Browsing by Author "Sherman, Seth L."

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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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    How to salvage the delivery of a wrong-sided meniscal allograft: A rare case series
    (Elsevier, 2021) Gudeman, Andrew; Murray, Iain; Sherman, Seth L.; Farr, Jack; Orthopaedic Surgery, School of Medicine
    Introduction: Although rare, tissue processing errors have occurred during meniscal transplantation. The anatomic differences between the lateral and medial menisci makes this problematic for surgeons who find themselves with an incorrectly labeled graft. Objective: To describe the management of a wrong-sided meniscal allograft transplant (MAT) and technical pearls when converting a lateral to a medial MAT. Methods: Retrospective case series of two patients with a wrong-sided MAT. Results: Both patients were found to have a properly sized left lateral MAT for a planned right medial MAT and the decision was made to proceed with surgery. Converting the bone tunnel to bone plugs and suturing the body to bone are key technical steps to replicate the biomechanics of the medial meniscus in these circumstances. Acceptable long-term outcomes were seen in the patient with available follow-up data. Conclusion: The decision to proceed with surgery in these circumstances should be made on an individual basis considering graft, patient, and surgeon factors. Knowledge of the technique for converting a wrong-sided meniscal transplant may reduce waste of grafts and prevent patients from being exposed to additional anesthesia.
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    Risk of Severe Acute Localized Reactions for Different Intraarticular Hyaluronic Acid Knee Injections in a Real-World Setting
    (Sage, 2021) Ong, Kevin L.; Farr, Jack; Gudeman, Andrew S.; Murray, Iain R.; McIntyre, Louis F.; Hummer, Charles D.; Ngai, Wilson; Lau, Edmund; Altman, Roy D.; Sherman, Seth L.; Orthopaedic Surgery, School of Medicine
    Objective: Case reports of severe acute localized reactions (SALR) following intraarticular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA) have been described. We compared surrogate SALR measures between patients using hylan G-F 20 and specific non-hylan G-F 20 HA products. Design: Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users, matched by single or multiple injection products. Occurrences of surrogate SALR measures including inflammation/infection, intraarticular corticosteroid (CS) injections, arthrocentesis/aspiration, arthrotomy/incision and drainage, and arthroscopy were evaluated within 3 days post-HA. Results: Based on 694,404 HA injections, inflammation/infection rate was rare within 3 days of HA (up to 0.03%), with no statistical differences between hylan G-F 20 and non-hylan G-F 20 groups (matched by single or multiple injection products). The risk of knee arthrotomy/incision and drainage, arthroscopy, or arthrocentesis for hylan G-F 20 (2 mL) 3 weekly injection patients was lower than Hyalgan/Supartz and Orthovisc patients, but greater than Euflexxa patients. Overall, we found that Hylan G-F 20 (2 mL) 3 weekly injection had lower SALR rates compared to Hyalgan/Supartz and Orthovisc. However, Hylan G-F 20 (2 mL) 3 weekly injection had slightly higher rates of SALR when compared to Euflexxa. Among the single injection products, Hylan G-F 20 (6 mL) single injection had lower rates of SALR than Monovisc and Gel-One. Conclusions: This study shows no clear correlation between avian-derived or cross-linked products and SALR and provides evidence against avian-derived products or crosslinking as a source for these reactions.