Volume 28, Spring 2018

Letter from the Editors
Michael Eby, MD and Adnan Cheema, MD

Dedication: Marvin Steinberg, MD
David Steinberg, MD

Letter from the Chair
L. Scott Levin, M, FACS

Letter from the Program Director
Craig Israelite, MD

In Memoriam: Dean Lorich, MD
David Helfet, MD

Faculty Updates

Faculty Awards and Appointments
Michael Eby, MD and Adnan Cheema, MD

Update: Penn Center for Musculoskeletal Disorders
Louis Soslowsky, PhD

2017 Penn Orthopaedics Cartilage Repair Symposium
Mackenzie Sennett

Division Updates

Orthoplastics Division Update
Stephen Kovach III, MD

Orthopaedic Trauma Division Update
Samir Mehta, MD

Spine Division Update
Vincent Arlet, MD

Sports Medicine Division Update
Brian Sennett, MD

Hand Division Update
David Bozentka, MD

Shoulder and Elbow Division Update
David Glaser, MD

Arthroplasty Division Update
Charles Nelson, MD

Foot and Ankle Update
Daniel Farber, MD

Oncology Division Update
Kristy Weber, MD

Children’s Hospital of Philadelphia Update
John Flynn, MD and Divya Talwar, PhD, MPH

Clinical Research


Tips & Tricks: Soft Tissue Reconstruction of the Complicated Knee Arthroplasty: Principles and Predictors of Salvage
David Colen, MD, Martin Carney, BS, Valeriy Shubinets, MD, Michael Lanni, MD, Tiffany Liu, BS, L. Scott Levin, MD, Gwo-Chin Lee, MD and Stephen Kovach, MD

All Hope is Not Lost: Saving Limbs with the Orthoplastic Approach
Shaun Mendenhall, MD, Oded Ben-Amotz, MD, Joshua Mirrer, MD, Samir Mehta, MD, David Glaser, MD and L. Scott Levin, MD, FACS

Hand Transplantation in the Rat: Technical Refinements of the Rat Forelimb Vascularized Composite Allotransplantation Model
Shaoqing Feng, MD, PhD, Shaun Mendenhall, MD, Oded Ben-Amotz, MD, Joshua Mirrer, MD, Ivan J. Zapolsky, MD, MS and L. Scott Levin, MD, FACS


Tips & Tricks: Preoperative Planning and Templating for Total Hip Arthroplasty
Matthew Sloan, MS, MD and Charles Nelson, MD

Increasing Rates of Obesity, Diabetes, and Depression Prevalence Among Primary and Revision Total Joint Arthroplasty from 2002-2014
Mark Hasenauer, MD, Matthew Sloan, MS, MD, Amanda Warkow and Neil P Sheth, MD

Prophylactic Tibial Stem Fixation in the Obese: Comparative Early Results in Primary Total Knee Arthroplasty
Joshua Steere, MD, Michael Sobieraj, MD, PhD, Christopher DeFrancesco, BS, Craig Israelite, MD, Charles Nelson, MD and Atul Kamath, MD

A Computational Modeling Approach to Optimize Cup Coverage and Minimize Impingement Risk Using Subject-Specific Activities of Daily Living
Josh Baxter, PhD, Jenna Bernstein, MD, Neza Stefanic and Michael Hast, PhD

Clinically relevant knee motion is accurately measured with a self-calibrated wearable sensor
Todd Hullfish, BSME, Annelise Slater, Brendan Stoeckl, Peter Gebhard, MS, Feini Qu, PhDand Josh Baxter, PhD

Foot & Ankle

Tips & Tricks: The Scandinavian Total Ankle Replacement (STAR): Design Evolution and Clinical Results
Ryan Charette, MD and Kathryn O’Connor, MD

Chronic Nicotine Exposure Alters Tendon Vascularity and Viscoelasticity
Daniel Gittings, MD; Corinne Riggin; James Boorman-Padgett, MS; Stephanie Weiss; George Fryhofer, MD; Daniel Farber, MD; David Steinberg, MD and Louis Soslowsky, PhD

Effect of Pulsed Electromagnetic Field Therapy on Healing in a Rat Achilles Tendon Partial Tear Model
James Boorman-Padgett, Julianne Huegel, Courtney Nuss, Molly Minnig, Andrew Kuntz, MD, E. Waldorff, N. Zhang, J. Ryaby and Louis Soslowsky, PhD

Modulation of Vascular Response after Injury in the Rat Achilles Tendon Alters Healing Capacity
Corinne Riggin, Ashley Rodriguez, Stephanie Weiss, Harina Raja, Mengcun Chen, Susan Schultz, Chandra Sehgal and Louis Soslowsky, PhD

Achilles Tendon Structure in Distance Runners does not Change Following a Competitive Season
Todd Hullfish, BSME, Kenton Hagan, Ellen Casey and Josh Baxter, PhD

Hand Surgery

Tips & Tricks: Local Anesthetic Techniques for the Hand
Rikesh Gandhi, MD, Ivan Zapolsky, MD, and Benjamin Gray, MD

CT Scans Oriented Along the Longitudinal Scaphoid Axis Do Not Change Surgical Management of Scaphoid Fractures
Adnan Cheema, MD, Paul Niziolek, David Steinberg, MD, Bruce Kneeland, MD, Nikolas Kazmers, MD, and David Bozentka, MD

The Porcine Accessory Carpal as a Model for Biologic Joint Replacement for Trapeziometacarpal Osteoarthritis
Brendan Stoeckl, Michael Hast, PhD, Mackenzie Sennett, Minwook Kim, PhD, Michael Eby, MD, Thomas Schaer, BS, VMD, Robert Mauck, PhD and David Steinberg, MD

Orthopaedic Oncology

Tips & Tricks: Determinant and Indeterminate Lesions: When is Biopsy Necessary?
Nicole Zelenski, MD and Kristy Weber, MD

Pediatric Orthopaedics

Tips & Tricks: Atraumatic foot drop: A case report of an intraneural peroneal ganglion cyst
Liane Miller, MD, Amirhossein Misaghi, Apurva Shah, MD and Alexandre Arkader, MD

Preliminary Mechanical and Ultrastructural Characterization of Pediatric Anterior Cruciate Ligaments and Tendons Used for Reconstruction
Elaine Schmidt, Theodore Ganley MD, Kevin Shea and Michael Hast, PhD

Trends in the Surgical Management of Osteochondritis Dissecans of the Knee at a High-Volume Pediatric Hospital Network
Scott LaValva, Eileen P. Storey, James Carey, MD, Kevin G. Shea, John Polousky and Theodore Ganley, MD

Type IV Tibial Spine Fractures Revisited: Arthroscopic Treatment and Outcomes for an Uncommon Injury
Alexander Adams, Taylor Jackson, Itai Gans, Julien Aoyama, Theodore Ganley, MD

Evidence-Based Orthopaedics: Current Concepts, Principles, and Practice
Jigar Gandhi, Julien Aoyama and Theodore Ganley, MD

IM Nails vs. Plate and Screws in Radial/Ulnar Fractures
Jermonte Lowe, Julien Aoyama, Tyrell Young-Hamilton and Lawrence Wells, MD

Shoulder & Elbow

Tips & Tricks: The Saline Load Test is Effective in Detecting Traumatic Arthrotomies of the Shoulder
Daniel Gittings, MD, Jonathan Dattilo, MD, George Fryhofer, MD, Michael Hast, PhD and Samir Mehta, MD

Rotator Cuff Repair: An Opportunity for Improved Efficiency, Cost-Effectiveness and Ultimately, Cost Savings
Zachary Zimmer, MD, Deepak Chona, MD, Andrew Kuntz, MD, Russell Huffman, MD and David Glaser, MD

Assessing the Contribution of the Central Screw to Glenoid Baseplate Fixation in the Presence of Osteopenic Bone
Michael Hast, PhD, Matthew Chin, PhD, Elaine Schmidt, Anthony Cresap and Andrew Kuntz, MD

Aging Related Degenerative Mechanical Changes Manifest Earlier in Supraspinatus Tendons
Joseph Newton, George Fryhofer, MD, Snehal Shetye, PhD Ashley Rodriguez, Andrew Kuntz, MD and Louis Soslowsky, PhD

Biceps Detachment Alters Joint Function and Tendon Mechanical Properties in a Chronic Massive Rotator Cuff Tear Rat Model
Mengcun Chen, Snehal Shetye, PhD, Julianne Huegel, Daniel Gittings, MD, Courtney Nuss, Stephanie Weiss, Andrew Kuntz, MD and Louis Soslowsky, PhD


Indirect Decompression Progresses Substantially after Immediate Postoperative Period following Lateral Lumbar Interbody Fusion
Matthew Webb, MD, Michael Eby, MD and Michael Murray, MD

Risk Factors for Surgical Site Infections after Posterior Spinal Fusion in Neuromuscular and Cerebral Palsy Scoliosis Patients: A Retrospective ACS NSQIP Pediatric Database Analysis
Alexander Adams, Nariman Oyoun, David Spiegel, MD and Keith Baldwin, MD

Development of Disc-Like Angle Ply Structures for Total Disc Replacement at Clinically Relevant Size Scales
Sarah Gullbrand, PhD, Dong Hwa Kim, PhD, Edward Bonnevie, PhD, Beth Ashinsky, Dawn Elliott, PhD, Lachlan Smith, PhD, Robert Mauck, PhD and Harvey Smith, MD

The Effect of Remobilization on the In Vivo Function of an Endplate-Modified Engineered Disc
Sarah Gullbrand, PhD, Beth Ashinsky, Dong Hwa Kim, PhD, Lachlan Smith, PhD, Dawn Elliott, PhD, Harvey Smith, PhD and Robert Mauck, PhD

TGF-b Improves Cell Viability in Human-Sized Disc-Like Angle Ply Structures (DAPS)
Dong Hwa Kim, PhD, Sarah Gullbrand, PhD, Dawn Elliott, PhD, Lachlan Smith, PhD, Harvey Smith MD and Robert Mauck, PhD

Nucleus Pulposus Cells have Epithelial Cell-Like Cytoskeleton and Highly Express N-Cadherin
Robert Tower, Zuozhen Tian, Brian Cosgrove, Robert Mauck, PhD, Ling Qin, PhD, Motomi Enomoto-Iwamoto and Yejia Zhang, PhD


Tips & Tricks: Concurrent Unicompartmental Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction
Agnes Dardas, MD, Msc, Anthony Martin, Atul Kamath, MD and James Carey, MD, MPH

Computational Optimization of Graft Tension in Simulated Superior Capsule Reconstructions
Michael Hast, PhD, Elaine Schmidt, MS, John Kelly IV, MD and Josh Baxter, PhD

Treatment of Focal Cartilage Defects of the Knee: An International Survey
Victor Qi, Julien Aoyama, Theodore Ganley, MD and James Carey, MD, MPH

Loss of Tension Increases Meniscus Degradation in a Degradative Microenvironment
Sonia Bansal, Edward Bonnevie, PhD, Sai Mandalapu, Robert Mauck, PhD and Miltiadis Zgonis MD

Single Cell Imaging of Col1/Col2 Fluorescent Reporters in the Murine Meniscus Reveals Marked Spatial Heterogeneity
Tonia Tsinman, Xi Jiang, Robert Mauck, PhD and Nathaniel Dyment, PhD


Tips & Tricks: Semiextended Suprapatellar Intramedullary Nailing of the Tibia
Mark Hasenauer, MD and Samir Mehta, MD

Additional Screw Use in Olecranon Fracture Reconstruction Changes Failure Mode During Fatigue Testing
Samir Mehta, MD, Matthew Chin, Jennifer Sanville, Surena Namdari, MD and Michael Hast, PhD

Reconstructing Proximal Humerus Fractures with Locking Plates: Don’t Miss High?
Samir Mehta, MD, Matthew Chin, Jennifer Sanville, Surena Namdari, MD and Michael Hast, PhD

Prior Focal Radiation Causes Atrophic Nonunion Fracture in Mice
Luqiang Wang, Abhishek Chandra, Robert J Tower, PhD, Jaimo Ahn, PhD, Yejia Zhang, PhD and Ling Qin, PhD

Delirium Reduced with Intravenous Acetaminophen in Geriatric Hip Fracture Patients
Keith Connolly, MD, Rachel Kleinman, MSHA, Kim Stevenson, MD, Mark Neuman, MD and Samir Mehta, MD

Basic Science Research


Notch signaling in osteoclasts is essential for resorption, but dispensable for osteoblast coupling
Peeyush Goel, PhD, John Hebb, Esq, Gurpreet Kaur, Kurt Hankenson, DVM, PhD, Jaimo Ahn, MD, PhD and Jason Ashley, PhD

Osteoprogenitor YAP and TAZ Promote Bone Fracture Repair
Christopher Kegelman, Joseph Collins, Devon Mason, and Joel D. Boerckel, PhD

Microarchitectural Adaptations in Rat Maternal Bone Induced by Pregnancy and Lactation Exert Protective Effects against Future Estrogen Deficiency
Chantal de Bakker, Laurel Leavitt, Hongbo Zhao, Yihan Li, MSE, Casey Krickus, Mengting Huang, Wei-Ju Tseng, MSE and X. Sherry Liu, PhD

Scleraxis Targeted Collagen V Deletion Affects Bone Morphology with Altered Skeletal Loading
Ashley Rodriguez, Snehal Shetye, PhD, Brianne Connizzo, Julianne Huegel, PhD, Wei-Ju Tseng, MSE, David Birk, PhD and Louis Soslowsky, PhD

Alternating Parathyroid Hormone (PTH) and Alendronate Treatment Regimens Further Improve the Efficacy of Daily and Cyclic PTH Regimens in Osteoporosis Therapy
Hongbo Zhao, Wei-Ju Tseng, MSE, Tien-Jung Lee, Wonsae Lee, Yihan Li, MSE, Chantal de Bakker, Thomas Leah and X. Sherry Liu, PhD


Roles of Collagen V in the Structure and Mechanics of TMJ Condyle Cartilage: A Fibro-Hyaline Hybrid
Prashant Chandrasekaran, Qing Li, Chao Wang, Mei Sun, Louis Soslowsky, PhD, David Birk, PhD and Lin Han, PhD

Meniscus Cell Migration Through Dense Fibrous Networks Is Regulated By Nuclear Mechanics
Su-Jin Heo, PhD, Kwang Hoon Song, Xuan Cao, Breanna Seiber, Vivek Shenoy, PhD, Jason A. Burdick, PhD and Robert Mauck, PhD

Biocompatibility and Bioactivity of an FGF-Loaded Microsphere-Based Bilayer Delivery System
Dong Hwa Kim, PhD, Julianne Huegel, Courtney Nuss, Stephanie Weiss, Louis Soslowsky, PhD, Robert Mauck, PhD and Andrew Kuntz, MD

In Vivo Translation of an Injectable Chondrocyte-Laden Micro-Scale ‘Noodle’ to Promote Cartilage Repair
Minwook Kim, PhD, Mackenzie Sennett, Blair Ashley, MD, Brendan Stoeckl, Eiki Koyama, James Friedman, MD, Alexander Neuwirth, MD, Elizabeth Henning, Nancy Pleshko, PhD, Jason Burdick, PhD, David Steinberg, MD and Robert Mauck, PhD

Resorbable Pins Enhance Retention of Nanofibrous Scaffolds in a Porcine Focal Chondral Defect Model
Mackenzie Sennett, Blair Ashley, MD, Jay Patel, PhD, James Friedman, MD, Robert Spiro, Jason Burdick, PhD, James Carey, MD, George Dodge, PhD and Robert Mauck, PhD


Induced Deletion of Biglycan in Mature Tendon Reveals a Surprising Role during Adulthood
Zachary Beach, Kelsey Robinson, MD, Ashley Rodriguez, Snehal Shetye, PhD, Stephanie Weiss, TH Adams, Sheila Adams, Mei Sun, David Birk, PhD and Louis Soslowsky, PhD

Gender Dependent Alterations in the Mechanical Response of Collagen V Haploinsufficient Murine Tendons
Jaclyn Carlson, Snehal Shetye, PhD, Ashley Rodriguez, Jessica Johnston, Mei Sun, Sheila Adams, David Birk, PhD and Louis Soslowsky, PhD

Predicting Multiscale Strain Transfer and ECM Stress Transmission during Healing and Dynamic Loading in Tendon
Benjamin Freedman, PhD, Ehsan Ban, Ashley Rodriguez, Joseph Newton, Ryan Leiphart, Vivek Shenoy and Louis Soslowsky, PhD

Collagen GFP Reporter Mice Reveal Unique Subsets of Cells Within The Tendon Midsubstance
Xi Jiang, Courtney Thompson, Pegah Abbasnia, Nicholas Oyster and Nathaniel Dyment, PhD

RNAseq-based Analysis of Differential Gene Expression Associated with Tendon Injury in the Mouse Achilles Injury Model
Kairui Zhang, Sohtaroh Izumi, Masatake Matsuoka, Ngozi Akabudike, John Tobias, Louis Soslowsky, PhD, Masahiro Iwamoto and Motomi Enomoto-Iwamoto

Prolonged Release of Ibuprofen from a Nanofibrous Delivery System Under Physiological Conditions
Brittany Taylor, PhD, Dong Hwa Kim, PhD, Corinne Riggin, PhD, Julianne Huegel, PhD, Andrew Kuntz, MD, Louis Soslowsky, PhD, Robert Mauck, PhD and Joseph Bernstein, MD