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ABSTRACT: HYPOTHESIS: In this study, we aim to test whether scapular winging results in a significant change in glenohumeral translation in the initial phase of the throwing motion. METHODS: Six shoulders underwent an abbreviated throwing motion (ATM) from late cocking to the end of acceleration by use of a validated robotic system. The intact specimens were tested to establish a baseline. The position of the scapula was then affected to simulate scapular winging by placing a cylindrical wedge under the inferior angle of the scapula, and the ATM was performed again. For both conditions, the average glenohumeral translations and scapular rotations were plotted over time to calculate the area under the curve, as a representative of the overall glenohumeral translations and scapular rotations observed during the ATM. RESULTS: Throughout the motion, the winged scapulae showed, on average, 7.7° more upward rotation, 1.6° more internal rotation, and 5.3° more anterior tipping as compared with the baseline. The scapular position relative to the hanging arm was significantly different between the baseline and scapular winging conditions in all arm positions, except for maximal external rotation and the neutral position. Comparing the area under the curve at baseline and with scapular winging indicated that scapular winging significantly increased anterior translation of the glenohumeral joint whereas translation in the superior/inferior and medial/lateral directions did not result in a change in translation. DISCUSSION: These results may suggest a more important role of abnormalities in scapular position in predisposing throwing athletes to shoulder injuries of the anterior capsulolabral structures and consecutive glenohumeral instability.
Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 01/2013; · 1.93 Impact Factor
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SGOT Yearly Conference; 06/2012
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Claudio Rosso,
Andreas Marc Müller,
William A. Dow,
Stacey K. Stanton,
Daniel Li,
Vahid Entezari,
Andrea Cereatti,
Ugo Della Croce,
Paolo Bonato, Joseph P. DeAngelis,
Victor Valderrabano,
Arun J. Ramappa,
Ara Nazarian
SGOT Yearly Conference; 06/2012
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EFORT Conference; 05/2012
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ABSTRACT: Before the US Patient Protection and Affordable Care Act of 2010, there were documented insurance-based disparities in access to orthopaedic surgeons and care of orthopaedic conditions. While Massachusetts passed healthcare reform in 2007 with many similar provisions, it is unknown whether the disparities were present during the period of the law's enactment.
We asked whether differences in rates of surgery between patients with novel government-subsidized healthcare plans and other forms of insurance, and between uninsured and insured patients, were similar after institution of the Massachusetts reform laws.
We identified 7577 patients diagnosed with upper extremity injuries between January 1, 2007 and October 1, 2010. From an institutional administrative database, we extracted demographics, insurance status, and plan of care. Insurance categories included government-subsidized healthcare plan (Commonwealth Care), private insurance, workers compensation, military-related (TriCare), Medicare, Medicaid (MassHealth), non-Commonwealth Care, and other insured and uninsured. After adjusting for age, gender, and diagnosis, we compared the proportions of patients who underwent elective surgery.
Of 7577 patients, 1685 (22%) underwent elective upper extremity surgery. The adjusted rates of surgery were similar across most insurance categories, with higher rates in the workers compensation and TriCare categories compared with Commonwealth Care. Uninsured patients were as likely to undergo surgery as insured patients.
In a population with near-universal health insurance, a government-run health insurance exchange, and novel, government-subsidized, managed care plans, we found few insurance-based differences in rates of elective upper extremity orthopaedic surgery in a cohort of patients after healthcare reform.
Clinical Orthopaedics and Related Research 03/2012; 470(7):1917-24. · 2.53 Impact Factor
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ABSTRACT: All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair.
All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing.
Controlled laboratory study.
Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated.
The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested (P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P < .001) and the Ultra FasT-Fix (88.3 ± 14.3 N, P = .002). It was not significantly higher than the inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure.
An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch.
Inside-out sutures and all-inside devices have similar responses to cyclic loading.
The American journal of sports medicine 12/2011; 39(12):2634-9. · 3.61 Impact Factor
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ABSTRACT: Many hospitals require all operative specimens be sent to pathologists for routine examination. Although previous studies indicate this practice increases medical cost, it remains unclear whether it alters patient management and whether it is cost-effective.
We therefore (1) determined the rate of discordance between clinical and histologic examinations of routine operative specimens during elective primary arthroplasties, (2) determined the cost of routine histologic screening, and (3) estimated its cost-effectiveness in terms of cost per quality-adjusted life year gained, as compared with gross examination or no examination.
We retrospectively reviewed medical records of 1247 patients who underwent 1363 routine elective primary total joint arthroplasties between January 18, 2006 and March 15, 2010. We compared preoperative, postoperative, and histologic diagnoses for each patient and categorized them into three classes: concordant (clinical and histologic diagnoses agreed), discrepant (diagnoses differed but with no resultant change in treatment), and discordant (diagnoses differed with resultant change in treatment). Medicare reimbursements were determined through the pathology department's administrative office.
In 1363 cases, 1335 (97.9%) clinical and histologic diagnoses were concordant, 28 (2.1%) were discrepant, and none were discordant. Total reimbursement for routine pathological examination was $139,532, or $102.37 per specimen. The average cost to identify each discrepant case was $4983.29. Routine histologic examination did not alter patient management, and there was no direct gain in quality-adjusted life years.
Our observations show routine histologic examinations of routine operative specimens during elective primary arthroplasties increase medical cost but rarely alter patient management and are not cost-effective.
Level I, economic and decision analyses. See Guidelines for Authors for a complete description of levels of evidence.
Clinical Orthopaedics and Related Research 11/2011; 470(5):1452-60. · 2.53 Impact Factor
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Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology. 01/2011; 141 (Suppl 186):13 S.
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New England Shoulder and Elbow Society Meeting, Jay Peak, VT, USA; 01/2010
