Faculty Bibliography

In January 2024, New York University Langone Orthopedic Surgery achieved a significant milestone with the first all-women team, from chief residents to interns, at Bellevue Hospital. In a field still dominated by men, only 16% of orthopaedic resident physicians and 6% of practicing orthopaedic surgeons are female, this was no small feat. Although there are many factors that made this historic team possible, it is clear that the earliest female pioneers of orthopaedic surgery were absolutely critical. This paper aims to discuss 5 pioneering women who not only created a path for the now thousands of female orthopaedic surgeons but also left a legacy of significant contributions to the practice of orthopaedics. These trailblazers are as follows: Dr. Marian Frauenthal Sloane, Dr. Ruth Jackson, Dr. Jacquelin Perry, Dr. Claudia Thomas, and Dr. Ericka Lawler.

Despite bone's robust regenerative capacity, complications such as delayed union and nonunion affect 5-10% of fractures, with significant clinical and economic burdens. The rising incidence of fractures, particularly in an aging population, highlights the importance of optimizing fracture healing strategies. This review explores current therapies aimed at enhancing bone regeneration, focusing on 2 main categories: local biologic therapies and mechanical therapies. Local biologic treatments, including concentrated bone marrow aspirate, platelet-rich plasma, bone morphogenetic proteins, and platelet-derived growth factor, aim to stimulate osteogenesis at the fracture site. Therapies, such as electrical stimulation, low-intensity pulsed ultrasound, and extracorporeal shockwave therapy, are theorized to modify the mechanical environment to promote healing. Although these therapies show promise, variability in clinical outcomes emphasizes the need for further research to standardize protocols and refine treatment strategies. Overall, advancing our understanding of bone healing mechanisms will continue to drive innovation in fracture management, improving patient outcomes and reducing health care costs.

BACKGROUND:Nordic combined (NC) and ski jumping (SJ) athletes have a high prevalence of chronic hip pathology, which may lead to altered knee and ankle biomechanics. PURPOSE/OBJECTIVE:The purpose of this study was to determine the relationship among athlete-reported lower extremity outcomes in a proximal-to-distal sequence. STUDY DESIGN/LEVEL OF EVIDENCE/UNASSIGNED:cross-sectional study, Level IV. METHODS:Elite SJ and NC athletes who competed at the national and international levels were prospectively recruited to complete a survey eliciting information about their Hip Disability and Osteoarthritis Outcome Score (HOOS), International Knee Demographic Committee (IKDC) score, and Foot and Ankle Outcome Score (FAOS). Univariate linear regressions modeling IKDC scores and FAOS subscores were performed for each of the following independent variables: age, sex, body mass index, Nordic event (NC or SJ), HOOS subscore, and FAOS subscore or IKDC score, respectively. RESULTS:A total of 22 athletes were included in the study. HOOS symptoms subscores were significantly lower (worse) among SJ athletes compared with NC athletes (P = .002). HOOS quality of life subscores were lower for female athletes compared with male athletes (54 ± 21, 73 ± 4.0; P = .029) in the entire cohort. An increase in the HOOS pain subscore (0.54 ± 0.20, P = .016) and HOOS sports subscore (0.40 ± 0.17, P = .042) was associated with a significant increase in the IKDC score. An increase in the HOOS symptoms subscore (0.63 ± 0.21, P = .011) was associated with a significant increase in the FAOS symptoms subscore. CONCLUSION/CONCLUSIONS:Elite NC and SJ athletes are at high risk of hip pain, which increases their risk of developing knee and ankle pain as well. These findings strongly suggest that training targeted at hip strength and conditioning may optimize knee and ankle outcomes in elite NC and SJ athletes. CLINICAL RELEVANCE/CONCLUSIONS:The results of this study may help guide physicians, allied health personnel, and coaches to alter lower extremity training regimens to decrease the risk of injury.

The need to perform revision anterior cruciate ligament reconstruction (ACLR) has several etiologies such as infection, arthrofibrosis, cyclops lesions, and graft failure, which should be distinguished before revision ACLR. Even the definition of graft failure varies within the literature. ACLR graft failure falls into modifiable, surgeon-controlled factors, such as tunnel position, graft choice, and alignment, and nonmodifiable factors, such as patient age, tissue quality, or secondary traumatic reruptures. In this review, we describe a facile framework for the workup of modifiable ACLR graft failure.

Since the beginning of documented medical history, amputation procedures, limb loss, and the myriad creative solutions attempted to care for these individuals have been reported. With the coalescence of multiple World Wars resulting in an ever-increasing number of individuals with limb loss and advancing medical technology, a need to innovate in this field has always been present. The complexity of the hand and upper extremity in self-care, communication, vocation, and exercise results in more demands of prostheses to mimic or replace these functions as opposed to the lower extremity, which is focused mostly on weight bearing and ambulation. As such, this need has pushed technological advances past the simpler passive or body-powered prostheses alone, now with externally powered and hybrid devices revolutionizing the way these appliances were implemented in everyday life. Despite the ever-advancing field of prosthetic technology, upper and lower extremity amputees alike still battle common challenges of pain, phantom limb sensation, and lack of prosthetic control and sensation. Targeted muscle reinnervation and regenerative peripheral nerve interface offer new surgical solutions to some of these challenges and are proving invaluable. As technology and surgical options continue to advance at an ever-rapid pace, a more thoughtful and individualized approach to the care of upper extremity limb loss is available. In this study, we review the history and evolution of upper extremity prostheses and discuss considerations in making optimal surgical and prosthetic decisions for upper extremity amputees.

The scapholunate ligament (SLL) is a critical stabilizer of the wrist joint. Disruption of the SLL leads to altered wrist kinematics, including scaphoid flexion, lunate extension, and increased stress on surrounding cartilage and ligaments, which can progress to dorsal intercalated segment instability and scapholunate advanced collapse. Despite predictable biomechanical changes, clinical outcomes vary widely because some patients develop significant functional limitations, whereas others remain asymptomatic. Nonoperative management, including immobilization, therapy, and bracing, remains the first-line treatment for partial tears or stable injuries. Surgical intervention, such as SLL repair with capsulodesis or reconstruction, is indicated for cases with persistent pain, instability, or functional deficits. Capsulodesis is a commonly used adjunct to SLL repair. Multiple surgical techniques exist for SLL repair in the acute setting and for reconstruction in the chronic setting when SLL is deemed irreparable. Although several surgical techniques are available for chronic injuries, a gold standard has not yet been established.

The knee is a complex joint composed of a combination of osseous, musculotendinous, ligamentous, neurovascular, and intra-articular structures, which must be taken into consideration when performing surgical approaches, whether it be for trauma, replacement, or joint preservation surgery. A wide variety of surgical approaches exist for exposure of the lateral side of the knee, including approaches to the distal femur, knee joint, and proximal tibia. Care must be taken to choose the appropriate approach depending on the procedure being performed to best preserve and protect important neurovascular structures. This review thoroughly describes the most frequently used surgical approaches to the lateral knee. The common themes and anatomical considerations presented in this review, in combination with continued experience, can provide surgeons with familiarity with various ways of accessing the knee joint.

INTRODUCTION/BACKGROUND:The integration of computer-assisted navigation systems (CASs) in total knee arthroplasty (TKA) procedures has gained popularity in recent years. However, additional validation of the accuracy of CAS feedback is necessary. We used short-length and full-length postoperative radiographs to quantify the differences between alignment parameters measured by a novel imageless CAS and alignment outcomes as evidenced on postoperative radiographs. MATERIALS AND METHODS/METHODS:A retrospective analysis was conducted on prospectively collected data from a cohort of patients undergoing navigated primary TKA. Fifty-eight patients had met inclusion criteria, and intraoperative CAS measurements were obtained from device recordings. Alignment parameters were measured digitally and included femorotibial angle on short-length films and hip-knee-ankle axis, mechanical lateral distal femoral angle (mLDFA), and mechanical medial proximal tibial angle (mMPTA) on full-length films. These were compared between CAS and radiograph measurements using a 2-tailed t test. RESULTS:The mean mLDFA measured by the CAS was 0.7° ± 1.1°, compared with 1.3° ± 1.4° as measured on full-body radiographs (P = .1). The mean mMPTA measured by the CAS was 0.2° ± 1.0°, compared with 0.9° ± 1.4° as measured on full-body radiographs (P = .06). On average, radiograph and CAS measurements differed by 0.5° ± 1.5° for mLDFA and 0.7° ± 1.5° for mMPTA. The average postoperative hip-knee-ankle axis was 177.6° ± 2.1°, and the average femorotibial angle was 176.0° ± 9.6° as measured on radiographs. CONCLUSION/CONCLUSIONS:No significant differences in either average or individual measured values for mLDFA or mMPTA were observed between the intraoperative CAS measurements and alignment outcomes postoperatively. Our data highlight the clinical utility of CASs to accurately achieve intended TKA alignment objectives.

BACKGROUND:The purpose was to investigate whether pain, function, satisfaction, or return to play (RTP) differs between sexes postoperatively in those undergoing medial patellofemoral ligament (MPFL) reconstruction for patellar instability. METHODS:A review of patients who underwent an MPFL reconstruction for patellar instability was performed. Kujala score, visual analogue scale (VAS), patient satisfaction, willingness to undergo surgery again, revisions, RTP, and MPFL-return to sport after injury (MPFL-RSI) score were evaluated. Clinical outcomes were compared between sexes. RESULTS:Our study included 141 knees that underwent MPFL reconstruction, and the population was 69.5% female. Postoperatively, the mean VAS score at rest was 1.0 ± 1.7 in male patients and 1.6 ± 2.1 in female patients (P = .0963). The mean Kujala score was 88.8 ± 13.3 and 83.5 ± 16.1 for male and female patients, respectively (P = .1062). Overall, there was a significant difference in RTP, with male patients returning at higher rates (58.1 vs. 33.3%, P = .0479). The mean VAS score during activity was significantly lower in male patients at 1.8 compared with female patients at 3 (P = .016). The MPFL-RSI score was also significantly worse in female patients (69.5 vs. 55.6, P = .0098). Although female patients had slightly higher rates of recurrent subjective instability (14.3 vs. 11.7%) and re-dislocation (2 vs. 0%), the difference was not statistically significant (P > .05). CONCLUSION/CONCLUSIONS:Female patients had worse clinical outcomes than male patients undergoing MPFL reconstruction for patellar instability, with significantly lower rates of RTP, VAS score during sport, and MPFL-RSI scores with a trend toward lower Kujala score and VAS score.

Genetics is a burgeoning field within adult reconstructive surgery. Genome-wide sequencing has identified genetic variants found to be associated with not only the development of osteoarthritis but also arthroplasty-related complications, such as aseptic loosening, prosthetic joint infection, arthrofibrosis, and postoperative pain. Examples include newer technology, such as next-generation sequencing, in diagnosing culture-negative prosthetic joint infection. Genetics drives new therapeutic technologies, such as gene therapy, gene-editing, and bacteriophage treatment. Although still rare, a handful of phase 3 clinical trials of gene therapy for osteoarthritis have begun to demonstrate efficacy with low-risk profiles. As the field continues to grow, public and professional buy-in as well as cost present challenges.