Andrew D Pearle

Weill Cornell Medical College, New York, New York, United States

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Publications (142)385.89 Total impact

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    ABSTRACT: To analyze knees in varying stages of osteoarthritis (OA) for the presence of coronal tibiofemoral (CTF) subluxation and to determine if CTF subluxation severity is related to knee OA worsening. We retrospectively evaluated CTF subluxation and limb alignment in 113 patients with different stages of knee OA who were being considered for an arthroplasty procedure. Knee OA was classified as "mild" or "severe" according to Kellgren-Lawrence scale. CTF subluxation was measured in the study groups and in 40 knees of healthy controls using software developed specifically on the basis of Iterative Closest Point mathematical algorithm. Mean CTF subluxation in "mild OA" and "severe OA" groups was 3.5 % (±2) and 3.5 % (±5) of the tibial plateau, respectively. For both the mild and severe OA groups, CTF subluxation was significantly increased compared to the 1.4 % (±1) CTF subluxation in the control group, (p < 0.0001) and (p = 0.012), respectively. However, there was no significant difference in CTF subluxation between the mild OA and severe OA groups (p = 0.75). Limb varus malalignment in mild OA and severe OA groups was 3.6° (±2.2) and 5.3° (±2.6), respectively. Both significantly increased comparing to the 1° (±0.7) control group alignment (p < 0.0001). Varus malalignment in the severe OA group was significantly increased comparing to the mild OA group (p = 0.0003). CTF subluxation is a radiographic finding related to knee OA which occurs mainly in the early stages of the osteoarthritic process and stagnates as OA progresses.
    Skeletal Radiology 08/2015; DOI:10.1007/s00256-015-2244-z · 1.51 Impact Factor
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    Andrew D Pearle · David McAllister · Stephen M Howell
    American journal of orthopedics (Belle Mead, N.J.) 06/2015; 44(6):253-258.
  • Kaitlin M Carroll · Andrew D Pearle
    American journal of orthopedics (Belle Mead, N.J.) 06/2015; 44(6):251-252.
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    ABSTRACT: The purpose of this study was to compare an open freehand mosaicplasty technique with an arthroscopic technique for the treatment of osteochondral lesions by measuring the instrument deviation, quantifying this deviation, and providing numerical information on the difference in the outcomes of these techniques. Four cadaveric knees were used. Reference markers were attached to the femur, tibia, and donor/recipient site guides. A total of 10 osteochondral grafts were harvested and inserted into recipient sites arthroscopically and 10 similar grafts were inserted freehand. The angles of graft removal and placement were calculated for each of the surgical groups compared. A navigation system was used as an aid, ostensibly to measure the graft placement parameters. Statistical analysis revealed that there was no statistically significant difference between the arthroscopic method and the freehand method regarding the angle of graft removal at the donor site (P = .162), recipient site plug removal angle (P = .731), and recipient site graft placement angle (P = .630). In the freehand group, the mean angle of graft removal at the donor site was 12°, the mean angle of recipient site plug removal was 10.7°, and the mean angle of recipient site plug placement was 10.6°. Using the arthroscopic technique, the mean angle of graft removal at the donor site was 17.14°, the mean angle of recipient site plug removal was 12.0°, and the mean angle of recipient site graft placement was 10.14°. Our study revealed there was no statistically significant difference regarding precision and accuracy during harvesting, recipient site preparation, and plug placement between the 2 techniques. Controversy exists whether an open or arthroscopic osteoarticular transfer system (OATS) technique provides superior accuracy. According to our results, there is no statistically significant difference regarding better visualization, precision, and accuracy between the freehand and arthroscopic techniques. However, larger number of specimens are required for study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 05/2015; DOI:10.1016/j.arthro.2015.03.016 · 3.21 Impact Factor
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    ABSTRACT: The purpose was to determine the effect of medial fixed bearing unicondylar knee arthroplasty (UKA) on postoperative patellofemoral joint (PFJ) congruence and analyze the relationship of preoperative PFJ degeneration on clinical outcome. We retrospectively reviewed 110 patients (113 knees) who underwent medial UKA. Radiographs were evaluated to ascertain PFJ degenerative changes and congruence. Clinical outcomes were assessed preoperatively and postoperatively. The postoperative absolute patellar congruence angle (10.05±10.28) was significantly improved compared with the preoperative value (14.23±11.22) (P=0.0038). No correlation was found between preoperative PFJ congruence or degeneration severity, and WOMAC scores at two-year follow up. Pre-operative PFJ congruence and degenerative changes do not affect UKA clinical outcomes. This finding may be explained by the post-op PFJ congruence improvement. Copyright © 2015. Published by Elsevier Inc.
    The Journal of Arthroplasty 05/2015; DOI:10.1016/j.arth.2015.05.034 · 2.67 Impact Factor
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    ABSTRACT: Unicompartmental knee arthroplasty (UKA) is a well established method for the treatment of single compartment arthritis; however, a subset of patients still present with continued pain after their procedure in the setting of a normal radiographic examination. This study investigates the effectiveness of magnetic resonance imaging (MRI) in guiding the diagnosis of the painful unicompartmental knee arthroplasty. An IRB-approved retrospective review identified 300 consecutive UKAs performed over a three years period with 28 cases of symptomatic UKA (nine percent) with normal radiographic images. MRI examination was instrumental in finding a diagnosis that went undetected on radiographs. Based on MRI findings, 10 (36%) patients underwent surgery whilst 18 (64%) were treated conservatively. This study supports the use of MRI as a valuable imaging modality for managing symptomatic unicompartmental knee arthroplasty. Case series. Copyright © 2015 Elsevier B.V. All rights reserved.
    The Knee 04/2015; 22(4). DOI:10.1016/j.knee.2015.03.007 · 1.94 Impact Factor
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    ABSTRACT: Medial unicompartmental knee arthroplasty (UKA) is a procedure designed for resurfacing the medial compartment in isolated medial compartment degenerative joint disease. Many long-term studies have reported the success of UKA. Despite recent interest and isolated reports of success, significant issues still exist today with early failure in UKA. Medial UKA is a promising alternative to TKA for isolated medial compartment DJD. Potential advantages of this treatment option compared to TKA include improved patient satisfaction, more consistent return to sporting activities, quicker recovery, decreased complication risk, and greater range of motion. With the introduction of robotic arm tools to help improve accuracy and reliability of implant position we may be able to decrease failure rates in UKAs. In addition, cementless technologies are promising approaches to improve the durability of UKA fixation. Robotic arm techniques coupled with cementless fixation strategies may dramatically reduce the incidence of aseptic loosening in UKA.
    Operative Techniques in Orthopaedics 03/2015; 60(2). DOI:10.1053/j.oto.2015.03.003
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    ABSTRACT: Limb alignment after unicondylar knee arthroplasty (UKA) has a significant impact on outcomes. The literature lacks lateral UKA alignment studies, making our understanding of this issue based on medial UKA. We evaluated limb alignment in 241 patients who underwent medial (229 knees) or lateral (37 knees) UKA. Alignment was measured pre and postoperatively in radiographs and intra-operatively using a navigation system. We compared the percentage of over-correction and the difference between post-operative alignment and navigation measurement. Percentage of overcorrection was significantly higher in the lateral UKAs (11%) compared to the medial UKAs (4%). In medial UKAs, the mean difference between the intraoperative alignment and the post-operative was 1.33°. This was significantly lower than the mean 1.86° difference in the lateral UKAs. Our data demonstrated an increased risk of "overcorrection," and greater difficulty in predicting postoperative alignment using computer navigation, when performing lateral UKAs compared to medial UKAs. Copyright © 2015 Elsevier B.V. All rights reserved.
    The Knee 03/2015; 22(4). DOI:10.1016/j.knee.2015.02.018 · 1.94 Impact Factor
  • Hassan M Ghomrawi · Ashley A Eggman · Andrew D Pearle
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    ABSTRACT: Trade-offs between upfront benefits and later risk of revision of unicompartmental knee arthroplasty compared with those of total knee arthroplasty are poorly understood. The purpose of our study was to compare the cost-effectiveness of unicompartmental knee arthroplasty with that of total knee arthroplasty across the age spectrum of patients undergoing knee replacement. Using a Markov decision analytic model, we compared unicompartmental knee arthroplasty with total knee arthroplasty with regard to lifetime costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) from a societal perspective for patients undergoing surgery at forty-five, fifty-five, sixty-five, seventy-five, or eighty-five years of age. Transition probabilities were estimated from the literature; survival, from the Swedish Knee Arthroplasty Register; and costs, from the literature and the Healthcare Cost and Utilization Project (HCUP) database. Costs and QALYs were discounted at 3.0% annually. We conducted sensitivity analyses to test the robustness of model estimates and threshold analyses. For patients sixty-five years of age and older, unicompartmental knee arthroplasty dominated total knee arthroplasty, with lower lifetime costs and higher QALYs. Unicompartmental knee arthroplasty was no longer cost-effective at a $100,000/QALY threshold when total knee arthroplasty rehabilitation costs were reduced by two-thirds or more for these older patients. Lifetime societal savings from utilizing unicompartmental knee arthroplasty in all older patients (sixty-five or older) in 2015 and 2020 were $56 to $336 million and $84 to $544 million, respectively. In the forty-five and fifty-five-year-old age cohorts, total knee arthroplasty had an ICER of $30,300/QALY and $63,000/QALY, respectively. Unicompartmental knee arthroplasty became cost-effective when its twenty-year revision rate dropped from 27.8% to 25.7% for the forty-five-year age group and from 27.9% to 26.7% for the fifty-five-year age group. Unicompartmental knee arthroplasty is an economically attractive alternative in patients sixty-five years of age or older, and modest improvements in implant survivorship could make it a cost-effective alternative in younger patients. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
    The Journal of Bone and Joint Surgery 03/2015; 97(5):396-402. DOI:10.2106/JBJS.N.00169 · 5.28 Impact Factor
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    ABSTRACT: The purpose of the study was to (1) investigate the rate of return to play among Major League Baseball (MLB) athletes after anterior cruciate ligament reconstruction (ACLR), (2) determine the impact of ACL injury on ability to perform baseball-specific planting and pivoting tasks (batting and stealing bases), and (3) to explore the effect of the injured side on these metrics. ACL injury data from 1999 to 2012 were compiled, along with player performance statistics recorded for players with at least 30 games before ACL injury. Predictor variables included side of injury and outcome variables focused on batting average, stolen bases, and number of times caught stealing before injury and after surgery. Twenty-three of 26 (88%) players were able to return to at least 30 games after ACLR, although they experienced a decline of 21.2% in number of games played (P = .004). Those who had a ACLR for a rear batting leg injury averaged a 12.3% decline in batting average, whereas those who had ACLR for a lead leg injury had a 6.4% increase in batting average (P = .04). Side of injury was not predictive of stolen base metrics. The overall rate of return to play among MLB position players after ACLR was 88%, although there was a 21.2% decline in the number of games played postoperatively. Injury to the rear batting leg resulted in a lower returning batting average compared with an injury to the lead batting leg. Side of injury had no effect on stolen bases or on the number of times a player was caught stealing. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 02/2015; 31(5). DOI:10.1016/j.arthro.2014.12.008 · 3.21 Impact Factor
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    ABSTRACT: Unicompartmental knee arthroplasty (UKA) is an increasingly popular option for the treatment of single-compartment knee osteoarthritis (OA) in adults. Two options for tibial resurfacing during UKA are (1) all-polyethylene inlays and (2) metal-backed onlays. The aim of this study was to determine whether there are any differences in clinical outcomes with inlay versus onlay tibial components. We identified 39 inlays and 45 onlays, with average 2.7- and 2.3-year follow-up, respectively, from a prospective robotic-assisted surgery database. The primary outcome was the Western Ontario and McMaster University Arthritis Index (WOMAC), subcategorized by the pain, stiffness, and function subscores, at 2 years postoperatively. The secondary outcome was the need for secondary or revision surgery. Postoperative WOMAC pain score was 3.1 for inlays and 1.6 for onlays (p = 0.03). For 25 inlays and 30 onlays with both preoperative and postoperative WOMAC data, pain score improved from 8.3 to 4.0 for inlays versus from 9.2 to 1.7 for onlays (p = 0.01). Function score improved from 27.5 to 12.5 for inlays versus from 32.1 to 7.3 for onlays (p = 0.03). Four inlays and one onlay required a secondary or revision procedure (p = 0.18). We advise using metal-backed onlays during UKA to improve postoperative clinical outcomes.
    HSS Journal 02/2015; 11(1):43-9. DOI:10.1007/s11420-014-9421-9
  • H A Zuiderbaan · S Khamaisy · R Thein · D H Nawabi · A D Pearle
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    ABSTRACT: Progressive degenerative changes in the medial compartment of the knee following lateral unicompartmental arthroplasty (UKA) remains a leading indication for revision surgery. The purpose of this study is to evaluate changes in the congruence and joint space width (JSW) of the medial compartment following lateral UKA. The congruence of the medial compartment of 53 knees (24 men, 23 women, mean age 13.1 years; sd 62.1) following lateral UKA was evaluated pre-operatively and six weeks post-operatively, and compared with 41 normal knees (26 men, 15 women, mean age 33.7 years; sd 6.4), using an Interactive closest point algorithm which calculated the congruence index (CI) by performing a rigid transformation that best aligns the digitised tibial and femoral surfaces. Inner, middle and outer JSWs were measured by sub-dividing the medial compartment into four quarters on pre- and post-operative, weight bearing tunnel view radiographs. The mean CI of knees following lateral UKA significantly improved from 0.92 (sd 0.06) pre-operatively to 0.96 (sd 0.02) (p < 0.001) six weeks post-operatively. The mean CI of the healthy control group was 0.99 sd 0.01. Post-operatively, the mean inner JSW increased (p = 0.006) and the outer decreased (p = 0.002). The JSW was restored post-operatively as no significant differences were noted in all three locations compared with the control group (inner JSW p = 0.43; middle JSW p = 0.019, outer JSW p = 0.51). Our data suggest that a well conducted lateral UKA may improve the congruence and normalise the JSW of the medial compartment, potentially preventing progression of degenerative change. Cite this article: Bone Joint J 2015;97-B:50-5. ©2015 The British Editorial Society of Bone & Joint Surgery.
    Bone and Joint Journal 01/2015; 97-B(1):50-5. DOI:10.1302/0301-620X.97B1.33057 · 1.96 Impact Factor
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    ABSTRACT: The purpose of this study was to define the limits of diagnostic glenohumeral arthroscopy and determine the prevalence and frequency of hidden extra-articular "bicipital tunnel" lesions among chronically symptomatic patients. Eight fresh-frozen cadaveric specimens underwent diagnostic glenohumeral arthroscopy with percutaneous tagging of the long head of the biceps tendon (LHBT) during maximal tendon excursion. The percentage of visualized LHBT was calculated relative to the distal margin of subscapularis tendon and the proximal margin of the pectoralis major tendon. Then, a retrospective review of 277 patients who underwent subdeltoid transfer of the LHBT to the conjoint tendon were retrospectively analyzed for lesions of the biceps-labral complex. Lesions were categorized by anatomic location (inside, junctional, or bicipital tunnel). Inside lesions were labral tears. Junctional lesions were LHBT tears visualized during glenohumeral arthroscopy. Bicipital tunnel lesions were extra-articular lesions hidden from view during standard glenohumeral arthroscopy. Seventy-eight percent of LHBT were visualized relative to the distal margin of the subscapularis tendon and only 55% relative to the proximal margin of the pectoralis major tendon. No portion of the LHBT inferior to the subscapularis tendon was visualized. Forty-seven percent of patients had hidden bicipital tunnel lesions. Scarring was most common and accounted for 48% of all such lesions. Thirty-seven percent of patients had multiple lesion locations. Forty-five percent of patients with junctional lesions also had hidden bicipital tunnel lesions. The only offending lesion was in the bicipital tunnel for 18% of patients. Diagnostic glenohumeral arthroscopy fails to fully evaluate the biceps-labral complex because it visualizes only 55% of the LHBT relative to the proximal margin of the pectoralis major tendon and did not identify extra-articular bicipital tunnel lesions present in 47% of chronically symptomatic patients. Level IV, therapeutic case series and cadaveric study. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2014; 31(2). DOI:10.1016/j.arthro.2014.10.017 · 3.21 Impact Factor
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    ABSTRACT: Objectives: Recent histological studies have shown that the ACL consists of two different structures: the direct and indirect insertions. The direct insertion is located along the lateral intercondylar ridge and the indirect insertion is ‘lower’ in the notch, adjacent to the posterior articular cartilage. The ‘lower’ position has become more popular for locating the femoral tunnel, as surgeons switch to the anteromedial (AM) portal drilling technique in order to place the graft in the region of the native footprint. However, a recent registry-based outcomes study has reported a 1.5 times higher graft failure rate for AM portal versus traditional transtibial techniques. The objective of this study was to investigate the load characteristics of the native ACL in the regions of the direct and indirect insertions. We hypothesized that the direct insertion would carry more load than the indirect insertion.
    12/2014; 2(1 Suppl). DOI:10.1177/2325967114S00008
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    ABSTRACT: Robotic-assisted unicompartmental knee arthroplasty (UKA) is accurate and repeatable. Lateral UKA is still considered a challenge, as the lateral side of the knee has different anatomy and kinematics compared with the medial side. The lateral compartment of the knee is less constrained than the medial compartment and is therefore less tolerant for mobile-bearing implants and ACL deficiency. However, the long-term outcomes of lateral UKA are scarce. Moreover, the impact of patellofemoral joint degeneration on the outcome of lateral UKA is unknown. We report our preliminary results with fixed bearing robotic-assisted lateral UKA, which are encouraging in the short term.
    Sports Medicine and Arthroscopy Review 12/2014; 22(4):223-8. DOI:10.1097/JSA.0000000000000053 · 1.68 Impact Factor
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    ABSTRACT: Purpose: In an effort to minimize graft impingement among various ACL deficient states, we sought to quantitatively determine requirements for bone resection during notchplasty with respect to both volumetric amount and location. Methods: A validated method was used to evaluate Magnetic Resonance Imaging scans. We measured the ATT of the medial and lateral compartments in the following four states: intact ACL (27 patients), acute ACL disruption; <2 months post-injury (76 patients), chronic ACL disruption; 12 months post-injury (42 patients) and failed ACL reconstruction (75 patients). Subsequently, 11 cadaveric knees underwent Computed Tomography (CT) scanning. Specialized software allowed virtual anterior translation of the tibia according to the average ATT measured on MRI. Impingement volume was analyzed by performing virtual ACLRs onto the various associated CT scans. Location was analyzed by overlaying an on-screen protractor. The center of the notch was defined as 0°. Results: Average impingement volume changed significantly in the various groups compared to the intact ACL group (acute 577 ± 200 mm(3), chronic 615 ± 199 mm(3), failed ACLR 678 ± 210 mm(3), p=0.0001). The location of the required notchplasty of the distal femoral wall border did not change significantly. The proximal femoral border moved significantly towards the center of the notch (acute 8.6° ± 4.8°, chronic 7.8° ± 4.2° (p=0.013), failed ACLR 5.1° ± 5.9° (p=0.002)). Conclusion: Our data suggests that attention should be paid peri-operatively to the required volume and location of notchplasty among the various ACL deficient states to minimize graft impingement.
    The Knee 09/2014; 21(6). DOI:10.1016/j.knee.2014.08.011 · 1.94 Impact Factor
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    ABSTRACT: Objectives: Histological studies have shown that the ACL has a direct and indirect insertion on the femur [1]. The direct insertion is located along the lateral intercondylar ridge and the indirect insertion is located ‘lower’ on the lateral wall of the notch. The trend towards anatomic ACL reconstruction using the anteromedial (AM) portal technique has resulted in ‘lower’ non-isometric femoral tunnel positions and increased graft failures [2]. To our knowledge, the load transfer properties of the direct and indirect ACL insertions have not been studied. This information may help in understanding the increased failures reported with AM portal drilling. The purpose of this study was, 1) to compare the load transferred across the native ACL at the direct and indirect femoral insertions and, 2) to determine the strain behavior of ACL grafts placed at different tunnel locations within the direct and indirect insertions.
    08/2014; 2(2 Suppl). DOI:10.1177/2325967114S00086
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    ABSTRACT: Background Coronal tibiofemoral (CTF) subluxation is a common finding in knee osteoarthritis (OA) which can be related to poor pain scores and tibial spine impingement. In this study we describe a new method for measuring CTF subluxation and present validation of the method using cadaveric knees. Methods A prototype software code based on the ICP mathematical algorithm was developed to measure CTF subluxation; the code finds the rigid transformation that best aligns the articular surfaces, measures CTF subluxation and the angle between articular surfaces. For validation, three stripped fresh frozen cadaveric knee specimens were transfixed to a specially designed knee fixation device where tibiofemoral angle and CTF subluxation can be measured directly. Fluoroscopic images were obtained with the tibiofemoral joint in neutral alignment and with 5, 10 and 15 (mm) of medial and lateral subluxation. This procedure was repeated with a neutral tibiofemoral angle, 10° of varus, and 10° of valgus. All images were analyzed independently by two investigators using the prototype software. Results The interclass correlation coefficient between the two investigators for CTF subluxation and tibiofemoral angle was 0.93 and 0.99 respectively. The CTF subluxation and tibiofemoral angle measured by the software correlated to the CTF subluxation and tibiofemoral angle defined using the knee fixation device, with Pearson product moments of 0.86 and 0.94 respectively. Conclusion Our suggested prototype software is precise, repeatable and reliable at measuring CTF subluxation and tibiofemoral angle. It may prove to be a useful tool to evaluate CTF subluxation in a clinical setting.
    The Knee 07/2014; 21(6). DOI:10.1016/j.knee.2014.07.013 · 1.94 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2014; 30(6):e31. DOI:10.1016/j.arthro.2014.04.068 · 3.21 Impact Factor
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    ABSTRACT: Lower limb alignment, tibiofemoral (TF) subluxation, and bone density changes around the knee are significant factors related to the development of knee osteoarthritis (OA) and have great impact on its severity. The relation of each factor to knee OA was evaluated separately in previous studies; however, few studies have attempted to integrate their respective effects. The purpose of this study was to determine if an identifiable interaction exists between coronal limb alignment, TF subluxation, and bone density in the development of knee OA. A total of 120 patients with symptomatic, varus knee OA, with preoperative standing anteroposterior (AP) hip-to-ankle radiographs and a computed tomographic scan of the knee, were included in this study. Overall mechanical lower extremity alignment, and TF subluxation were measured on the AP radiographs, while trabecular bone density (TBD) was measured in four regions of interest for both the tibial plateau and distal femur in all patients. The patients were stratified into the following four cohorts: (A) high subluxation, high angulation; (B) high subluxation, low angulation; (C) low subluxation, high angulation; and (D) low subluxation, low angulation. The mean TBD in group B was significantly higher than in groups C and D (p = 0.003 and 0.03, respectively). In addition, the mean TBD in group A was significantly higher than in group C. This study highlights the relationship between limb alignment, knee subluxation, and bone density in the osteoarthritic knee. These preliminary results present a proof-of-principle, that bone mineral density affects the degree of coronal alignment and TF subluxation in OA.
    The journal of knee surgery 05/2014; 28(03). DOI:10.1055/s-0034-1376327 · 1.44 Impact Factor

Publication Stats

2k Citations
385.89 Total Impact Points


  • 2015
    • Weill Cornell Medical College
      • Department of Orthopaedic Surgery
      New York, New York, United States
  • 2002–2015
    • Hospital for Special Surgery
      • Department of Orthopaedic Surgery
      New York, New York, United States
  • 2013–2014
    • Cornell University
      • Department of Orthopaedic Surgery
      Итак, New York, United States
    • Washington University in St. Louis
      • Department of Orthopaedic Surgery
      San Luis, Missouri, United States
    • CUNY Graduate Center
      New York, New York, United States
  • 2011
    • Kerlan-Jobe Orthopaedic Clinic
      Los Angeles, California, United States
  • 2008
    • Gracie Square Hospital, New York, NY
      New York City, New York, United States
  • 2006
    • Hannover Medical School
      • Trauma Department
      Hannover, Lower Saxony, Germany