Mark S Myerson

Weil Foot and Ankle Institute, Chicago, Illinois, United States

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Publications (183)218.04 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus.
    Foot & Ankle International 09/2014; · 1.47 Impact Factor
  • Casey Jo Humbyrd, Mark S Myerson
    Foot & Ankle International 09/2014; · 1.47 Impact Factor
  • Mark S Myerson, Raheel Shariff, Alan J Zonno
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    ABSTRACT: Little has been published on the management of infected total ankle replacements. This study reviewed our experience with this difficult clinical problem.
    Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 07/2014;
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    ABSTRACT: Although plain radiographs have been historically used to evaluate the status of arthrodesis in the foot and ankle, computed tomography (CT) has gained popularity for evaluation of fusion status. The degree of fusion identified on CT scan has been correlated with functional outcome, with an arthrodesis area of 25-50% necessary for clinical success. In the clinical setting, orthopaedic surgeons often evaluate CT scans independently. The purpose of this study was to evaluate the interrater reliability of CT scans to assess the status of hindfoot or ankle fusions among orthopaedic foot and ankle surgeons.
    Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 07/2014;
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    ABSTRACT: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base. This study reports the outcome of a cohort of patients who underwent an adjunctive procedure of resection of the fifth metatarsal, either partial or complete, in conjunction with cavovarus foot reconstruction to offload the lateral border of the foot. This was a retrospective study looking at the clinical and radiographic outcome of patients with an underlying neuromuscular problem with a cavovarus foot who underwent a resection of the fifth metatarsal. This was used as an adjunctive procedure during reconstruction for lateral foot pressure overload symptoms. Case notes and radiographs were reviewed. The distance on weight-bearing radiographs from the inferior most part of the bony prominence on the lateral border of the foot to the floor was measured and compared between pre- and postoperatively. Eighteen patients met the inclusion criteria. Mean age was 55 years. Mean follow-up was 32 months. Fourteen patients had a partial base of fifth metatarsal resection, and 4 had a complete fifth ray resection. Radiographic measurements showed a statistically significant improvement in the distance from the inferior most part of the bony prominence on the lateral border of the foot to the floor between pre- and postoperative radiographs. Sixteen patients reported a significant improvement in their symptoms, 2 had some persistent lateral overload symptoms. The technique described in this study has not been reported previously for this indication. We believe it is a good adjunctive procedure in cavovarus foot reconstruction for patients suffering from lateral pressure overload. We describe strict guidelines and indications for this procedure. Level IV, case series.
    Foot & ankle international. / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society. 04/2014;
  • Shariff R, Myerson MS, Palmanovich E
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    ABSTRACT: Abstract BACKGROUND: Cavovarus deformity associated with neuromuscular imbalance is a challenging pathology. Most of these deformities lead to pressure symptoms at the lateral border of the foot. This leads to pain, callosity, and commonly fracture of the fifth metatarsal base. This study reports the outcome of a cohort of patients who underwent an adjunctive procedure of resection of the fifth metatarsal, either partial or complete, in conjunction with cavovarus foot reconstruction to offload the lateral border of the foot. METHODS: This was a retrospective study looking at the clinical and radiographic outcome of patients with an underlying neuromuscular problem with a cavovarus foot who underwent a resection of the fifth metatarsal. This was used as an adjunctive procedure during reconstruction for lateral foot pressure overload symptoms. Case notes and radiographs were reviewed. The distance on weight-bearing radiographs from the inferior most part of the bony prominence on the lateral border of the foot to the floor was measured and compared between pre- and postoperatively. Eighteen patients met the inclusion criteria. Mean age was 55 years. Mean follow-up was 32 months. RESULTS: Fourteen patients had a partial base of fifth metatarsal resection, and 4 had a complete fifth ray resection. Radiographic measurements showed a statistically significant improvement in the distance from the inferior most part of the bony prominence on the lateral border of the foot to the floor between pre- and postoperative radiographs. Sixteen patients reported a significant improvement in their symptoms, 2 had some persistent lateral overload symptoms. CONCLUSION: The technique described in this study has not been reported previously for this indication. We believe it is a good adjunctive procedure in cavovarus foot reconstruction for patients suffering from lateral pressure overload. We describe strict guidelines and indications for this procedure. LEVEL OF EVIDENCE: Level IV, case series. KEYWORDS: Charcot–Marie–Tooth, cavovarus foot, fifth metatarsal resection, lateral pressure overload
    foot ankle international. 04/2014;
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    Ezequiel Palmanovich, Mark Myerson
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    ABSTRACT: KEYWORD � Severe hallux valgus � Distal metatarsal osteotomy � Chevron � Correction power � Intramedullar plate � Novel technique KEY POINTS Q6 � The concept of minor and moderate deformities being treated by distal osteotomies and the severe deformities treated best by proximal metatarsal osteotomies is changing. � High, powerful correction for aggressive distal chevron osteotomy can be fixed by a stable intramedullar plate. � A new technique of fixation is based on the Murawski and Beskin concept, because a powerful correction can be performed with a minimally invasive approach. � A low rate of complications is due to minimal invasive technique.
    Foot and ankle clinics 04/2014; Volume 19,Issue 2.
  • J Kent Ellington, Sanjeev Gupta, Mark S Myerson
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    ABSTRACT: Few studies have focused on treatment following failed total ankle replacement. The purpose of this study was to report the outcomes of patients undergoing revision total ankle replacement and to propose a talar component subsidence grading system that may be helpful in making decisions regarding how to revise failed total ankle replacements in the future. A retrospective review was performed of fifty-three patients who underwent revision total ankle replacement and had been followed for a minimum of two years. Patients were assessed radiographically and with outcome scores. The rates of conversion to amputation or fusion were also assessed. The mean follow-up period was 49.1 months after the revision arthroplasty. The average time from primary total ankle replacement to revision was fifty-one months. Forty-one of the fifty-three patients (77%) were available for follow-up. The revision arthroplasty had been converted to an arthrodesis in five of the forty-one patients, and two additional patients had undergone amputation. The most common indication for revision total ankle replacement was talar subsidence (63%; twenty-six of forty-one). Twenty-two patients (54%) had a subtalar arthrodesis performed at the time of the revision arthroplasty, with nineteen of those having a custom-designed long-stem talar component placed simultaneously. The mean radiographic measurements of component position did not change significantly postoperatively. The mean postoperative scores for the thirty-four patients with a retained total ankle replacement were: 4.4 of 10 possible points on a visual analog pain scale (VAS), 65 of 100 possible points on the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot scale, 93.5 of 100 possible points on the Short-Form 12 (SF-12), 137.9 of 204 possible points on the Revised Foot Function Index (FFI-R), and 64 of 180 possible points on the Ankle Osteoarthritis Scale (AOS). The mean arc of motion radiographically was 18° preoperatively and 23° postoperatively, with all improvement occurring in plantar flexion. A lesser amount of preoperative talar subsidence was a significant predictor of a good outcome based on the AOFAS hindfoot score (p < 0.03) and the AOS (p < 0.01) score. Revision arthroplasty may be considered as an alternative to arthrodesis when treating patients with a failed Agility total ankle implant. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
    The Journal of Bone and Joint Surgery 12/2013; 95(23):2112-8. · 3.23 Impact Factor
  • Jacob R Zide, Mark S Myerson
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    ABSTRACT: When the cavus foot has become rigid, midfoot and triple arthrodesis may be the only reasonable surgical options left. The apex of the deformity is multiplanar and some deformities may have more than one apex. The best outcomes are achieved with minimal shortening of the foot, so correction should be by rotation and translation and with minimal wedge resection wherever possible. Posterior tibial tendon transfer and peroneus longus transfer are nearly always required for correction. If the principles of soft tissue balancing are followed, arthrodesis is an excellent procedure despite the literature that states to the contrary.
    Foot and ankle clinics 12/2013; 18(4):755-67.
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    ABSTRACT: Lateral transfers of the flexor hallucis longus (FHL) or flexor digitorum longus (FDL) tendons have been described for treatment of concomitant, irreparable peroneal tears. This study evaluated the anatomic benefits and constraints of lateral FHL and FDL tendon transfers with regard to available tendon length, diameter, and proximity to the posterior neurovascular bundle. In 9 cadaveric specimens, the FHL and FDL tendons were transected through a medial approach distal to the knot of Henry. Each tendon was transferred into a lateral incision, passing the FDL tendon both posterior and anterior to the tibial neurovascular bundle. The tendons were individually secured to the base of the fifth metatarsal with the foot in maximal eversion and dorsiflexion. The length of donor tendon available for fixation at the fifth metatarsal was measured. After the FDL tendon transfer was secured, the posterior neurovascular bundle was examined for signs of compression. Average FHL tendon diameter measured 5.1 mm; the FDL measured 4.5 mm. After passage through a bone tunnel, an additional 4.9 cm of FHL tendon remained to suture to itself; only 0.5 cm remained for the posterior and anterior FDL transfers. Transfer of the FHL did not increase muscle bulk within the retrofibular groove. Every FDL transfer posterior to the neurovascular bundle produced obvious visual compression of the tibial nerve with plantar flexion and inversion of the foot. Use of the FHL tendon for lateral transfer consistently provided sufficient length of tendon for multiple fixation options and a stronger muscle for transfer. Fixation options for the FDL were limited due to its shorter length. Lateral transfer of the FDL tendon posterior to the neurovascular bundle caused visible compression on the tibial nerve with ankle and hindfoot range of motion. This anatomic study confirmed several advantages for the use of the FHL tendon transfer in cases of concomitant peroneal tears.
    Foot & Ankle International 09/2013; · 1.47 Impact Factor
  • Mark S Myerson, Jacob R Zide
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    ABSTRACT: The goal of osteotomy in the treatment of varus ankle arthritis is to shift the forces imparted to the ankle to a portion of the joint that is not involved in the degenerative process. The redistribution of loads and stresses seen by the tibiotalar joint can be approached either above or below the ankle with an osteotomy of the tibia or calcaneus. Evaluation of the deformity as being subtalar, supramalleolar, or a combination allows the surgeon to best address the increased joint stresses, thereby reducing the risk of failure of the osteotomy.
    Foot and ankle clinics 09/2013; 18(3):471-80.
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    ABSTRACT: The Ludloff osteotomy is a technique option to address hallux valgus in patients with a moderately to significantly increased first-second intermetatarsal angle. The Ludloff osteotomy is an oblique osteotomy of the first metatarsal extending dorsal-proximal to plantar-distal when viewed in the sagittal plane. The dorsal-proximal portion of the metatarsal is cut with the saw while maintaining the plantar-distal surface intact. A screw is inserted across the proximal aspect of the osteotomy, then the osteotomy is extended across the plantar surface distally. The metatarsal is rotated around the axis of the screw to the desired correction. In order to perform the osteotomy correctly, the surgeon must not only effectively complete the nuances of the technique, but also understand the limitations and contraindications of the Ludloff osteotomy. This review of current concepts for the Ludloff osteotomy reviews recent literature as well as technique pearls and pitfalls in the application of this powerful osteotomy.
    International Orthopaedics 08/2013; · 2.32 Impact Factor
  • Jacob R Zide, Mark Myerson
    Foot & Ankle International 07/2013; · 1.47 Impact Factor
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    ABSTRACT: BACKGROUND: Tibiotalocalcaneal arthrodesis in patients with large segmental bony defects presents a substantial challenge to successful reconstruction. These defects typically occur following failed total ankle replacement, avascular necrosis of the talus, trauma, osteomyelitis, Charcot, or failed reconstructive surgery. This study examined the outcomes of tibiotalocalcaneal (TTC) arthrodesis using bulk femoral head allograft to fill this defect. METHODS: Thirty-two patients underwent TTC arthrodesis with bulk femoral head allograft. Patients who demonstrated radiographic union were contacted for SF-12 clinical scoring and repeat radiographs. Patients with asymptomatic nonunions were also contacted for SF-12 scoring alone. Preoperative, intraoperative, and postoperative factors were analyzed to determine positive predictors for successful fusion. RESULTS: Sixteen patients healed their fusion (50% fusion rate). Diabetes mellitus was found to be the only predictive factor of outcome; all 9 patients with diabetes developed a nonunion. In this series, 19% of the patients went on to require a below-knee amputation. CONCLUSIONS: Although the radiographic fusion rate was low, when the 7 patients who had an asymptomatic nonunion were combined with the radiographic union group, the overall rate of functional limb salvage rose to 71%. TTC arthrodesis using femoral head allograft should be considered a salvage procedure that is technically difficult and carries a high risk for complications. Patients with diabetes mellitus are at an especially high risk for nonunion. LEVEL OF EVIDENCE: Therapeutic level IV.
    Foot & Ankle International 05/2013; · 1.47 Impact Factor
  • J Kent Ellington, Mark S Myerson
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    ABSTRACT: BACKGROUND: Ball and socket ankle (BASA) deformity is a rare condition. Little is known about outcomes and treatments in the adult population. METHODS: Retrospective comparative review was performed of 13 patients treated for BASA with a minimum follow-up of 2.5 years. Evaluation included clinical and radiographic review, outcome scores, a questionnaire, and a subjective satisfaction survey. RESULTS: Nine patients with correctable valgus deformity not associated with arthritis of the ankle joint underwent a supramalleolar osteotomy (SMO). Four patients underwent arthrodesis-2 a tibiotalocalcaneal (TTC) arthrodesis and 2 a pantalar arthrodesis. AOFAS scores improved from 30.1 to 77.6 (range, 16-82) (P < .05) in the SMO group. AOFAS scores improved from 24 to 60.5 (range, 16-66) (P < .05) in the arthrodesis group. Arthritis grade in the SMO patients was unchanged in 4 patients at final follow-up and worsened in 5 patients by only 1 grade. Nine patients reported good results (all 4 arthrodesis patients, 5 SMO patients) and 4 reported fair results (all SMO patients). CONCLUSIONS: BASA deformity and dysfunction can be improved with corrective surgery. LEVEL OF EVIDENCE: Level III, prospective comparative study.
    Foot & Ankle International 04/2013; · 1.47 Impact Factor
  • Graham McCollum, Mark S Myerson
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    ABSTRACT: The Agility total ankle replacement system was the most commonly performed implant in the United States for more than 20 years and has undergone four generations and seven phases of improvement. Much attention has been placed on intraoperative complications, such as malleolar fracture; nerve or tendon injury; and incision healing-related problems, such as wound coverage and infection. However, it is the intermediate- and long-term complications (ie, aseptic osteolysis, subsidence, component loosening, and progressive malalignment) that require careful consideration, because the revision options remain limited. This article reviews the history of the Agility total ankle replacement system in detail, to understand the revision possibilities available.
    Clinics in Podiatric Medicine and Surgery 04/2013; 30(2):207-23.
  • Adam Ajis, Jeffrey D Seybold, Mark S Myerson
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    ABSTRACT: BACKGROUND: Painful degenerative diseases of the metatarsophalangeal joints (MTPJs) are frequently progressive and difficult to treat. Traditional operative treatments such as debridement, distal metatarsal osteotomies, and arthroplasty present a unique set of complications, and pain and deformity may still occur. Osteochondral distal metatarsal allograft reconstruction (ODMAR) is presented as a salvage procedure, reserved for patients with significant bone loss or avascular necrosis in whom traditional interventions have failed or are inadequate to address the underlying joint deformity. METHODS: A retrospective review identified all ODMAR cases performed by the senior author over the past 10 years. Patient symptoms, satisfaction, and MTPJ range of motion were measured at each postoperative evaluation. Graft healing and subsequent degenerative changes at the MTPJ were observed at each visit with foot radiographs. The surgical techniques for both first and lesser metatarsal reconstructions are described. RESULTS: Six patients were identified with average follow-up interval of 36 months (range, 6-66). Preoperative diagnoses included infection (1), fracture (1), and avascular necrosis (4). Mean total arc of motion was 40 degrees (range, 30-50). All patients maintained viability of the allograft metatarsal head and joint space was normal or Kellgren-Lawrence grade 1 in 5 of 6 patients at final follow-up. All patients demonstrated osseous union of the metatarsal osteotomy site. No patients have undergone revision surgery to date. CONCLUSIONS: ODMAR is a safe and effective procedure for treatment of painful, degenerative conditions of the MTPJs. Further studies are required to determine the definitive indications and long-term outcomes for this procedure. LEVEL OF EVIDENCE: Level IV, retrospective case series.
    Foot & Ankle International 03/2013; · 1.47 Impact Factor
  • Adam Ajis, Hugo Henriquez, Mark Myerson
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    ABSTRACT: BACKGROUND: It is still unknown how ankle range of motion changes following total ankle arthroplasty. This study was undertaken to more accurately address patient expectations, guide postoperative rehabilitation, and improve our understanding of how ankle range of motion changes with time. METHODS: 119 total ankle replacements of 3 different prosthetic designs from 1 surgeon were retrospectively examined and compared. Ankle dorsiflexion and plantar flexion ranges of motion were calculated and analyzed preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 1 year. The different ankle replacement systems were analyzed individually and together to determine whether trends were replicated. RESULTS: No significant increase in ankle range of motion was found 6 months postoperatively (P = .75). Mean combined postoperative range of motion did not change significantly from 24.3 degrees at 1 year versus a preoperative mean of 22.7 degrees (P = .75). Mean dorsiflexion improved significantly at the 6-week postoperative stage by 5.5 degrees (P < .001), whereas plantar flexion only improved by 2.9 degrees (P = .06). Mean dorsiflexion improved from preoperative levels by 5.4 degrees (P = .001), whereas mean plantar flexion decreased by 3.7 degrees (P = .004). CONCLUSIONS: We found no notable improvement in ankle range of motion after 6 months following total ankle arthroplasty. We also found a disproportionately higher increase in dorsiflexion compared with plantar flexion following surgery and an overall reduction in mean plantar flexion range compared with preoperative values. Notwithstanding this discrepancy, total mean ankle range of motion 1 year postoperatively was similar to preoperative values. Reasons for the discrepancy between dorsiflexion and plantar flexion are unclear. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
    Foot & Ankle International 03/2013; · 1.47 Impact Factor
  • Adam Ajis, Ken-Jin Tan, Mark S Myerson
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    ABSTRACT: BACKGROUND: It is believed that patients with an ankle arthrodesis (AA) have better outcomes than after a tibiotalocalcaneal (TTC) arthrodesis due to preservation of subtalar motion. However, there are no studies comparing actual functional outcomes and patient satisfaction between AA and TTC arthrodesis. METHODS: We retrospectively analyzed patient satisfaction and functional outcomes of patients after an AA and TTC arthrodesis using a postal survey. A total of 173 patients who underwent TTC and 100 AA patients from 2002 to 2010 were identified with a minimum of 24 months follow-up. In all, 53 AA and 64 TTC arthrodesis patients were included in the study, with the remainder lost to follow-up. A return to activity questionnaire and SF-12 scores were used to compare functional outcomes. The mean follow-up time was 63 months. RESULTS: Both groups showed good outcomes with a low visual analogue pain score (2.7 for AA and 2.8 for TTC), high satisfaction score (90.6% for AA and 87.5% for TTC), and return to work (77.4% for AA and 73.0% for TTC). In all, 84.6% of AA and 81.0% of TTC patients would have the surgery again. There were no significant differences between the 2 groups for these parameters. However, when asked if their desired activity level was met, fewer AA patients met their desired level (58.5% for AA and 66.5% for TTC, P = .02). AA patients were also more likely to feel their level was unmet due to the foot and ankle (85.6% for AA vs 25.7% for TTC, P < .001). CONCLUSIONS: Both AA and TTC arthrodesis were associated with good functional outcomes and satisfaction. AA patients had higher postoperative activity expectations and were less likely to meet them. When they failed to meet these expectations, they were much more likely to attribute it to their operated ankle. We believe it is because of the different ways the 2 groups of patients are counseled preoperatively, which highlights the importance of managing patient expectations. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
    Foot & Ankle International 03/2013; · 1.47 Impact Factor
  • Graham A McCollum, Mark S Myerson, Jacques Jonck
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    ABSTRACT: Osteochondral lesions of the talus are generally benign, and many heal or are not symptomatic. A subset of these defects progress to large cystic lesions, which have a less favorable prognosis. The treatment options are joint preservation or sacrifice. Joint salvage entails marrow stimulation techniques or hyaline cartilage replacement with allograft or autograft. When lesions reach greater than 3 cm or Raikin class IV or become uncontained on the shoulders of the talus, autografting techniques become more challenging. Osteochondral allografting may be a better surgical option, often achievable without a malleolar osteotomy for exposure.
    Foot and ankle clinics 03/2013; 18(1):113-33.

Publication Stats

2k Citations
218.04 Total Impact Points

Institutions

  • 2003–2014
    • Weil Foot and Ankle Institute
      Chicago, Illinois, United States
  • 2002–2014
    • Mercy Medical Center
      • Institute for Foot and Ankle Reconstruction
      Baltimore, Maryland, United States
    • Northwestern University
      • Department of Orthopaedic Surgery
      Evanston, IL, United States
  • 2013
    • Wirral University Teaching Hospital NHS Foundation Trust
      Mexborough, England, United Kingdom
  • 2012
    • Mayo Clinic - Rochester
      Rochester, Minnesota, United States
  • 2011
    • Mayo Foundation for Medical Education and Research
      • Department of Orthopedics
      Scottsdale, AZ, United States
  • 2010
    • Massachusetts General Hospital
      • Department of Orthopaedic Surgery
      Boston, MA, United States
  • 2008
    • University of Michigan
      • Department of Orthopaedic Surgery
      Ann Arbor, MI, United States
    • University of Zurich
      • Department of Pediatric Orthopaedics
      Zürich, ZH, Switzerland
  • 2007
    • Madigan Army Medical Center
      Tacoma, Washington, United States
  • 1992–2007
    • Union Memorial Hospital
      Baltimore, Maryland, United States
  • 2006
    • University of British Columbia - Vancouver
      • Department of Orthopaedics
      Vancouver, British Columbia, Canada
  • 2004
    • Alpert Medical School - Brown University
      • Department of Orthopaedics
      Providence, RI, United States
  • 2000
    • Orthopädisches Spital Speising Wien
      Wien, Vienna, Austria
  • 1997
    • Geisel School of Medicine at Dartmouth
      Hanover, New Hampshire, United States
  • 1996
    • Mount Sinai School of Medicine
      • Department of Orthopaedics
      Manhattan, NY, United States
  • 1995
    • William Beaumont Army Medical Center
      El Paso, Texas, United States