TOCA’s Dr. Gerald Yacobucci Shares the Benefits of Knee Preservation vs. Knee Surgery

The Benefits of Knee Preservation … And Why Knee Replacement Should Be a Last Resort

Have you put off seeking relief for knee pain for fear of having knee replacement surgery? The Orthopedic Clinic Association’s Dr. Gerald Yacobucci, MD, a fellowship-trained orthopedic sports medicine specialist, wants to educate patients about the many benefits of minimally invasive knee preservation and why knee replacement surgery should be viewed as a last resort.

Knee Preservation

When it comes to preserving knees, Dr. Yacobucci says, “My mission is to provide all available options to patients with damaged knees in order to relieve their pain and restore maximum function. Even more importantly, I aim to delay or even eliminate the need for total knee replacement. My sports medicine background has taught me to approach these complex knees from a preserve and protect standpoint. If possible, I only want to repair what is damaged and never replace what is still viable.”

Knee Replacement

Regarding knee replacement surgery, Dr. Yacobucci says, “I always use biology (growing or grafting with living tissue) when available and only move on to prosthetic (non-biologic) implantation when all else fails. If biology is not an option, I use a minimalist approach to prosthetic implantation. This involves using mini-implants that resurface the damaged areas only, leaving the remainder of the knee intact. Partial knee replacement is explored in many cases when the patient is younger and has a large portion of the knee that is undamaged.”

Learn more about the benefits of knee preservation below and contact TOCA today for a knee pain consult with Dr. Gerald Yacobucci: 602-277-6211.

Knee Preservation Postcard

 

Dr. Blazuk and colleagues study the Validity of Indirect Ultrasound Findings…

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

Click here for full article!

 

Dr. Lederman and colleagues present a study comparing new techniques for rotator cuff repair!

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

Purpose

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.

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]

https://www.arthroscopyjournal.org/article/S0749-8063(18)30029-X/fulltext

Dr. Evan Lederman and colleagues review how bone reacts to shoulder replacements and propose a classification system for critical review of implant/bone interaction

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

Introduction

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

https://doi.org/10.1016/j.jse.2017.12.020

Dr. Lederman and colleagues discuss the outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Title: Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty

Reuben Gobezie MD, Patrick Denard MD, Yousef Shishani MD, Anthony Romeo MD, Evan S. Lederman MD

Background

The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases.

Full article: https://doi.org/10.1016/j.jse.2017.02.013

Journal of Shoulder and Elbow Surgery

Volume 26, Issue 9, September 2017, Pages 1603-1608

Dr Lederman, Dr Harmsen and colleagues review strategies to prevent infection in shoulder replacement. *

Title: Preventing infection in shoulder arthroplasty: Navigating the minefields

Abstract

Periprosthetic infection after shoulder arthroplasty represents a devastating complication that often requires extensive revision surgery with substantial economic and patient burden, and ultimately leads to reduced patient function.

Seminars in Arthroplasty

Volume 28, Issue 3, September 2017, Pages 145-149

https://doi.org/10.1053/j.sart.2017.12.006

*This is based on a lecture by Dr Lederman at the 2017 Current Concepts in Shoulder Arthroplasty conference in Las Vegas, NV.

Dr. Lederman, Dr. Lund and former fellows have described a new class of labral tears in the shoulder*

Title: The Glenoid Labral Articular Teardrop Lesion: A Chondrolabral Injury With Distinct Magnetic Resonance Imaging Findings

Evan S. Lederman MD, Stephen Flores MD, Christopher Stevens MD, Damien Richardson MD, Pamela Lund MD

*Identification of this lesion of MRI can help in diagnosis and treatment of labral tears.

Purpose

Evaluation and description of a pathognomonic lesion identified on magnetic resonance imaging (MRI) of a chondrolabral injury of the glenohumeral joint.

Methods

Patients were prospectively identified at the time of MRI by a characteristic teardrop appearance of a pedicled displaced chondrolabral flap in the axillary recess on coronal imaging and retrospectively reviewed.

Full article: https://doi.org/10.1016/j.arthro.2017.08.236

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 34, Issue 2, February 2018, Pages 407-411

 

Dr. Lederman and colleagues discuss the outcome and safety of a short stem shoulder replacement

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

Background

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

Dr. Lederman and Dr. Harmsen compare different techniques for shoulder replacement*

Title: Glenohumeral osteoarthritis in young patients: Stemless total shoulder arthroplasty trumps resurfacing arthroplasty—Opposes

Samuel Harmsen MD and Evan S Lederman MD

Abstract

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.

Seminars in Arthroplasty

Volume 28, Issue 3, September 2017, Pages 121-123
*This is based on a lecture/Debate by Dr. Lederman with Dr. Sumant Krishnan at the 2017 Current Concepts in Shoulder Arthroplasty Conference in Las Vegas, NV.