Gregory S Difelice

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Verified

Gregory verified their affiliation via an institutional email.

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• MD
• Professor (Associate) at Hospital for Special Surgery

Background The superficial medial collateral ligament (sMCL) is commonly injured, with treatment varying based on associated injuries, tear grade, and location. However, the prevalence of different tear locations and the predictors of tear types have not been studied. Purpose To evaluate the interrater and intrarater reliability for a magnetic res...

While conventional high strength orthopedic sutures are made from synthetic materials, here we present a novel collagen co-braid with a unique composition of approximately 50 wt% type I collagen fibers and 50 wt% Ultra-High Molecular Weight Polyethylene (UHMWPE). Collagen is the most abundant protein in the human body and has been shown to have bio...

Suture augmentation in anterior cruciate ligament (ACL) reconstruction has the potential to combine improved long-term stability and high functional outcomes with accelerated rehabilitation, enhancing the biomechanical properties of the graft, and reducing the risk of graft failure, particularly during the critical early phases of rehabilitation. S...

Objectives To evaluate the psychological readiness to return to sports (RTS), and assess the rates of RTS at preinjury level in patients undergoing anterior cruciate ligament (ACL) primary repair (ACLPR) with suture versus autograft ACL reconstruction (ACLR) at minimum 2-year follow-up (FU). Methods Consecutive patients <50 years old and a preinju...

Multiligament knee injuries (MLKI) are rare and complex, significantly impacting long-term outcomes, with risks of osteoarthritis, joint stiffness, and reduced activity levels. To explore the evolution of MLKI treatment protocols, comparing historical and modern approaches, and to present a patient-tailored, preservation-first algorithm. This artic...

Objectives: Short-term follow-up of anterior cruciate ligament (ACL) primary repair (ACLPR) presented increased failure risk (37%) in patients ≤21 years of age (y/o), however low rates in patients >21 y/o (3.5%). Mid- and long-term clinical evidence for contemporary anterior cruciate ligament primary repair (ACLPR) is lacking, whereas outcomes of h...

Purpose Despite established tear grade classifications, there is currently no radiological classification for sMCL tear locations. This study aims to establish a magnetic resonance imaging (MRI) tear location classification system for sMCL tears, to enhance understanding and guide treatment decisions by categorizing tear types. Methods A retrospec...

Purpose: To evaluate the impact of age as a risk factor on the revision rates of anterior cruciate ligament (ACL) primary repair (ACLPR), dynamic intraligamentary stabilization (DIS) and bridge-enhanced ACL restoration (BEAR) compared to ACL reconstruction (ACLR). Methods: A systematic literature search was performed for comparative studies compar...

There are various treatment options for medial meniscus posterior root tears, such as conservative management, meniscectomy, pull-out repair, and suture anchor repair. However, the ultimate repair technique for optimal meniscal healing remains a topic of discussion, as each technique has its own set of risks and pitfalls. This technique provides a...

Tibial spine avulsion injuries, including fractures, are a variant of anterior cruciate ligament injuries. Treatment historically consisted of open reduction and internal fixation of the avulsion fracture, with anterior cruciate ligament reconstruction considered in cases of failed open reduction and internal fixation or residual laxity. However, i...

Anterior cruciate ligament (ACL) tears are among the most common injuries to the knee. With recent improvements in imaging that allow for more precise identification of ACL tear patterns, improved techniques for repair, and advancements in biological augmentation, there has been a re-emerging interest in primary ACL repair, especially for acute pro...

Purpose: To intraoperatively evaluate the ability of Anterior Cruciate Ligament Primary Repair (ACLPR) to restore anterior-tibial translation (ATT) at time-zero, and to assess the influence of additional suture augmentation (SA) on ATT. Methods: Patients with proximal ACL tears undergoing arthroscopic ACLPR with dual suture anchor fixation (ACLPR-...

Purpose: To assess the clinical and patient-reported outcome measures (PROMs) of acute superficial medial collateral ligament (sMCL) repair with suture augmentation (SA) in the setting of a multiligamentous injured knees (MLIKs) at 2-year follow-up. Methods: A retrospective analysis of consecutive patients with MLIK with grade III sMCL injuries wh...

Background Anterior cruciate ligament (ACL) reconstruction (ACLR) is associated with postoperative pain and necessitates using perioperative nerve blocks and multimodal analgesic plans. Purpose To assess postoperative pain and daily opioid use after ACL repair versus ACLR and to assess whether ACL repair could be performed successfully without usi...

Case: This report describes 2 cases of femoral-sided posterior cruciate ligament (PCL) avulsion injuries. A 10-year-old male patient presented with a chronic nonunion of a bony PCL femoral avulsion. In addition, a 4-year-old boy presented with an acute, displaced PCL femoral avulsion off the medial femoral condyle. Both injuries were repaired usin...

Within the last decade, various highly diverse anterior cruciate ligament (ACL) preservation techniques have been proposed, as contemporary selective arthroscopic ACL preservation experienced a resurgence. Among surgical techniques , there are a variety of suturing, fixation, and augmentation methods, whereas a common thread, considering essential...

Case: A 57-year-old man presented with a left knee dislocation after a motor vehicle collision. Clinical and imaging evaluation demonstrated disruption of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), anterolateral ligament (ALL), and posterolateral corner (PLC). The patient underwent acute, single-stage arthroscopic pri...

Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar tendon. Methods: Six fresh-frozen matched pair cadaveric knee specimens were utilized. The superficial femoral arteries were cannulated in all knees. The experimental knee underwent an anterior approach, patellar tendon transection from the inferior...

Posterior cruciate ligament (PCL) injuries occur most often in the setting of a multiligamentous injured knee and are frequently the result of high-energy trauma. For severe and multiligamentous PCL injuries, surgical intervention is recommended. Although PCL reconstruction has traditionally been the standard treatment, arthroscopic primary PCL rep...

Purpose To assess the influence of demographic risk factors, anatomic risk factors, and injury mechanisms on anterior cruciate ligament (ACL) tear patterns. Methods All patients undergoing knee magnetic resonance imaging at our institution for acute ACL tears (within 1 month of injury) in 2019 were retrospectively analyzed. Patients with partial A...

Purpose Surgical reconstruction is the current standard for ACL rupture treatment in active individuals. Recently, there is renewed interest in primary repair of proximal ACL tears. Despite this, ACL biology and healing potential are currently not well understood. Vascularity is paramount in ACL healing; however, previous ACL vascularity studies ha...

Background The medial collateral ligament (MCL) is considered to have superior healing and has classically been treated nonoperatively in low-grade MCL injuries. The MCL injury in the setting of concomitant anterior cruciate ligament (ACL) injury is usually treated with a delay of surgery to allow for nonoperative MCL treatment. Recent studies have...

Purpose: The purpose is to evaluate knee preference and functional outcomes of patients with primary anterior cruciate ligament (ACL) repair in one knee and ACL reconstruction in the contralateral side. Methods: All patients who underwent both procedures were retrospectively reviewed at minimum two-year follow-up. Patients were asked to complete...

Introduction and importance Simultaneous bilateral anterior cruciate ligament (ACL) injuries are a rare injury pattern within the literature. There is not a consensus optimal management of this injury. Bilateral primary ACL repair in a single stage surgery provides knee stability with a minimally morbid surgery in a single rehabilitation period. Th...

Purpose: To assess the outcomes of arthroscopic primary repair of proximal anterior cruci-ate ligament (ACL) tears with suture augmentation in the literature. Methods: A systematic search was performed using PubMed, EMBASE, and Cochrane for studies reporting on outcomes of primary repair of proximal ACL tears with suture augmentation between 2015...

Combined injury of the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) remains among the most common knee injury patterns in orthopedics. Optimal treatment of grade III MCL injuries is still debated, especially when combined with ACL injury. Most patients with these severe injuries are treated conservatively for at least six w...

Background: Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes. Purpose: To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery. Study Design: Meta-analyses of Level 1, 2, and 3 studies; Le...

Case: A 34-year-old male presented with a Neer type IIa clavicle fracture after a direct fall on the right shoulder following a cycling accident. The patient subsequently underwent percutaneous reduction and fixation with a coracoclavicular TightRope. The postoperative course was uncomplicated, and radiographic union was noted at 12 weeks postopera...

» Recently, there has been a resurgence of interest in primary anterior cruciate ligament (ACL) repair that has the potential to preserve native tissue using a more minimally invasive approach. Multiple repair techniques for different tear types have been reported over the last decade. » From a healing perspective, proximal tears can be reapproxima...

Purpose: To validate the Forgotten Joint Score-12 (FJS-12) as a subjective outcome metric for patients undergoing arthroscopic primary anterior cruciate ligament (ACL) repair. Methods: In this retrospective study, all patients undergoing primary ACL repair for complete isolated proximal tears between 2008 and 2018 were eligible for inclusion. Pat...

Background: Historically, the midterm outcomes of open anterior cruciate ligament (ACL) repair were rather disappointing, and ACL reconstruction subsequently became the surgical standard for ACL injuries. Recent studies, however, have shown that there might be a role for arthroscopic primary repair in appropriately selected patients with proximal A...

Introduction Long-term use of minocycline at high doses is associated with hyperpigmentation with multiple sites of involvement. While the cutaneous organs and the oral cavity are most commonly affected, bone discoloration is a rare entity. Case presentation A 19-year-old male patient with a history of acne vulgaris and intermittent treatment with...

Background To assess whether primary repair of proximal ACL tears in the delayed setting leads to similar clinical and functional outcomes as compared to ACL repair in the acute setting. Methods All patients with proximal tears with good tissue quality treated in the acute (≤3 weeks post-injury) and delayed setting (>3 months post-injury) were ret...

The posterior cruciate ligament (PCL) is one of the four major stabilizers of the knee joint and functions as the primary restraint to posterior tibial translation. PCL tears rarely occur in isolation and most commonly presents in the setting of multiligamentous knee injuries. Several treatment strategies for these injuries have been proposed over...

Historically, inconsistent and disappointing outcomes of open primary repair of the anterior cruciate ligament (ACL) have been reported. Recently, however, there has been a resurgence of interest in primary repair resulting from better patient selection (only treating patients with proximal tears) and modern-day advances (arthroscopic surgery and m...

Background: Recently, there has been renewed interest in primary anterior cruciate ligament (ACL) repair. The aim of this study is to report early clinical and radiological results of a consecutive series of acute ACL tears treated with arthroscopic primary ACL repair within 14 days from injury. Patients and methods: A consecutive series of pati...

Purpose: To assess failure rates and patient-reported outcomes measures (PROMs) following arthroscopic primary ACL repair of proximal tears in different age groups. Methods: Between 2008 and 2017, the first 113 consecutive patients treated with repair were retrospectively reviewed at minimum of 2-years. Patients were stratified into three age grou...

Primary repair has been increasingly advocated for the treatment of proximal and distal anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears. Because of modern developments in preoperative imaging, arthroscopic surgery and rehabilitation, excellent outcomes of primary repair have been reported when applied to a select group...

Purpose To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears. Methods In this case–control study, all adult patients undergoing acute A...

The original article can be found online.

Purpose To improve outcomes of anterior cruciate ligament reconstruction (ACLR), it is important to understand the reasons for failure of this procedure. This systematic review was performed to identify current failure modes of ACLR. Methods A systematic search was performed using PubMed, EMBASE, Cochrane, and annual registries for ACLR failures....

Injuries to the lateral collateral ligament (LCL) most commonly occur with concomitant cruciate ligament tears. Over the past decade, there has been increased interest in anatomic reconstruction of the posterolateral corner (PLC). Not much attention has been paid to anatomic primary LCL repair given the historically high failure rates of primary re...

Purpose: To assess current surgical preferences and practice patterns regarding primary anterior cruciate ligament (ACL) repair among European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) members. Methods: A web-based survey was designed, including questions regarding indications for primary repair, outcomes of primary rep...

Background To assess return to sport (RTS) rates and evaluate the timeline of rehabilitation milestones following arthroscopic primary anterior cruciate ligament (ACL) repair. Methods A retrospective review of all patients treated with primary repair between 2008 and 2018 was conducted. All adult patients with preoperative Tegner of ≥ 6 and minimu...

Injury to the posterior cruciate ligament (PCL) is most commonly seen in the setting of a multiligamentous injured knee, and isolated PCL tears are rare. PCL injuries are generally treated either conservatively or by PCL reconstruction using a graft. If a proximal or distal tear is present, the injured ligament can also be treated by primary repair...

Recently, there has been a resurgence of interest in ligament preservation of the anterior cruciate ligament (ACL) that has the advantage of preserving the native tissue and maintaining proprioceptive function. Studies reporting outcomes of remnant-preserving ACL surgery have shown encouraging results with a higher potential for early healing and b...

Background Recently, there has been a resurgence of interest in primary repair of the anterior cruciate ligament (ACL), with fixation techniques evolving. However, to date, there have been no biomechanical studies comparing fixed to adjustable fixation repair techniques. Hypothesis Adjustable ACL repair provides for improved stabilization compared...

Background The latest biomechanical studies on some form of internal bracing have shown improved stabilization for anterior cruciate ligament (ACL) repair, but gap formation and load-sharing function have not yet been reported. Hypothesis Internal bracing of an adjustable ACL repair construct provides improved stabilization with reduced gap format...

Purpose: To assess the extent to which patients forget their operative knee joint on a daily basis following arthroscopic primary repair as compared with reconstruction of the anterior cruciate ligament (ACL) at short- to mid-term follow-up. Methods: For this retrospective study, all patients undergoing ACL surgery between May 2012 and May 2017 we...

Introduction: Treatment of multiple ligament-injured knees (MLIKs) remains complex and most often requires ligament reconstruction surgery. Reconstruction effectively restores knee stability but the procedure is invasive and can be complicated by stiffness or arthrofibrosis. There has been recent resurgence of interest in primary repair of knee lig...

Purpose To assess the outcomes of the various techniques of primary repair of proximal anterior cruciate ligament (ACL) tears in the recent literature using a systematic review with meta-analysis. Methods PRISMA guidelines were followed. All studies reporting outcomes of arthroscopic primary repair of proximal ACL tears using primary repair, repai...

Objectives To compare the failure and reoperation rates of arthroscopic primary repair versus reconstruction of the anterior cruciate ligament (ACL). Methods This study retrospectively reviewed all patients with ACL injury operatively treated between April 2008 and May 2016 by one surgeon. All patients with proximal tears were treated with primary...

Background: Over the last decade, there has been a resurgence of interest in arthroscopic primary repair for patients with proximal anterior cruciate ligament (ACL) tears. This procedure is minimally invasive, quick and has few complications. Theoretically, if primary repair fails, a reconstruction procedure can still be performed, but no studies h...

The multiple-ligament injured knee (MLIK) includes a variety of severe injuries, in which at least two major knee ligaments are disrupted. Recommended treatment of each type of MLIK generally consists of reconstruction of all injured ligaments, which can successfully restore knee stability and function. Recently, arthroscopic primary repair has bee...

Introduction: Recently, there has been a resurgence of interest in arthroscopic primary anterior cruciate ligament (ACL) repair. To date, no studies have assessed the role of postoperative magnetic resonance imaging (MRI) on the status and maturation of the repaired ligament. The goal of this study was therefore to assess (I) the accuracy of MRI o...

Introduction: There has been a recent resurgence of interest in arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears. Patient selection is critical but not much is currently known on what predicts the possibility of repair. Goal of this study was therefore to assess predictive factors for the possibility of arthroscopic p...

Purpose: Recent outcomes of arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears have been promising in small cohort studies. The purpose of this study was to assess outcomes of arthroscopic ACL repair in a larger cohort and to assess the role of additional augmentation. Methods: The first 56 consecutive patients that und...

Objectives Over the last years, arthroscopic primary repair of anterior cruciate ligament (ACL) tears has shown excellent results owing to appropriate patient selection (only repairing proximal ACL tears and good tissue quality), minimal invasive surgery (arthroscopy) and focus on early range of motion. Some surgeons have repaired proximal ACL tear...

Knee dislocations often result in a severe multiligament injured knee (MLIK) with complex instability. Multiligament reconstruction can successfully restore knee stability and is commonly recommended, although surgical morbidity is induced by graft harvesting and tunnel drilling, and convergence of multiple tunnels can complicate the surgery. There...

Purpose: To assess the midterm clinical outcomes in patients with proximal avulsion anterior cruciate ligament (ACL) tears undergoing arthroscopic primary repair with suture anchors. Methods: The first 11 consecutive patients with proximal avulsion tears treated with arthroscopic primary repair were evaluated at midterm (minimum 5-year) follow-up....

Recently, there has been a renewed interest in primary repair of proximal anterior cruciate ligament (ACL) tears. Magnetic resonance imaging (MRI) plays an important role in preoperative patient selection and in postoperative ligament assessment. Knowledge of the imaging factors that make patients candidates for primary ACL repair, namely proximal...

The current surgical gold standard of treating anterior cruciate ligament (ACL) injuries is ACL reconstruction. Recently, there has been a resurgence of interest in arthroscopic primary ACL repair if the tear is a proximal avulsion type. Primary repair has several advantages over reconstruction as the ligament with proprioception is preserved, the...

Over the last decades, the incidence of ACL injuries in the pediatric population has significantly increased, and more pediatric patients are undergoing ACL reconstruction. ACL reconstruction, however, is a relatively morbid procedure and has several disadvantages for the pediatric population, such as high failure rates for young patients, damage t...

Isolated posterior cruciate ligament (PCL) injuries are relatively rare and PCL injuries most commonly occur in the setting of multiligamentous knee injuries. PCL injuries can be treated with primary repair, which has the advantages of preserving the native tissue, maintaining proprioception, and minimal invasive surgery when compared with reconstr...

Historically, poor results of open primary repair of anterior cruciate ligament (ACL) injuries have been reported. In hindsight, however, appropriate patient selection (i.e. proximal tears and good tissue quality) was not performed, because it has recently been recognized that good outcomes of primary ACL repair are possible when selectively perfor...

Background: Recently, a resurgence of interest has been noted in anterior cruciate ligament (ACL) preservation in pediatric and adolescent patients. Different tear types, defined by their tear location, require different preservation techniques: proximal and distal avulsion tears can be treated with arthroscopic primary repair, whereas primary repa...

Purpose: To assess the role of preoperative magnetic resonance imaging (MRI) on the eligibility for arthroscopic primary anterior cruciate ligament (ACL) repair. Methods: All patients undergoing ACL surgery between 2008 and 2017 were included. Patients underwent arthroscopic primary repair if sufficient tissue length and quality were present, or t...

The medial collateral ligament (MCL) is commonly injured in the setting of anterior cruciate ligament (ACL) injuries. Because the MCL has better healing capacity than the ACL, the general perception is that MCL injuries can be treated conservatively. Treating these injuries conservatively, however, can lead to residual valgus laxity. Furthermore, i...

Background: Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for differ...

In the first part of this series, we (I) discussed the history of anterior cruciate ligament (ACL) preservation, (II) discussed how modern advances altered the risk-benefit ratio for ACL preservation, and (III) proposed our treatment algorithm for ACL injuries, which is based on tear location and tissue quality. In the second part of this series, w...

The gold standard of anterior cruciate liga- ment (ACL) injuries is currently single-bundle autograft reconstruction. However, many disadvantages of reconstructive surgery exist, such as: anterior knee pain, muscle atrophy, and loss of range of motion. In addition, native kinematics are not restored, and osteoarthritis is not prevented. Finally, re...

Over the last century, many surgical treatments have been developed in the orthopedic field, including treatments of anterior cruciate ligament (ACL) injuries. These treatments ideally evolve in a process of trial and error with prospective comparison of new treatments to the current treatment standard. However, these evolutions are sometimes not l...

In a select group of patients with proximal anterior cruciate ligament (ACL) tears, primary repair can be a useful technique. Preservation of the native ACL may be advantageous for proprioceptive function and is thought to restore normal knee joint kinematics. The procedure is a less morbid and more conservative surgical approach to restore knee st...

Purpose: To propose a technique of arthroscopic suture anchor primary anterior cruciate ligament (ACL) preservation for patients with proximal avulsion ACL tears that maintain excellent tissue quality. Methods: We performed a retrospective review and early follow-up of 11 consecutive cases of ACL preservation. Patients were included if they had...

To describe the clinical and preclinical research conducted on primary repair of the anterior cruciate ligament (ACL) during the past 10 years. A systematic search of PubMed, the Cochrane Central Register of Controlled Trials, and Embase was performed for all English-language studies published between 2003 and April 2014 on primary repair of the AC...

The majority of posterior cruciate ligament (PCL) ruptures are treated conservatively. The gold standard of surgical treatment, when indicated, is surgical reconstruction. However, there is a wide variety of clinical opinion as to the best practices in this regard. In addition, systematic reviews of this topic have revealed that surgical reconstruc...

Exercise-induced rhabdomyolysis related to military training, marathon running, and other forms of strenuous exercise has been reported. The incidence of acute kidney injury appears to be lower in exercise-induced cases. We present 2 cases of exercise-induced rhabdomyolysis following spinning classes, one of which was further complicated by acute c...

Objective: To determine whether subarticular marrow changes deep to the posterior horn medial meniscal root anchor might predict subsequent medial meniscal root tear. Materials and methods: Fifteen patients with MR-diagnosed posterior horn medial meniscal root (PHMMR) tear and a knee MRI antecedent to the tear were identified at three imaging ce...