Browsing by Author "Peebles A.M."
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Item Metadata only Characteristics of High-Risk Bipolar Bone Loss Lesions Using 3-Dimensional Imaging(2024-12-01) Golijanin P.; Arner J.W.; Ryan C.B.; Zai Q.; Peebles L.A.; Peebles A.M.; Ganokroj P.; Whalen R.J.; Eble S.K.; Rider D.; Ninković S.; Provencher M.T.; Golijanin P.; Mahidol UniversityBackground: The concept of on-track versus off-track bone lesions in glenohumeral instability continues to evolve. Although much has been ascertained from an original biomechanical model, bony pathological changes, especially on 3-dimensional (3D) imaging, have not been fully evaluated. Purpose: To compare the differences in on-track versus off-track lesions to characterize glenoid and humeral head bone defects using 3D modeling software. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A consecutive cohort of 75 patients with recurrent anterior instability, with evidence of Hill-Sachs lesions (HSLs) and glenoid bone loss (GBL) and a mean age of 27.1 years (range, 18-48 years), were reviewed. 3D models of unilateral proximal humeri and glenoids were reconstructed. The volume, surface area, width, and depth of identified HSLs were quantified, along with their location (medial, superior) and orientation (Hill-Sachs angle). The percentage, width, and length of GBL as well as the glenoid track status were calculated. The on-track and off-track groups were compared using the Mann-Whitney U test. Results: The off-track group had greater HSL surface area (374.23 vs 272.64 mm2, respectively; P =.001), more HSL medialization (14.96 vs 17.62 mm, respectively; P =.028), greater HSL volume (603.08 vs 433.61 mm3, respectively; P =.007), and a greater mean HSL width (16.06 vs 11.53 mm, respectively; P =.001) than the on-track group. The off-track group also had greater GBL (22.55% vs 17.73%, respectively; P =.037), a greater GBL width (6.92 vs 3.58 mm, respectively; P <.001), and a greater GBL length (21.61 vs 16.1mm, respectively; P =.015) than the on-track group. Further analysis of large off-track lesions revealed a greater Hill-Sachs angle (33.16° vs 26.20°, respectively; P =.035) and a more superior extent of HSLs compared with borderline off-track and on-track lesions. Conclusion: Off-track lesions were found to have larger GBL, a larger HSL width, a more medialized HSL, and greater HSL surface area. This study outlines the specific characteristics of high-risk bipolar bone loss lesions to simplify the identification of patients in a clinical setting and aid in appropriate treatment planning.Item Metadata only Early versus standard return to play following ACL reconstruction: impact on volume of play and career longevity in 180 professional European soccer players: a retrospective cohort study(2025-12-01) Battaglia M.; Arner J.W.; Midtgaard K.S.; Haber D.B.; Peebles L.A.; Peebles A.M.; Ganokroj P.; Whalen R.J.; Provencher M.T.; Torre G.; Ciatti R.; Mariani P.P.; Battaglia M.; Mahidol UniversityBackground: Patients typically follow a 7–9-month return to play (RTP) protocol following anterior cruciate ligament reconstruction (ACLR); however, much of these data have been based on non-elite athletes. The purpose of this study is to understand whether professional soccer players returning to competition < 6-months following ACLR will have an increased risk of graft failure, play fewer seasons postoperatively, and have lower volume of play compared with those returning > 6 months. Materials and methods: A total of 180 male professional European soccer players were enrolled and underwent ACLR with a single surgeon between April 2008 and December 2016 and returned to sport < 6 months (early RTP group, n = 92) or > 6 months (standard RTP group, n = 88). Time from intervention to RTP (days), same season returns, total games and average minutes played in return season, seasons played after surgery, and playing status were recorded. Results: The early RTP group returned to soccer sooner (142.8 ± 21.4 days) than the standard RTP group (276.2 ± 118.9) (p < 0.01), and more players returned the same season as the injury in the early RTP group (n = 55/92, 62.5%) than the standard RTP group (n = 18/88, 20.5%) (p < 0.01). The difference in average minutes per game in the first season back was not statistically significant (early RTP, 56.7 ± 22.3 min; standard RTP 49.9 ± 29.8 min, p = 0.094). The early RTP group had significantly longer careers following ACLR (5.7 ± 2.2 seasons) than the standard RTP group (4.7 ± 2.4 seasons) (p = 0.005). The early RTP group sustained more reruptures (n = 4, 4.4%) than the standard RTP group (n = 1, 1.1%). Conclusions: Professional European soccer players returning to competition < 6 months following ACLR did not have poorer outcomes than those who returned > 6 months despite the fact that there were three more failures. However, the early RTP group players were more likely to return during the same season, had longer careers after ACLR, and played a similar number of games and minutes per game, but had more graft failures. Level of evidence: Retrospective cohort study level IV. Trial registration: Retrospectively registered according to prot. Professionisti_OSS_22.Item Metadata only Humeral Head Reconstruction With Osteochondral Allograft: Bone Plug Optimization for Hill-Sachs Lesions Using CT-Based Computer Modeling Analysis(2023-09-01) Ganokroj P.; Hollenbeck J.; Peebles A.M.; Brown J.R.; Hanson J.A.; Whalen R.J.; Golijanin P.; Provencher C.M.T.; Mahidol UniversityBackground: Engaging Hill-Sachs lesions (HSLs) pose a significant risk for failure of surgical repair of recurrent anterior shoulder instability. Reconstruction with fresh osteochondral allograft (OCA) has been proposed as a treatment for large HSLs. Purpose: To determine the optimal characteristics of talus OCA bone plugs in a computer-simulated HSL model. Study Design: Descriptive laboratory study; Level of evidence, 6 Methods: Included were 132 patients with recurrent anterior instability with visible HSLs; patients who had multidirectional instability or previous shoulder surgery were excluded. Three-dimensional computed tomography models were constructed, and a custom computer optimization algorithm was generated to maximize bone plug surface area at the most superior apex (superiorization) and minimize its position relative to the most medial margin of the HSL defect (medialization). The optimal number, diameter, medialization, and superiorization of the bone plug(s) were reported. Percentages of restored glenoid track width and conversion from off- to on-track HSLs after bone plug optimization were calculated. Results: A total of 86 patients were included in the final analysis. Off-track lesions made up 19.7% of HSLs and, of these, the mean bone plug size was 9.9 ± 1.4 mm, with 2.2 mm ± 1.7 mm of medialization and 3.3 mm ± 2.9 mm of superiorization. The optimization identified 21% of HSLs requiring 1 bone plug, 65% requiring 2 plugs, and 14% requiring 3 plugs, with a mean overall coverage of 60%. The mean width of the restored HSLs was 68%, and all off-track HSLs (n = 17) were restored to on-track. A Jenks natural-breaks analysis calculated 3 ideal bone plug diameters of 8 mm (small), 10.4 mm (medium), and 12 mm (large) in order to convert this group of HSLs to on-track. Conclusion: Using a custom computer algorithm, we have demonstrated the optimal talus OCA bone plug diameters for reconstructing HSLs to successfully restore the HSL track and, on average, 60% of the HSL surface area and 68% of the HSL width. Clinical Relevance: Reconstructing HSLs with talus OCA is a promising treatment option with excellent fit and restoration of HSLs. This study will help guide surgeons to optimize OCA bone plugs from the humeral head, femoral head, and talus for varying sizes of HSLs.Item Metadata only Qualitative and Quantitative Anatomy of the Humeral Attachment of the Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study(2022-09-01) Ganokroj P.; Midtgaard K.; Elrick B.P.; Hazra R.O.D.; Douglass B.W.; Nolte P.C.; Peebles A.M.; Fossum B.W.; Brown J.R.; Millett P.J.; Provencher M.T.; Mahidol UniversityBackground: Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment. Purpose: To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structures at risk. Study Design: Descriptive laboratory study. Methods: Eight fresh-frozen male cadavers were dissected. The relevant landmarks that were collected and measured included (1) PM footprint length at the humeral insertion (total, sternal head, and clavicular head insertions); (2) PM tendon length from the humeral insertion to the musculotendinous junction; (3) distance from the PM humeral insertion to the lateral (LPN) and medial (MPN) pectoral nerves; and (4) distance from the coracoid process to the musculocutaneous nerve (MCN) in anatomical position. Results: The total PM footprint length was 81.4 mm (95% CI, 71.4-91.3). The sternal and clavicular heads that make up the PM had footprint lengths of 42.1 mm (95% CI, 32.9-51.4) and 56.6 mm (95% CI, 46.5-66.7), respectively. The PM tendon was wider at the clavicular head (74.7 mm; 95% CI, 67.5-81.7) than the sternal head insertions (43.0 mm; 95% CI, 40.1-45.9). The distances from the PM humeral insertion to LPN and MPN were 93.2 mm (95% CI, 83.1-103.3) and 103.8 mm (95% CI, 98.3-109.4), respectively. The coracoid process to MCN distance was 68.5 mm (95% CI, 60.2-76.8). Conclusion: This study successfully quantifies anatomic dimensions of the PM tendon, its sternal and clavicular head insertions, and its location relative to nearby vital structures. Such knowledge can provide surgeons with a better understanding of the PM in relation to nearby neurovascular structures during anatomic PM repair and reconstruction to avoid debilitating complications. Clinical Relevance: Knowledge of the quantitative anatomy of the PM at the humeral footprint along structures at risk may aid surgeons with identifying the injured part of the PM and improve outcomes for anatomic repair and reconstruction.Item Metadata only Revision Anterior Cruciate Ligament, Lateral Collateral Ligament Reconstruction, and Osteochondral Allograft Transplantation for Complex Knee Instability(2022-12-01) Peebles A.M.; Ganokroj P.; Macey R.L.; Lilley B.M.; Provencher M.T.; Mahidol UniversityAnterior cruciate ligament (ACL) injuries rarely occur as an isolated event and often include associated meniscal, subchondral bone, and collateral ligament injuries. Concomitant pathology frequently complicates primary and revision ACL reconstruction and must be addressed to ensure comprehensive diagnosis and treatment. In this Technical Note, we describe our method for treatment of complex knee instability following multiple failed ACL reconstruction using a multiligament reconstruction technique with an osteochondral allograft transplantation to the lateral femoral condyle. This comprehensive repair technique restores the anatomic load bearing forces of the cruciate and collateral ligaments and promotes biological repair through incorporation of cartilage resurfacing to ultimately achieve optimal kinematics of the knee joint.Item Metadata only Revision Reverse Total Shoulder Arthroplasty for Failed Anatomic Total Shoulder Arthroplasty With Massive Irreparable Rotator Cuff Tear(2023-01-01) Ganokroj P.; Preuss F.R.; Peebles A.M.; Smith N.S.; Donovan M.; Whalen R.J.; Provencher M.T.; Mahidol UniversityAnatomic total shoulder arthroplasty (TSA) has become more common as surgical indications have expanded. However, the burden of revision shoulder arthroplasty has inevitably increased as well. Multiple studies have examined the use of reverse total shoulder arthroplasty (rTSA) as a revision option for failed anatomic TSA with a massive irreparable rotator cuff tear. Successful reconstruction of failed TSA with rTSA requires sufficient glenoid bone to place the glenoid segment, enough proximal humeral bone to allow for implantation of the humeral component, and sufficient tension in the soft-tissue envelope to ensure implant stability. In this article, we describe our preferred rTSA revision technique for the treatment of a failed TSA.Item Metadata only Superior Capsular Reconstruction for Irreparable Rotator Cuff Tear(2023-01-01) Ganokroj P.; Peebles A.M.; Vopat M.L.; Provencher M.T.; Mahidol UniversityItem Metadata only Surgical Stabilization for Recurrent Shoulder Instability Using Distal Tibial Allograft: Open Technique With Fresh Allograft Versus Arthroscopic Technique With Frozen Allograft, a Cohort Study(2026-02-01) Wong I.; Adriani M.; Remedios S.; Ganokroj P.; Dickinson N.J.; Peebles A.M.; Whalen R.J.; Eble S.K.; Arner J.W.; Jildeh T.R.; Peebles L.A.; Romeo A.A.; Provencher C.M.T.; Wong I.; Mahidol UniversityBACKGROUND: The distal tibial allograft (DTA) procedure has been described as an effective treatment option for reconstruction of glenoid bone deficiency in the setting of recurrent anterior shoulder instability; however, no comparative data between an arthroscopic or open DTA approach are available. PURPOSE: To compare the clinical and radiographic outcomes of patients who underwent open fresh versus arthroscopic frozen DTA stabilization procedures. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: A retrospective review was performed of consecutive patients with a minimum of 5% anterior glenoid bone loss (GBL) associated with recurrent anterior shoulder instability who underwent stabilization with either open fresh or arthroscopic frozen DTA glenoid reconstruction and had a minimum 2-year follow-up. Consecutive patients undergoing arthroscopic frozen DTA were matched in a 1-to-1 format to patients undergoing open fresh DTA by age, body mass index, and number of previous shoulder operations. Patients were evaluated postoperatively in terms of the Western Ontario Shoulder Instability Index (WOSI) score, pain relief, and episodes of recurrent instability. All patients also underwent postoperative imaging evaluation with computed tomography (CT) in which graft incorporation and allograft angle were measured. RESULTS: A total of 100 patients (50 open fresh DTA, 50 arthroscopic frozen DTA) with a median ± IQR age of 32.0 ± 6.7 and 27.9 ± 15.9 years, respectively, were analyzed at minimum 2-year follow-up. The open fresh DTA group had significantly more male patients than the arthroscopic frozen DTA group (98% vs 70%, respectively; P < .01), and patients in the open fresh DTA group had significantly greater GBL defects (25% ± 6% vs 21% ± 11%, respectively; P < .01). Both groups demonstrated significantly improved WOSI scores (P < .05) and had similar clinical outcomes regarding improvement postoperatively (P = .61), pain relief (P = .09), and recurrence rates (P = .31). Only 1 case of recurrent instability was noted, which occurred in the open fresh DTA cohort. Analysis of CT data at a mean of 15 months postoperatively showed no significant difference between open fresh versus arthroscopic frozen DTA groups. CONCLUSION: Open fresh and arthroscopic frozen DTA for anatomic glenoid reconstruction in patients with recurrent anterior shoulder instability resulted in a clinically stable joint with comparable outcomes and excellent healing rates. Additional long-term studies are needed to determine whether the surgical technique and type of allograft used influence clinical outcomes and whether these results are maintained over time.Item Metadata only Talar Allograft Preparation for Treatment of Reverse Hill-Sachs Defect in Recurrent Posterior Shoulder Instability(2022-09-01) Liles J.L.; Peebles A.M.; Saker C.C.; Ganokroj P.; Mologne M.S.; Provencher M.T.; Mahidol UniversityReverse Hill-Sachs lesions (rHSLs) after chronic posterior shoulder instability are important to recognize and treat appropriately. Treatment options for posterior instability with rHSL in the current literature are primarily based on percentage of humeral bone loss. In cases of moderate (25% to 50%) anterolateral humeral head bone loss, fresh osteochondral allografts are preferred. Recent literature has indicated that the talus serves as a robust grafting alternative site for the humeral head, as the talar dome shows high congruency and offers variable sizes. The purpose of this Technical Note is, therefore, to describe our technique for talus allograft preparation for the treatment of a large rHSL that highlights precise cutting anatomy, sizing options, and use of orthobiologics to ensure excellent talus union to the native humeral head surface.Item Metadata only Utility of Talus Osteochondral Allograft Augmentation for Varying Hill-Sachs Lesion Sizes: A Cadaveric Study(2023-10-01) Ganokroj P.; Garcia A.R.; Hollenbeck J.F.M.; Fossum B.W.; Peebles A.M.; Whalen R.J.; Chang P.S.; Provencher M.T.; Mahidol UniversityBackground: Humeral head reconstruction with fresh osteochondral allografts (OCA) serves as a potential treatment option for anatomic reconstruction. More specifically, talus OCA is a promising graft source because of its high congruency with a dense cartilaginous surface. Purpose: To analyze the surface geometry of the talus OCA plug augmentation for the management of shoulder instability with varying sizes of Hill-Sachs lesions (HSLs). Study Design: Controlled laboratory study. Methods: Seven fresh-frozen cadaveric shoulders were tested in this study. The humeral heads were analyzed using actual patients’ computed tomography scans. Surface laser scan analysis was performed on 7 testing states: (1) native state; (2) small HSL; (3) talus OCA augmentation for small HSL; (4) medium HSL; (5) talus OCA augmentation for medium HSL; (6) large HSL; and (7) talus OCA augmentation for large HSL. OCA plugs were harvested from the talus allograft and placed in the most medial and superior aspect of each HSL lesion. Surface congruency was calculated as the mean absolute error and the root mean squared error in the distance. A 1-way repeated-measures analysis of variance was performed to evaluate the effects of the difference in the HSL size and associated talus OCA plugs on surface congruency and the HSL surface area. Results: The surface area analysis of the humeral head with the large (1469 ± 75 mm2), medium (1391 ± 81 mm2), and small (1230 ± 54 mm2) HSLs exhibited significantly higher surface areas than the native state (1007 ± 88 mm2; P <.001 for all sizes). The native state exhibited significantly lower surface areas as compared with after talus OCA augmentation for large HSLs (1235 ± 63 mm2; P <.001) but not for small or medium HSLs. Talus OCA augmentation yielded improved surface areas and congruency after treatment in small, medium, and large HSLs (P <.001). Conclusion: Talus OCA plug augmentation restored surface area and congruency across all tested HSLs, and the surface area was best improved with the most common HSLs—small and medium. Clinical Relevance: Talus OCA plugs may provide a viable option for restoring congruity of the shoulder in patients with recurrent anterior glenohumeral instability and an HSL.