Try a new search

Format these results:

Searched for:

person:grantj06

in-biosketch:true

Total Results:

40


A modified Delphi consensus statement on patellar instability: part II

Hurley, Eoghan T; Sherman, Seth L; Chahla, Jorge; Gursoy, Safa; Alaia, Michael J; Tanaka, Miho J; Pace, J L; Jazrawi, Laith M; ,; Hughes, Andrew J; Arendt, Elizabeth A; Ayeni, Olufemi R; Bassett, Ashley J; Bonner, Kevin F; Camp, Christopher L; Campbell, Kirk A; Carter, Cordelia W; Ciccotti, Michael G; Cosgarea, Andrew J; Dejour, David; Edgar, Cory M; Erickson, Brandon J; Espregueira-Mendes, João; Farr, Jack; Farrow, Lutul D; Frank, Rachel M; Freedman, Kevin B; Fulkerson, John P; Getgood, Alan; Gomoll, Andreas H; Grant, John A; Gwathmey, F W; Haddad, Fares S; Hiemstra, Laurie A; Hinckel, Betina B; Savage-Elliott, Ian; Koh, Jason L; Krych, Aaron J; LaPrade, Robert F; Li, Zachary I; Logan, Catherine A; Gonzalez-Lomas, Guillem; Mannino, Brian J; Lind, Martin; Matache, Bogdan A; Matzkin, Elizabeth; Mandelbaum, Bert; McCarthy, Thomas F; Mulcahey, Mary; Musahl, Volker; Neyret, Philippe; Nuelle, Clayton W; Oussedik, Sam; Verdonk, Peter; Rodeo, Scott A; Rowan, Fiachra E; Salzler, Matthew J; Schottel, Patrick C; Shannon, Fintan J; Sheean, Andrew J; Strickland, Sabrina M; Waterman, Brian R; Wittstein, Jocelyn R; Zacchilli, Michael; Zaffagnini, Stefano
AIMS/UNASSIGNED:The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process. METHODS/UNASSIGNED:This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous. RESULTS/UNASSIGNED:Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus. CONCLUSION/UNASSIGNED:Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport.
PMID: 38035602
ISSN: 2049-4408
CID: 5590422

A modified Delphi consensus statement on patellar instability: part I

Hurley, Eoghan T; Hughes, Andrew J; Savage-Elliott, Ian; Dejour, David; Campbell, Kirk A; Mulcahey, Mary K; Wittstein, Jocelyn R; Jazrawi, Laith M; ,; Alaia, Michael J; Arendt, Elizabeth A; Ayeni, Olufemi R; Bassett, Ashley J; Bonner, Kevin F; Camp, Christopher L; Carter, Cordelia W; Chahla, Jorge; Ciccotti, Michael G; Cosgarea, Andrew J; Edgar, Cory M; Erickson, Brandon J; Espregueira-Mendes, João; Farr, Jack; Farrow, Lutul D; Frank, Rachel M; Freedman, Kevin B; Fulkerson, John P; Getgood, Alan; Gomoll, Andreas H; Grant, John A; Gursoy, Safa; Gwathmey, F W; Haddad, Fares S; Hiemstra, Laurie A; Hinckel, Betina B; Koh, Jason L; Krych, Aaron J; LaPrade, Robert F; Li, Zachary I; Logan, Catherine A; Gonzalez-Lomas, Guillem; Mannino, Brian J; Lind, Martin; Matache, Bogdan A; Matzkin, Elizabeth; McCarthy, Thomas F; Mandelbaum, Bert; Musahl, Volker; Neyret, Philippe; Nuelle, Clayton W; Oussedik, Sam; Pace, J L; Verdonk, Peter; Rodeo, Scott A; Rowan, Fiachra E; Salzler, Matthew J; Schottel, Patrick C; Shannon, Fintan J; Sheean, Andrew J; Sherman, Seth L; Strickland, Sabrina M; Tanaka, Miho J; Waterman, Brian R; Zacchilli, Michael; Zaffagnini, Stefano
AIMS/UNASSIGNED:The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach. METHODS/UNASSIGNED:A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous. RESULTS/UNASSIGNED:Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus. CONCLUSION/UNASSIGNED:The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed.
PMID: 38037678
ISSN: 2049-4408
CID: 5590442

Safety and early results of Subchondroplasty® for the treatment of bone marrow lesions in osteoarthritis: a systematic review

Nairn, Leah N; Subramaniam, Maegha; Ekhtiari, Seper; Axelrod, Daniel E; Grant, John A; Khan, Moin
PURPOSE/OBJECTIVE:Subchondroplasty® is a novel minimally invasive procedure for painful subchondral bone marrow lesions (BMLs). The aim of this systematic review was to characterize the clinical outcomes of the Subchondroplasty® procedure, a novel minimally invasive procedure for the treatment of BMLs. The hypothesis tested was that patients experience improvements in pain and functional outcomes following the Subchondroplasty® procedure. METHODS:MEDLINE, Embase, Web of Science, and Clinicaltrials.gov were searched from database inception to search date (June 10, 2020) for all clinical studies which discussed Subchondroplasty®. Two reviewers independently screened 45 unique results and 17 studies were included in the final analysis. Data were collected regarding patient demographics, indications, pain, functional scores, conversion to TKA, and complications of the procedure. RESULTS:All but one study were level IV evidence; the mean MINORS score was 9 ± 2. There were 756 patients included, 45.1% were female, and the mean age was 54 years (range 20-85). Thirteen studies investigated the effect Subchondroplasty® to the knee, while four studied the impact on the foot and ankle. Median length of follow-up was 12 months. The most common indication for Subchondroplasty® was joint pain with corresponding BML. Major contraindications to Subchondroplasty® included severe OA, joint instability, and malalignment. Mean pain score on visual analogue scale (VAS) prior to Subchondroplasty® was 7.8 ± 0.6, but decreased to 3.4 ± 0.7 postoperatively. All studies investigating functional scores reported improvement following Subchondroplasty® (IKDC 31.7 ± 1.9-54.0 ± 4.2 and KOOS 38.1 ± 0.6-70.0 ± 4.1). There were consistently high levels of patient satisfaction; 87 ± 8% of patients would be willing to undergo the procedure again. Seven cases of complications were reported, most seriously osteomyelitis and avascular necrosis. Conversion to knee arthroplasty ranged from 12.5 to 30% with length of follow-up ranging from 10 months to 7 years. CONCLUSIONS:Existing low-quality studies show Subchondroplasty® to benefit patients with BMLs through reduction in pain and improvement in function, along with a high degree of satisfaction following the procedure. The low short-to-medium term conversion rate to arthroplasty suggests that Subchondroplasty® may play a role in delaying more invasive and expensive procedures in patients with BMLs. Subchondroplasty® is a novel procedure that has promising initial findings, but requires further high-quality, comparative studies with long-term follow-up to better understand the outcomes of the procedure and impact clinical practice recommendations. LEVEL OF EVIDENCE/METHODS:Systematic Review of Level III and IV Studies, Level IV.
PMID: 32990774
ISSN: 1433-7347
CID: 5035812

Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization

Baron, Jacqueline E; Duchman, Kyle R; Hettrich, Carolyn M; Glass, Natalie A; Ortiz, Shannon F; Baumgarten, Keith M; Bishop, Julie Y; Bollier, Matthew J; Bravman, Jonathan T; Brophy, Robert H; Carpenter, James E; Cox, Charles L; Feeley, Brian T; Frank, Rachel M; Grant, John A; Jones, Grant L; Kuhn, John E; Lansdown, Drew A; Benjamin Ma, C; Marx, Robert G; McCarty, Eric C; Miller, Bruce S; Neviaser, Andres S; Seidl, Adam J; Smith, Matthew V; Wright, Rick W; Zhang, Alan L; Wolf, Brian R
BACKGROUND:Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions. HYPOTHESIS:Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed. RESULTS:< .001). CONCLUSION:Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study. REGISTRATION:NCT02075775 (ClinicalTrials.gov identifier).
PMID: 34019439
ISSN: 1552-3365
CID: 5035852

Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess PCL Insufficiency: Response [Comment]

Grant, John A; Martin, Ryan; Holliday, Charles L
PMID: 34190649
ISSN: 1552-3365
CID: 5035862

Male Sex, Western Ontario Shoulder Instability Index Score, and Sport as Predictors of Large Labral Tears of the Shoulder: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study

Cronin, Kevin J; Magnuson, Justin A; Wolf, Brian R; Hawk, Gregory S; Thompson, Katherine L; Jacobs, Cale A; Hettrich, Carolyn M; Bishop, Julie Y; Bollier, Matthew J; Baumgarten, Keith M; Bravman, Jonathan T; Brophy, Robert H; Cox, Charles L; Feeley, Brian T; Frank, Rachel M; Grant, John A; Jones, Grant L; Kuhn, John E; Ma, C Benjamin; Marx, Robert G; McCarty, Eric C; Miller, Bruce S; Neviaser, Andrew S; Seidl, Adam J; Smith, Matthew V; Wright, Rick W; Zhang, Alan L
PURPOSE:To identify factors predictive of a large labral tear at the time of shoulder instability surgery. METHODS:As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients undergoing open or arthroscopic shoulder instability surgery for a labral tear were evaluated. Patients with >270° tears were defined as having large labral tears. To build a predictive logistic regression model for large tears, the Feasible Solutions Algorithm was used to add significant interaction effects. RESULTS:After applying exclusion criteria, 1235 patients were available for analysis. There were 222 females (18.0%) and 1013 males (82.0%) in the cohort, with an average age of 24.7 years (range 12 to 66). The prevalence of large tears was 4.6% (n = 57), with the average tear size being 141.9°. Males accounted for significantly more of the large tears seen in the cohort (94.7%, P = .01). Racquet sports (P = .01), swimming (P = .02), softball (P = .05), skiing (P = .04), and golf (P = .04) were all associated with large labral tears, as was a higher Western Ontario Shoulder Instability Index (WOSI; P = .01). Age, race, history of dislocation, and injury during sport were not associated with having a larger tear. Using our predictive logistic regression model for large tears, patients with a larger body mass index (BMI) who played contact sports were also more likely to have large tears (P = .007). CONCLUSIONS:Multiple factors were identified as being associated with large labral tears at the time of surgery, including male sex, preoperative WOSI score, and participation in certain sports including racquet sports, softball, skiing, swimming, and golf. LEVEL OF EVIDENCE:I, prognostic study.
PMID: 33460709
ISSN: 1526-3231
CID: 5035832

Effect of a brief scenario-tailored educational program on parents' risk knowledge, perceptions, and decisions to administer prescribed opioids: a randomized controlled trial

Voepel-Lewis, Terri; Malviya, Shobha; Grant, John A; Dwyer, Sarah; Becher, Asif; Schwartz, Jacob H; Tait, Alan R
ABSTRACT:This randomized, controlled trial evaluated whether a brief educational program (ie, Scenario-Tailored Opioid Messaging Program [STOMP]) would improve parental opioid risk knowledge, perceptions, and analgesic efficacy; ensure safe opioid use decisions; and impact prescription opioid use after surgery. Parent-child dyads (n = 604) who were prescribed an opioid for short-term use were randomized to routine instruction (Control) or routine plus STOMP administered preoperatively. Baseline and follow-up surveys assessed parents' awareness and perceived seriousness of adverse opioid effects, and their analgesic efficacy. Parents' decisions to give an opioid in hypothetical scenarios and total opioid doses they gave to children at home were assessed at follow-up. Scenario-Tailored Opioid Messaging Program parents gained enhanced perceptions of opioid-related risks over time, whereas Controls did not; however, risk perceptions did not differ between groups except for addiction risk. Scenario-Tailored Opioid Messaging Program parents exhibited marginally greater self-efficacy compared to Controls (mean difference vs controls = 0.58 [95% confidence interval 0.08-1.09], P = 0.023). Scenario-Tailored Opioid Messaging Program parents had a 53% lower odds of giving an opioid in an excessive sedation scenario (odds ratio 0.47 [95% confidence interval 0.28-0.78], P = 0.003), but otherwise made similar scenario-based opioid decisions. Scenario-Tailored Opioid Messaging Program was not associated with total opioid doses administered at home. Instead, parents' analgesic efficacy and pain-relief preferences explained 7%, whereas child and surgical factors explained 22% of the variance in opioid doses. Scenario-tailored education enhanced parents' opioid risk knowledge, perceptions, and scenario-based decision-making. Although this may inform later situation-specific decision-making, our research did not demonstrate an impact on total opioid dosing, which was primarily driven by surgical and child-related factors.
PMCID:7886960
PMID: 33009245
ISSN: 1872-6623
CID: 5035822

Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency

Holliday, Charles L; Martin, Ryan; Grant, John A
BACKGROUND:Kneeling posterior cruciate ligament (PCL) stress radiographs are commonly used to evaluate PCL laxity. Patients, however, report significant pain, and the method's reproducibility may be challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement. Weighted gravity stress radiography may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied. HYPOTHESIS:Weighted gravity PCL stress radiographs will be more comfortable and produce similar measurements of side-to-side difference in posterior tibial displacement when compared with the kneeling technique. STUDY DESIGN:Cohort study (diagnosis); Level of evidence, 3. METHODS:tests were used to compare the side-to-side difference, pain score, and time to complete the radiographs. RESULTS:< .0001). Of the patients, 88% preferred the weighted gravity method. CONCLUSION:Weighted gravity stress radiographs produce similar side-to-side differences in posterior tibial translation compared with the kneeling stress technique, but do not rely on patient weightbearing and provide significantly better patient comfort. Clinicians should therefore consider the use of weighted gravity stress radiographs in clinical practice to minimize the pain associated with stress radiography while allowing for accurate decision making.
PMID: 33599526
ISSN: 1552-3365
CID: 5035842

Does the Symmetry of Patellar Morphology Matter When Matching Osteochondral Allografts for Osteochondral Defects Involving the Central Ridge of the Patella?

Patel, Karan; Salka, Nabeel S; Ramme, Austin; Scott, Jaron C; Grant, John A
OBJECTIVE:The purpose of this study was to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allografts to match the native patellar surface when treating osteochondral defects of the patellar apex. DESIGN/METHODS:Twenty (10 Wiberg I and 10 Wiberg II/III) human patellae were designated as the recipient. Each recipient was size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm circular osteochondral "defect" was created on the central ridge of the recipient patella. The randomly ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT (computed tomography) scanned, digitally reconstructed, registered to the initial nano-CT scan of the recipient patella, and processed to determine root mean squared circumferential step-off heights as well as surface height deviation. The process was then repeated for the other allograft plug. RESULTS:= 0.68). CONCLUSIONS:For osteochondral allograft sizes up to 16 mm there appears to be no advantage to match donor and recipient patellar morphology. Further study is warranted to evaluate defects requiring larger graft sizes.
PMID: 32819146
ISSN: 1947-6043
CID: 5035802

Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability

Lansdown, Drew A; Cvetanovich, Gregory L; Zhang, Alan L; Feeley, Brian T; Wolf, Brian R; Hettrich, Carolyn M; Baumgarten, Keith M; Bishop, Julie Y; Bollier, Matthew J; Bravman, Jonathan T; Brophy, Robert H; Cox, Charles L; Frank, Rachel M; Grant, John A; Jones, Grant L; Kuhn, John E; Marx, Robert G; McCarty, Eric C; Miller, Bruce S; Ortiz, Shannon F; Smith, Matthew V; Wright, Rick W; Ma, C Benjamin
BACKGROUND:Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear. HYPOTHESIS:We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes. STUDY DESIGN:Cross-sectional study; Level of evidence, 3. METHODS:< .05. RESULTS:= .011). CONCLUSION:Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.
PMID: 32150443
ISSN: 1552-3365
CID: 5035792