Volume 29, Spring 2019

Letter from the Editors
Liane Miller, MD and Matthew Counihan, MD

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

Letter from the PD
Craig Israelite, MD

Dedication: Dr. Paul A. Lotke
Matthew Counihan, MD

In Memoriam: Dr. Robert Campbell
John M. Flynn, MD


Leadership Curriculum
John Kelly IV, MD

Quality Improvement
Eric Hume, MD, Hannah Lacko, and Luke Lopas, MD

Delivering Orthopaedic Care in Sub-Saharan Africa: An Update on Tanzania
W. Mack Hardaker, MS and Neil P. Sheth, MD

Protecting Our Patients Against the Opioid Endemic: Doing Our Part at Penn Orthopaedics
Matthew Counihan, MD, Krista Tarducci, MSN, RN, and Jaimo Ahn, MD, PhD, FACS

Faculty Updates

Faculty Achievements
Liane Miller, MD

Cartilage Symposium
Liane Miller, MD

Penn Center for Musculoske letal Disorders Symposium
Liane Miller, MD

Division Updates

Orthopaedic Trauma Division Update
Samir Mehta, MD

Spine Division Updates
Harvey Smith, MD

Sports Division Update
Brian Sennett, MD

Hand Division Update
David Bozentka, MD

Shoulder and Elbow Division Update
David Glaser, MD

Arthroplasty – Faculty

Foot Ankle Division Update
Keith Wapner, MD

Orthopaedic Oncology Division Update
Kristy Weber, MD

Neuro-orthopaedics Division Update
Keith Baldwin, MD, MPH, MSPT and David Spiegel, MD

Orthoplastics Division Update
Stephen Kovach III, MD

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

Resident and Fellow Updates

Chief’s Corner: Academic Chief Update
Luke A. Lopas, MD, Kristin L. Buterbaugh, MD, and Nicole A. Zelenski, MD

Alumni Residents: Where Are They Now?
Matthew Counihan, MD

Visiting Professor Series 2018-2019

Current Residents

Current Fellows

Clinical Research


Tips & Tricks: Cortical Replacing Screws for Reducing Proximal-Third Tibial Shaft Fractures
Agnes Z. Dardas, MD, MSc and Samir Mehta, MD

Characterizing the Mechanical Effects of Bone Substitute Material and Far-Cortical Locking Techniques in Proximal Humerus Fracture Reconstructions: A Cadaveric Study
Michael W. Hast, PhD, Matthew Chin, BS, Elaine C. Schmidt, MS, Jennifer Sanville, G. Karl Van Osten, MD, Samir Mehta, MD

Cost Comparison of Sliding Hip Screw (SHS) and Cephalomedullary Nails (CMN) for the Treatment of Stable Intertrochanteric Hip Fractures
Logan Brock, BS, Nicole Zelenski, MD, Ryan Charette, MD, Samir Mehta, MD

Parameterization of Proximal Humerus Locking Plate Impingement with In Vitro, In Silico, and In Vivo Techniques
Emily Bachner, BS, Elaine C. Schmidt, MS, Matthew Chin, BS, Surena Namdari, MD, Josh R. Baxter, PhD, Michael W. Hast, PhD

Mechanical Behavior of Additive Manufactured Proximal Humerus Fracture Fixation Plate: Experimental Study on Unstable 3-Part Fractures with Osteoporosis
Maryam Tilton, BS, April Armstrong, MD, MSc, Jennifer Sanville, Matthew Chin, BS, Michael W. Hast, PhD, Gregory S. Lewis, PhD, Guha Manogharan, PhD

Estimating Micromotion in Distal Femur Fracture Reconstructions: A Lightweight Computational Framework
Michael W. Hast, PhD, Elaine C. Schmidt, MS, Samir Mehta, MD, Josh R. Baxter, PhD

Direct and Indirect Costs of Ankle Fracture Fixation Between Two Surgical Departments
Elizabeth Duckworth, BA, Kimberly Stevenson, MD, Samir Mehta, MD, Derek Donegan, MD, MBA

Classical Beam Theory Provides Reasonable Estimates of Interfragmentary Motion in Dynamic Simulations of Distal Femur Fracture Reconstructions
Josh R. Baxter, PhD, Elaine C. Schmidt, MS, Samir Mehta, MD, Michael W. Hast, PhD


Tips & Tricks: Increasing Sacropelvic Fixation with the “Four Rods” Technique in Parkinson’s-Related Camptocormia
Andrew Tyler, MD, PhD, Vincent Arlet, MD

Evaluation of a Human-Scale Tissue Engineered Intervertebral Disc in a Large Animal Model
Sarah E. Gullbrand, Beth G. Ashinsky, Edward D. Bonnevie, Dong Hwa Kim, Lachlan J. Smith, Dawn M. Elliott, Thomas P. Schaer, Harvey E. Smith, Robert L. Mauck

Inflammatory Cytokine Expression in a Goat Model of Intervertebral Disc Degeneration
Chenghao Zhang, Sarah E. Gullbrand, Thomas P. Schaer, Dawn M. Elliot, George R. Dodge, Robert L. Mauck, Neil R. Malhotra, Lachlan J. Smith

Non-Invasive Imaging of Therapeutic Cells Delivered Percutaneously to the Mouse Intervertebral Disc
Chenghao Zhang, Sun H. Peck, Justin R. Bendigo, Yian Kai A. Lau, Neil R. Malhotra, Lachlan J. Smith


Tips and Tricks: Endoscopic Fasciotomy for Exertional Compartment Syndrome
Matt Webb, MD, Brian Sennett, MD

Anterolateral and Anterior Cruciate Ligament Reconstruction in the Young Athlete: When Should Both Be Considered?
Scott M LaValva, BA, Theodore J Ganley, MD

Macro- and Micro-Scale Changes in Meniscus and Cartilage in a Large Animal Model of Meniscal Injury
Sonia Bansal, BS, Jay M. Patel, PhD, Michael Eby, MD MS, Kevt’her Hoxha, BS, Mackenzie L. Sennett, Kamiel S. Saleh, BS, Brendan D. Stoeckl, MSE BSE, Anthony R. Martin, BSE, Liane M. Miller, MD, Dawn M. Elliott, PhD, Michael W. Hast, PhD, Lin Han, PhD, Miltiadis H. Zgonis, MD, Robert L. Mauck, PhD

Reverse Total Shoulder Arthroplasty: Impressive Recent Increase in Utilization
Alex M Beschloss, BA, John D Kelly IV, MD

What’s New in Tibial Spine Fractures? A Review of the Literature from 2017 to 2019
Blake C Meza, BS, Julien T Aoyama, BA, Sprikena Nako, Theodore J Ganley, MD


Tips and Tricks: Treatment of a Volar Coronal Shear Lunate Fracture with Midcarpal Instability
Viviana Serra Lopez, MD, MS, David Falk, MD, Brittany Behar, MD, Daniel Gittings, MD, David Steinberg MD

Low profile volar rim plates do not Prevent Flexor Pollicus Longus Tendon Wear Compared to Distally Placed Conventional Plate
Nicole A. Zelenski, MD, Elaine Schmidt, BA, Daniel Gittings, MD, David Steinberg, MD, Michael Hast, PhD

Design and Implantation of an Engineered Porcine Accessory Carpal Osteochondral Unit
Brendan Stoeckl, MS, Hannah Zlotnick, BS, Megan Farrell, PhD, Liane Miller, MD, Thomas Schaer, VMD, Michael Hast, PhD, Robert Mauck, PhD, David Steinberg, MD


Tips & Tricks: Management of Pediatric Capitellar Fractures
Brandon Haghverdian MD, Apurva S. Shah MD, Alexandre Arkader MD

Duration of Legg-Calvé-Perthes Disease Stages in Children Under Four Years of Age at Disease Onset
Jigar S. Gandhi, PharmD, Arianna Trionfo, MD, Wudbhav N. Sankar, MD

Force Variability in a Classic Distraction Technique
Vincent Ruggieri, BS, Patrick J Cahill, MD, John M Flynn, MD, Robert M Campbell, MD, Jason B Anari, MD

Fracture Healing in Pediatric Patients with Neurofibromatosis Type 1: A Case Series and Review of the Literature
Daniel J. Miller, MD, Todd J. Blumberg, MD, Susan E. Nelson, MD MPH, Wudbhav N. Sankar, MD

Mechanical and Microstructural Properties of Native Pediatric Posterior Cruciate and Collateral Ligaments
Elaine C. Schmidt, Matthew Chin, Julien T. Aoyama, Theodore J. Ganley, Kevin G. Shea, Michael W. Hast

Simultaneous Bilateral Femur Fractures in Children: A Case Series from a Pediatric Level I Trauma Center and Review of the Literature
Ronit Shah, BS, Daniel J. Miller, MD, Mahmoud Abo-elm Mahmoud, MD, Alexandre Arkader, MD

Tibial Spine Fractures in Children: Is there Historical and Geographic Variability in Epidemiology?
Scott M LaValva, BA, Julien T Aoyama, BA, Sprikena Nako, Alexander J Adams, BS, Theodore J Ganley MD

Shoulder and Elbow

Loss of Elbow Flexion in Congenital Arthrogryposis Treated with a Bipolar Latissimus Transfer
Matthew Stein, MS, MD, Blair Ashley, MD, David Falk, MD, Daniel Gittings, MD, David Glaser, MD, Lawrence Scott Levin, MD, FACS

Localized Delivery of Ibuprofen via a Bilayer Delivery System (BiLDS) for Supraspinatus Tendon Healing in a Rat Model
Brittany L. Taylor, Dong Hwa Kim, Julianne Huegel, Sophie J. Burkholder, Stephanie N. Weiss, Courtney A. Nuss, Harina A. Raja, Louis J. Soslowsky, Robert L. Mauck, Andrew F. Kuntz, Joseph Bernstein

Reproduction and Lactation Lead to Long-Term Changes in Supraspinatus Tendon and Humeral Trabecular Bone Properties in a Rat Model
Ashley K. Fung, Yihan Li, Thomas P. Leahy, Snehal S. Shetye, X. Sherry Liu, Louis J. Soslowsky


Short-Stay Total Joint Arthroplasty: The Way Forward?
Joseph Koressel, MD, Neil P. Sheth, MD

Post-Traumatic Arthritis Increases Total Knee Arthroplasty Complication Rates
Chelsea Hendow, MD, MS, Matthew Sloan, MD, MS, Neil P. Sheth, MD

Albumin as a Predictor of Total Joint Arthroplasty Complications: A Systematic Review
Chukwuemeka Mbagwu, BS, Matthew Sloan, MD, MS, Alexander L. Neuwirth MD, Keith D. Baldwin MD, MSPT, MPH, Atul F. Kamath MD, Bonnie Simpson Mason MD, Charles L. Nelson MD

Foot and Ankle

The Operative Management of Os Trigonum Syndrome in Dancers Through a Posteromedial Approach
Karim Mahmoud, MD, Sreenivasulu Metikala, MD, Viviana M. Serra López, MD MS, Wen Chao, MD

A Novel Technique of Triplane Tarsometatarsal (TMT) Joint Corrective Arthrodesis in Hallux Valgus
Karim Mahmoud, MD, Sreenivasulu Metikala, MD, Daniel C. Farber, MD

Automated Fascicle Tracking to Characterize Changes in Muscle Architecture During Isokinetic Contractions
John F. Drazan, Todd J. Hullfish, Josh R. Baxter

Functional Deficits Following Aacute Achilles Tendon Rupture are Correlated with Changes in Muscle Structure
Todd J. Hullfish, Kathryn M. O’Connor, MD, Josh R. Baxter, PhD

Plantarflexor Torque and Work is Positively Correlated with Medial Gastrocnemius Fascicle Length in Healthy Adults
John F Drazan, Todd J Hullfish, Josh R Baxter

Simulated Single-Leg Heel Raise Function is Governed Primarily by Optimal Fiber Length
Josh R. Baxter, Daniel C. Farber, Michael W. Hast


Tips and Tricks: Vascularized Free Fibula Intercalated Graft for Humeral Shaft Reconstruction after Ewing’s Sarcoma Resection
Kelsey Bonilla, MD, Alexandre Arkader, MD


Bilateral Navicular Osteonecrosis Treated with Medial Femoral Condyle Vascularized Autograft
Ivan J. Zapolsky, MD, Christopher R. Gajewski, BA, Matthew Webb, MD, Keith L. Wapner, MD, L. Scott Levin MD

Medial Femoral Condyle Free Flap Reconstruction of Complex Foot and Ankle Pathology
John T. Stranix MD, Merisa Piper MD, Said Azoury MD, Oded Ben-Amotz MD, Keith L. Wapner MD, L. Scott Levin MD

Cervical Spine Fusion After Osteomyelitis Using Vascularized Free Fibula Autograft
Brittany Behar, MD, Chelsea Hendow, MD, Merisa Piper, MD, L. Scott Levin, MD


Influence of Interviewer Number on Applicant Rank Position
Joshua T. Bram BS, James Bernstein, Derek J. Donegan MD, Kevin Pirruccio BA, Jaimo Ahn MD, PhD

Levels of Influence in Orthopaedic Surgery Journals Vary by Specialty
Meghan L. Morley, MD, Sara Weintraub, BA, Jaimo Ahn, MD, PhD, Joseph Bernstein, MD

Basic Science Research


Deciphering the in vivo Heterogeneity of Mouse Bone Marrow Mesenchymal Progenitors at Single Cell Resolution
Leilei Zhong, Robert J Tower, Jihwan Park, Luqiang Wang, Rojesh Shrestha, Patrick Seale, Kaitlin Susztak, Ling Qin

Lithium Treatment Improves Vertebral Trabecular Bone Architecture in Mucopolysaccharidosis I Dogs during Postnatal Growth
Sun H. Peck, Yian Khai A. Lau, Justin R. Bendigo, Megan Lin, Toren Arginteanu, Jessica H. Bagel, Patricia O’Donnell, Neil R. Malhotra, Peter S. Klein, Eileen M. Shore, Margret L. Casal, Lachlan J. Smith


An Engineered Biomaterial Microenvironment to Direct the Formation of a Living Barrier to Seal Cartilage Defects
Jay M Patel, PhD, Claudia Loebel, MD, PhD, Brian C Wise, BS, Kamiel S Saleh, BS, James L Carey, MD, MPH, Jason A Burdick, PhD, Robert L Mauck, PhD

Developing a Biologic Replacement for the Porcine Accessory Carpal as a Model for the Treatment of Thumb OA
Brendan Stoeckl, Hannah Zlotnick, Michael Hast, Mackenzie Sennett, homas Schaer, Robert Mauck, David Steinberg

Dual Biofactor Release from Acellular Hyaluronic Acid Scaffolds for Cartilage Repair in a Pig Model
Anthony Martin, BSE, Jay Patel, PhD, Michael Eby, MD, Mackenzie Sennett, BS, Hannah Zlotnick, BSE, Kamiel Saleh, BSE, Andrew Chang, BS, Matthew Davidson, PhD, James Carey, MD, Jason Burdick, PhD, Robert Mauck, PhD

The Impact of Matrix Stiffness and O-GlcNAcylation on YAP Nuclear Localization and Matrix Deposition in Mesenchymal Stem Cells
Ryan Daniels, Claudia Loebel, Thea Ornstein, Jason Burdick, Robert Mauck

The Regulatory Role of EGFR Signaling in Adult Cartilage Homeostasis and Osteoarthritis
Yulong Wei, Xiaoyuan Ma, Hao Sun, Biao Han, Lin Han, Motomi Enomoto-Iwamoto, Ling Qin


Collagen VI Plays an Important Role in FDL Tendon Mechanics that is Distinct from the Role of Biglycan
Ryan J Leiphart, Snehal S Shetye, Hai Pham, Stephanie N Weiss, Marian F Young, Louis J Soslowsky

Differential Roles for Decorin and Biglycan in Tendon Aging
Beach ZM, Dekhne M, Rodriguez AR, Weiss SN, Shetye SS, Adams TH, Adams SM, Sun M, Birk DE, Soslowsky LJ

Effects of Aging on the Molecular Profile of Cultured Tendon Cells
Carrie E. Barnum, Julianne Huegel, Louis J. Soslowsky, Andrew F. Kuntz

Effects of Pulsed Electromagnetic Field Therapy on Healing in a Rat Achilles Tendon Partial Width Injury Model Without Immobilization
Boorman-Padgett JF, Huegel J, Nuss CA, Minnig MCC, Raja HA, Kuntz AF, Waldorff EI, Zhang N, Ryaby JT, Soslowsky LJ

Estrogen Deficiency and Intermittent Parathyroid Hormone Treatment Affect Regional Achilles Tendon Vessel Microarchitecture
Thomas P. Leahy, Benjamin R. Freedman, Wei-Ju Tseng, Snehal S. Shetye, X. Sherry Liu, Louis J. Soslowsky

Female Rat Supraspinatus Tendon Mechanical Properties Exhibit a Differential Response to Estrogen- Deficiency Depending on Reproductive History
Ashley K. Fung, Snehal S. Shetye, Chantal M. de Bakker, Yihan Li, X. Sherry Liu, Louis J. Soslowsky

Gender Dependent Alterations in the Mechanical Response of Injured Collagen V Haploinsufficient Murine Tendons
Carlson JA, Johnston JM, Bonilla KA, Shetye SS, Nuss CA, Weiss SN, Rodriguez AB, Birk DE, Soslowsky LJ

Quantitative Comparison of Three Rat Models of Achilles Tendon Injury: A Multidisciplinary Approach
Huegel J, Boorman-Padgett JF, Nuss CA, Minnig MCC, Kuntz AF, Waldorff E, Zhang N, Ryaby JT, Soslowsky LJ

Ultrasound Echogenicity is Associated with Fatigue Damage of Achilles Tendon in a Cadaveric Loading Model
Elaine C. Schmidt, Todd J. Hullfish, Michael W. Hast, Josh R. Baxter