Kenneth J Faber

The University of Western Ontario, London, Ontario, Canada

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Publications (74)145.06 Total impact

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    ABSTRACT: Hand dominance has been reported to be an important factor affecting outcomes following upper extremity trauma; but remains unstudied following hemiarthroplasty for fracture. This study determined whether dominance affected outcomes following hemiarthroplasty for proximal humerus fractures. Retrospective Cohort Study SETTING:: Tertiary Care Referral Center PATIENTS:: INTERVENTION:: Fracture-specific proximal humeral hemiarthroplasty for displaced proximal humerus fractures. Patients were assessed with self-reported outcomes (VAS pain, ASES, DASH, SST, and SF-12), and objective (range-of-motion and hand-held dynamometer strength) testing. At 49 months mean follow-up, there were no significant differences between groups for gender, age, follow up time, or VAS pain (p>0.256). The Dominant-affected group had significantly worse scores for ASES (p=0.043), DASH (p=0.039) and SST (p=0.021). The Dominant-affected group also had consistently higher correlations between self-reported and objective outcomes than the Non-Dominant group. Patients who underwent hemiarthroplasty for fracture on their dominant shoulders had significantly poorer outcomes than patients with non-dominant sided injuries. Although positive outcomes can be expected following hemiarthroplasty, patients should be instructed that they may have less satisfactory function and strength if their injury was on the dominant side. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
    Journal of Orthopaedic Trauma 01/2015; DOI:10.1097/BOT.0000000000000294 · 1.54 Impact Factor
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    ABSTRACT: Radial head implant sizing can be based on the maximum head diameter (D-MAX), the minimum head diameter (D-MIN), or the articular dish diameter (D-DISH). The purpose of this study was to assess the reliability of the different radial head sizing techniques and to investigate the effect of radial head fracture comminution on measurement accuracy. Ten observers measured 11 cadaveric radial heads with 3 radial head features (D-MAX, D-MIN, and D-DISH diameter). Radial heads were then fractured into 2, 3, and 4 parts, and the measurements were repeated. Variability was assessed by intraclass correlation. The measurements were compared with the intact state to assess the effect of radial head fracture comminution on sizing accuracy. D-MAX and D-MIN measurements were the most reliable among all observers (intraclass correlation coefficients, 0.980, 0.973). The D-DISH measurement was less reliable (intraclass correlation coefficient, 0.643). Radial head comminution did not significantly affect the reliability of any measurement (P > .2). Fracture comminution, however, significantly affected measurement accuracy with D-MAX and D-DISH. With fracture comminution, D-MAX underestimated radial head diameter (-0.4 ± 0.3 mm; P < .001), whereas D-DISH overestimated diameter (+0.5 ± 0.4 mm; P < .001). Comminution did not significantly affect D-MIN (-0.1 ± 0.3 mm; P = .13). The D-MAX and D-MIN measurements were more reliable than D-DISH for diameter sizing of intact and comminuted radial heads. Overall, increasing comminution did not significantly affect measurement reliability. However, the accuracy of the D-MIN technique was least affected by comminution, suggesting that D-MIN should be used in selecting the diameter of a radial head implant. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 01/2015; 24(3). DOI:10.1016/j.jse.2014.10.026 · 2.37 Impact Factor
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    ABSTRACT: The purpose of this cohort study was to compare scapular notching rates, range of motion, and functional outcomes between patients who underwent a standard Grammont-style reverse shoulder arthroplasty (RSA) and patients who underwent bony increased-offset reverse shoulder arthroplasty (BIO-RSA) at a minimum of 2 years' follow-up. We hypothesized that the BIO-RSA cohort would have lower notching rates and improved rotational range of motion; however, validated outcome scores between cohorts would be no different. A comparative cohort study was designed after a sample size calculation. A total of 40 patients were studied with 20 in each cohort (RSA vs BIO-RSA). All patients underwent an interview and physical examination. Outcomes included range of motion; shoulder strength; Disabilities of the Arm, Shoulder and Hand (DASH) score; American Shoulder and Elbow Surgeons score; Simple Shoulder Test score; Constant score; and Global Rating of Change scale score. Radiographs were obtained for all patients and examined for scapular notching. When we compared demographic characteristics between the standard RSA and BIO-RSA cohorts, including age, sex, and follow-up duration, there were no significant differences between groups (P > .05). In addition, there were no significant differences between cohorts when we compared forward elevation (P = .418); external rotation (P = .999); internal rotation (P = .071); strength (P > .376); Disabilities of the Arm, Shoulder and Hand score (P = .229); American Shoulder and Elbow Surgeons score (P = .579); Simple Shoulder Test score (P = .522); Constant score (P = .917); or Global Rating of Change scale score (P = .167). The frequency of scapular notching, however, was significantly higher (P = .022) in the RSA cohort than in the BIO-RSA cohort: 75% versus 40%. Although the scapular notching rate was significantly higher in the standard RSA group, no other outcome measures were statistically different, including range of motion, strength, and validated outcome scores. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2014; 24(3). DOI:10.1016/j.jse.2014.08.015 · 2.37 Impact Factor
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    ABSTRACT: Radial head fractures can occur in isolation or in association with elbow and forearm injuries. Treatment options include nonoperative management, fragment or whole-head excision, open reduction and internal fixation (ORIF), and radial head arthroplasty. However, the evidence supporting ORIF for repairable radial head fractures is inconclusive. We compared patients undergoing ORIF for isolated radial head fractures or for radial head fractures associated with other fractures or elbow dislocations in terms of patient-related disability, presence of posttraumatic arthritis, complications, and rate of reoperation for capsular release. Between 1997 and 2008, 52 patients underwent ORIF of the radial head for isolated radial head fractures (simple group) and 29 underwent ORIF for radial head fracture with an associated fracture or dislocation (complex group). General indications for ORIF included displaced radial fractures, large articular surface fragments, and greater than 2 mm of displacement and/or a mechanical block to forearm rotation or associated fractures or ligament injuries requiring surgery. Thirty-one patients (60%) in the simple group and 20 (69%) in the complex group were available for followup at a mean of 4 years (range, 1.0-9.5 years). We evaluated the patients using a validated self-reported pain and disability questionnaire (Patient-rated Elbow Evaluation [PREE]). Records review included radiographic examination and assessment of major complications and secondary surgery rates for capsular release. With the numbers available, the groups were not different in terms of the mean PREE scores (8 versus 15 for the simple and complex groups, respectively; p = 0.13, lower values indicate lower pain and disability). The simple and complex groups were also not different with the numbers available in terms of major complications (13% versus 25%, respectively; p = 0.29) or secondary capsular release (3% versus 20%, respectively; p = 0.07). At short term, we found no differences between patients treated with ORIF for isolated radial head fractures and those treated for radial head fractures in association with other elbow injuries with regard to pain and disability scores; loss to followup in this series precludes making statements with great confidence about function after these injuries. However, the substantial capsular release and complication rates should weigh into the preoperative discussion with patients before selecting ORIF for radial head fractures. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 03/2014; 472(7). DOI:10.1007/s11999-014-3519-8 · 2.88 Impact Factor
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    ABSTRACT: The crista supinatoris is the insertion site of the lateral collateral ligament complex on the proximal part of the ulna. The purpose of this study was to report the presentation, management, and outcomes of patients with crista supinatoris fractures. Twelve patients with fractures of the crista supinatoris were assessed clinically and radiographically and with validated outcomes at a mean of thirty-nine months after injury. Outcome measures included the Patient-Rated Elbow Evaluation (PREE), Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, American Shoulder and Elbow Surgeons elbow (ASES-e) score, and strength measured with a dynamometer. No crista supinatoris fracture occurred in isolation. Other associated injuries included radial head fracture in ten patients (83%), a radial neck fracture in one patient, and a capitellar fracture in one. At the time of presentation, all crista factures were difficult to identify on standard radiographs, but oblique radiographs and/or computed tomography (CT) allowed definitive fracture identification. Four patients were managed nonoperatively, and eight patients were managed surgically, with the indication for surgery being the associated injuries, not specifically the presence of a crista fracture. At the time of surgery, posterolateral rotatory elbow instability, if present, was due to the crista fracture. At the time of follow-up, all elbows were clinically stable and had radiographic concentric reductions. Elbow flexion and extension were a mean (and standard deviation) of 136° ± 6° and 5° ± 8°, respectively. The mean PREE score was 15 ± 20, and the mean DASH was 13.5 ± 18. Crista supinatoris fractures are difficult to identify on standard elbow radiographs. Fracture management is based on an assessment of elbow stability and on appropriate treatment of the associated injuries. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 02/2014; 96(4):326-331. DOI:10.2106/JBJS.L.01751 · 4.31 Impact Factor
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    ABSTRACT: While the majority of terrible triad elbow injuries (ulnohumeral dislocation with radial head and coronoid fractures) are managed surgically, nonoperative treatment may be appropriate in selected patients, but results with this approach have been limited by very small studies. We assessed (1) functional outcomes using two validated questionnaires, (2) elbow ROM, strength, and stability, (3) the presence of union and arthritis on radiographs, and (4) complications among a group of patients managed nonoperatively for terrible triad injuries. Between 2006 and 2012, we retrospectively identified 12 patients with terrible triad elbow injuries who were treated nonoperatively and met the following criteria: (1) a concentric joint reduction, (2) a radial head fracture that did not cause a mechanical block to rotation, (3) a smaller coronoid fracture (Regan-Morrey Type 1 or 2), and (4) a stable arc of motion to a minimum of 30° of extension to allow active motion within the first 10 days. Eleven patients were available for followup of at least 12 months after the injury (mean, 36 months; range, 12-90 months). Outcome measures included two patient-reported functional outcome measures (DASH, Mayo Elbow Performance Index [MEPI]), a standardized physical examination to record elbow ROM and stability, isometric strength measurements, and radiographic evidence of bony union and elbow arthrosis. Complications were also recorded. At latest followup, mean ± SD DASH score was 8.0 ± 11.0 and mean MEPI score was 94 ± 9. Mean ROM of the affected elbow was 134° ± 5° flexion, 6° ± 8° extension, 87° ± 4° pronation, and 82° ± 10° supination. No instability was detected. Strength assessments demonstrated the following mean percentages of the contralateral, unaffected elbow: flexion 100%, extension 89%, pronation 79%, and supination 89%. Four patients had arthritic changes on radiographs that did not call for treatment as of latest followup. Complications included one patient who underwent surgical stabilization for early recurrent instability and another who underwent arthroscopic débridement for heterotopic bone. In selected patients, nonoperative treatment of terrible triad injuries is an option that can provide good function and restore stable elbow ROM. However, nonoperative management requires close clinical and radiographic followup to monitor for any delayed elbow subluxation or fracture displacement. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
    Clinical Orthopaedics and Related Research 02/2014; 472(7). DOI:10.1007/s11999-014-3518-9 · 2.88 Impact Factor
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    ABSTRACT: Purpose: Frozen Shoulder Syndrome is a fibrosis of the shoulder joint capsule that is clinically associated with Dupuytren's disease, a fibrosis of the palmar fascia. Little is known about any commonalities in the pathophysiology of these connective tissue fibroses. β-catenin, a protein that transactivates gene expression, and levels of IGF2 mRNA, encoding insulin-like growth factor-II, are elevated in Dupuytren's disease. The aim of this study was to determine if correlating changes in β-catenin levels and IGF2 expression are evident in Frozen Shoulder Syndrome. Methods: Tissue from patients with Frozen Shoulder Syndrome and rotator cuff tear were obtained during shoulder arthroscopies. Total protein extracts were prepared from tissue aliquots and β-catenin immunoreactivity was assessed by Western immunoblotting. In parallel, primary fibroblasts were derived from these tissues and assessed for IGF2 expression by quantitative PCR. Results: β-catenin levels were significantly increased in Frozen Shoulder Syndrome relative to rotator cuff tear when assessed by Western immunoblotting analyses. IGF2 mRNA levels were significantly increased in primary fibroblasts derived from frozen shoulder syndrome tissues relative to fibroblasts derived from rotator cuff tissues. Conclusions: As in Dupuytren's disease, β-catenin levels and IGF2 expression are elevated in Frozen Shoulder Syndrome. These findings support the hypothesis that these connective tissue fibroses share a common pathophysiology.
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    ABSTRACT: To describe and evaluate the lateral para-olecranon approach for total elbow arthroplasty and to compare it with the paratricipital and triceps splitting approaches. A total of 34 patients who underwent total elbow arthroplasty were evaluated: 25 with rheumatoid arthritis (28 elbows) and 9 with fractures. The average duration of follow-up was 54 months (range, 12-105 mo). Of the 28 elbows with rheumatoid arthritis, 17 underwent a triceps splitting approach, 6 a lateral para-olecranon, and 5 a paratricipital approach. Of the 9 fracture cases, 5 patients underwent a lateral para-olecranon and 4 a paratricipital approach. Extension strength, range of motion, elbow function (Mayo Elbow Performance Index), and complications related to triceps insufficiency were compared for all 3 approaches. In addition, we compared triceps strength after lateral para-olecranon and paratricipital approaches with the contralateral healthy elbow in the 9 fracture cases. Patients with rheumatoid arthritis had better extension torque when the prosthesis was implanted through the lateral para-olecranon approach (20 ± 8 N-m) compared with the triceps splitting (13 ± 4 N-m) or paratricipital approaches (12 ± 6 N-m). In the fracture group, the extension strength of the replaced elbow was similar to the contralateral normal elbow in both the paratricipital and lateral para-olecranon groups. The lateral para-olecranon approach avoids triceps tendon detachment from and repair to the olecranon, thereby reducing the risk of triceps insufficiency while maintaining better extension strength relative to a triceps splitting approach. Therapeutic III.
    The Journal of hand surgery 11/2013; 38(11):2219-2226.e3. DOI:10.1016/j.jhsa.2013.07.029 · 1.66 Impact Factor
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    ABSTRACT: Double-row suture anchor fixation of the rotator cuff was developed to reduce repair failure rates. The purpose of this study was to determine the effects of simulated rotator cuff tears and subsequent repairs using single- and double-row suture anchor fixation on three-dimensional shoulder kinematics. It was hypothesized that both single- and double-row repairs would be effective in restoring active intact kinematics of the shoulder. Sixteen fresh-frozen cadaveric shoulder specimens (eight matched pairs) were tested using a custom loading apparatus designed to simulate unconstrained motion of the shoulder. In each specimen, the rotator cuff was sectioned to create a medium-sized (2 cm) tear. Within each pair, one specimen was randomized to a single-row suture anchor repair, while the contralateral side underwent a double-row suture anchor repair. Joint kinematics were recorded for intact, torn, and repaired scenarios using an electromagnetic tracking device. Active kinematics confirmed that a medium-sized rotator cuff tear affected glenohumeral kinematics when compared to the intact state. Single- and double-row suture anchor repairs restored the kinematics of the intact specimen. This study illustrates the effects of medium-sized rotator cuff tears and their repairs on active glenohumeral kinematics. No significant difference (P ≥ 0.10) was found between the kinematics of single- and double-row techniques in medium-sized rotator cuff repairs. Determining the relative effects of single- and double-row suture anchor repairs of the rotator cuff will allow physicians to be better equipped to treat patients with rotator cuff disease.
    International Journal of Shoulder Surgery 04/2013; 7(2):46-51. DOI:10.4103/0973-6042.114224 · 0.51 Impact Factor
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    Minerva Ortopedica e Traumatologica 01/2013; 64:377-94.
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    ABSTRACT: Recurrence of instability after isolated Bankart repairs is common in patients with co-existing glenoid and humeral head bone loss. Remplissage is an arthroscopic procedure used to fill the Hill-Sachs defect and prevent recurrence. This arthroscopic procedure is performed in conjunction with a Bankart repair, filling the humeral head defect with the infraspinatus tendon and the posterior joint capsule. Short-term clinical studies demonstrate a technique with predictable healing, good quality of life outcome scores, an average recurrence rate of 6.6 %, and with most patients returning to pre-injury levels. Biomechanical studies have demonstrated a loss of internal-external rotation after this procedure compared to Bankart repair alone. We suggest remplissage as a procedure for patients with engaging Hill-Sachs defects with minimal glenoid-sided bone loss. Longer-term prospective and comparative studies are still needed to fully evaluate remplissage outcomes.
    Surgery of Shoulder Instability, 01/2013: pages 95-106; Springer Berlin Heidelberg.
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    ABSTRACT: Fractures of the radial head are the most common fractures in the elbow, and they frequently have associated ligamentous, cartilaginous, or other bony injuries. Clinical assessment and radiological investigation allow for accurate diagnosis and the formulation of a management plan. Undisplaced or minimally displaced fractures with no rotational block to motion can be treated nonoperatively with excellent results expected. The minimum amount of displacement in a partial articular radial head fracture required for open reduction and internal fixation to provide a superior outcome to nonoperative management is still unknown. Medium-term data suggest that patients with comminuted radial head fractures do well with radial head replacement.
    The Journal of hand surgery 12/2012; 37(12):2626-34. DOI:10.1016/j.jhsa.2012.10.001 · 1.66 Impact Factor
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    ABSTRACT: Fractures of the radial head are common with most partial articular fractures resulting in an anterolateral fragment. The exact mechanism of radial head fracture is unknown; however, forces transmitted and variations in local bone density are believed important. This study quantifies the regional variations in bone density and volume of the radial head to better understand the pathomechanics of fracture patterns.Methods Computer tomography scan data of 18 cadaver elbows were imported into imaging analysis software. The radial head was divided into quadrants based on neutral forearm rotation. Bone density and volume were calculated and compared between quadrants.ResultsThe regional densities of bone expressed in Hounsfield units (HU) were posteromedial quadrant (PM) 496 ± 87 HU, anteromedial quadrant (AM) 443 ± 72 HU, anterolateral quadrant (AL) 409 ± 60 HU, and posterolateral quadrant (PL) 406 ± 57 HU. The volume of bone in descending order was PM 1138 ± 179 mm3, PL 1013 ± 213 mm3, AM 1010 ± 210 mm3, and AL 938 ± 175 mm3. The PM quadrant was significantly denser than the AM, AL, and PL quadrants, (P = .001) and the AM quadrant was significantly denser than the AL and PL quadrants (P = .006 and .009). The PM quadrant had significantly more bone volume when compared to the AM, AL, and PL (P = .001). The AM and PL quadrants had significantly greater bone volume compared to AL quadrant (P = .023 and .018, respectively).Conclusion Radial head bone volume and density is highest in the posteromedial quadrant and lowest in the anterolateral quadrant where fractures occur more frequently.
    Journal of Shoulder and Elbow Surgery 12/2012; 21(12):1669-1673. DOI:10.1016/j.jse.2012.07.002 · 2.37 Impact Factor
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    ABSTRACT: BACKGROUND: Bone mineral density measurements with dual-energy x-ray absorptiometry (DXA) are commonly used to diagnose osteoporosis and assess fracture risk. This study describes the association between radiographic measures of proximal humeral cortical bone thickness and bone mineral density measured by DXA. The study also assesses the discriminative capability of clinical cortical bone thickness measurements at the proximal humerus to differentiate patients with osteoporosis. METHODS: Patients (N = 108) with shoulder radiographs and DXA studies were evaluated. Cortical bone thickness was assessed with 2 techniques, the gauge method and the average method. Pearson correlations were used to describe the relationship between cortical bone thickness measurement techniques and femoral and lumbar DXA. Sensitivity, specificity, and negative predictive value for predicting osteoporosis were determined for several cortical bone thickness thresholds. Rater reliability of measures was assessed with intraclass correlation coefficients. RESULTS: The intra-rater and inter-rater reliability of measures was excellent (intraclass correlation coefficient > 0.85). Average cortical bone thickness measurements at the proximal humerus strongly correlated with DXA femur measurements (r = 0.64, P < .0001) and moderately correlated with DXA lumbar measurements (r = 0.49, P < .0001). Gauge cortical thickness measurements also correlated with DXA femur measurements (R = 0.53, P < .0001) and DXA lumbar measurements (R = 0.35, P < .001). An average proximal humerus cortical thickness measurement of 6 mm was identified as a potential threshold value for predicting osteoporosis, with a sensitivity of 93%, specificity of 52%, and negative predictive value of 95%. CONCLUSIONS: Average cortical bone thickness measurements obtained from standard anteroposterior shoulder radiographs are correlated with DXA. Furthermore, they provide a clinically relevant, rapid, sensitive, and inexpensive method for ruling out osteoporosis.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 11/2012; 22(6). DOI:10.1016/j.jse.2012.08.018 · 2.37 Impact Factor
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    ABSTRACT: BACKGROUND: This biomechanical study evaluated the effects of 3 remplissage techniques on shoulder stability and motion in a Hill-Sachs (HS) instability model. MATERIALS AND METHODS: Cadaveric forequarters were tested on an active shoulder simulator. Three remplissage techniques were performed for 15% and 30% HS defects. Testing conditions included intact and 15% and 30% HS defects, and the 3 remplissage techniques: T1, anchors in the defect valley; T2, anchors in humeral head rim; and T3, anchors in valley with medial suture placement. Outcomes included stability, internal-external rotation range of motion (IE-ROM), and joint stiffness. RESULTS: All remplissage techniques improved shoulder stability. In 15% HS defects tested in adduction, T3 significantly reduced IE-ROM (P = .037), whereas T1 and T2 did also (mean IE-ROM reductions: T1, 14°; T2, 11°; T3, 21°), but not to significance (P ≥ .088). In abduction, no significant reductions in IE-ROM occurred (P ≥ .060). In 30% HS defects tested in adduction (mean reduction IE-ROM: T1, 11°; T2, 19°; T3, 28°) and abduction (mean reduction: T1, 9°; T2, 15°; T3, 21°), all techniques significantly reduced IE-ROM (P ≤ .046). All techniques increased joint stiffness from 100% to 320% beyond the Bankart repair alone. A significant increase in joint stiffness was observed for T3 compared with the 30% HS group (P = .004), whereas T2 trended toward an increase (P = .078). There was no significant increase in joint stiffness with T1 (P = .249). CONCLUSIONS: All remplissage techniques enhanced shoulder stability, restricted ROM, and increased joint stiffness. No significant differences were found between anchors placed in the valley (T1) vs those placed in the humeral head rim (T2). Medial suture placement (T3) resulted in the greatest joint stiffness values and mean restriction in motion.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 10/2012; 22(6). DOI:10.1016/j.jse.2012.08.015 · 2.37 Impact Factor
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    ABSTRACT: INTRODUCTION: Glenohumeral instability with glenoid bone loss is commonly treated with the Latarjet procedure. The procedure involves transfer of the coracoid and conjoint tendon, which is thought to provide a stabilizing sling effect; however, its significance is unknown. This study evaluated the effects of the Latarjet procedure, with and without conjoint tendon loading, on shoulder stability and range of motion (ROM). MATERIALS AND METHODS: A custom simulator was used to evaluate anterior shoulder stability and ROM in 8 cadaveric shoulders. Testing conditions included intact, 30% glenoid defect, and Latarjet with and without conjoint loading. Unloaded and 10-N loaded states were tested in adduction and 90° abduction. Outcome variables included dislocation, stiffness (neutral and 60° external rotation), and internal-external rotational ROM. RESULTS: All 30% defects dislocated in abduction external rotation. The loaded Latarjet prevented dislocation in all specimens, whereas the unloaded Latarjet stabilized 6 of 8 specimens. In abduction external rotation, there were no significant differences in stiffness between loaded and unloaded transfers (P = .176). In adduction, there were no significant differences between the intact and the loaded Latarjet (P ≥ .228); however, in neutral rotation, the unloaded Latarjet (P = .015) and the 30% defects (P = .011) were significantly less stiff. Rotational ROM in abduction was significantly reduced with the loaded Latarjet (P = .014) compared with unloaded Latarjet, and no differences were found in adduction. CONCLUSIONS: These findings indicate that glenohumeral stability is improved, but not fully restored to intact, with conjoint tendon loading. The results support the existence of the sling effect and its importance in augmenting stability provided by the transferred coracoid.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 09/2012; 22(6). DOI:10.1016/j.jse.2012.08.002 · 2.37 Impact Factor
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    ABSTRACT: This clinical trial was done to evaluate outcomes of the single and double-incision techniques for acute distal biceps tendon repair. We hypothesized that there would be fewer complications and less short-term pain and disability in the two-incision group, with no measureable differences in outcome at a minimum of one year postoperatively. Patients with an acute distal biceps rupture were randomized to either a single-incision repair with use of two suture anchors (n = 47) or a double-incision repair with use of transosseous drill holes (n = 44). Patients were followed at three, six, twelve, and twenty-four months postoperatively. The primary outcome was the American Shoulder and Elbow Surgeons (ASES) elbow score. Secondary outcomes included muscle strength, complication rates, and Disabilities of the Arm, Shoulder and Hand (DASH) and Patient-Rated Elbow Evaluation (PREE) scores. All patients were male, with no significant differences in the mean age, percentages of dominant hands affected, or Workers' Compensation cases between groups. There were also no differences in the final outcomes (at two years) between the two groups (p = 0.4 for ASES pain score, p = 0.10 for ASES function score, p = 0.3 for DASH score, and p = 0.4 for PREE score). In addition, there were no differences in isometric extension, pronation, or supination strength at more than one year. A 10% advantage in final isometric flexion strength was seen in the patients treated with the double-incision technique (104% versus 94% in the single-incision group; p = 0.01). There were no differences in the rate of strength recovery. The single-incision technique was associated with more early transient neurapraxias of the lateral antebrachial cutaneous nerve (nineteen of forty-seven versus three of forty-three in the double-incision group, p < 0.001). There were four reruptures, all of which were related to patient noncompliance or reinjury during the early postoperative period and appeared to be unrelated to the fixation technique (p = 0.3). There were no significant differences in outcomes between the single and double-incision distal biceps repair techniques other than a 10% advantage in final flexion strength with the latter. Most complications were minor, with a significantly greater prevalence in the single-incision group.
    The Journal of Bone and Joint Surgery 07/2012; 94(13):1166-74. DOI:10.2106/JBJS.K.00436 · 4.31 Impact Factor
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    ABSTRACT: The remplissage procedure may be performed as an adjunct to Bankart repair to treat recurrent glenohumeral dislocation associated with an engaging Hill-Sachs humeral head defect. The purpose of this in vitro biomechanical study was to examine the effects of the remplissage procedure on glenohumeral joint motion and stability. Cadaveric shoulders (n = 8) were mounted on a biomechanical testing apparatus that applies simulated loads to the rotator cuff and the anterior, middle, and posterior heads of the deltoid muscle. Testing was performed with the shoulder intact, after creation of the Bankart lesion, and after repair of the Bankart lesion. In addition, testing was performed after Bankart repair with and without remplissage in shoulders with 15% and 30% Hill-Sachs defects. Shoulder motion and glenohumeral translation were recorded with an optical tracking system. Outcomes measured included stability (joint stiffness and defect engagement) and internal-external glenohumeral rotational motion in adduction and in 90° of composite shoulder abduction. In specimens with a 15% Hill-Sachs defect, Bankart repair combined with remplissage resulted in a significant reduction in internal-external range of motion in adduction (15.1° ± 11.1°, p = 0.039), but not in abduction (7.7° ± 9.9, p = 0.38), compared with the intact condition. In specimens with a 30% Hill-Sachs defect, repair that included remplissage also significantly reduced internal-external range of motion in adduction (14.5° ± 11.3°, p = 0.049) but not in abduction (6.2° ± 9.3°, p = 0.60). In specimens with a 15% Hill-Sachs defect, addition of remplissage significantly increased joint stiffness compared with isolated Bankart repair (p = 0.038), with the stiffness trending toward surpassing the level in the intact condition (p = 0.060). In specimens with a 30% Hill-Sachs defect, addition of remplissage restored joint stiffness to approximately normal (p = 0.41 compared with the intact condition). All of the specimens with a 30% Hill-Sachs defect engaged and dislocated after Bankart repair alone. The addition of remplissage was effective in preventing engagement and dislocation in all specimens. None of the specimens with a 15% Hill-Sachs defect engaged or dislocated after Bankart repair. In this experimental model, addition of remplissage provided little additional benefit to a Bankart repair in specimens with a 15% Hill-Sachs defect, and it also reduced specific shoulder motions. However, Bankart repair alone was ineffective in preventing engagement and recurrent dislocation in specimens with a 30% Hill-Sachs defect. The addition of remplissage to the Bankart repair in these specimens prevented engagement and enhanced stability, although at the expense of some reduction in shoulder motion.
    The Journal of Bone and Joint Surgery 06/2012; 94(11):1003-12. DOI:10.2106/JBJS.J.01956 · 4.31 Impact Factor
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    ABSTRACT: Physiologic dorsal apex angulation of the proximal ulna is present in 96% of the population. We hypothesize that a correlation exists between the physiologic dorsal ulnar angulation and elbow range of motion (ROM). Fifty healthy adults underwent bilateral lateral elbow radiographs in neutral forearm rotation in the following positions: terminal flexion (TF), 90° of flexion, and terminal extension (TE). The proximal ulna dorsal angulation (PUDA), TF, and TE were measured on the digital lateral radiographs by 2 independent observers. ROM was calculated as the difference between TF and TE measurements. Subjects were divided into 2 groups: those with PUDA measurements less than the median and those with PUDA measurements equal to or greater than the median. The relationship between the PUDA and TE, TF, and ROM was evaluated by use of Pearson correlation coefficients. The mean age of the cohort was 31 ± 9 years, and there were 30 women among the 50 volunteers. The sample of 100 elbow radiographs had a mean TF of 150.8° ± 4.5°, a mean TE (ie, flexion contracture) of 11.5° ± 7.3°, and a mean ROM of 139.3° ± 8.4°. The mean PUDA was 5.2° ± 2.8°. Elbows with a greater PUDA had significantly less TE (r = 0.381, P ≤ .001) and ROM (r = -0.351, P ≤ .001). The group of elbows with a lesser PUDA had better TE (9.4° vs 13.6°, P = .004) and ROM (142.0° vs 136.7°, P = .001) than elbows with a greater PUDA. The increasing magnitude of the PUDA is associated with decreased maximal elbow extension and global elbow ROM.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 03/2012; 21(3):384-8. DOI:10.1016/j.jse.2011.10.008 · 2.37 Impact Factor
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    ABSTRACT: The purpose was to review the literature on the outcomes of elbow arthroscopy and to make evidence-based recommendations for or against elbow arthroscopy for the treatment of various conditions. Our hypothesis was that the evidence would support the use of elbow arthroscopy in the management of common elbow conditions. A literature search was performed by use of the PubMed database in October 2010. All therapeutic studies investigating the results of treatment with elbow arthroscopy were analyzed for outcomes and complications. The literature specific to common elbow arthroscopy indications was summarized and was assigned a grade of recommendation based on the available evidence. There is fair-quality evidence for elbow arthroscopy in the treatment of rheumatoid arthritis of the elbow and lateral epicondylitis (grade B recommendation). There is poor-quality evidence for, rather than against, the arthroscopic treatment of degenerative arthritis, osteochondritis dissecans, radial head resection, loose bodies, post-traumatic arthrofibrosis, posteromedial impingement, excision of a plica, and fractures of the capitellum, coronoid process, and radial head (grade C(f) recommendation). There is insufficient evidence to give a recommendation for or against the arthroscopic treatment of posterolateral rotatory instability and septic arthritis (grade I recommendation). The available evidence supports the use of elbow arthroscopy in the management of the majority of conditions where it is currently used. The quality of the evidence, however, is generally fair to poor. Level IV, systematic review of Level II-IV studies.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2012; 28(2):272-82. DOI:10.1016/j.arthro.2011.10.007 · 3.19 Impact Factor

Publication Stats

1k Citations
145.06 Total Impact Points


  • 2003–2015
    • The University of Western Ontario
      • • Department of Surgery
      • • The Hand and Upper Limb Centre
      London, Ontario, Canada
  • 2006–2012
    • St. Joseph's Health Care London
      London, Ontario, Canada
    • University of Manitoba
      Winnipeg, Manitoba, Canada
  • 2010
    • McMaster University
      • School of Rehabilitation Science
      Hamilton, Ontario, Canada
  • 2007
    • St. Joseph's Hospital
      Savannah, Georgia, United States
    • Lawson Health Research Institute
      Guilford, England, United Kingdom
  • 2000–2005
    • Lawson Health Research Institute
      London, Ontario, Canada