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Each month, the experts at The Rothman Institute will share their diagnostic and treatment insights in 3 areas of orthopaedics: adult reconstruction (hip and knee), shoulder reconstruction, and sports medicine. This program is exclusive to the International Congress for Joint Reconstruction's website, ICJR.net.

Current Articles

Latissimus Dorsi and Teres Major Tear in a Throwing Athlete
A 23-year-old male professional baseball player presents with pain in the posterior axillary fold of the right arm following 1 specific pitch. MRI demonstrates a tear of the latissimus dorsi and possibly the teres major. What is the next step? Authors Brandon J. Erickson, MD, and Anthony A. Romeo, MD Introduction Injuries to the latissimus…
By Anthony A Romeo MD, Brandon J Erickson MD - 10 Oct 2018

Surgical Dislocation of the Hip for the Treatment of a Femoral Head Chondroblastoma
A 17-year-old, high-level female athlete has persistent groin pain that's limiting her performance. What is the best way to manage the lesion found in her femoral head? Authors Daniel Baquet, BA; Keenan Sobol, BA; and John A. Abraham, MD Introduction Chondroblastoma is a rare tumor that represents 1% to 2% of all primary bone tumors.…
By Daniel Baquet BA, Keenan Sobol BA, John A Abraham MD - 12 Sep 2018

Proximal Tibiofibular Joint Reconstruction in a Young Equestrian
A 16-year-old female patient who is a competitive equestrian presents with painful proximal tibiofibular joint instability of the left knee and numbness and paresthesia in her peroneal nerve distribution. MRI shows proximal tibiofibular ligament injury. She has failed conservative treatment – what’s the next step? Authors Yehuda E. Kerbel, MD; Nimit Patel, MD; and Sommer…
By Nimit Patel MD, Yehuda E Kerbel MD, Sommer Hammoud MD - 11 Jul 2018

Managing Extensive Femoral Bone Loss in 2-Stage Revision THA for Infection
A 57-year-old male with a history of multiple revision surgeries on his right hip presents with recurrent chronic periprosthetic joint infection. What is the best option to manage this patient at explantation and reconstruction? Authors Jessica L. Phillips, MD; Andrew Battenberg, MD; and P. Maxwell Courtney, MD Introduction Periprosthetic joint infection (PJI) is a challenging…
- 14 May 2018

MPFL Reconstruction in a Young Athlete
A 14-year-old female patient presents with left knee pain and swelling after sustaining a non-contact injury to her knee while playing soccer. MRI shows an injury to the medial patellofemoral ligament with patellar subluxation, which is treated conservatively. She returns 11 months later with a recurrent injury. What is the best option to manage this…
By Nimit Patel MD, Neel A Gupta MD, Shyam Brahmabhatt MD - 19 Apr 2018

Total Shoulder Arthroplasty with a Glenoid Augment
A 69-year-old male patient with chronic left shoulder pain had been “just trying to live with it,” but now the pain and impaired motion are interfering with his job as truck driver. Authors Cory Lebowitz, DO, and Luke S. Austin, MD Case Presentation A 69-year-old right-hand-dominant male patient who works as a truck driver presents…
By Cory Lebowitz DO, Luke S Austin MD - 21 Mar 2018

Polyethylene and Tibial Baseplate Wear in a TKA Patient with a PJI
A 61-year-old male presents with an acute periprosthetic infection of his left knee. Radiographs demonstrate severe polyethylene wear and likely tibial base plate damage. What is the best option to manage this patient? Authors Arjun Saxena, MD, and John R. Schnell, MD Case Presentation A 61-year-old male patient with rheumatoid arthritis presented to our office…
By Arjun Saxena MD, John R Schnell MD - 14 Feb 2018

A Case of Anatomic Reconstruction of an ACL Tear
A 26-year-old female patient presents with a non-contact valgus injury to her left knee, which she sustained while playing soccer. She felt a pop, with immediate pain and swelling, which have persisted. The authors diagnosed a tear of the anterior cruciate ligament, a common injury in athletes. Authors Nirav K. Patel, MD, MS, FRCS, and…
By Nirav K Patel MD MS FRCS, Christopher C Dodson MD - 08 Feb 2018

Chronic Extensor Mechanism Disruption Following Revision TKA
A 65-year old female presents with a severe extensor lag following 3 revision knee surgeries. She has also failed a direct repair of her patellar tendon and has undergone an irrigation and debridement for suspected periprosthetic joint infection. What is the best option to manage this patient? Authors Anthony J. Boniello, MD; P. Maxwell Courtney,…
By P Maxwell Courtney MD, Scott M Sporer MD, Anthony J Boniello MD - 06 Dec 2017

Arthroscopic Suprascapular Nerve Decompression and Posterior Labral Repair
A 55-year-old patient with chronic mild shoulder pain presents when she suddenly develops weakness and an inability to perform normal activities. Will an arthroscopic procedure alleviate her symptoms? Authors Mark Ghobrial, DO, and Luke S. Austin, MD Disclosures Dr. Ghobrial has no disclosures relevant to this article. Dr. Austin has disclosed that he receives research…
By Mark Ghobrial DO, Luke S Austin MD - 15 Nov 2017

Management of Recurrent Anterior Shoulder Instability with Open Bankart Labral Repair
A 20-year-old Division I college football player with recurrent anterior shoulder instability has persistent instability 2 years after arthroscopic labral repair, which involved a small bony Bankart lesion. Will open Bankart repair resolve his symptoms? Authors  William Emper, MD, and Zaira Chaudhry, MPH  Disclosures The authors have no disclosures relevant to this article.  Background The…
By William Emper MD, Zaira Chaudhry MPH - 11 Oct 2017

Development of an Abiotrophia Defectiva Infection after TKA
A 61-year-old male patient presents with sudden onset of intense knee pain 6 years after total knee arthroplasty. A positive alpha-defensin and high synovial CRP levels raise the suspicion of an acute periprosthetic joint infection. Further cultures reveal an extremely rare cause of infection in orthopaedic implants: Abiotrophia defectiva. Authors Rahul Goel, BA; Asim M.…
By Rahul Goel BA, Asim M Makhdom MD MSc FRCSC, Matthew Austin MD - 13 Sep 2017

Management of End-Stage Patellofemoral Post-Traumatic Chondromalacia with Fresh Osteochondral Allograft
A 40-year-old with a history of recurrent patellar dislocation resulting in post-traumatic patellofemoral chondromalacia has persistent anterior knee pain and swelling 2 years after patellofemoral chondroplasty and synovectomy. Will fresh osteochondral allograft transplantation offer pain relief? Authors Zaira Chaudhry, MPH, and Robert W. Frederick, MD Disclosures The authors have no disclosures relevant to this article.…
By Zaira Chaudhry MPH, Robert Frederick MD - 22 Mar 2017

Complex Femoral Reconstruction in Revision Total Knee Arthroplasty
A 74-year-old total knee arthroplasty patient presents with recurrent aseptic loosening of cemented femoral component. She has already undergone 4 attempts at revision/salvage arthroplasty using fully cemented hinged prostheses, with no success. What would be the best option for achieving durable femoral reconstruction in this patient? Authors R. Andrew Henderson, MD, MSc, and Matthew S.…
By R Andrew Henderson MD MSc, Matthew S Austin MD - 01 Feb 2017

Femoral Head-Stem Dissociation Secondary to Severe Trunnion Corrosion
An 81-year-old male patient was doing well 11 years after an uncomplicated primary THA – until he felt a “pop” in the hip accompanied by pain and an inability to bear weight. Authors Christopher Bechtel, MD, and John A. Abraham, MD Disclosures The authors have no disclosures relevant to this article. Introduction Modular femoral heads…
By Christopher Bechtel MD, John A Abraham MD - 21 Dec 2016

A Case of Terrible Triad Injury to the Elbow
A fall from a ladder sends a 65-year-old male patient to the emergency department with left elbow pain. Following closed reduction of an elbow dislocation, imaging shows an unusually large anteromedial coronoid fragment requiring surgical fixation. Authors Alexander W. Aleem, MD, and Charles L. Getz, MD Disclosures The authors have no disclosures relevant to this…
By Alexander W Aleem MD, Charles L Getz MD - 16 Nov 2016

Superior Capsular Reconstruction: An Alternative for a Recurrent Irreparable Supraspinatus Tendon Tear
A 61-year-old male patient is still in pain 6 months after surgery for a rotator cuff tear. Will a new type of procedure offer pain relief and restore the function of his left shoulder? Authors Eric Secrist, BS; Max Greenky, MD; and Sommer Hammoud, MD Disclosures The authors have no disclosures relevant to this article.…
By Eric Secrist BS, Sommer Hammoud MD, Max Greenky MD - 18 Oct 2016

Simultaneous Bilateral Extensor Mechanism Reconstruction for Acute Patellar Tendon Rupture
Following a fall at home, a 46-year-old male with alkaptonuria and a history of bilateral total knee arthroplasty presents with bilateral knee pain and an inability to actively extend either knee. The surgical plan calls for primary patellar tendon and retinacular repair and reconstruction of the bilateral extensor mechanisms. Authors James Fraser, MD, MPH, and…
By James Fraser MD MPH, Gregory K Deirmengian MD - 14 Sep 2016

Arthroscopic Transosseus Tunnel Repair for a Large Rotator Cuff Tear
A 64-year-old male patient who had previously been treated for a partial rotator cuff tear presents with significant anterior shoulder pain in the same shoulder. When an acute retracted large rotator cuff tear is diagnosed, decisions need to be made about non-operative versus operative treatment. Authors John G. Horneff, MD, and Joseph A. Abboud, MD…
By John G Horneff MD, Joseph A Abboud MD - 17 Aug 2016

Jumper’s Knee: When Conservative Treatment Fails
A college basketball player presents with a more than 1-year history of pain and disability in his knee. He was pain-free after a 6-week course of non-operative treatment – but then he began playing basketball again and the pain returned. Should surgery be the next step? Author Christopher M. Aland, MD Disclosures The author has…
By Christopher M Aland MD - 13 Jul 2016

Rapidly Progressive Osteoarthritis of the Hip
The authors describe a uniquely aggressive case of rapidly destructive osteoarthritis of the left hip in a 91-year-old female patient. An infectious etiology was suspected but ultimately ruled out. Authors Andrew Fleischman, MD, and Antonia F. Chen, MD, MBA Disclosures The authors have no disclosures relevant to this article. Background Rapidly destructive osteoarthritis (RDOA) is…
By Andrew Fleischman MD, Antonia F Chen MD MBA - 13 Jun 2016

A Case of Severe Systemic Cobalt Toxicity in THA
A 61-year-old female patient presents with worsening groin pain and symptoms suggesting cobalt toxicity – including vision and hearing loss – following revision of a fractured ceramic-on-ceramic bearing surface to a cobalt-chrome-on-polyethylene bearing surface. Authors Michael Feldstein MD, MS; Max Greenky MD; Lindsay McAlpine; and Matthew S. Austin, MD Disclosures The authors have no disclosures…
By Lindsay McAlpine, Max Greenky MD, Michael Feldstein MD MS, Matthew S Austin MD - 23 Mar 2016

RSA for Locked Anterior Shoulder Dislocation
A 56-year-old female patient with a prior left humeral shaft fracture presents with pain and dysfunction following a fall on the same shoulder. Will a reverse shoulder arthroplasty provide pain relief and restore range of motion? Authors Bradley Schoch, MD, and Surena Namdari, MD Disclosures Dr. Schoch has no disclosures relevant to this article. Dr.…
By Bradley Schoch, Surena Namdari - 10 Feb 2016

ACI for Articular Cartilage Injury in the Knee
A 25-year-old male who had previously played college football is diagnosed with full-thickness articular cartilage defect of the medial femoral condyle and trochlea. Would he benefit from an autologous chondrocyte implantation procedure? Authors Patrick Kane, MD, and Kevin B Freedman, MD, MSCE Disclosures The authors have no disclosures relevant to this article. Background Injury to…
- 11 Jan 2016

Revision THA for Osteolysis after Failed SCFE Pinning and Primary THA
The authors describe a complex case of a young patient in need of revision total hip after a primary total hip for SCFE. Authors Laura Matsen Ko, MD; Julie Shaner, MD; and Javad Parvizi, MD, FRCS Disclosures The authors have no disclosures relevant to this article. Background Slipped capital femoral epiphysis (SCFE) is a hip…
- 16 Dec 2015

ORIF with Intramedullary Nail for a Proximal Humerus Fracture
When a 66-year-old woman presents with a displaced 2-part proximal humerus fracture, the authors weigh the advantages and disadvantages of closed versus open reduction. Authors Justin Wong, MD, and Luke S. Austin, MD Disclosures Dr. Wong has no disclosures relevant to this article. Dr. Austin has disclosed that he is a consultant for Tornier. Case…
- 11 Nov 2015

Treating Patellofemoral Instability with Bony and Soft Tissue Procedures
A high school athlete presents with left knee patella dislocation, her first dislocation after 8 incidents of subluxation of the patella in a 1-year period. Author Bradford S. Tucker, MD Disclosures Dr. Tucker has disclosed that he is a consultant for Mitek and the owner of Johnson & Johnson stock. Background Multiple factors contribute to…
- 20 Oct 2015

Arthroscopic Repair of a Full-Thickness Rotator Cuff Tear
A middle-aged male presents with persistent shoulder pain after lifting heavy boxes. MRI reveals a full-thickness supraspinatus rotator cuff tear. Authors Daniel Huttman, MD, and Mark Lazarus, MD Disclosures The authors have no disclosures relevant to this article. Case Presentation A 49-year-old male presented with a chief complaint of right shoulder pain. He had injured…
- 16 Sep 2015

Hip Preservation vs. THA for Legg-Calve-Perthes Disease
A 22 year-old woman with history of left hip Legg-Calvé-Perthes disease treated with a femoral osteotomy during childhood presents with severe groin pain that is compromising her quality of life. Should she undergo a hip preservation procedure, or would total hip arthroplasty be the better option? Authors Claudio Diaz-Ledezma, MD, and Javad Parvizi, MD FRCS…
- 12 Aug 2015

Fracture of a Ceramic-on-Ceramic Total Hip Implant
When a 62-year-old male presents with severe squeaking 3 years after a THA with a ceramic-on-ceramic implant, the authors discover that the implant has fractured and a revision procedure is necessary. Authors Antonia F. Chen, MD, MBA, and Javad Parvizi, MD, FRCS Disclosures The authors have no disclosures relevant to this article. Background Ceramic-on-ceramic (CoC)…
- 15 Jul 2015

A Case of Multidirectional Instability of the Shoulder
When physical therapy fails to resolve a 23-year-old female patient's chronic multidirectional shoulder instability, she agrees to undergo an arthroscopic capsulorraphy. Author William Emper, MD Disclosures Dr. Emper has no disclosures relevant to this article. Background Multidirectional instability (MDI) of the shoulder is a condition that is characterized by instability in more than one direction.…
- 12 Jun 2015

Recurrent Knee Contracture after Total Knee Arthroplasty
A 66-year-old female presents with severe flexion contracture following posterior-stabilized TKA at another facility. Physical therapy and MUA have been unsuccessful in restoring ROM. A complicated revision procedure is the next option. Authors Peter Pyrko, MD, PhD; Antonia F. Chen, MD, MBA; and Matthew S. Austin, MD Disclosures The authors have no disclosures relevant to…
- 10 Jun 2015

An Anterior-based Muscle-sparing Approach to THA
Although multiple names have been used to describe the ABMSparing approach described in this study, it is inaccurate to characterize this approach as either anterolateral (ALMI) or modified Watson-Jones, both of which involve detachment of the abductors. The senior author has performed more than 2,000 consecutive primary THA procedures utilizing the AMBSparing approach over the…
- 20 May 2015

A Case of Ulnar Collateral Ligament Instability of the Elbow
A 21-year-old elite collegiate baseball player presents with a 6-month history of mild right medial elbow pain. When non-operative treatment fails, the author recommends right elbow UCL reconstruction. Author Michael G. Ciccotti, MD Disclosures The author has no disclosures relevant to this article. Background Injury to the ulnar collateral ligament (UCL) of the elbow was…
- 14 May 2015

Acute Avulsion of the Medial Meniscus Posterior Root Attachment
A young, active male presents with knee pain and swelling after rolling his ankle a week earlier. When an MRI reveals a meniscus tear, the author recommends arthroscopy and medial meniscus root repair. Author Sommer Hammoud, MD Disclosures The author has no disclosures relevant to this article. Background Meniscal root tears (MRTs) disrupt the collagen…
- 16 Apr 2015

Total Elbow Arthroplasty for Rheumatoid Arthritis
A 77-year-old female presents with long-standing right elbow pain caused by rheumatoid arthritis. She has taken disease-modifying anti-rheumatic drugs and has had a corticosteroid injection without relief. The authors recommend total elbow arthroplasty to get her back to the gardening she loves. Authors Brian Lee, MD, and Matthew L. Ramsey, MD Disclosures Brian Lee, MD,…
By Matthew L Ramsey MD, Brian Lee MD - 11 Mar 2015

Staged Patellofemoral Arthroplasty for Bilateral Knee Pain
A 74-year-old woman presents with bilateral anterior knee pain. She has significant pain when going up or down stairs, kneeling, squatting, and standing from a seated position. Because non-operative treatment has failed to provide relief, the authors recommend patellofemoral arthroplasty. Authors Julie Shaner, MD, and Jess H. Lonner, MD Disclosures Julie Shaner, MD, has no…
By Jess H Lonner MD, Julie Shaner MD - 09 Mar 2015

Hip Arthroscopy for a Labral Tear with FAI
A 21-year-old collegiate hockey player presents with a 2-year history of right hip and groin pain that has increased in frequency and intensity. When an MRI arthrogram reveals a labral tear with mixed CAM and pincer FAI, the author recommends hip arthroscopy to address the issue. Author John P. Salvo, Jr. MD Disclosures The author…
By John P Salvo - 09 Feb 2015

Using the Direct Anterior Approach for THA
A 65-year-old female presents with severe pain in the right groin area that worsens with activity. When she's diagnosed with advanced degenerative joint disease of the right hip, the authors recommend a total hip arthroplasty, and they deem her a good candidate for the procedure through the direct anterior approach. Authors Victor H Hernandez, MD,…
- 16 Jan 2015

Arthroscopic Repair of a Suspected Type II SLAP Tear
A 16-year-old high school athlete who plays football and baseball presents with pain while throwing but no specific history of injury. Six months of physical therapy has provided no relief. When an MRI arthrogram reveals a superior labral tear, the patient agrees to shoulder arthroscopy with labral repair. Author Christopher M. Aland, MD Disclosures Dr.…
By Christopher M Aland MD - 12 Jan 2015

Arthroscopic Latarjet Procedure for Shoulder Instability
A 24-year-old hockey player had undergone a Bankart repair due to recurrent instability of his left shoulder. After a fall, he’s now dislocating at rest, with significant subjective instability of the shoulder. What can be done to stabilize the joint? Authors Eric M. Black, MD; George S. Athwal, MD, FRCSC; and Charles Getz, MD Disclosures…
By George S Athwal MD FRCSC, Eric M Black MD, Charles Getz MD - 08 Dec 2014

Managing Osteochondritis Dessicans of the Capitellum
A young gymnast presents with 16-month history of recurrent left elbow pain, swelling, and occasional locking and catching. Conservative treatment has failed to provide relief. Is surgery the best treatment option at this point? Authors Edward S. Chang, MD, and Christopher C. Dodson, MD Disclosures The authors have no disclosures relevant to this article. Background…
By Edward S Chang MD, Christopher C Dodson MD - 08 Dec 2014

Distal Femoral Replacement with a Metaphyseal Sleeve
A 63-year-old morbidly obese male has had 11 previous knee surgeries, including a total knee arthroplasty and multiple revisions. He now has severe, intolerable pain in his leg following a distal femoral replacement. When another revision procedure fails to relieve the pain, what options are left? Authors Laura Matsen Ko, MD, and Matthew S. Austin,…
- 08 Dec 2014

A Case of Anterior Shoulder Instability with Labral Tear
When a 17-year-old patient is diagnosed with recurrent posterior subluxation, posterior shoulder instability, and labral tear without significant capsular laxity, the author recommends arthroscopic repair. Author Steven B. Cohen, MD Disclosures The author has no disclosures relevant to this article. Background Anterior instability of the shoulder is commonly associated with the young, active patient. A…
By Steven B Cohen - 10 Nov 2014

Mini-open FAO to Manage FAI with Bilateral Calcified Labrum
A 32-year-old female presents with a history of bilateral groin and greater trochanteric pain. Conservative treatment has failed to provide relief. When she is diagnosed with bilateral pincer femoroacetabular impingement, the authors discuss the pros and cons of various surgical options with her. Authors Pouya Alijanipour, MD, and Javad Parvizi, MD, FRCS Disclosures The authors…
- 10 Nov 2014

A New Option for Irreparable Rotator Cuff Tears
After a fall at work, a 51-year-old male can no longer perform his job functions, which include lifting heavy loads. He’s diagnosed with a massive rotator cuff tear, but when the surgical repair fails, what options are available? The authors offer him a lower trapezius tendon transfer with Achilles allograft reconstruction. Authors Brian Lee, MD,…
- 10 Nov 2014

Biceps Tenodesis for Biceps Tendonitis and Rotator Cuff Tear
A 55-year-old male patient presents with increasing right shoulder pain and mild weakness when performing overhead activities and lifting heavy objects. When pathology of the long head of the biceps is diagnosed, the authors propose subpectoral biceps tenodesis, the surgical technique for which is outlined in this article. Authors Patrick Kane, MD, and Kevin B.…
By Patrick Kane, Kevin B Freedman - 13 Oct 2014

Arthroscopic Repair of the Rotator Cuff and Subscapularis
A 65-year-old woman presents with a 2-month history of increased anterior/lateral right shoulder pain without trauma. She had previously been treated non-operatively for a small rotator cuff tear - which appears to have have progressed. Authors Justin C. Wong, MD, and Joseph A. Abboud, MD Disclosures The authors have no disclosures relevant to this article.…
- 13 Oct 2014

Cementless TKA as an Option for a Younger, Active Patient
A 52-year-old healthy male presents with severe, intolerable left knee pain that has failed to respond to conservative treatment. Radiographs show severe advanced osteoarthritis in both knees. The authors recommend total knee arthroplasty, offering him the option of cemented or cementless fixation. Authors Victor H Hernandez MD, MSc, and Fabio Orozco MD Disclosures The authors…
- 13 Oct 2014

Femoral Component Revision through a DAA THA
The authors describe a unique case of a total hip arthroplasty patient with failure at the modular head neck junction due to trunnion wear that was revised through a direct anterior approach. Authors Snir Heller MD, and William J. Hozack MD Disclosures The authors have no disclosures relevant to this article. Case Presentation A 61-year-old…
By Snir Heller MD, William J Hozack MD - 08 Sep 2014

External Fixation for a Proximal Humerus Fracture
An older patient with serious medical comorbidities cannot undergo surgery to repair a 2-part proximal humerus fracture. The authors chose closed reduction with external fixation as a safer alternative. Authors Daniel Davis, MD, and Luke Austin, MD Disclosures Dr. Davis has no disclosures relevant to this article. Dr. Austin has disclosed that he is a…
- 08 Sep 2014

Posterior Shoulder Instability with Labral Tear
A 19-year-old college student who plays basketball and baseball presents with a history of left shoulder pain, restricted range of motion and occasional numbness. Conservative treatment provides only temporary relief. When he's diagnosed with posterior glenohumeral instability, shoulder arthroscopy is recommended. Author Fotios Paul Tjoumakaris, MD Disclosures The author has disclosures relevant to this article.…
- 08 Sep 2014