Injuries to the posterolateral corner of the knee are rare
but significant injuries that occur most commonly in the
context of a multiligamentous knee injury. The structures
of the posterolateral corner serve as a primary restraint to
varus and external rotation and as a secondary restraint
to posterior translation. Contemporary reconstructive
techniques focus on anatomic restoration of function of the
posterolateral corner and excellent long-term results have
been demonstrated.
The Hip-Spine Relationship Simplified
Nima Eftekhary, MD, Jessica Morton, MD, Ameer Elbuluk, MD, Ran Schwarzkopf, MD, MSc,
Aaron Buckland, MBBS, FRACS, and Jonathan Vigdorchik, MD
Much attention has recently been focused on the relationship
between the hip and spine and its contribution to postoperative
instability following total hip arthroplasty. However, the
terminology can be confusing. Through an understanding
of spinopelvic parameters, spinopelvic motion, and the
interplay between the spine and pelvis, the surgeon can
plan for and decrease the risk of instability after total hip
arthroplasty. This review details spinopelvic parameters that
predispose to instability and guides readers in understanding
spinopelvic motion as it relates to THA instability.
Robotic Spine Surgery Where Did We Come From, And Where Are We Headed?
John A. Buza, III, MD, MS, and Jeffrey A. Goldstein, MD
Robotic spine surgery has a number of potential advantages,
including more precise preoperative planning, a high degree
of accuracy in pedicle screw placement, and significantly
reduced radiation exposure to the surgical team. Despite the
potential advantages, many surgeons feel that it is still too
early for the widespread adoption of this technology, citing
increased cost, increased operating room time, and lack
of necessity. Most spine surgeons will agree, however, that
robotic technology is still in its infancy and that there will
be a significant role for this technology in the future. Amidst
this debate, it is important to understand the evolution of
this technology from its initial inception to the present day,
with a critical appraisal of the technology in its current
form. It is important to consider the probable next steps in
the development of this technology so that we may develop
and shape this technology to most benefit our patients. This
article reviews the history and development of robotic technology
in spine surgery, critically assesses the technology in
its current form, and explores the future directions.
Applying Systems Engineering to Increase Operating Room Efficiency
Austin J. Ramme, MD, PhD, Lorraine H. Hutzler, MPA, Robert J. Cerfolio, MD, MBA, and
Joseph A. Bosco, MD
Systems engineering is an interdisciplinary approach to
creating, evaluating, and managing a complex process in
order to increase reliability, cost-effectiveness, and quality.
The operating room is a complex environment that requires
human-human interaction, human-device interaction, planning,
and coordination of scarce resources for the purpose
of providing surgery to patients in a safe and efficient manner.
The operating room is an important revenue generator,
but it can also be responsible for unsustainable costs if not
managed effectively. Reducing costs and increasing the efficiency
of surgical cases is important for generating health
care value. Efficiency efforts that aim for standardization
of surgical protocols must be balanced by flexibility in the
unpredictable operating room environment. This paper
reviews systems engineering efforts to improve efficiency
in the operating room including operating room scheduling,
personnel factors, resource management, orthopedicspecific
initiatives, and future innovations.
Review of Craniocervical Sagittal Alignment
Shaleen Vira, MD, Nisha Reddy, BA, Themistocles Protopsaltis, MD, and Peter G. Passias, MD
Cervical alignment plays a critical role in the diagnosis and
treatment of spinal pathology. There has been a proliferation
of novel radiographic parameters to quantify cranial
and cervical alignment. These parameters have been placed
in clinical context by their correlation with health-related
quality of life (HRQOL) scores. This article reviews these
parameters and describes their utility in understanding
spinal deformity and other pathologies of the cervical spine.
The Military Medical System and Wartime Injuries to the Spine
War has historically been a major catalyst for advancement
in military medical care and medicine in general.
In our current conflicts, advances in battlefield medicine,
evacuation techniques, and personal protective equipment
have improved survival rates among members of the armed
services. With increased survival, there has been increased
prevalence of serious but nonfatal injuries, particularly from
blunt and penetrating trauma. Blast injuries are the major
cause of trauma and have both blunt and penetrating components.
With respect to the spine, blasts have led to open,
contaminated wounds that are complex and difficult to treat.
Additionally, blasts have led to an increased incidence of
lower lumbar burst fractures and lumbosacral dissociation.
As these and other injuries are being seen more commonly
during war, we must ensure that our military medical system
is adapting to ensure we are taking care of our military
personnel at the highest level.
Anterior Cruciate Ligament Ruptures in the Skeletally Immature Current State of the Art
Anterior cruciate ligament (ACL) injuries in children and
adolescents are increasing every year. This patient population
has unique risk factors and treatment considerations
depending on specific patient factors and the level of bone
maturity. This review summarizes the current data regarding
pertinent features of the history and physical exam,
indications for nonoperative management, assessment of
skeletal maturity, and the surgical management of patients
based on their unique physeal considerations. To prevent
physeal injury, the surgical considerations differ from the
adult population with respect to graft choice, location
of fixation, reconstruction technique, and postoperative
protocol. Orthopedic surgeons should be familiar with
the various surgical techniques, graft selection choices,
postoperative rehabilitation programs, controversies, and
outcomes associated with the management of ACL injuries
in the pediatric population.
Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament Reconstruction
Bone tunnel-related issues are frequently encountered
during revision anterior cruciate ligament reconstruction.
Tunnel malposition, widening, and interference pose unique
challenges that may complicate surgery and compromise
outcomes. Preoperative planning is critical to identify and
characterize bone tunnel pathology. Choice of technique,
graft, and implant are influenced by numerous patientrelated
and technical factors. Despite this complexity, a
variety of strategies are available to help manage and
navigate common bone tunnel problems. Among these
include alternative techniques for reaming, bone grafting,
and fixation. This review provides a modern evidence-based
and practical guide to equip the orthopedic surgeon with
a systematic approach to the evaluation and management
of bone tunnel-related issues encountered during revision
anterior cruciate ligament reconstruction.
The Role of the Hindfoot in Total Knee Arthroplasty Alignment
Jessica Hooper, MD, Joshua Rozell, MD, Peter S. Walker, PhD, and Ran Schwarzkopf, MD, MSc
Limb alignment is a critically important factor to consider in
the management of the patient with knee arthritis. Abnormal
alignment is associated with the accelerated progression of
osteoarthritis and, if not addressed at the time of surgery,
may contribute to early failure of knee replacement implants.
The contribution of the hindfoot to overall limb alignment
has received limited attention in the context of deformity
correction in total knee arthroplasty (TKA). In this review,
we present evidence supporting the inclusion of the hindfoot
in the consideration of overall limb alignment for TKA and
propose a management algorithm.
Expanding Indications for Meniscal Repair
Abigail L. Campbell, MD, MSc, Eric Strauss, MD, Guillem Gonzalez-Lomas, MD, and
Michael Alaia, MD
Wrist arthroscopy is a useful surgical technique that has been
steadily gaining popularity since the 1980s. In addition to
being a valuable diagnostic tool, wrist arthroscopy can be
used for an expanding array of therapeutic interventions
and is an attractive, minimally invasive treatment modality
for patients. However, wrist arthroscopy is not without its
complications, and a detailed understanding of the relevant
anatomy, instrumentation, and methodology is critical for
success.
Articles
Posterolateral Corner Injury Evolution of Diagnosis and Treatment
Kristofer E. Chenard, MD, Laith M. Jazrawi, MD, and Michael J. Alaia, MD
Injuries to the posterolateral corner of the knee are rare
but significant injuries that occur most commonly in the
context of a multiligamentous knee injury. The structures
of the posterolateral corner serve as a primary restraint to
varus and external rotation and as a secondary restraint
to posterior translation. Contemporary reconstructive
techniques focus on anatomic restoration of function of the
posterolateral corner and excellent long-term results have
been demonstrated.
The Hip-Spine Relationship Simplified
Nima Eftekhary, MD, Jessica Morton, MD, Ameer Elbuluk, MD, Ran Schwarzkopf, MD, MSc,
Aaron Buckland, MBBS, FRACS, and Jonathan Vigdorchik, MD
Much attention has recently been focused on the relationship
between the hip and spine and its contribution to postoperative
instability following total hip arthroplasty. However, the
terminology can be confusing. Through an understanding
of spinopelvic parameters, spinopelvic motion, and the
interplay between the spine and pelvis, the surgeon can
plan for and decrease the risk of instability after total hip
arthroplasty. This review details spinopelvic parameters that
predispose to instability and guides readers in understanding
spinopelvic motion as it relates to THA instability.
Robotic Spine Surgery Where Did We Come From, And Where Are We Headed?
John A. Buza, III, MD, MS, and Jeffrey A. Goldstein, MD
Robotic spine surgery has a number of potential advantages,
including more precise preoperative planning, a high degree
of accuracy in pedicle screw placement, and significantly
reduced radiation exposure to the surgical team. Despite the
potential advantages, many surgeons feel that it is still too
early for the widespread adoption of this technology, citing
increased cost, increased operating room time, and lack
of necessity. Most spine surgeons will agree, however, that
robotic technology is still in its infancy and that there will
be a significant role for this technology in the future. Amidst
this debate, it is important to understand the evolution of
this technology from its initial inception to the present day,
with a critical appraisal of the technology in its current
form. It is important to consider the probable next steps in
the development of this technology so that we may develop
and shape this technology to most benefit our patients. This
article reviews the history and development of robotic technology
in spine surgery, critically assesses the technology in
its current form, and explores the future directions.
Applying Systems Engineering to Increase Operating Room Efficiency
Austin J. Ramme, MD, PhD, Lorraine H. Hutzler, MPA, Robert J. Cerfolio, MD, MBA, and
Joseph A. Bosco, MD
Systems engineering is an interdisciplinary approach to
creating, evaluating, and managing a complex process in
order to increase reliability, cost-effectiveness, and quality.
The operating room is a complex environment that requires
human-human interaction, human-device interaction, planning,
and coordination of scarce resources for the purpose
of providing surgery to patients in a safe and efficient manner.
The operating room is an important revenue generator,
but it can also be responsible for unsustainable costs if not
managed effectively. Reducing costs and increasing the efficiency
of surgical cases is important for generating health
care value. Efficiency efforts that aim for standardization
of surgical protocols must be balanced by flexibility in the
unpredictable operating room environment. This paper
reviews systems engineering efforts to improve efficiency
in the operating room including operating room scheduling,
personnel factors, resource management, orthopedicspecific
initiatives, and future innovations.
Review of Craniocervical Sagittal Alignment
Shaleen Vira, MD, Nisha Reddy, BA, Themistocles Protopsaltis, MD, and Peter G. Passias, MD
Cervical alignment plays a critical role in the diagnosis and
treatment of spinal pathology. There has been a proliferation
of novel radiographic parameters to quantify cranial
and cervical alignment. These parameters have been placed
in clinical context by their correlation with health-related
quality of life (HRQOL) scores. This article reviews these
parameters and describes their utility in understanding
spinal deformity and other pathologies of the cervical spine.
The Military Medical System and Wartime Injuries to the Spine
War has historically been a major catalyst for advancement
in military medical care and medicine in general.
In our current conflicts, advances in battlefield medicine,
evacuation techniques, and personal protective equipment
have improved survival rates among members of the armed
services. With increased survival, there has been increased
prevalence of serious but nonfatal injuries, particularly from
blunt and penetrating trauma. Blast injuries are the major
cause of trauma and have both blunt and penetrating components.
With respect to the spine, blasts have led to open,
contaminated wounds that are complex and difficult to treat.
Additionally, blasts have led to an increased incidence of
lower lumbar burst fractures and lumbosacral dissociation.
As these and other injuries are being seen more commonly
during war, we must ensure that our military medical system
is adapting to ensure we are taking care of our military
personnel at the highest level.
Anterior Cruciate Ligament Ruptures in the Skeletally Immature Current State of the Art
Anterior cruciate ligament (ACL) injuries in children and
adolescents are increasing every year. This patient population
has unique risk factors and treatment considerations
depending on specific patient factors and the level of bone
maturity. This review summarizes the current data regarding
pertinent features of the history and physical exam,
indications for nonoperative management, assessment of
skeletal maturity, and the surgical management of patients
based on their unique physeal considerations. To prevent
physeal injury, the surgical considerations differ from the
adult population with respect to graft choice, location
of fixation, reconstruction technique, and postoperative
protocol. Orthopedic surgeons should be familiar with
the various surgical techniques, graft selection choices,
postoperative rehabilitation programs, controversies, and
outcomes associated with the management of ACL injuries
in the pediatric population.
Bone Tunnel Management in Modern Revision Anterior Cruciate Ligament Reconstruction
Bone tunnel-related issues are frequently encountered
during revision anterior cruciate ligament reconstruction.
Tunnel malposition, widening, and interference pose unique
challenges that may complicate surgery and compromise
outcomes. Preoperative planning is critical to identify and
characterize bone tunnel pathology. Choice of technique,
graft, and implant are influenced by numerous patientrelated
and technical factors. Despite this complexity, a
variety of strategies are available to help manage and
navigate common bone tunnel problems. Among these
include alternative techniques for reaming, bone grafting,
and fixation. This review provides a modern evidence-based
and practical guide to equip the orthopedic surgeon with
a systematic approach to the evaluation and management
of bone tunnel-related issues encountered during revision
anterior cruciate ligament reconstruction.
The Role of the Hindfoot in Total Knee Arthroplasty Alignment
Jessica Hooper, MD, Joshua Rozell, MD, Peter S. Walker, PhD, and Ran Schwarzkopf, MD, MSc
Limb alignment is a critically important factor to consider in
the management of the patient with knee arthritis. Abnormal
alignment is associated with the accelerated progression of
osteoarthritis and, if not addressed at the time of surgery,
may contribute to early failure of knee replacement implants.
The contribution of the hindfoot to overall limb alignment
has received limited attention in the context of deformity
correction in total knee arthroplasty (TKA). In this review,
we present evidence supporting the inclusion of the hindfoot
in the consideration of overall limb alignment for TKA and
propose a management algorithm.
Expanding Indications for Meniscal Repair
Abigail L. Campbell, MD, MSc, Eric Strauss, MD, Guillem Gonzalez-Lomas, MD, and
Michael Alaia, MD
Wrist arthroscopy is a useful surgical technique that has been
steadily gaining popularity since the 1980s. In addition to
being a valuable diagnostic tool, wrist arthroscopy can be
used for an expanding array of therapeutic interventions
and is an attractive, minimally invasive treatment modality
for patients. However, wrist arthroscopy is not without its
complications, and a detailed understanding of the relevant
anatomy, instrumentation, and methodology is critical for
success.