Volume 25, Spring 2015

Letter from the Editors-in-Chief
Alexander L. Neuwirth and Tyler R. Morris

Letter from the Chairman
L. Scott Levin

Letter from the Program Director
Craig L. Israelite

Dedication to Dr. John L. Esterhai
Alexander L. Neuwirth and Tyler R. Morris

Letter from Dr. John L. Esterhai
John L. Esterhai

A tribute to Barbara Weinraub
Alexander L. Neuwirth and Tyler R. Morris

Clinical Articles


Subtrochanteric Femur Fractures: Optimal Incision Location for Clamp-assistant Intramedullary Nailing
Derek J. Donegan, Jason B. Anari, Richard Yoon, Frank A. Liporace

The Failed Pilon: Factors Associated with Delayed Amputation,Arthroplasty, or Arthrodesis after Open Reduction and Internal Fixation
Mara L. Schenker, Daniel Patton, Jonathan Kark, David Barei, Daphne Beingessner

Operative Technique:A Modification of the “Push-Pull Screw” Distraction Technique for Obtaining Fibular Length
Chase C. Woodward, Derek J. Donegan

Circumferential Negative Pressure Wound Therapy for Lower Extremity Fractures: A New Technique
Ryan M. Taylor, Richard Yoon, Frank A. Liporace, Derek J. Donegan


An Economic Evaluation of Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis (AIS)
Chia H. Wu, Lisa Mcleod, John M. Flynn

Spinal Deformity Surgery in a Limited-Resource Environment: Trinidad, West Indies
Andrew H. Milby, Dylan Thomas, David Toby, Vincent M. Arlet

Avoiding Pedicle Subtraction Osteotomies with Hyperlordotic Anterior Cages: A Case Report
Philip A Saville, Vincent M. Arlet


Operative Repair of an Adolescent Knee Dislocation: A Case Report
Deren Bagsby, Robert Klitzman, George Gantsoudes

Non-Arthroplastic Treatment of Glenohumeral Osteoarthritis
Nicole S. Belkin, Joseph A. D’Alonzo, Jr., John D. Kelly IV

Post-Traumatic Patellofemoral Joint Ankylosis
Nicole S. Belkin, Nicole Zelenski, Samir Mehta, John D. Kelly IV


Diagnostic Utility of Wrist MRI in The Pediatric Population
Alex L. Gornitzky, Robert B. Carrigan


Tips of the Trade for Residents
Brittany N. Atuahene, Lawrence Wells

Reliability Assessment of the EOS® Imaging in Clinical Evaluation of Lower Limb Deformity
Saba Pasha, Michelle Ho, Victor Ho Fung, Richard S. Davidson

Management of Distal Femoral Osseous Sarcomas using Expandable Endoprosthesis
Juan Pretell-Mazzini, Emmanouil Grigoriou, Lauren A. Tomlinson, John P. Dormans

Risk of Osteochondritis Dissecans (OCD) Lesions in Family Members of Patients with OCD: A Pedigree Analysis
Alex L. Gornitzky, R. Justin Mistovich, Brittany Atuahene, Theodore J. Ganley

Shoulder and Elbow

Triceps Tendon Reconstruction in the Setting of Elbow Stiffness: A Surgical Technique
Mohit Gilotra, G. Russell Huffman

Neuropathic Arthropathy of the Glenohumeral Joint as the presenting symptom of a Cervical Syrinx: A Case Report
Nicole S. Belkin, George Hung, Gabriel E Lewullis

Measurement of Adult Hill-Sachs Lesions on Magnetic Resonance Arthrography
Vishal Saxena, Alexander T. Ruutiainen, Andrew S. Wilmot, Luis I. Ruffolo, Stuart D. Kinsella, Nancy A. Chauvin, John D. Kelly IV


Failure of Cementless Total Hip Arthroplasty in a Patient with Contralateral Hip Arthrodesis: A Case Report
Jason B. Anari, Neil P. Sheth

Operative Technique:Acetabular Distraction for Severe Acetabular Bone Loss with Associated Chronic Pelvic Discontinuity
Christopher M. Melnic, Neil P. Sheth

A Systematic Approach to Soft-tissue Balancing in Primary Varus Total Knee Arthroplasty
Russell N. Stitzlein, Alexander L. Neuwirth, Tyler R. Morris, Neil P. Sheth

Patellar Dislocation after Total Knee Arthroplasty for Neglected Chronic Post-traumatic Patellar Dislocation: A Case Report
Joshua C. Rozell, Pramod B. Voleti, Craig L. Israelite

Dual Aantibiotic Prophylaxis is Associated with Acute Kidney Injury after Primary Joint Arthroplasty
P. Maxwell Courtney, Christopher M. Melnic, Zachary Zimmer, Jason Anari, Gwo-Chin Lee

The Effect of Malnutrition and Morbid Obesity on Complication Rates Following Primary Total Joint Arthroplasty
P. Maxwell Courtney, Joshua C. Rozell, Christopher M. Melnic, Neil P. Sheth, Charles L. Nelson

The Use of Press-fit Stems in Revision Total Knee Arthroplasty
P. Maxwell Courtney, Neil P. Sheth, Wayne G. Paprosky

Heart Murmurs as a Predictor for Post-arthroplasty Complications and Performance
James M. Friedman, Venus Vakhshori, Chia Wu, Cody Hillin, Josh Steere, Jaimo Ahn, Eric Hume


Musculoskeletal Health Literacy in patients with Carpal Tunnel Syndrome: Pilot Results of a Cross-sectional Study
Andrew J. Rosenbaum, Richard L. Uhl, Michael Mulligan, John Saunders, Andrew Dunkman, Daniel Goldberg

Relationships – The “Lifeblood” of Peace
John D. Kelly, IV

Who Should not Undergo Short Stay Hip and Knee Arthroplasty? Risk Factors Associated with Major Medical Complications Following Primary Total Joint Arthroplasty
P. Maxwell Courtney, Joshua C. Rozell, Christopher M. Melnic, Gwo-Chin Lee

Are There Identifiable Risk Factors and Causes Associated with Unplanned Readmissions Following Total Knee Arthroplasty?
Michael M. Kheir, R. Carter Clement, Peter B. Derman, David N. Flynn, Rebecca M. Speck, L. Scott Levin, Lee A. Fleisher

Basic Science Articles


Altered Force Sensing and Cell-cell Adhesion by Mutant ALK2 FOP Cells—Implications for Heterotopic Ossification
Julia Haupt, Brian Cosgrove, Claire McLeod, Andria Culbert, Robert L. Mauck, Eileen M. Shore

Heterozygous Inactivation of Gnas Alters Skeletal Development and Bone Quality
Girish Ramaswamy, Deyu Zhang, Frederick S Kaplan, Robert J. Pignolo, Eileen M. Shore

The FOP R206H Acvr1 Mutation is Sufficient to Cause Heterotopic Ossification in Mouse Limbs and is Inhibited by a Selective RARy Agonist Treatment
Salin Chakkalakal, Kenta Uchibe, Deyu Zhang, Kieran Feeley, Andria Culbert, Michael Convente, Frederick Kaplan, Aris Economides, Maurizio Pacifici, Masahiro Iwamoto, Eileen M. Shore

Notch Signaling is Required for Osteoclast Differentiation and Function
Jason W. Ashley, Jaimo Ahn, Kurt D Hankenson

Intermittent PTH after Prolonged Bisphosphonate Treatment Improves Bone Structure by Inducing Substantial New Bone Formation with Decoupled, Inhibited Bone Resorption in Ovariectomized Rats
Allison R. Altman, Carina Lott, Chantal de Bakker, Wei-Ju Tseng, Ling Qin, X. Sherry Liu

Role of Canonical Wnt/B-catenin Pathway in DNA Repair and Osteoblast Survival as a Novel Anabolic Treatment for Radiotherapy Associated Bone Damage
Abhishek Chandra, Tiao Lin, Wei-ju Tseng, Ji Zhu, Keith Cengel, Bing Xia, Sherry X. Liu, Ling Qin

A Comprehensive Study of Long-term Skeletal Changes after Spinal Cord Injury in Adult Rats
Tiao Lin, Wei Tong, Abhishek Chandra, Shao-Yun Hsu, Haoruo Jia, Ji Zhu, Wei-ju Tseng, Yejia Zhang, X. Sherry Liu, Dongming Sun, Wise Young, Ling Qin

Pregnancy, Lactation, and Weaning Induce a Physiological Redistribution of Bone Mass at Multiple Skeletal Sites with Minimal Impact on Bone Quality
Chantal de Bakker, Connie Li, Allison Altman, Juhanna Robberts, Wei-Ju Tseng, X. Sherry Liu

Simultaneous Measurement of Changes in Bone Remodeling and Microvasculature in Response to Estrogen Deficiency-Induced Bone Loss and Intermittent PTH-Induced Bone Gain
Wei-Ju Tseng, Chantal de Bakker, Lin T, Wei T, Jia H, Levin LS, Qin L, Liu XS

Impaired Chondrocyte Hypertrophic Differentiation is Associated with Failed Vertebral Bone Formation in Mucopolysaccharidosis VII Dogs
Sun H. Peck, Philip J.M. O’Donnell, Eileen M. Shore, Maurizio Pacifici, Mark E. Haskins, Neil R. Malhotra, Lachlan J. Smith


Reduced Epidermal Growth Factor Receptor (EGFR) Signaling Enhances Cartilage Destruction in Mouse Osteoarthritis Model
Haoruo Jia, Xianrong Zhang, Ji Zhu, Frank Beier, Motomi Enomoto-Iwamoto, Ling Qin

Population Average T2 MRI Maps Reveal Quantitative Regional Transformations in the Degenerating Rabbit Intervertebral Disc that Vary by Lumbar Level
John T. Martin, Christopher M. Collins, Kensuke Ikuta, Robert L. Mauck, Dawn M. Elliott, Yeija Zhang, D. Greg Anderson, Alexander R. Vaccaro, Todd J. Albert, Vincent Arlet, Harvey E. Smith

In Vitro Growth Trajectory and In Vivo Implantation of a Cell-Based Disc-like Angle Ply Structure for Total Disc Replacement
John T. Martin, Kensuke Ikuta, Kim, Dong Hwa, Christian G. Pfeifer, Lachlan J. Smith, Dawn M. Elliott, Harvey E. Smith, Robert L. Mauck

Sprifermin (rhFGF18) Preserves Articular Cartilage Depth-Dependent Properties During in Vitro Culture
Gregory R. Meloni, AJE Farran, R Cocca, Bhavana Mohanraj, A Gigout, Robert L. Mauck, George R. Dodge

Biphasic Finite Element Modeling Reconciles Mechanical Properties of Engineered Cartilage Constructs Derived from Different Testing Modalities
Gregory R. Meloni, Brendan D. Stoeckl, Matthew B. Fisher, George R. Dodge, Robert L. Mauck

In Vitro Maturation and In Vivo Delivery of Cartilage Repair Composites Composed of Minced Cartilage in a Photopolymerizable Hyaluronic Acid Hydrogel
Christian G. Pfeifer, Anish Potty, Vishal Saxena, Alexander L. Neuwirth, Minwook Kim, Niobra M. Keah, Matthew B. Fisher, Rebekah S. Decker, Maurizio Pacifici, Robert L. Mauck

Age Dependent Cartilage Repair and Subchondral Bone Remodeling in a Minipig Defect Model
Christian G. Pfeifer, Matthew B. Fisher, Vishal Saxena, Minwook, Kim, Elizabeth A. Henning, George R. Dodge, David A. Steinberg, Robert L. Mauck


Critical Regulatory Role for Collagen V in Establishing the Unique Mechanical Properties of Joint Stabilizing Tendons
Brianne K. Connizzo, Joanna H. Fried, Mei Sun, David E. Birk, Louis J. Soslowsky

Biceps Detachment Alters Rotator Cuff Tendon Properties and Joint Function in a Supraspinatus Tendon Tear Rat Model
Jennica J. Tucker, Stephen J. Thomas, Katherine E. Reuther, Chancellor F Gray, CS Lee, DL Glaser, Louis J. Soslowsky

Effect of Ultrasound-Guided Dry Needling on the Healthy Rat Supraspinatus Tendon
Corinne N. Riggin, Viviane Khoury, Joshua A. Gordon, Susan M. Schultz, Adam M. Pardes, Chandra M. Sehgal, Louis J. Soslowsky

P2 Porous Titanium Implants Improve Early Tendon Healing in a Rat Supraspinatus Repair Model
Jennica J. Tucker, Joshua A. Gordon, RC Zanes, A Zuskov, JM Cirone, JD Vinciguerra, RD Bloebaum, Louis J. Soslowsky

Novel Application of a μCT Perfusion Technique to Evaluate Achilles Tendon Vessel Microarchitecture in Three Dimensions
Benjamin R. Freedman, Wei-Ju Tseng, George W. Fryhofer, X Sherry Liu, Louis J. Soslowsky

Multidisciplinary Evaluation of Treatments for Achilles Tendon Ruptures During Early Healing in an Animal Model
Benjamin R. Freedman, Joshua A. Gordon, Stephen J. Thomas, PB Bhatt, Corinne N. Riggin, JJ Sarver, Jennica J. Tucker, B Zanes, Adam M. Pardes, Daeyeon Lee, MW Hast, Louis J. Soslowsky

Differential Effects of Growth Factors on Neonatal and Adult Achilles Tenocytes
J. Huegel, Robert L. Mauck, Louis J. Soslowsky, Andrew F. Kuntz

Achilles Tendons from Decorin and Biglycan Deficient Mice Demonstrate Inferior Mechanical and Structural Properties Predicted by an Image-based Empirical Damage Model
Joshua A. Gordon, Benjamin R. Freedman, Andrey Zuskov, Renato Iozzo, David E. Birk, Louis J. Soslowsky

Genetic Response of Rat Supraspinatus Tendon and Muscle to Exercise
S.I. Rooney, J.W. Tobias, P.R. Bhatt, Andrew F. Kuntz, Louis J. Soslowsky

Tendon Healing in a Supraspinatus Tear and Repair Rat Model is not Altered by Overuse-Induced Tendinopathy
Jennica J. Tucker, Brianne K. Connizzo, Corinne N. Riggin, Robert L. Mauck, DR Steinberg, Andrew F. Kuntz, Louis J. Soslowsky, J Bernstein

Effect of Scapular Dyskinesis on Supraspinatus Tendon Healing in a Rat Model
Katherine E. Reuther, Jennica J. Tucker, Stephen J. Thomas, Rameen P. Vafa, Stephen S. Liu, Joshua A. Gordon, Sarah M. Yannascoli, Adam C. Caro, Andrew F. Kuntz, Louis J. Soslowsky

Cellular Processes

Mechano-activatable Microcapsules for Tunable Drug Delivery
Bhavana Mohanraj, Fuquan Tu, Daeyeon Lee, George R. Dodge, Robert L. Mauck

TGF-beta and BMP Signaling Pathways Regulate Chromatin Condensation in Mesenchymal Stem Cells in Response to Dynamic Loading
Su-Jin Heo, Woojin M. Han, Tristan P. Driscoll, Dawn M. Elliott, Randall L. Duncan, Robert L. Mauck

Mechanically Induced Purinergic and Calcium Signaling Directs Chromatin Condensation in Mesenchymal Stem Cells
Su-Jin Heo, Tristan P. Driscoll, Woojin M. Han, SD Thorpe, Dawn M. Elliott, DA Lee, Robert L. Mauck

Preconditioning Stem Cells to Maximize Regenerative Potential in the Challenging Microenvironment of the Intervertebral Disc
Katherine E. Lothstein, JM Philip, BA O’Donnell, Sun H. Peck, George R. Dodge, Robert L. Mauck, Neil R. Malhotra, Lachlan J. Smith


Excellence Symposium, September 13, 2014
Tyler R. Morris

Penn Orthopaedics Human Tissue Lab
Tyler R. Morris, Alexander L. Neuwirth

Visiting Professor Lecture Series
Tyler R. Morris, Blair S. Ashley, Luke A. Lopas, Chia Wu, MD, Alexander L. Neuwirth, Kristin L. Buterbaugh

PCMD Symposium, November 12, 2014
Tyler R. Morris

American Shoulder & Elbow Surgeons European Traveling Fellows, October 16th, 2014
Tyler R. Morris

Penn Orthopaedics Throwing Symposium, January 31st, 2014
Tyler R. Morris

The Perry Initiative at Penn
Nicole S.Belkin, Kristy L.Weber

Tony Searles Casting Room Dedication, November 14th, 2014
Tyler R. Morris, Alexander L. Neuwirth

Philadelphia Orthopaedic Society
Tyler R. Morris

Penn Orthopaedics 2015 Cartilage Repair Symposium, April 24th-25th, 2015
Tyler R. Morris, MD and Alexander L. Neuwirth, MD

Departmental Items

Chief Residents

Current Residents

Resident Updates

Administrative Chief Residents’ Perspective
J.Gabe Horneff III, Christos D.Photopoulos, Ryan M.Taylor

Health System Updates

The University of Pennsylvania Musculoskeletal and Rheumatology Service Line
Tyler R. Morris, Alexander L. Neuwirth

Bundled Care Management
Nicole A. Zelenski, Blair S.Ashley, Tyler R. Morris, Alexander L. Neuwirth, Eric L. Hume

Philadelphia Veterans Affairs Medical Center
John L. Esterhai

Penn Orthopaedics Service Summary, 2014 at a Glance
Lori Gustave, Fabian Marechal, Ryan Gonzales

Pennsylvania Hospital
Tyler R. Morris, Neil Sheth

Penn Presbyterian Medical Center
David J. Bozentka

Penn Orthopaedics Does Not Rest On Its Laurels
Dan Gittings, Brian J. Sennett

The Children’s Hospital of Philadelphia
John P. Dormans, Ashley Trocle

2015 UPOJ Clinical Research Update
Annamarie D. Horan

McKay Orthopaedic Research Laboratory
Louis J. Soslowsky

Biedermann Lab for Orthopaedic Research
Michael W. Hast

What’s New at the PVAMC Translational Musculoskeletal Research Center?
Robert L. Mauck, George R. Dodge