The Journal of the American Academy of Orthopaedic Surgeons
The use of bioabsorbable implants in orthopaedic surgical procedures is becoming more frequent. A... more The use of bioabsorbable implants in orthopaedic surgical procedures is becoming more frequent. Advances in polymer science have allowed the production of implants with the mechanical strength necessary for such procedures. Bioabsorbable materials have been utilized for the fixation of fractures as well as for soft-tissue fixation. These implants offer the advantages of gradual load transfer to the healing tissue, reduced need for hardware removal, and radiolucency, which facilitates postoperative radiographic evaluation. Reported complications with the use of these materials include sterile sinus tract formation, osteolysis, synovitis, and hypertrophic fibrous encapsulation. Further study is required to determine the clinical situations in which these materials are of most benefit.
The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgic... more The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgically implanted electrodes was evaluated in a group of nine hemiplegic patients. After a mean duration of 25 months nerve conduction velocity averaged 47.3 meters/sec in the uninvolved and 46.1 meters/sec in the stimulated (paretic) extremity. In a control group of ten hemiplegic subjects who did not receive stimulation, nerve conduction velocity averaged 43.1 meters/sec in the hemiplegic leg, and 41.3 meters/sec in the uninvolved leg. These differences were not statistically significant. Maximum dorsiflexion strength was increased in all patients following chronic stimulation.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety an... more We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety and midterm effectiveness of microtenotomy using a radiofrequency probe to treat chronic tendinosis of the elbow. All patients had failed conservative treatment for 6 months. The radiofrequency-based microtenotomy was performed using the Topaz Microdebrider (ArthroCare). Patients were followed annually for up to 9 years postoperatively. Pain status was documented using a visual analog scale self-reported measure. Eighty consecutive patients with tendinosis of the elbow were enrolled; 69 patients were treated for lateral epicondylitis and 11 for medial epicondylitis. The duration of follow-up ranged from 6 months to 9 years (mean, 2.5 years). Ninety-one percent of the patients reported a successful outcome. Within the lateral epicondylitis group, the preoperative visual analog scale improved from 6.9 to 1.3 postoperatively and demonstrated an 81% improvement (P ≤ .01). For the medial epicondylitis patients, the preoperative visual analog scale improved from 6.1 to 1.3 after surgery, a 79% improvement (P ≤ .01). No complications were reported. Radiofrequency-based microtenotomy is a safe and effective procedure for elbow epicondylitis. The results are durable with successful outcomes observed at 9 years after surgery.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014
To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during i... more To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal. Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra-articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures. An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra-articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal du...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2000
Purpose: Nonablative thermal capsular shrinkage has been developed in an attempt to address the p... more Purpose: Nonablative thermal capsular shrinkage has been developed in an attempt to address the plastic capsule deformation thought to cause increased rates of recurrent instability following arthroscopic stabilization procedures. Although the temperature required to optimize collagen shrinkage is known, a safe depth of thermal penetration, in various locations about the shoulder capsule, has not been defined. The purpose of this study was to measure shoulder capsule thickness by quadrant and circumferentially from the glenoid to the humerus so that thermal energy in shoulder procedures can be more precisely applied to limit possible injury to pericapsular structures. Type of Study: This is an anatomic study using a cadaveric shoulder specimens. Materials and Methods: Soft tissue was dissected from 8 fresh cadaveric shoulders to isolate intact glenohumeral joint capsules. The humeral insertion was released and the capsule was cut into 6 longitudinal quadrants around the glenoid. The capsule specimens were then flash frozen and stored at Ϫ80°C. Quadrant tissue was cut into longitudinal sections 14 to 16 µm wide and stained with hematoxylin and eosin. The specimens were then digitized under a dissecting microscope and measured using computer imaging software at approximately 4-mm intervals. Two-way analysis of variance (ANOVA) was performed on the measurements of the intact capsule specimens 2.5 cm off the glenoid. Humeral insertion data were recorded separately. Results: A total of 248 separate measurements were made throughout the capsule in 8 specimens. Capsular thickness increased from an average of 2.42 mm anteriorly to 2.80 mm in the inferior capsular pouch and again thinned to 2.22 mm posteriorly. Global shoulder capsule thickness ranged from 1.32 to 4.47 mm. When analyzed by position, from glenoid to humerus, a general thinning was noted with a mean thickness of 3.03 mm at the glenoid to 2.17 mm at the humeral insertion. Two-way ANOVA showed a significant thickness variation along the specimen (P Ͻ .05), a nearly significant thickness variation with regard to quadrant (P Ͻ .03), and no significant interaction (P Ͼ .07) when applied to specimen measurements approximately 2.5 cm off the glenoid. Conclusions: The thickness of the shoulder capsule ranges from 1.32 to 4.47 mm, with a significant thinning laterally from the glenoid to the humerus. Further, capsule thickness ranges from 2.76 to 3.18 mm in the regions in closest proximity to the axillary nerve. These data may help determine the proper amount of thermal penetration necessary when performing shrinkage procedures and provide safety guidelines to limit the depth of thermal penetration to avoid possible injury to pericapsular structures.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2000
Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approa... more Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approach. However, fixation of the rotator cuff tendon to suture anchors can be tedious and time consuming. The supraclavicular fossa portal allows improved access to the tear for passing suture. The authors describe the relevant anatomy, positioning. and surgical technique for use of the supraclavicular fossa portal to simplify arthroscopic rotator cuff repair.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
ABSTRACT We conducted this study to evaluate the effect of radiofrequency (RF) stimulation with s... more ABSTRACT We conducted this study to evaluate the effect of radiofrequency (RF) stimulation with suture repair on the healing of tears in the meniscal white-white zone. Fifty-four New Zealand white rabbits underwent surgically induced meniscal injuries within the white-white region. RF was applied using a 0.8-mm TOPAZ MicroDebrider RF wand (ArthroCare) at level 4 for 500 milliseconds. Rabbits were sacrificed at 28 and 84 days for gross and histologic analysis by 3 blinded observers and at 9, 28, and 84 days for biochemical examination. Biochemical analyses included evaluation of cell proliferation (3H-thymidine), as well as mitogenic (IGF-1, bFGF) and angiogenic (VEGF, αV) factors. Of specimens repaired with RF combined with suture, 19 (58%) showed a degree of gross morphologic and histologic healing. No significant healing was seen in specimens with either no repair or repair with suture alone. We observed a 40% increase in cellular proliferation when RF supplementation was used (P < .05). With regards to mitogenic and angiogenic markers (IGF-1, bFGF, VEGF, and αV), there was a significant increase in groups treated with RF at 9 and 28 days (P > 0.05). RF supplementation of avascular zone meniscal repairs may lead to an increased healing response.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
Purpose: To evaluate the safety and effectiveness of microtenotomy using a radiofrequency (RF) pr... more Purpose: To evaluate the safety and effectiveness of microtenotomy using a radiofrequency (RF) probe to treat chronic tendinosis of the common extensor tendon origins of the elbow (lateral epicondyle). Type of Study: Prospective, nonrandomized consecutive case series. Methods: The average age of the 13 patients was 48.3 Ϯ 5.5 years. Before receiving the microtenotomy, all patients had tendinosis symptoms for 6 months or longer and had failed conservative treatment. The RF-based microdebridement was performed on the symptomatic tendon using the TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). Patients were followed-up at regular postoperative intervals for 24 months. Pain status was documented using a visual analog scale self-reported measure. Functional outcome was assessed using the upper limb DASH evaluation and grip-strength measures. Quality of life assessment was evaluated using the SF-36 questionnaire. Magnetic resonance imaging was performed at regular intervals over the follow-up period. Results: Patients reported significantly reduced pain from baseline at the 7-to 10-day postoperative examination (P Յ .01). Pain reduction was statistically stable from 7 to 10 days through the 24-month postoperative period (P Յ .01). Limb-specific functional outcomes and quality of life scores were improved over baseline values. There were no perioperative or postoperative complications related to the procedure. Conclusions: The RF-based microtenotomy procedure was safe and effective through at least 2 years. This procedure provides a valuable addition for treating patients with lateral epicondylitis associated with tendinosis who have failed conservative therapy. Level of Evidence: Level IV.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003
The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar ... more The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar radiofrequency for the treatment of chronic tendinosis. Study Design: Prospective, nonrandomized, single center pilot study. Materials and Methods: There were 20 patients in the study. Each patient had chronic tendinosis of the patellar tendon, achilles tendon, or lateral or medial epicondyle. They all had symptoms for at least 6 months (average 3.5 years), and failed at least 3 conservative treatments (average 5.3 treatments). A pre-operative MRI and pain and function scores were recorded. The patients had open radiofrequency stimulation of the tendon involved using a bipolar radiofrequency Topaz Wand TM (ArthroCare Corp., Sunnyvale, CA). The generator was set to a power level of 4 (175V RMS). The wand was placed on the surface of the tendon and activated for 0.5 seconds at 5mm distance intervals around the symptomatic area. The tendon involved was stimulated 15-20 times over an area of 3.0 square cm. Post-operative pain and function scores were recorded at 7-10 days, 4-6 weeks, 3 months, and 6 months. Post-operative MRI's were performed at 4 weeks and 6 months. Results: All 20 patients improved and there were no complications. The postoperative VAS pain scores were significantly lowered by 7-10 days. The VAS scores continued to improve at 4-6 weeks, 3 months, and at the 6 month follow up. There was improvement in the SF-36, IKDC, Upper Limb DASH, and the AOFAS scores. The majority of patients had pre-operative MRI's that showed changes consistent with tendinosis. Post surgical and tendinosis changes were observed in the 4 week MRI's. The 6 month MRIs showed an improvement in the tendinosis changes. Conclusion: Bipolar radiofrequency stimulation appears to be a safe and effective treatment of chronic tendinosis. Further research is needed in this area to better understand the biochemical processes by which bipolar radiofrequency stimulation leads to pain relief and potential tendon repair.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003
tion as proliferation cell nuclear antigens (PCNA), procollagen I and decorin. In vitro studies o... more tion as proliferation cell nuclear antigens (PCNA), procollagen I and decorin. In vitro studies on tendon fibroblast culture showed that hrBMP13 could increase cell proliferation and the gene expression of pro-collagen I and biglycan, but the gene expression of decorin was not affected. Our findings suggest that BMP13 may play a role in tendon healing.
The Journal of the American Academy of Orthopaedic Surgeons
The use of bioabsorbable implants in orthopaedic surgical procedures is becoming more frequent. A... more The use of bioabsorbable implants in orthopaedic surgical procedures is becoming more frequent. Advances in polymer science have allowed the production of implants with the mechanical strength necessary for such procedures. Bioabsorbable materials have been utilized for the fixation of fractures as well as for soft-tissue fixation. These implants offer the advantages of gradual load transfer to the healing tissue, reduced need for hardware removal, and radiolucency, which facilitates postoperative radiographic evaluation. Reported complications with the use of these materials include sterile sinus tract formation, osteolysis, synovitis, and hypertrophic fibrous encapsulation. Further study is required to determine the clinical situations in which these materials are of most benefit.
The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgic... more The effects of electric stimulation on nerve conduction velocity of the peroneal nerve via surgically implanted electrodes was evaluated in a group of nine hemiplegic patients. After a mean duration of 25 months nerve conduction velocity averaged 47.3 meters/sec in the uninvolved and 46.1 meters/sec in the stimulated (paretic) extremity. In a control group of ten hemiplegic subjects who did not receive stimulation, nerve conduction velocity averaged 43.1 meters/sec in the hemiplegic leg, and 41.3 meters/sec in the uninvolved leg. These differences were not statistically significant. Maximum dorsiflexion strength was increased in all patients following chronic stimulation.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014
We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety an... more We conducted a prospective, nonrandomized, single-center clinical study to evaluate the safety and midterm effectiveness of microtenotomy using a radiofrequency probe to treat chronic tendinosis of the elbow. All patients had failed conservative treatment for 6 months. The radiofrequency-based microtenotomy was performed using the Topaz Microdebrider (ArthroCare). Patients were followed annually for up to 9 years postoperatively. Pain status was documented using a visual analog scale self-reported measure. Eighty consecutive patients with tendinosis of the elbow were enrolled; 69 patients were treated for lateral epicondylitis and 11 for medial epicondylitis. The duration of follow-up ranged from 6 months to 9 years (mean, 2.5 years). Ninety-one percent of the patients reported a successful outcome. Within the lateral epicondylitis group, the preoperative visual analog scale improved from 6.9 to 1.3 postoperatively and demonstrated an 81% improvement (P ≤ .01). For the medial epicondylitis patients, the preoperative visual analog scale improved from 6.1 to 1.3 after surgery, a 79% improvement (P ≤ .01). No complications were reported. Radiofrequency-based microtenotomy is a safe and effective procedure for elbow epicondylitis. The results are durable with successful outcomes observed at 9 years after surgery.
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2014
To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during i... more To quantify the amount of the extra-articular long head of the biceps tendon (LHBT) seen during intra-articular shoulder arthroscopy by pulling the tendon into the joint with a probe through an anterior portal while viewing through a standard posterior portal. Intra-articular shoulder arthroscopy was performed on 10 forequarter cadaveric specimens. The extra-articular portion of the LHBT was evaluated by pulling the tendon into the joint with an arthroscopic probe inserted through an anterior portal. The tendon was marked at the pulley insertion on the humerus with a vascular clip before and after the tendon was pulled into the joint. An open deltopectoral approach was performed, and the amount of extra-articular tendon visualized was calculated as an absolute amount and in relation to nearby anatomic structures. An additional 1.9 cm (range, 1.4 to 2.6 cm) of extra-articular LHBT was viewed by pulling the tendon into the joint with an arthroscopic probe through an anterior portal du...
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2000
Purpose: Nonablative thermal capsular shrinkage has been developed in an attempt to address the p... more Purpose: Nonablative thermal capsular shrinkage has been developed in an attempt to address the plastic capsule deformation thought to cause increased rates of recurrent instability following arthroscopic stabilization procedures. Although the temperature required to optimize collagen shrinkage is known, a safe depth of thermal penetration, in various locations about the shoulder capsule, has not been defined. The purpose of this study was to measure shoulder capsule thickness by quadrant and circumferentially from the glenoid to the humerus so that thermal energy in shoulder procedures can be more precisely applied to limit possible injury to pericapsular structures. Type of Study: This is an anatomic study using a cadaveric shoulder specimens. Materials and Methods: Soft tissue was dissected from 8 fresh cadaveric shoulders to isolate intact glenohumeral joint capsules. The humeral insertion was released and the capsule was cut into 6 longitudinal quadrants around the glenoid. The capsule specimens were then flash frozen and stored at Ϫ80°C. Quadrant tissue was cut into longitudinal sections 14 to 16 µm wide and stained with hematoxylin and eosin. The specimens were then digitized under a dissecting microscope and measured using computer imaging software at approximately 4-mm intervals. Two-way analysis of variance (ANOVA) was performed on the measurements of the intact capsule specimens 2.5 cm off the glenoid. Humeral insertion data were recorded separately. Results: A total of 248 separate measurements were made throughout the capsule in 8 specimens. Capsular thickness increased from an average of 2.42 mm anteriorly to 2.80 mm in the inferior capsular pouch and again thinned to 2.22 mm posteriorly. Global shoulder capsule thickness ranged from 1.32 to 4.47 mm. When analyzed by position, from glenoid to humerus, a general thinning was noted with a mean thickness of 3.03 mm at the glenoid to 2.17 mm at the humeral insertion. Two-way ANOVA showed a significant thickness variation along the specimen (P Ͻ .05), a nearly significant thickness variation with regard to quadrant (P Ͻ .03), and no significant interaction (P Ͼ .07) when applied to specimen measurements approximately 2.5 cm off the glenoid. Conclusions: The thickness of the shoulder capsule ranges from 1.32 to 4.47 mm, with a significant thinning laterally from the glenoid to the humerus. Further, capsule thickness ranges from 2.76 to 3.18 mm in the regions in closest proximity to the axillary nerve. These data may help determine the proper amount of thermal penetration necessary when performing shrinkage procedures and provide safety guidelines to limit the depth of thermal penetration to avoid possible injury to pericapsular structures.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2000
Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approa... more Advances in arthroscopic technology allow rotator cuff repair through a minimally invasive approach. However, fixation of the rotator cuff tendon to suture anchors can be tedious and time consuming. The supraclavicular fossa portal allows improved access to the tear for passing suture. The authors describe the relevant anatomy, positioning. and surgical technique for use of the supraclavicular fossa portal to simplify arthroscopic rotator cuff repair.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2012
ABSTRACT We conducted this study to evaluate the effect of radiofrequency (RF) stimulation with s... more ABSTRACT We conducted this study to evaluate the effect of radiofrequency (RF) stimulation with suture repair on the healing of tears in the meniscal white-white zone. Fifty-four New Zealand white rabbits underwent surgically induced meniscal injuries within the white-white region. RF was applied using a 0.8-mm TOPAZ MicroDebrider RF wand (ArthroCare) at level 4 for 500 milliseconds. Rabbits were sacrificed at 28 and 84 days for gross and histologic analysis by 3 blinded observers and at 9, 28, and 84 days for biochemical examination. Biochemical analyses included evaluation of cell proliferation (3H-thymidine), as well as mitogenic (IGF-1, bFGF) and angiogenic (VEGF, αV) factors. Of specimens repaired with RF combined with suture, 19 (58%) showed a degree of gross morphologic and histologic healing. No significant healing was seen in specimens with either no repair or repair with suture alone. We observed a 40% increase in cellular proliferation when RF supplementation was used (P < .05). With regards to mitogenic and angiogenic markers (IGF-1, bFGF, VEGF, and αV), there was a significant increase in groups treated with RF at 9 and 28 days (P > 0.05). RF supplementation of avascular zone meniscal repairs may lead to an increased healing response.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2005
Purpose: To evaluate the safety and effectiveness of microtenotomy using a radiofrequency (RF) pr... more Purpose: To evaluate the safety and effectiveness of microtenotomy using a radiofrequency (RF) probe to treat chronic tendinosis of the common extensor tendon origins of the elbow (lateral epicondyle). Type of Study: Prospective, nonrandomized consecutive case series. Methods: The average age of the 13 patients was 48.3 Ϯ 5.5 years. Before receiving the microtenotomy, all patients had tendinosis symptoms for 6 months or longer and had failed conservative treatment. The RF-based microdebridement was performed on the symptomatic tendon using the TOPAZ Microdebrider device (ArthroCare, Sunnyvale, CA). Patients were followed-up at regular postoperative intervals for 24 months. Pain status was documented using a visual analog scale self-reported measure. Functional outcome was assessed using the upper limb DASH evaluation and grip-strength measures. Quality of life assessment was evaluated using the SF-36 questionnaire. Magnetic resonance imaging was performed at regular intervals over the follow-up period. Results: Patients reported significantly reduced pain from baseline at the 7-to 10-day postoperative examination (P Յ .01). Pain reduction was statistically stable from 7 to 10 days through the 24-month postoperative period (P Յ .01). Limb-specific functional outcomes and quality of life scores were improved over baseline values. There were no perioperative or postoperative complications related to the procedure. Conclusions: The RF-based microtenotomy procedure was safe and effective through at least 2 years. This procedure provides a valuable addition for treating patients with lateral epicondylitis associated with tendinosis who have failed conservative therapy. Level of Evidence: Level IV.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003
The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar ... more The purpose of this study is to demonstrate the safety and document the effectiveness of bipolar radiofrequency for the treatment of chronic tendinosis. Study Design: Prospective, nonrandomized, single center pilot study. Materials and Methods: There were 20 patients in the study. Each patient had chronic tendinosis of the patellar tendon, achilles tendon, or lateral or medial epicondyle. They all had symptoms for at least 6 months (average 3.5 years), and failed at least 3 conservative treatments (average 5.3 treatments). A pre-operative MRI and pain and function scores were recorded. The patients had open radiofrequency stimulation of the tendon involved using a bipolar radiofrequency Topaz Wand TM (ArthroCare Corp., Sunnyvale, CA). The generator was set to a power level of 4 (175V RMS). The wand was placed on the surface of the tendon and activated for 0.5 seconds at 5mm distance intervals around the symptomatic area. The tendon involved was stimulated 15-20 times over an area of 3.0 square cm. Post-operative pain and function scores were recorded at 7-10 days, 4-6 weeks, 3 months, and 6 months. Post-operative MRI's were performed at 4 weeks and 6 months. Results: All 20 patients improved and there were no complications. The postoperative VAS pain scores were significantly lowered by 7-10 days. The VAS scores continued to improve at 4-6 weeks, 3 months, and at the 6 month follow up. There was improvement in the SF-36, IKDC, Upper Limb DASH, and the AOFAS scores. The majority of patients had pre-operative MRI's that showed changes consistent with tendinosis. Post surgical and tendinosis changes were observed in the 4 week MRI's. The 6 month MRIs showed an improvement in the tendinosis changes. Conclusion: Bipolar radiofrequency stimulation appears to be a safe and effective treatment of chronic tendinosis. Further research is needed in this area to better understand the biochemical processes by which bipolar radiofrequency stimulation leads to pain relief and potential tendon repair.
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003
tion as proliferation cell nuclear antigens (PCNA), procollagen I and decorin. In vitro studies o... more tion as proliferation cell nuclear antigens (PCNA), procollagen I and decorin. In vitro studies on tendon fibroblast culture showed that hrBMP13 could increase cell proliferation and the gene expression of pro-collagen I and biglycan, but the gene expression of decorin was not affected. Our findings suggest that BMP13 may play a role in tendon healing.
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Papers by James Tasto