Peter J. MillettThe Steadman Clinic · Department of Orthopaedics
Peter J. Millett
M.D., M.Sc.
About
580
Publications
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Introduction
Additional affiliations
September 2005 - present
Publications
Publications (580)
Objectives
Instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet results are limited to small case series, to date. To date, studies on baseline p...
Background
Injuries to the glenoid labrum have been recognized as a source of joint pain and discomfort, which may be associated with the inflammatory responses that lead to the deterioration of labral tissue. However, it is unclear whether the torn labrum prompts mast cell (MC) activation, resulting in synovial inflammatory responses that lead to...
Background:
Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baselin...
Background
Shoulder arthroplasty (SA) has been shown to improve quality of life, though outcomes may vary between individuals. Multiple factors may affect outcomes, including preoperative mental health conditions (MHCs). The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients with MHC compared to...
Background
Snapping scapula syndrome (SSS) is a rare condition that is oftentimes debilitating. For patients whose symptoms are resistant to nonoperative treatment, arthroscopic surgery may offer relief. Because of the rarity of SSS, reports of clinical outcomes after arthroscopic SSS surgery are primarily limited to small case series and short-ter...
Background
To report clinical and activity-specific outcomes after arthroscopic rotator cuff repair (ARCR) for full-thickness supraspinatus tears in active individuals aged less than or equal to 45 years. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along w...
There is a growing need for nonarthroplasty treatment options for irreparable rotator cuff tears. Options include superior capsular reconstruction (SCR), tendon transfers, subacromial balloon spacer, bridge grafting, biological tuberoplasty, and partial rotator cuff repair with or without augmentation. In our experience, repair with marginal conver...
Background: The substances present in cigarette smoke have a negative impact on cellular integrity and metabolism, can reduce blood flow to tissues, and can disrupt collagen synthesis. Ultimately this can lead to cell death, which clinically may result in impaired tendon healing and the onset of chronic tendinopathy. Within the shoulder, the exact...
Background
In the Latarjet procedure, the ideal placement of the coracoid graft in the medial-lateral position is flush with the anterior glenoid rim. However, the ideal position of the graft in the superior-inferior position (sagittal plane) for restoring glenohumeral joint stability is still controversial.
Purpose
To compare coracoid graft clock...
Rotator cuff tears are a common soft tissue injury that can significantly decrease function of the shoulder and cause severe pain. Despite progress in surgical technique, rotator cuff repairs (RCRs) do not always heal efficiently. Many failures occur at the bone-tendon interface as a result of poor healing capacity of the tendon and failure to rege...
Background
The influence of bony morphology on the development of posterior shoulder instability is not well known.
Purpose
To determine if acromial morphology, as measured on magnetic resonance imaging (MRI), is associated with posterior or anterior shoulder instability.
Design
Cross-sectional study; Level of evidence, 3.
Methods
MRI measuremen...
Background:
Although short-term results are promising, there are limited data for long-term results of arthroscopic SSC repair. The purpose of this study is to report minimum ten-year outcomes of primary arthroscopic repair of isolated partial or full-thickness tears of the upper third of the subscapularis (SSC) tendon.
Methods:
Patients who und...
Objectives:
The purpose of this study is to systematically review the comparative studies in the literature to compare outcomes of the Latarjet procedure in the setting of a previously failed Bankart repair versus those undergoing the Latarjet procedure as a primary surgery for anterior shoulder instability.
Methods:
A systematic search in Pubme...
Fisetin has been shown to be beneficial for brain injury and age-related brain disease via different mechanisms. The purpose of this study was to determine the presence of senescent cells and the effects of fisetin on cellular senescence in the brain and other vital organs in old sheep, a more translational model. Female sheep 6–7 years old (N = 6)...
Background:
Patients with a history of anterior shoulder instability (ASI) commonly progress to glenohumeral arthritis or even "dislocation arthropathy" and often require total shoulder arthroplasty (TSA). The purposes of this study were to 1) report patient reported outcomes (PROs) after TSA in patients with a history of ASI, 2) compare TSA outco...
Objectives
The standard of care for treating anterior shoulder instability caused by a labral detachment is the Bankart repair. In the case of a deficient labrum with significant antero-inferior glenoid bone loss, the latarjet technique can be used instead. However, when the labrum is deficient and the bone loss is minimal, labral reconstruction ha...
Objectives
To determine if acromial morphology is associated with posterior or anterior shoulder instability as measured on MRI.
Methods
MRI measurements of posterior acromial coverage (PAC), posterior acromial height (PAH), posterior acromial tilt (PAT), and anterior acromial coverage (AAC) were completed for three separate matched groups who und...
This chapter discusses humeral avulsions of the glenohumeral ligament (HAGL) lesions, both anterior and posterior. While injuries of the anteroinferior glenoid labrum (Bankart lesions) and of the posteroinferior glenoid labrum (posterior Bankart lesions) are well-recognized, common injuries following traumatic shoulder dislocations and subluxations...
Clinical instability of the sternoclavicular (SC) joint is a challenging problem. Recurrent subluxation and pain can lead to significant functional limitations. Although many patients respond positively to conservative treatment, chronic dislocations often require operative intervention. The complex anatomy of the diarthrodial SC joint and the exis...
In the management of multidirectional type of shoulder instability (MDI), arthroscopic surgical stabilization is a preferred treatment option after failed conservative therapy regimens because of the ability to easily access all aspects of the capsule with one surgical procedure. As arthroscopic techniques have evolved, factors critical to postoper...
Fisetin has been shown to be beneficial for brain injury and age-related brain disease via different mechanisms. The purpose of this study was to determine the presence of senescent cells and the effects of fisetin on cellular senescence in the brain and other organs in old sheep, a more translational model. Approximately 6-7 years old female sheep...
Background:
Existing biomechanical studies of posterior glenoid bone loss and labral pathology are limited by their use of anterior instability models, which differ in both orientation and morphology and have been performed in only a single, neutral arm position.
Purpose:
To evaluate the biomechanical effectiveness of a posterior labral repair i...
Symptomatic primary glenohumeral joint (GH) osteoarthritis (OA) can be challenging to treat. Hyaluronic acid (HA) has emerged as a promising treatment for the non-surgical management of GH-OA. In this systematic review with meta-analysis, we aimed to evaluate the current evidence regarding efficacy of intra-articular HA on pain relief in patients s...
Background:
The prevalence of partial-thickness rotator cuff tears (PTRCTs) has been reported to be 13% to 40% within the adult population, accounting for 70% of all rotator cuff tears. Approximately 29% of PTRCTs will progress to full-thickness tears if left untreated. The long-term clinical course after arthroscopic repair of PTRCTs is not well...
Background:
Massive rotator cuff tears (MRCTs) can be challenging to treat, and the efficacy of repair of MRCTs in older patients has been debated.
Purpose:
To report minimum 5-year outcomes after primary arthroscopic rotator cuff repair of MRCT and determine whether age affects outcomes.
Study design:
Case series; Level of evidence 4.
Method...
Purpose:
The goal of this study was to investigate the effects of combining bone marrow stimulation (BMS) with oral losartan to block Transforming growth factor-beta 1 (TGF- β1) on biomechanical repair strength in a chronic injury rabbit model.
Methods:
Forty rabbits were randomly allocated into 4 groups (n=10 each). The supraspinatus tendon was...
Background:
The healing capacity of the human glenoid labrum varies by tear location. Current evidence suggests that the healing capacity of meniscal and cartilage injuries relates to cellular composition and vascularity. However, little is known about the histological characteristics of the glenoid labrum and how they may affect healing potential...
Background
Rotator cuff tears are common in the elderly population and are associated with increased pain, decreased function, and decreased enjoyment of recreational activities.
Purpose
To evaluate clinical outcomes at a minimum of 5 years after arthroscopic repair of full-thickness rotator cuff tears in recreational athletes aged ≥70 years at th...
Background
Arthroscopic superior capsular reconstruction (SCR) has been introduced as a successful alternative to latissimus dorsi tendon transfer (LDTT) for irreparable posterosuperior rotator cuff tears.
Purpose
To compare minimum 5-year clinical outcomes of SCR and LDTT for the treatment of irreparable posterosuperior rotator cuff tears in pati...
Background: Glenoid bone loss is a critical factor in the management of anterior shoulder instability (ASI). Computed tomography (CT) is often considered the gold standard to evaluate glenoid bone loss, but it is associated with negative factors such as radiation. Thus, interest exists as to when orthopaedic surgeons need a CT scan to guide decisio...
Objectives
Massive rotator cuff tears (MRCTs) are a frequent and challenging entity encountered by for orthopedic surgeons, accounting for up to 40% of all rotator cuff tears (RCT). Furthermore, the efficacy of repair of MRCTs in older patients is questioned by some. The purpose of this study is to report minimum 5-year outcomes after primary arthr...
Purpose:
The purpose of this study was to evaluate minimum 2-years outcomes after arthroscopic knotless all-suture soft anchor Bankart repair in patients with anterior shoulder instability.
Methods:
This was a retrospective case series of patients who underwent Bankart repair using soft, all-suture, knotless anchors (FiberTak anchors) from 10/20...
Reconstruction of unstable osteochondritis dissecans lesions of the capitellum using fresh osteochondral allograft transplantation from the capitellum has the advantages of restoring hyaline cartilage, matching the native radius of curvature, and avoiding the donor-site morbidity encountered with osteochondral autograft transfer. This technical not...
Background:
Preoperative assessment of the glenoid and surgical placement of the initial guide wire are important in implant positioning during reverse total shoulder arthroplasty (rTSA). Three-dimensional (3D) computed tomography (CT) and patient specific instrumentation (PSI) have improved the placement of the glenoid component, but the impact o...
Purpose of Review
Shoulder instability in patients with underlying joint hyperlaxity can be challenging to treat. Poorly defined terminology, heterogeneous treatments, and sparse reports on clinical outcomes impair the development of best practices in this patient population. This article provides a review of the current literature regarding optima...
While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for clinical and biomechanical improvements in shoulder pain and function.
Recentering of the glenohumeral joint reduces the moment arm and helps the delto...
IntroductionScrew cut out and varus collapse are the most common complication of locked plate fixation of proximal humerus fractures. The purpose of this study was to compare dual plating and endosteal fibular allograft struts as augmentation strategies to prevent varus collapse.Materials and methodsA trapezoidal osteotomy was created at the metaph...
Background:
Arthroscopic treatment of multidirectional instability (MDI) of the shoulder is being increasingly performed, but there is a paucity of studies with minimum 5-year follow-up.
Purpose:
To report on survivorship and patient-reported outcomes (PROs) after arthroscopic pancapsulorraphy (APC) for MDI with a minimum 5-year follow-up.
Stud...
Purpose
The purpose of the current study was to create a dynamic cadaveric shoulder model to determine the effect of graft fixation angle on shoulder biomechanics following SCR and to assess which commonly used fixation angle (30° vs 45° of abduction) results in superior glenohumeral biomechanics.
Methods
Twelve fresh-frozen cadaveric shoulders we...
Background
Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment.
Purpose
To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structur...
Purpose
To assess clinical outcomes following pectoralis major tendon (PMT) repairs and to compare outcomes of PMT repairs augmented with and without leukocyte-poor platelet-rich plasma (LP-PRP).
Methods
A retrospective review of prospectively collected data was performed of patients who underwent a PMT repair from May 2007 to June 2019 with a min...
Background
Anterior shoulder instability (ASI) is a frequently encountered pathology. Patients with a history of ASI have an increased rate of developing glenohumeral osteoarthritis and becoming candidates for shoulder arthroplasty. This systematic review aims to synthesize outcomes for patients undergoing shoulder arthroplasty with a history of AS...
Posterior shoulder instability (PSI) is a relatively less common form of instability that frequently affects young overhead or contact athletes. The etiology of PSI may be traumatic or atraumatic, with establishment of the diagnosis being more difficult in cases of atraumatic instability. Surgical management of PSI has evolved from open techniques...
Background
Despite the ubiquity of health information on YouTube, the quality of the information as it pertains to total shoulder arthroplasty (TSA) rehabilitation is unknown. The purpose of this study was to investigate the quality of information available on YouTube as it pertains to rehabilitation following TSA, including anatomic and reverse to...
Objectives
Though recognized as a risk factor, posterior glenoid bone loss has only recently been characterized and is distinctly different than anterior glenoid bone loss patterns. Existing biomechanical studies are limited by employment of anterior glenoid bone loss models which are different in both orientation and morphology than posterior glen...
Objectives
Knotless, all suture anchors have significant theoretical and technical advantages such as less bone removal, easier revision, lower profile so less risk for cartilage damage, but clinical results are lacking. The purpose of this study was to report on minimum 2-year outcomes after arthroscopic knotless all-suture Bankart repair in patie...
Objectives
The Latarjet procedure has been shown to be effective in treating recurrent shoulder instability, especially in the setting of glenoid bone loss and after failed previous Bankart repair. Several studies have additionally shown a significant reduction in recurrent instability rates when compared to Bankart repair in contact athletes when...
Objectives
Arthroscopic treatment with suture anchors of multidirectional instability (MDI) of the shoulder is gaining popularity as compared to an open approach, but no studies with mid to long-term outcomes are reported in the literature. Meanwhile, atraumatic onset MDI is associated with worse outcomes compared to traumatic onset MDI in short-te...
Objectives
The open Latarjet procedure has been demonstrated to be reliable in achieving acceptable patient reported outcomes (PROs). However, clinical predictors of outcome, return to sport and complications/failures have been more variable. The purpose of this study is to report patient reported outcomes (PROs), clinical correlations, and predict...
Snapping scapula syndrome (SSS) is a painful and debilitating condition that occurs as a result of disruption of normal scapulothoracic articulation and inflammation of numerous soft tissue and bursal structures that function to facilitate scapulothoracic motion. Historically, when nonoperative management of SSS failed, patients progressed to open...
Purpose
To elucidate the clinical outcomes of patients who underwent anterior capsular reconstruction (ACR) with dermal allograft for irreparable subscapularis tears in native shoulders at a minimum of 2-year follow-up.
Methods
This study included patients who underwent ACR by a single surgeon between March 2015 and September 2018. Clinical and in...
Background
It remains unclear if young overhead athletes with isolated superior labrum anterior-posterior (SLAP) type 2 lesions benefit more from SLAP repair or subpectoral biceps tenodesis.
Purpose
To evaluate clinical outcomes and return to sport in overhead athletes with symptomatic SLAP type 2 lesions who underwent either biceps tenodesis or S...
Chronic instability or degenerative arthritis of the sternoclavicular (SC) joint may occur after traumatic or spontaneous dislocation of the SC joint. Most commonly, chronic instability of the SC joint occurs anteriorly; however, posterior instability has an increased risk of serious complications because of proximity to mediastinal structures. Alt...
Massive irreparable rotator cuff tears in young, active patients pose a challenging treatment dilemma. Since the relatively recent development of the superior capsular reconstruction (SCR) procedure, the technique has been increasingly used to stave off reverse total shoulder arthroplasty in this demographic. As a result of continued output of supp...
Background
Neurovascular anatomy has not been previously quantified for the arthroscopic snapping scapula approach with the patient in the most frequent patient position (chicken wing). The purposes of this study are to 1) determine anatomical relationships of the superomedial scapula and neurovascular structures at risk during arthroscopic surgica...
Background
Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA.
Metho...
Background
Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions can occur in recurrent anterior shoulder instability, which may lead to the labrum scarring medially to the glenoid. ALPSA lesions have also been associated with greater preoperative dislocations, larger Hill-Sachs lesions, and greater degrees of glenoid bone loss. Ther...
Glenohumeral arthritis is a challenging problem, especially in the young, active patient. After nonoperative treatment, including activity modification, anti-inflammatory medications, physical therapy, and injections, is exhausted, surgical treatment ranging from simple debridement to arthroplasty is commonly offered. Given concerns regarding arthr...
Eight decades after Blundell Bankart first described the characteristic anteroinferior labral lesion following an anterior shoulder dislocation, there are still various recommendations regarding the timelines for returning to sport and work after nonsurgical and surgical treatments. The differences stem from diverse patient collectives and the vast...
:
Orthobiologics encompass numerous substances that are naturally found in the human body including platelet-rich plasma (PRP), isolated growth factors, and cell therapy approaches to theoretically optimize and improve the healing of cartilage, fractures, and injured muscles, tendons, and ligaments.
➤:
PRP is an autologous derivative of whole bl...
Background:
The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature.
Purpose/hypothesis:
The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (...
The critical shoulder angle (CSA) reflects the lateral extent of the acromion and the inclination of the glenoid. In 2013, CSA was first introduced and its association with rotator cuff (RC) tears and glenohumeral osteoarthritis (GHOA) was shown. It was speculated that with a high CSA, there was an increased superior force vector from the deltoid a...