Andrew D Pearle

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

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Publications (136)358.26 Total impact

  • [Show abstract] [Hide abstract]
    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; DOI:10.1016/j.knee.2015.03.007 · 1.70 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. 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; DOI:10.1016/j.knee.2015.02.018 · 1.70 Impact Factor
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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.
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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; DOI:10.1016/j.arthro.2014.12.008 · 3.19 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.
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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.
    01/2015; 97-B(1):50-5. DOI:10.1302/0301-620X.97B1.33057
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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; DOI:10.1016/j.arthro.2014.10.017 · 3.19 Impact Factor
  • 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 · 1.98 Impact Factor
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    ABSTRACT: Purpose: In an effort to minimize graft impingement among various ACL deficient states, we sought to quantita-tively 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; b 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) scan-ning. 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 · 1.70 Impact Factor
  • 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 · 1.70 Impact Factor
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2014; 30(6):e31. DOI:10.1016/j.arthro.2014.04.068 · 3.19 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; DOI:10.1055/s-0034-1376327
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    ABSTRACT: Purpose: Unicompartmental knee arthroplasty (UKA) is an alternative to total knee arthroplasty (TKA) in patients with unicompartmental knee osteoarthritis. UKA has higher revision rates 5-10 years postoperatively, yet requires little rehabilitation, has fewer complications, and may offer patients higher function. Two prior cost-effectiveness (CE) analyses limited to older patients (age 65+) found little benefit to UKA. With rising demand expected among patients <65 who would favor better function and quicker return to work (50% of 3.4 million in 2030), we evaluated CE of UKA vs. TKA in younger and older patients. Method: We developed a Markov, state-transition model to determine the CE of UKA vs. TKA in hypothetical younger (age 45) and older (age 65) patients. Patients transition to either a full- or limited-function state postoperatively based on their Western Ontario and McMaster Universities Osteoarthritis Index score. The limited-function state is associated with lower quality-of-life (QOL) and increased costs compared to full-function. Patients in either state may experience an implant failure. We assumed that limited-function state patients fail at a higher rate than full-function state and UKA patients only have home health rehabilitation while TKA patients could also have either inpatient rehabilitation or skilled nursing facilities options. Failure rates were calculated from 20-year follow-up data in the Swedish national registry. Procedure and complication costs were based on DRG and ICD-9 codes. Inpatient rehabilitation, outpatient healthcare utilization and return to work costs were derived from the literature. QOL data and transition probability to limited-function state were also from the literature. We report costs, quality-adjusted life years (QALYs), and ICERs over the lifetime of the patient from a societal perspective in US dollars (discounted at 3% annually). Result: UKA dominated TKA in both younger and older patients in the base case In the younger patients only, TKA has an ICER <$100,000/QALY when the annual revision rate for UKA increased from 1.0% in the base case to 2.45% beginning at age 66 . Results were not sensitive to lowering TKA rehab costs. Increasing UKA’s transition probability to the limited-function state to equal that of TKA produced an ICER >$100,000/QALY. Conclusion: Unlike previous studies, we found UKA had substantial economic value in older and younger patients. Our results indicate that UKA should be recommended for eligible patients regardless of age.
    The 35th Annual Meeting of the Society for Medical Decision Making; 10/2013
  • Denis Nam, Saker Khamaisy, Andrew D Pearle
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    ABSTRACT: No abstract available.
    American journal of orthopedics (Belle Mead, N.J.) 10/2013; 42(10):447-450.
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    ABSTRACT: BACKGROUND:Abnormal anterior-posterior and rotational motion secondary to anterior cruciate ligament (ACL) insufficiency is typically described in terms of dynamic laxity. An original description of the abnormal tibiofemoral relationship in the setting of ACL insufficiency has highlighted the presence of a fixed anterior tibial subluxation in this population of failed ACL reconstruction (ACLR); however, no study has quantified the degree of tibial subluxation in both the medial and lateral compartments. PURPOSE:To measure and compare the amount of anterior tibial subluxation among various states of ACL competency, including (1) intact ACL, (2) acute ACL disruption, and (3) failed ACLR (ie, patients requiring revision ACLR). We hypothesized that anterior tibial displacement would be greater in the lateral compartment and in cases of failed ACLR compared with intact and acute ACL injured states. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:Using sagittal magnetic resonance imaging (MRI) and a standardized measurement technique, we determined the amount of anterior tibial subluxation relative to a constant posterior condylar reference point. Measurements were performed in both the medial and the lateral compartments and were compared with 1-way analysis of variance. The presence of meniscal tears along with meniscal volume loss and chondral damage was correlated with the amount of subluxation in each group. RESULTS:Compared with the intact ACL state, the medial tibial plateau was positioned more anteriorly relative to the femur in both acute ACL injured knees (mean 1.0 mm) and those that failed ACLR (mean 1.8 mm) (P = .072). In the lateral compartment, there was 0.8 mm of mean anterior tibial displacement after acute ACL injury and 3.9 mm of mean anterior subluxation in patients who failed ACLR (P < .001). Mean anterior displacement of the lateral plateau in patients who failed ACLR was almost 5 times greater than the amount observed in patients with acute ACL injuries. There was no correlation between meniscal/chondral injury and the amount of subluxation. CONCLUSION:Patients who require revision ACLR have an abnormal tibiofemoral relationship noted on MRI that is most pronounced in the lateral compartment and should be taken into account during revision surgery. These observations may explain the suboptimal clinical results seen in some patients who undergo revision ACLR.
    The American Journal of Sports Medicine 08/2013; 41(10). DOI:10.1177/0363546513498995 · 4.70 Impact Factor
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    ABSTRACT: OBJECTIVES/PURPOSE: The purpose of this study was to examine the effect of flexion angle on isometry and fiber obliquity of the anterior meniscofemoral ligament (Humphrey's ligament (HL)). METHODS: Following a medial parapatellar arthrotomy on 7 fresh frozen cadavers, the insertion points of the anterolateral (AL) and posteromedial (PM) bundles of the PCL, and HL were identified. Using a 9mm circular software tool, virtual fibers were created. Within each virtual graft, a central fiber was calculated and used to generate anisometry profiles for the AL and PM bundles and HL at flexion angles of 0°, 30°, 60°, 90°, and 120°. Previously validated computer navigation software was used to re-create three dimensional bundles to measure fiber obliquity in the sagittal, frontal, and axial planes. RESULTS: HL length increased with knee flexion from 0 to 120°, and underwent similar length changes as the PCL bundles. In full extension and at 90°, the average length of the PM and AL bundles were not statistically different (p=0.13 and p=0.85 respectively). From 0 to 120°, the PM bundle was the most isometric, but the anisometry profile was statistically similar to the AL bundle and HL. In general, HL and the PM bundle had similar graphic trends in terms of fiber obliquity in all planes. CONCLUSIONS: Using computer navigation, we have demonstrated that HL has similar isometry profiles as the PM and AL bundles of the PCL, and "mirrored" the obliquity of the PM bundle in all planes throughout flexion to 120°.
    The Knee 05/2013; DOI:10.1016/j.knee.2013.04.002 · 1.70 Impact Factor
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    ABSTRACT: The purposes of this study were to describe a method for measuring tibiofemoral subluxation in UKA, and to report the mean amount of tibiofemoral subluxation seen both preoperatively and postoperatively in a cohort of patients undergoing UKA. Two hundred thirty-five patients who received a medial UKA, and 39 patients who received a lateral UKA, were reviewed. In the medial UKA cohort, the mechanical alignment was corrected from 7.7°±5.9° preoperatively, to 2.9°±2.5° postoperatively, while the tibiofemoral subluxation was corrected from 4.5mm±3.0mm preoperatively, to 2.3mm±2.7mm postoperatively. In the lateral UKA cohort, the mechanical alignment was corrected from -5.5°±3.8° to -1.6°±3.4°, while the tibiofemoral subluxation was corrected from 4.3mm±2.7mm to 2.8mm±2.5mm. This study presents a novel method for measurement of tibiofemoral subluxation, the mean amount of tibiofemoral subluxation present preoperatively, and the amount of correction that can be expected during both medial and lateral unicondylar knee arthroplasty.
    The Journal of arthroplasty 04/2013; DOI:10.1016/j.arth.2013.03.001 · 2.37 Impact Factor

Publication Stats

2k Citations
358.26 Total Impact Points


  • 2013–2015
    • Weill Cornell Medical College
      • Department of Orthopaedic Surgery
      New York, 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
  • 2002–2015
    • Hospital for Special Surgery
      • Department of Orthopaedic Surgery
      New York, New York, United States
  • 2014
    • Cornell University
      • Department of Orthopaedic Surgery
      Итак, New York, United States
  • 2011
    • University of Michigan
      Ann Arbor, Michigan, United States
    • Kerlan-Jobe Orthopaedic Clinic
      Los Angeles, California, United States
  • 2009
    • University of California, San Francisco
      • Department of Orthopaedic Surgery
      San Francisco, CA, 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