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Item Improved Tissue Repair in Articular Cartilage Defects in Vivo by rAAV-Mediated Overexpression of Human Fibroblast Growth Factor 2(Elsevier, 2005-08-01) Cucchiarini, Magali; Madry, Henning; Ma, Chunyan; Thurn, Tanja; Zurakowski, David; Menger, Michael D.; Kohn, Dieter; Trippel, Stephen B.; Terwilliger, Ernest F.; Orthopaedic Surgery, School of MedicineTherapeutic gene transfer into articular cartilage is a potential means to stimulate reparative activities in tissue lesions. We previously demonstrated that direct application of recombinant adeno-associated virus (rAAV) vectors to articular chondrocytes in their native matrix in situ as well as sites of tissue damage allowed for efficient and sustained reporter gene expression. Here we test the hypothesis that rAAV-mediated overexpression of fibroblast growth factor 2 (FGF-2), one candidate for enhancing the repair of cartilage lesions, would lead to the production of a biologically active factor that would facilitate the healing of articular cartilage defects. In vitro, FGF-2 production from an rAAV-delivered transgene was sufficient to stimulate chondrocyte proliferation over a prolonged period of time. In vivo, application of the therapeutic vector significantly improved the overall repair, filling, architecture, and cell morphology of osteochondral defects in rabbit knee joints. Differences in matrix synthesis were also observed, although not to the point of statistical significance. This process may further benefit from cosupplementation with other factors. These results provide a basis for rAAV application to sites of articular cartilage damage to deliver agents that promote tissue repair.Item Indiana Orthopaedic Journal, Volume 1(Indiana University School of Medicine Department of Orthopaedic Surgery, 2007) Feinberg, Judy R.; Roberts, Donna L.Inaugural edition (volume 1) of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.Item Indiana Orthopaedic Journal, Volume 2(Indiana University School of Medicine Department of Orthopaedic Surgery, 2008) Feinberg, Judy R.; Roberts, Donna L.Volume 2 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.Item Indiana Orthopaedic Journal, Volume 3(Indiana University School of Medicine Department of Orthopaedic Surgery, 2009) Feinberg, Judy R.; Roberts, Donna L.Volume 3 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.Item Indiana Orthopaedic Journal, Volume 4(Indiana University School of Medicine Department of Orthopaedic Surgery, 2010) Feinberg, Judy R.; Roberts, Donna L.Volume 4 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.Item Lumbar extraforaminal decompression: A technical note and retrospective study looking at potential complications as an outpatient procedure(Elsevier, 2011) Miller, Justin W.; Sasso, Rick C.; Department of Orthopaedic Surgery, IU School of MedicineBACKGROUND: Lumbar disc herniation and stenosis that results in compression of a nerve root lateral to the foramen is defined as extraforaminal. In recent years the recognition of such pathology has increased with technology and greater awareness. Various approaches and techniques have been developed for extraforaminal decompression in the lumbar region. The purpose of this study was two fold: 1) Determine the safety of treating patients operatively via a paramedian muscle splitting approach on an outpatient basis, and 2) Highlight the technical aspects of the approach to the extraforaminal region. METHODS: One hundred consecutive extraforaminal decompressions were performed from 1992 to 2007 by a single surgeon. A retrospective review was performed consisting of chart reviews. Summary statistics and the Pierson Chi-square test were used to analyze the data. The primary outcome measure was the need for hospital admission or readmission following surgical decompression. RESULTS: Seven of 100 patients (7%) were required to remain in the hospital for twenty-three hour observation due to Medicare requirements. Five (5%) of the patients originally scheduled for an outpatient procedure were converted to inpatient status due to postoperative pain. All were released within 2 days (average 1.25 days). Only one (1%) patient was readmitted for urinary retention that resolved without incident. There was no significant difference (P = 0.137) in complication rate between our control and those that underwent extraforaminal decompression. CONCLUSIONS: Extraforaminal lumbar decompression as an outpatient procedure can be done safely without the need for hospital admission.Item A comparison of the shock-absorbing properties of cervical disc prosthesis bearing materials(Elsevier, 2011) Dahl, Michael C.; Jacobsen, Stephen; Metcalf, Newton; Sasso, Rick; Ching, Randal P.; Department of Orthopaedic Surgery, IU School of MedicineBACKGROUND DATA: Cervical arthroplasty offers theoretical advantages over traditional spinal fusion, including elimination of adjacent segment disease and elimination of the risk of pseudoarthrosis formation. Initial studies of cervical arthroplasty have shown promising results, however, the ideal design characteristics for disc replacement constructs have not been determined. The current study seeks to quantify the differences in the shock absorption characteristics of three commonly used materials in cervical disc arthroplasty. METHODS: Three different nucleus materials, polyurethane (PU), polyethylene (PE) and a titanium-alloy (Ti) were tested in a humidity- and temperature-controlled chamber. Ten of each nucleus type underwent three separate mechanical testing protocols to measure 1) dynamic stiffness, 2) quasi-static stiffness, 3) energy absorption, and 4) energy dissipation. The results were compared using analysis of variance. RESULTS: PU had the lowest mean dynamic stiffness (435 ± 13 N/mm, P < .0001) and highest energy absorption (19.4 ± 0.1 N/mm, P < .0001) of all three nucleus materials tested. PU was found to have significantly higher energy dissipation (viscous damping ratio 0.017 ± 0,001, P < .0001) than the PE or TI nuclei. PU had the lowest quasi-static stiffness (598 ± 23 N/mm, P < .0001) of the nucleus materials tested. A biphasic response curve was observed for all of the PU nuclei tests. CONCLUSIONS: Polyurethane absorbs and dissipates more energy and is less stiff than either polyethylene or titanium. LEVEL OF EVIDENCE: Basic Science/Biomechanical Study. CLINICAL RELEVANCE: This study characterizes important differences in biomechanical properties of materials that are currently being used for different cervical disc prostheses.Item Evaluation of Joint Space Width and Narrowing After Isolated Partial Medial Meniscectomy for Degenerative Medial Meniscus Tears(SAGE Publications, 2013-10) Shelbourne, K. Donald; Barnes, Adam F.; Urch, Scott E.; Gray, Tinker; Department of Orthopaedic Surgery, IU School of MedicineBACKGROUND: Few studies have evaluated the effect of existing articular cartilage damage and sex on joint space measurements after isolated degenerative medial meniscus tears. PURPOSE: To determine what factors affected joint space width and narrowing in patients after removal of isolated degenerative medial meniscus tears. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A total of 62 patients (15 women and 47 men) with all ligaments intact, no previous surgery to either knee, and an isolated degenerative medial meniscus tear removed in 1 knee were examined. The mean age at examination was 58.2 years at a mean follow-up of 9.4 years (range, 4-20 years). Subjective results were obtained with the International Knee Documentation Committee (IKDC) knee survey. Radiographs were taken using 45° weightbearing posteroanterior views. Midpoint and perceived minimum joint space width of the medial and lateral compartments of both knees were measured to the nearest 0.1 mm by 2 observers at different times, and they were blinded as to the previous measurements (Pearson intra- and interclass correlations, >0.93). Joint space narrowing was found by calculating the difference in joint space width between knees. Percentage of normal joint space loss was calculated by dividing joint space narrowing by the joint space width in the contralateral knee. Other factors considered were patient sex and Outerbridge grading of articular cartilage. RESULTS: Women had a mean 1.5 mm less normal joint space width than men in the involved and noninvolved knees (P < .01). Mean joint space narrowing was 0.7 mm for both measurements. The mean ± standard deviation narrowing was 0.4 ± 1.2 mm for patients with grade 0-2 damage and 1.1 ± 1.3 for patients with grade 3-4 damage (P = .04). Five women (33%) and 3 men (6%) had narrowing of >50% of the normal joint space as measured in the noninjured knee (P = .016). The mean IKDC total score was 66.1 points for women, which was statistically significantly lower than the mean of 82.7 points for men (P < .01). CONCLUSION: Patients undergoing partial medial meniscectomy have greater joint space narrowing and lower subjective scores after surgery if they also have existing Outerbridge grade 3-4 damage. Women have less normal joint space than men, and more women than men experience >50% joint space narrowing after surgery.Item Generation of the first Autosomal Dominant Osteopetrosis Type II (ADO2) disease models(Elsevier B.V., 2014-02) Alam, Imranul; Gray, Amie K.; Chu, Kang; Ichikawa, Shoji; Mohammad, Khalid S.; Capannolo, Marta; Capulli, Mattia; Maurizi, Antonio; Muraca, Maurizio; Teti, Anna; Econs, Michael J.; Del Fattore, Andrea; Department of Orthopaedic Surgery, IU School of MedicineAutosomal Dominant Osteopetrosis Type II (ADO2) is a heritable osteosclerotic disorder dependent on osteoclast impairment. In most patients it results from heterozygous missense mutations in the chloride channel 7 (CLCN7) gene, encoding for a 2Cl−/1H+ antiporter. By a knock-in strategy inserting a missense mutation in the Clcn7 gene, our two research groups independently generated mouse models of ADO2 on different genetic backgrounds carrying the homolog of the most frequent heterozygous mutation (p.G213R) in the Clcn7 gene found in humans. Our results demonstrate that the heterozygous model holds true presenting with higher bone mass, increased numbers of poorly resorbing osteoclasts and a lethal phenotype in the homozygous state. Considerable variability is observed in the heterozygous mice according with the mouse background, suggesting that modifier genes could influence the penetrance of the disease gene.Item High Survivorship With a Titanium-encased Alumina Ceramic Bearing for Total Hip Arthroplasty(Springer US, 2014-02) D’Antonio, James A.; Capello, William N.; Naughton, Marybeth; Department of Orthopaedic Surgery, IU School of MedicineBackground Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern. Questions/purposes Our primary objective of this report was to determine overall survivorship of a titanium- encased ceramic-on-ceramic bearing couple. Our secondary objectives were to evaluate for ceramic fracture, insertional chips, osteolysis, and device squeaking. Methods Six surgeons at six institutions implanted 194 patients (209 hips) with an average age of 52 years with cementless hips and alumina ceramic bearings. One hun- dred thirty-seven patients (146 hips) have 10-year followup (70%). We determined Kaplan-Meier survivorship of the bearing surface and implant system and collected radio- graphic and clinical data to evaluate for osteolysis and squeaking. Results Survivorship using revision for any reason as the end point was 97% at 10 years and survivorship end point bearing surface failure or aseptic loosening of 99%. There was one ceramic insert fracture (0.5%), there were no insertional chips, there was no visible osteolysis on AP and lateral radiographs, and there was a 1% patient- self-reported incidence of squeaking at the last clinical followup. Six hips underwent revision (3.7%). Conclusions Ceramic bearings for THA with a titanium- encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. Level of Evidence Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.