complication encountered was a lateral antebrachial cutaneous nerve palsy (n = 162), which was significantly more common in the single-incision repairs than in the double-incision repairs (24.4% vs 4.1%, P < .001). When excluding lateral antebrachial cutaneous nerve palsies, there was no significant difference in the overall nerve palsies between single-incision and double-incision (5.8% vs 6.9%, P = .612). The overall rate of tendon rerupture was 1.9% (single incision, 1.6%; double incision, 2.8%; P = .327). The overall rate of postoperative wound infection was 1.5% (single incision, 1.3%; double incision, 2.8%; P = .182). The average time from surgery to release from medical care was 14.4 weeks (single incision, 14 weeks; double incision, 16 weeks; P = .286). Patients treated with cortical button plus interference screw were released significantly sooner than were patients with other single-incision repair types (13.1 ± 8.01 weeks, P = .011). There were no significant differences in rates of motor neurapraxia, infection, rerupture, and reoperation with regard to surgeon's years of practice, fellowship training, or case volume., Conclusion: The surgical repair of distal biceps tendon ruptures has an overall low rate of serious complications, regardless of approach or technique. However, the double-incision technique has a higher rate of posterior interosseous nerve palsy, heterotopic bone formation, and reoperation rate. Surgeon's years of practice, fellowship training, and case volume do not affect the rate of major complications.
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- 2017
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50. In Vivo Analysis of Biceps Tendon Characteristics in Subpectoral Tenodesis.
- Author
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Mirzayan R, Takara T, Batech M, and McCrum CL
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- Adult, Aged, Body Mass Index, Female, Hamstring Tendons anatomy & histology, Humans, Male, Middle Aged, Pectoralis Muscles anatomy & histology, Plastic Surgery Procedures, Reference Values, Shoulder Joint anatomy & histology, Hamstring Tendons surgery, Pectoralis Muscles surgery, Shoulder Joint surgery, Shoulder Pain surgery, Tenodesis methods
- Abstract
Purpose: To report the in vivo characteristics of the long head of the biceps tendon (LHBT); to evaluate the relation of age, gender, height, weight, and body mass index to the length and sutured and tubularized diameter of the LHBT; and to determine the smallest possible tunnel diameter for a subpectoral biceps tenodesis (SPBT) that can accommodate most patients., Methods: The study included 66 patients (33 men and 33 women) with an average age of 54 years (range, 29-73 years) undergoing SPBT. After tenotomy, the length from the biceps musculotendinous junction to the released end was measured. The tendon was transected 3 cm proximal to the musculotendinous junction and sutured, and the diameter was measured. The depth of the reamed tunnel was recorded., Results: The average tendon length was 84.0 mm, measuring 91.9 mm in men and 76.2 mm in women (P < .001), and the average tendon diameter was 4.4 mm, varying slightly between men (4.5 mm) and women (4.3 mm) (P < .001). Mean bone tunnel depth was 17.5 mm, with 19 mm in men and 16.1 mm in women (P < .001). Patient height showed a significant relation to both tendon length and tendon diameter. Weight was not correlated with tendon diameter but did show a significant relation to tendon length., Conclusions: We have characterized the in vivo length and diameter of the LHBT at the time of an SPBT. Our findings have shown that there was a statistically significant gender difference in tendon length and diameter, but the diameter of the sutured tendon, which was placed into the tunnel, averaged 4.4 mm and ranged from 3.5 to 5 mm for all ages, both genders, all heights, and all weights. This finding is clinically relevant in that a small tunnel measuring 5.5 mm or less is sufficient to perform an SPBT., Level of Evidence: Level IV, case series, anatomic study., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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