eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
79
90
10.22038/abjs.2018.31615.1827
11647
The Role of Gene Therapy in Cartilage Repair
E. Carlos RODRIGUEZ-MERCHAN
ecrmerchan@hotmail.com
1
Leonard A. Valentino
whybloodclots@gmail.com
2
Department of Orthopaedic Surgery and La Paz Research Institute (“Instituto de Investigación La Paz – IdiPaz”), “La Paz” University Hospital, Madrid, Spain
Rush University, Chicago, Illinois, USA
The key principle of gene delivery to articulations by direct intra-articular injection is to release complementary DNA(cDNA)-encoding medical products that will lead to maintained, endogenous production of the gene products withinthe articulation. In fact, this has been accomplished for both in vivo and ex vivo gene delivery, using several vectors,genes, and cells in some animal models. Some clinical trials for rheumatoid arthritis and osteoarthritis (OA) usingretrovirus vectors for ex vivo gene delivery and adeno-associated virus (AAV) for in vivo delivery have been reported.AAV is of special attention because, contrary to other viral vectors, it can enter deep within joint cartilage and transducechondrocytes in situ. This quality is of special significance in OA, in which modifications in chondrocyte metabolismare believed to be crucial to the pathophysiology of the disease. The clinical effectiveness of TissueGene-C (TG-C), acell and gene therapy for OA consisting of nontransformed and transduced chondrocytes (3:1) retrovirally transducedto overexpress TGF-β1 has been reported in patients with knee OA. The most common complications of TG-C wereperipheral edema (9%), arthralgia (8%), articular swelling (6%), and injection site pain (5%). TG-C was associatedwith relevant ameliorations in function and pain. Gene therapy appears to be a viable method for the management ofarticular cartilage defects and OA.Level of evidence: III
https://abjs.mums.ac.ir/article_11647_2439ae42f899063d0e8b5d31dde033ec.pdf
cartilage
Gene Therapy
Injury
repair
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
91
104
10.22038/abjs.2019.36340.1961
12340
Clinical Outcomes of Open versus Arthroscopic Surgery for Lateral Epicondylitis, Evidence from a Systematic Review
Ali Moradi
moradial@mums.ac.ir
1
Pouria Pasdar
pouriapasdar@yahoo.com
2
Hasan Mehrad Majd
mehradmajdh@mums.ac.ir
3
Mohammad H. Ebrahimzadeh
4
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Clinical Research Unit, Mashhad University of Medical Sciences, Mashhad, Iran
Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Background: Lateral epicondylitis (LE) also known as tennis elbow is a common disease of middle-aged population.Surgery is a treatment of choice in patients not responded to the conservative management. Open and arthroscopicrelease are the two main choices for LE surgery; however, an overall consensus is not available. This study was aimedto compare the clinical outcomes after conventional open and arthroscopic procedures.Methods: An electronic search of databases including, Medline, Web of Science, Embase, Cochrane Library, andScopus was conducted to identify all eligible studies describing the post-operative clinical outcomes of patients withLE, up to October 2018. All studies considering the non-pediatric cases who received at least 6-month preoperativeconservative treatment and were followed more than 6 months after surgery were included. Data on patient satisfaction,functional outcomes, pain, and complication rates, were extracted for each study. If appropriate, the meta-analysiswas performed to combine the results for all outcomes that were reported in a minimum of 3 studies utilizing the samesurgical technique.Results: A total of 34 eligible articles including 15 open studies, 13 arthroscopic studies, and 6 studies in bothtechniques were enrolled. Studies were from different parts of the world with a whole sample size of 1508 cases.Various outcome measuring methods including Quick DASH and VAS, and different clinical outcomes were reported.The results indicated no significant difference between arthroscopic and open surgery methods in terms of VAS,DASH score, time for returning to work, overall outcomes, and patients’ satisfaction (P >0.05). However, postoperativecomplications were significantly higher in the open group when compared with the arthroscopic procedure (57.3%vs 33.4% P=0.001).Conclusion: The present study suggests that despite no superiority for each techniques regarding the pain relief,subjective function, and better rehabilitation, arthroscopic method have been associated with less complications.Level of evidence: II
https://abjs.mums.ac.ir/article_12340_83c2d6f4ec6032e89d8fd3eb4c17fad2.pdf
Arthroscopy
Lateral epicondylitis
Open surgery
Systematic review
Tennis elbow
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
105
111
10.22038/abjs.2018.22677.1593
10828
Precontoured Locking Plate Treatment in Mid-Shaft Clavicle Fractures: Outcomes and Complications with a Minimun of 2- Years Follow up
Juan Martìn Patiño
drpatinojm@gmail.com
1
Alejandro Felix Rullan Corna
afrullancorna@gmail.com
2
Alejandro Emilio Michelini
alemichelini7@hotmail.com
3
Ignacio Abdon
ignacioabdon@yahoo.com.ar
4
Sandra Denise Hochbaum
denynett@hotmail.com
5
Fernando Zicovich Wilson
fzicovich@gmail.com
6
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Upper Extremity Unit Orthopedics and Traumatology Department, Hospital Militar Central, Cosme Argerich, Buenos Aires, Argentina
Background: The aim of this study was to evaluate functional outcome and complications with a long term followup (minimum of 2 years post-operative) in patients with mid-shaft clavicle fractures treated with precontoured lockingplates.Methods: We included 41 patients. Goniometric measurement of shoulder range of motion (ROM) was performed,as well as functional evaluation using the rating scale shoulder of the University of California (UCLA), the Constantscale, score of disability of the arm, shoulder and hand (DASH) and visual analog scale (VAS). Postoperativecomplications, implants removal rates and new x-rays were analized.Results: The mean postoperative follow-up was 41.5 (24; 69. SD 13.4) months. Mean shoulder anterior elevationwas 168.5º (120; 180. SD 22.9). The average value obtained for abduction was 175.2° (150; 180. SD 27.8), as tointernal and external rotations, these were not affected. DASH 1.27% (0%; 25%. SD 4.3), UCLA 33.6 points (20;35. SD 3.5), Constant 90.5 points (50; 100. SD 11.2) and VAS was 0 in 34 patients (83%). Complications: mildresidual pain (3), hypoesthesia of the infraclavicular area (2), and rupture (1) and loosening (1) of the implant.hardware removal due to intolerance (2 cases) and new osteosynthesis due to acute implant rupture (1 case).Conclusion: Our experience after a mean follow-up of 41.5 months with precontoured locking plates for the treatmentof displaced mid-shaft clavicle fractures has shown good functional results, with low complication and reoperationrate.Level of evidence: IV
https://abjs.mums.ac.ir/article_10828_a7c8cf4567545b0f43a63ec2883b426c.pdf
Clavicle
Complications
Fractures
Hardware Removal
Osteosynthesis
outcomes
Plates
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
112
117
10.22038/abjs.2018.32035.1870
11652
Long-term Outcomes after Primary Radial Head Resection Arthroplasty vs. Acute Radial Head Resection vs. Secondary Prosthetic Removal in Comminuted Radial Head Fractures
Martin Kiechle
martin.kiechle@bgu-murnau.de
1
Andreas Thannheimer
andreas.thannheimer@bgu-murnau.de
2
Sven Hungerer
sven.hungerer@bgu-murnau.de
3
Jan Friederichs
jan.friederichs@bgu-murnau.de
4
Volker Bühren
vbuehren@t-online.de
5
Christian Von Rüden
christian.vonrueden@bgu-murnau.de
6
Department of Trauma Surgery, BG Trauma Center Murnau, Germany
Department of Trauma Surgery, BG Trauma Center Murnau, Germany
Department of Trauma Surgery, BG Trauma Center Murnau, Germany Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
Department of Trauma Surgery, BG Trauma Center Murnau, Germany
Department of Trauma Surgery, BG Trauma Center Murnau, Germany
Department of Trauma Surgery, BG Trauma Center Murnau, Germany Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
Background: Aim of this study was to compare the clinical and radiological long-term outcomes following operativetreatment of comminuted radial head fractures using 1) primary radial head resection arthroplasty, 2) acute radial headresection, or 3) necessary secondary prosthetic removal. Additionally, we evaluated complex radial head fracturescombined with elbow dislocation and verified the hypothesis of whether primary radial head resection arthroplasty couldcontribute to ligament healing.Methods: In a comparative retrospective cohort study between 2004 and 2014, 87 (33 female, 54 male) patients withcomminuted radial head fractures with a median age of 45 (range 18-77) years were included and followed-up clinicallyand radiologically. Functional results were evaluated according to MEPS, DASH, Broberg and Morrey, and VAS scores.Results: After a median range of 46 months postoperatively, 48 patients (group 1) obtained an acute radial headresection arthroplasty (MEPS: 70 points, Broberg and Morrey: 63 points, DASH: 34 points, VAS: 3.3 points). Twentypatients (group 2) were treated by radial head resection (MEPS: 63 points, Broberg and Morrey: 50 points, DASH: 49points, VAS 4.2 points) and 19 patients (group 3) needed secondary prosthesis removal (MEPS: 73 points, Brobergand Morrey: 66 points, DASH: 38 points, VAS: 2.8 points). The overall outcome demonstrated a trend towards betterresults and the Kellgren-Lawrence grade of postoperative osteoarthritis was significantly better in groups 1 and 3compared to group 2 (P=0.02).Conclusion: Clinical and radiological long-term results of this study demonstrate a trend towards a better outcomeafter acute radial head resection arthroplasty compared to primary radial head resection, especially in complex fracturesassociated with elbow dislocation. Furthermore, our results encourage the use of primary radial head replacement incases of comminuted non-reconstructable radial head fractures.Level of evidence: III
https://abjs.mums.ac.ir/article_11652_ab0a877d3bf24b3553be7ad6bccbcba9.pdf
Broberg and Morrey
DASH, Outcome, Radial head fracture, Radial head resection arthroplasty
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
118
135
10.22038/abjs.2018.32214.1853
11654
Do Patient Preferences Influence Surgeon Recommendations for Treatment?
Lisanne J. H. Smits
lisanne_smits@hotmail.com
1
Suzanne C. Wilkens
suzanne.c.wilkens@gmail.com
2
David Ring
david.ring@austin.utexas.edu
3
Thierry G. Guitton
guitton@gmail.com
4
Neal C. Chen
nchen1@partners.org
5
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas, USA
Department of Plastic Surgery, University Medical Center Groningen, Groningen, The Netherlands
Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
Background: When the best treatment option is uncertain, a patient’s preference based on personal values should bethe source of most variation in diagnostic and therapeutic interventions. Unexplained surgeon-to-surgeon variation intreatment for hand and upper extremity conditions suggests that surgeon preferences have more influence than patientpreferences.Methods: A total of 184 surgeons reviewed 18 fictional scenarios of upper extremity conditions for which operativetreatment is discretionary and preference sensitive, and recommended either operative or non-operative treatment.To test the influence of six specific patient preferences the preference was randomly assigned to each scenario in anaffirmative or negative manner. Surgeon characteristics were collected for each participant.Results: Of the six preferences studied, four influenced surgeon recommendations. Surgeons were more likelyto recommend non-operative treatment when patients; preferred the least expensive treatment (adjusted OR,0.82; 95% CI, 0.71 – 0.94; P=0.005), preferred non-operative treatment (adjusted OR, 0.82; 95% CI, 0.72 – 0.95;P=0.006), were not concerned about aesthetics (adjusted OR, 1.15; 95% CI, 1.0 – 1.3; P=0.046), and when patientsonly preferred operative treatment if there is consensus among surgeons that operative treatment is a useful option(adjusted OR, 0.78; 95% CI, 0.68 – 0.89; P<0.001).Conclusion: Patient preferences were found to have a measurable influence on surgeon treatment recommendationsthough not as much as we expected-and surgeons on average interpreted surgery as more aesthetic. This emphasizesthe importance of strategies to help patients reflect on their values and ensure their preferences are consistent withthose values (e.g. use of decision-aids).Level of evidence: III
https://abjs.mums.ac.ir/article_11654_5d068eb69a6b9a539406a0281f77fd98.pdf
conservative treatment
decision making
Patient preference
Surgery
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
136
142
10.22038/abjs.2018.22176.1600
11636
Physician Rating Websites: an Analysis of Physician Evaluation and Physician Perception
Usman A. Syed
usyed11@gmail.com
1
Daniel Acevedo
acevedomd@gmail.com
2
Alexa C. Narzikul
acn003@jefferson.edu
3
Wade Coomer
wcoomer1@jhu.edu
4
Pedro K. Beredjiklian
pedro.beredjiklian@rothmaninstitute.com
5
Joseph A. Abboud
abboudj@gmail.com
6
Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
Kaiser Permanente, Los Angeles, CA, USA
Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
Shoulder and Elbow Division, The Rothman Institute, Philadelphia, PA, USA
Division of Hand Surgery Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
Director of Research, Shoulder and Elbow Division, Director of Clinical Operations at The Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
Background: The goal of this study was to evaluate current physician ratings websites (PRWs) to determine whichfactors correlated to higher physician scores and evaluate physician perspective of PRWs.Methods: This study evaluated two popular websites, Healthgrades.com and Vitals.com, to gather information onpracticing physician members of the American Shoulder and Elbow Society database. A survey was conducted ofthe American Shoulder and Elbow Society (ASES) membership to gather data on the perception held by individualphysicians regarding PRWs.Results: We found that patients were more likely to give physicians positive reviews and the average overall scorewas 8.35 (3.75-10). Patient wait time (P=0.052) trended toward significance as a major factor in determining theoverall scores, while ratings in both physician bedside manner (P=0.001) and physician/staff courtesy (P=0.002)were significant in reflecting the overall score given to the physician. According to our survey, a majority of therespondents were indifferent to highly unfavorable to PRWs (88%) and the validity of their ratings (78%).Conclusion: As PRWs become increasingly popular amongst patients in this digital age, it is critical to understand thatthe scores are not reflective of a significant proportion of the physicians’ patient population. Physicians can use thisstudy to determine what affects a patient’s experience and focus efforts on improving patients’ perception of quality,overall satisfaction, and overall care. Consumers may use this study to increase their awareness of the potential forsignificant sampling error inherent in PRWs when making decisions about their care.Level of evidence: III
https://abjs.mums.ac.ir/article_11636_243f03af0df4ba931a214b19989f4d28.pdf
Healthgrades
online ratings
physician ratings
Vitals
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
143
150
10.22038/abjs.2018.29951.1774
10836
Acromion Clavicular Joint Reconstruction with LARS Ligament in Acute Dislocation
Alessandro Geraci
geracialessandro@libero.it
1
Alberto Ricciardi
alberto.ricciardi@virgilio.it
2
Isabella Monia Montagner
montagner.isabella@gmail.com
3
Dario Pilla
tamamoca@libero.it
4
Lawrece Camarda
antonino.sanfilippo@unipa.it
5
Antonio D’Arienzo
antu84@gmail.com
6
Michele D’arienzo
michele.darienzo@unipa.it
7
Orthopedic Department, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
Orthopedic Department, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
Orthopedic Department, San Giacomo Apostolo Hospital, Castelfranco Veneto, Italy
Department of Orthopedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
Department of Orthopedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
Department of Orthopedic Surgery, University of Palermo (DiChirOnS), Palermo, Italy
Background: The acromion clavicular joint dislocations are common injuries of the shoulder. The severity is dependentupon the degree of ligamentous injury. Surgical treatment is typically performed in higher grade acromioclavicularseparation with several static and dynamic operative procedures with or without primary ligament replacement.Methods: 47 patients with acute Rockwood type III, IV, and V injuries were treated surgically with LARS reconstruction.The success of technique was evaluated by radiographic outcomes for each patient at every follow-up visit (one,three, 12 months), while to assess pain reduction and clinical evaluation Visual Analogue scale score (VAS) andConstant-Murley score (CMA) was performed, respectively. An One Way Analysis of Variance (Kruskal-Wallis test), amultiple comparison Turket test, or a t-test (Mann-Whitney Rank Sum Test) were used when required.Results: Follow-up radiographs revealed maintenance of anatomical reduction in 41 patients, and no bone erosionshas been identified. In short-term joint functional recovery has been observed. Indeed, after 12 months pain on theVAS-scale in all groups decreased significantly (P < 0.05), and the CMS revealed a significant overall improvement(P < 0.05).Conclusion: These data demonstrate that the use of the LARS allows to provide stability to the joint and especially toensure its natural elasticity, relieving pain and improving joint function already one month post-surgery.Level of evidence: III
https://abjs.mums.ac.ir/article_10836_1c865362bd5aef8d65cfe06f9ae61578.pdf
acromionclavicular joint
coracoclavicular ligament reconstruction
coracoid process
shoulder injury
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
151
160
10.22038/abjs.2018.30048.1776
11643
Evaluating Glenohumeral Osteoarthritis: The Relative Impact of Patient Age, Activity Level, Symptoms, and Kellgren-Lawrence Grade on Treatment
Adam Schumaier
adam.schumaier@uc.edu
1
Joseph Abboud
abboudj@gmail.com
2
Brian Grawe
grawebn@ucmail.uc.edu
3
J. Gabriel Horneff
4
Charles Getz
charles.getz@rothmaninsitute.com
5
Gerald Williams
grwjr@me.com
6
Matthew Ramsey
matthew.ramsey@rothmaninsitute.com
7
Surena Namdari
surena.namdari@gmail.com
8
Anthony Romeo
9
Gregory Nicholson
10
Jay Keener
11
Richard Friedman
12
Ed Yian
13
Stephanie Muh
14
Ruth Delaney
15
Randall Otto
16
William Levine
17
JT Tokish
18
Jack Kazanjian
19
Joshua Dines
20
Andrew Green
21
Scott Paxton
escottpaxton@gmail.com
22
Brody Flanagin
23
Samer Hasan
24
Scott Kaar
25
Anthony Miniaci
26
Frances Cuomo
27
University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
University of Cincinnati Department of Orthopaedics and Sports Medicine, Cincinnati, Ohio, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
Department of Orthopaedics, Southern California Permanente Medical Group, Anaheim, California, USA
Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, USA
University College Dublin, Dublin, Ireland
Premier Care Orthopaedics and Sports Medicine, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York, USA
Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
Premier Orthopaedics, Havertown, Pennsylvania, USA
Hospital for Special Surgery, New York, New York, USA
Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island
Department of Orthopaedic Surgery, Warren-Alpert School of Medicine at Brown University, Providence, Rhode Island
Orthopaedic Associates of Dallas, Dallas, Texas, USA
Cincinnati Sports Medicine, Cincinnati, Ohio, USA
Department of Orthopaedic Surgery, Saint Louis University, St. Louis, Missouri, USA
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
Department of Orthopaedic Surgery, Montefiore, New York, New York, USA
Background: It is not always clear how to treat glenohumeral osteoarthritis, particularly in young patients. The goals ofthis study were to 1) quantify how patient age, activity level, symptoms, and radiographic findings impact the decisionmakingof shoulder specialists and 2) evaluate the observer reliability of the Kellgren-Lawrence (KL) grading system forprimary osteoarthritis of the shoulder.Methods: Twenty-six shoulder surgeons were each sent 54 simulated patient cases. Each patient had a differentcombination of age, symptoms, activity level, and radiographs. Responders graded the radiographs and chose atreatment (non-operative, arthroscopy, hemiarthroplasty, or total shoulder arthroplasty). Spearman correlations andchi square tests were used to assess the relationship between factors and treatments. Sub-analysis was performedon surgical cases. An intra-class correlation (ICC) was used to assess observer agreement.Results: The significant correlations (P<0.01) were: symptoms [0.46], KL grade [0.44], and age [0.11]. In the subanalysisof operative cases, the significant correlations were: KL grade [0.64], age [0.39], and activity level [-0.10].The chi square analysis was significant (P<0.01) for all factors, but the practical significance of activity level wasminimal. The ICCs were [inter](intra): KL [0.79] (0.84), patient management [0.54].Conclusion: When evaluating glenohumeral osteoarthritis, patient symptoms and KL grade are the factors moststrongly associated with treatment. In operative cases, the factors most strongly associated with the choice of operationwere the patient’s KL grade and age. Additionally, the KL classification demonstrated excellent observer reliability.However, there was only moderate agreement among shoulder specialists regarding treatment, indicating that thisremains a controversial topic.Level of evidence: III
https://abjs.mums.ac.ir/article_11643_d9c2539e36ab0247b03668fa09f3cec3.pdf
Clinical Decision-Making
Glenohumeral Osteoarthritis
Hemiarthroplasty
Kellgren-Lawrence
Patient Factors
Total Shoulder Arthroplasty
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
161
167
10.22038/abjs.2018.31453.1816
12341
Short Term Complications and Functional Results of Sarcoma Limb Salvage Surgeries
Mohammad Ghareh Daghi
gharahdaghim@mums.ac.ir
1
Mohammad Hassani
drmhasani57@sbmu.ac.ir
2
Ali Parsa
aliparsadr@yahoo.com
3
Farzad Omidi-Kashani
omidif@mums.ac.ir
4
Lida Jarahi
jarahil@mums.ac.ir
5
rahim hosseini
rahim.hosseini1365@gmail.com
6
Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Department of Orthopedic Surgery, Orthopedic Research Centre, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Orthopedic Research Center, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
Department of Orthopedic Surgery, Imamreza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Background: Limb salvaging surgeries are current surgical treatment of extremity bone sarcomas. Resected bonereplacement consists of two main methods; tumor prosthesis versus structural allograft. Biological reconstruction withan allograft is an economic cheap method in young sarcoma patients, however, the surgeons are more convinced withtumor prosthesis replacement.Methods: We evaluated the short-term complications and functional results of 40 patients with aggressive extremitytumors in a retrospective cohort study. The mean age of cases was 25 and we followed them for 24 months. 17patients underwent tumor prosthesis replacement after wide resection of limb sarcomas. 16 cases had structuralallograft reconstruction and 7 patients treated with amputation. We matched confounders including age, sex, bloodcell count and chemotherapy treatment in the study groups.Results: We found 15 major complications (45.5%) in limb salvage surgeries composing infection, allograft nonunion,allograft fracture, prosthesis fracture, prosthesis loosening and device failure that needed another surgery to beresolved. We had 10 major complications in allograft group (62%) and 5 in tumor prosthesis group (29.4%). Althoughthe rate of complications was higher in allograft group, it didn’t statistically indicate strong correlation (Fisher’s exact:0.084). Mean Musculo-Skeletal tumor rating Scale (MSTS) score was 25.8(73.7%) and 22.3(63.7%) in allograftgroup and prosthesis cases respectively. MSTS score had a normal distribution in the different groups with nosignificant difference between them.Conclusion: Although complications were higher in the allograft group, allograft could be offered to bone sarcomapatients, whom are predicted to have short life expectancy.Level of evidence: III
https://abjs.mums.ac.ir/article_12341_0cbf4bbb6403ce865babb13bad288983.pdf
Allograft
Limb salvage
Sarcoma
Tumor prosthesis
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
168
172
10.22038/abjs.2018.24942.1658
11637
Diagnostic Value of Ischial Spine Sign in Patients with Acetabular Retroversion
Mohamad Qoreishy
mohamad.qoreishy@gmail.com
1
Hamid R.S. Hosseinzadeh
hamidihamid500@gmail.com
2
Ali Keipourfard
alikeipour@gmail.com
3
Arya Shoghli
drary89@aol.com
4
Akhtar hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Rowan University, NJ, USA
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background: Acetabular Retroversion (AR) is a hip disorder and one of the causes of pain in this area. Evaluationof positive Cross Over Sign (COS) on AP X-Rays of the hip is currently the best method of diagnosis of AR. Severalstudies have measured co-existence of Ischial Spine Sign (ISS) in patients with AR. In this study we evaluated thediagnostic value of ISS in confirmation of AR and compared it with the diagnostic value of COS.Methods: In this study, 4120 AP hip X-Rays from Akhtar Hospital, Shahid Beheshti University of Medical Sciences,Tehran, were studied. Based on radiologic criteria, 1180 X-Rays were considered as standards and evaluated for ISS,COS and PWS (Posterior Wall Sign). Data analysis was done for correlation between ISS and COS.Results: A total of 1180 out of 4120 X-Rays were considered as standard; among which, 86 were diagnosed withAR based on positive COS in presence of PWS. Both ISS and COS were positive concurrently in 69 X-Rays. ISSwas positive in absence of COS in 11 X-rays. No significant difference in diagnostic value for diagnosis of acetabularretroversion was found between ISS and COS (P<0.05).Conclusion: According to our results, both ISS and COS signs can be employed for diagnosis of AR (acetabularretroversion). Considering the absence of a significant difference between these two signs in confirmation of AR, it canbe perceived that the diagnostic value of ISS in confirmation of AR is equal to COS. Validation of the mentioned resultsrequires further studies.Level of evidence: IV
https://abjs.mums.ac.ir/article_11637_58ab9a51812fb54746cd1541140a0cc1.pdf
Acetabular Retroversion
Crossover Sign
Diagnostic value
Ischial Spine Sign
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
173
181
10.22038/abjs.2018.28625.1739
11156
Translation and Psychometric Properties of the Persian Version of Oxford Non-technical Skills 2 System: Assessment of Surgical Teams’ Non-technical Skills in Orthopedic Surgery Wards
Reza Kalantari
rkalantari@sums.ac.ir
1
Ahmad Zanjirani Farahani
zanjirania@yahoo.com
2
Ehsan Garosi
e-garosi@alumnus.tums.ac.ir
3
Hamze Badeli
hamzebadeli@gmail.com
4
Jamshid Jamali
jamalij@mums.ac.ir
5
Department of Ergonomics, School of Health and Nutrition, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Occupational Health Engineering, School of Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Anatomy, School of medicine, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Biostatistics and Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
Background: Non-technical skills are interpersonal and cognitive skills involved in safe performance and preventingadverse events during surgery. it is necessary to dominate the non-technical skills to ensure patient safety. This studyhas aimed to assess the validity and reliability of Oxford Non-technical skills 2 system (Oxford NOTECHS 2) in Iran andto evaluate surgical teams’ non-technical skills in orthopedic surgery wards.Methods: This cross-sectional study was conducted in Tehran, Iran during 2015. The level of evidence is III based onCanadian Task Force on the Periodic Health Examination. We followed the Beaton’s guideline for Persian translationand cross-cultural adaptation of the checklist. In this study, 60 orthopedic surgical team members working in twoselected public hospitals were selected by cluster random sampling method.Oxford NOTECHS 2 system which isconsisted of four subscales including leadership and management, teamwork and collaboration, decision-makingand problem-solving, and situational awareness was used to collect the data.Results: The overall mean score of non-technical skills was 69.52±6.64. The mean score for surgery, anesthesia, andnursing sub-teams were 24.98±3.71, 21.12±4.29, and 23.42±3.60, respectively. The teams’ scores in total, leadershipand management, teamwork and collaboration, problem solving and decision making, and situational awareness atthe standard level were 74.70%, 76.95%, 73.75%, 66.87%, and 74.70% of maximum score, respectively.Conclusion: The validity and reliability of the Persian version of Oxford NOTECHS 2 scale in Iran was confirmed. Theresults of this study showed that surgical teams’ non-technical skills were at a moderate level in orthopedic surgerywards. The minimum score of the surgical teams’ non-technical skills belonged to anesthesia and maximum to surgerysub-team. Using the training programs and setup workshop is recommended to improve the surgical teams’ nontechnicalskills, especially surgery-nursing sub-team.Level of evidence: III
https://abjs.mums.ac.ir/article_11156_e02e5846a39b786562529c192e977fe2.pdf
Non-technical skills
Operating room, Orthopedic surgery, Oxford non-technical skills 2, Oxford NOTECHS 2, Persian version
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
182
190
10.22038/abjs.2018.29116.1754
10835
Histomorphometric Analysis of Newly-formed Bone Using Octacalcium Phosphate and Bone Matrix Gelatin in Rat Tibial Defects
Fereydoon Sargolzaei Aval
fsargolzaei@yahoo.com
1
Mohamad R. Arab
mr_arabz@yahoo.com
2
Narjes Sargolzaei
:n_sargol@yahoo.com
3
Sanam Barfroushan
barforushan93@gmail.com
4
Mohsen Mir
niktel_printer@yahoo.com
5
Gholam Hossein Sargazi
ghsargazi1@gmail.com
6
Forough Sargolzaei Aval
fsargol@yahoo.com
7
Maryam Arab
arabmery5@gmail.com
8
Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Department of Pathology, University of Washington, Seattle, Washington, USA
Cellular and Molecular Research Center & Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
Background: Repair of bone defects is challenging for reconstructive and orthopedic surgeons. In this study, we aimedto histomorphometrically assess new bone formation in tibial bone defects filled with octacalcium phosphate (OCP),bone matrix gelatin (BMG), and a combination of both.Methods: A total of 96 male Sprague Dawley rats aged 6-8 weeks weighing 120-150 g were randomly allocatedinto three experimental (OCP, BMG, and OCP/BMG) and one control group (n=24 in each group). The defects inexperimental groups were filled with OCP (6 mg), BMG (6 mg), or a combination of OCP and BMG (6 mg, 2:1 ratio).No material was used to fill the defects in the control group and the defect was only covered with Surgicel. Sampleswere taken on days 7, 14, 21, and 56 after the surgery. The sections were stained with hematoxylin-eosin (H&E) andassessed using light microscopy.Results: In our experimental groups, bone formation was started from the margins of the defect towards the centerwith an increasing rate during the study period. Moreover, the formed bone was more mature. Bone formation in ourcontrol group was only limited to the margins of the defect. The newly formed bone mass was significantly higher inthe experimental groups (P=0.001).Conclusion: OCP, BMG, and OCP/BMG compound enhanced osteoinduction in long bones.Level of evidence: III
https://abjs.mums.ac.ir/article_10835_153b8b56f1aa5befd495b8f8d0b76310.pdf
Bone formation
Bone matrix gelatin
Octacalcium phosphate
Rat
Tibia
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
191
198
10.22038/abjs.2018.32469.1860
11656
The Use of Eponyms for Surgical Approaches and Fractures in Elbow Surgery: Accuracy and Reliability Pre- and Post-Training
Jetske Viveen
jetskeviveen@gmail.com
1
Matthijs P. Somford
mp_somford@hotmail.com
2
Koen L.M. Koenraadt
kkoenraadt@amphia.nl
3
Michel P. J. van den Bekerom
bekerom@gmail.com
4
Denise Eygendaal
deygendaal@amphia.nl
5
Inger B. Schipper
i.b.schipper@lumc.nl
6
Job N. Doornberg
jobdoornbergortho@gmail.nl
7
Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands
Department of Orthopedic Surgery, Rijnstate Hospital, 6815 AD Arnhem, The Netherlands
Foundation for Orthopedic Research, Care & Education, Amphia Hospital, 4818 CK Breda, The Netherlands
Shoulder and elbow Unit, Department of Orthopedic Surgery, Onze Lieve Vrouwe Gasthuis, 1091 AC Amsterdam, The Netherlands
Upper Limb Unit, Department of Orthopedic Surgery, Amphia Hospital, 4818 CK Breda, The Netherlands Department of Orthopedic Surgery, University of Amsterdam, 1105 AZ Amsterdam-Zuidoost, The Netherlands
Department of Surgery and Traumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
Department of Orthopedic Surgery, Flinders Medical Centre, Adelaide, Australia
The use of eponymous terms in orthopedic trauma surgery is common. In an assessment pre-training versus posttrainingat an AO Advanced Elbow Trauma Course, we aimed to report on (1) the accuracy and (2) reliability of 10common eponymous terms used for surgical approaches and fractures in elbow surgery. Before training, eponymswere described correctly in 38% of questions versus 47% after training. The percentage of correct answers onlyimproved significantly in one question (P<0.005). A generalized kappa of 0.37 before training versus 0.31 aftertraining represents an overall fair reliability of the eponymous terms. In conclusion, the accuracy and reliabilityof eponymous terms used in elbow surgery is disappointing. Moreover, this type of standardized training formatdoes not seem to improve the knowledge of eponymous terms of experienced trauma- and orthopedic surgeons.Therefore, we suggest considering descriptive terms or standardized fracture classifications instead of eponymousterms.Level of evidence: II
https://abjs.mums.ac.ir/article_11656_c15835329ddc8bd7d280e3069791f946.pdf
Accuracy
Elbow
Eponyms
Fracture
Reliability
Surgical approach
Teaching
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
199
202
10.22038/abjs.2018.30742.1798
11157
Fetal Rhabdomyoma of the upper Extremity in a 31- Year Old Patient: a Case Report
Georg Hauer
georg.hauer@medunigraz.at
1
Jörg Friesenbichler
joer.friesenbichler@medunigraz.at
2
Franz Gollowitsch
franz.gollowitsch@medunigraz.at
3
Andreas Leithner
andreas.leithner@medunigraz.at
4
Lukas A. Holzer
lukas.holzer@medunigraz.at
5
Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
Institute of Pathology, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
AUVA Trauma Center Klagenfurt, Waidmannsdorferstraße 35, Klagenfurt am Wörthersee, Austria Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5, Graz, Austria
Fetal rhabdomyomas (RM) are extremely rare benign mesenchymal tumours that occur primarily in the head and neck.This tumour exhibits immature skeletal muscle differentiation. The patients’ median age is four years and surgical resectionis the recommended treatment.Fetal RM of limbs are rare and not well described in the literature and if, predominantly in form of case reports. We reportthe second case of a fetal RM in the upper extremity in a 31-year old male patient.One should be aware of this skeletal muscle tumour and fetal RM should be considered as a differential diagnosis to itsmalignant counterpart rhabdomyosarcoma.Level of evidence: V
https://abjs.mums.ac.ir/article_11157_6aa1e9c874c64782349544db42caad83.pdf
fetal
rhabdomyoma
rhabdomyosarcoma
tumour
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
203
208
10.22038/abjs.2018.28805.1741
11640
Treatment of an Insertional High Grade Partial Patellar Tendon Tear Utilizing a Bio-Inductive Implant
Sean Mc Millan
mcmillansean@hotmail.com
1
DO FAOAO
2
Elizabeth Ford
eaford93@gmail.com
3
Lourdes Medical Associates, Burlington, New Jersey, USA
Lourdes Medical Associates, Burlington, New Jersey, USA Our Lady of Lourdes Burlington Campus, Burlington, New Jersey, USA
Lourdes Medical Associates, Burlington, New Jersey, USA Rowan University School of Osteopathic Medicine, Stratford, New Jersey, U.S.A.USA
The management of recalcitrant patellar tendinopathies in the athletic population can be vexing to both the surgeonand patient. To date the majority of treatments for this disease pathology are non-surgical in nature. When surgicalintervention is required, open debridement and/or tendon take-down with repair has been necessary. We proposea novel technique for the treatment of insertional patellar tendinopathies and symptomatic partial tearing utilizing abio-inductive implant.Level of evidence: V
https://abjs.mums.ac.ir/article_11640_fe1d5c0cc21bdc946e8412a143c2571b.pdf
bio-inductive
Biologic
Jumpers’ knee
Patella tendon
patellar tendinopathy
partial tendon tear
eng
Mashhad University of Medical Sciences, Iranian Society of Knee Surgery, Arthroscopy and Sports Tramatology,Iranian Orthopaedic Association
The Archives of Bone and Joint Surgery
2345-4644
2345-461X
2019-03-01
7
2
209
210
10.22038/abjs.2018.35332.1933
12345
How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty?
Aditya V. Maheshwari
adityavikramm@gmail.com
1
Neil V. Shah
neil.shah.v@gmail.com
2
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY), Downstate Medical Center, Brooklyn, New York, USA
Dear Editor, We read with great interest the timely study by Satish et al., How Much Bone Cement Is Utilized for Component Fixation in Primary Cemented Total Knee Arthroplasty? (1). We applaud the authors, yet we hope they can clarify some points to make this study more applicable to a wider population.
https://abjs.mums.ac.ir/article_12345_2b2de54cdd4c3b0524662c81a500b0c8.pdf
Letter to editor
cementing technique
Total knee arthroplasty