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First Session
Moderator:   Harry E. Rubash, MD

Thesis Presenter: R. Ronald Tabaddor, MD
Topic: Treatment of osteochondritis dissecans lesions of the knee using poly 96l/4d-lactide copolymer bioabsorbable screws
Discusser: Scott D. Martin, MD
Advisor: Mininder S. Kocher, MD

Dr. Ronald Tabaddor investigated a new treatment for osteochondritis dissecans (OCD) in adolescents. He acknowledged the shortcomings of current treatment methods including metal implants, staples, bone pegs and bioabsorbable implants. Hoping to avoid the adverse events associated with these devices, he sought to demonstrate the efficacy and safety of a new bioabsorbable copolymer fixation. He used a retrospective case-control design using a series of patients with unstable OCD lesions of the knee which were treated with bioabsorbable implants. His population had OCD lesions of the medial femoral condyle, lateral femoral condyle, or patella. Three standardized and validated knee-function questionnaires, participants’ medical records, plain films, MRI’s and pain level and satisfaction scale questionnaires were reviewed. The mean age of the 24 patients he evaluated was 14.4 years old. His mean follow-up was 39.6 months. Dr. Tabaddor reported a mean IKDC score at follow-up of 84.9, a mean Lysholm score of 88.0 and a mean Tegner score of 7.9. Upon review of radiographs which averaged 19.2 months post-operatively, he reported interval healing in 9 patients, no significant change in 1 patient, complete healing in 13 patients and loose bodies with no interval healing in 1 patient. Two required re-operation for non healing lesions and 2 patients developed sterile effusions. Twenty two of 24 patients had good to excellent outcomes. Dr. Tabaddor concluded that copolymer fixation as an effective treatment for unstable OCD lesions of the knee as it offers stability for the healing OCD lesions with minimal reaction from degradation products and recommended it for use in the adolescent population.

Thesis Presenter: Mark D. Price, MD, PhD
Topic: Surgical Correction of Clinodactyly in the Skeletally Immature Patient
Discusser: Sang-Gil Lee, MD
Advisor: Don S. Bae, MD

Dr. Mark Price sought to demonstrate that surgical management of clinodactyly yields safe and effective deformity correction with maintenance of function and growth. He conducted a retrospective evaluation of 67 digits (32 fingers and 35 thumbs) in 48 patients (average age 3.9 years, range 0.4 to 13.4 years) who underwent surgical correction for clinodactyly. Corrective procedures included 35 reverse-wedge osteotomies, 14 closing-wedge osteotomies, three opening-wedge osteotomies, two physiolyses and 14 excisions of a delta phalanx. Dr. Price assessed digits for: 1) angular correction; 2) motion; 3) continued growth; 4) recurrence; 5) need for additional surgery; 6) overall hand function using the QuickDASH outcomes instrument; and 7) patient/family satisfaction. He had an average clinical and radiographic follow-up of 46 months (range 1 to 153 months). Preoperative angulation of the fingers averaged 40 degrees (range 22 - 70), while the thumbs averaged 42 degrees (range 17 - 83). Postoperative angulation for the fingers averaged 12 degrees (range 0 - 37), while the thumbs averaged 14 degrees (range 0 - 30). Two fingers demonstrated postoperative growth disturbance and motion was restricted in two of the fingers and eleven of the thumbs. Recurrent deformity was seen in one finger and five thumbs. Two thumbs required revision or repeat surgery. Dr. Price reported an average QuickDASH score of 24.1 (range 0 - 54). Average QuickDASH in patients with finger involvement was 15.6 (range 0 - 38); average QuickDASH scores in patients with thumb involvement was 29.5 (range 0 - 54). Average child and family satisfaction was 9.1 and 9.3 out of 10, respectively, for the fingers and 9.3 and 9.2 out of 10, respectively, for the thumbs. Dr. Price concluded that surgical correction of clinodactyly yields good results and high patient and parent satisfaction as well as describing its complications. Dr. Pellegrini commented on the disparity of reported disability between the finger and thumb cohorts.

Thesis Presenter: Catherine E. Johnson, MD
Topic: A Retrospective Analysis of a Modified Peroneal Groove Deepening Technique for Chronic Peroneal Instability
Discusser: Richard de Asla, MD
Advisor: Christopher P. Chiodo, MD

Dr. Catherine Johnson described a new procedure for the treatment of chronic peroneal tendon instability, a frequent cause of ankle disability. Dr. Johnson reviewed the traditional “trap door” technique whereby the surgeon creates a rectangular fibular osteotomy; and she discussed the common frustration of this technique when the hinge of the “trap door” fractures. She described and assessed the results of a modified peroneal groove deepening procedure that utilized inward impaction of a steeple-shaped fibular osteotomy with an intact periosteal hinge in a retrospective review of 27 consecutive cases between 2001 and 2005. She excluded patients if any procedure other than a peroneal repair or debridement was performed at the same setting. She evaluated her patients using physical examination, a subjective satisfaction scale, the AOFAS Ankle-Hindfoot score and the Foot and the Ankle Ability Measure (FAAM). Out of the 25 patients available for followup, 8 were male and 17 were female with an average age of 45 years (range, 21 - 65 years). Seventeen out of the 25 patients (68%) underwent concomitant peroneal repair or debridement. The peroneal retinaculum was repair in all patients. Mean follow-up was 38 months (range, 12 - 63 months). On follow-up physical examination, 24/25 patients had stable tendons with full ROM and motor strength compared to the non-operative side. Subjectively, 21 patients reported that they were completely satisfied with the operation, while 3 were satisfied with minor reservations and one was dissatisfied. The average AOFAS Ankle-Hindfoot score was 96 out of 100 points (range, 89 – 100 points). The average Foot and Ankle Ability Measure was also 96 out of 100 points (range, 76 – 100 points). The one patient that was dissatisfied had required revision surgery. Except for this patient, all of Dr. Johnson’s patients stated they would undergo surgery again. Dr. Catherine Johnson demonstrated that peroneal groove deepening using inward impaction of a steeple-shaped fibular osteotomy with an intact periosteal hinge is a reliable procedure for patients with chronic peroneal instability, and that it yields both excellent subjective and objective outcomes. Of note, Dr. Johnson’s series is the largest reported for a fibular groove deepening procedure. Dr. Pellegrini was impressed with the new technique and lauded Dr. Johnson for her hard work in obtaining meticulous follow up for these patients. She won the Best Clinical Research Paper award for her efforts and innovation.