Laith M Jazrawi, M.D.

Advances in magnetic resonance imaging of articular cartilage
Jazrawi, Laith M; Alaia, Michael J; Chang, Gregory; Fitzgerald, Erin F; Recht, Michael P
2011 Jul;19(7):420-429, Journal of the American Academy of Orthopaedic Surgeons
The pathology, assessment, and management of articular cartilage lesions of the hip and knee have been the subject of considerable attention in the recent orthopaedic literature. MRI has long been an important tool in the diagnosis and management of articular cartilage pathology, but detecting and interpreting early cartilaginous degeneration with this technology has been difficult. Biochemical-based MRI has been advocated to detect early cartilaginous degenerative changes and assess cartilage repair. Techniques such as T2 mapping, T1rho (ie, T1 in the rotating frame), sodium MRI, and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) take advantage of changes in the complex biochemical composition of articular cartilage and may help detect morphologic cartilaginous changes earlier than does conventional MRI. Although the newer modalities have been used primarily in the research setting, their ability to assess the microstructure of articular cartilage may eventually enhance the diagnosis and management of osteoarthritis
— id: 135561, year: 2011, vol: 19, page: 420, stat: Journal Article,

Intra-articular hyaluronic acid: potential treatment of younger patients with knee injury and/or post-traumatic arthritis
Jazrawi, Laith M; Rosen, Jeff
2011 May;39(2):107-113, Physician & Sportsmedicine
Anterior cruciate ligament (ACL) and meniscal injuries are common in both athletes and the general population. Such injuries may lead to early-onset post-traumatic osteoarthritis (OA) in 50% to 60% of patients, regardless of whether patients had reconstruction performed. In younger patients, intra-articular (IA) injection of hyaluronic acid (HA) may be useful for improving short-term outcomes and possibly slowing or arresting the progression of OA. Hyaluronic acid has anti-inflammatory, anabolic, and chondroprotective effects, which have been demonstrated in in vitro and animal models of meniscal and ACL injury. Results from several clinical trials and patient series have demonstrated the benefit of IA HA injection in younger patients with acute knee damage, including symptomatic meniscal tears and isolated ACL injury with chondral injury, although evidence for this is less extensive than the large database supporting the use of IA HA injection in older patients with knee OA. Administration of HA has been shown to improve outcomes in patients undergoing knee arthroscopy, and IA HA also has direct antinociceptive effects that may contribute to its benefit in patients with patellofemoral pain. However, the use of IA HA in patients with ACL injury or early OA has been evaluated in only a few studies. Thus, there is a need for larger-scale randomized controlled trials with longer durations of follow-up to provide more definitive evaluation of the efficacy and safety of IA HA in these patients. Such studies provide an opportunity to further elucidate the benefits of IA HA in younger patients with knee damage and may result in appropriate expansion of use in this large population, which has a substantial need for new treatment alternatives
— id: 134462, year: 2011, vol: 39, page: 107, stat: Journal Article,

Suture loosening and its effect on tendon fixation in knotless double-row rotator cuff repairs
Kummer, Frederick; Hergan, David J; Thut, David C; Pahk, Brian; Jazrawi, Laith M
2011 Nov;27(11):1478-1484, Arthroscopy
PURPOSE: We have occasionally observed suture loosening in initial suture legs after final fixation of adjacent suture legs in the lateral row of rotator cuff repairs during arthroscopic rotator cuff repair with transosseous-equivalent suture-bridge constructs. We sought to determine how this occurred and what effects it had on tendon fixation stability. METHODS: Six pairs of fresh-frozen human shoulders were prepared with a simulated cuff defect. A suture-bridge repair was performed in each specimen with one of each pair randomized to one type of 'knotless' lateral-row screw-in anchor and the other of the pair to a knotless push-in type. The repairs were cyclically loaded with 100 N for 1,000 cycles. Suture leg tensions were measured during the repair and after cycling. Lateral tendon laxity was measured before and after cycling. A pilot study on the effect of suture tension on the tendon contact footprint was also performed. RESULTS: The initial suture legs did not show a decrease in tension after the second lateral-row anchor was secured. Tension of the suture legs after cycling showed that no one leg loosened more than another; however, they all loosened when compared with total suture tensions before cycling (0.1 to 1.0 mm, P = .008). There was no significant difference between suture tension changes for the 2 anchor types after cycling (P = .140). Although the lateral tendon laxity increased slightly (0.04 mm) after cycling, this was not significant (P = .245), nor was there a difference between anchor types. CONCLUSIONS: Suture loosening occurred after cycling these rotator cuff repairs, but this did not appear to affect lateral tendon laxity for the 2 lateral anchor types studied, although medial tendon movement was observed. CLINICAL RELEVANCE: Suture loosening after cycling the 2 transosseous-equivalent suture-bridge repairs studied could affect the area and pressure of tendon-bone contact
— id: 140526, year: 2011, vol: 27, page: 1478, stat: Journal Article,

Irreducible anterior and posterior dislocation of the shoulder due to incarceration of the biceps tendon
Day, Michael S; Epstein, David M; Young, Brett H; Jazrawi, Laith M
2010 Jul;4(3):83-85, International journal of shoulder surgery. IJSS
Mechanical obstacles may infrequently impede closed reduction of anterior shoulder dislocation. Imaging techniques such as arthrography, computed tomography (CT) and magnetic resonance imaging (MRI) complement conventional radiography by allowing identification of obstacles to reduction. We present a case of irreducible anterior glenohumeral dislocation resulting from an initial anterior dislocation, converted to a posterior dislocation with an attempt at reduction, then converted back to anterior dislocation with a second reduction attempt. Soft tissue obstacles to shoulder reduction should be suspected when plain films do not identify a bony fragment as the culprit. CT and MRI are useful for identifying the cause of irreducibility and for operative planning
— id: 130313, year: 2010, vol: 4, page: 83, stat: Journal Article,

Management of humeral and glenoid bone loss--associated with glenohumeral instability
DiPaola, Matthew J; Jazrawi, Laith M; Rokito, Andrew S; Kwon, Young W; Patel, Lava; Pahk, Brian; Zuckerman, Joseph D
2010 ;68(4):245-250, Bulletin of the NYU Hospital for Joint Diseases
Anterior glenohumeral instability complicated by bone loss is a challenging problem and, when severe, may require surgical treatment with bone grafting. We review our institution's experience with humeral head and glenoid bone grafting for large Hill-Sachs lesions and glenoid defects. MATERIALS AND METHODS: Patients who underwent intra-articular bone reconstruction for Hill-Sachs and large glenoid defects for anterior instability at our institution during 2002-2008 were retrospectively reviewed. Those who had undergone concomitant humeral head replacement were excluded. Six patients were identified as having undergone allograft or autograft iliac crest bone graft reconstruction of the glenoid, with four available for full follow-up (average 39 months; range, 7 to 63). Five patients were identified as having undergone humeral head allograft reconstruction and four were available for full follow-up (average 28 months; range, 11 to 40). The remaining three patients were available for telephone follow-up. American Shoulder and Elbow Society (ASES) and University of California, Los Angles (UCLA) scores were recorded and radiographs obtained. RESULTS: Average postoperative ASES and UCLA scores for glenoid bone graft patients were 91 and 33, respectively. Average postoperative ASES and UCLA scores for humeral bone graft patients were 85.3 and 28.4, respectively. Glenoid bone graft shoulders, when compared to the opposite normal side, lost an average of 3 degrees of forward flexion, 10 degrees of external rotation, and two levels of internal rotation. Humeral head bone-grafted shoulders, lost an average of 23 degrees of forward flexion, 8 degrees of external rotation, and two levels of internal rotation. No episodes of recurrent subluxation or dislocations were reported. Radiographs showed no evidence of graft resorption or hardware prominence. CONCLUSIONS: Bone grafting procedures around the shoulder for the treatment of instability provided relief from recurrent instability and good functional results
— id: 133848, year: 2010, vol: 68, page: 245, stat: Journal Article,

The boards
Egol, Kenneth A; Jazrawi, Laith M; Zuckerman, Joseph D
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5484, year: 2010, vol: , page: ?, stat: Chapter,

Letters of recommendation
Jazrawi, Laith M
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5474, year: 2010, vol: , page: ?, stat: Chapter,

Orthopedic residency & fellowship : a guide to success
Jazrawi, Laith M; Egol, Kenneth A; Zuckerman, Joseph D
Thorofare NJ : Slack, 2010,
— id: 2208, year: 2010, vol: , page: , stat: ,

Fellowships : getting a position and succeeding
Jazrawi, Laith M; [et al]
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5482, year: 2010, vol: , page: ?, stat: Chapter,

Job search : what to look for in a potential position
Jazwari, Laith M;
Orthopedic residency & fellowship : a guide to success Thorofare NJ : Slack, 2010,
— id: 5483, year: 2010, vol: , page: ?, stat: Chapter,

The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance
Petchprapa, Catherine N; Beltran, Luis S; Jazrawi, Laith M; Kwon, Young W; Babb, James S; Recht, Michael P
2010 Sep;195(3):567-576, American journal of roentgenology
OBJECTIVE: The purpose of this article is to review imaging of the rotator interval, an anatomically complex region in the shoulder that plays an important role in the normal function of the shoulder joint. The rotator interval can be difficult to evaluate by imaging, and it is not routinely evaluated arthroscopically unless the clinical examination or imaging findings suggest an abnormality of the rotator interval. Rotator interval pathology is implicated in glenohumeral instability, biceps instability and adhesive capsulitis-entities which remain a challenge to diagnose and treat. CONCLUSION: Imaging can play an important role in increasing suspicion for injury to the rotator interval so that this region can be evaluated and appropriate treatment can be initiated
— id: 111895, year: 2010, vol: 195, page: 567, stat: Journal Article,

Platelet-rich plasma: current concepts and application in sports medicine
Hall, Michael P; Band, Phillip A; Meislin, Robert J; Jazrawi, Laith M; Cardone, Dennis A
2009 Oct;17(10):602-608, Journal of the American Academy of Orthopaedic Surgeons
Platelet-rich plasma is defined as autologous blood with a concentration of platelets above baseline values. Platelet-rich plasma has been used in maxillofacial and plastic surgery since the 1990s; its use in sports medicine is growing given its potential to enhance muscle and tendon healing. In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair. Although minimal clinical evidence is currently available, the use of platelet-rich plasma has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery. Its use in surgery to augment rotator cuff and Achilles tendon repair has also been reported. As the marketing of platelet-rich plasma increases, orthopaedic surgeons must be informed regarding the available preparation devices and their differences. Many controlled clinical trials are under way, but clinical use should be approached cautiously until high-level clinical evidence supporting platelet-rich plasma efficacy is available
— id: 104722, year: 2009, vol: 17, page: 602, stat: Journal Article,

Proximal biceps tendon--a biomechanical analysis of the stability at the bicipital groove
Kwon, Young W; Hurd, Jason; Yeager, Keith; Ishak, Charbel; Walker, Peter S; Khan, Sami; Bosco, Joseph A 3rd; Jazrawi, Laith M
2009 ;67(4):337-340, Bulletin of the NYU Hospital for Joint Diseases
The subscapularis tendon, coracohumeral ligament, and transverse humeral ligament are all believed to contribute to biceps tendon stability within the bicipital groove. In order to examine the relative contribution of these soft tissue structures to proximal biceps tendon stability, 11 fresh frozen cadaveric shoulder specimens were prepared and mounted onto a custom jig. A three-dimensional digitizer was utilized to record biceps tendon excursion in various shoulder positions. In sequential order, these structures were then sectioned, and biceps tendon excursion was again recorded. We found that sectioning of the subscapularis tendon significantly increased biceps tendon excursion, compared to intact specimens (8.1 +/- 4.1 mm vs. 4.3 +/- 3.6 mm; p < 0.006). In contrast, isolated sectioning of the transverse humeral ligament or the coracohumeral ligament did not significantly increase biceps excursion (5.4 +/- 2.5 mm, p = 0.26; 5.6 +/- 1.3 mm, p = 0.24). When two structures were sectioned, significant excursion in the biceps tendon only occurred in specimens where the subscapularis tendon was one of the sectioned structures. The preliminary data suggest that, of the three tested soft tissue structures, the subscapularis tendon is the most important stabilizer of the proximal biceps and that clinically significant lesions of the proximal biceps tendon may be associated with a defect in the subscapularis tendon
— id: 105972, year: 2009, vol: 67, page: 337, stat: Journal Article,

Percutaneous fixation of unstable proximal humeral fractures with cannulated screws
Watford, Kyle E; Jazrawi, Laith M; Eglseder, W Andrew Jr
2009 Mar;32(3):166-166, Orthopedics (Thorofare NJ)
Proximal humeral fractures treated at level I trauma centers are typically displaced, unstable, high-energy injuries associated with injuries to other extremities and closed head injuries. One method that can be used to treat 2-part proximal humeral fractures, if the patient meets certain criteria, is closed reduction and percutaneous cannulated screw fixation. We conducted a retrospective review of 20 consecutive patients treated with this technique, and complete follow-up data were available for 14. Thirteen achieved union and functional range of motion at a mean of 10.5 weeks. Three experienced complications: failure of fixation, infection, and heterotopic ossification. The technique of closed reduction and percutaneous cannulated screw fixation is safe and effective for proximal humeral fractures in carefully selected patients
— id: 114463, year: 2009, vol: 32, page: 166, stat: Journal Article,

Early complications in proximal humerus fractures (OTA Types 11) treated with locked plates
Egol, Kenneth A; Ong, Crispin C; Walsh, Michael; Jazrawi, Laith M; Tejwani, Nirmal C; Zuckerman, Joseph D
2008 Mar;22(3):159-164, Journal of orthopaedic trauma
PURPOSE: To examine our incidence of early complications that occur using the Proximal Humeral Internal Locking System (PHILOS) and to determine the contributing factors. SETTING: Academic medical center. PATIENTS: Fifty-one consecutive patients treated with a proximal humerus locking plate. OUTCOME: Development of an intraoperative, acute postoperative, or delayed postoperative complication. METHODS: A retrospective analysis was undertaken of a consecutive series of proximal humerus fractures treated with a locking plate between February 2003 and January 2006 at our institution. Fifty-one fractures or fracture nonunions were identified in 18 male and 33 female patients with an average age of 61. All acute injuries were treated with a similar protocol of open reduction internal fixation with the PHILOS plate followed by early range of shoulder motion. Nonunions were treated in a similar manner with the addition of iliac crest bone graft placement. Patients were objectively assessed on their outcome by physical as well as radiological examination. All complications were recorded. Statistical analyses were performed to determine if patient age, fracture type, or number of screws placed in the humeral head contributed to complications. RESULTS: Fifty-one patients were available for minimum 6-month follow-up (mean, 16 months; range, 6 to 45 months). Radiographically, 92% of the cases united at 3 months after surgery, and 2 fractures had signs of osteonecrosis at latest follow-up. Sixteen complications were seen in 12 patients (24%). Eight shoulders in eight patients (16%) had screws that penetrated the humeral head. Two patients developed osteonecrosis at latest follow-up. One acute fracture and one nonunion failed to unite after index surgery. Significant heterotopic bone developed in 1 patient. Early implant failure occurred in 2 patients; one was revised to a longer plate, and one underwent resection arthroplasty. There was one acute postoperative infection. CONCLUSION: The major complication reported in this study was screw penetration, suggesting that exceptional vigilance must be taken in estimating the appropriate number and length of screws used to prevent articular penetration; although the device provides exceptional fixation stability, its indication must be scrutinized for each individual patient, taking the extent of trauma/fracture and age into consideration and carefully weighing it against other forms of treatment
— id: 76798, year: 2008, vol: 22, page: 159, stat: Journal Article,

Effect of specialty and experience on the interpretation of knee MRI scans
Kim, Allis; Khoury, Lisa; Schweitzer, Mark; Jazrawi, Laith; Ishak, Charbel; Meislin, Robert; Kummer, Fred; Sherman, Orrin H
2008 ;66(4):272-275, Bulletin of the NYU Hospital for Joint Diseases
The purpose of this study was to evaluate any differences in the accuracy of knee MRI interpretation between radiology and orthopaedic surgery residents as well as to evaluate differences in quality of interpretation relative to resident training level. In this study, 20 MRI scans demonstrating specific pathology of the knee were identified. From one institution, two radiology residents and two orthopaedic surgery residents of each postgraduate year (PGY) of training (2 to 5) were recruited. Each resident was asked to interpret all the studies and choose up to 16 diagnoses for each scan from the list provided. Orthopaedic surgery residents showed improvement in overall accuracy and specificity with each year of additional training. Level of training did not correspond with increased sensitivity in the orthopaedic residents tested. Radiology residents did not demonstrate a consistent trend toward improved accuracy, sensitivity, or specificity with additional years of training. The only statistically significant differences in specificity observed between the two groups were seen in the readings of ACL tears, lateral femoral condyle chondromalacia, and chondromalacia patella. This study found that the accuracy of knee MRI interpretations between radiology and orthopaedic surgery residents did not demonstrate any differences. Level of training had no effect on the interpretation of the MRIs by radiology residents. Orthopaedic surgery residents did show an improvement with each year of additional training
— id: 94695, year: 2008, vol: 66, page: 272, stat: Journal Article,

Distal clavicular osteolysis: a review of the literature
Schwarzkopf, Ran; Ishak, Charbel; Elman, Michael; Gelber, Jonathan; Strauss, David N; Jazrawi, Laith M
2008 ;66(2):94-101, Bulletin of the NYU Hospital for Joint Diseases
Acute distal clavicular osteolysis was first described in 1936. Since then, distal clavicular osteolysis (DCO) has been separated into traumatic and atraumatic pathogeneses. In 1982 the first series of male weight trainers who developed ADCO was reported. The association of weightlifting and ADCO is especially important considering how routine a component weights are to the male athlete's training. The pathogenesis of DCO has often been debated. The most widely accepted etiology involves a connection between microfractures of the subchondral bone and subsequent attempts at repair, which is consistent with repetitive microtrauma. Symptoms usually begin with an insidious aching pain in the AC region that is exacerbated by weight training. On examination, patients have point tenderness over the affected AC joint and pain with a cross-body adduction maneuver. Although DCO may seem like an easy and quick diagnosis, one must rule out other possibilities. Avoidance of provocative maneuvers, modification of weight training techniques, ice massage, and nonsteroidal anti-inflammatory drugs (NSAID) constitute the basis of initial treatment. Much of the literature supports the same general indications for surgery. These include point tenderness of the AC joint, evident abnormal signs with AC joint scintigraphy and AC radiographs, lack of response to conservative treatment, and an unwillingness to give up or modify weight training or manual labor. Distal clavicle resection has provided good results. Distal clavicle osteolysis is a unique disease most likely due to an overuse phenomenon
— id: 93315, year: 2008, vol: 66, page: 94, stat: Journal Article,

The modified racking hitch(MRH) knot: a new sliding knot for arthroscopic surgery
Chokshi, Biren V; Ishak, Charbel; Iesaka, Kazuho; Jazrawi, Laith M; Kummer, Frederic J; Rosen, Jeffrey E
2007 ;65(4):306-307, Bulletin of the NYU Hospital for Joint Diseases
Sliding knots are commonly used in arthroscopic surgery and can be problematic in terms of strength and loop security. A new sliding knot for arthroscopic surgery, a modified racking hitch (MRH) knot, is described. The knot is essentially a modified cow's hitch knot that includes two self-locking loops. By tensioning the loop strands, a snug knot is created without backward sliding and provides excellent knot and loop security. In laboratory testing, the MRH knot provided comparable strength and security to other sliding knots. Experience gained from approximately 5 years of clinical use has added to the promise of the useful application of the MRH knot in arthroscopy
— id: 76150, year: 2007, vol: 65, page: 306, stat: Journal Article,

The effect of cartilage-derived morphogenetic protein 2 on initial healing of a rotator cuff defect in a rat model
Murray, Douglas H; Kubiak, Erik N; Jazrawi, Laith M; Araghi, Arash; Kummer, Frederick; Loebenberg, Mark I; Zuckerman, Joseph D
2007 Mar-Apr;16(2):251-254, Journal of shoulder & elbow surgery
This animal study evaluated the healing of supraspinatus tendon tears by use of a cartilage-derived morphogenetic protein 2 growth factor (CDMP-2) delivered to the repair. Forty-eight rats had bilateral, surgically created complete tears repaired by sutures with the growth factor introduced on one side. They were killed at 2, 3, 4, and 6 weeks, and the strength of the repairs was determined and histologic analysis performed. At 4 and 6 weeks, the CDMP-2-treated repairs were significantly stronger than the untreated repairs and histologic analysis showed more organized healing. The use of growth factors introduced at the time of rotator cuff repair might promote more rapid healing and subsequent, rapid patient rehabilitation
— id: 70978, year: 2007, vol: 16, page: 251, stat: Journal Article,

Surgical management of os acromiale: a case report and review of the literature
Sahajpal, Deenesh; Strauss, Eric J; Ishak, Charbel; Keyes, J M O'Malley; Joseph, George; Jazrawi, Laith M
2007 ;65(4):312-316, Bulletin of the NYU Hospital for Joint Diseases
— id: 76152, year: 2007, vol: 65, page: 312, stat: Journal Article,

Initial loop and knot security of arthroscopic knots using high-strength sutures
Shah, Mehul R; Strauss, Eric J; Kaplan, Kevin; Jazrawi, Laith; Rosen, Jeffrey
2007 Aug;23(8):884-888, Arthroscopy
Purpose: There are many options for arthroscopic knots including the type of knot and suture material used. The current investigation evaluated knot properties using 3 high-strength suture materials tied in 5 common arthroscopic knot configurations. Methods: Four arthroscopic sliding knots including the Roeder, Weston, SMC, and Tennessee Slider and an arthroscopic nonsliding Surgeon's knot were evaluated. Each knot was tied with each of 3 No. 2 polyblended suture types (Fiberwire [Arthrex, Naples, FL], Ultrabraid [Smith & Nephew, Andover, MA], and Orthocord [Mitek, Raynham, MA]). Each configuration was tied 8 times, for a total of 120 samples. Loop security and knot security were then evaluated by using a previously described protocol comparing the different knot types and suture material. Results: With respect to loop security, Orthocord performed better than the other tested suture materials, producing on average smaller knot loops. For the nonsliding Surgeon's knot, there was no difference in loop security observed between suture types. For the Roeder knot, Fiberwire had superior knot security compared with Ultrabraid and Orthocord (P < .001). For the Weston knot, Ultrabraid showed superior knot security compared with Orthocord (P < .02). Knot security for the Tenessee slider knot was better for both Fiberwire and Ultrabraid compared with Orthocord (P < .001, respectively). Similar results were seen with the SMC knot, with Fiberwire and Ultrabraid outperforming Orthocord (P < .001, respectively). The nonsliding Surgeon's knot had significantly lower mean loads to failure compared with arthroscopic sliding knots for each tested suture material (P < .02 for all comparisons). Conclusions: Loop security and knot security varied depending on the type of knot tied and suture material used. Arthroscopic sliding knots performed better than the nonsliding Surgeon's knot. Clinical Relevance: Surgeons should try to use sliding knots instead of Surgeon's knots when using polyblend suture material. Differences between the brands in this suture category will change the characteristics of the knots thrown and may ultimately affect tissue fixation
— id: 73341, year: 2007, vol: 23, page: 884, stat: Journal Article,

Effect of tibial positioning on the diagnosis of posterolateral rotatory instability in the posterior cruciate ligament-deficient knee
Strauss, Eric J; Ishak, Charbel; Inzerillo, Christopher; Walsh, Michael; Yildirim, Gokce; Walker, Peter; Jazrawi, Laith; Rosen, Jeffrey
2007 Aug;41(8):481-485, British journal of sports medicine
OBJECTIVE: To determine whether positioning of the tibia affects the degree of tibial external rotation seen during a dial test in the posterior cruciate ligament (PCL)-posterolateral corner (PLC)-deficient knee. DESIGN: Laboratory investigation. SETTING: Biomechanics laboratory. Hypothesis: An anterior force applied to the tibia in the combined PCL-PLC-deficient knee will yield increased tibial external rotation during a dial test. METHODS: The degree of tibial external rotation was measured with 5 Nm of external rotation torque applied to the tibia at both 30 degrees and 90 degrees of knee flexion. Before the torque was applied, an anterior force, a posterior force, or neutral (normal, reduced control) force was applied to the tibia. External rotation measurements were repeated after sequential sectioning of the PCL, the posterolateral structures and the fibular collateral ligament (FCL). RESULTS: Baseline testing of the intact specimens demonstrated a mean external rotation of 18.6 degrees with the knee flexed to 30 degrees (range 16.1-21.0 degrees ), and a mean external rotation of 17.3 degrees with the knee flexed to 90 degrees (range 13.8-20.0 degrees ). Sequential sectioning of the PCL, popliteus and popliteofibular ligament, and the FCL led to a significant increase in tibial external rotation compared with the intact knee for all testing scenarios. After sectioning of the popliteus and popliteofibular ligament, the application of an anterior force during testing led to a mean tibial external rotation that was 5 degrees greater than during testing in the neutral position and 7.5 degrees greater than during testing with a posterior force. In the PCL, popliteus/popliteofibular ligament and FCL-deficient knee, external rotation was 9 degrees and 12 degrees greater with the application of an anterior force during testing compared with neutral positioning and the application of a posterior force, respectively. CONCLUSION: An anterior force applied to the tibia during the dial test in a combined PCL-PLC-injured knee increased the overall amount of observed tibial external rotation during the dial test. The anterior force reduced the posterior tibial subluxation associated with PCL injury, which is analogous to what is observed when the dial test is performed with the patient in the prone position. Reducing the tibia with either an anterior force when the patient is supine or performing the dial test with the patient in the prone position increases the ability of an examiner to detect a concomitant PLC injury in the setting of a PCL-deficient knee
— id: 73874, year: 2007, vol: 41, page: 481, stat: Journal Article,

Operative treatment of acute Achilles tendon ruptures: an institutional review of clinical outcomes
Strauss, Eric J; Ishak, Charbel; Jazrawi, Laith; Sherman, Orrin; Rosen, Jeffrey
2007 Jul;38(7):832-838, Injury
PURPOSE: To retrospectively review the clinical outcome and incidence of post-operative complications after open end-to-end repair of acute Achilles tendon ruptures. METHODS: Seventy consecutive patients (74 open Achilles tendon repairs) operated on between 1989 and 2002 were identified for inclusion in this investigation. The medical records were reviewed and patients were contacted for a follow up interview in order to survey their post-operative function. Outcome scores were calculated based on the Boyden outcome and AOFAS ankle-hindfoot scoring systems. Post-operative complications were documented during the chart review and follow up interview, including an additional nine patients (nine repairs), who were not included in the clinical evaluation portion of the study. RESULTS: Fifty-two patients (54 repairs) were successfully contacted and completed the follow up interview. Within this cohort there were 44 males and 8 females with a mean age of 41 years. Achilles tendon rupture in this population was attributable to participation in athletic activity in 87% of cases. At a mean post-operative follow up of 45 months, 96% of cases achieved an overall Boyden outcome score of good to excellent. The mean AOFAS ankle-hindfoot score was 96, with 74% of cases scoring greater than 90. Forty-two cases (78%) reported no pain and 40 cases (74%) reported no activity limitations. Fourteen post-operative complications were identified after 83 open Achilles tendon repairs, resulting in an institutional complication rate of 16.8%. The complications included four superficial wound infections, five deep wound infections requiring irrigation and debridement, one heel ulcer secondary to post-operative boot wear, three partial Achilles tendon re-ruptures, and one complete Achilles tendon re-rupture. CONCLUSION: Our results demonstrate that open end-to-end repair of acute Achilles tendon ruptures provides long-term functional outcomes with consistent good to excellent results. However, this high clinical success rate was associated with a relatively high incidence of post-operative complications. With careful attention to the surgical wound and patient adherence to post-operative rehabilitation protocols, operative repair of acute Achilles tendon ruptures is a reliable treatment for active patients
— id: 74164, year: 2007, vol: 38, page: 832, stat: Journal Article,

A biodegradable button to augment suture attachment in rotator cuff repair
Bravman, Jonathan T; Guttman, Dan; Rokito, Andrew S; Kummer, Frederick J; Jazrawi, Laith M
2006 ;63(3-4):126-128, Bulletin (Hospital for Joint Diseases)
Recent experimental studies suggest that the use of suture anchors for rotator cuff tear (RCT) repair transfers the 'weak link' to the suture-tendon interface where failure occurs as the sutures cut through the tendon. The purpose of this study was to evaluate the effect of using a suture augmentation button on the fixation strength of rotator cuff tendon repair. A 1.5 cm by 2 cm defect was created in the supraspinatus tendon of seven cadaveric shoulder pairs and two suture anchors inserted in each humerus for suture attachment. For one of each pair, the defect was repaired with sutures placed in a horizontal mattress configuration. The other side was repaired with the sutures being passed through low profile, bioabsorbable buttons placed on the bursal tendon surface prior to knot tying. The supraspinatus tendon was cyclically loaded at a physiologic rate and load (33 mm/sec and 180 N, respectively). The number of loading cycles was recorded when the specimens developed 0.75 cm and 1.5 cm gaps at the repair site. The specimens were then tested to failure. Specimens in the unaugmented group developed 0.75 cm and 1.5 cm gaps at an average of 135 cycles and 362 cycles, respectively. The button augmented group developed these gaps at average of 420 cycles and 708 cycles, respectively. These differences were statistically significant (p < 0.05). The gaps progressively increased in all specimens, which eventually failed by suture cutting through tendon in all specimens. This study demonstrates that in vitro, suture augmentation with a low profile, bioabsorbable button provides significantly enhanced fixation when using suture anchors to repair torn rotator cuff tendon. This device may be a useful adjunct to current methods of rotator cuff repair
— id: 69067, year: 2006, vol: 63, page: 126, stat: Journal Article,

The interaction between the whipstitch sutures of multi-strand ACL grafts and interference screw fixation
Bravman, Jonathan; Ishak, Charbel; Gelber, Jonathan; Namkoong, Suk; Jazrawi, Laith M; Kummer, Frederick J
2006 ;63(3-4):156-157, Bulletin (Hospital for Joint Diseases)
In a recent experiment examining the effect of interference screw sizing on the fixation stability of multi-strand anterior cruciate ligament grafts, we noticed a large variation in fixation strengths and attributed it to the suturing of the grafts and its interaction with the screw. We performed an experiment using interference screws for fixation of hamstring grafts within a bone tunnel model to compare how the presence of sutures affected graft fixation. We found that having sutures along the region of the graft that contacts the screw within the bone tunnel can increase graft fixation strength 100%
— id: 69071, year: 2006, vol: 63, page: 156, stat: Journal Article,

The effect of arthroscopic suture passing instruments on rotator cuff damage and repair strength
Chokshi, Biren V; Kubiak, Erik N; Jazrawi, Laith M; Ticker, Jonathan B; Zheng, Nigel; Kummer, Frederick J; Rokito, Andrew S
2006 ;63(3-4):123-125, Bulletin (Hospital for Joint Diseases)
There are a variety of arthroscopic devices used to pass sutures through the rotator cuff for its repair. Because they vary in size and shape, it is possible that they could damage the cuff and affect the integrity of the repair. We chose four devices for assessment--SutureLasso (Arthrex, Naples, FL), straight BirdBeak (Arthrex, Naples, FL), Viper (Arthrex, Naples, FL), and a #7 tapered Mayo needle--and performed cuff reattachments in four paired shoulders using suture anchors. These repairs were cycled and tested to failure. The SutureLasso and Mayo needle repairs failed at approximately 285 N whereas the BirdBeak and Viper failed during cycling at 150 N. It appears that the devices, which made the bigger holes in the cuff, can compromise the integrity of the repair
— id: 69066, year: 2006, vol: 63, page: 123, stat: Journal Article,

MR imaging features of radial tunnel syndrome: initial experience
Ferdinand, Brett D; Rosenberg, Zehava Sadka; Schweitzer, Mark E; Stuchin, Steven A; Jazrawi, Laith M; Lenzo, Salvatore R; Meislin, Robert J; Kiprovski, Kiril
2006 Jul;240(1):161-168, Radiology
PURPOSE: To retrospectively assess magnetic resonance (MR) imaging features of radial tunnel syndrome. MATERIALS AND METHODS: Institutional review board approval was obtained, and informed consent was waived for the retrospective HIPAA-compliant study. MR images of 10 asymptomatic volunteers (six men, four women; mean age, 30 years) and 25 patients (11 men, 14 women; mean age, 49 years) clinically suspected of having radial tunnel syndrome were reviewed for morphologic and signal intensity alterations of the posterior interosseous nerve and adjacent soft-tissue structures. MR images of the asymptomatic volunteers were reviewed to establish the normal appearance of the radial tunnel. MR images of the symptomatic patients were evaluated for the following: signal intensity alteration and morphologic alteration of the posterior interosseous nerve; the presence of mass effect on the posterior interosseous nerve such as the presence of bursae, a thickened leading edge of the extensor carpi radialis brevis, or prominent radial recurrent vessels; signal intensity alteration within the depicted forearm musculature such as edema or atrophy; and signal intensity changes at the origin of the common extensor and common flexor tendons, which would suggest a diagnosis of epicondylitis. RESULTS: All images of volunteers demonstrated normal morphology and signal intensity within the posterior interosseous nerve and adjacent soft tissues. Two volunteers had borderline thickening of the leading edge of the extensor carpi radialis brevis. Thirteen patients (52%) had denervation edema or atrophy within muscles (supinator and extensors) innervated by the posterior interosseous nerve. One patient had isolated pronator teres edema. Seven (28%) patients had the following mass effects along the posterior interosseous nerve: thickened leading edge of the extensor carpi radialis brevis (n = 4), prominent radial recurrent vessels (n = 1), schwannoma (n = 1), or bicipitoradial bursa (n = 1). The rest of the patients had either normal MR imaging findings (n = 4) or lateral epicondylitis (n = 2). CONCLUSION: Muscle denervation edema or atrophy along the distribution of the posterior interosseous nerve is the most common MR finding in radial tunnel syndrome
— id: 66465, year: 2006, vol: 240, page: 161, stat: Journal Article,

Fixation of greater tuberosity fractures: a biomechanical comparison of three techniques
Ishak, Charbel; Sahajpal, Deenesh; Chiang, Alexis; Atallah, William; Kummer, Frederick; Jazrawi, Laith M
2006 ;63(3-4):98-99, Bulletin (Hospital for Joint Diseases)
The fixation of displaced greater tuberosity fractures with 5-0 Fiberwire, Fiberwire tape, and 5-0 Ethibond sutures was compared in 12 pairs of cadaveric humeri. A simulated fracture was created and fixed with suture in a figure-of-eight pattern. The tuberosity was cyclically loaded and its displacement measured. There was no statistical difference in fixation stability between the three suture types
— id: 69063, year: 2006, vol: 63, page: 98, stat: Journal Article,

Magnetic resonance imaging evaluation of the ulnar collateral ligament in young baseball pitchers less than 18 years of age
Jazrawi, Laith M; Leibman, Matt; Mechlin, Mike; Yufit, Pavel; Ishak, Charbel; Schweitzer, Mark; Rokito, Andrew
2006 ;63(3-4):105-107, Bulletin (Hospital for Joint Diseases)
INTRODUCTION: It has been shown that the asymptomatic, dominant elbow of professional baseball pitchers can demonstrate magnetic resonance (MR) imaging signal abnormalities of the ulnar collateral ligament (UCL) consistent with a strain. The purpose of this study was to determine if younger, asymptomatic, adolescent baseball pitchers exhibit similar signal abnormalities in the UCL. METHODS: Magnetic resonance images of both elbows of 14 asymptomatic, young male baseball pitchers (ranging in age from 12 to 20 years) were performed on an outpatient basis using a 1.5-T Sigma MRI unit with a dedicated extremity coil to obtain T1 and T2 coronal and axial images which were subsequently evaluated by a musculoskeletal radiologist. Chronic tears of the UCL were suspected if the signal was attenuated or absent. Magnetic resonance images of the UCL were also evaluated for high-intensity signal or thinning. Morphologic changes such as complete tears, avulsions or thickening were identified. The images were classified into 4 grades from 0 to 3 depending on the degree of signal abnormality. RESULTS: No discrete tears were found in any of the subjects. For the dominant pitching arm, 4 of 14 subjects had increased thickness of the ulnar collateral ligament, 3 of 14 demonstrated Grade 1 changes, and 11 of 14 demonstrated no abnormal signal within the ligament. No focal tears were present in any of the subjects. Contralateral elbows in 13 of 14 patients demonstrated Grade 0 signals with 1 patient demonstrating morphological thickening of the ligament without increased signal. DISCUSSION: Signal abnormalities in the throwing elbow of asymptomatic, adolescent pitchers were uncommon. These pitchers may not have experienced sufficient pitching time to develop changes in the UCL
— id: 69065, year: 2006, vol: 63, page: 105, stat: Journal Article,

Loose bodies in a sublabral recess: diagnosis and treatment
Kaplan, Kevin; Sahajpal, Deenesh T; Jazrawi, Laith
2006 ;63(3-4):161-165, Bulletin (Hospital for Joint Diseases)
A case of a 26-year-old male with symptoms resulting from loose bodies residing in a sublabral recess is presented. Operative intervention using the standard arthroscopic portals in addition to an accessory posterior portal was successful in removing the loose bodies and approximating the edges of the sublabral foramen. The shoulder is a complex region made up of numerous anatomic structures, which if damaged may be responsible for a patient's pathology. Normal anatomic variations also exist, which in certain situations, may contribute to a patient's presentation. One example of a normal anatomic variation is the sublabral foramen, which represents an unattached anterosuperior labrum
— id: 69072, year: 2006, vol: 63, page: 161, stat: Journal Article,

A survey of decision-making processes in the treatment of common shoulder ailments among primary care physicians
Loebenberg, Mark I; Rosen, Jeffrey E; Ishak, Charbel; Jazrawi, Laith M; Zuckerman, Joseph D
2006 ;63(3-4):137-144, Bulletin (Hospital for Joint Diseases)
To encourage consistent care for patients with musculoskeletal complaints, the AAOS developed treatment algorithms to aid primary care physicians in the management of these patients. A survey was designed to assess whether a random group of primary care physicians treated their patients in a manner consistent with these algorithms. The AAOS algorithm for shoulder pain was used to develop a questionnaire for primary care physicians. An Internet company provided access to a national base of physicians who volunteered to complete the survey. Ten questions were presented on five shoulder conditions: rotator cuff disease, fractures, instability, arthritis, and frozen shoulder The 'correct' answer was based upon the AAOS algorithm. The survey was completed by 706 physicians who treated variable (one to greater than ten) numbers of shoulder patients per month. Forty-eight percent of the physicians treated acute trauma according to the algorithm, 87% treated arthritis, and 58% treated instability. Only 46% of physicians chose the correct answer for an acute rotator cuff tear and 29% for chronic rotator cuff symptoms. Forty-four percent followed the algorithm for frozen shoulder. Overall only 49% of the patients described were treated according to the AAOS algorithms. Based on the number of shoulder patients seen each month, in one month over 2000 patients could be tested by the surveyed physicians in a manner inconsistent with the treatment algorithms, suggesting the need for improved musculoskeletal education for primary care physicians
— id: 69068, year: 2006, vol: 63, page: 137, stat: Journal Article,

Hybrid femoral fixation of soft-tissue grafts in anterior cruciate ligament reconstruction using the EndoButton CL and bioabsorbable interference screws: a biomechanical study
Oh, Young Ho; Namkoong, Suk; Strauss, Eric J; Ishak, Charbel; Hecker, Aaron T; Jazrawi, Laith M; Rosen, Jeffrey
2006 Nov;22(11):1218-1224, Arthroscopy
PURPOSE: The purpose of this study was to evaluate the effect of hybrid femoral fixation with bioabsorbable interference screws (BioRCI; Smith & Nephew Endoscopy, Andover, MA) and EndoButton CL (Smith & Nephew Endoscopy) fixation. METHODS: Biomechanical testing of 3 different fixation techniques was performed by use of porcine hind-limb distal femurs and mature bovine extremity common extensor tendons. Two independent testing sessions were examined. The first testing session (group A) compared femoral fixation via the EndoButton CL device (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The second testing session (group B) compared femoral fixation via BioRCI screws alone (n = 6) with femoral fixation via the EndoButton CL device with the addition of a BioRCI screw (n = 6). The femur-graft complex was cyclically loaded between 50 and 250 N at 1 Hz for 1,000 cycles. After cycling, the amount of graft slippage was determined by measuring the change in grip-to-grip distance. The complex was then loaded to failure at 1 mm/s, and the ultimate tensile strength, stiffness, and mode of failure were determined. RESULTS: In group A the addition of an interference screw to the EndoButton CL fixation increased the ultimate tensile strength (1,364.7 +/- 102.4 N for EndoButton CL alone v 1,449.3 +/- 94.4 N for combined technique, P = .035) and stiffness (195.5 +/- 12.1 N/mm for EndoButton CL alone v 307.3 +/- 54.9 N/mm for combined technique, P = .004) and decreased the amount of graft slippage (2.6 +/- 0.5 mm for EndoButton CL alone v 2.0 +/- 0.3 mm for combined technique, P = .017). In group B the addition of the EndoButton CL device to interference screw fixation significantly increased the ultimate tensile strength (643.5 +/- 148.4 N for BioRCI screws alone v 1,290.3 +/- 254.4 N for combined technique, P = .004) but had no effect on stiffness (315.7 +/- 38.9 N/mm for BioRCI screws alone v 341.5 +/- 64.0 N/mm for combined technique, P = .267) or graft slippage (2.7 +/- 1.0 mm for BioRCI screws alone v 2.0 +/- 0.6 mm for combined technique, P = .087). CONCLUSIONS: Our study shows that hybrid femoral fixation of double-looped gracilis-semitendinosus grafts via the EndoButton CL device and a bioabsorbable interference screw is stronger than interference or EndoButton CL fixation alone with respect to ultimate tensile strength, stiffness, and slippage. The addition of an interference screw to suspensory fixation via the EndoButton CL device increased the ultimate tensile strength from 1,360 N to 1,450 N, improved reconstruction stiffness from 200 N/mm to 300 N/mm, and decreased the amount of graft slippage resulting from cyclic loading from 2.6 mm to 2.0 mm. CLINICAL RELEVANCE: The hybrid fixation of the EndoButton CL device and an interference screw is a stronger and stiffer construct than either device alone and allows for aperture fixation, which may translate into better clinical results
— id: 96724, year: 2006, vol: 22, page: 1218, stat: Journal Article,

Arthroscopic Rotator Interval Closure: Effect of Sutures on Glenohumeral Motion and Anterior-Posterior Translation
Plausinis, Derek; Bravman, Jonathan T; Heywood, Christian; Kummer, Frederick J; Kwon, Young W; Jazrawi, Laith M
2006 Oct;34(10):1656-1661, American journal of sports medicine
BACKGROUND: The effect of arthroscopic rotator interval closure on glenohumeral motion and translation is not well understood, nor is the ideal location or number of sutures required for closure. HYPOTHESIS: The number of arthroscopic rotator interval closure sutures and their placement will have a significant effect on glenohumeral range of motion and anterior-posterior translation. STUDY DESIGN: Controlled laboratory study. METHODS: Using a custom testing apparatus, the authors measured range of motion in 12 fresh-frozen cadaveric shoulders; anterior-posterior translation in adduction and neutral rotation was measured in 9. Specimens were initially tested without sutures and then tested after 3 interval closures using a random sequence of (1) an isolated medial suture at the level of the glenoid, (2) an isolated lateral suture 1 cm lateral to the glenoid, or (3) both sutures followed by removal of all sutures. RESULTS: Analysis of variance demonstrated that interval closure had a significant effect on decreasing flexion (mean, 6 degrees ), external rotation (mean, 10 degrees ), and anterior translation (mean, 3 mm) of the adducted shoulder. There was no significant difference between the 3 interval closures in any of the tests. CONCLUSION: Arthroscopic interval closure produced significant decreases in range of motion and anterior-posterior translation. The effects of single lateral or medial suture closures were similar to the use of 2 sutures. CLINICAL RELEVANCE: This study suggests that the initial effect of arthroscopic rotator interval closure on anterior translation of the shoulder will be similar whether 1 or 2 sutures are used. In vivo studies are necessary to determine if the effect of these 2 methods would be the same over time
— id: 65801, year: 2006, vol: 34, page: 1656, stat: Journal Article,

Chronic exertional compartment syndrome: diagnosis and management
Bong, Matthew R; Polatsch, Daniel B; Jazrawi, Laith M; Rokito, Andrew S
2005 ;62(3-4):77-84, Bulletin (Hospital for Joint Diseases)
During exercise, muscular expansion and swelling occur. Chronic exertional compartment syndrome represents abnormally increased compartment pressures and pain in the involved extremity secondary to a noncompliant musculofascial compartment. Most commonly, it occurs in the lower leg, but has been reported in the thigh, foot, upper extremity, and erector spinae musculature. The diagnosis is obtained through a careful history and physical exam, reproduction of symptoms with exertion, and pre- and post-exercise muscle tissue compartment pressure recordings. It has been postulated that increased compartment pressures lead to transient ischemia and pain in the involved extremity. However; this is not universally accepted. Other than complete cessation of causative activities, nonoperative management of CECS is usually unsuccessful. Surgical release of the involved compartments is recommended for patients who wish to continue to exercise
— id: 58724, year: 2005, vol: 62, page: 77, stat: Journal Article,

Suture versus screw fixation of displaced tibial eminence fractures: a biomechanical comparison
Bong, Matthew R; Romero, Anthony; Kubiak, Erik; Iesaka, Kazuho; Heywood, Christian S; Kummer, Fredrick; Rosen, Jeffrey; Jazrawi, Laith
2005 Oct;21(10):1172-1176, Arthroscopy
PURPOSE: Classification and treatment of tibial eminence fractures are determined by the degree of fragment displacement. A variety of surgical procedures have been proposed to stabilize displaced fractures using both open and arthroscopic techniques. Two common fixation techniques involve use of cannulated screws and sutures tied over an anterior tibial bone bridge. We are unaware of any biomechanical studies that have compared the strength of various techniques of fixation. TYPE OF STUDY: Biomechanical study in a cadaveric model. METHODS: Seven matched pairs of fresh-frozen human cadaveric knees were stripped of all soft tissue except the anterior cruciate ligament (ACL). Simulated type III tibial eminence fractures were created using an osteotome. Fragments of each matched pair were randomized to fixation with either a single 4-mm cannulated cancellous screw with a washer or an arthroscopic suture technique using 3 No. 2 Fiberwire sutures (Arthrex, Naples, FL) passed through the tibial base of the ACL and tied over bone tunnels on the anterior tibial cortex. Specimens were then loaded with a constant load rate of 20 mm/min, and load-deformation curves were generated. The ultimate strength and stiffness were computed for each curve. The failure mode for each test was observed. A paired 2-tailed t test was used to determine the statistically significant difference between the two methods. RESULTS: Specimens fixed with Fiberwire had a mean ultimate strength of 319 N with a standard deviation of 125 N. Those fixed with cannulated screws had a mean ultimate strength of 125 N with a standard deviation of 74 N. This difference was statistically significant (P = .0038). There was no significant difference between the mean stiffness of Fiberwire constructs (63 N; SD, 50 N) and the mean stiffness of the cannulated screw constructs (20 N; SD, 32 N). The failure modes of the Fiberwire constructs included 1 ACL failure, 3 failures of suture cutting through the anterior tibial cortex, and 3 of suture cutting through the tibial eminence fragment. The single mode of failure for the cannulated screw constructs was screw pullout of cancellous bone. CONCLUSIONS: The initial ultimate strength of Fiberwire fixation of tibial eminence fractures in these specimens was significantly stronger than that of cannulated screw fixation. CLINICAL RELEVANCE: It appears that Fiberwire fixation of eminence fractures provides biomechanical advantages over cannulated screw fixation and may influence the type of treatment one chooses for patients with tibial eminence fractures
— id: 61595, year: 2005, vol: 21, page: 1172, stat: Journal Article,

Simultaneous ipsilateral ruptures of the anterior cruciate ligament and patellar tendon: a case report
Chiang, Alexis S; Shin, Steven S; Jazrawi, Laith M; Rose, Donald J
2005 ;62(3-4):134-136, Bulletin (Hospital for Joint Diseases)
The simultaneous diagnosis of ipsilateral patellar tendon rupture and anterior cruciate ligament tear is rare. Surgical repair is complicated by different rehabilitation regimens as well as anterior cruciate ligament graft choices. We present a case where at the same operative setting, the patellar tendon was repaired, and the anterior cruciate ligament reconstructed with autologous hamstring graft
— id: 58718, year: 2005, vol: 62, page: 134, stat: Journal Article,

Glenohumeral chondrolysis after shoulder arthroscopy: case reports and review of the literature
Petty, Damon H; Jazrawi, Laith M; Estrada, Lance S; Andrews, James R
2004 Mar;32(2):509-515, American journal of sports medicine
— id: 96725, year: 2004, vol: 32, page: 509, stat: Journal Article,

Superior labral anterior and posterior lesions and internal impingement in the overhead athlete
Jazrawi, Laith M; McCluskey, George M 3rd; Andrews, James R
2003 ;52:43-63, Instructional course lectures (American Association of Orthopaedic Surgeons)
Superior labral lesions and internal impingement are believed to be the primary cause of shoulder pathology in the overhead athlete, particularly the baseball player. Increased shoulder external rotation can lead to repetitive impingement of the rotator cuff and superior labrum resulting in a superior labrum anterior and posterior lesion and partial articular-sided rotator cuff tearing. Although the etiology for this phenomenon remains controversial, the end result remains the same: pathology in the rotator cuff and superior labrum. Isolated treatment of the pathology alone, without addressing the capsular laxity, results in lower return to play rates. Addressing the capsular laxity arthroscopically at the same time as the intra-articular pathology is necessary to give these athletes the best chance to return to their prior competitive level. Although short-term results are promising, long-term follow-up is necessary to determine the ultimate usefulness of this treatment philosophy
— id: 114464, year: 2003, vol: 52, page: 43, stat: Journal Article,

Arthroscopic management of osteoarthritis of the knee
Jazrawi, Laith; Sherman, Orrin; Hunt, Steve
2003 Jul-Aug;11(4):290-290, Journal of the American Academy of Orthopaedic Surgeons
— id: 63817, year: 2003, vol: 11, page: 290, stat: Journal Article,

Orthopaedic resident-selection criteria
Bernstein, Adam D; Jazrawi, Laith M; Elbeshbeshy, Basil; Della Valle, Craig J; Zuckerman, Joseph D
2002 Nov;84-A(11):2090-2096, Journal of bone & joint surgery (American volume)
— id: 32637, year: 2002, vol: 84-A, page: 2090, stat: Journal Article,

Treatment of acromioclavicular joint separation: suture or suture anchors?
Breslow, Marc J; Jazrawi, Laith M; Bernstein, Adam D; Kummer, Frederick J; Rokito, Andrew S
2002 May-Jun;11(3):225-229, Journal of shoulder & elbow surgery
This investigation compared the stability of 2 methods of fixation for acromioclavicular (AC) joint separations. A complete AC joint separation was simulated in 6 matched pairs of fresh-frozen human cadaveric shoulders. One specimen from each pair was repaired with two No. 5 nonabsorbable braided sutures passed around the base of the coracoid and the other with 2 suture anchors preloaded with the same suture material placed into the base of the coracoid process. The specimens were cyclically loaded for 10(4) cycles to simulate our early postoperative rehabilitation protocol for coracoclavicular repairs. Before cycling, the repairs had a mean superior laxity of 1.68 +/- 0.44 mm for the sutures alone and 1.23 +/- 0.31 mm for the suture anchors. After 10(4) cycles, the laxity was 1.32 +/- 0.59 mm and 1.33 +/- 0.94 mm, respectively. These differences were not statistically significant (P =.2). This study demonstrated that similar stability can be achieved for coracoclavicular fixation with suture anchors or with sutures placed around the base of the coracoid for the treatment of AC joint separations. The clinical relevance includes the following: (1) the potentially diminished risk of neurovascular injury with the use of suture anchors compared with the passage of sutures around the base of the coracoid and (2) the potentially reduced surgical time associated with the use of suture anchors
— id: 32640, year: 2002, vol: 11, page: 225, stat: Journal Article,

Arthroscopic management of osteoarthritis of the knee
Hunt, Stephen A; Jazrawi, Laith M; Sherman, Orrin H
2002 Sep-Oct;10(5):356-363, Journal of the American Academy of Orthopaedic Surgeons
Recent advances in instrumentation and a growing understanding of the pathophysiology of osteoarthritis have led to increased use of arthroscopy for the management of degenerative arthritis of the knee. Techniques include lavage and debridement, abrasion arthroplasty, subchondral penetration procedures (drilling and microfracture), and laser/thermal chondroplasty. In most patients, short-term symptomatic relief can be expected with arthroscopic lavage and debridement. Greater symptomatic relief and more persistent pain relief can be achieved in patients who have acute onset of pain, mechanical disturbances from cartilage or meniscal fragments, normal lower extremity alignment, and minimal radiographic evidence of degenerative disease. Arthroscopic chondroplasty techniques provide unpredictable results. Concerns include the durability of the fibrocartilage repair tissue in subchondral penetration procedures and thermal damage to subchondral bone and adjacent normal articular cartilage in laser/thermal chondroplasty. Although recent prospective, randomized, double-blinded studies have demonstrated that outcomes after arthroscopic lavage or debridement were no better than placebo procedure for knee osteoarthritis, controversy still exists. With proper selection, patients with early degenerative arthritis and mechanical symptoms of locking or catching can benefit from arthroscopic surgery
— id: 32638, year: 2002, vol: 10, page: 356, stat: Journal Article,

Arthroscopic stabilization of anterior shoulder instability: a review of the literature
Stein, Drew A; Jazrawi, Laith; Bartolozzi, Arthur R
2002 Oct;18(8):912-924, Arthroscopy
The treatment of anterior glenohumeral instability has been a topic of debate in the recent literature. Current surgical management of shoulder instability has included a variety of open and arthroscopic procedures. Open techniques for anterior reconstruction have been quite successful in preventing recurrent dislocations and continue to be the gold standard of care. In an attempt to address some of the disadvantages associated with open procedures, arthroscopic stabilization procedures have been developed. Arthroscopic capsuloligamentous repair presumably has clear advantages including better cosmesis, decreased perioperative morbidity, and a possible decrease in the loss of external rotation. Advances in arthroscopic instrumentation and improved arthroscopic techniques have increased the popularity of arthroscopic stabilization. The art of diagnosing the anatomic pathology associated with instability and proper patient selection continues to evolve. Most previous reports of arthroscopic stabilization have included small numbers of patients, variable patient pathology, and a variety of surgical techniques, making comparisons between stabilization procedures difficult. Arthroscopy can be valuable in both the confirmation of the degree and severity of the instability and to correct the pathoanatomy responsible for the instability
— id: 67443, year: 2002, vol: 18, page: 912, stat: Journal Article,

Distal biceps tendon ruptures: a historical perspective and current concepts
Bernstein AD; Breslow MJ; Jazrawi LM
2001 Mar;30(3):193-200, American journal of orthopedics (Belle Mead, NJ)
Distal biceps tendon rupture is a relatively rare injury most commonly seen in the dominant extremity of men between 40 and 60 years of age. It occurs when an eccentric extension force is applied to a contracting biceps muscle. The hallmark finding is a palpable defect in the distal biceps, which is accentuated by elbow flexion. Radiographic evaluation is usually not necessary. Acute surgical repair is advocated for optimal return of function by either a one-incision or a modified two-incision muscle-splitting technique. The arm is protected for 6 to 8 eight weeks after surgery. Unrestricted range of motion and gentle strengthening may begin after the 6 - 8 week protection period. Return to unrestricted activity is usually allowed by 5 months after surgery
— id: 26755, year: 2001, vol: 30, page: 193, stat: Journal Article,

Arthroscopic treatment of an intra-articular lipoma of the knee joint
Bernstein AD; Jazrawi LM; Rose DJ
2001 May;17(5):539-541, Arthroscopy
Intra-articular lipoma is an exceedingly rare diagnosis. There have been less than 15 documented cases of an intra-articular lipoma of the knee joint. This report presents the first description of an intra-articular knee lipoma treated entirely by arthroscopic methods. Preoperative history, examination, and imaging studies are reviewed. Intraoperative findings, treatment, and postoperative evaluation are discussed as well. Symptomatic intra-articular lipoma of the knee joint can be successfully treated by arthroscopic resection. Differentiating intra-articular lipoma from lipoma arborescens, a similar but more common condition, is important with regards to optimal treatment
— id: 20661, year: 2001, vol: 17, page: 539, stat: Journal Article,

Orthopaedic manifestations of systemic lupus erythematosus
Egol KA; Jazrawi LM; DeWal H; Su E; Leslie MP; Di Cesare PE
2001 ;60(1):29-34, Bulletin (Hospital for Joint Diseases)
Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease of unknown origin. It affects multiple organ systems, but most frequently the musculoskeletal system. Highly variable manifestations include small and large joint involvement, spinal involvement, periarticular tissue symptoms, and complications associated with chronic steroid use such as osteonecrosis, osteoporosis, and stress fractures. The following review summarizes the common orthopaedic manifestations of SLE
— id: 32642, year: 2001, vol: 60, page: 29, stat: Journal Article,

The effect of alendronate (Fosamax) and implant surface on bone integration and remodeling in a canine model
Frenkel, S R; Jaffe, W L; Valle, C D; Jazrawi, L; Maurer, S; Baitner, A; Wright, K; Sala, D; Hawkins, M; Di Cesare, P E
2001 ;58(6):645-650, Journal of biomedical materials research
Patients at high risk for osteoporosis and its associated morbidity, including postmenopausal women, are being pharmacologically managed to stabilize and improve bone mass. Alendronate sodium (Fosamax) is a commonly used antiresorptive agent effective in osteopenic women for reducing bone resorption, increasing bone density, and decreasing fracture incidence. With the increased incidence of alendronate-treated women who are undergoing hip replacement or fracture repair by prosthesis placement, data are needed to predict how alendronate affects host bone integration with uncemented surfaces. The aim of this study was to determine the effect of alendronate on new bone formation and attachment to implant surfaces in a normal and simulated estrogen-deficient, calcium-deficient canine model, using an implantable bone growth chamber. Alendronate did not affect host bone integration to surfaces commonly used in uncemented total joint arthroplasty, but there were significant differences dependent solely on the type of surface
— id: 105470, year: 2001, vol: 58, page: 645, stat: Journal Article,

The effect of stem modularity and mode of fixation on tibial component stability in revision total knee arthroplasty
Jazrawi LM; Bai B; Kummer FJ; Hiebert R; Stuchin SA
2001 Sep;16(6):759-767, Journal of arthroplasty
The effect of stem length, diameter, and mode of fixation on the motion and stress transfer of a cemented tibial tray were evaluated for in 12 cadaver knees. There was a significant decrease in motion of the tibial tray with increasing press-fit stem length (75-150 mm) and increasing stem diameter (10-14 mm). Cemented tibial stems showed significantly less tray motion than uncemented stems. The short cemented stems produced tray stability equivalent to long press-fit stems. Although there was a trend for increased proximal tibial stress shielding with the use of cement and longer, wider stems, the trend was not statistically significant. Modular, press-fit stems can achieve tray stability similar to a smaller cemented stem and can avoid the potential problems with cement
— id: 26667, year: 2001, vol: 16, page: 759, stat: Journal Article,

Laboratory evaluation of hip fracture fixation devices
Jazrawi LM; DeWal H; Kummer FJ; Koval KJ
2001 2002;60(3-4):114-123, Bulletin (Hospital for Joint Diseases)
— id: 32639, year: 2001, vol: 60, page: 114, stat: Journal Article,

Synovial chondromatosis of the elbow
Jazrawi LM; Ong B; Jazrawi AJ; Rose D
2001 Mar;30(3):223-224, American journal of orthopedics (Belle Mead, NJ)
Synovial chondromatosis is an uncommon disorder with rare occurrence in the elbow. Case reports in the literature for elbow synovial chondromatosis have described presenting symptoms secondary to peripheral nerve compressions or localized bursitis. We discuss a case of synovial chondromatosis of the elbow that presented as an isolated soft-tissue mass over the radial head-more suggestive of a soft-tissue tumor than of synovial chondromatosis
— id: 26754, year: 2001, vol: 30, page: 223, stat: Journal Article,

Bilateral carpal tunnel syndrome in a child on growth hormone replacement therapy: a case report
Ong BC; Klugman JA; Jazrawi LM; Stutchin S
2001 2002;60(2):94-95, Bulletin (Hospital for Joint Diseases)
— id: 32641, year: 2001, vol: 60, page: 94, stat: Journal Article,

Arthroscopic stabilization of anterior shoulder instability: a historical perspective
Stein DA; Jazrawi LM; Rosen JE; Loebenberg MI
2001 ;60(3-4):124-129, Bulletin (Hospital for Joint Diseases)
The role of arthroscopic procedures in the management of glenohumeral instability continues to evolve and represents an effective alternative for addressing the pathology associated with this condition. Patient selection criteria, operative techniques, and implants all continue to evolve and have resulted in improved rates of success. Arthroscopic procedures benefit patients by avoiding the common morbidities associated with the disruption of the anterior soft tissues, including a loss of external rotation associated with open procedures. Arthroscopic procedures remain technically demanding and require skills to address all of the existing pathology. The surgeon must be prepared to address many conditions beyond the Bankart lesions including glenoid bone lesions. capsular laxity, rotator interval lesions, and SLAP lesions. In addition to the documentation of recurrence, the success of this procedure must be evaluated within the context of retained ranges of motion, recovery time, proprioceptive control, and the return to prior levels of activity. Further studies are necessary to continue to validate the efficacy of arthroscopic stabilization
— id: 32333, year: 2001, vol: 60, page: 124, stat: Journal Article,

Spontaneous rib fracture during pregnancy. A case report and review of the literature
Baitner AC; Bernstein AD; Jazrawi AJ; Della Valle CJ; Jazrawi LM
2000 ;59(3):163-165, Bulletin (Hospital for Joint Diseases)
No studies have demonstrated a direct relationship between pregnancy and rib fracture. A case of spontaneous rib fracture in the third trimester presents the opportunity to examine factors unique to pregnancy that may predispose the patient to stress fractures of the lower ribs. A 28-year old woman in week 31 of her pregnancy presented with the chief complaint of acute onset of right upper quadrant pain. A chest radiograph demonstrated a minimally displaced fracture of the right 10th rib. During pregnancy, the enlarging uterus causes certain opposing muscular forces to act on the ribs, making them more susceptible to fracture after minimal trauma or after repeated stresses such as a chronic cough
— id: 32645, year: 2000, vol: 59, page: 163, stat: Journal Article,

Elbow joint biomechanics: basic science and clinical applications
Bernstein AD; Jazrawi LM; Rokito AS; Zuckerman JD
2000 Dec;23(12):1293-1301, Orthopedics (Thorofare NJ)
— id: 32643, year: 2000, vol: 23, page: 1293, stat: Journal Article,

Anticoagulant treatment of thromboembolism with intravenous heparin therapy in the early postoperative period following total joint arthroplasty
Della Valle CJ; Jazrawi LM; Idjadi J; Hiebert RN; Stuchin SA; Steiger DJ; Di Cesare PE
2000 Feb;82(2):207-212, Journal of bone & joint surgery (American volume)
BACKGROUND: Treatment of thromboembolism with intravenous heparin therapy in the early postoperative period after total joint arthroplasty has been associated with a high rate of complications. The purpose of the present study was to compare the rate of bleeding complications in a group of patients who required intravenous heparin therapy for the treatment of thromboembolism after total hip or knee arthroplasty with the rate in a control group of patients who received only prophylactic anticoagulation. METHODS: The postoperative courses of forty-four consecutive patients who were managed with intravenous administration of heparin and oral administration of warfarin for the treatment of a thromboembolic event following unilateral total hip or knee arthroplasty were compared with those of a control group of 376 consecutive patients who had these same procedures but did not have a thromboembolic complication. The patients in the control group were managed with prophylactic anticoagulation with use of enoxaparin. Sixty-eight percent (thirty) of the forty-four patients in the heparin group received the initial dose of heparin on or before the fourth postoperative day, and 82 percent (thirty-six) received an initial bolus of 5000 units of heparin at the initiation of therapy. RESULTS: The rate of bleeding complications was 9 percent (four of forty-four) in the heparin group, compared with 6 percent (twenty-three of 376) in the control group (p = 0.44). The mean transfusion requirement in the heparin group (1.8 units of packed red blood cells) was significantly greater than that in the control group (0.8 unit) (p < 0.0001). Three of the four patients who had a bleeding complication while receiving heparin and warfarin had coagulation parameters that were substantially higher than recommended levels. The mean duration of hospitalization in the heparin group (fifteen days) was significantly longer than that in the control group (seven days) (p < 0.0001). CONCLUSIONS: The results of the present study suggest that the use of intravenous heparin therapy for the treatment of thromboembolism in the early postoperative period after total joint arthroplasty is associated with a rate of bleeding complications that is similar to that associated with the use of prophylactic anticoagulation with use of enoxaparin alone. One should expect an increased transfusion requirement and a longer duration of hospitalization for patients who require intravenous heparin therapy for the treatment of a thromboembolic event
— id: 32648, year: 2000, vol: 82, page: 207, stat: Journal Article,

Radiographic comparison of grit-blasted hydroxyaptite and arc-deposited hydroxyapatite acetabular components. A four-year follow-up study
Jazrawi LM; Adler EM; Jazrawi AJ; Jaffe WL
2000 ;59(3):144-148, Bulletin (Hospital for Joint Diseases)
High rates of aseptic loosening have been reported for microstructured hydroxyapatite-coated acetabular components. A macrostructured component surface (arc-deposition) not only improves resistance to shear forces experienced by the acetabular component and increases initial stability, but also provides channels for bone ingrowth. The purpose of this investigation was to radiographically compare a series of grit-blasted (microstructured) and arc-deposited (macrostructured) hydroxyapatite-coated acetabular components. A minimum 4-year retrospective radiographic analysis of acetabular components was performed on a total of 50 total hip arthroplasties. At 4 years, arc-deposited components were associated with fewer radiolucent lines in all Charnley zones, particularly Charnley zone III. While the 4-year results for arc-deposited hydroxyapatite acetabular components are superior to their microstructured predecessors, long-term results are still unknown
— id: 32646, year: 2000, vol: 59, page: 144, stat: Journal Article,

The accuracy of computed tomography for determining femoral and tibial total knee arthroplasty component rotation
Jazrawi LM; Birdzell L; Kummer FJ; Di Cesare PE
2000 Sep;15(6):761-766, Journal of arthroplasty
Patellofemoral complications, instability, and tibial polyethylene wear after total knee arthroplasty (TKA) resulting from malrotation of the tibial or femoral components (or both) may be difficult to diagnose based on physical examination and standard knee radiographs. The preoperative assessment of implant rotational alignment is critical in planning treatment because the femoral or tibial component (or both) may need to be revised if malpositioned. The purpose of this study was to ascertain the accuracy of computed tomography (CT) scan for determining rotational alignment of femoral and tibial components in TKA. TKA components were inserted in human cadaver specimens at neutral and 5 degrees of external or internal rotation. For each position, the amount of rotation, determined from digital photographs, was compared with CT scan. The correlation coefficient between these two values averaged 0.87, which was significant at P < .05. The CT scan protocol described in this study can be applied clinically to patients with patellofemoral complaints to confirm or rule out the presence of component malrotation
— id: 32647, year: 2000, vol: 15, page: 761, stat: Journal Article,

New technique for treatment of unstable distal femur fractures by locked double-plating: case report and biomechanical evaluation
Jazrawi LM; Kummer FJ; Simon JA; Bai B; Hunt SA; Egol KA; Koval KJ
2000 Jan;48(1):87-92, Journal of trauma
BACKGROUND: A comminuted, intra-articular distal femur fracture was surgically treated by the authors with a locked, double-plating technique because fixation stability could not be initially achieved by using a standard double-plating technique. The purpose of this study was to determine biomechanically whether a locked double-plate construct would enhance fixation stability compared with a nonlocked double-plate construct. METHODS: Six matched pairs of mildly osteopenic femurs were selected and all had a reproducible intra-articular fracture pattern created. Each pair underwent fixation with either a double-plating construct or a locked, double-plating construct that was randomly assigned. The instrumented femurs were then mechanically tested in several loading modes to determine fixation stability. After initial testing, specimens were cyclically loaded and retested for stability. RESULTS: The locked, double-plating construct provided significantly greater fixation stability than the standard double-plating construct in precycling and postcycling biomechanical testing. CONCLUSION: The technique described is particularly applicable for severely comminuted fractures of the distal femur and fractures in osteopenic bone with poor screw purchase. It offers a simple alternative for enhancing fixation stability, which avoids the potential complications of methylmethacrylate-enhanced screw fixation
— id: 18478, year: 2000, vol: 48, page: 87, stat: Journal Article,

Long-term follow-up of the one-bone forearm procedure
Lee SJ; Jazrawi LM; Ong BC; Raskin KB
2000 Dec;29(12):969-972, American journal of orthopedics (Belle Mead, NJ)
The one-bone forearm procedure can be a successful salvage option for forearm stability in selected patients and is indicated if instability and bone loss are irreparable by other means. We report a case of a dysfunctional arm secondary to radical debridement of the ulna after osteomyelitis treated successfully with a one-bone forearm procedure and followed up for 8 years
— id: 32644, year: 2000, vol: 29, page: 969, stat: Journal Article,

The use of an injectable, biodegradable calcium phosphate bone substitute for the prophylactic augmentation of osteoporotic vertebrae and the management of vertebral compression fractures
Bai B; Jazrawi LM; Kummer FJ; Spivak JM
1999 Aug 1;24(15):1521-1526, Spine
STUDY DESIGN: A biomechanical study comparing two materials for augmentation of osteoporotic vertebral bodies and vertebral bodies after compression fracture. OBJECTIVES: To compare an injected, biodegradable calcium phosphate bone substitute with injected polymethylmethacrylate bone cement for strengthening osteoporotic vertebral bodies and improving the integrity of vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Injection of polymethylmethacrylate bone cement into fractured vertebral bodies has been used clinically. However, there is concern about thermal damage to the neural elements during polymerization of the polymethylmethacrylate bone cement as well as its negative effects on bone remodeling. Biodegradable calcium phosphate bone substitutes have been studied for enhancement of fixation in fractured vertebrae. METHODS: Forty fresh osteoporotic thoracolumbar vertebrae were used for two separate parts of this study: 1) injection into osteoporotic vertebrae: intact control (n = 8), calcium phosphate (n = 8), and polymethylmethacrylate bone cement (n = 8) groups. Each specimen then was loaded in anterior compression until failure; 2) injection into postfractured vertebrae: calcium phosphate (n = 8) and polymethylmethacrylate bone cement (n = 8) groups. Before and after injection, the specimens were radiographed in the lateral projection to determine changes in vertebral body height and then loaded to failure in anterior bending. RESULTS: For intact osteoporotic vertebrae, the average fracture strength was 527 +/- 43 N (stiffness, 84 +/- 11 N/mm), 1063 +/- 127 N (stiffness, 157 +/- 21 N/mm) for the group injected with calcium phosphate, and 1036 +/- 100 N (stiffness, 156 +/- 8 N/mm) for the group injected with polymethylmethacrylate bone cement. The fracture strength and stiffness in the calcium phosphate bone substitute group and those in the polymethylmethacrylate bone cement group were similar and significantly stronger than those in intact control group (P < 0.05). For the compression fracture study, anterior vertebral height was increased 58.5 +/- 4.6% in the group injected with calcium phosphate and 58.0 +/- 6.5% in the group injected with polymethylmethacrylate bone cement as compared with preinjection fracture heights. No significant difference between the two groups was found in anterior vertebral height, fracture strength, or stiffness. CONCLUSION: This study demonstrated that the injection of a biodegradable calcium phosphate bone substitute to strengthen osteoporotic vertebral bodies or improve vertebral compression fractures might provide an alternative to the use of polymethylmethacrylate bone cement
— id: 6183, year: 1999, vol: 24, page: 1521, stat: Journal Article,

Paradoxical cerebral embolism complicating a major orthopaedic operation. A report of two cases
Della Valle CJ; Jazrawi LM; Di Cesare PE; Steiger DJ
1999 Jan;81(1):108-110, Journal of bone & joint surgery (American volume)
— id: 7320, year: 1999, vol: 81, page: 108, stat: Journal Article,

Supratherapeutic levels of heparin anticoagulation result in increased complications
Della, Valle C J; Jazrawi, L M; Zuckerman, J D; Di, Cesare P E
1999 Jun 04-05;29(Suppl. 1):125-125, Haemostasis
— id: 15809, year: 1999, vol: 29, page: 125, stat: Journal Article,

Arthroscopic removal of bullet fragments from the subtalar joint
Jazrawi L; Egol KA; Astion DJ; Rose DJ
1999 Oct;15(7):762-765, Arthroscopy
A case of arthroscopic removal of a bullet fragment from the subtalar joint and the calcaneus is presented. The bullet fragments impinged on the fibula, limiting eversion and causing pain. The fragments were removed both arthroscopically and through open incision. The patient noted complete relief of pain and improved range of motion within 1 week, and complete recovery soon thereafter
— id: 6261, year: 1999, vol: 15, page: 762, stat: Journal Article,

Wear rates of ceramic-on-ceramic bearing surfaces in total hip implants: a 12-year follow-up study
Jazrawi LM; Bogner E; Della Valle CJ; Chen FS; Pak KI; Stuchin SA; Frankel VH; Di Cesare PE
1999 Oct;14(7):781-787, Journal of arthroplasty
A retrospective clinical and radiographic analysis was performed on 58 patients (60 hips; mean age at time of surgery, 45.2 years) at a minimum of 10-year follow-up (mean, 12.7 years) after total hip replacement using a ceramic-on-ceramic hearing total hip implant (Autophor, Smith and Nephew, Memphis, TN). Mean wear rate at final follow-up was 0.21 mim, averaging 0.016 mm/y. There were no cases of periprosthetic osteolysis in the acetabuulum or femur. For the unrevised components, there were 3 (5%) cases of protrusio acetabuli and 4 (7%) cases of acetabular component loosening. On the femoral side, 78.3% had distal pedestal formation, and 83% had greater than 2 mm implant-bone radiolucencies in more than 5 Gruen zones as a result of gross motion of the stem. Despite radiographic evidence of implant loosening, this hard bearing articulation functioned well in vivo for more than 12 years with remarkably low wear--approximately one tenth the rate reported for metal-on-polyethylene total hip bearings
— id: 30805, year: 1999, vol: 14, page: 781, stat: Journal Article,

Catastrophic failure of a cemented, collarless, polished, tapered cobalt-chromium femoral stem used with impaction bone-grafting. A report of two cases
Jazrawi LM; Della Valle CJ; Kummer FJ; Adler EM; Di Cesare PE
1999 Jun;81(6):844-847, Journal of bone & joint surgery (American volume)
— id: 6151, year: 1999, vol: 81, page: 844, stat: Journal Article,

Hard bearing surfaces in total hip arthroplasty
Jazrawi LM; Kummer FJ; Di Cesare PE
1998 Apr;27(4):283-292, American journal of orthopedics (Belle Mead, NJ)
Periprosthetic osteolysis and aseptic loosening are serious problems affecting the outcome of total joint replacement. Polyethylene particulate debris generated from metal-on-polyethylene bearing surfaces and the resulting biologic response to this debris are thought to be largely responsible. As a result, there has been a renewal of interest in hard bearing surfaces for total joint arthroplasty, including both metal-on-metal and ceramic-on-ceramic components. The new-generation all-ceramic and all-metal prostheses have demonstrated, both clinically and in the laboratory, lower friction and wear rates than metal-on-polyethylene bearing surfaces. Theoretically, lower wear rates result in less particulate debris and decreased inflammatory response. Despite excellent tribologic (lubrication, friction, wear) properties, metal-on-metal bearings raise associated issues of metal sensitivity and toxicity. For ceramic-on-ceramic bearing surfaces, issues of ceramic quality and the possibility of brittle fracture must be considered
— id: 32650, year: 1998, vol: 27, page: 283, stat: Journal Article,

Alternative bearing surfaces for total joint arthroplasty
Jazrawi LM; Kummer FJ; DiCesare PE
1998 Jul-Aug;6(4):198-203, Journal of the American Academy of Orthopaedic Surgeons
The biologic response to polyethylene particulate debris generated from metal-on-polyethylene bearing surfaces is thought to be largely responsible for periprosthetic osteolysis and aseptic loosening in total joint arthroplasty. As a result, there has been an interest in developing polyethylene with improved wear characteristics, as well as a renewed interest in alternative bearing surfaces for total joint arthroplasty, including ceramic-polyethylene, metal-metal, and ceramic-ceramic articulations. These alternative surfaces have demonstrated less friction and lower wear rates than metal-on-polyethylene bearing surfaces in both clinical and laboratory experiments. Clinical results, although only short- to mid-term, have been encouraging. Alternative bearing surfaces, with lower wear rates and less particulate debris formation, may have the potential to improve total joint arthroplasty survivorship by decreasing periprosthetic osteolysis, especially in younger, high-demand patients
— id: 32649, year: 1998, vol: 6, page: 198, stat: Journal Article,

Bone and cartilage formation in an experimental model of distraction osteogenesis
Jazrawi LM; Majeska RJ; Klein ML; Kagel E; Stromberg L; Einhorn TA
1998 Feb;12(2):111-116, Journal of orthopaedic trauma
OBJECTIVES: (a) To develop a reliable and reproducible system for distraction osteogenesis in the rat to establish a model for future investigations of bone repair and regeneration. (b) To describe and characterize the histological events in distraction osteogenesis in the rat and to determine whether cartilage development is a normal component of the process. STUDY DESIGN: Species-specific, longitudinal time study. METHODS: Twenty rats underwent production of a middiaphyseal femoral osteotomy and application of a monolateral external fixator specifically designed for distraction. Animals were divided into five groups based on the time and extent of lengthening. RESULTS: During distraction, gap tissue showed collagen bundles and fibroblasts that were oriented longitudinally to the direction of the distraction force. Woven bone appeared to be laid down on these collagen scaffolds, and the newly formed vascular sinuses appeared to be the sites from which bone formation was initiated within the distraction gap. All groups undergoing active distraction showed intramembranous ossification in the distraction gap and endochondral ossification peripherally. However, when distraction was discontinued, endochondral ossification was observed in the gap. CONCLUSION: Distraction produces an environment in the distraction gap that suppresses the formation of cartilage. The formation of cartilage by injured periosteum, however, is obligatory and does not appear to be influenced by distraction. Bone formation within the distraction gap occurs where angiogenesis develops
— id: 7622, year: 1998, vol: 12, page: 111, stat: Journal Article,