Posts

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, 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 colleagues review how bone can react differently to shoulder replacements and document the potential benefit and safety of short stem shoulder implants

Title: Proximal Stress is Decreased with a Short Stem Compared to a Traditional Length Stem In Total Shoulder Arthroplasty

Patrick J. Denard MD, Matthew P Noyes MD, J B Walker, MD, Yousef Shishani, MD, Reuben Gobezie MD, Anthony A Romeo, MD, Evan S. Lederman, MD

Background

This study compared the outcome and radiographic humeral adaptations after placement of a traditional-length (TL) or short-stem (SS) humeral component during total shoulder arthroplasty (TSA). The hypothesis was there would be no difference in outcome or radiographic adaptations.

Full article: https://doi.org/10.1016/j.jse.2017.06.042

The Journal of Shoulder and Elbow Surgery

Volume 27, Issue 1, January 2018, Pages 53-58

Dr. Lederman was a recent invited lecturer at the American Academy of Orthopedic Surgeons Annual Meeting 2018

 

Complex Shoulder Arthroplasty: Primary and Revision, Anatomic and Reverse, Three-Dimensional Planning – When and How? A case-based, comprehensive review of shoulder arthroplasty.

Moderator: Asheesh Bedi, MD: Panelists: Evan Lederman, Anthony Romeo, Gilles Walch, JP Warner, Brad Parsons, john Tokish, David Dines, Josh Dines, Michael Freehill, Xinning Li

New Orleans, LA – AAOS 2018 – American Academy of Orthopedic Surgeons (AAOS) 2018 Annual meeting at the Ernest Morial Convention Center ,Tuesday March 6, 2018. With over 30,000 attendees, the conference is the preeminent meeting on musculoskeletal education to orthopaedic surgeons and allied health professionals in the world.

Congratulations to Dr. Evan Lederman for his recent publication!

Title: The Evolution of the Superior Capsular Reconstruction Technique

Alan M. Hirahara, MD, FRCSC; Evan S. Lederman, MD; Wyatt J. Andersen, ATC; and Kyle Yamashiro, PT, DPT, CSCS

Introduction

Irreparable, massive rotator cuff tears can result in unacceptable functional deficits in patients. When the supraspinatus tears and retracts medially, the superior capsule is also disrupted, and superior constraint is lost. With no superior restraint to the humerus, the humeral head migrates superiorly, causing a decrease in the acromial-humeral distance. [1-4]

Biomechanical analysis has shown that a defect in the superior capsule results in a minimum 200% greater glenohumeral superior translation and subacromial peak contact pressure compared with an intact capsule. [3] The malposition of the humeral head leads to functional abnormalities and pseudoparalysis.

Numerous proposed treatments for massive rotator cuff tears – including debridement and tenotomy, tendon transfers, and reverse total shoulder arthroplasty – have yielded mixed results and high complication rates. [5-12] In particular, reverse shoulder arthroplasty can result in humeral or glenoid fractures, persistent anterior or posterior instabilities, loosening of the glenoid or humeral cemented components, dislocations, and infection. [5-7]

The superior capsular reconstruction (SCR) was described by Hanada et al [13] in 1993 and by Mihata et al [1] in 2013 as an alternative procedure to increase function and decrease pain by restoring the restraint mechanisms in the shoulder. Using a graft to recreate the superior capsule, the humeral head is centered in the glenoid, allowing the larger muscles (ie, deltoid, latissimus dorsi, and pectoralis major) to function appropriately. Mihata et al [3,4] have found that the SCR reduces glenohumeral superior translation and subacromial contact force.

Full article link below.

ICJR.net  March 2018

Celebrate Global Running Day 2017

Celebrate Global Running Day 2017

The world will be running on June 7. This is your invitation to join.

If you forgot to put it on the calendar, June 7 is Global Running Day. Over two million runners from across the globe, in 164 countries, have pledged to get up, get out, and go for a run. This is a great day to invite a non runner to take up the sport.

You’ve probably heard it said that exercise is medicine. Well, it’s not just a saying; it’s the truth. There’s a raft of scientific evidence that proves that regular exercise (150 minutes per week, which is about 30 minutes five times per week)—and running in particular—has health benefits that extend well beyond any pill a doctor could prescribe. Studies have shown that running can help prevent obesity, type 2 diabetes, heart disease, high blood pressure, stroke, some cancers, and a host of other unpleasant conditions. What’s more, scientists have shown that running also vastly improves the quality of your emotional and mental life, and even helps you live longer.

A study out in the Journal of the American College of Cardiology finds that even five to 10 minutes a day of low-intensity running is enough to extend life by several years, compared with not running at all. It shows that the minimal healthy “dose” of exercise is smaller than many people might assume.

Benefits of Running That Make You Healthier (and Happier)

Everyone knows that running is a great way to get into shape, but did you know that it can benefit almost every part of your body, as well as lift your mood? Running is incredibly effective at making you healthier in a number of ways. While it may not be everybody’s favorite form of exercise, knowing what it can do for your life just may make you look at running in an entirely new light.

Improve Your Health

Believe it or not, running is actually a great way to increase your overall level of health. Research shows that running can raise your levels of good cholesterol while also helping you increase lung function and use. In addition, running can also boost your immune system and lower your risk of developing blood clots.

Running Is Good for Your Heart

Running is the king of cardio. Running even five to 10 minutes a day, at slow speeds (how does a nice 12-minute mile sound to you?) is associated with a drastically reduced risk of dying from cardiovascular disease, according to a landmark study in the Journal of the American College of Cardiology. Compared with never-runners, regular runners have half the chance of dying from heart disease. Every time you run, you decrease your resting heart rate, so your heart doesn’t need to work as hard, says exercise physiologist Greg Justice, founder of AYC Health & Fitness in Kansas City.

Running Strengthens Your Joints and Increases bone density

A Medicine & Science in Sports & Exercise study of nearly 100,000 runners and walkers found that, nope, running doesn’t up the risk of osteoarthritis—even people who cover 26.2 miles on the regular. In fact, the study showed runners were half as likely to suffer from knee osteoarthritis compared with walkers. Surprised? Every time you pound the pavement, you stress your bones and cartilage, just like your muscles, causing them to spring back stronger, explains Janet Hamilton, CSCS, an exercise physiologist with Running Strong in Atlanta. Low-impact exercises like walking, or even spinning or swimming, don’t have that same bone-building benefit. Running stresses your bones. Essential minerals are sent to the bones when under stress, which makes them stronger. However, running does not make you unbreakable, and jumping, say, a 10-foot high fence is still a bad idea.

Prevent Disease

For women, running can actually help to lower your risk of breast cancer. It can also help reduce the risk of having a stroke. Many doctors today recommend running for people who are in the early stages of diabetes, high blood pressure, and osteoporosis, and it is proven to help reduce the risk of having a heart attack. By helping the arteries retain their elasticity and strengthening the heart, your chances of suffering a heart attack can be significantly reduced.

Lose Weight

Running is one of the best forms of exercise for losing or maintaining a consistent weight. You will find that it is a leading way to burn off extra calories and that it is the second most effective exercise in terms of calories burned per minute, following only after cross country skiing.

Boost Your Confidence

Not all of the benefits of running are physical. Running can provide an noticeable boost to your confidence and self-esteem. By setting and achieving goals, you can help give yourself a greater sense of empowerment that will leave you feeling much happier.

Relieve Stress

Stress can actually cause a number of health and mood problems. It can also diminish appetite and sleep quality. When you run, you force your body to exert excess energy and hormones. Running also helps to reduce your chances of developing tension headaches.

It may seem surprising to learn all of the different ways that running can improve your health, but the truth of the matter is that these are only a few of the many benefits that it can offer to your body.  Running really is incredibly beneficial to the body, mind, and spirit, and you will find that even short runs can leave you feeling more energized, more focused, and better able to enjoy all that life has to offer.

If you have a sports injury/ injury prevention, physical therapy, sports medicine question or concern the team at TOCA is here to help! To learn more or schedule an appointment call us at: 602-277-6211!

#GlobalRunningDay #run #InjuryPrevention #SportsMedicine #RunnersLife #RunforHealth #KeepRunning #TOCA #TOCAMD

Ankle Sprain

Ankle Sprain

Ankle sprains are very common injuries. There’s a good chance that while playing as a child or stepping on an uneven surface as an adult you sprained your ankle–some 25,000 people do it every day.​​​

Sometimes, it is an awkward moment when you lose your balance, but the pain quickly fades away and you go on your way. But the sprain could be more severe; your ankle might swell and it might hurt too much to stand on it. If it’s a severe sprain, you might have felt a “pop” when the injury happened.

Even though ankle sprains  are common, they are not always minor injuries. Some people with repeated or severe sprains can develop long-term joint pain and weakness. Treating a sprained ankle can help prevent ongoing ankle problems.

A sprained ankle means one or more ligaments on the outer side of your ankle were stretched or torn. If a sprain is not treated properly, you could have long-term problems. Typically the ankle is rolled either inward (inversion sprain) or outward (eversion sprain). Inversion sprains cause pain along the outer side of the ankle and are the most common type. Pain along the inner side of the ankle may represent a more serious injury to the tendons or to the ligaments that support the arch and should always be evaluated by a doctor.

With a mild sprain, the ankle may be tender, swollen, and stiff. But it usually feels stable, and you can walk with little pain. A more serious sprain might include bruising and tenderness around the ankle, and walking is painful. In a severe ankle sprain, the ankle is unstable and may feel “wobbly.”

More about Your Injury

There are 3 grades of ankle sprains:

  • Grade I sprains: Your ligaments are stretched. It is a mild injury that can improve with some light stretching.
  • Grade II sprains: Your ligaments are partially torn. You may need to wear a splint or a cast.
  • Grade III sprains: Your ligaments are fully torn. You may need surgery for this severe injury.

The last 2 kinds of sprains are often associated with tearing of small blood vessels. This allows blood to leak into tissues and cause black and blue color in the area. The blood may not appear for several days. Most of the time it is absorbed from the tissues within 2 weeks.

If your sprain is more severe:

  • You may feel strong pain and have a lot of swelling.
  • You may not be able to walk, or walking may be painful.

Some ankle sprains may become chronic (long-lasting). If this happens to you, your ankle may continue to be:

  • Painful and swollen
  • Weak or giving way easily

What to Expect

Your health care provider may order an x-ray to look for a bone fracture, or an MRI scan to look for an injury to the ligament.

To help your ankle heal, your provider may treat you with a brace, a cast, or a splint, and may give you crutches to walk on. You may be asked to place only part or none of your weight on the bad ankle. You will also need to do physical therapy or exercises to help you recover from the injury.

Self-care

You can decrease swelling by:

  • Resting and not putting weight on your foot

Ice it to keep down the swelling. Don’t put ice directly on the skin (use a thin piece of cloth such as a pillow case between the ice bag and the skin) Apply ice every hour while you are awake, 20 minutes at a time and covered by a towel or bag, for the first 24 hours after the injury. After the first 24 hours, apply ice 20 minutes 3 to 4 times per day.

  • Compression can help control swelling as well as immobilize and support your injury.
  • Elevating your foot on a pillow at or above the level of your heart
  • Pain medicines, such as ibuprofen or naproxen, may help to ease pain and swelling. You can buy these medicines without a prescription. DO NOT use these drugs for the first 24 hours after your injury. They may increase the risk of bleeding. DO NOT take more than the amount recommended on the bottle or more than your provider advises you to take. Carefully read the warnings on the label before taking any medicine.

Getting Active

The pain and swelling of an ankle sprain most often gets better within 48 hours. After that, you can begin to put weight back on your injured foot.

  • Put only as much weight on your foot as is comfortable at first. Slowly work your way up to your full weight.
  • If your ankle begins to hurt, stop and rest.

 

Rehabilitating your Sprained Ankle

Every ligament injury needs rehabilitation. Otherwise, your sprained ankle might not heal completely and you might re-injure it. All ankle sprains, from mild to severe, require three phases of recovery:

  • Phase I includes resting, protecting and reducing swelling of your injured ankle.
  • Phase II includes restoring your ankle’s flexibility, range of motion and strength.
  • Phase III includes gradually returning to straight-ahead activity and doing maintenance exercises, followed later by more cutting sports such as tennis, basketball or football.

Once you can stand on your ankle again, your doctor will prescribe exercise routines to strengthen your muscles and ligaments and increase your flexibility, balance and coordination. Later, you may walk, jog and run figure eights with your ankle taped or in a supportive ankle brace.

It’s important to complete the rehabilitation program because it makes it less likely that you’ll hurt the same ankle again. If you don’t complete rehabilitation, you could suffer chronic pain, instability and arthritis in your ankle. If your ankle still hurts, it could mean that the sprained ligament has not healed right, or that some other injury also happened.

To prevent future sprained ankles, pay attention to your body’s warning signs to slow down when you feel pain or fatigue, and stay in shape with good muscle balance, flexibility and strength in your soft tissues.

Talk to your provider before returning to more intense sports or work activities.

When to Call the Doctor

You should call your provider if you notice any of the following:

  • You cannot walk, or walking is very painful.
  • The pain does not get better after ice, rest, and pain medicine.
  • Your ankle does not feel any better after 5 to 7 days.
  • Your ankle continues to feel weak or gives away easily.
  • Your ankle is increasingly discolored (red or black and blue), or it becomes numb or tingly.

 

If you have an Foot or Ankle Injury, the dedicated team of Orthopedic Physicians and Physical Therapists are here to help. For questions or to schedule an appointment call 602-277-6211!

 

#Results #Recovery #Relief #anklesprain #injuryprevention #sportsinjury #orthopedicinjury #TOCA #TOCAMD #physicaltherapy #healmyankle