Andrew S. Rokito, M.D.

Anterior shoulder instability - a history of arthroscopic treatment
Pope, E Jeffrey; Ward, James P; Rokito, Andrew S
2011 ;69(1):44-49, Bulletin of the NYU Hospital for Joint Diseases
The glenohumeral joint is the most commonly dislocated joint in the body. The prevalence of this condition and the instability that may result from it has been a focus of diagnosis and treatment since the original description of the Bankart lesion in 1923. Now, with the introduction of MRI, lesions causing anterior shoulder instability can be diagnosed more accurately. This has led to improved understanding of the pathoanatomy that must be addressed and corrected during surgical repair. Initial attempts at arthroscopic treatment, including staple repair, transosseus suture repair, rivets, and thermal capsulorraphy were fraught with complications and unacceptably high recurrence rates. The development of arthroscopic suture anchors have revolutionized the treatment of anterior shoulder instability, such that arthroscopic management is now the standard of care. In the hands of experienced surgeons, outcomes for arthroscopic treatment of shoulder instability now approaches the success of open treatment
— id: 128795, year: 2011, vol: 69, page: 44, stat: Journal Article,

Frozen shoulder: a consensus definition
Zuckerman, Joseph D; Rokito, Andrew
2011 Mar;20(2):322-325, Journal of shoulder & elbow surgery
INTRODUCTION: Frozen shoulder (FS) is a common diagnosis treated by orthopaedic surgeons and other physicians caring for musculoskeletal problems. However, there is no standard definition and classification for this common condition. MATERIALS AND METHODS: We asked 211 clinician members of the American Shoulder and Elbow Surgeons to review our proposed definition of FS and its classification into primary and secondary types. Secondary FS was further divided into intrinsic, extrinsic, and systemic types. The survey required responses to 5 specific questions via an analog scale (1, strongly disagree; 5, strongly agree). Agreement was defined as a 4 or 5 on the analog scale. RESULTS: We received 190 responses (90%). Eighty-two percent agreed with the proposed definition of FS. Eighty-five percent agreed that FS should be divided into primary and secondary types. Sixty-six percent agreed with subdivision of secondary FS into intrinsic, extrinsic, and systemic types. Eighty-four percent agreed that there was a clinical entity of primary or idiopathic FS. Eighty-five percent agreed that obtaining a consensus definition and classification of FS was a worthwhile endeavor. DISCUSSION: Significant benefits can be gained from the development of a standard definition and classification of FS, achieved through a consensus of shoulder specialists, that provides a strong foundation for potential acceptance by all musculoskeletal specialists who treat this condition
— id: 138147, year: 2011, vol: 20, page: 322, 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,

Patella tendon rupture after arthroscopic resection of the prepatellar bursa--a case report
Epstein, David M; Capeci, Craig M; Rokito, Andrew S
2010 ;68(4):307-310, Bulletin of the NYU Hospital for Joint Diseases
The use of arthroscopic techniques for excision of the pre-patellar bursa has become more common in recent years for the treatment of prepatellar bursitis. The current literature includes several case series that report few complications with this technique. We report the case of a 73-year-old male who sustained a low-energy patella tendon rupture 2 months after arthroscopic resection of the prepatellar bursa. We hypothesize that during arthroscopic excision of the prepatellar bursa there was an iatrogenic injury to the patellar tendon, which contributed to the subsequent rupture. Surgical repair was successfully performed using an open technique with a 1-year follow-up. To our knowledge, this is the first case report of patella tendon rupture following arthroscopic excision of the prepatellar bursa
— id: 133849, year: 2010, vol: 68, page: 307, stat: Journal Article,

Recovery of shoulder strength and proprioception after open surgery for recurrent anterior instability: a comparison of two surgical techniques
Rokito, Andrew S; Birdzell, Maureen Gallagher; Cuomo, Frances; Di Paola, Matthew J; Zuckerman, Joseph D
2010 Jun;19(4):564-569, Journal of shoulder & elbow surgery
BACKGROUND: Previous studies have documented a decrease in proprioceptive capacity in the unstable shoulder. The degree to which surgical approach affects recovery of strength and proprioception is unknown. MATERIALS AND METHODS: The recovery of strength and proprioception after open surgery for recurrent anterior glenohumeral instability was compared for 2 surgical procedures. A prospective analysis of 55 consecutive patients with posttraumatic unilateral recurrent anterior glenohumeral instability was performed. Thirty patients (group 1) underwent an open inferior capsular shift with detachment of the subscapularis, and 25 (group 2) underwent an anterior capsulolabral reconstruction. RESULTS: Mean preoperative proprioception and strength values were significantly lower for the affected shoulders in both groups. At 6 months after surgery, there were no significant differences for mean strength and proprioception values between the unaffected and operative sides for group 2 patients. In group 1 patients, however, there were still significant deficits in mean position sense and strength values. Complete restoration of proprioception and strength, however, was evident by 12 months in group 1. CONCLUSION: This study demonstrates that there are significant deficits in both strength and proprioception in patients with posttraumatic, recurrent anterior glenohumeral instability. Although both are completely restored by 1 year after surgery, a subscapularis-splitting approach allows for complete recovery of strength and position sense as early as 6 months postoperatively. Detachment of the subscapularis delays recovery of strength and position sense for up to 12 months after surgery
— id: 113725, year: 2010, vol: 19, page: 564, stat: Journal Article,

Ipsilateral nonunions of the coracoid process and distal clavicle--a rare shoulder girdle fracture pattern
Ruchelsman, David E; Christoforou, Dimitrios; Rokito, Andrew S
2010 ;68(1):33-37, Bulletin of the NYU Hospital for Joint Diseases
Coracoid fractures are uncommon injuries, in isolation or in association with other osseoligamentous injuries about the shoulder girdle. We report a case of successful operative management of symptomatic ipsilateral nonunions of a type I coracoid base fracture and a lateral one-third clavicular fracture, which developed following nonoperative treatment of this exceedingly rare injury pattern. Following open distal clavicle excision and reduction of the coracoclavicular interval with screw fixation, radiographic union and excellent clinical outcome were achieved. This rare and potentially troublesome injury pattern is discussed, and the literature regarding ipsilateral coracoid and osseoligamentous injuries about the shoulder is reviewed
— id: 108931, year: 2010, vol: 68, page: 33, stat: Journal Article,

Snapping scapula syndrome
Lazar, Meredith A; Kwon, Young W; Rokito, Andrew S
2009 Sep;91(9):2251-2262, Journal of bone & joint surgery (American volume)
Snapping scapula syndrome arises from either a soft-tissue or a skeletal anomaly within the scapulothoracic space that creates a cracking sound during scapulothoracic motion that patients associate with pain. Nonoperative measures consisting of supervised physical therapy, anti-inflammatory medications, and therapeutic injections are the mainstay of treatment. Open, arthroscopic, and combined operative approaches have been described for the treatment of refractory cases, with good overall outcomes in many relatively small case series. However, the optimal operative approach has yet to be determined
— id: 101965, year: 2009, vol: 91, page: 2251, stat: Journal Article,

The effect of the angle of suture anchor insertion on fixation failure at the tendon-suture interface after rotator cuff repair: deadman's angle revisited
Strauss, Eric; Frank, Darren; Kubiak, Erik; Kummer, Frederick; Rokito, Andrew
2009 Jun;25(6):597-602, Arthroscopy
PURPOSE: To evaluate what effect the angle of screw-in suture anchor insertion has on fixation stability at the suture-tendon interface. METHODS: Supraspinatus tendons from 7 matched pairs of human cadaveric shoulders were split, yielding 4 tendons per cadaver. An experimental rotator cuff tear was created and repaired, using a 5.0-mm diameter screw-in suture anchor. In a staggered, matched pair arrangement, the angle of anchor insertion was varied between 45 degrees (deadman's angle) and 90 degrees to the articular surface. Each repair underwent cyclic loading, and 2 failure points were defined: the first at 3 mm of repair site gap formation and the second at the point of complete failure. The number of cycles to failure was compared between the 2 groups. RESULTS: The mean number of cycles to 3-mm gap formation for anchors inserted at 90 degrees was 380. This was significantly higher than for repairs made with the 45 degrees angle of anchor insertion (mean, 297 cycles). Complete failure occurred at a significantly greater number of cycles with the 90 degrees anchors (mean, 443 cycles) compared with the 45 degrees anchors (mean, 334 cycles). CONCLUSIONS: Compared with anchors placed at the current standard of the deadman's angle of 45 degrees, suture anchors placed at 90 degrees to the junction of the greater tuberosity and the humeral head articular surface provided improved soft tissue fixation in an experimental rotator cuff model. CLINICAL RELEVANCE: The angle of suture anchor insertion into the greater tuberosity during rotator cuff repair has an effect on the soft tissue fixation at the tendon-suture interface
— id: 99331, year: 2009, vol: 25, page: 597, stat: Journal Article,

Simultaneous bilateral distal biceps tendon rupture during a preacher curl exercise: a case report
Rokito, Andrew S; lofin, Ilya
2008 ;66(1):68-71, Bulletin of the NYU Hospital for Joint Diseases
Complete rupture of the distal biceps tendon is a rare injury, the overwhelming majority occurring in the dominant arm of males during the fourth to sixth decades of life. Simultaneous bilateral rupture of the distal biceps tendon is an extremely rare occurrence, with only three cases reported in the literature. This unusual injury occurred in a recreational weightlifter during a preacher curl exercise. In this particular case, a 6-week delay in presentation necessitated a staged procedure in which a primary repair was feasible in one elbow, while reconstruction using allograft tissue was required in the contralateral elbow. Satisfactory results for both elbows were achieved, with return to weightlifting by one year following surgery
— id: 79558, year: 2008, vol: 66, page: 68, stat: Journal Article,

Acute acromioclavicular injuries in adults. L
White, Brian; Epstein, David; Sanders, Samuel; Rokito, Andrew
2008 Dec;31(12):?-?, Orthopedics (Thorofare NJ)
The acromioclavicular joint is comprised of the articulation between the distal end of the clavicle and the acromion. It functions to anchor the clavicle to the scapula and to the shoulder girdle. The subcutaneous location of this joint makes it vulnerable to injury. It comprises approximately 9% of all injuries to the shoulder girdle. The majority of these injuries occur in males with a male to female ratio of approximately 5:1, and the most common age group affected are those in their 20s. Injuries to the acromioclavicular joint are prevalent in football, rugby, and other contact sports. Given the high incidence of acromioclavicular injuries, it is common for orthopedists, emergency physicians, and physical therapists to recognize and initiate treatment for the full spectrum of this type of injury. The current literature outlines joint biomechanics, various methods of fixation, and outcomes of both nonoperative and operative therapy. This article reviews the anatomy, biomechanics, classification of injury, fixation techniques, and outcomes
— id: 97784, year: 2008, vol: 31, page: ?, stat: Journal Article,

MRI quantitative morphologic analysis of patellofemoral region: lack of correlation with chondromalacia patellae at surgery
Endo, Yoshimi; Schweitzer, Mark E; Bordalo-Rodrigues, Marcelo; Rokito, Andrew S; Babb, James S
2007 Nov;189(5):1165-1168, American journal of roentgenology
OBJECTIVE: In numerous studies, the morphologic features of the patellofemoral joint have been analyzed on radiographs. The objective of this study was to assess patellofemoral measurements on MR images and to correlate the measurements with the presence or absence of chondromalacia patellae confirmed at surgery. MATERIALS AND METHODS: Axial and sagittal MR images of 98 knees (97 patients) were evaluated. Lateral and medial patellar facet lengths, lateral-to-medial facet length ratio, and interfacet angle were measured at three levels through the patella. Trochlear depth was measured on an axial slice. Patella and patellar tendon lengths, patellar tendon-to-patella ratio, and overlap of the patellar and trochlear articular cartilages were measured on sagittal slices. These measurements in knees with chondromalacia patellae were compared with those in knees without chondromalacia patellae. For assessment of reproducibility, axial measurements were repeated by a second observer. RESULTS: There was no statistically significant difference in any of the axial and sagittal slice measurements between knees with and those without chondromalacia patellae. Interobserver reliability was excellent for measurements of trochlear depth and measurements in the superior and middle aspects of the patella. Measurements through the inferior patella were slightly less reproducible. CONCLUSION: The results of our study with MRI confirmed many previous radiographic findings. Although we did not find correlation between the presence of chondromalacia patellae and the patellofemoral indexes we analyzed, it is possible that the results of further investigations incorporating different grades of chondromalacia and different locations along the patellar articular surface may lead to further insight regarding the morphologic risk factors for chondromalacia patellae
— id: 75394, year: 2007, vol: 189, page: 1165, stat: Journal Article,

Posterolateral corner injuries of the knee
Frank, Joshua B; Youm, Thomas; Meislin, Robert J; Rokito, Andrew S
2007 ;65(2):106-114, Bulletin of the NYU Hospital for Joint Diseases
The posterolateral region of the knee is an anatomically complex area that plays an important role in the stabilization of the knee relative to specific force vectors at low angles of knee flexion. A renewed interest in this region and advanced biomechanical studies have brought additional understanding of both the anatomy and the function of posterolateral structures in knee stabilization and kinematics. Through sectioning and loading studies, the posterolateral corner has been shown to play a role in the prevention of varus angulation, external rotation, and posterior translation. The potential for long-term disability from these injuries may be related to increased articular pressure and chondral degeneration. The failure of the reconstruction of cruciate ligaments may be due to unrecognized or untreated posterolateral corner injuries. Various methods of repair and reconstruction have been described and new research is yielding superior results from reconstruction of this region
— id: 73804, year: 2007, vol: 65, page: 106, stat: Journal Article,

Glove tears during arthroscopic shoulder surgery using solid-core suture
Kaplan, Kevin M; Gruson, Konrad I; Gorczynksi, Chris T; Strauss, Eric J; Kummer, Fred J; Rokito, Andrew S
2007 Jan;23(1):51-56, Arthroscopy
PURPOSE: Surgeons have noticed an increased incidence of finger lacerations associated with arthroscopic knot tying with solid-core suture material. This study examines glove perforations and finger lacerations during arthroscopic shoulder surgery. METHODS: We collected 400 surgical gloves from 50 consecutive arthroscopic shoulder repair procedures using No. 2 solid-core sutures. Two surgeons using double gloves were involved in every case, with one being responsible for tying all knots. Powder-free latex gloves were worn in all cases. Knots consisted of a sliding stitch of the surgeon's preference followed by 3 half-hitches via a knot-pusher instrument. All gloves were inspected grossly and then tested for tears with an electroconductivity meter. RESULTS: The knot-tying surgeon had significantly more glove tears than the control (P < .01). Tears were localized to the radial side of the index finger of the glove at the distal interphalangeal joint in all cases. Of the tying surgeon's gloves, 68 (34%) were found to have tears. These included 17 inner gloves (17%) and 51 outer gloves (51%). If an inner glove was torn, the corresponding outer glove was torn in all cases. A mean of 3.96 knots were tied in each case. There was a significantly higher incidence of inner glove tears when more than 3 knots were tied (P < .03). There was no significant difference in glove tears between suture types. Finger lacerations did occur in the absence of glove tears. However, in the presence of an inner glove tear, there was a statistically significant association with a finger laceration at the corresponding level (P < .03). CONCLUSIONS: Intraoperative glove tears and subsequent finger lacerations occur with a high frequency when arthroscopic knots are tied with solid-core suture material. Risk can potentially be minimized by frequent glove changes or use of more durable, less penetrable gloves. CLINICAL RELEVANCE: This study addresses surgeon and patient safety during arthroscopic shoulder surgery
— id: 70320, year: 2007, vol: 23, page: 51, stat: Journal Article,

Arthroscopic revision of Bankart repair
Neri, Brian R; Tuckman, David V; Bravman, Jonathan T; Yim, Duke; Sahajpal, Deenesh T; Rokito, Andrew S
2007 Jul-Aug;16(4):419-424, Journal of shoulder & elbow surgery
The success of revision surgery for failed Bankart repair is not well known. This purpose of this study was to report the success rates achieved using arthroscopic techniques to revise failed Bankart repairs. Twelve arthroscopic revision Bankart repairs were performed on patients with recurrent unidirectional shoulder instability after open or arthroscopic Bankart repair. Follow-up was available on 11 of the 12 patients at a mean of 34.4 months (range, 25-56 months). The surgical findings, possible modes of failure, shoulder scores (Rowe score, University of California Los Angeles [UCLA], Simple Shoulder Test), and clinical outcome were evaluated. Various modes of failure were recognized during revision arthroscopic Bankart repairs. Good-to-excellent results were obtained in 8 patients (73%) undergoing revision stabilization according to Rowe and UCLA scoring. A subluxation or dislocation event occurred in 3 (27%) of the 11 patients at a mean of 8.7 months (range, 6-12 months) postoperatively. Arthroscopic revision Bankart repairs are technically challenging procedures but can be used to achieve stable, pain-free, functional shoulders with return to prior sport. Owing to limited follow-up and the small number of patients in this study, we were unable to conclude any pattern of failure or selection criteria for this procedure
— id: 74157, year: 2007, vol: 16, page: 419, stat: Journal Article,

ACL injuries in the skeletally immature patient
Schachter, Aaron K; Rokito, Andrew S
2007 May;30(5):365-370, Orthopedics (Thorofare NJ)
Anterior cruciate ligament injuries in the pediatric and adolescent population are becoming more common with the trends of increased participation in competitive athletics in younger children. The natural history of this injury is similar to that of the adult and results in frequent reinjury, instability, and debilitation. Delayed reconstruction has proven to be a clinically effective treatment method but requires a prolonged restriction of competitive athletics. Reconstruction in the acute and subacute period has been shown by many authors to be a successful, reproducible treatment regimen. Nonetheless, the unique pitfalls of ACL reconstruction in a skeletally immature patient must not be overlooked. A thorough preoperative evaluation for leg-length discrepancy or subtle angular deformity is essential to identify the presence of an entity that might otherwise be attributed to surgical complication. For the patient nearing skeletal maturity with little growth remaining, we recommend the standard tunnel positioning and the use of soft-tissue graft. For younger patients who have significant growth remaining, alternative physeal 'safe' procedures should be considered. No prospective, randomized studies compare the clinical success of graft type, graft placement, or graft fixation in this age group. Further follow-up of existing study groups and prospective research is warranted to fine-tune the result-based decision making for treatment of this injury
— id: 73113, year: 2007, vol: 30, page: 365, 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 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,

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,

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,

Enthesopathy on shoulder MRI: A potential secondary marker for rotator cuff disorders
Coen, AR; Schweitzer, ME; Rafii, M; Sherman, OH; Rokito, AS
2005 JUN 21 ;184(4):103-104, American journal of roentgenology
— id: 56260, year: 2005, vol: 184, page: 103, stat: Journal Article,

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation
Hale, James; Rokito, Andrew S; Chu, Jamie
2005 ;62(3-4):94-98, Bulletin (Hospital for Joint Diseases)
The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved
— id: 58722, year: 2005, vol: 62, page: 94, stat: Journal Article,

Assessment of clavicular translation after arthroscopic Mumford procedure: direct versus indirect resection--a cadaveric study
Miller, Craig A; Ong, Bernard C; Jazrawi, Laith M; Joseph, Thomas; Heywood, Christian S; Rosen, Jeffrey; Rokito, Andrew S
2005 Jan;21(1):64-68, Arthroscopy
PURPOSE: To compare the horizontal stability of the distal clavicle following arthroscopic resection of its lateral end by direct and indirect techniques. TYPE OF STUDY: Biomechanical test of cadaveric specimens. METHODS: We performed arthroscopic distal clavicle resection on 12 fresh-frozen human cadaveric shoulders using direct (group 1, n = 6) or indirect (group 2, n = 6) approaches. In both groups 5 mm of distal clavicle were resected using an arthroscopic burr. The specimens were mounted on a materials testing device that allowed translation of the clavicle along the anteroposterior axis. The degree of posterior translation was measured from maximum anterior displacement of the clavicle. RESULTS: Mean posterior translation was 19.4 mm (range, 18 to 23 mm; SD, 2.2) and 21.3 mm (range, 18 to 25 mm; SD, 3.1) for groups 1 and 2, respectively. This difference was not statistically significant ( P = .27). Conclusions: This study suggests that there is no significant difference in anteroposterior stability of the clavicle following arthroscopic distal clavicle resection with either a direct or indirect approach. CLINICAL RELEVANCE: Clinically, this study addresses concerns about increased potential instability associated with the indirect technique of distal clavicle resection. From a biomechanical standpoint, based on this study, there is no concern for increased instability with the indirect technique of distal clavicle resection compared to a direct technique
— id: 56063, year: 2005, vol: 21, page: 64, stat: Journal Article,

Ochronotic arthropathy: a report of 3 cases
Moghtaderi, Sam; Rokito, Andrew S; Zuckerman, Joseph D
2005 Mar;34(3):136-139, American journal of orthopedics (Belle Mead, NJ)
— id: 70984, year: 2005, vol: 34, page: 136, stat: Journal Article,

Posterior capsulorrhaphy for treatment of recurrent posterior glenohumeral instability
Shin, Robert D; Polatsch, Daniel B; Rokito, Andrew S; Zuckerman, Joseph D
2005 ;63(1-2):9-12, Bulletin (Hospital for Joint Diseases)
The surgical treatment of recurrent posterior shoulder instability via a posterior approach has had a variable degree of success reported in the literature with recurrence rates ranging between 8% and 45%. The purpose of this study was to review the results of posterior capsulorrhaphy in a consecutive series of patients with recurrent posterior instability. Seventeen consecutive patients underwent operative management for posterior glenohumeral instability. The dominant shoulder was involved in ten patients. All patients were male with an average age of 28.1 years (range: 16 to 54 years). Ten patients had sustained a specific injury which precipitated the instability. Six patients reported dislocations requiring formal closed reduction maneuvers; the remainder described episodes of recurrent subluxation with spontaneous reduction. All patients underwent a posterior capsulorrhaphy using an infraspinatus splitting approach. Eight shoulders required repair of a posterior capsulolabral detachment. In addition, one patient required augmentation with a posterior bone block for significant glenoid rim deficiency. Outcome was assessed by personal interview, clinical assessment, and standardized radiographs. At an average follow-up of 3.9 years (range: 1.8 to 10.8 years) patients estimated their overall shoulder function to be 81% of the contralateral unaffected shoulder. The subjective result was excellent for eight patients, good for five patients, fair in two patients, and poor in two patients. One of the poor outcomes was in a patient with glenohumeral degenerative changes at the index procedure which progressed and eventually required a total shoulder arthroplasty. The other poor result was in a patient found to have a full-thickness rotator cuff tear 10.6 years after the index procedure. Two patients (12%) had recurrence of their instability. Both of these patients sustained a significant re-injury which precipitated their symptoms. Five patients complained of occasional night pain at the time of their last follow-up examination. Only one patient (who was re-injured) had to change professions as a result of shoulder symptoms. Posterior capsulorrhaphy for treatment of isolated posterior glenohumeral instability yields satisfactory clinical results. Recurrent instability in this series was associated with a specific re-injury and did not appear to increase with longer follow-up
— id: 64472, year: 2005, vol: 63, page: 9, stat: Journal Article,

Arthroscopic versus mini-open rotator cuff repair: a comparison of clinical outcomes and patient satisfaction
Youm, Thomas; Murray, Doug H; Kubiak, Erik N; Rokito, Andrew S; Zuckerman, Joseph D
2005 Sep-Oct;14(5):455-459, Journal of shoulder & elbow surgery
This study compares the results of arthroscopic and arthroscopically assisted mini-open rotator cuff repair in a series of 84 patients who underwent repair of small, medium, or large tears between March 1997 and September 2001 with at least 2 years of follow-up. There were 42 arthroscopic repairs and 42 mini-open repairs. Of the patients, 81 (96.4%) had good or excellent UCLA (University of California, Los Angeles) scores (40 arthroscopic repairs [95.2%] and 41 mini-open repairs [97.6%]); there were 2 fair results and 1 poor outcome. The ASES (American Shoulder and Elbow Surgeons) scores averaged 91.1 for the arthroscopic group and 90.2 for the mini-open group (P > .05). Six patients required further surgery (three from the arthroscopic group and three from the mini-open group). Of 84 patients, 83 (98.8%) reported being satisfied with the procedure. At greater than 2 years of follow-up, arthroscopic and mini-open rotator cuff repairs produced similar results for small, medium, and large rotator cuff tears with equivalent patient satisfaction rates
— id: 62378, year: 2005, vol: 14, page: 455, stat: Journal Article,

Accuracy of non-contrast MRI for diagnosis of SLAP lesions
Bhandarkar, P; Rafii, M; Moore, S; Sherman, O; Rokito, A
2004 APR ;182(4):57-57, American journal of roentgenology
— id: 46654, year: 2004, vol: 182, page: 57, stat: Journal Article,

Modified Weaver-Dunn procedure for acromioclavicular joint dislocations
Rokito, Andrew S; Oh, Young Ho; Zuckerman, Joseph D
2004 Jan;27(1):21-28, Orthopedics (Thorofare NJ)
— id: 44531, year: 2004, vol: 27, page: 21, stat: Journal Article,

The role of the acromioclavicular joint in impingement syndrome
Chen, Andrew L; Rokito, Andrew S; Zuckerman, Joseph D
2003 Apr;22(2):343-357, Clinics in sports medicine
Although AC pathology usually represents a late manifestation of outlet impingement, it typically presents as a cause of pain that is resistant to nonoperative and operative measures designed to treat purely anterior acromial pathology. The bursitis that occurs with AC joint impingement may be indistinguishable from anterior acromial impingement on clinical presentation; however, physical examination, diagnostic injection, and radiographic evaluation are generally sufficient to establish the diagnosis of AC joint impingement. Nonoperative measures are indicated for the treatment of acute bursitis, although operative intervention may be necessary in cases of large, distally projecting osteophytes in the presence of AC joint degeneration. Acromioclavicular pathology, when present, should be addressed at the time of subacromial decompression, and may involve distal clavicular resection, beveling of the AC joint, or excision of marginal osteophytes. The results of surgery to address the AC contribution to impingement are generally favorable; future investigation may further clarify the role of coplaning and its potential contribution to continued postoperative AC pain and symptomatic instability
— id: 44546, year: 2003, vol: 22, page: 343, stat: Journal Article,

Imaging of the elbow in the overhead throwing athlete
Chen, Andrew L; Youm, Thomas; Ong, Bernard C; Rafii, Mahvash; Rokito, Andrew S
2003 May-Jun;31(3):466-473, American journal of sports medicine
Elbow injuries in athletes who perform overhead throwing motions often present diagnostic challenges because of the undue stresses and often chronic, repetitive patterns of injury. Accurate and efficient assessment of the injured elbow is essential to maximize functional recovery and expedite return to play. Radiographic evaluation should be tailored to the specific injury suspected and requires a thorough understanding of normal anatomic relationships as well as familiarity with common injuries affecting these athletes
— id: 62380, year: 2003, vol: 31, page: 466, stat: Journal Article,

The effects of radiofrequency bipolar thermal energy on human meniscal tissue
Jazrawi, Laith M; Chen, Andrew; Stein, Drew; Heywood, Christian S; Bernstein, Adam; Steiner, German; Rokito, Andrew
2003 ;61(3-4):114-117, Bulletin (Hospital for Joint Diseases)
This study performed the first in vitro histological analysis of the effects of bipolar thermal energy on human meniscal tissue. Sixteen fresh human menisci were mounted on a cutting block and placed in a water bath simulating an arthroscopic environment. Each specimen was divided into four sections and randomized to one of four treatment options: 1. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power 3 setting); 2. thermal ablation with a bipolar multielectrode 3 mm Covac wand (power setting 7); 3. resection with a scalpel blade; and 4. resection with a motorized 4.5 full-radius resector. Six micron sections were cut and stained with Hematoxylin and Eosin and Masson's trichrome stain. Menisci were evaluated for the contour of the cut edge: straight, jagged, frayed, or combined. The zone of thermal necrosis and zone of thermal alteration were determined by examining the differential staining of the connective tissue and measuring the affected area. Menisci treated with the bipolar thermal probe were noted to have a smoother contoured edge in comparison to motorized cutters. The zone of thermal penetration for the Arthrocare power setting 3 averaged 0.18 mm (range: 0.09 to 0.20; SD 0.04) and for Arthrocare power setting 7 averaged 0.33 mm (range: 0.26 to 0.36; SD 0.03). The difference in thermal penetration between Arthrocare power settings 3 and 7 was 0.15 mm. This was statistically significant at p < 0.0001 (95% CI: 0.11 to 0.19 mm). The zone of thermal penetration was non-existent for the shaver and scalpel groups. This study provides the first histological description of the effects of bipolar radiofrequency energy on meniscal tissue. It demonstrates that there is intra-substance thermal penetration and alteration of the meniscal tissue. Its clinical significance is unclear and further in vivo studies are needed to address its clinical applicability
— id: 45992, year: 2003, vol: 61, page: 114, stat: Journal Article,

MRI features of chronic injuries of the superior peroneal retinaculum
Rosenberg, Zehava Sadka; Bencardino, Jenny; Astion, Donna; Schweitzer, Mark E; Rokito, Andrew; Sheskier, Steven
2003 Dec;181(6):1551-1557, American journal of roentgenology
OBJECTIVE: The aims of this study were to assess, grade, and surgically correlate previously unreported MRI features of superior peroneal retinacular injuries in nine surgically proven cases and to record all soft-tissue and bony abnormalities associated with these injuries. CONCLUSION: MRI was found to be a useful tool for detecting and grading superior peroneal retinacular injuries and providing information, important for presurgical planning, regarding common concomitant soft-tissue and osseous abnormalities of the lateral collateral ligaments, peroneal tendons, and fibular groove. Superior peroneal retinacular injuries are frequently associated with MRI evidence of peroneal tendon dislocations and tears. Conversely, routine MRI studies may not depict dislocated peroneal tendon injuries, despite clinical history to that effect
— id: 43808, year: 2003, vol: 181, page: 1551, stat: Journal Article,

The effect of instability and subsequent anterior shoulder repair on proprioceptive ability
Zuckerman, Joseph D; Gallagher, Maureen A; Cuomo, Frances; Rokito, Andrew
2003 Mar-Apr;12(2):105-109, Journal of shoulder & elbow surgery
Proprioceptive ability was prospectively evaluated in patients with recurrent traumatic anterior instability who subsequently underwent anterior shoulder repair. Thirty consecutive patients were evaluated for passive position sense and detection of motion with the shoulder in flexion, abduction, and external rotation 1 week before surgery. They were then retested at 6 and 12 months postoperatively. A significant deficit in proprioception was found when the unstable side was compared with the uninvolved side before surgery. Six months after surgical repair, position sense showed an improvement of approximately 50% but was still found to be significantly different on the involved side; detection of motion was no longer significantly different from the uninvolved shoulder. One year after open anterior shoulder repair, both position sense and detection of motion were equivalent to those of the uninvolved shoulder
— id: 44547, year: 2003, vol: 12, page: 105, 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,

Reconstruction of chronic distal biceps tendon rupture with use of fascia lata combined with a ligament augmentation device: a report of 3 cases
Kaplan, F Thomas D; Rokito, Andrew S; Birdzell, Maureen G; Zuckerman, Joseph D
2002 Nov-Dec;11(6):633-636, Journal of shoulder & elbow surgery
— id: 44550, year: 2002, vol: 11, page: 633, stat: Journal Article,

The shoulder in baseball pitching: biomechanics and related injuries-part 1
Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D
2002 2003;61(1-2):68-79, Bulletin (Hospital for Joint Diseases)
The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance
— id: 44543, year: 2002, vol: 61, page: 68, stat: Journal Article,

The shoulder in baseball pitching: biomechanics and related injuries-part 2
Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D
2002 2003;61(1-2):80-88, Bulletin (Hospital for Joint Diseases)
The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. The athlete's symptoms and signs, as well as radiographic imaging, are key elements in arriving at a diagnosis of shoulder injuries. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance
— id: 44542, year: 2002, vol: 61, page: 80, stat: Journal Article,

Severe ulnar neuropathy after subcutaneous transposition in a collegiate tennis player
Polatsch, Daniel B; Bong, Matthew R; Rokito, Andrew S
2002 Nov;31(11):643-646, American journal of orthopedics (Belle Mead, NJ)
We report the case of an 'overhead' athlete (a collegiate tennis player) who developed severe ulnar neuropathy after anterior subcutaneous transposition and placement of a fasciodermal sling. Treatment consisted of opening the sling, excising suture material, releasing all other areas of potential compression, and performing anterior submuscular transposition of the ulnar nerve deep to the flexor muscle group. Two years after surgery, subjective symptoms were significantly improved, though the patient continued to experience mild medial-side elbow discomfort and intermittent paresthesia along the ulnar nerve distribution. Pain relief achieved without full sensory and motor recovery is consistent with results reported elsewhere. In short, extreme care must be taken when creating a fasciodermal sling during anterior subcutaneous transposition of the ulnar nerve
— id: 56210, year: 2002, vol: 31, page: 643, stat: Journal Article,

A comparison of nonoperative and operative treatment of type II distal clavicle fractures
Rokito, Andrew S; Zuckerman, Joseph D; Shaari, Jeffrey M; Eisenberg, David P; Cuomo, Frances; Gallagher, Maureen A
2002 2003;61(1-2):32-39, Bulletin (Hospital for Joint Diseases)
A retrospective study was performed to compare nonoperative and operative treatments of Type II distal clavicle fractures. From a total of 30 diagnosed patients, 16 were identified as receiving nonoperative treatment and 14 open reduction and coracoclavicular stabilization. The average follow-up was 53.5 months for the nonoperative group and 59.8 months for the operative group. All patients were evaluated postoperatively for pain, range of motion, function, and fracture healing as well as for isokinetic strength. Fractures treated surgically achieved union within six to ten weeks. Nonoperative treatment resulted in seven nonunions. There were no significant differences between the two groups in the mean UCLA, Constant, and ASES scores. Nonunion had no significant effect on functional outcome or strength. This study suggests that Type II distal clavicle fractures can be successfully managed nonoperatively. The high incidence of nonunion does not impede a clinical outcome comparable to that achieved by surgical treatment
— id: 44545, year: 2002, vol: 61, page: 32, stat: Journal Article,

Thermal capsular shrinkage: Basic science and clinical applications
Medvecky, MJ; Ong, BC; Rokito, AS; Sherman, OH
2001 JUL-AUG ;17(6):624-635, Arthroscopy
Recently, the use of thermal energy to shrink the redundant glenohumeral joint capsule in patients with instability has generated a great deal of interest. Proponents assert that the procedure avoids the need for an open stabilization and it may be used as an adjunct to an open or arthroscopic capsulolabral repair. The use of nonablative thermal energy to shrink soft-tissue collagen appears to induce ultra-structural and mechanical changes at or above 60 degreesC. The microscopic changes reflect the unwinding of the collagen triple helix and loss of the fiber orientation. The fibrils contract into a shortened state and reactive fibroblasts have been shown to grow into this treated area and synthesize the collagen matrix. The biomechanical properties of the tissue do not appear to be detrimentally altered if shrinkage is limited to less than 15% and if ablation or excess focal treatment is avoided. The endpoint of optimal shrinkage is not known and clinical estimations of tissue changes and volumetric reduction are used as guides to treatment. The first clinical follow-up study was only recently published in the peer-reviewed literature and prior preliminary reports were optimistic regarding the use of thermal energy for the treatment of glenohumeral instability. Thermal capsular shrinkage has been used as an adjunct to a capsulolabral repair, as well as an isolated treatment for the disorders of internal impingement and multidirectional instability. Additional evaluation is necessary to determine the optimal quantity of energy needed for tissue shrinkage without inadvertent tissue destruction. The long-term clinical effect, mechanical propel-ties, and durability of the newly produced collagen need to be analyzed further. The basic science and clinical applications of this newly applied technology are reviewed in this article
— id: 55016, year: 2001, vol: 17, page: 624, stat: Journal Article,

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder
Bencardino JT; Beltran J; Rosenberg ZS; Rokito A; Schmahmann S; Mota J; Mellado JM; Zuckerman J; Cuomo F; Rose D
2000 Jan;214(1):267-271, Radiology
PURPOSE: To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder. MATERIALS AND METHODS: From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography. RESULTS: SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography. CONCLUSION: MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon
— id: 27850, year: 2000, vol: 214, page: 267, 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,

Long-term functional outcome of repair of large and massive chronic tears of the rotator cuff
Rokito AS; Cuomo F; Gallagher MA; Zuckerman JD
1999 Jul;81(7):991-997, Journal of bone & joint surgery (American volume)
BACKGROUND: There have been conflicting reports regarding the effect of the size of a tear of the rotator cuff on the ultimate functional outcome after repair of the rotator cuff. While some authors have reported that the size of the tear does not adversely affect the overall result of repair, others have reported that the outcome is less predictable after repair of a large tear than after repair of a small tear. The purpose of the present study was to examine the long-term functional outcome and the recovery of strength in thirty consecutive patients who had had repair of a large or massive tear of the rotator cuff. METHODS: Thirty consecutive patients who had operative repair of a large or massive chronic tear of the rotator cuff had a comprehensive isokinetic assessment of the strength of the shoulder preoperatively, twelve months postoperatively, and a mean of sixty-five months (range, forty-six to ninety-three months) postoperatively. The functional outcome was assessed with the University of California at Los Angeles shoulder score. RESULTS: All patients reported that they were satisfied with the result and had increased strength compared with preoperatively. There was a significant decrease in pain (p < 0.01) and significant improvements in function (p < 0.01) and the range of motion (p < 0.01). The mean University of California at Los Angeles shoulder score increased significantly from 12.3 points preoperatively to 31.0 points at the most recent follow-up examination (p < 0.01). The mean peak torque in flexion, abduction, and external rotation increased significantly to 80 percent (p < 0.01), 73 percent (p < 0.01), and 91 percent (p < 0.01), respectively, of that of the uninvolved shoulder by the time of the most recent follow-up examination. CONCLUSIONS: Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. The results of the present study suggest that more than one year is needed for complete restoration of strength. The strength of the affected shoulders still did not equal that of the unaffected, contralateral shoulders by the time of the long-term follow-up
— id: 56462, year: 1999, vol: 81, page: 991, stat: Journal Article,

MR imaging of superior peroneal retinacular injuries
Rosenberg, ZS; Bencardino, JT; Cheung, YY; Schweitzer, ME; Astion, D; Rokito, A
1999 ;213P(1):1543-1543, Radiology
— id: 114530, year: 1999, vol: 213P, page: 1543, stat: Journal Article,

The effect of intraarticular anesthesia and elastic bandage on elbow proprioception
Khabie V; Schwartz MC; Rokito AS; Gallagher MA; Cuomo F; Zuckerman JD
1998 Sep-Oct;7(5):501-504, Journal of shoulder & elbow surgery
Twenty uninjured male volunteers were studied to characterize normal elbow proprioception and to investigate the effect of applying an elastic bandage to the extremity and injection of an intraarticular anesthetic. A modified Biodex dynamometer was used to study position sense and detection of motion. In part 1 of the study position sense was tested by flexing the elbow to a predetermined angle, returning to the starting position, and then asking the subject to identify that angle. In part 2 detection of motion was tested by asking the subject to disengage the apparatus by pressing a stop button when movement was detected. The testing conditions in part 1 and part 2 were repeated after the elbow was wrapped with an elastic bandage and again after an intraarticular injection of 3 cc 1% lidocaine with the bandage removed. Ten additional subjects underwent testing of both elbows to examine the effect of arm dominance. Mean position sense was within 3.3 degrees+/-1.3 degrees of the actual angle in trials without an elastic bandage or an anesthetic. A significant improvement in position sense was observed (2.2 degrees+/-1.2 degrees) after an elastic bandage was applied (P < .004). No significant difference was seen in position sense after lidocaine was injected. The mean threshold for detection of motion in trials without an elastic bandage or an anesthetic was 4.21 degrees+/-1.56 degrees. No significant differences were seen in detection of motion observed with the elastic bandage or intraarticular anesthetic. No significant differences were seen between dominant and nondominant extremities for both position sense and detection of motion. The application of an elastic bandage improved position sense, suggesting that tactile cues from cutaneous or other extraarticular receptors may play a role in elbow proprioception. Intraarticular anesthesia, however, had little effect, suggesting that intracapsular receptors play a lesser role in elbow proprioception. The determination of proprioceptive qualities for the normal elbow can aid in the understanding of elbow function and provide a basis for defining its role in elbow dysfunction
— id: 57041, year: 1998, vol: 7, page: 501, stat: Journal Article,

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part I
Rokito AS; Namkoong S; Zuckerman JD; Gallagher MA
1998 Nov;27(11):723-725, American journal of orthopedics (Belle Mead, NJ)
Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although these procedures were usually popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. Often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures that aim to prevent recurrent instability while maintaining full range of motion and function have been devised. Part I of this paper presents a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II, which will be published in the December 1998 issue, includes the Putti-Platt, Magnuson-Stack, Bristow, and newer procedures
— id: 12054, year: 1998, vol: 27, page: 723, stat: Journal Article,

Open surgical treatment of anterior glenohumeral instability: an historical perspective and review of the literature. Part II
Rokito AS; Namkoong S; Zuckerman JD; Gallagher MA
1998 Dec;27(12):784-790, American journal of orthopedics (Belle Mead, NJ)
Anterior glenohumeral instability is an undesirable result of trauma to the shoulder. Several surgical treatments for this condition have been developed, beginning in the early years of the twentieth century. Although many of these procedures were popular at their inception, many of them have fallen out of favor as more information has been acquired concerning the long-term results and complications of their use. While often successful in preventing recurrent instability, these earlier procedures also often led to a loss of external rotation, and consequently, function. Newer procedures have been devised that aim to prevent recurrent instability while maintaining full range of motion and function. Part I of this paper, published in the November issue, presented a brief history of the treatment of glenohumeral instability and a review of the literature, including the Bankart and du Toit procedures. Part II includes the Putti-Platt, the Magnuson-Stack, the Bristow, and capsular shift procedures
— id: 12049, year: 1998, vol: 27, page: 784, stat: Journal Article,

Examination of the lateral antebrachial cutaneous nerve: an anatomic study in human cadavers
Rosen JE; Rokito AS; Khabie V; Zuckerman JD
1998 Oct;27(10):690-692, American journal of orthopedics (Belle Mead, NJ)
Variations in the anatomic course of the cutaneous nerves about the lateral aspect of the elbow are important when surgical exposures and the establishment of arthroscopic portals are considered. The specific anatomic course taken by the lateral antebrachial cutaneous nerve and its relationship to the lateral epicondyle were determined by studying 33 upper extremities in 22 preserved adult cadavers. Considerable anatomic variation was found regarding the location of the lateral antebrachial cutaneous nerve as it crossed the elbow. The nerve pierced the brachial fascia an average of 3.2 cm proximal to the lateral epicondyle and was located an average of 4.5 cm medial to the lateral epicondyle as it crossed the interepicondylar line. In two instances, the nerve passed through the biceps muscle directly, prior to piercing the brachial fascia
— id: 24521, year: 1998, vol: 27, page: 690, stat: Journal Article,

Glenohumeral instability: evaluation with MR arthrography
Beltran J; Rosenberg ZS; Chandnani VP; Cuomo F; Beltran S; Rokito A
1997 May-Jun;17(3):657-673, Radiographics
Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement
— id: 8094, year: 1997, vol: 17, page: 657, stat: Journal Article,

Efficacy of injections of corticosteroids for subacromial impingement syndrome
Blair B; Rokito AS; Cuomo F; Jarolem K; Zuckerman JD
1996 Nov;78(11):1685-1689, Journal of bone & joint surgery (American volume)
A prospective, randomized, controlled, double-blind clinical study was performed to determine the short-term efficacy of subacromial injection of corticosteroids for the treatment of subacromial impingement syndrome. Forty patients were randomized to receive either six milliliters of 1 per cent lidocaine without epinephrine (the control group) or two milliliters containing forty milligrams of triamcinolone acetonide per milliliter with four milliliters of 1 per cent lidocaine without epinephrine (the corticosteroid group). The patients were re-examined serially until completion of the study. Nineteen patients, whose mean age was fifty-six years (range, thirty-two to eighty years), were randomized to the corticosteroid group, and twenty-one patients, whose mean age was fifty-seven years (range, thirty-two to eighty-one years), were randomized to the control group. The mean duration of symptoms before the injection was eight months for both groups. Eighteen patients in the corticosteroid group and nineteen patients in the control group had moderate or severe pain before the injection. At the most recent follow-up evaluation, at a mean of thirty-three weeks for the corticosteroid group and twenty-eight weeks for the control group, three patients in the corticosteroid group had moderate or severe pain, compared with fifteen patients in the control group. The mean active range of forward elevation and external rotation improved by 24 and 11 degrees, respectively, for the corticosteroid group and by 10 and 5 degrees, respectively, for the control group. We concluded that subacromial injection of corticosteroids is an effective short-term therapy for the treatment of symptomatic subacromial impingement syndrome. The use of such injections can substantially decrease pain and increase the range of motion of the shoulder
— id: 44578, year: 1996, vol: 78, page: 1685, stat: Journal Article,

Patients with femoral neck and intertrochanteric fractures. Are they the same?
Koval KJ; Aharonoff GB; Rokito AS; Lyon T; Zuckerman JD
1996 Sep;(330):166-172, Clinical orthopaedics & related research
A prospective analysis was performed involving 680 geriatric patients with hip fractures to determine whether the demographic profile of patients with femoral neck fractures was similar to that of patients with intertrochanteric fractures. All patients were community dwelling, cognitively intact, previously ambulatory elderly with femoral neck or intertrochanteric fracture. Three hundred fifty-eight patients (52.6%) sustained a femoral neck fracture; 322 (47.4%), an intertrochanteric fracture. Patients with an intertrochanteric fracture were significantly older, more likely to be limited to home ambulation, and were more dependent regarding basic and instrumental activities of daily living. After stratification by gender and adjustment for age, these differences remained significant in women only. There were no differences in age, prefracture ambulatory ability, or dependence in activities of daily living in men with either type of fracture
— id: 47556, year: 1996, vol: , page: 166, stat: Journal Article,

Medial dislocation of the long head of the biceps tendon. Magnetic resonance imaging evaluation
Rokito AS; Bilgen OF; Zuckerman JD; Cuomo F
1996 Apr;25(4):314, 318-23, American journal of orthopedics (Belle Mead, NJ)
Medial dislocation of the long head of the biceps branchii tendon is a rare occurrence and is often associated with degenerative or traumatic tears of the rotator cuff, specifically tears of the subscapularis tendon. Following a dislocation, the biceps tendon will assume either an intra- or extra-articular position depending on whether or not the subscapularis tendon detaches from its humoral insertion. Magnetic resonance imaging (MRI) has been found to provide valuable information concerning the location of the biceps tendon and the integrity of the rotator cuff. In this report, three patients with suspected dislocations of the biceps tendon are evaluated using MRI
— id: 44581, year: 1996, vol: 25, page: 314, 318, stat: Journal Article,

Partial rupture of the distal biceps tendon
Rokito AS; McLaughlin JA; Gallagher MA; Zuckerman JD
1996 Jan-Feb;5(1):73-75, Journal of shoulder & elbow surgery
— id: 44582, year: 1996, vol: 5, page: 73, stat: Journal Article,

Strength after surgical repair of the rotator cuff
Rokito AS; Zuckerman JD; Gallagher MA; Cuomo F
1996 Jan-Feb;5(1):12-17, Journal of shoulder & elbow surgery
Forty-two consecutive patients (20 men and 22 women, age range 39 to 78 years) with full-thickness rotator cuff tears underwent a comprehensive isokinetic strength assessment before and at 3-month intervals for 1 year after surgery. All patients underwent acromioplasty and rotator cuff repair and were treated with a standardized postoperative rehabilitation program. Isokinetic strength testing was performed in flexion/extension, abduction/adduction, and external/internal rotation at 60 degrees/sec. The unaffected contralateral shoulder was tested for comparison. Clinical outcomes were assessed with the University of California Los Angeles Shoulder Rating Scale (maximum = 35 points). The average University of California Los Angeles score was 31.2 by 1 year after operation. Patients with small and medium tears had an average rating of 33.5, whereas those with large and massive tears had an average score of 28.3. Strength increased gradually during the first postoperative year. The preoperative mean peak torque was 54%, 45%, and 64% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively; after operation it increased to 78%, 80%, and 79% by 6 months and 84%, 90%, and 91% by 12 months. The greatest improvement in strength consistently occurred during the first 6 months after surgery. Patients also showed marked increases in both work and power. By 12 months after operation mean work had increased to 70% in flexion and abduction and 90% in external rotation of the uninvolved shoulder. Similarly, mean power had increased to 68%, 79%, and 90% of the uninvolved shoulder in flexion, abduction, and external rotation, respectively, by 12 months after operation. Recovery of strength correlated primarily with the size of the tear: for small and medium tears recovery of strength was almost complete during the first year, and for large and massive tears it was much slower and less consistent. By using isokinetic strength evaluation we found that recovery of strength after rotator cuff repair requires at least 1 year of rehabilitation
— id: 44584, year: 1996, vol: 5, page: 12, stat: Journal Article,

Technical pitfalls in the use of the sliding hip screw for fixation of intertrochanteric hip fractures
Rokito AS; Koval KJ; Zuckerman JD
1993 Apr;26(4):349-356, Contemporary orthopaedics
Two hundred fifty consecutive intertrochanteric fractures treated with a sliding hip screw (SHS) over a three year period were reviewed and specific types of technical pitfalls identified. Most pitfalls were technique dependent and potentially preventable with proper attention to the principles of fracture reduction and insertion of the device. Pitfalls encountered with the use of the SHS occurred as a result of either poor fracture reduction or implant insertion. Problems related to fracture reduction included poor radiographic visualization, posterior sag, varus angulation, and internal rotation of the femoral shaft in relation to the femoral neck. Potential pitfalls encountered during SHS insertion included superior guide wire placement, guide wire breakage or penetration into the hip joint or pelvis, loss of reduction during lag screw insertion, improper screw-barrel relationship, and improper plate application. Finally, the SHS may not be the implant of choice for all extracapsular hip fractures (i.e., the reverse obliquity fracture). This paper identifies the various pitfalls that may occur with the use of the SHS for the fixation of intertrochanteric hip fractures. Illustrative cases are provided and guidelines for avoiding these surgical pitfalls suggested
— id: 44599, year: 1993, vol: 26, page: 349, stat: Journal Article,

Symptomatic displacement of the lesser trochanter following trochanteric fracture fixation
Rokito AS; Simon M; Koval KJ; Zuckerman JD
1993 Winter;52(2):52-54, Bulletin (Hospital for Joint Diseases)
Unstable intertrochanteric hip fractures are characterized by comminution of the posteromedial cortex, resulting in a fragment of variable size containing the lesser trochanter. Controversy exists as to whether it is necessary to perform reduction and fixation of this fragment. This case lends further support to the practice of fixating the lesser trochanteric fragment in unstable intertrochanteric fractures
— id: 44602, year: 1993, vol: 52, page: 52, stat: Journal Article,