Seth L. Sherman

Why do some patients rupture both ACLs, while others only sustain a unilateral injury? To answer this, we compared bilateral vs unilateral ACL reconstruction patients in a matched cohort study (age, sex, sport, and other confounders carefully controlled to reduce bias). 🔎 Key Finding We found that a steeper medial posterior tibial slope (MPTS) is significantly associated with bilateral ACL reconstruction. This suggests that intrinsic anatomical morphology, beyond chance or exposure, may predispose certain patients to bilateral injury. 🧭 Clinical Takeaway • Bilateral ACL rupture may not be “just bad luck.” • Identifying patients with a steeper tibial slope could help with risk stratification, prevention strategies, and patient counseling after a first ACL injury. 👉 Read the full paper in JEO Journal : https://lnkd.in/drvRwCau Julien Druel Dr. Apoorva Khajuria Antoine PIERCECCHI Christophe Jacquet Jean-Noël Argenson #ACL #KneeSurgery #SportsMedicine #InjuryPrevention #Orthopaedics

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Why is the Center of Rotation of the Knee Important in Total Knee Replacement? The journey from Hollister's groundbreaking 1993 research publication to our current clinical framework illustrates why the center of rotation is the critical factor in total knee replacement success. 🎯 Key Breakthrough: Hollister et al. (1993) changed conventional wisdom by proving the knee operates about two fixed, offset axes, not the variable center previously assumed. 🔧 Further Refinement: Eckhoff's cylindrical axis concept (2007) refined Hollister's work, showing this axis accurately represents the true functional flexion-extension center with only 0.27° measurement error vs. 5-10° variability of epicondylar axis methods. 🎯 The Two Critical References: Eckhoff's cylindrical axis depends on two key measurements: • mLDFA (mechanical Lateral Distal Femoral Angle) - defines the most distal aspect of the cylinder • PCA (Posterior Condylar Axis) - defines the most posterior aspect of the cylinder     Neither mLDFA nor PCA alone can define Eckhoff's cylindrical axis: mLDFA alone: Provides coronal orientation but lacks rotational reference PCA alone: Provides rotational reference but lacks coronal orientation Combined: They create the complete 3D geometric definition of the true functional center of rotation 🚀 Modern Application: Our 2024 JAAOS framework illustrates Eckhoff's cylindrical axis for clinical implementation • See case illustration below, radiographs and clinical outcomes using a 3D cylindrical axis plan. 💡 The Bottom Line: These biomechanical insights can now be translated into 3-D planning and achieved surgically with precise execution using augmented reality, or robotics. References: Hollister AM, et al. The axes of rotation of the knee. Clin Orthop Relat Res. 1993;290:259-268. Eckhoff DG, et al. Difference between the epicondylar and cylindrical axis of the knee. Clin Orthop Relat Res. 2007;461:238-244. Liu B, et al. Kinematic alignment versus mechanical alignment in primary total knee arthroplasty: An updated meta-analysis. J Orthop Surg Res. 2022;17:201. Dossett HG, et al. Individualizing a Total Knee Arthroplasty with Three-Dimensional Planning. JAAOS Glob Res Rev. 2024;8(3):e23.00245. #OrthopedicSurgery #TotalKneeReplacement #KneeArthroplasty #KinematicAlignment #RoboticSurgery #Biomechanics #PersonalizedMedicine #SurgicalInnovation #PatientOutcomes #OrthopedicResearch #JAAOS #ClinicalOrthopedics #ComputerNavigatedSurgery #IndividualizedCare #SurgicalTechnology

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𝐅𝐔𝐋𝐋𝐘 𝐂𝐔𝐒𝐓𝐎𝐌 𝐓𝐊𝐀: 𝐇𝐨𝐰 𝐝𝐨 𝐲𝐨𝐮 𝐞𝐯𝐚𝐥𝐮𝐚𝐭𝐞 𝐧𝐞𝐰 𝐭𝐞𝐜𝐡𝐧𝐨𝐥𝐨𝐠𝐲? I recently did a series of fully custom total knee arthroplasties with restor3d. Here's how I evaluated the technology in my practice: 1. 𝐊𝐍𝐎𝐖 𝐘𝐎𝐔𝐑 𝐖𝐇𝐘 ➡️ New tech must be cheaper, faster in the OR, or improve patient outcomes. Trade-offs in any of these three categories must be balanced by benefit in the other two areas 💡 Custom TKA was time neutral by my 4th case, cheaper overall, and will hopefully improve patient outcomes 2. 𝐃𝐄𝐃𝐈𝐂𝐀𝐓𝐄 𝐓𝐈𝐌𝐄 ➡️ Don't wait until the end of the OR day when your patience is thin to try something new. 💡 I scheduled a day with 4 left knees: standard varus, bad varus, standard valgus, bad valgus to put the technology to the test. It performed best in the bad valgus knee! 3. 𝐏𝐀𝐓𝐈𝐄𝐍𝐓 𝐁𝐔𝐘-𝐈𝐍 ➡️ Would you want the new technology used on your knee? Involve patients in your decision and let them know they are the first to recieve it 💡 Patients jumped at the opportunity for a full-custom knee replacement and were excited to be the first in my practice What other things do you look for when evaluating new technology in your practice?

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