Browsing by Author "Hinckel, Betina B."

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    Algorithm for Treatment of Focal Cartilage Defects of the Knee: Classic and New Procedures
    (Sage, 2021) Hinckel, Betina B.; Thomas, Dimitri; Vellios, Evan E.; Hancock, Kyle John; Calcei, Jacob G.; Sherman, Seth L.; Eliasberg, Claire D.; Fernandes, Tiago L.; Farr, Jack; Latterman, Christian; Gomoll, Andreas H.; Orthopaedic Surgery, School of Medicine
    Objective: To create a treatment algorithm for focal grade 3 or 4 cartilage defects of the knee using both classic and novel cartilage restoration techniques. Design: A comprehensive review of the literature was performed highlighting classic as well as novel cartilage restoration techniques supported by clinical and/or basic science research and currently being employed by orthopedic surgeons. Results: There is a high level of evidence to support the treatment of small to medium size lesions (<2-4 cm2) without subchondral bone involvement with traditional techniques such as marrow stimulation, osteochondral autograft transplant (OAT), or osteochondral allograft transplant (OCA). Newer techniques such as autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate implantation have also been shown to be effective in select studies. If subchondral bone loss is present OAT or OCA should be performed. For large lesions (>4 cm2), OCA or matrix autologous chondrocyte implantation (MACI) may be performed. OCA is preferred over MACI in the setting of subchondral bone involvement while cell-based modalities such as MACI or particulated juvenile allograft cartilage are preferred in the patellofemoral joint. Conclusions: Numerous techniques exist for the orthopedic surgeon treating focal cartilage defects of the knee. Treatment strategies should be based on lesion size, lesion location, subchondral bone involvement, and the level of evidence supporting each technique in the literature.
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    Evidence-based Risk Stratification for Sport Medicine Procedures During the COVID-19 Pandemic
    (Wolters Kluwer, 2020-10) Hinckel, Betina B.; Baumann, Charles A.; Ejnisman, Leandro; Cavinatto, Leonardo M.; Martusiewicz, Alexander; Tanaka, Miho J.; Tompkins, Marc; Marc, Seth L.; Chahla, Jorge A.; Frank, Rachel; Yamamoto, Guilherme L.; Bicos, James; Arendt, Liza; Fithian, Donald; Farr, Jack; Orthopaedic Surgery, School of Medicine
    Orthopaedic practices have been markedly affected by the emergence of the COVID-19 pandemic. Despite the ban on elective procedures, it is impossible to define the medical urgency of a case solely on whether a case is on an elective surgery schedule. Orthopaedic surgical procedures should consider COVID-19-associated risks and an assimilation of all available disease dependent, disease independent, and logistical information that is tailored to each patient, institution, and region. Using an evidence-based risk stratification of clinical urgency, we provide a framework for prioritization of orthopaedic sport medicine procedures that encompasses such factors. This can be used to facilitate the risk-benefit assessment of the timing and setting of a procedure during the COVID-19 pandemic.