Volume 27, Spring 2017

Letter from the Editors in Chief
Blair Ashley, MD, Daniel Gittings, MD

Dedication: Malcolm L. Ecker, MD
Blair Ashley, MD, Daniel Gittings, MD

Letter from the Dedicated
Malcolm Ecker, MD

Clinical Research


Tips & Tricks: The Use of Big Clinical Databases for Orthopaedic Research
Matthew Sloan, MD, MS, Neil Sheth, MD

Validation of Utilizing a Modern Pedometer as a Measure of Patient Activity
Russell Stitzlein, MD, Alexander Neuwirth, MD, Keith Baldwin, MD, MPH, Neil Sheth, MD

Evaluation and Treatment of Femoral Osteolysis Following Total Hip Arthroplasty
William Hardaker, MS, Daniel Gittings, MD, Jonathan Dattilo, MD, Neil Sheth, MD

Preoperative Risk Factor Score Predicts Malnutrition in Total Joint Arthroplasty Patients
Sarah Rudasill, Daniel Gittings, MD, Nabil Elkassabany, MD, Jiabin Liu, MD, PhD, Charles Nelson, MD, Atul Kamath, MD

Foot & Ankle

Tips & Tricks: The Essentials of the Foot and Ankle Physical Examination
Adnan Cheema, MD, Kathryn O’Connor, MD

Integrating Functional Ultrasonography and Motion Analysis into the Clinical Treatment of Patients with Achilles Tendon Rupture
Josh Baxter, PhD, Todd Hullfish, BS, Kathryn O’Connor, MD, Daniel Farber, MD, Keith Wapner, MD, Wen Chao, MD

Mechanical and Histological, but not Functional, Properties Remain Inferior in Conservatively Treated Achilles Tendons in Rodents: Long Term Evaluation
Benjamin Freedman, PhD, George Fryhofer, MD, Nabeel Salka, BS, Harina Raja, MS, Cody Hillin, MD, Courtney Nuss, Daniel Farber, MD, Louis Soslowsky, PhD

Aging Decreases Rat Achilles Tendon Vessel Density and Blood Flow after Injury
Corinne Riggin, BS, Susan Schultz, RDMS, Chandra Sehgal, PhD, Louis Soslowsky, PhD

Immobilization Angle Effects on Tendon Healing in Achilles Tendon Rupture
Cody Hillin, MD, George Fryhofer, MD, Benjamin Freedman, PhD, Daniel Choi, BS, Stephanie Weiss, BS, Louis Soslowsky, PhD


Tips & Tricks: Wrist and Hand Radiography
Kristin Buterbaugh, MD, Glenn Buterbaugh, MD

Ultrasonographic Evaluation of Zone II Flexor Tendon Lacerations and Repairs: A Cadaveric Study
Kristin Buterbaugh, MD, Joshua Gordon, MD, Nikolas Kazmers, MD, Viviane Khoury, MD, David Bozentka, MD, David Steinberg, MD

Acute Deep Infections of the Upper Extremity: The Utility of Obtaining Atypical Cultures and Factors Associated with Culture Positivity
George Fryhofer, MD, Nikolas Kazmers, MD, MSE, Daniel Gittings, MD, David Bozentka, MD, David Steinberg, MD, Benjamin Gray, MD

Height-to-length Ratios to Assess Flexion Deformity in Scaphoid Fractures—a Comparison of Measurement Techniques
Adnan Cheema, MD, Paul Niziolek, MD, PhD, J. Bruce Kneeland, MD, David Bozentka, MD, David Steinberg, MD

Variable-Angle Locking Compression Plate Fixation of Distal Radius Volar Rim
Mengcun Chen, MD, Daniel Gittings, MD, Shuhua Yang, MD, Guohui Liu, MD, PhD, Tian Xia, MD, PhD


Tips & Tricks: Management of Posterior Sternoclavicular Joint Injuries
Mark Hasenauer, MD, Apurva Shah, MD, MBA, Keith Baldwin, MD, MSPT, MPH, David Spiegel, MD

Single Leg Spica Casting for Low Energy Pediatric Femur Fractures—Operative Technique
Daniel Miller, MD, Susan Nelson, MD, MPH, Todd Blumberg, MD, Andrew Gambone, MD, Joseph Monteleone

Concomitant Injury and Complications Following Pediatric Tibial Spine Fractures
Taylor Jackson, BA, Eileen Storey, BA, Theodore Ganley, MD

Current Concepts in Management of Unstable Slipped Capital Femoral Epiphysis
Brendan Striano, BA, Taylor Jackson, BA, Daniel Miller, MD, Wudbhav Sankar, MD

Hip Pain: A Case Report of Diagnosing Femoroacetabular Impingement in an Adolescent Athlete
Jermonte Lowe, BS, Julien Aoyama, BA, Nancy Chauvin, MD, Lawrence Wells, MD

Medial Epicondyle Fractures in Adolescent Athletes: Two Cases where Conservative Treatment is Surgery
Dwayne Carney, BS, Alexander Akoto, BS, Jermonte Lowe, BS, Julien Aoyama, BS, Lawrence Wells, MD

Arthroscopic Assisted Reduction of a Salter-Harris Type III Fracture of the Distal Femur with Concomitant Anterior Cruciate Ligament Reconstruction: A Case Report
Andrew Gambone, MD, Alexander Akoto, BA, Todd Blumberg, MD, Susan Nelson, MD, MPH, Daniel Miller, MD, Lawrence Wells, MD

Mehta Casting for Early Onset Scoliosis—Operative Technique
Todd Blumberg, MD, Susan Nelson, MD, MPH, Daniel Miller, MD, Andrew Gambone, MD, Joseph Monteleone, Patrick Cahill, MD

Value in Pediatric Orthopaedics
Brendan Striano, BA, John Flynn, MS; Edited by Matthew Webb, MD

Shoulder & Elbow

Preliminary Biomechanical Analysis of Superior Capsular Reconstruction Grafts During Activities of Daily Living
Andrea Simi, Matthew Chin, BS, John Kelly IV, MD, Josh Baxter, PhD, Michael Hast, PhD

Current Trends in Treatment Options for Glenohumeral Arthritis in the Active Adult
Christopher DeFrancesco, BS, Nicole Zelenski, MD, John Kelly IV, MD

Supraspinatus Tendons Have Different Mechanical Properties Across Sex
Kelsey Robinson, MD, Adam Pardes, BS, Benjamin Freedman, PhD, Louis Soslowsky, PhD


Tips & Tricks: Thoracolumbar Injury Anatomy, Biomechanics and Classification
Michael Eby, MD

Growth Modulation for Idiopathic Scoliosis with an Anterior Tether—Operative Technique
Susan Nelson, MD, MPH, Todd Blumberg MD, Andrew Gambone, MD, Daniel Miller, MD, Patrick Cahill, MD

Growth Factor and Extracellular Matrix Expression and Localization during Nucleus Pulposus Formation
Sun Peck, PhD, Kendra McKee, Neil Malhotra, MD, Brian Harfe, PhD, Lachlan Smith, PhD

Novel Techniques for the Evaluation of Physical Activity in a Large Animal Intervertebral Disc Degeneration Model
Justin Bendigo, BS, Sarah Gullbrand, PhD, Brendan Stoeckl, MSE, Zosia Zawacki, VMD, Thomas Schaer, VMD, Harvey Smith, MD, Robert L. Mauck, PhD, Neil Malhotra, MD, Feini Qu, BS, Lachlan Smith, PhD


Tips & Tricks: Technical Evaluation of ACL Graft Dimensions: Staying Out of Trouble
Joshua Rozell, MD, Brian Sennett, MD

A Surgeon’s Case-Based Guide to the Management of Osteochondritis Dissecans of the Knee in the Pediatric Athlete
Scott LaValva, BS, Eileen Storey, BA, James Carey, MD, MPH, Kevin Shea, MD, Eric Wall, MD, Theodore Ganley, MD

Anterior Cruciate Ligament Reconstruction in the Adolescent: A Hybrid Approach to Physeal-Respecting Autograft Reconstruction
R. Justin Mistovich, MD, Rushyuan Jay Lee, MD, Eileen Storey, BA, Theodore Ganley, MD

ACL Reconstruction in Children Using Growth Plate Sparing Techniques
Christopher DeFrancesco, BS, Andrew Gambone, MD, Theodore Ganley, MD


Tips & Tricks: Peroneal Nerve Palsy Part II
Tyler Morris, MD, Keith Baldwin, MD, MPH, MSPT

Single Leg Spica Casting for Low Energy Pediatric Femur Fractures—Operative Technique
Daniel Miller, MD, Susan Nelson, MD, MPH, Todd Blumberg, MD, Andrew Gambone, MD, Joseph Monteleone

Biomechanical Comparison of Fully-Threaded Solid Cortical versus Partially-Threaded Cannulated Cancellous Screw Fixation for the Treatment of Lisfranc Injuries
Joshua Rozell, MD, Matthew Chin, BS, Derek Donegan, MD, Michael Hast, PhD

Well-positioned Calcar Screws Have Decreased Variability in Mechanical Loading Compared to More Distant Screws in Proximal Humerus Fracture Fixation
Samir Mehta, MD, Matthew Chin, BS, Surena Namdari, MS, MD, Michael Hast, PhD


Tips & Tricks: Prophylactic Femoral Nailing for Metastatic Carcinoma
Andrew Tyler, MD, PhD, Kristy Weber, MD

Basic Science Research Articles


Rescuing Chondrocyte Hypertrophic Differentiation Potential and Exploring Therapeutic Approaches for Enhancing Bone Formation in Mucopolysaccharidosis VII Dogs
Sun Peck, PhD, Jennifer Kang, BS, Justin Bendigo, BS, Patricia O’Donnell, Caitlin Fitzgerald, Jessica Bagel, Neil Malhotra, MD, Eileen Shore, PhD, Margret Casal, DVM, PhD, Lachlan Smith, PhD

Reproduction-Induced Changes in Maternal Bone Confer Protective Effects against Estrogen Deficiency
Chantal de Bakker, BS, Laurel Leavitt, Casey Krickus, Wei-Ju Tseng, MSE, Tiao Lin, MD, Wei Tong, MD, Ling Qin, PhD, X. Sherry Liu, PhD

Relationships Between Peak Bone Microstructure and Rate of Estrogen-Deficiency-Induced Bone Loss
Yihan Li, MSE, Wei-Ju Tseng, MSE, Chantal de Bakker, BS, Hongbo Zhao, BS, X. Sherry Liu, PhD

Cyclic Treatment Regime Rescues PTH Withdrawal-Induced Bone Loss and Microarchitecture Deterioration
Wei-Ju Tseng, MSE, Wonsae Lee, Hongbo Zhao, BS, Yang Liu, DDS, Chantal de Bakker, BS, Yihan Li, MSE, Wei Tong, MD, Luqiang Wang, MD, Xiaoyuan Ma, MD, Ling Qin, PhD, X. Sherry Liu, PhD

Cartilage & Meniscus

Engineered Endplates Enhance the In Vivo Performance of a Replacement Disc-Like Angle Ply Structure (DAPS), *NIRA AWARD WINNER*
Sarah Gullbrand, PhD, John Martin, PhD, Beth Ashinsky, BA, Dong Hwa Kim, PhD, Lachlan Smith, PhD, Dawn Elliott, PhD, Harvey Smith, MD, Robert Mauck, PhD

Interposition of a Cell-seeded Slow-Degrading Membrane Generates a Stable Osteochondritis Dissecans-Like Lesion in a Large Animal Model
James Friedman, MD, Mackenzie Sennett, BS, Marcelo Bonadio, MD, Kerry Orji, BS, Blair Ashley, MD, Robert Mauck, PhD, James Carey, MD

Nuclear Softening Enhances Meniscus Cell Migration into Dense Fiber Networks and Native Tissue
Su-Jin Heo, Kwang Hoon Song, Breanna Seiber, BS, Feini Qu, BS, Jason Burdick, PhD, Robert Mauck, PhD

Mechanical Function of a Composite Nanofibrous Biomaterial Analogue of the Knee Meniscus Radial Inclusive of Radial Tie Fiber-Like Elements
Sonia Bansal, BS, Breanna Seiber, BS, Niobra Keah, MS, Robert Mauck, PhD, Miltiadis Zgonis, MD

Effects of Hypoxia and TGF- Exposure during Monolayer Expansion on the Survival and Matrix Producing Capacity of Mesenchymal Stem Cells
Sun Peck, PhD, Justin Bendigo, BS, Sarah Gullbrand, PhD, John Tobias, PhD, George Dodge, PhD, Robert Mauck, PhD, Neil Malhotra, MD, Lachlan Smith, PhD

Tendon & Ligament

Structural and In Vivo Functional Measures Predict Achilles Tendon Fatigue Mechanics During Healing
Snehal Shetye, PhD, Benjamin Freedman, PhD, George Fryhofer, MD, Corinne Riggin, BS, Joshua Gordon, MD, Stephen Thomas, PhD, Daniel Farber, MD Louis Soslowsky, PhD

Biceps Tenotomy in the Presence of a Supraspinatus Tear Alters the Adjacent Intact Tendons and Glenoid Cartilage
Zakary Beach, BS, Jennica Tucker, BS, Stephen Thomas, PhD, Katherine Reuther, PhD, Chancellor Gray, MD, Chang-Soo Lee, MD, David Glaser, MD, Louis Soslowsky, PhD

Achilles Tendon Mechanical and Compositional Properties Differ Drastically in Early Healing Between Repaired and Non-Repaired Tendons
Benjamin Freedman, PhD, Tyler Morris, MD, George Fryhofer, MD, Pankti Bhatt, BS, Nabeel Salka, BS, Daniel Farber, MD, Louis Soslowsky, PhD

Tendon Strain Stiffening is Reduced During Healing and High Magnitude Long Duration Dynamic Loading
Benjamin Freedman, PhD, Ashley Rodriguez, BS, Cody Hillin, MD, Stephanie Weiss, BS, Joseph Sarver, PhD, Louis Soslowsky, PhD

Effects of Pulsed Electromagnetic Field Therapy at Different Frequencies and Durations on Rotator Cuff Tendon-to-Bone Healing in a Rat Model
Julianne Huegel, PhD, Daniel Choi, BS, Courtney Nuss, Molly Minnig, Jennica Tucker, BS, Cody Hillin, MD, Andrew Kuntz, MD, Erik Waldorff, PhD, Nianli Zhang, James Ryaby, Louis Soslowsky, PhD

Poly-N-Acetyl Glucosamine (sNAG) Enhances Rotator Cuff Tendon Healing in a Rat Model
Courtney Nuss, Daniel Choi, BS, Julianne Huegel, PhD, Stephanie Weiss, BS, John Vournakis, Louis Soslowsky, PhD

Aging Leads to Inferior Achilles Tendon Mechanics and Altered Ankle Function in Rodents
Adam Pardes, BS, Ashley Rodriguez, BS, Benjamin Freedman, PhD, George Fryhofer, MD, Louis Soslowsky, PhD

Effect of Pro- and Anti-Angiogenic Factors on Vascular Response in the Rat Achilles Tendon after Injury
Corinne Riggin, BS, Susan Schultz, RDMS, Chandra Sehgal, PhD, Louis Soslowsky, PhD

Conditional Deletion of Decorin and Biglycan in Mature Mouse Tendons Results in Inferior Mechanical Properties and Delayed Collagen Fiber Realignment
Kelsey Robinson, MD, Carrie Barnum, MS, Stephanie Weiss, BS, Julianne Huegel, PhD, Snehal Shetye, PhD, Mei Sun, Sheila Adams, David Birk, PhD, Louis Soslowsky, PhD

Muscle Adapts Dynamically Following Acute Achilles Tendon Rupture in a Rat Model
Nabeel Salka, BS, Pankti Bhatt, BS, Benjamin Freedman, PhD, Tyler Morris, MD, Zakary Beach, BS, Joshua Gordon, MD, Louis Soslowsky, PhD

Department Updates

Letter from the Chairman
L. Scott Levin, MD, FACS

Letter from the Program Director
Craig Israelite, MD

Division Updates

Arthroplasty Division Update: Value Driven Readmission Mitigation for Hip and Knee Arthroplasty at Penn Medicine
Eric Hume, MD, Finnah Pio, Michele Fang, Laura Kosseim, MD

Foot & Ankle Division Update
Daniel Farber, MD

Hand Division Update
David Bozentka, MD

Paris to Penn Medicine: The First Trans-Atlantic Bilateral Hand Transplant
Erwin Kruger, MD, Oded Ben-Amotz, MD, and L. Scott Levin, MD, FACS

The Children’s Hospital of Philadelphia Division Update
Divya Talwar, PhD, MPH and John (Jack) Flynn, MD

Shoulder & Elbow Division Update
David Glaser, MD

Spine Division Update
Vincent Arlet, MD, Harvey Smith, MD

Sports Division Update: Dream Team Continues to Add Depth Across All Fields
Daniel Gittings, MD, John Kelly IV, MD, Brian Sennett, MD

Trauma Division Update
Blair Ashley, MD, Samir Mehta, MD, Jaimo Ahn, MD, PhD, Derek Donegan, MD

Orthopaedic Oncology Division Update
Kristy Weber, MD


CPL Michael J. Crescenz Veterans Affairs Medical Center Update
Marlene DeMaio, MD

Basic Science Research Updates

Council of Research Laboratories Established within Penn Orthopaedics
Michael Hast, PhD

Penn Center for Musculoskeletal Disorders
Louis Soslowsky, PhD

McKay Orthopaedic Research Laboratory
Robert Mauck, PhD, Louis Soslowsky, PhD

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

The Center for Research in FOP and Related Disorders
Eileen Shore, PhD, Frederick Kaplan, MD

Update on the Biedermann Lab for Orthopaedic Research
Michael Hast, PhD

Human Tissue Laboratory
Lorianne Kish

The Research Year: Looking Back
James Friedman, MD, Cody Hillin, MD, MS

Education Update

Where Are They Now? 10 Years After Graduating From Penn Orthopaedic Surgery Residency
Daniel Gittings, MD, Blair Ashley, MD

Home Town Heroes, International Outreach
Daniel Gittings, MD

The Implementation of an Intern Surgical Curriculum at Penn
Nicole Zelenski, MD, Nicholas Pulos, MD

Leadership Training: A Critical Aspect of Education
John Kelly IV, MD

Penn Orthopaedics and Penn MERT Team Up for Success
Daniel Klyde, EMT-B, Jaimo Ahn, MD, PhD, Derek Donegan, MD, Samir Mehta, MD

The University of Pennsylvania Orthopaedic Residency Curriculum
Joshua Gordon, MD, Michael Talerico, MD, Jason Anari, MD, Jonathan Dattilo, MD

Quality Improvement in the Department of Orthopaedic Surgery in the University of Pennsylvania Health System
Joshua Gordon, MD, Finnah Pio, Alex Neuwirth, MD, Eric Hume, MD

Visiting Professor Lecture Series

Visiting Professor Lecture Series: Joseph Hsu
Chelsea Hendow, MD

Visiting Professor Lecture Series: Kevin Chung
Liane Miller, MD

Visiting Professor Lecture Series: Judy Baumhauer
Matthew Webb, MD, MHS

Visiting Professor Lecture Series: Todd Albert
Christina Nypaver, MD

Chief Residents

Current Residents

Chiefs Corner