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Article ; Online: Treatment of Unfixable Inferior Pole Fractures of the Patella Using an All-Suture Internal Fixation Technique.

Bhumiwat, Pongpak / Fossum, Bradley W / Dey Hazra, Rony-Orijit / Ganokroj, Phob

2024 Volume 16, Issue 1, Page(s) 168–172

Abstract: Inferior pole fractures of the patella are a type of patellar fracture that has various complexities. Most current techniques are associated with hardware-related complications, which is one of the main concerns when treating this complex fracture. We ... ...

Abstract	Inferior pole fractures of the patella are a type of patellar fracture that has various complexities. Most current techniques are associated with hardware-related complications, which is one of the main concerns when treating this complex fracture. We present a new technique that does not require metal implant removal, causes little to no irritation of the quadriceps muscle, and provides strong fixation that allows for early range of motion postoperatively.
MeSH term(s)	Humans ; Patella/surgery ; Treatment Outcome ; Retrospective Studies ; Fractures, Bone/surgery ; Fracture Fixation, Internal/methods ; Sutures ; Fractures, Comminuted/surgery ; Bone Wires
Language	English
Publishing date	2024-01-15
Publishing country	Korea (South)
Document type	Case Reports
ZDB-ID	2502788-8
ISSN	2005-4408 ; 2005-291X
ISSN (online)	2005-4408
ISSN	2005-291X
DOI	10.4055/cios23111
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Article: Reanalysis of the Posterior Oblique Ligament: Quantitative Anatomy, Radiographic Markers, and Biomechanical Properties.

Casp, Aaron J / Bryniarski, Anna / Brady, Alex W / Fossum, Bradley W / Godin, Jonathan A

Orthopaedic journal of sports medicine

2023 Volume 11, Issue 6, Page(s) 23259671231174857

Abstract: Background: The posterior oblique ligament (POL) is the largest structure of the posteromedial knee that is at risk of injury in conjunction with the medial collateral ligament (MCL). Its quantitative anatomy, biomechanical strength, and radiographic ... ...

Abstract	Background: The posterior oblique ligament (POL) is the largest structure of the posteromedial knee that is at risk of injury in conjunction with the medial collateral ligament (MCL). Its quantitative anatomy, biomechanical strength, and radiographic location have not been assessed in a single investigation. Purpose: To evaluate the 3-dimensional and radiographic anatomy of the posteromedial knee and the biomechanical strength of the POL. Study design: Descriptive laboratory study. Methods: Ten nonpaired fresh-frozen cadaveric knees were dissected and medial structures were elevated off bone, leaving the POL. The anatomic locations of the related structures were recorded with a 3-dimensional coordinate measuring machine. Anteroposterior and lateral radiographs were taken with radiopaque pins inserted into the pertinent landmarks, and the distances between the collected structures were calculated. Each knee was then mounted to a dynamic tensile testing machine, and pull-to-failure testing was performed to record the ultimate tensile strength, stiffness, and failure mechanism. Results: The POL femoral attachment was a mean of 15.4 mm (95% CI, 13.9-16.8 mm) posterior and 6.6 mm (95% CI, 4.4-8.8 mm) proximal to the medial epicondyle. The tibial POL attachment center was a mean of 21.4 mm (95% CI, 18.1-24.6 mm) posterior and 2.2 mm (95% CI, 0.8-3.6 mm) distal to the center of the deep MCL tibial attachment and a mean of 28.6 mm (95% CI, 24.4-32.8 mm) posterior and 41.9 mm (95% CI, 36.8-47.0 mm) proximal to the center of the superficial MCL tibial attachment. On lateral radiographs, the femoral POL was a mean of 17.56 mm (95% CI, 14.83-21.95 mm) distal to the adductor tubercle and 17.32 mm (95% CI, 14.6-21.7 mm) posterosuperior to the medial epicondyle. On the tibial side, the center of the POL attachment was a mean of 4.97 mm (95% CI, 3.85-6.79 mm) distal to the joint line on anteroposterior radiographs and 6.34 mm (95% CI, 5.01-8.48 mm) distal to the tibial joint line on lateral radiographs, at the far posterior tibial aspect. The biomechanical pull-to-failure demonstrated a mean ultimate tensile strength of 225.2 ± 71.0 N and a mean stiffness of 32.2 ± 13.1 N. Conclusion: The anatomic and radiographic locations of the POL and its biomechanical properties were successfully recorded. Clinical relevance: This information is useful to better understand POL anatomy and biomechanical properties as well as to clinically address an injury with repair or reconstruction.
Language	English
Publishing date	2023-06-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671231174857
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Treatment of the 'The Naked Humeral Head': Repair of Supraspinatus Avulsion, Subscapularis Tear, and Humeral Avulsion of the Glenohumeral Ligament.

Liles, Jordan L / Fossum, Bradley W / Mologne, Mitchell / Su, Charles A / Godin, Jonathan A

Arthroscopy techniques

2022 Volume 11, Issue 11, Page(s) e2103–e2111

Abstract: A humeral avulsion of the glenohumeral ligament, or HAGL, lesion is a rare yet debilitating shoulder injury, which can lead to recurrent instability, pain, and overall shoulder dysfunction. The diagnosis is often difficult, requiring both high clinical ... ...

Abstract	A humeral avulsion of the glenohumeral ligament, or HAGL, lesion is a rare yet debilitating shoulder injury, which can lead to recurrent instability, pain, and overall shoulder dysfunction. The diagnosis is often difficult, requiring both high clinical suspicion, as well as identification on magnetic resonance imaging. In patients with an anterior HAGL, repair often requires an open approach. In extremely rare circumstances, the initial traumatic event that causes a HAGL can also cause disruption of the supraspinatus and subscapularis insertions on the humeral head. We have termed this the "naked humeral head". The purpose of this technical note is to describe our preferred technique to surgically treat the naked humeral head by repairing a supraspinatus avulsion fracture, HAGL lesion, and complete subscapularis tear.
Language	English
Publishing date	2022-10-20
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2022.08.010
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Article ; Online: Subscapularis repair in reverse total shoulder arthroplasty: a systematic review and descriptive synthesis of cadaveric biomechanical strength outcomes.

Preuss, Fletcher R / Fossum, Bradley W / Peebles, Annalise M / Eble, Stephanie K / Provencher, Matthew T

JSES reviews, reports, and techniques

2022 Volume 2, Issue 4, Page(s) 437–441

Abstract: Hypothesis/background: There is no consensus on whether to repair the subscapularis in the setting of reverse total shoulder arthroplasty (rTSA). There have been an assortment of studies showing mixed results regarding shoulder stability and ... ...

Abstract	Hypothesis/background: There is no consensus on whether to repair the subscapularis in the setting of reverse total shoulder arthroplasty (rTSA). There have been an assortment of studies showing mixed results regarding shoulder stability and postoperative strength outcomes when looking at subscapularis repair in rTSA. The purpose of this systematic review was to investigate differences in biomechanical strength outcomes of cadaveric subscapularis repair vs. no repair in rTSA.Increased force will be required to move the shoulder through normal range of motion (ROM) in cadaveric rTSA shoulders with the subscapularis repaired when compared with no subscapularis repair. Methods: A comprehensive literature review was conducted in accordance with the 2009 Preferred Reporting Items for Systematic Review and Meta-Analysis statement. The databases used to search the keywords used for the concepts of subscapularis, reverse total shoulder arthroplasty, and muscle strength were PubMed (includes MEDLINE), Embase, Web of Science, Cochrane Reviews and Trials, and Scopus. Original, English-language cadaveric studies evaluating rTSA and subscapularis management were included, with subscapularis repair surgical techniques and strength outcomes being evaluated for each article meeting inclusion criteria. Results: The search yielded 4113 articles that were screened for inclusion criteria by 4 authors. Two articles met inclusion criteria and were subsequently included in the final full-text review. A total of 11 shoulders were represented between these 2 studies. Heterogeneity of the data across the 2 studies did not allow for meta-analysis. Hansen et al found that repair of the subscapularis with rTSA significantly increased the mean joint reaction force and the force required by the posterior deltoid, total deltoid, infraspinatus, teres minor, total posterior rotator cuff, and pectoralis major muscles. Giles et al found that rotator cuff repair and glenosphere lateralization both increased total joint load. Conclusion: The present review of biomechanical literature shows that repair of the subscapularis in the setting of rTSA can effectively restore shoulder strength by increasing joint reactive forces and ROM force requirements of other rotator cuff muscles and of the deltoid muscle. Available biomechanical evidence is limited, and further biomechanical studies evaluating the strength of various subscapularis repair techniques are needed to evaluate the effects of these techniques on joint reactive forces and muscle forces required for ROM.
Language	English
Publishing date	2022-06-30
Publishing country	Netherlands
Document type	Journal Article ; Review
ISSN	2666-6391
ISSN (online)	2666-6391
DOI	10.1016/j.xrrt.2022.05.006
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Article ; Online: Accuracy and Reliability of Software Navigation for Acetabular Component Placement in THA: An In Vitro Validation Study.

Brady, Alex W / Tatka, Jakub / Fagotti, Lorenzo / Kemler, Bryson R / Fossum, Bradley W

Medicina (Kaunas, Lithuania)

2022 Volume 58, Issue 5

Abstract: Background and ... ...

Abstract	Background and Objectives
MeSH term(s)	Arthroplasty, Replacement, Hip ; Hip Prosthesis ; Humans ; Reproducibility of Results ; Software ; Tomography, X-Ray Computed/methods
Language	English
Publishing date	2022-05-14
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina58050663
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Article: Ulnar Collateral Ligament (UCL) Reconstruction With Proximal Single-Tunnel Suspensory Fixation.

Fossum, Bradley W / Vopat, Matthew L / Brown, Justin R / Comfort, Spencer M / Su, Charles A / Viola, Randall W

Arthroscopy techniques

2023 Volume 12, Issue 6, Page(s) e997–e1002

Abstract: Ulnar collateral ligament (UCL) reconstruction of the medial elbow is considered to be the gold standard for treating valgus instability seen in overhead throwing athletes. The first UCL construction was performed by Frank Jobe in 1974, and this ... ...

Abstract	Ulnar collateral ligament (UCL) reconstruction of the medial elbow is considered to be the gold standard for treating valgus instability seen in overhead throwing athletes. The first UCL construction was performed by Frank Jobe in 1974, and this procedure has evolved over time to include multiple techniques that improved the biomechanical strength of the graft fixation and maximize the rate of return to athletic competition for these patients. The most common UCL-reconstruction technique used today is the docking technique. The purpose of this Technical Note is to describe our technique, including pearls and pitfalls, which combines the many advantages of the docking technique with a proximal single-tunnel suspensory fixation technique. This method allows for optimal tensioning of the graft, allowing for secure fixation that relies on metal implants as opposed to tying sutures over a proximal bone bridge.
Language	English
Publishing date	2023-05-29
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2023.02.038
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Article ; Online: Direct measurement of three-dimensional forces at the medial meniscal root: A validation study.

Brown, Justin R / Hollenbeck, Justin F M / Fossum, Bradley W / Melugin, Heath / Tashman, Scott / Vidal, Armando F / Provencher, Matthew T

Journal of biomechanics

2023 Volume 148, Page(s) 111429

Abstract: The posterior medial meniscal root (PMMR) experiences variable and multiaxial forces during loading. Current methods to measure these forces are limited and fail to adequately characterize the loads in all three dimensions at the root. Our novel ... ...

Abstract	The posterior medial meniscal root (PMMR) experiences variable and multiaxial forces during loading. Current methods to measure these forces are limited and fail to adequately characterize the loads in all three dimensions at the root. Our novel technique resolved these limitations with the installation of a 3-axis sensing construct that we hypothesized would not affect contact mechanics, would not impart extraneous loads onto the PMMR, would accurately measure forces, and would not deflect under joint loads. Six cadaveric specimens were dissected to the joint capsule and a sagittal-plane, femoral condyle osteotomy was performed to gain access to the root. The load sensor was placed below the PMMR and was validated across four tests. The contact mechanics test demonstrated a contact area precision of 44 mm
MeSH term(s)	Humans ; Biomechanical Phenomena ; Cadaver ; Menisci, Tibial/surgery ; Knee Joint/surgery ; Tibia/surgery
Language	English
Publishing date	2023-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	218076-5
ISSN	1873-2380 ; 0021-9290
ISSN (online)	1873-2380
ISSN	0021-9290
DOI	10.1016/j.jbiomech.2022.111429
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Article: Patient-Specific Instrumentation for Medial Closing Wedge Distal Femoral Osteotomy With Patellar Osteochondral Allograft.

Liles, Jordan L / Vopat, Matthew L / Ganokroj, Phob / Mologne, Mitchell S / Fossum, Bradley W / Peebles, Annalise M / Provencher, Matthew T

Arthroscopy techniques

2023 Volume 12, Issue 7, Page(s) e1203–e1209

Abstract: The primary indications for performing a medial closing wedge distal femoral osteotomy are valgus knee malalignment, lateral knee compartment overload, lateral meniscus insufficiency, and/or lateral compartment osteoarthritis or cartilage damage. Without ...

Abstract	The primary indications for performing a medial closing wedge distal femoral osteotomy are valgus knee malalignment, lateral knee compartment overload, lateral meniscus insufficiency, and/or lateral compartment osteoarthritis or cartilage damage. Without correction of this malalignment, there is an increased risk for chondral damage in the lateral and patellofemoral compartment of the knee. The optimal candidates for this procedure are young, active individuals with moderate to severe arthritis in the lateral compartment. Recently, preoperative planning for high tibial and distal femoral osteotomies (HTOs and DFOs) using 3-dimensional (3D) patient-specific instrumentation (PSI) has increased in popularity. Successful patient outcomes have been reported using this technique. This Technical Note illustrates our preferred technique that uses 3D PSI in addition to a patellar OCA transplant when treating a symptomatic cartilage lesion associated with genu valgum.
Language	English
Publishing date	2023-06-26
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2653101-X
ISSN	2212-6287
ISSN	2212-6287
DOI	10.1016/j.eats.2023.03.010
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Article ; Online: Meniscotibial Ligament Insufficiency Increases Force on the Posterior Medial Meniscus Root.

Melugin, Heath P / Brown, Justin R / Hollenbeck, Justin F M / Fossum, Bradley W / Whalen, Ryan J / Ganokroj, Phob / Vidal, Armando F / Provencher, Matthew T

The American journal of sports medicine

2023 Volume 51, Issue 13, Page(s) 3502–3508

Abstract: Background: Posterior medial meniscus root (PMMR) tears are a challenge to assess and treat. However, the forces sustained at the PMMR are yet to be fully characterized. In addition, it has been shown that meniscotibial ligament (MTL) injuries happen ... ...

Abstract	Background: Posterior medial meniscus root (PMMR) tears are a challenge to assess and treat. However, the forces sustained at the PMMR are yet to be fully characterized. In addition, it has been shown that meniscotibial ligament (MTL) injuries happen before PMMR tears, suggesting that insufficiency of the MTL results in a change of forces acting on the PMMR. Purpose/hypothesis: The purpose of this study was to evaluate the 3-dimensional forces acting on the PMMR in the intact, MTL cut, and MTL tenodesis states. It was hypothesized that the MTL cut state would increase medial shear forces seen at the PMMR, whereas the medial shear force in the MTL tenodesis state would return PMMR forces to that of the intact state. Study design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees were tested in 3 states (intact, MTL cut, and tenodesis). A 3-axis load cell was installed below the posterior tibial plateau and attached to the enthesis of the PMMR. The specimen was mounted to a load frame that applied an axial load, an internal torque, and an external torque. The amount of compression-tension, mediolateral shear force, and anteroposterior shear force acting on the PMMR was measured. Results: When the joint was loaded in compression, the MTL cut state significantly increased compression of the PMMR ( Conclusion: When evaluated biomechanically, MTL insufficiency resulted in increased compressive force at the PMMR. A single-anchor centralization procedure did not restore PMMR forces to that of the intact state. Increased knee flexion angle resulted in increased medial shear force on the PMMR. Clinical relevance: The findings in this study provide clinicians information on PMMR forces when the MTL is disrupted. These data can aid in the decision-making for adding an MTL repair to augment PMMR repairs.
MeSH term(s)	Humans ; Menisci, Tibial/surgery ; Biomechanical Phenomena ; Knee Joint/surgery ; Tibia/surgery ; Ligaments, Articular/surgery ; Cadaver ; Anterior Cruciate Ligament Injuries ; Range of Motion, Articular
Language	English
Publishing date	2023-09-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	197482-8
ISSN	1552-3365 ; 0363-5465
ISSN (online)	1552-3365
ISSN	0363-5465
DOI	10.1177/03635465231194606
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Article: Biomechanical Analysis Evaluating Meniscal Extrusion After Knotless Suture Anchor Fixation for Segmental Medial Meniscal Allograft Transplantation.

Ganokroj, Phob / Fossum, Bradley W / Hollenbeck, Justin / Whalen, Ryan J / Garcia, Alexander R / Foster, Michael J / Provencher, Capt Matthew T

Orthopaedic journal of sports medicine

2023 Volume 11, Issue 8, Page(s) 23259671231182978

Abstract: Background: Segmental medial meniscal allograft transplantation (MAT) has been shown to restore knee biomechanics; however, stable fixation of the transplantation is critical to avoid extrusion and maximize healing.: Purpose: To evaluate the degree ... ...

Abstract	Background: Segmental medial meniscal allograft transplantation (MAT) has been shown to restore knee biomechanics; however, stable fixation of the transplantation is critical to avoid extrusion and maximize healing. Purpose: To evaluate the degree of meniscal extrusion and biomechanical function of segmental medial MAT performed with meniscocapsular sutures versus repair augmentation with knotless suture anchors. Study design: Controlled laboratory study. Methods: Segmental midbody medial meniscectomy and subsequent segmental medial MAT were performed on 10 fresh-frozen cadaveric knees. The knees were then loaded in a dynamic tensile testing machine to 1000 N for 60 seconds at 0°, 30°, 60°, and 90° of flexion, and 4 conditions were tested: (1) intact, (2) segmental defect, (3) inside-out segmental repair, and (4) anchor plus inside-out segmental repair of the medial MAT. Meniscal extrusion was measured using high-fidelity ultrasound imaging. The mean contact area and the mean and peak contact pressures were assessed with submeniscal pressure-mapping sensors. Data from testing conditions were compared with 2-way repeated-measures analysis of variance, with pairwise comparison using the Bonferroni method. Results: At 90° of flexion, the segmental defect state showed a higher degree of meniscal extrusion compared with all other states ( Conclusion: Meniscal extrusion was not significantly increased at any flexion angle after segmental resection. The addition of knotless anchors did not improve meniscal extrusion or contact pressures/area compared with capsular repair alone. The addition of knotless anchors did improve contact mechanics from the segmental defect state, but only at 0° of flexion. Clinical relevance: The addition of knotless suture anchors to segmental meniscal transplantation increased stabilization of the meniscus at full extension compared with repair with sutures alone. This increased stabilization may lead to better long-term outcomes.
Language	English
Publishing date	2023-08-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2706251-X
ISSN	2325-9671
ISSN	2325-9671
DOI	10.1177/23259671231182978
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