To compare the biomechanical properties of single-row repair with triple-loaded (TL) anchor repair versus a knotless rip stop (KRS) repair in a rotator cuff repair model.
TOCA’s Dr. Evan Lederman, MD, regularly educates, lectures, and participates in groundbreaking research to further the field of orthopedics. His expertise in arthroscopic surgery of the shoulder and knee has earned him the honor of being one of only two Arizona surgeons to be accepted into the American Shoulder and Elbow Surgeons (ASES) as an associate member.
Orthopedics Today recently highlighted the results of one of Dr. Lederman’s studies comparing functional outcome scores and revision rates between different surgical techniques in total shoulder arthroplasty. Dr. Lederman presented the results of the study at the American Shoulder and Elbow Surgeons Annual Meeting, which was held in Chicago this past fall.
Read more about Dr. Lederman’s impressive study HERE.
“You have a stress fracture” is a diagnosis shared all too often by orthopedic specialists, especially when treating athletes. Athletes are most at risk due to repetitive activity and overuse of their feet and legs. Overuse causes the lower extremities to continually absorb these forces and potentially causing tiny cracks in the bones.
If athletic activity is too frequent, it diminishes the body’s ability to repair and replace bone. And the likelihood of sustaining a stress fracture increases. That’s why runners, dancers, soccer players, and basketball players are particularly vulnerable to stress fractures.
And, according to The Orthopedic Clinic Association (TOCA) orthopedic and sports medicine care expert, Dr. Gerald Yacobucci, MD, “If they are already experiencing consistent pain, the more these athletes train and compete, the more they may be placing themselves at greater risk for injury – and time away – from the sport or activity they enjoy.”
Here’s what Dr. Yacobucci and the TOCA team want ALL athletes, parents, and coaches to know in order to recognize stress fracture symptoms, help prevent stress fractures from occurring, and remain injury-free.
Stress Fracture Symptoms
What are some of the signs of stress fracture to watch out for? Rather than the sharp pain resulting from an acute fracture, stress fractures are typically accompanied by a dull pain that increases gradually. Often, the pain subsides during rest and intensifies during activity. Swelling around the site may be present as well as some tenderness and bruising. As mentioned above, stress fractures can be caused by overuse of lower extremities, common in athletes, but they can also arise from a sudden upsurge in physical activity. Osteoporosis can also increase the chance of a stress fracture.
It’s important to remember that, if dull pain persists, it’s time to seek help from an orthopedic specialist!
Treatment of Stress Fractures
Immediately after injury or stress fracture symptoms occur, patients are encouraged to follow the RICE (Rest, Ice, Compression, Elevation) method. Once you consult with you orthopedic specialist, he/she will examine the “pain point” and X-rays will likely be taken. If the stress fracture is not visible via X-ray, but your doctor still suspects that you have a stress fracture, he/she may recommend that you get an MRI.
Nonsurgical treatment options for stress fractures include keeping weight off of the area (perhaps wearing a boot or using crutches), and modified activity for a period of up to 8 weeks. In some, more severe, cases, surgery may be necessary to allow the stress fracture to heal properly. This typically entails using a pin, screw, or plate to “fasten” the bones together in order to promote healing. The key to recovery is to allow ample time for rest, healing, and rehabilitation. Taking time off ensures that you can eventually get back to the activities you enjoy safely and without placing yourself at risk for additional injury.
Stress Fracture Prevention
According to Dr. Yacobucci, “One of the most important pieces of advice I share with patients, especially athletes, is to monitor and be mindful of your activity and pain level. If you find that you’re consistently experiencing pain during training or workouts, then it’s time to listen to your body’s signals. Refrain from activity until you seek further treatment from an orthopedic expert.”
Additional stress fracture prevention tips from Dr. Yacobucci and TOCA experts include:
- Wearing footwear with good support.
- Strength training and cross-training to avoid overuse of certain muscle sets and strain on bones.
- Good nutrition, including plenty of calcium and Vitamin D for optimal bone strength.
- And good common sense. Listen to your body’s signals and seek help if pain persists after adequate rest.
To schedule a consult with Dr. Yacobucci, or one of TOCA’s knowledgeable and highly trained orthopedics specialists, please contact us at 602.277.6211.
Title: Validy of Indirect Ultrasound Findings in Acute Anterior Cruciate Ligament Ruptures
Ken Mautner, MD, Walter I. Sussman, DO, Katie Nanos, MD, Joseph Blazuk, MD, Carmen Brigham, ATC, Emily Sarros, ATC
Objectives: Ultrasound (US) is increasingly being used as an extension of the physical examination on the sidelines, in training rooms, and in clinics. Anterior cruciate ligament (ACL) injury in sport is common, but the literature on US findings after acute ACL rupture is limited. Three indirect US findings of ACL rupture have been described, and this study assessed the validity of these indirect signs.
American Institute of Ultrasound in Medicine / J Ultrasound Med 2018; 9999:1-8 / 0278-4297
Title: Triple-Loaded Suture Anchors Versus a Knotless Rip Stop Construct in a Single-Row Rotator Cuff Repair Model
Matthew Noyes, MD, Christopher Adams MD, Evan S. Lederman MD, Patrick Denard MD
Full article link below.
The Journal of Arthroscopy and Related Research: 2018 Feb 15. pii: S0749-8063(18)30029-X. doi: 10.1016/j.arthro.2017.12.024. [Epub ahead of print]
Title: Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation
Patrick Denard MD, Patric Raiss MD, Reuben Gobezie MD, T. Bradley Edwards MD, Evan S. Lederman MD
Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings.
Full article link below.
Journal of Shoulder and Elbow Surgery E-pub February 6, 2018
Title: Short-term clinical outcome of an anatomic short-stem humeral component in total shoulder arthroplasty
Anthony A. Romeo MD, Robert J Thorness MD, Shelby A Sumner MPH, Reuben Gobezie MD, Evan S Lederman MD, Patrick J Denard MD
Short-stem press-fit humeral components have recently been developed in an effort to preserve bone in total shoulder arthroplasty (TSA), but few studies have reported outcomes of these devices. The purpose of this study was to evaluate the short-term clinical outcomes of an anatomic short-stem humeral component in TSA. We hypothesized that the implant would lead to significant functional improvement with low rates of radiographic loosening.
Full Article: https://doi.org/10.1016/j.jse.2017.05.026
The Journal of Shoulder and Elbow Surgery
Volume 27, Issue 1, January 2018, Pages 70-74
Title: Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty—Opposes
Samuel Harmsen MD and Evan S Lederman MD
When considering shoulder arthroplasty in a younger patient the surgeon can choose between stemmed, stemless or resurfacing implants for humeral reconstruction. Resurfacing arthroplasty can reproduce humeral anatomy independent of the humeral shaft, minimize bone resection and offer potential easier revision surgery. The resurfacing implant has been in use for over 30 years and has favorable long-term outcome.
Dr. Roberts, MD is excited to be joining the outstanding physicians at The Orthopedic Clinic Association.
Dr. Justin Roberts is an orthopaedic surgeon who is fellowship trained in surgery of the foot and ankle. He specializes in comprehensive care of both simple and complex foot and ankle conditions including sports injuries, fractures, arthritis, and deformity. He has special interests in ankle replacement, flat foot correction, bunion correction, arthroscopy, traumatic and post-traumatic reconstruction.
Dr. Roberts was born and raised in Bakersfield, California. He received his undergraduate degree at the University of California, Santa Barbara, then attended medical school at the University of California, San Diego. Dr. Roberts came to Phoenix for orthopaedic residency at Banner University Medical Center, then completed fellowship training at the Orthopaedics Associates of Michigan in Grand Rapids, MI. During fellowship, he received comprehensive training in complex surgical reconstruction of the foot and ankle.
Dr. Roberts promotes a relaxed atmosphere where open and honest communication is encouraged. Patient education is a critical part of his practice, and he will take the time to explain your condition and all treatment options. He emphasizes exhausting non-operative measures prior to recommending surgical intervention. Dr. Roberts understands that foot and ankle problems can be very disabling and recovery can be extensive. He is dedicated to working with you through every step to get you back to the quality of life you desire.
When not working, Dr. Roberts enjoys rugby, fishing, golf and spending time with his family.