Stephen L Tocci

Hospital for Special Surgery, New York, New York, United States

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Publications (5)8.72 Total impact

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    ABSTRACT: Background: The purpose of this study was to take an initial step in examining the potential application of flexible endoscopic technology to arthroscopic foot and ankle surgery. Methods: A thawed cadaveric lower extremity was mounted on a jig. Three sizes of flexible bronchoscopes (Pentax Medical, Montavale, NJ) and one 2.7-mm 30° offset rigid arthroscope (Smith and Nephew, Memphis, TN) were inserted through two standard anterior portals to compare respective visual fields and ease of joint access during tibiotalar arthroscopy. Neither an accessory portal nor distraction was permitted. Results: The primary limitation of the standard rigid arthroscope was its inability to navigate beyond the midtalar dome in the sagittal plane without incurring iatrogenic cartilage damage. Approximately 60% of the joint was directly accessible. Conversely, all three flexible scopes easily navigated across the talar dome from both anterior portals and permitted direct access to the entire ankle joint, including the medial and lateral gutters and posterior fossa, without iatrogenic injury. The disadvantages of the flexible scopes included their small visual fields, the need for a plastic cannula to facilitate joint entry and the inability to maintain joint orientation. Conclusion: Flexible arthroscopic technology is still in its infancy when considering orthopaedic applications. Focused development of this technique may improve access and visualization of the tibiotalar joint while eliminating potentially complicating factors such as the need for distraction, additional portal placement and iatrogenic articular damage. Further objective study of this technology is necessary for confirmation of these initial subjective impressions.
    Current Orthopaedic Practice 05/2009; 20(3):320–325. DOI:10.1097/BCO.0b013e3181981e94
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    ABSTRACT: Prospective outcome studies are generally considered to be better than retrospective studies. The purpose of this study was to assess correlations between prospective and retrospective outcome assessment after rotator cuff repair. One-hundred and twelve patients (118 shoulders) with chronic rotator cuff tears were evaluated at a mean of 54 months (34-85) after rotator cuff repair, using several outcome measures including a retrospective assessment of improvement. The retrospective assessment of post-operative pain, function, and quality of life had fair correlations with the prospectively determined improvement (R = .23-.25, P < .01). Post-operative patient satisfaction was more highly correlated with all retrospective evaluations than with the prospective improvement in all functional outcome measures. Retrospective and prospective evaluations of the outcome of rotator cuff repair are different. Patient satisfaction has a greater correlation with retrospective outcomes. Retrospective evaluation may aid in supplementing prospective evaluations, as it may better reflect a patient's perception of the success after surgery.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 08/2008; 17(6):853-9. DOI:10.1016/j.jse.2008.04.003 · 2.37 Impact Factor
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    ABSTRACT: This study determined the effect of tear size on gap formation of single-row simple-suture arthroscopic rotator cuff repair (ARCR) vs transosseous Mason-Allen suture open RCR (ORCR) in 13 pairs of human cadaveric shoulders. A massive tear was created in 6 pairs and a large tear in 7. Repairs were cyclically tested in low-load and high-load conditions, with no significant difference in gap formation. Under low-load, gapping was greater in massive tears. Under high-load, there was a trend toward increased gap with ARCR for large tears. All repairs of massive tears failed in high-load. Gapping was greater posteriorly in massive tears for both techniques. Gap formation of a modeled RCR depends upon the tear size. ARCR of larger tears may have higher failure rates than ORCR, and the posterior aspect appears to be the site of maximum gapping. Specific attention should be directed toward maximizing initial fixation of larger rotator cuff tears, especially at the posterior aspect.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2008; 17(5):808-14. DOI:10.1016/j.jse.2008.02.016 · 2.37 Impact Factor
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    ABSTRACT: A number of variables are used to assess the outcome of rotator cuff repair (RCR), including patient satisfaction. The purpose of this study was to determine the factors that affect patient satisfaction after RCR. The study assessed 112 patients (118 shoulders) with chronic rotator cuff tears preoperatively and at a mean of 54 months (range, 34-85 months) after RCR by using several functional outcome questionnaires and an evaluation of patient satisfaction. Of these, 95% were satisfied with the outcome of the surgery. Satisfaction was significantly correlated with the improvement in functional outcomes and general health status and absolute postoperative functional outcomes. Married, currently working, and nondisabled patients had greater satisfaction. High preoperative and postoperative met expectations were also positively correlated with patient satisfaction. Patient satisfaction is most highly correlated with the pain, function, and general health status of the patient after RCR. We conclude that aspects of treatment that maximize the functional outcome are important in achieving patient satisfaction after RCR.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 11/2007; 16(6):752-8. DOI:10.1016/j.jse.2007.02.136 · 2.37 Impact Factor
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    ABSTRACT: MRI is being used with increasing frequency and seems to have become more popular as a screening tool rather than as an adjunct to narrow specific diagnoses or plan operative interventions. Our hypothesis was that the rising accessibility of this test may be resulting in its overuse. We retrospectively reviewed 221 consecutive patients referred over a 3-month period for treatment of a lower extremity problem to determine: (1) the number of patients who presented with an MRI already obtained from an outside source, (2) the number of patients who obtained an MRI from the foot and ankle specialist after referral, and (3) the number of times the foot and ankle specialist used these studies or found them helpful in the care of the patient. Fractures (20) were excluded. Of the 201 patients without fractures included in the study, 19.9% (40 of 201) had MRI scans during the course of their treatment; 15.4% (31 of 201) presented to their initial visit with an MRI scan from an outside source, and 4.5% (9 of 201) received MRI scans as ordered by the foot and ankle specialist. Eighty-seven percent (27 of 31) of the pre-referral MRI scans were thought to be unnecessary, and 48.4% (15 of 31) had radiographic interpretations that were considered either immaterial to the patient's pertinent clinical diagnosis or inconsistent with the specialist's interpretations. All nine MRI scans ordered by the specialist were useful in the care of the patient. Therefore, of the 221 consecutive patients, the foot and ankle specialist would have ordered MRI scans in only 5.9% (13 of 221). This study suggests that many of the pre-referral foot or ankle MRI scans obtained before evaluation by a foot and ankle specialist are not necessary. Further studies need to be performed to determine the role of MRI in the screening of foot and ankle disorders.
    Foot & Ankle International 03/2007; 28(2):166-8. DOI:10.3113/FAI.2007.0166 · 1.63 Impact Factor