Gregory S Difelice

Gregory S Difelice
Hospital for Special Surgery · Department of Orthopaedic Surgery

MD

About

91
Publications
35,246
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Introduction
My current research interest is mainly focused on Ligament Preservation in the knee. I been using Primary Repair techniques in my practice, to my patients' benefit, for the past 15 years . Having performed over 350 ligament repairs in the past decade, it is my feeling that there is most definitely a place for these techniques in the surgical armamentarium of the modern day knee surgeon. Sharing my experience, and refining techniques and indications are the goals of my group.
Additional affiliations
January 2010 - present
Hospital for Special Surgery
Position
  • Medical Doctor
Description
  • Specialty focus on Sports Traumatology and Joint Reconstruction Surgery of the Knee, Shoulder & Hip.

Publications

Publications (91)
Article
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...
Article
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...
Article
Full-text available
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...
Article
» 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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Article
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...
Chapter
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...
Article
Full-text available
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...
Article
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...
Chapter
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...
Article
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...
Article
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....
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
Full-text available
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...
Conference Paper
Full-text available
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...
Article
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...
Chapter
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Conference Paper
Full-text available
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...
Article
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...
Article
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....
Article
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...
Article
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...
Chapter
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Chapter
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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...
Chapter
Full-text available
Multiligamentous injuries of the knee (MLIK) are rare and devastating injuries. The literature regarding the optimal management of MLIK is both inconsistent and confusing, thus creating numerous controversies regarding the best treatment strategies for the MLIK. One of the most controversial topics is the role of acute repair versus reconstruction...
Article
This case report describes the reimplantation of a 15-cm osteoarticular segment of the distal tibia in a 14-year-old girl who was hit by a truck. The bone fragment was debrided and reimplanted on the day of injury. A free flap was performed within 1 week. Bony union was achieved without complication. At 5-year follow-up, the patient is able to ambu...
Article
Full-text available
Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2-3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can b...
Article
Full-text available
We present the case of a 71-year-old man with a large acromioclavicular (AC) joint cyst successfully managed with surgical excision. AC joint cysts are soft tissue masses generally signifying underlying rotator cuff pathology. Traditionally, these cysts were identified with shoulder arthrography as a "geyser" of fluid escaping through the AC joint....