Brian Christopher Werner

Brian Christopher Werner
University of Virginia | UVa · Department of Orthopaedic Surgery

MD

About

403
Publications
59,879
Reads
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6,565
Citations
Citations since 2017
275 Research Items
6049 Citations
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201720182019202020212022202302004006008001,0001,200
201720182019202020212022202302004006008001,0001,200
Additional affiliations
July 2015 - present
Hospital for Special Surgery
Position
  • Fellow
July 2015 - August 2016
Hospital for Special Surgery
Position
  • Clinical Fellow
June 2009 - August 2015
University of Virginia
Position
  • Medical Doctor

Publications

Publications (403)
Article
Full-text available
Background: Arthrofibrosis after knee arthroscopy is a challenging complication. Previous studies reporting incidences of manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after knee arthroscopy are limited by confounders such as small sample size and regional sampling bias. Purpose: To investigate the incidence of MUA or LOA after co...
Article
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Tenodesis of the long head of the biceps tendon has become a popular surgical treatment option for patients with pain or instability attributed to a diseased or unstable biceps tendon. No previous studies have characterized the practice patterns of surgeons performing biceps tenodesis in the United States. To investigate current trends in both arth...
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Objectives: While a vast body of literature exists describing biceps tenodesis techniques and evaluating the biomechanical aspects of tenodesis locations or various implants, little literature presents useful clinical outcomes to guide surgeons in their decision to perform a particular method of tenodesis. The goal of this study is to compare the c...
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Background Knee dislocations resulting in multiligament knee injuries (MLIs) are usually associated with high-energy mechanisms such as motor vehicle accidents or sports injuries; however, obese patients are at risk of MLIs from simple falls. Termed “ultra-low velocity” (ULV) dislocations, these injuries occur in obese patients during activities of...
Article
Background: An accurate and reliable measurement of shoulder range of motion (ROM) is important in the evaluation of the shoulder. A smartphone digital clinometer application is a potentially simpler method for measuring shoulder ROM. The goal of this study was to establish the reliability and validity of shoulder ROM measurements among varying he...
Article
Rotator cuff tears are common and multifactorial in etiology. Natural history studies suggest that following initiation of a tear, rotator cuff disease may advance along a continuum of tear enlargement and symptom progression, muscular degeneration and fatty infiltration, and glenohumeral arthritis. Patient- and tear-specific features influence bot...
Article
Background: The use of administrative databases and clinical registries in lower extremity arthroplasty research is growing. Such observational studies are unable to fully control for confounders and cannot establish causality. However, many authors use causal language when describing their aims or findings, potentially misleading readers. We exam...
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Purpose: The purpose of the current study was to utilize a nationwide administrative-claims database to characterize the substance use disorder trends of patients undergoing arthroscopic RCR. Additionally, we sought to evaluate the influence of preoperative substance use disorder on postoperative outcomes following arthroscopic RCR. Methods: The...
Article
Background The application of orthobiologics at the time of arthroscopic rotator cuff repair (RCR) has received an increasing amount of clinical interest despite a relative scarcity of human clinical studies on their efficacy. Purpose To utilize a national administrative database to determine the association of bone marrow aspirate concentrate (BM...
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Purpose To investigate surgeon preferences for graft use, including biologic augmentation and superior capsular reconstruction (SCR) associated with surgical treatment of rotator cuff repair (RCR). Methods A 26-question survey was completed by arthroscopic shoulder surgeons. Surgeon demographics were evaluated. Surgeons were queried about shoulder...
Article
Purpose The purpose of this study was to use a national claims database to assess the impact of preexisting social determinants of health disparities (SDHD) on postoperative outcomes following RCR. Methods A retrospective review of the Mariner Claims Database was used to capture patients undergoing primary RCR with at least one year of follow-up....
Article
Introduction Interscalene brachial plexus blocks are a commonly performed procedure to reduce pain following total shoulder arthroplasty. Liposomal bupivacaine has been purported to prolong the duration of brachial plexus blocks for up to 72 hours; however, there has been controversy surrounding the analgesic benefits of this drug. Our hypothesis w...
Article
Background The purpose of this study was to evaluate the relationship between preoperative resiliency and outcomes following arthroscopic rotator cuff repair (ARCR). The hypothesis was that patients with low preoperative resilience would have poorer postoperative patient reported outcomes compared to patients with high preoperative resilience follo...
Article
Background Restoring the native center of rotation (COR) in total shoulder arthroplasty (TSA) has been shown to improve post-surgical function, subjective outcomes and implant longevity. The primary purpose of this study was to compare postoperative radiographic restoration of the humeral center of rotation (COR) between short stem and stemless hum...
Article
Background There is limited literature exploring how non-medical factors such as social determinants of health (SDOH) are associated with postoperative outcomes following shoulder arthroplasty. Methods A retrospective cohort review of Mariner Claims Database was used to capture patients undergoing either a primary anatomic total or reverse shoulde...
Article
Background The severity of primary glenohumeral osteoarthritis (PGOA) has been associated with advanced radiographic findings including inferior humeral head osteophytes. The primary objective of this study is to analyze for any correlation between the size of the inferior humeral head osteophyte and functional outcomes in patients undergoing anato...
Article
Purpose To identify the influence of timing between staged bilateral hip arthroscopy on 90-day postoperative medical complications and 2-year surgical complications including revision, conversion to total hip arthroplasty (THA) and infection. Methods The Mariner dataset of the PearlDiver all-payer claims database was queried for patients undergoin...
Article
Background The objective of this study was to compare complication rates between patients undergoing reverse shoulder arthroplasty (RSA) after a prior open reduction and internal fixation (ORIF) for proximal humerus fracture (PHF) to those undergoing RSA as a primary treatment for PHFs, glenohumeral osteoarthritis, or rotator cuff tear arthropathy...
Article
Background In performing reverse total shoulder arthroplasty (rTSA), the role of repairing the subscapularis has been debated. Our objective was to determine the effect of subscapularis repair following rTSA on postoperative shoulder range of motion and patient reported outcome scores (PROs). Methods A prospective registry was reviewed to establis...
Article
Background Prosthetic instability is one of the most common short term complications following reverse total shoulder arthroplasty (RTSA). Numerous strategies exist to attempt to mitigate this complication, including utilization of constrained polyethylene humeral liners. A concern of constrained humeral liners is that they may come at the expense...
Article
Background The purpose of this study is to investigate the association between supplemental home oxygen prior to surgery and both medical and surgical complications after primary elective total hip arthroplasty (THA) in patients who have respiratory disease (RD). Methods The Mariner database was used to identify patients who have RD who received p...
Article
Background Osteopetrosis is a rare, inherited disorder in which bone remodels to become pathologically dense. There has been a paucity of data evaluating medical and surgical complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in this patient population. The objective of this study was to evaluate osteopetrosis as...
Article
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Purpose To evaluate whether contralateral limb strength represents a dynamic, rather than static, data point after anterior cruciate ligament reconstruction (ACL-R). Methods Patients who underwent isolated ACL-R at a single institution were identified. Patients completed an institutional Lower-Extremity Assessment Protocol (LEAP) testing protocol...
Article
Background: There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). Purpose: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on...
Article
Objectives The administration of return to sport assessments have become common in patients following Anterior Cruciate Ligament Reconstruction (ACLR). However, they are often administered after the time of clinical supervision which may leave patients without access to clinical personnel to appropriately address the functional deficits identified....
Article
Objectives To determine the amount of tibial graft tunnel mismatch during application of the “N+10” rule in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft using independent femoral tunnel drilling. To compare actual (measured) tibial tunnel length and desired (calculated) tibial tunn...
Article
Objectives Some literature suggests that strength deficits and functional impairment of the contralateral, uninjured leg exist following ACL injury. Given the emergence of these findings and the contralateral, uninjured limb frequently being used as a control for comparison to the operative extremity in return-to-play, limb symmetry assessments, th...
Article
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The purpose of this study was to compare the short-term clinical and radiographic outcomes of a lateralized glenoid construct with either a central screw or post. Methods: A multicenter retrospective study was conducted of reverse shoulder arthroplasties (RSAs) with minimum 2-year clinical followup. All RSAs implanted had a 135° neck shaft angle (N...
Article
Background: The primary purpose of this study was to compare two-year anatomic total shoulder (TSA) functional and radiographic outcomes between Walch A and B glenoids treated with an all-polyethylene glenoid designed for hybrid fixation with peripheral cement and central osseous integration. The secondary purpose was to evaluate outcomes based on...
Article
Study design: Review of health care record database and determination of population statistics. Objective: The purpose of this study was to quantify the incidence of clinically significant venous thromboembolic (VTE) events in patients undergoing spinal fusion surgery for adolescent idiopathic scoliosis (AIS) and to identify risk factors for VTE...
Article
Background The objective of this study was to evaluate preoperative supplemental home oxygen use as a potential risk factor for both medical and surgical complications following primary elective total knee arthroplasty (TKA) in patients who have respiratory disease (RD). Methods Patients with a diagnosis of RD who underwent elective TKA from 2010...
Article
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Background: Humeral stem length in reverse total shoulder arthroplasty (RTSA) has decreased in recent years in an attempt to preserve more bone and facilitate stem removal in the revision setting. The purpose of this study was to compare the clinical and radiographic outcomes of a short- to standard-length stem RTSA. The authors hypothesized that...
Article
Background Performance on strength and functional tests is often used to guide postoperative rehabilitation progress and return to activity decisions after anterior cruciate ligament reconstruction (ACLR). Clinicians may have difficulty in determining which criteria to follow if there is disagreement in performance outcomes among the tests. Purpos...
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While short stems in total shoulder arthroplasty (TSA) preserve bone stock and facilitate revision surgery, they have been associated with higher rates of malalignment and loosening in some cases compared to standard length stems. The purpose of this study was to analyze the intramedullary canal in progressive increments distal to the greater tuber...
Article
Background: Neuromas, neuralgia, and phantom limb pain commonly occur after lower-extremity amputations; however, incidence of these issues is poorly reported and understood. Present literature is limited to small cohort studies of amputees, and the reported incidence of chronic pain after amputation ranges as widely as 0% to 80%. We sought to obj...
Article
Background While preoperative function and range of motion (ROM) are determinants of postoperative outcome following reverse shoulder arthroplasty (RSA), there is limited data on the influence of preoperative rotator cuff status. The purpose of this study was to evaluate the relationship between preoperative physiologic rotator cuff cross-sectional...
Article
Background The significance of preoperative urinary tract infection (UTI) in total hip and knee arthroplasty is controversial. The purpose of this study was to investigate the timing of preoperative UTI diagnosis and association with prosthetic joint infection (PJI), as well as determine if antibiotics impact this risk. Methods A national database...
Article
Background Evaluation, characterization and correction of glenoid deformity is an important part of performing anatomic total shoulder arthroplasty (TSA) Three-dimensional computed tomography (3D CT) planning has been shown to improve implant position but the impact on clinical outcomes is less clear. The purpose of the current study is to compare...
Article
Background As the indications for reverse shoulder arthroplasty (RSA) continue to expand, the need for revision surgery after RSA will become more frequent. The objective of this study was to characterize patient-related risk factors for revision RSA and to compare reasons for early versus late revision after RSA. Methods Patients who underwent pr...
Article
Background: Osteonecrosis of the femoral head (ONFH) is a potentially debilitating condition, often requiring total hip arthroplasty (THA). Patients on hemodialysis (HD) are at increased risk for complications after THA for osteoarthritis, however there is limited information on outcomes of THA for ONFH in patients on HD. With increasing prevalenc...
Article
Background: Osteonecrosis of the femoral head (ONFH) is a potentially debilitating condition, often requiring total hip arthroplasty (THA). Patients with solid organ transplant (SOT) are at increased risk of postoperative complications after THA for osteoarthritis. The objective of the present study is to evaluate SOT as a potential risk factor fo...
Article
Background Revision or conversion to arthrodesis following metatarsophalangeal (MTP) joint arthroplasty are salvage procedures to manage complications of MTP joint arthroplasty. The purpose of this study is to use a national administrative database to characterize nationwide trends of patients undergoing hallux MTP arthrodesis vs arthroplasty for h...
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Recommendations from the ICM-VTE General Delegates.
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Question: 1-Concerning VTE risk, which surgeries can be considered major, and which surgeries can be considered non-major in shoulder and elbow surgery? Response/Recommendation: Shoulder arthroscopy, non-fracture related shoulder arthroplasty, and all elbow procedures can be considered non-major venous thromboembolism (VTE) risk. Fracture related s...
Article
Introduction: In an effort to preserve bone, humeral stems in reverse total shoulder arthroplasty (RTSA) have gradually decreased in length. The purpose of this study was to compare the immediate postoperative radiographic appearance of short-length with standard-length RTSA stems. Methods: Patients who underwent RTSA using a press-fit standard-...
Article
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Purpose There is a common belief among some shoulder surgeons that the increased utilization of reverse shoulder arthroplasty (RSA) is driven by the operation being performed in younger patients. The primary purpose of this study was to evaluate the change in patient age at the time of primary RSA in the USA. Methods All patients undergoing primar...
Article
Orthopedic sports surgery of the knee and shoulder is generally considered to be safe and effective. Vascular complications can occur during or after arthroscopy of either joint. A thorough understanding of anatomy, particularly when placing portals in non-routine locations, is extremely important. Prompt recognition of any vascular complication is...
Article
Background: The use of translaminar screws may serve as a viable salvage method for complicated cases. To our understanding, the study of the feasibility of translaminar screw insertion in the actual entire subaxial cervical spine has not been carried out yet. The purpose of this study was to report the feasibility of translaminar screw insertion...
Article
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Purpose The purpose of this study was to compare perianchor cyst formation between soft and hard suture anchors placed in the same patient 1 year after arthroscopic rotator cuff repair (ARCR). Methods This study reviewed patients who underwent primary ARCR using a “hybrid” technique using at least one soft anchor (FiberTak, Arthrex, Naples, FL) an...
Article
Brachial plexus injuries can have a significant impact on patient outcomes following RTSA by slowing the overall recovery and return of function. Risk factors for brachial plexopathy include traction injury related to arm positioning and exposure during the procedure, direct nerve injury from surgical dissection, and compression injury from retract...
Article
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Background Radiographic and cadaveric studies have suggested that anatomic anterior cruciate ligament reconstruction (ACLR) femoral tunnel drilling with the use of a flexible reaming system through an anteromedial portal (AM-FR) may result in a different graft and femoral tunnel position compared with using a rigid reamer through an accessory anter...
Article
Several methods are available for subscapularis management in total shoulder arthroplasty (TSA). The goal of this study was to compare radiographic and clinical outcomes of short-stem TSA stratified by subscapularis management technique. A multicenter trial was completed evaluating primary short-stem TSA performed with a subscapularis peel (n=80) o...
Article
Reverse shoulder arthroplasty (RSA) leads to improvement in pain and function with a durable outcome in most cases. While improvement in forward flexion, and to a lesser degree external rotation are predictably seen after RSA, restoration of internal rotation (IR) is much less predictable. The purpose of this review is to provide a narrative of the...
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The COVID-19 pandemic caused major disruptions to the healthcare system, but its impact on the transition to same-day discharge shoulder arthroplasty remains unexplored. This study assessed the effect of COVID-19 on length of stay (LOS), same-day discharge rates, and other markers of resource use after elective total shoulder arthroplasty. A total...
Article
Background: Sports injuries have increased dramatically in the pediatric and adolescent population. Return-to-sport testing and criteria are increasingly utilized, however, the guidelines for return to play in adolescents are unclear. The purpose of this study was to compare strength and function at the time of the return-to-sport progression to t...
Article
Background One of the leading challenges for surgeons shifting to stemless anatomic total shoulder arthroplasty (TSA) is subscapularis repair. In the available literature reporting outcomes after stemless TSA, subscapularis tenotomy with side-to-side repair is the most common technique despite some concerns in biomechanical and clinical literature...
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Background: The purpose of this study was to compare patient-reported outcomes (PROs) and range of motion (ROM) measurements between patients achieving and failing to achieve a Patient Acceptable Symptom State (PASS) after anatomic total shoulder arthroplasty (TSA) to determine which PRO questions and ROM measurements were the primary drivers of p...
Article
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Background Patients undergoing reverse total shoulder arthroplasty (RTSA) predictably report reduced pain and improved function postoperatively. However, it is not known if patients with differing preoperative active motion achieve the same benefit after surgery. The purpose of the current study is to evaluate patient-reported outcomes (PROs), rang...
Article
Background Hepatitis C is associated with increased adverse events following surgery. The goals of this study were therefore to evaluate postoperative outcomes in patients with hepatitis C following ankle arthrodesis. Materials and Methods A review of Medicare patients was performed to identify patients who underwent ankle arthrodesis. Patients we...
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Significance Dry age-related macular degeneration (AMD) affects the vision of millions of people worldwide. There is currently no Food and Drug Administration–approved treatment for dry AMD. The inflammasome components NLRP3 and ASC have been implicated in the pathogenesis of dry AMD. We report that fluoxetine, which is approved for the treatment o...
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Background: Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction...
Article
Full-text available
Background Recent studies have suggested that femoral tunnel drilling during anterior cruciate ligament (ACL) reconstruction (ACLR) with the use of a flexible reaming system through a standard anteromedial portal (AM-FR) may result in a different tunnel geometry compared with a rigid reamer through an accessory anteromedial portal with hyperflexion...
Article
Background While literature describing the increased risk of postoperative infection for patients undergoing lower extremity arthroplasty with a preoperative urinary tract infection (UTI) is inconclusive, this relationship has yet to be adequately studied for shoulder arthroplasty. The goals of the present study were to (1) examine the association...
Article
Background For patients with end-stage glenohumeral osteoarthritis, anatomic total shoulder arthroplasty (TSA) serves as a reliable option for pain relief and improving function. It is not well understood if patients with pain due to osteoarthritis but preserved preoperative active range of motion (ROM) experience a similar postoperative benefit co...
Article
Background While reverse shoulder arthroplasty (RTSA) has excellent reported outcomes and satisfaction, patients often have postoperative limitations in range of motion (ROM), specifically internal rotation. Increased lateralization is thought to improve ROM following RTSA. The purpose of this study was to evaluate the association between radiograp...
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Objectives The incidence of anterior cruciate ligament (ACL) injuries continues to rise, and meniscal injuries are commonly associated with these tears. Treatment of meniscal injuries can impart delayed weightbearing range-of-motion restrictions, which can affect the post-operative rehabilitation protocol. These limitations after a meniscal repair...
Article
In the setting of an opioid epidemic, this study aims to provide evidence on opioid use trends, risk factors for prolonged use, and complications from perioperative opioid consumption in hallux valgus surgery. A national database was queried for patients who underwent hallux valgus correction. Regression analysis identified: 1) risk factors for pro...
Article
Background Anterior closing wedge osteotomy of the proximal tibia may be considered in revision anterior cruciate ligament (ACL) reconstruction surgery for patients with excessive posterior tibial slope (PTS). Purpose (1) To determine the ratio of wedge thickness to degrees of correction for supratubercle (ST) versus transtubercle (TT) osteotomies...
Article
Purpose: To identify patient-related risk factors for infection following anterior cruciate ligament reconstruction (ACLR). Methods: The Mariner database within PearlDiver was queried for patients from 2010 to 2019 undergoing primary arthroscopic ACLR. Patients undergoing ACLR with concomitant open surgery or additional ligament reconstructions...
Article
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Background Corticosteroid injection and physical therapy remain the mainstay of treatment for idiopathic adhesive capsulitis of the shoulder; however, a certain percentage of patients will not improve using these interventions and will require manipulation under anesthesia (MUA) and/or lysis of adhesions (LOA). Purpose To evaluate whether the imme...
Article
Background The purpose of this study was to compare the 5 year radiographic and clinical outcomes of anatomic total shoulder arthroplasties (TSA) performed with either a standard length (SL) or short stem. The hypothesis was there would be no difference in radiographic or clinical outcomes based on stem length. Methods A multicenter retrospective...
Article
Context: Return to activity(RTA) assessments are commonly administered following ACL-Reconstruction(ACLR) to manage post-operative progressions back to activity. To date, there is little knowledge on the clinical utility of these assessments to predict patient outcomes such as secondary ACL injury once returned to activity. Objective: To identify w...
Article
Background Although previous studies have reported acceptable clinical outcomes after simultaneous, single-stage bilateral and staged bilateral rotator cuff repair (RCR), few studies have been adequately powered to compare postoperative complication rates at various time intervals between procedures. Purpose To examine the relationship between the...
Article
Background In order to avoid implant related complications related to glenosphere malposition, there has been an increased interest in the use of advanced imaging, including computed tomography (CT) and magnetic resonance imaging (MRI) for preoperative planning and patient-specific instrumentation for reverse shoulder arthroplasty (RSA). While rece...
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Background Charge and reimbursement trends for arthroscopic partial meniscectomies among orthopaedic surgeons, anesthesiologists, and hospital/surgery centers have not been formally analyzed, even though meniscectomies are the most commonly performed orthopaedic surgery. Purpose To analyze Medicare charge and reimbursement trends for surgeons, ane...
Article
Purpose The objective was to: (1) evaluate any recent changes in the United States in the incidences of medial patellofemoral ligament (MPFL) reconstruction and isolated lateral release for patellar instability in children and adolescents, (2) identify concomitant procedures with MPFL, and (3) report national complication rates after MPFL reconstru...