Marc Raymond Safran

Marc Raymond Safran
Stanford University | SU · Department of Orthopaedic Surgery

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370
Publications
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Publications

Publications (370)
Article
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Purpose of Review This literature review aims to survey the current knowledge about the management FAI in the setting of borderline hip dysplasia. Recent Findings With better understanding, hip arthroscopy has recently been advocated for treating mild or borderline hip dysplasia (BDH) with concomitant femoroacetabular impingement (FAI) despite ear...
Article
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Major league baseball (MLB) pitchers are at risk of numerous injuries during play, and there is an increasing focus on evaluating their performance in the context of injury. Historically, performance after return to play (RTP) from injury has focused on general descriptive statistics, such as innings or games played, or rate statistics with inheren...
Article
Background Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete’s ability to return to sport after surgery. Purpose To systematically review the literature to determine whether patients...
Article
Background Compared with nonoperative management, Achilles tendon repair is associated with increased rates of complications and increased initial healthcare cost. However, data are currently lacking on the risk factors for these complications and the added healthcare cost associated with common preoperative comorbidities. Hypothesis Identify the...
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Background Ulnar collateral ligament reconstruction (UCLR) is commonly performed in Major League Baseball (MLB) pitchers, with variable reported effects on velocity and traditional rate statistics. Currently, no studies have evaluated spin rate in the context of return to play (RTP) after injury. Greater spin rate has become increasingly sought aft...
Article
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic m...
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Purpose Hip microinstability is a relatively new diagnosis which is increasingly being discussed in the literature and yet there are no clear guidelines for making a diagnosis. Microinstability has generally been defined as persistent excessive hip motion that has become symptomatic especially with pain. This aim of this Delphi study was to seek ex...
Article
The influence of health literacy on involvement in decision-making in orthopedic surgery has not been analyzed and could inform processes to engage patients. The goal of this study was to determine the relationship between health literacy and the patient's preferred involvement in decision-making. We conducted a cross-sectional observational study...
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PurposePatient-reported outcome measures are tools for evaluating symptoms, magnitude of limitations, baseline health status, and outcomes from the patient’s perspective. Healthcare professional organizations and payers increasingly recommend PROMs for clinical care, but there lacks guidance regarding effective communication of PROMs with orthopedi...
Article
Purpose The purpose of this study was to establish an international expert consensus on operating room findings that aid in the diagnosis of hip instability. Methods An expert panel was convened to build an international consensus on the operating room diagnosis / confirmation of hip instability. Seventeen surgeons who have published and/or lectur...
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Background Femoroacetabular impingement (FAI) is an increasingly recognized cause of hip pain in young athletes. Although there are multiple studies that describe the radiographic prevalence of FAI in athletes, its true incidence within this population is unknown. Purpose To report on the overall and sport-specific incidence of symptomatic FAI in...
Article
Purpose: The purpose of this systematic review is to present the most common causes, diagnostic features, treatment options and outcomes of patients with hip micro-instability. Methods: Three online databases (MEDLINE, Embase, and PubMed) were searched from database inception March 2022, for literature addressing the diagnosis and management of...
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Background Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite th...
Article
Background Hip microinstability has recently gained acceptance as a cause of hip pain. In this condition, the femoral head demonstrates increased motion relative to the acetabulum, which may lead to chondrolabral damage. Even though patients are initially prescribed a trial of nonoperative treatment, the success rates of rehabilitation are unknown....
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Elbow injuries are frequently seen in throwing and overhead athletes. This review provides a framework for diagnosis, treatment, and particularly rehabilitation of common elbow pathologies, including ulnar collateral ligament injury, valgus extension overload, and medial and lateral epicondylitis. Advanced rehabilitation facilitates complete return...
Article
Purpose: To identify factors associated with ease of hip distraction at the time of hip arthroscopy. Methods: A retrospective review of patients 17-50 years old undergoing hip arthroscopy with a single high-volume hip arthroscopist was performed from 2014 to 2020. Demographics, clinical history, examination, and imaging findings were collected....
Article
Background Ulnar collateral ligament (UCL) tears are prevalent in Major League Baseball (MLB) pitchers and can cause significant loss of time with varying reports of impact on performance. Revision UCL reconstruction (UCLR) is becoming increasingly common, with little known about the effects on fastball velocity (FB) and usage (FB%) in this setting...
Article
Objective To examine the current evidence regarding return-to-play (RTP) and performance after Achilles tendon rupture in elite athletes treated with operative intervention. Design Scoping review. Data sources Published sources identified through a PubMed search of elite athletes, defined as professional or division one collegiate athletes in bas...
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Engineering scaffolds to augment the repair of hard-to-soft multitissue musculoskeletal tissue units, such as bone-tendon, to simultaneously support tissue healing and functional movement has had limited success. Overcoming this challenge will require not only precise spatial control of bone- and tendon-like biomechanical properties, but also consi...
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Purpose To compare the locations and patterns of femoral head chondral damage in patients with instability in contrast to those with femoroacetabular impingement (FAI) without instability. Methods All consecutive hip arthroscopies were reviewed from 2013 to 2020 from a single surgeon. Intraoperative records were reviewed on all patients identified...
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Purpose To identify postoperative complications and risk factors associated with hip fracture and dislocation following primary arthroscopic surgical management of femoroacetabular impingement (FAI) syndrome. Methods MarketScan was queried to identify patients who underwent FAI surgery from 2007 to 2016. Patients were stratified into 2 groups: ace...
Article
Background: Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function, assisting in clinical decision making, and quantifying outcomes of surgical and nonsurgical management. However, PROMs are often designed using patients with preexisting pathology and typically assume that a patient without...
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Background Various surgical treatment options exist for repairing, replacing, or regenerating tissue to fill osteochondral defects. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models. Purpose/Hypothesis The purpose of the study was to systemati...
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Objectives Femoroacetabular impingement (FAI) morphology is associated with hip pain and disability. Water polo players utilize the eggbeater motion (method of treading water with legs rotating like an “egg-beater”), and it is currently unclear what the relationship is between eggbeater and FAI morphology. Our objective was to associate hip range o...
Chapter
The hip is a constrained and encapsulated articulation between the concave acetabulum of the pelvis and the spherical femoral head. Despite this apparent simplicity, there exists a wide variation in the morphology and version of the proximal femur and acetabulum. This leads to a femoral head that is slightly out-of-round, an acetabulum that is hors...
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Background Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients su...
Chapter
While the hip is an intrinsically stable joint due its bony congruence, architecture, and morphology, much of the function of the hip is the result of its soft tissue structures, including the labrum, capsuloligamentous structures, and the periarticular muscles. Thus, damage to the soft tissues about the hip can have a significant effect on the bio...
Article
Aims The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed...
Chapter
This chapter presents a case scenario of an athletic 38‐year‐old woman who presents with insidious onset, moderately severe, groin pain that is activity related, especially when she is walking or pivoting on the right leg. A magnetic resonance arthrogram is performed of her right hip which reveals a labral tear. Compelling data on labral repair ver...
Article
PurposeThe purpose of this study is to evaluate and define what is considered an adequate radiographic correction in arthroscopic osteochondroplasty for FAI and to secondarily assess how radiographic outcomes relate to patient reported outcomes and complications.Methods The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature...
Article
Existing literature is varied in the methods used to make this determination in the treatment of athletes who have undergone recent anterior cruciate ligament (ACL) reconstruction. Some authors report using primarily time-based criteria, while others advocate for physical measures and kinematic testing to inform decision-making. The goal of this pa...
Article
Objective The objective of this study is to compare the (1) reoperation rates, (2) 30-day complication rates, and (3) cost differences between patients undergoing isolated autologous chondrocyte implantation (ACI) or osteochondral allograft transplantation (OCA) procedures alone versus patients with concomitant osteotomy. Study Design Retrospectiv...
Article
Purpose: To assess the associations between serious injury (> 3-month time loss) and level of specialization among high-level female soccer players and to compare the specialization and college commitment ages of female youth soccer players to Division I college and professional soccer athletes. Methods: Youth, college, and professional female s...
Article
Hip pain is a common complaint in athletes and can result in a significant amount of time lost from sport. Diagnosis of the source of hip pain can be a clinical challenge because of the deep location of the hip and the extensive surrounding soft tissue envelope. Establishing whether the source of hip pain is intra-articular or extra-articular is th...
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The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on femoroacetabular impingement syndrome (FAIS) was intended to build an international physiotherapy consensus on the assessment, non-surgical physiotherapy treatment, pre-/post-operative management, and return to sport decisions for those patients with FAIS. The pane...
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Background Injuries to the articular cartilage in the knee are common in jumping athletes, particularly high‐level basketball players. Unfortunately, these are often diagnosed at a late stage of the disease process, after tissue loss has already occurred. Purpose/Hypothesis To evaluate longitudinal changes in knee articular cartilage and knee func...
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Purpose: To determine and compare the accuracy and interobserver reliability of the different methods for localizing acetabular labral, acetabular chondral, and femoral head chondral lesions with hip arthroscopy . Methods: Three cadaver hips were placed in the supine position. Three labral, three femoral chondral, and six acetabular chondral les...
Article
Purpose To compare post-operative infection rates following ACL reconstruction performed with grafts pre-soaked in vancomycin versus those without vancomycin. Methods A systematic review was performed using PRISMA guidelines. PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were searched for therapeutic level I-III studies that c...
Article
Background: Most conditions in orthopaedic surgery are preference-sensitive, where treatment choices are based on the patient's values and preferences. One set of tools increasingly used to help align treatment choices with patient preferences are question prompt lists (QPLs), which are comprehensive lists of potential questions that patients can...
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Background Studies have reported relatively high failure rates of isolated meniscal repairs. Platelet-rich plasma (PRP) has been suggested as a way to increase growth factors that enhance healing. Purpose To compare (1) meniscal repair failures and (2) patient-reported outcomes after isolated arthroscopic meniscal repair augmented with and without...
Article
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Objective To compare (1) the reoperation rates, (2) risk factors for reoperation, (3) 30-day complication rates, and (4) cost differences between autologous chondrocyte implantation (ACI) and osteochondral allograft transplantation (OCA) of the knee in a large insurance database. Design Subjects who underwent knee ACI (Current Procedural Terminolo...
Chapter
Basketball has become a more physical sport with a corresponding increase in the number of injuries. Fortunately, while the majority of injuries can be handled off the court, a number of injuries may require on-court evaluation. Concussions and sudden cardiac events have received increased attention more recently, especially among the basketball co...
Chapter
Effective management of in-season basketball injuries requires a multidisciplinary approach and a well-organized health-care team. Preseason evaluation, including thorough history and physical examinations, affords prospective risk stratification, identification of modifiable risk factors, and objective measures for guiding treatment. In-season inj...
Article
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Purpose: To discern differences between the PearlDiver and MarketScan databases with regards to patient demographics, costs, re-operations, and complication rates for isolated meniscectomy. Methods: We queried the PearlDiver Humana Patient Records Database and the IBM® MarketScan® Commercial Claims and Encounters database for all patients who ha...
Article
Purpose: To survey members of The ACL study group to determine the current practice patterns surrounding the technique of pre-soaking ACL grafts in vancomycin. Methods: A web-based questionnaire was distributed to members of the ACL Study Group. Questions included the use of vancomycin solution for graft soaking during ACL reconstruction, their...
Article
Background: Surgical site infections (SSIs) after anterior cruciate ligament (ACL) reconstruction procedures are an unfortunate complication. Soaking grafts in vancomycin before implantation has been reported to reduce the incidence of postoperative SSI after ACL reconstruction. There is potential for vancomycin to compromise graft integrity becau...
Article
Background: Arthroscopic osteochondroplasty may improve range of motion and relieve pain in patients with symptomatic hip impingement. Femoral neck fracture is a risk of this procedure because of the weakening of the proximal femur. To our knowledge, there are no biomechanical studies in young human cadaveric bone evaluating the effect of osteocho...
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Background Return to sport is a commonly studied outcome of hip arthroscopy that is relevant to both patients and providers. There exists substantial variability in criteria used to define successful return to sport. Purpose To review and evaluate the definitions used in the literature so as to establish a single standard to enable comparison of o...
Article
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Hip microinstability is a recognized cause of hip pain in young patients. Intra-operative evaluation is used to confirm the diagnosis, but limited data exist associating magnetic resonance arthrography (MRA) findings with hip microinstability. To determine if a difference exists in the thickness of the anterior joint capsule and/or the width of the...
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Introduction: Approximately 10% of men and 13% of women older than the age of 60 are affected by symptomatic osteoarthritis of the knee. Anatomic repair or reconstruction after knee injury has been a central tenet of surgical treatment to reduce the risk of osteoarthritis. The purpose of this study was to examine common sports medicine procedures...
Article
Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconcep...
Article
Case: A 64-year-old woman developed worsening sciatica associated with snapping at the hip over a period of 4 years. The physical examination and dynamic ultrasound revealed the snapping of the sciatic nerve (SN) provoked by impingement between the greater trochanter (GT) and the ischium. Additional imaging studies demonstrated hyperintense signal...
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Background Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series. Purpose To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database. Study Design Cohort study; Level of evidence, 3. Methods A national insura...
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The posteromedial and posterolateral corner structures contribute significantly to knee stability. The posterior oblique ligament is a primary restraint to internal rotation and a secondary restraint to valgus. The superficial fibres of the medial collateral ligament are the primary valgus restraint and also provide secondary internal and external...
Article
Purpose The purpose of this study was to determine the (1) reoperation rate and (2) 30-day complication rate in a large insurance database. Methods The Truven Database was queried for subjects that underwent meniscus allograft transplantation (CPT code 29868) in the outpatient setting with minimal two year follow up. Patients without confirmed lat...
Article
Orthobiologic approaches can be defined as strategies that seek to enhance musculoskeletal tissue healing and regeneration by modulating the biologic environment. Approaches include growth factors, autologous and allogeneic blood products, scaffolds, and cell therapies that can be used in isolation or to augment surgical procedures. Orthobiologic t...
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Background Biomechanical studies have demonstrated that arthroscopic rotator cuff repair using a linked double-row equivalent construct results in significantly higher load to failure compared with conventional transosseous-equivalent constructs. Purpose To determine the patient-reported outcomes (PROs), reoperation rates, and complication rates a...
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Purpose To evaluate the reoperations, complications, and costs up to 5 years following arthroscopic rotator cuff repair (RCR) alone, with acromioplasty (acro), with biceps tenodesis (BT), or with both acro and BT. Methods We queried the MarketScan database to identify patients who underwent RCR from 2007 to 2016. Patients were stratified into grou...
Article
Case: A 36-year-old male professional soccer player sustained an acute left hip injury during a tournament game while defending the goal. Magnetic resonance imaging demonstrated a complete avulsion of the iliopsoas tendon from the left trochanter. The patient was treated nonoperatively, and after 10 weeks, he was able to return to full activity. A...
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Femoroacetabular impingement (FAI) is a disorder that causes hip pain and disability in young patients, particularly athletes. Increased stress on the hip during development has been associated with increased risk of cam morphology. The specific forces involved are unclear, but may be due to continued rotational motion, like the eggbeater kick. The...
Article
Background The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies. Purpose To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants. Study Design Systematic review. Methods A sy...
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Background Hip microinstability and labral pathology are commonly treated conditions with increasing research emphasis. To date, there is limited understanding of the biomechanical effects of the hip capsule and labrum on controlling femoral head motion. Purpose/Hypothesis The purpose of this study was to determine the relative role of anterior ca...
Article
Background Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA <20°) traditionally require treatment with bony realignment through a periacetabular osteotomy (PAO) and/or derotational femoral osteotomy, while patients with borderline hip dysplasia (BHD) present a challeng...
Article
Background: Previous studies have shown that runners demonstrate elevated T2 and T1ρ values on magnetic resonance imaging (MRI) after running a marathon, with the greatest changes in the patellofemoral and medial compartment, which can persist after 3 months of reduced activity. Additionally, marathon running has been shown to increase serum infla...
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Background Atraumatic hip instability, or microinstability, is a challenging diagnosis for clinicians to make. Several radiographic parameters have been proposed to help identify patients with instability as a means to direct treatment. The Femoro-epiphyseal Acetabular Roof (FEAR) index was recently offered as a parameter to predict instability in...
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Objectives Treatment algorithms for the arthroscopic management of femoroacetabular impingement syndrome (FAI) remain controversial due to a paucity of evidence-based guidance. Consequently, significant variability in clinical practice exists between different practitioners, necessitating expert consensus. The purpose of this study is to establish...