Northwell Health Department of Orthopaedic Surgery - Alumni Day 2018

Alumni Day 2018

Long Island Jewish Medical Center
Department of Orthopaedic Surgery
10th Annual Alumni Day
June 1, 2018

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Table of Contents

3 Message from the Chairman
4 Message from the Program Director
5 Department Leadership
7 History of the Long Island Jewish Residency Program
10 Keynote Spotlight
11 Alumni Day Program
13 2017 Research Day Abstracts
45 2018 Chief Residents
46 Physician Partners
49 LIJ and NSUH Faculty
50 Orthopaedic Surgery Residency Alumni/Alumnae
52 Giving Back
53 2017 Faculty Scholarly Activity
63 Research & Grants
64 Faculty Committees & Positions
65 2017 Resident Scholarly Activity
70 What’s NEW…

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Message from the Chairman

It is with great pride that I welcome all to our 10th Annual Northwell Health LIJ Alumni Day. At its inception ten
years ago, we never imagined how this event would develop into such a celebration of past and future
accomplishments.
Our vision has been to provide a formal venue for our resident physicians to present their research and scholarly
activity in a peer-reviewed forum. We continue to celebrate with the 133 graduates of the program including our
Distinguished Visiting Professor Keynote Speaker, Kevin Trapp (Class of 2003).
Our efforts have expanded and fortified the Northwell orthopaedic collegial network and we remain very excited
to share our department’s growth and accomplishments.
We look forward to a productive and enjoyable meeting and thank all for your dedication and continued support.

Respectfully,

Nicholas A. Sgaglione, MD
Chairman, Orthopaedic Surgery
Northwell Health

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Message from the Program Director

We extend to you, our alumni/ae, a most enthusiastic greeting at this annual event. Our current
residents are pleased to present the results of their basic science and clinical research again this year.
2017/2018 was another banner year. Our residents have been selected to present their research at
national meetings and have published their work in many Orthopaedic and related journals.
Daniel Grande, PhD continues to mentor our residents in basic science research as the Director of the
Orthopaedic Research Laboratory, and has recently been named Assistant Vice President of Research
Services at the Feinstein Institute for Medical Research. In clinical research, residents have benefited
from the guidance and mentoring of a large number of fulltime and voluntary faculty members that
has resulted in a large number of high quality studies.

Applications to the program this year showed steady growth in volume with exceptional quality of the
applicants that resulted in excellent match results. Our residents continue to be chosen for
outstanding fellowships (HSS, Texas Back, UCSF, Kerlan Jobe and Miami) reflecting well on their
accomplishments as well as on the program.

Welcome back to the residents who have been on this ten year journey with us and to those who are
joining us for the first time this year. We urge you to take the opportunity to meet our current
residents as well as to renew old friendships with your colleagues from years past. We hope that you
enjoy the program this year and will make it a perennial event on your future calendar.

With warmest regards,
Program Director

Lewis B. Lane, MD
Orthopaedic Residency Program Director
Long Island Jewish Medical Center
The Donald and Barbara Zucker School of Medicine
at Hofstra/Northwell

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Departmental Leadership

Nicholas A. Sgaglione, MD
Chairman, Orthopaedic Surgery, Northwell Health
Senior Vice President, Orthopaedic Service Line
Executive Director, Northwell Health Orthopaedic Institute
Chair & Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell

Thomas M. Mauri, MD
Vice Chairman, Orthopaedic Surgery, North Shore University Hospital & Long Island
Jewish Medical Center
Vice President Clinical Services, Orthopaedic Service Line
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell

Jeff Silber, MD
Associate Chairman, Orthopaedic Surgery, Long Island Jewish Medical Center
Chief, Orthopaedic Spine Surgery, Long Island Jewish Medical Center
Associate Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell

Lewis B. Lane, MD
Chief, Hand Surgery, North Shore University Hospital & Long Island Jewish Medical
Center
Residency Program Director, Orthopaedic Surgery, Long Island Jewish Medical Center
Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell

Kate Nellans, MD, MPH
Associate Residency Program Director, Orthopaedic Surgery, Long Island Jewish Medical
Center
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of
Medicine at Hofstra/Northwell

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Nina DePaola, MHA, PT
Vice President, Orthopaedic & Rehabilitation Service Line
Northwell Health

Michael Langino MPT, MBA
Assistant Vice President, Orthopaedic Service Line
Northwell Health

Janice A. Vetrano, MS
Administrative Director, Orthopaedic Surgery
Teaching Program Administrator, Orthopaedic Surgery
Long Island Jewish Medical Center

Daniel Grande, PhD
Assistant Vice President of Research Services, Feinstein Institute for Medical Research
Research Director, Feinstein Institute for Medical Research
Associate Professor, Orthopaedic Surgery,
The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

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The History of Long Island Jewish Residency Program

One could not begin to discuss the history of our distinguished Orthopaedic Residency Program without looking
back at the history of Long Island Jewish Medical Center from its inception to today.

After the Second World War health care services were critically needed as Nassau County was booming with
housing growth and population boom and two community hospitals – North Shore University Hospital and Long
Island Jewish Medical Center – would soon play a role in the settling and development of this area. Pertinent
historical facts:

 LIJ Groundbreaking – December 10, 1950
 Construction Begins – April 1952
 LIJ accepts the first patient – May 16, 1954
 Contract with SUNY Downstate to make LIJ a teaching hospital – 1955
 LIJ launches a graduate training program in conjunction with SUNY Downstate raising the hospital’s national

profile as a teaching hospital - 1966
 LIJ and AECOM – Albert Einstein College of Medicine Affiliation – 1989
 Merger between LIJ and North Shore Health System – 1997
 Hofstra North Shore – LIJ School of Medicine accepts its first class – 2011
 Katz Women’s Hospital/Zuckerberg Pavilion opens – 2012
 North Shore – LIJ Health System is branded as Northwell Health – 2015

Orthopaedic Surgery in the early days was a division in the department of surgery. The first chief to hold the
position was Leroy Lavine, MD. The leadership in the department was as follows:

Leroy Lavine, MD David Dines, MD

1956-1981 1997-2007

Richard Laskin, MD Stanley Asnis, MD

1981-1991 2007-2010

John Handelsman, MD Nicholas Sgaglione, MD

1991-1997 2010- Present

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John B. Manly MD was the Chief of Queens Hospital Center who is associated with the commencement of the LIJ
residency program. As the records were not maintained by today’s standards it appears that our oldest resident
is Gilbert Young MD who was in the program from July 1, 1961 to June 30, 1964. The time frame between 1964
and the next graduating class in 1974 cannot be validated. However, we went from three residents per year to
four residents per year in 2015.
After 1997 many of the off-site specialty experiences transitioned to other facilities. The resident trauma
experience was originally at Jamaica Hospital transitioning to North Shore University Hospital as well as the hand
rotation at Beth Israel eventually was able to remain at LIJ. The tumor experience has remained with Memorial
Sloan Kettering Cancer Center.
Over the years the residency changed from a four year program to a five year program with the PGY-1 year in
Surgery now under the auspices of Orthopaedic Surgery and the PGY-1 year evolved from a three month
rotation to orthopaedics to a six month rotation to orthopaedics.
Our medical school affiliation changed from SUNY Downstate to Albert Einstein College (AECOM) of Medicine to
Hofstra Northwell School of Medicine.
These are such exciting times and we look forward to continuing to update the history of the program as the
years evolve.

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Keynote Spotlight

Kevin Trapp, MD

Kevin Trapp was born in West Palm Beach, Florida and grew up in Erie, Pennsylvania. He attended medical
school at Weil Cornel Medical School in New York. His orthopaedic residency was completed at Long Island
Jewish Medical Center in 2003 followed by a fellowship in adult reconstruction at The Hospital for Special
Surgery.
Kevin has been married to Gerri for fifteen years. He met Gerri while at LIJ where she was a nurse in the ICU.
They married when he was a PGY-4 resident. Kevin states, “Marrying Gerri was the best part of my residency”.
Kevin and Gerri have four children: Kyle (14), Kieran (13), Aiden (11) and Gianna (5).
Kevin’s practice is at Crystal Run Healthcare, a multispecialty group that started in Orange and Sullivan Counties
in New York and now has offices in Orange, Sullivan, Rockland and Ulster counties and has expanded into
Manhattan. There are 20 orthopaedic surgeons and over 600 providers including allied health professionals.
The practice has a clinical affiliation with Montefiore Medical Center in the Bronx. Kevin’s practice is almost
exclusively hip and knee replacement.
Kevin holds the title of Chairman of the Surgical Executive Committee at Orange Regional Medical Center; Vice
Chairman of the Department of Orthopaedic Surgery at Orange Regional Medical Center and is listed as a Top
Doctor of the Hudson Valley and Top Doctors of New York State.
Kevin and Gerri have been foster parents for the Orange County Children Services for the past five years and are
proud to be the adoptive parents of their youngest child, Gianna, who was their first foster child.

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10th Annual - Alumni Day Program

Friday June 1, 2018

 Registration…………………………………………………………………………………………………………….12:00-1:00pm
Welcome from the Chairman – Nicholas Sgaglione, MD
Introductions – Daniel Grande, PhD

 Session I…………………………………………………………………………………………………..………………..1:00-2:30pm
Moderator: Lewis B. Lane, MD
PGY-4 presentations
Co-Moderator: Frank Lombardo, MD (2008)
 Andrew Lee MD – “Is Distal Locking Necessary in Long Cephalomedullary Nailing of Intertrochanteric
Fractures?”
 Michael Mashura MD – “Chondrocytes in Femoroacetabular Impingement Syndrome Express Higher
Levels of Proinflammatory and Cell Senescence Genes”
 Alexander Satin MD – “The Incidence of Subsequent Cervical Spine Surgery after Cervical Disc
Arthroplasty, A Minimum Two-Year Follow-Up”
 Drew Stal MD – “The Costs of Operative Fixation for Ankle Fractures: A Multi-Center Retrospective
Comparison of Inpatient and Outpatient Surgery”
 Spencer Stein MD – “A Novel Approach to Improving Patient Experience in Orthopaedics”

PGY-3 presentations
Co-Moderator: David Tuckman, MD (2003)
 Yen Chen MD – “Does Liposomal Bupivacaine Improve Postoperative Pain Control for Distal Radius

Fractures”
 Travis Doering MD – “Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures with Volar

Instability”
 Daniel Kiridly MD – “The Creation of a Novel Synthetic Periosteum Using 3D Bioprinting on a Biolgoic

Matrix”
 Ryan Nixon MD – “Evaluation of TRB-N0224, a Chemically Modified Curcumin for Treatment of

Osteoarthritis”

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 Break…………………………………………………………………………………………………………….…….…...2:30-2:45pm

 Session II…………………………………………………………………………………………………….………….….2:45-4:00pm
Moderator: Kate Nellans, MD, MPH

PGY-2 presentations
Co-Moderator: Adam Gitlin, MD (2016)
 Isaac Gammal MD – “Hip Arthroplasty Episode of Care Cost Analysis in the Oncologic Versus Non-

Oncologic Patient”
 Luke Garbarino MD – “The Predictive Value of the Pain Catastrophizing Score in Total Joint Arthroplasty”
 Peter Gold MD – “Direct Anterior Approach Using Second Generation Cementless Wedge Tapered

Femoral Stems: Assessment of Radiographs and Early Component Complications”
 Jeffrey Goldstein MD – “Analysis of Symptomatic Recurrent Lumbar Disc Herniation and Reoperation

Rates in Patients Undergoing Laminectomy with Discectomy or Microdiscectomy”

PGY-5 presentations
Co - Moderator: Mikael Starecki MD (2015)
 Yonah Heller MD – “Using Three-Dimensional Printing to Construct Chitosan-Alginate Scaffolds for

Articular Cartilage Tissue Engineering”
 Shachar Kenan MD – “5-Aminolevulinic Acid Photodynamic Therapy for Myxofibrosarcoma and

Chordoma: In Vitro Cellular Destruction Visualized Via Time-Lapse Confocal Microscopy”
 James Mullen MD – “Biomechanical Analysis of an Interference Screw: A Novel Twist Lock Screw Design

for Bone Graft Fixation”

 Keynote Speaker……………………………………………………………………………………………………4:00-4:45pm
Introduction: Nicholas A. Sgaglione, MD

Kevin Trapp, MD ‘03
Crystal Run Healthcare

“The Super Hip – My First 100 Cases”
 Cocktails and Dinner……………………………………………………………………………………………………….…5:00pm

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Is Distal Locking Necessary In Long Cephalomedullary Nailing Of Intertrochanteric Hip
Fractures?

Authors: Andrew Sanghyup Lee MD, Manhasset, NY, UNITED STATES
Paul Tornetta, III MD, FACS, Boston, MA, UNITED STATES
Hamid Mostafavi MD, Manhasset, NY, UNITED STATES

Location: Northwell Health , Manhasset, NY, UNITED STATES

Summary: Examining 341 patients, we conclude that when treating intertrochanteric hip fractures with a long
nail, that distally locking will decrease the overall and major complication rates and recommend their routine
use.

Abstract: Objectives: To determine the incidence of complications in a series of long cephalomedullary nails for
the treatment of OTA 31-A1 and A2 intertrochanteric hip fractures with and without distal locking.
Design: Retrospective review.
Setting: University hospital.

Methods: A single surgeon series of patients were treated prospectively entered into a database. All patients were
treated with an InterTAN long cephalomedullary nail (Smith & Nephew, Memphis,TN). Demographic data, fracture
type, sub-fracture characteristics, reduction quality, and complications were prospectively entered. Patients with
subtrochanteric fractures and pure reverse obliquity fractures (OTA 31-A3) were excluded as these were all locked
distally. All other fractures patterns were included. We defined basicervical fractures as any fracture that exited
medially proximal to the lesser trochanter and lateral wall incompetence by the criteria of Hsu, et al. All fractures
were treated with a double integrated screw into the femoral head. During the first half of the study distal locking
screws were never used and all patients in the second half of the study were locked distally. Complications were
categorized as major (neck axis shortening =10mm, axial shortening =10mm, unplanned return to the OR, clinical
malrotation, distal nail perforation or distal fracture) and minor (neck axis shortening of 5-10mm, broken distal
screw with <10mm axial shortening, distal abutment without need for change in treatment).
Results: We prospectively evaluated 341(248F:93M patients) avg age 84 (48 – 102) with 167 right and 174 left
intertrochanteric fractures (OTA 31-A1 and 31-A2). Follow-up averaged 436 days and 87% had radiographic
follow-up past 30 days. Distal locking added an average of 20 mins to the procedure (81 (39-163) mins vs. 61 (31-
144) mins). Overall there were 68 complications (42 major and 26 minor). Complications were more common in
the unlocked group (43/158 (27%) vs. 25/183 (14%); p = 0.003). Most important, major complications were also
more common in the unlocked group (33/158 (21%) vs. 9/183 (5%); p = 0.0001). Unplanned return to the OR was
three times more common in the unlocked cohort but did not reach significance (9/158 vs. 3/183; p = 0.07).
Fractures that were more proximally located, defined as basicervical had the highest complication rate for both
cohorts, 25% in the locked and 39% in the unlocked group, this was primarily driven by neck axis collapse.
Conclusion: We evaluated the complications of a large series of patients with intertrochanteric fractures treated
with the same long nail with and without distal locking screws. The overall complication rate was statistically
different and almost twice as high and the major complication rate was 4 times higher in the patients in whom
the nail was unlocked distally. This series is limited by its sequential nature, however, the operative surgeon had
performed hundreds of cases prior to the inception of the prospective database. We conclude that when treating
intertrochanteric hip fractures with a long nail, that distally locking will decrease the overall and major
complication rates and recommend their routine use.

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Chondrocytes in Femoroacetabular Impingement Syndrome Express Higher Levels of
Proinflammatory and Cell Senescence Genes

Mashura M, Liang H, Bhagat P, Bharam S, Grande D

Introduction: Femoroacetabular impingement (FAI) is a frequent cause of hip pain and may lead to secondary
osteoarthritis, yet little is known about the molecular events linking mechanical hip impingement and articular
cartilage degeneration. Surgical treatment for FAI of the hip remains controversial. Therefore, knowledge of how
much articular cartilage is available for resection is important when evaluating between surgical options. The
hypothesis is that from a histologic and molecular perspective the cartilage in FAI is not analogous to normal
articular cartilage.

Methods: Experimental specimens were taken from eight donors undergoing hip arthroscopy for debridement
of CAM lesions for FAI. Two control specimens were obtained from cadavers. Specimens were subdivided for
histologic analysis and molecular analysis. The histologic specimens were fixed in formalin, dehydrated, and
embedded in paraffin. Sections were cut at 5µm thickness and stained with safranin-o/fast green for qualitative
measure of aggrecan content.
Quantitative RT-PCR was performed in triplicate to examine gene expression profiles of proinflammatory markers
ADAMTS4, IL-1B, CCL3L1, and MMP13 as well as markers of cell senescence including P21, FasL, P16, and ASF1A.
A paired student’s T-test was used to determine significance.
Results: The cartilage of FAI samples exhibited histologic differences to normal articular cartilage. There was
lower density of chondrocytes and smaller chondrocyte size in FAI samples (Figure 1). In addition, aggrecan was
lower in the matrix between cells. Grossly, chondrocytes observed in FAI specimen had a clear distinguishable
edge with the bone in what appears to be a quiescent state.
Quantitative RT-PCR demonstrated significantly lower expression of type II collagen (Figure 2). Significantly higher
levels (P<0.05) of the proinflammatory markers ADAMTS4, IL-1β, MMP13, and near significance of CCL3L1 (Figure
3) were found. In addition, the cells were found to be in a more senescent state with significantly higher levels of
P21 and FasL expression with near significance (P=0.08) of increased P16 expression and decreased ASF1A
expression (Figure 4).
Conclusion: Specimen histology and gene expression suggest that cartilage in FAI is morphologically different
than normal articular cartilage. Histology demonstrates that cells are held in a more quiescent state with lower
expression of extracellular matrix and lower density. This study suggests that there are molecular differences
between normal cartilage and the cartilage seen in FAI. FAI cartilage exists with higher inflammatory markers and
has markers of cell senescence.

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Gene ExpressionFigure 1. Cells stained with Safranin O/fast green are seen to have decreased matrix between cells and
decreased concentration of chondrocytes (left). A distinct boundary between bone and cartilage is seen in FAI
specimen (right).

1.4
1.2

1
0.8
0.6
0.4
0.2

**0

Control Collagen-II FAI

Figure 2. Gene expression of Collagen II is significantly lower in FAI than control (P<0.005). Expression of control
specimen has been standardized to 1.

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4 ** 5 14 5 p=0.06
3
4 ** 12 **

10 4

2 38 3

26 2

1 1 4 1
2

0 00 0
Control FAI Control FAI
Control FAI ControILl-1β FAI -2 MMP13 CCL1L3
ADAMTS4

Figure 3. Gene expression of Proinflammatory Genes is significantly (P<0.05) increased in FAI compared to
control in ADAMTS4, IL-1β, and MMP13, and approaches significance for CCL3L1 (P=0.06). Expression of all
control specimen has been standardized to 1.

7 ** 12 18 p=0.08 2
6 16
5 10 1.5
** 14

12
4 8 10
3 68 1

2 4 6 0.5
4
1 22
p=0.08

0 00 Control FAI 0
P16
Control FAI -2 Control FAI -2 Control FAI
Axis Title P21 ASF1A

Figure 4. Expression of genes associated with cell senescence is significantly (P<0.05) increased in FAI compared
to control in FasL and P21. P16 gene expression approaches significance for increased expression(P=0.08) while
expression of ASF1A approaches significance for decreased expression (P=0.08). Expression of all control
specimen has been standardized to 1.

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The Incidence of Subsequent Cervical Spine Surgery after Cervical Disc Arthroplasty, a
Minimum Two-Year Follow-Up

Alexander M. Satin1, MD, Dean Perfetti1 MD MPH, Deepak Kaji2 BS, Jeff S. Silber1,3, David A. Essig1,3, MD
1 Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, 270-05 76th Avenue,
New Hyde Park, NY 11040
2 Department of Orthopedic Surgery, Mount Sinai Hospital, 5 E 98th St, New York, NY 10029
3Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

Introduction:
Anterior cervical discectomy and fusion (ACDF) is the current gold standard for cervical degenerative disc disease.
In recent years, cervical disc arthroplasty (CDA) has emerged as an alternative to ACDF. CDA is a motion-sparing
device that mimics natural cervical motion, theoretically reducing adjacent level pathology.[1, 2] Recently, authors
have investigated potential sources of bias in the CDA literature. [3] More specifically, the most commonly cited
CDA literature comes from the Food Drug Administration (FDA) Investigational Device Exemption (IDE) studies.
The authors note that the surgeons in these studies are highly selected, and thus their results may not be
reproducible the general population of surgeons (expertise bias). As a result, they recommended that database
studies be performed to improve the external validity of CDA outcomes. We used the New York Statewide
Planning and Research Cooperative Systems (SPARCS) database to identify the risk factors and incidence of
subsequent cervical spine surgery in patients undergoing primary CDA.

Methods:
We analyzed the SPARCS inpatient database from 2005 to 2015 to identify patients who underwent isolated CDA.
International Classification of Diseases, Ninth Revision (ICD-9) codes were used to extract the index CDA procedure
(84.61, 84.62) and to identify patient demographics and re-operation procedures. Patients were longitudinally
followed until September 2015, corresponding to a minimum of two-year follow-up, to determine the incidence
of subsequent cervical spine re-operation, which included another primary CDA, revision CDA, anterior cervical
discectomy and fusion (ACDF), posterior cervical fusion (PCF), and laminectomy without fusion. Univariate and
Multivariate Analyses were used to identify demographic risk factors for subsequent re-operation.

Results:
A total of 835 patients underwent an inpatient CDA procedure between January 2005 and September 2013. After
2007, there was a decreasing number of inpatient CDA procedures performed in New York State (m=-33
cases/year, p<0.001). Subsequent cervical spine re-operation after an index CDA procedure occurred in 7.5% of
patients, with a 4.4% re-operation rate at two-year follow-up. The most common cervical re-operation was a
primary ACDF (76.2%). ACDF was performed at an average of 837 days (2.29 years) after CDA. Compared to those
patients who did not undergo subsequent cervical spine surgery, those who did undergo a re-operation were
more likely to be younger (42.4 years vs. 44.0 years, p=0.034) and female (68.3% vs. 50.6%, p=0.007). However,
logistic regression analysis found only female sex to have increased odds of re-operation (OR=2.10, 95% CI 1.21-
3.63). There was no statistical difference between the two cohorts in race, insurance, comorbidity score, tobacco
use or cervical diagnosis for the index CDA procedure.

Conclusions:
We found a 4.4% rate of subsequent cervical spine surgery following CDA at 2 years and a 7.5% rate of subsequent
cervical spine surgery overall using the SPARCS database. The most common cervical spine procedure following
CDA was ACDF. Inpatient CDA procedures in New York State have been declining since 2008. Female sex was the
only patient demographic factor to significantly influence the odds of cervical spine re-operation.

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References
1. Puttlitz CM, Rousseau MA, Xu Z, Hu S, Tay BK, Lotz JC. Intervertebral disc replacement maintains

cervical spine kinetics. Spine. 2004;29(24):2809-14.
2. DiAngelo DJ, Roberston JT, Metcalf NH, McVay BJ, Davis RC. Biomechanical testing of an artificial

cervical joint and an anterior cervical plate. Journal of spinal disorders & techniques.
2003;16(4):314-23.
3. Radcliff K, Siburn S, Murphy H, Woods B, Qureshi S. Bias in cervical total disc replacement trials.
Curr Rev Musculoskelet Med. 2017;10(2):170-6.

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The Costs of Operative Fixation for Ankle Fractures: A Multi-Center Retrospective
Comparison of Inpatient and Outpatient Surgery

Stal, D1; Chernet, R2, Saquib, Z2; Phillips, G1
Department of Orthopaedic Surgery1, Donald and Barbara Zucker School of Medicine at
Hofstra/Northwell2, Northwell Health System, New Hyde Park, NY

Introduction:
One of the emerging trends in healthcare is the shift in surgical resources to the outpatient setting coupled with
reducing inpatient length of stay. Through a multi-center retrospective review of operatively treated ankle
fractures, we aimed to calculate the financial cost of each procedure, as well as determine the economic impact
of ambulatory surgery. Additionally, we sought to see whether surgery location was associated with specific
patient demographics, medical co-morbidities, or surgeon practice patterns.

Methods:
A retrospective study of 240 surgically treated ankle fractures over a two-year period was performed. Two tertiary
care hospitals and their affiliated ambulatory surgery centers were included. Patient selection was based on
Current Procedural Terminology codes for ankle fractures. A full cost breakdown for each procedure was
analyzed. Patient risk factor and co-morbidities were also evaluated.

Results:
142 inpatient and 98 outpatient ankle fracture surgeries were performed. Full financial data was only available
for 134 of 142 inpatient and 85 of 98 outpatient cases. The median length of stay for the inpatient cases was 5
days. Inpatient procedures had a total direct cost of $11,728.44 compared to $3,071.8 for outpatient procedures.
Room and board costs for inpatients was $2,722.8. There was a higher cost for both surgical labor and supply for
inpatient cases, totaling $3,237.67 and $2,181.17 respectively, compared to outpatient cases ($1,545.9 and
$1,075 respectively).
Higher percentages were recorded among inpatients for age 65+ years (p <0.0003), and ordering of CT-scan (p <
0.0001). There was no statistically significant difference between the groups for any of the other demographic
variables.

Conclusion:
Our study sought to quantify the potential financial advantage of surgical management of ankle fractures in the
outpatient setting. Inpatient cases resulted in a nearly 4-fold increase in total direct cost, as well as 2-fold increase
in surgical labor and supply costs compared to outpatient cases. Increased patient age was statistically linked with
inpatient admission. Healthcare institutions may realize substantial practice management cost savings by shifting
ankle fracture surgery to the outpatient setting.

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A Novel Approach to Improving Patient Experience in Orthopaedics

Stein, Spencer M, MD; Shah, Shah S, MD; Carcich, Alanna, BS; McGill, Marlena, BS; Gammal, Isaac, MD, MBA;
Langino, Michael, MPT, MBA; Mauri, Thomas, MD
Department of Orthopedic Surgery, Northwell Health, Manhasset, NY

Introduction
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a national,
standardized, publically reported evaluation of how patients perceive their hospital care. The HCAHPS survey is
essential in determining how to improve patient-centered care, which can lead to improved outcomes of medical
care.1-5
Policy makers have recognized the importance of physician-patient communication by linking payments to
effective-patient centered communication through the HCAHPS survey.1 Despite the understanding that
communication is a teachable skill, there remains a gap in the literature describing effective methods to improve
physician-patient communication, especially in the surgical literature.6 7, 8
In this study we examined whether an intervention aimed at the entire inpatient multi-disciplinary team had an
effect on physician communication and overall hospital ratings as measured by the HCAHPS survey. We
hypothesized that physician communication as well as the overall patient experience would significantly improve
after our intervention.

Methods
At the beginning of 2015, the quality of care improvement project began at an 800 bed tertiary care, level one
trauma center, part of a 21 hospital healthcare system.
First, we introduced physician specific scorecards, which provided physicians with direct feedback on responses
to the HCAHPS survey (Figure 1). We also engaged residents and physician assistants (PAs) and designated a
resident and PA quality liaison that attended monthly performance improvement meetings.
Finally, we developed patient experience teams which consisted of a nurse manager, supervising PA, senior
physical therapist, patient and family care coordinator and a case manager. These teams conducted daily
multidisciplinary bedside rounds to help identify patients’ or families’ questions or concerns; thereby enabling a
patient centric shared decision-making model.
We retrospectively reviewed the HCHAPS survey responses, specifically general hospital ratings and physician-
patient communication metrics before and after implantation of our improvement project. Responses were
coded on a numerical scale and the mean and statistical significance was calculated using one-way analysis of
variance. Additionally, we compared the percentage of respondents who chose the top-box (best possible choice
for the question) before and after implementation via the chi-square tests. Patient demographics were analyzed
using a pearson chi-squired test. Significance was set to p<0.05. All statistical analyses were performed using
SPSS.

Results
There was a total of 492 respondents in 2014 and 473 in 2015.
The mean scores for willingness to recommending the hospital, overall hospital rating, and all patient-physician
communication metrics improved after implementation of the quality improvement project. Patients’ perception
that the physician explained their condition in ways they understood improved significantly (p=0.02) (Figure 2).
In all the categories we examined there was improvement in the portion of patients who chose the “top-box”
response. There was a significant improvement in the proportion of patient who stated doctors always
communicated in ways they understood (p=0.01). There was also a significant improvement in the proportion of
patients who rated the hospital a “9 or 10” or responded “definitely yes” to the questions “Would you recommend
the hospital to your friends or family?” (p=0.1 and 0.49, respectively) (Figure 3).

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Discussion
Our approach of emphasizing patient-physician communication showed significant improvement in HCAHPS
scores, including the overall hospital rating. By linking patient experience to reimbursement, the onus has been
placed on healthcare providers to develop successful strategies to improve the patient experience.1
Our primary goal was improving patient experience by focusing on patient-physician communication. Providing
feedback and allowing comparison amongst peers was a likely contributing factor to the improvement in
communication metrics.
Like surgical skills, communication skills can be taught. 9-11 We introduced seminars aimed at teaching residents
and PAs patient experience concepts. We also included a resident liaison in quality meetings where areas of
improvement were discussed. We believe self-directed resident education was essential to our improvement in
patient-physician communication.
We believe the multidisciplinary patient experience team was instrumental in identifying patients’ unique needs
and involving patients in their care planning. It allowed the development of a unique culture of care between the
patient and healthcare team.
In addition to our goal of improving patient-physician communication, we also demonstrated significantly
improved overall ratings of the hospital. There are multiple reasons to explain the association between physician
communication and overall patient experience as measured by HCAHPS12-15. One mechanism may be through
improved healthcare literacy. The relationship between improving physician communication and increased
patient compliance and medical outcomes has been borne out in the medical literature16-22.
There were limitations to the study. This was a non-randomized pre-post study based on patient-reported
experience surveys, which are subject to response bias23. In addition, the investigation was conducted at a single
institution on a hospital level, which may limit generalizability. We were also unable to specifically control for
changes to patient care before and after the intervention, which could introduce confounders. However, there
were no other systematic changes to patient care during this time period.
This study gives rise to potential future areas of improvement. Although this investigation was performed at a
hospital level, the themes of physician awareness, education, and the use of a multidisciplinary team approach
are likely to be beneficial in an office setting as well.
Despite the well-documented importance of patient-physician communication, we recognized there was room for
improvement, especially amongst surgeons 7, 8, 11, 24. In this investigation, we report a successful and novel
approach to improving patient experience on an orthopaedic service. Through a multidisciplinary team approach,
we were able to show significant improvement in physician communication and global rating of the hospital
through HCAHPS indicators. In conclusion, our methods may serve as a protocol for other institutions to improve
the patient experience.

- 21 -

Figure 1: An example of a physician specific scorecard.

2014 2015 p-value

Mean Score Mean Score

Rate hospital 0-10 8.68 8.90 0.813

Recommend the hospital 2.69 2.76 0.082

Doctors treat with 2.81 2.85 0.164

courtesy/respect

Doctors listen carefully to you 2.69 2.75 0.101

Doctors explained in way you 2.67 2.76 0.020*

understand

Figure 2: Calculated average scores from 2014 to 2015 for overall rating of the

hospital and physician communication.

- 22 -

2014 2015 p-value

Top-Box Percent Top-Box

Percent

Rate hospital 0-10 69 76.4 0.010*

Recommend the hospital 75.1 80.3 0.049*

Doctors treat with 84.4 87.8 0.126

courtesy/respect

Doctors listen carefully to you 75.3 79.6 0.113

Doctors explained in way you 74.2 81.1 0.011*
understand
Figure 3: Percentage of respondents who chose the top-box response from 2014

to 2015 for overall rating of the hospital and physician communication.

References

1. Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered
care. Health affairs (Project Hope). 2010 Jul;29(7):1310-8. Epub 2010/07/08.

2. Stein SM, Day M, Karia R, Hutzler L, Bosco JA, 3rd. Patients' perceptions of care are associated with
quality of hospital care: a survey of 4605 hospitals. American journal of medical quality : the official
journal of the American College of Medical Quality. 2015 Jul-Aug;30(4):382-8. Epub 2014/04/18.

3. Menendez ME, Ring D. Do hospital-acquired condition scores correlate with patients' perspectives
of care? Quality management in health care. 2015 Apr-Jun;24(2):69-73. Epub 2015/04/02.

4. Isaac T, Zaslavsky AM, Cleary PD, Landon BE. The relationship between patients' perception of care
and measures of hospital quality and safety. Health services research. 2010 Aug;45(4):1024-40.
Epub 2010/06/10.

5. Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience
and clinical safety and effectiveness. BMJ open. 2013;3(1). Epub 2013/01/08.

6. Simpson M, Buckman R, Stewart M, Maguire P, Lipkin M, Novack D, et al. Doctor-patient
communication: the Toronto consensus statement. BMJ (Clinical research ed). 1991 Nov
30;303(6814):1385-7. Epub 1991/11/30.

7. Gysels M, Richardson A, Higginson IJ. Communication training for health professionals who care for
patients with cancer: a systematic review of training methods. Supportive care in cancer : official
journal of the Multinational Association of Supportive Care in Cancer. 2005 Jun;13(6):356-66. Epub
2004/12/09.

8. Curtis JR, Back AL, Ford DW, Downey L, Shannon SE, Doorenbos AZ, et al. Effect of communication
skills training for residents and nurse practitioners on quality of communication with patients with
serious illness: a randomized trial. Jama. 2013 Dec 4;310(21):2271-81. Epub 2013/12/05.

9. Tongue JR, Epps HR, Forese LL. Communication skills. Instructional course lectures. 2005;54:3-9.
Epub 2005/06/14.

10. Frymoyer JW, Frymoyer NP. Physician-patient communication: a lost art? The Journal of the
American Academy of Orthopaedic Surgeons. 2002 Mar-Apr;10(2):95-105. Epub 2002/04/04.

11. Banka G, Edgington S, Kyulo N, Padilla T, Mosley V, Afsarmanesh N, et al. Improving patient
satisfaction through physician education, feedback, and incentives. Journal of hospital medicine.
2015 Aug;10(8):497-502. Epub 2015/05/28.

12. Hall JA, Irish JT, Roter DL, Ehrlich CM, Miller LH. Satisfaction, gender, and communication in medical
visits. Medical care. 1994 Dec;32(12):1216-31. Epub 1994/12/01.

- 23 -

13. Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters.
Medical care. 1988 Jul;26(7):657-75. Epub 1988/07/01.

14. Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient
satisfaction. The Journal of family practice. 1991 Feb;32(2):175-81. Epub 1991/02/01.

15. Roter DL, Hall JA, Katz NR. Relations between physicians' behaviors and analogue patients'
satisfaction, recall, and impressions. Medical care. 1987 May;25(5):437-51. Epub 1987/05/01.

16. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Annals of
internal medicine. 1984 Nov;101(5):692-6. Epub 1984/11/01.

17. Kaplan SH, Greenfield S, Ware JE, Jr. Assessing the effects of physician-patient interactions on the
outcomes of chronic disease. Medical care. 1989 Mar;27(3 Suppl):S110-27. Epub 1989/03/01.

18. Greenfield S, Kaplan SH, Ware JE, Jr., Yano EM, Frank HJ. Patients' participation in medical care:
effects on blood sugar control and quality of life in diabetes. Journal of general internal medicine.
1988 Sep-Oct;3(5):448-57. Epub 1988/09/01.

19. Greenfield S, Kaplan S, Ware JE, Jr. Expanding patient involvement in care. Effects on patient
outcomes. Annals of internal medicine. 1985 Apr;102(4):520-8. Epub 1985/04/01.

20. Neuwirth ZE. An essential understanding of physician-patient communication. Part II. The Journal
of medical practice management : MPM. 1999 Sep-Oct;15(2):68-72. Epub 2004/08/21.

21. Graham S, Brookey J. Do patients understand? The Permanente journal. 2008 Summer;12(3):67-9.
Epub 2008/07/01.

22. BD W. Health Literacy and and patient safety: Help patients understand. AMA Foundation; 2007.
23. Mazor KM, Clauser BE, Field T, Yood RA, Gurwitz JH. A demonstration of the impact of response

bias on the results of patient satisfaction surveys. Health services research. 2002 Oct;37(5):1403-
17. Epub 2002/12/14.
24. O'Neill J, Williams JR, Kay LJ. Doctor-patient communication in a musculoskeletal unit: relationship
between an observer-rated structured scoring system and patient opinion. Rheumatology (Oxford,
England). 2003 Dec;42(12):1518-22. Epub 2003/07/02.

- 24 -

Does Liposomal Bupivacaine Provide Additional Postoperative Pain Control for Distal
Radius Fracture Volar Plating Performed with a Supraclavicular Nerve Block

Yen Hsun Chen, MD; Charles Ekstein, MD; Sohum Patwa, BS; Marlena McGill, BS; David Tuckman, MD; Andrew
Greenberg, MD; Lewis Lane, MD; Kate Nellans, MD, MPH

Hypothesis
Effective post-operative pain control is critical for facilitating recovery and improving patient satisfaction after
ambulatory surgery for distal radius fractures. At our institution, regional nerve block is standard of care, providing
up to 18 hours of analgesia. A problem to this approach is reports of “rebound pain” when the block wears off.
Liposomal bupivacaine (LB) has been reported to provide pain relief for up to 72 hours. We hypothesize that LB
will improve pain control and prevent rebound pain in post-operative distal radius patients who received a
regional nerve block.

Methods
After Institutional Review Board approval, 46 patients (age>18) with isolated distal radius fractures treated with
open reduction and volar plating between Jan 1, 2017 and Feb 1, 2018 were prospectively enrolled. Exclusion
criteria includes polytrauma, peripheral neuropathy, baseline narcotic use, and preexisting pain syndrome.
Patients received either a supraclavicular nerve block alone (n=20), or a supraclavicular nerve block with LB (n=26),
based on surgeon preference. For administration of LB, an 18G angiocath was inserted into the surgical bed under
direct visualization. 20 mL of undiluted LB was administered via the angiocath after wound closure (Figure 1).
Baseline Pain Catastrophizing Score (PCS), Visual Analogue Scale (VAS) pain score, and QuickDASH scores were
obtained prior to surgery. VAS and QuickDASH scores were obtained 18h, 72h, 1 week, and 2 weeks post-
operatively.

Results
No significant difference in age (58.4±13.8 vs 57.8±15.8 years), gender (69% vs 75% female), insurance status,
baseline VAS (4.5±2.8 vs 3.3±2.5), baseline QuickDASH (79.1±11.1 vs 75.3±9.9), PCS (17.5±14.4 vs 10.9±9.4), or
time to surgery (8.1±5.2 vs 9.7±6.0 days) was observed between the block + LB and the block-only cohorts,
respectively. 18 hours after surgery, the block + LB cohort exhibited higher VAS pain scores (4.7±2.9) than the
block-only group (2.8±2.9), although this did not reach statistical significance. No other differences in VAS scores
(Figure 2) or QuickDASH scores were found. PCS and VAS scores were correlated at 18h (r=0.29, p=0.05) and at
72h (r=0.35, p=0.04) after surgery.

Conclusion
 No significant rebound pain was observed after the supraclavicular nerve block wears off following distal
radius volar plating.
 Liposomal bupivacaine did not provide measurable benefit in VAS pain or QuickDASH function scores in
patients undergoing distal radius surgery who also received a supraclavicular nerve block.
 Higher Pain Catastrophizing Score patients reported higher VAS pain scores after surgery.

- 25 -

- 26 -

Dorsal Plating for Intra-articular Middle Phalangeal Base Fractures with Volar
Instability

Travis A. Doering, MD a, Andrew S. Greenberg, MD a,b, David V. Tuckman, MD a,b

a. Northwell Health Department of Orthopaedics
270-05 76th Avenue, Office 250, New Hyde Park, New York 11040, USA

b. Orthopaedic Associates of Manhasset
600 Northern Boulevard #300, Great Neck, New York 11021, USA

Background
Intra-articular middle phalangeal base fractures with volar instability are rare injuries with scant literature on
optimal management. Our purpose is to describe our method of dorsal plating and report post-operative
outcomes.

Methods
A retrospective case review of 5 patients with intra-articular middle phalangeal base fractures with volar proximal
interphalangeal joint instability, measuring subjective, clinical, and radiographic outcomes.

Results
Patient age averaged 38.2 years (range 23-56), and 80% of whom were male. Sporting injuries were the most
common mechanism (80%). Time to surgery averaged 7 days, and post-operative follow up duration averaged
19.6 months (median 8 months). All fractures were intra-articular at the PIP joint with volar instability. There were
no complications and no patients required secondary surgery. Grip strength was maintained and range of motion
was good, based on the American Society for Surgery of the Hand Total Active Motion score. Average Quick
Disability of the Arm, Shoulder, and Hand was 0.5 (range 0-2.3), 100% of patients were satisfied, and average
visual analogue pain score was 1.2. Patients returned to work at a median of 4 days. There was radiographic union
at an average of 6.6 weeks (range 6-7) in all fractures.

Conclusions
Dorsal plating using a 1.5mm modular hand plate is a viable option for rigid fixation of intra-articular middle
phalangeal base fractures with volar instability. This fixation method allows for early range of motion without
complications in this case series. All fractures united, patients had minimal functional deficits, and were able to
maintain good range of motion.

- 27 -

Literature Cited
1. Kang GC, Yam A, Phoon ES, Lee JY, Teoh LC. The hook plate technique for fixation of phalangeal

avulsion fractures. J Bone Joint Surg Am. 2012;94(11):e72.
2. Kiefhaber TR, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am.

1998;23(3):368-380.
3. Kiral A, Erken HY, Akmaz I, Yildirim C, Erler K. Pins and rubber band traction for treatment of

comminuted intra-articular fractures in the hand. J Hand Surg Am. 2014;39(4):696-705.
4. Majumder S, Peck F, Watson JS, Lees VC. Lessons learned from the management of complex intra-

articular fractures at the base of the middle phalanges of fingers. J Hand Surg Br. 2003;28(6):559-
565.
5. Mcelfresh EC, Dobyns JH, O'brien ET. Management of fracture-dislocation of the proximal
interphalangeal joints by extension-block splinting. J Bone Joint Surg Am. 1972;54(8):1705-1711.
6. Meyer ZI, Goldfarb CA, Calfee RP, Wall LB. The Central Slip Fracture: Results of Operative
Treatment of Volar Fracture Subluxations/Dislocations of the Proximal Interphalangeal Joint. J Hand
Surg Am. 2017;42(7):572.e1-572.e6.
7. Peimer CA, Sullivan DJ, Wild DR. Palmar dislocation of the proximal interphalangeal joint. J Hand
Surg Am. 1984;9A(1):39-48.
8. Rockwood, CA, Green, DP, Heckman, JD, & Bucholz, RW. Rockwood and Green's fractures in adults.
Philadelphia: Lippincott Williams & Wilkins; 2001.
9. Rosenstadt BE, Glickel SZ, Lane LB, Kaplan SJ. Palmar fracture dislocation of the proximal
interphalangeal joint. J Hand Surg Am. 1998;23(5):811-820.
10. Ruland RT, Hogan CJ, Cannon DL, Slade JF. Use of dynamic distraction external fixation for unstable
fracture-dislocations of the proximal interphalangeal joint. J Hand Surg Am. 2008;33(1):19-25.
11. Strickland JW, Glogovac SV. Digital function following flexor tendon repair in Zone II: A comparison
of immobilization and controlled passive motion techniques. J Hand Surg Am. 1980;5(6):537-43.
12. Stern PJ, Roman RJ, Kiefhaber TR, Mcdonough JJ. Pilon fractures of the proximal interphalangeal
joint. J Hand Surg Am. 1991;16(5):844-850.
13. Tekkis PP, Kessaris N, Gavalas M, Mani GV. The role of mini-fragment screw fixation in volar
dislocations of the proximal interphalangeal joint. Arch Orthop Trauma Surg. 2001;121(1-2):121-
122.
14. Zhang X, Yang L, Shao X, Wen S, Zhu H, Zhang Z. Treatment of bony boutonniere deformity with a
loop wire. J Hand Surg Am. 2011;36(6):1080-1085.

- 28 -

The Creation of a Novel Synthetic Periosteum Using 3D Bioprinting on a Biologic Matrix

Daniel Kiridly, MD, MBA, Brandon Alba, BS, Pooja Swami MS, Howard Goodman, MD, Daniel Grande PhD

Introduction
Periosteum plays a vital role in the maintenance and repair of long bones. The absence of healthy periosteum has
been shown to impair healing of fractures and bone grafts. Moreover, it has been shown that periosteal flaps can
enhance healing at the bone-tendon or bone-ligament interface, for example, in ACL reconstruction.1
Periosteum consists of a tough, fibroblast-rich outer layer known as the ‘fibrous layer’, and an osteogenic inner
layer called the ‘cambrium layer’. It serves as a source of local growth factors as well as osteoprogenitor cells
which can aid in bony healing.
In a number of clinical scenarios, there is an absence of available healthy periosteum which inhibits bony union
and can lead to poor outcomes. For example, comminuted fractures with significant bone loss and devitalization
or large bony resections of intraosseous tumors. In particular oncologic cases with periosteal loss present a
challenge because the bone may be further devitalized through neoadjuvant or preoperative radiation therapy.
The loss of periosteum is a reconstructive challenge, and periosteal flaps are frequently insufficient for larger
defects.
To date, there is no commercially available product which emulates the biologic augmentation of bony healing
that periosteum provides. Prior attempts to engineer a synthetic periosteum-like biomaterial have been
undertaken, with some success in augmenting bony healing in-vitro and in animal models.2, 3 However, these
typically involve the use of mesenchymal stem cells or osteoblasts, and are constructed utilizing a scaffold of inert
materials, or have no structural scaffolding.3, 4, 5
Our study seeks to create a novel synthetic periosteum biomaterial utilizing pluripotent periosteum-derived cells
instilled into a biologic matrix (Collagen type 1 or 2) in a complex lattice pattern utilizing 3D bioprinting in order
to emulate the natural structure and function of periosteum. To our knowledge, a synthetic periosteum of this
nature generated with bioprinting has not previously been described. Initially, we sought to determine the
viability of the 3D bioprinted cells on a biologic matrix, and to determine whether collagen 1 or collagen 2 would
achieve superior osteogenesis.

Methods
Periosteal-derived cells (PDCs) were isolated from the periosteum of bovine femurs and expanded in culture. The
isolated cells were then mixed with alginate gel to create a bio-ink, which was printed in three different
experimental groups: bio-ink alone; bio-ink printed onto a type 1 collagen (COL1) scaffold; and bio-ink printed on
a type 2 collagen (COL2) scaffold. (Figure 1) To maximize the viability of the PDCs, the bio-ink was printed in a
previously described lattice pattern that was created using computer-aided design software.6 PDCs were also
cultured in a monolayer (i.e., not bioprinted using an alginate suspension) to serve as a control group.
All of the synthetic periosteum constructs were incubated in a culture media and evaluated at one, two, and three
week time points. Live/Dead staining was used to assess cell viability within the respective constructs. Polymerase
chain reaction (PCR) was used to quantify gene expression and assess osteogenic differentiation of the PDCs.

Results
On gross examination, the COL1 and COL2 scaffold groups maintained greater structural integrity than the bio-ink
only group. Live/Dead imaging showed high viability of cells at one and two weeks in all constructs. (Figure 2) PCR
results demonstrated an increase in gene expression of the osteogenic differentiation markers osteocalcin (OCN)
and alkaline phosphate (ALP) in all treatment groups relative to the monolayer control group. In the collagen
scaffold groups, expression of COL1 and COL2 tended to peak at the one or two week time point, whereas
expression of ALP and RUNX2 peaked at the three week time point. (Figures 3, 4, 5)

- 29 -

Discussion
The results presented here support a novel method for using 3D bioprinting to engineer periosteum constructs.
The COL1 and COL2 scaffolds promoted cell viability and structural stability. The time course of gene expression
suggests that the synthetic periosteum will follow a typical fracture healing sequence. Factors associated with the
callus phase of fracture healing (i.e. COL2) peaked earlier than those associated with the remodeling phase
(RUNX2, ALP). The COL2 scaffold generated higher OCN expression, suggesting it may have superior osteogenesis
properties. In vivo studies are currently underway to assess the capacity of this tissue engineered periosteum to
induce bone repair in an animal model.
References
1. Chen CH, et. al. Arthroscopic single-bundle anterior cruciate ligament reconstruction with periosteum-

enveloping hamstring tendon graft: clinical outcome at 2 to 7 years. Arthroscopy. 2010 Jul;26(7):907-17.
2. Guo H, Li X, Yuan X, Ma X. Reconstruction of radial bone defects using the reinforced tissue-engineered

periosteum: an experimental study on rabbit weightbearing segment. J Trauma Acute Care Surg. 2012
Feb;72(2):E94-100.
3. Kang Y, Ren L, Yang Y. Engineering vascularized bone grafts by integrating a biomimetic periosteum and β-
TCP scaffold. ACS Appl Mater Interfaces. 2014 Jun 25;6(12):9622-33.
4. Filion TM, Song J. A sulfated nanofibrous mesh supporting the osteogenic differentiation of periosteum-
derived cells. J Biomater Tissue Eng. 2013 Aug 1;3(4):486-493.
5. Hoffman MD, Benoit DS. Emerging ideas: Engineering the periosteum: revitalizing allografts by mimicking
autograft healing. Clin Orthop Relat Res. 2013 Mar;471(3):721-6.
6. Jia J, Richards DJ, Pollard S, et al. Engineering alginate as bioink for bioprinting. Acta biomaterialia.
2014;10(10):4323-4331.

- 30 -

Figure 1. 3D bioprinting of PDC/alginate bioink onto Figure 2. Live/Dead staining of PDC/alginate bio-ink
COL1 scaffold. on a COL1 scaffold, one week post-printing.
Fluorescent green dots represent live cells.

Figure 3. Expression of collagen type 2 by PCR over a 3 week period in the different constructs

COL2

8

7

6

5

4

3

2

1

0
Mono Alg COL1 COL2 Mono Alg COL1 COL2 Mono Alg COL1 COL2

WK1 WK2 WK3

- 31 -

Figure 4. Expression of alkaline phosphatase by PCR over a 3 week period in the different constructs
Figure 5. Expression of RUNX2 over a 3 week period in the different constructs

- 32 -

Evaluation of TRB-N0224, a Chemically Modified Curcumin for Treatment of
Osteoarthritis

Nixon, R; Coury, J; Chahine, N; Grande, D

Abstract

Objective:
To evaluate the effects of TRB-N0224, a chemically modified curcumin with zinc binding properties and improved
pharmacokinetics, in a rabbit injury-induced model of osteoarthritis (OA).

Design:
38 skeletally mature New Zealand-like rabbits were studied in 4 groups: a sham with arthrotomy (n=6), control
with ACL transection (n=6), and two treatment groups with ACL transection and administration of TRB-N0224 at
low (25mg/kg/day) (n=13) and high (50mg/kg/day) (n=13) doses. After euthanization at 12 weeks, outcomes were
measured by post-necropsy gross morphology, biomechanics, and cartilage and synovium histology. Rabbit blood
ELISA quantified cytokine and MMP concentrations at 0, 4, 8, and 12 weeks.

Results:
Both treatment groups had fewer distal femoral condyle defects than the control; the low dose demonstrated a
mean 78% decrease (p<0.01). Biomechanical testing of the tibial femoral condyle revealed 1.41 MPa lower
compressive strength in treatment groups than the control (p<0.05). This finding did not correlate with other
tested parameters. According to the Mankin scale for OA, the low and high dose cartilage had fewer
histopathological changes exhibited by lower scores (2.60 and 1.25, respectively) than the control (3.50). The
control had more severe synovitis than both treatment groups. ELISA results suggested that the key mediators of
OA, IL-1β, IL-6, TNFα, MMP-9, and MMP-13, decreased concentrations with TRB-N0224 treatment between weeks
4 to 12.

Conclusions:
In pathogenesis of OA, an imbalance exists between catabolic and anabolic mediators. These results suggest the
potential of TRB-N0224 to modulate MMPs and cytokines, the catabolic mediators, slowing the macroscopic and
histopathological progression of OA.
Key words: osteoarthritis, rabbit model, chemically modified curcumin, MMP inhibitor
Abbreviations: OA (osteoarthritis), CMC (TRB-N0224)

- 33 -

Hip Arthroplasty Episode of Care Cost Analysis in the Oncologic Versus Non-oncologic
Patient

Isaac Gammal, Shachar Kenan, Christopher Larsen, Samuel Kenan, Howard Goodman

Introduction:
Lower extremity joint replacement is the most common inpatient surgery for Medicare beneficiaries and can
require lengthy recovery and rehabilitation periods. The Comprehensive Care for Joint Replacement (CJR) model
aims to support more efficient care for patients undergoing these procedures. We examined the impact of patient
and surgical characteristics, post-acute care and clinical outcomes on episode of care (EOC) costs in patients
undergoing hip arthroplasty. We hypothesized that due to the complexity of care for the oncologic patient, EOC
costs would be greater than in the general population, which has implications for inclusion of these patients in
the CJR model.

Methods:
We retrospectively collected data from a large administrative database of all patients over age 18 undergoing hip
arthroplasty with standard prostheses for any diagnosis (MS-DRG 469 and 470) between 2014 and 2017. Data
were collected from 3 large hospitals within the Northwell System. This yielded 2122 total patients: 1993 in the
non-oncologic group and 129 in the oncologic group. We compared demographic variables, EOC costs, and
outcome variables, including length of stay and readmission rates, between the two groups using Student’s t-
tests. We also estimated the association between an oncologic-associated procedure and EOC costs from a
multiple regression analysis.

Results:
Pre-operatively, a greater proportion of patients in the oncologic group was admitted through the emergency
department (77% vs 31%, p = 0.00) and had a proximal femur fracture (89% vs 29%, p = 0.00). A lower proportion
of oncologic patients had a total hip arthroplasty performed in favor of hemiarthroplasty (37% vs 69%, p = 0.00).
The length of stay was significantly greater in the oncologic group (7.2 days vs 4.2 days, p = 0.00). In the post-acute
period, a greater proportion of oncologic patients was discharged to a skilled care facility (93% vs 51%, p = 0.00)
and was re-admitted at a greater rate (29% vs 14%, p = 0.05). Index hospitalization costs (mean difference (MD)
$1,561, p = 0.05), skilled nursing costs (MD $5,932, p = 0.001), and total EOC costs (MD $20,012, p = 0.00) were
all greater in the oncologic group. Along with increasing age and fracture diagnosis, an oncologic diagnosis is
independently associated with greater EOC costs in arthroplasty patients, estimated from a multivariate analysis
(β = 16,163 ± 2,258, p = 0.00, r2 = 29%)

Conclusion:
Hip arthroplasty for an oncologic diagnosis is associated with worse outcomes and greater costs than in the
general population, independent of associated hip fracture. Consideration should be given to excluding the
oncologic cohort of patients from the CJR model. Future studies should focus on the feasibility of other EOC
bundles in the oncologic patient, which presents both medical and fiscal challenges for the surgeon and healthcare
system at large.

- 34 -

Variable Mean SD

Age 65.89 25.32

Sex 64.9% 47.8%

Emergency admission 33.3% 47.2%

Fracture 29.7% 45.7%

Oncologic 6.0% 23.8%

THA performed 66.8% 47.1%

LOS (days) 4.24 3.15

Skilled post-acute care 52.1% 50.0%

Readmission 14.3% 34.9%

Variable Onc Non-onc p-value
1993
N 129 65.7 0.002
65% 0.746
Age 75.7 30.5% 0.000
28.6% 0.000
Sex 70% 68.8% 0.000
4.18 0.000
Emergency admission 76.6% 51.3% 0.000
13.9% 0.046
Fracture 88.9%

THA performed 36.7%

LOS (days) 7.21

Skilled post-acute care 92.9%

Readmission 28.6%

- 35 -

Variable Mean (USD) SD (USD)

Index hospitalization 13597 2575

Skilled nursing facility 9305 10166

Home care 2777.8 1347.8

Part B 4429.9 2953.0

Total episode of care 24967 11105

Variable Onc (USD) Non-onc (USD) p-value

Index hospitalization 15125 13564 0.050

Skilled nursing facility 15092 9160 0.001

Home care 3016 2774 0.313

Part B 7769 4359 0.000

Total episode of care 43771 23759 0.000

- 36 -

Can the Pain Catastrophizing Scale Predict Patient Pain and Discharge Disposition
After Total Joint Arthroplasty?

Garbarino L1, Bub, C1, Motta F1, Rasquinha VJ1, Danoff JR1
Northwell Health Orthopaedic Institute, 611 Northern Blvd, Suite 200, Great Neck, NY 11021, United States

Introduction:
It is important to be able to identify patients who can tolerate minimal narcotic, accelerated postoperative total
joint arthroplasty (TJA) recovery protocols. Conversely, surgeons must be able to identify patients likely to
experience higher levels of post-arthroplasty pain. This study aims to utilize the Pain Catastrophizing Scale (PCS)
and other baseline variables, to differentiate patients who are able to rapidly recover with minimal pain from
those who subjectively experience more pain after TJA.

Methods:
This is a prospective observational cohort study of 64 total knee arthroplasty (TKA) and 36 total hip arthroplasty
(THA) patients who underwent unilateral total joint arthroplasty between January and May 2018 at four academic
and community hospitals. All patients completed a preoperative PCS, which is a validated, 13-question survey that
aims to identify patients that have an exaggerated perception of pain.8,9 Patients also completed the Risk
Assessment and Prediction Tool (RAPT), which is a 6-question survey that assess patients preoperative function in
order to predict discharge destination after TJA.3 The primary outcome was length of stay (LOS), in addition to
secondary outcomes including discharge destination (home versus sub-acute rehabilitation facility), narcotic pain
medication usage, readmission rate, 90-day complication rate, and baseline demographics age, gender, BMI,
Charleston Comorbidity Index, RAPT, American Society of Anesthesiologists Physical Status Classification System
(ASA), home support, and diagnosis of depression.

Results:
The overall mean LOS was 2.0 days, with a daily total opioid requirement of 23.84 morphine equivalents (MEQ).
Patients discharged home on postoperative day (POD) 1 or earlier showed less daily opioid use (13.98 MEQ/day)
compared to a LOS > 1 day (28.49 MEQ/day, p<0.0001). PCS<15 showed less daily opioid use (19.92 MEQ)
compared to PCS>15 (28.47 MEQ, p= 0.012). However, PCS was not predictive of LOS, as the mean LOS for PCS <
15 (LOS=1.944 days) was not significantly different than for PCS>15 (LOS=2.065, p=0.535). ASA of 1 or 2 also
predicted less narcotic requirements (p= 0.002), but was not predictive of LOS. THA patients had a decreased LOS
(1.65 days) compared to TKA (2.20 days, p = 0.004) and the direct anterior approach THA had a shorted LOS (1.29
days) compared to posterolateral (2.33, p=0.002). Following discharge, patients with a RAPT less than 10 (p<
0.0001) and those who live alone (p= 0.001) were more likely to require transfer to a sub-acute rehabilitation
facility. There was one postoperative readmission for medical treatment of a pulmonary embolism.

Conclusions:
The PCS can help surgeons anticipate postoperative opioid requirements in TJA patients. Although in this study
PCS did not predict those patients more likely to discharge home on POD1, PCS is a valuable tool to facilitate the
identification of those patients that may be candidates for minimal narcotic, accelerated recovery protocols in
patients with PCS<15. Although not proven by this study, further research is encouraged to intervene in those
patients with PCS>15 with additional pre- and post-operative pain education, pain management consultants, and
additional postoperative care. Overall, healthy patients (ASA 1 or 2) with a PCS < 15 and RAPT > 10 who have
support at home tend to experience less pain and be successfully discharged home.

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Works Cited
1. Basques, Bryce A., et al. “Same-Day Discharge Compared with Inpatient Hospitalization Following Hip and

Knee Arthroplasty.” The Journal of Bone and Joint Surgery, vol. 99, no. 23, 2017, pp. 1969–1977.,
doi:10.2106/jbjs.16.00739.
2. Forsythe, Michael E, et al. “Prospective Relation between Catastrophizing and Residual Pain Following Knee
Arthroplasty: Two-Year Follow-Up.” Pain Research and Management, vol. 13, no. 4, 2008, pp. 335–341.,
doi:10.1155/2008/730951.
3. Hansen, Viktor J., et al. “Does the Risk Assessment and Prediction Tool Predict Discharge Disposition After
Joint Replacement?” Clinical Orthopaedics and Related Research®, vol. 473, no. 2, 2014, pp. 597–601.,
doi:10.1007/s11999-014-3851-z.
4. Kohring., Jessica M., et al. “Treated versus Untreated Depression in Total Joint Arthroplasty Impacts
Outcomes.” The Journal of Arthroplasty, 2018, doi:10.1016/j.arth.2018.01.065.
5. Kurtz, Steven. “Projections of Primary and Revision Hip and Knee Arthroplasty in the United States from
2005 to 2030.” The Journal of Bone and Joint Surgery (American), vol. 89, no. 4, Jan. 2007, p. 780.,
doi:10.2106/jbjs.f.00222.
6. Lovecchio, Francis, et al. “Is Outpatient Arthroplasty as Safe as Fast-Track Inpatient Arthroplasty? A
Propensity Score Matched Analysis.” The Journal of Arthroplasty, vol. 31, no. 9, 2016, pp. 197–201.,
doi:10.1016/j.arth.2016.05.037.
7. Rondon, Alexander J., et al. “Who Goes to Inpatient Rehabilitation or Skilled Nursing Facilities Unexpectedly
Following Total Knee Arthroplasty?” The Journal of Arthroplasty, vol. 33, no. 5, 2018,
doi:10.1016/j.arth.2017.12.015.
8. Wood, Thomas J., et al. “Preoperative Predictors of Pain Catastrophizing, Anxiety, and Depression in Patients
Undergoing Total Joint Arthroplasty.” The Journal of Arthroplasty, vol. 31, no. 12, 2016, pp. 2750–2756.,
doi:10.1016/j.arth.2016.05.056.
9. Wright, David, et al. “Pain Catastrophizing as a Predictor for Postoperative Pain and Opiate Consumption in
Total Joint Arthroplasty Patients.” Archives of Orthopaedic and Trauma Surgery, vol. 137, no. 12, Mar. 2017,
pp. 1623–1629., doi:10.1007/s00402-017-2812-x.

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The Use of a Center-Center Technique to Decrease Femoral Implant Complications
Through the Direct Anterior Approach

Authors and Affiliations:
Peter A. Gold MDa; Spencer Stein MDa; Levi Brown BSb; Mark R. Jones MDc; Sreevathsa Boraiah, MDa

a Department of Orthopaedic Surgery Zucker School of Medicine at Hofstra/Northwell Health, North Shore/LIJ.
270-05 76th Ave, Queens, NY 11040, USA.
b Zucker School of Medicine at Hofstra/Northwell Health. 500 Hofstra Blvd, Hempstead NY 11549, USA.
c Harvard Medical School, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care
and Pain Medicine. 330 Brookline Ave, Boston, MA, 02215, USA.

Background:
Despite advances in medial-lateral wedge tapered implants, the direct anterior approach is still criticized as a risk
factor for subsidence, perioperative fracture, and thigh pain in total hip arthroplasty. The purpose of this study
was to investigate if a center-center technique could obtain consistent femoral fit and fill with decreased
component complications.

Methods:
Consecutive primary total hip arthroplasty performed using the center-center technique were retrospectively
reviewed from May 2015-February 2017. The technique focuses on central alignment of the implant on both
anteroposterior and lateral radiographs. Standardized objective radiographic measurements of fit and fill were
recorded at proximal and distal anatomic segments. Early implant complications: subsidence, intra- or
postoperative fracture, infection, early revision, and thigh pain were assessed.

Results:
151 THA patients were analyzed with an average age of 65 years and follow up of 2.5 years. 90% of implants had
acceptable radiographic fit and fill in both proximal and distal segments with an average subsidence of 1mm. 74%
of implants subsided less than 1mm, and 91% subsided less than 2mm. 1 implant had radiographic subsidence of
9mm, but was not clinically significant. There were no intraoperative fractures and 1 postoperative fracture
secondary to mechanical fall. No patient required revision arthroplasty for any reason and none reported
postoperative thigh pain.

Conclusion:
The center-center technique, through the anterior approach, consistently obtains acceptable radiographic fit and
fill with the second generation cementless medial-lateral wedge tapered implants. This technique can aide in
proper femoral placement thereby reducing implant stresses and limiting early component complications.

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Analysis of symptomatic recurrent lumbar disc herniations and reoperation rates in
patients undergoing laminectomy with discectomy or microdiscectomy

Goldstein J, Brown, L, McGill M, Silber J, Essig D

Background:
Lumbar hemilaminectomy/laminotomy with discectomy is a common surgical procedure for individuals suffering
from lumbar related radiculopathy with excellent patient reported outcomes. In certain cases, a full laminectomy
with partial facetectomies and foraminotomies is necessary to address degenerative stenosis in addition to
excision of the herniated disc. Due to the more extensive decompression, some surgeons feel that the motion
segment may be rendered iatrogenically unstable, and that the rate of recurrent disc herniation or subsequent
instability is high. It has been demonstrated in biomechanical studies that increasing resection of the posterior
elements leads to increasing spinal instability. Thus, some believe that this procedure requires a concomitant
fusion to mitigate the risk of further treatment or surgery to the segment. The addition of a fusion increases
surgical time and complication rates.

Purpose:
To evaluate the rate of symptomatic recurrent disc herniations in patients who underwent either a
hemilaminectomy/laminotomy with discectomy (traditional microdiscectomy) compared to those that underwent
bilateral laminectomies with discectomy.

Methods:
Adult patients who underwent a lumbar hemilaminectomy/laminotomy with discectomy (MD) or full laminectomy
with partial facetectomies and foraminotomies along with discectomy (FD) as a primary procedure were be
analyzed with minimum 6 month follow-up. Included patients had CPT codes 63047 and/or 63030. Procedures
performed adjacent to concomitant or prior fusion, those with radiographic evidence of instability, pediatric
patients, multilevel laminectomies, and revision procedures were excluded. Charts were reviewed and data
collected for index procedure, length of follow-up, and demographic information. Primary outcome was return
to operating room for revision laminectomy, laminectomy discectomy, and or fusion.

Results:
240 consecutive cases that were performed by two spine surgeons for either a MD or FD were reviewed ranging
from 2011 to 2014. 26 cases were excluded. Sixty five (30%) cases were MD. There were no significant differences
in sex (49.2% male MD, 57.7% male FD), Smoking (25% current, 18% current), and Alcohol Use (71% Current MD,
60% FD). Average length of follow up was 14.9 Months for MD and 19.7 for LD. Six (9.2%) from the MD required
return to OR and (5.4%) from the FD(p=0.92). There were 9 revision laminectomy/discectomies performed (4,
6.1% MD; 5, 3.4% FD), and 5 laminectomy with posterior spinal fusion and instrumentation (4, 6.1% MD; 1, 0.07%
FD).

Conclusions:
Most patients in both the MD and FD groups did not require return to the operating room for revision surgery
following their surgical intervention. We saw no significant differences in reoperation rates and type of
reoperation in each cohort. This data suggests that there is no increased risk of instability in patients undergoing
full laminectomy with discectomy.

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Using Three-Dimensional Printing to Construct Chitosan-Alginate Scaffolds for
Articular Cartilage Tissue Engineering

Yonah Heller, Pooja Swami, Daniel Grande

Background:
Defects in articular cartilage can cause significant pain and functional impairment. Tissue engineered neocartilage
is emerging as a promising new alternative to traditional reconstruction with autologous cartilage grafts, which
can be limited by donor-site availability and morbidity. However, conventional methods of tissue engineering are
restricted in their ability to generate cartilage with precise dimensions. The synthetic scaffolds that are commonly
used for cartilage engineering, such as polyglycolic acid, are also suboptimal for cell growth and can release
inflammatory degradative byproducts. The aim of this study was to use three-dimensional (3D) printing to
construct a precise scaffold of natural biomaterials for articular cartilage engineering.

Methods:
Computer-aided design (CAD) software was used to create a negative mold of a circular-shaped scaffold. The mold
was fabricated by a 3D printer using acrylonitrile butadiene styrene (ABS). A hydrogel of homogenized alginate
and chitosan was compressed into the negative mold, then frozen in liquid nitrogen and lyophilized to produce a
solid, porous scaffold. Bovine articular chondrocytes were seeded onto the scaffold, and then incubated in culture
media. The constructs were then evaluated at three and five week time points. Live/Dead staining was used to
evaluate cell survival, and histology with hematoxylin and eosin (H&E) staining was used to evaluate tissue
structure and extracellular matrix (ECM) production. Polymerase chain reaction (PCR) was used to quantify gene
expression and assess cell phenotype and differentiation.

Results:
Live/Dead staining showed high viability of chondrocytes throughout the scaffolds, with very few dead cells
relative to live cells. Histologic examination showed cells had aggregated, produced ECM, and were able to
penetrate into the deepest layers of the scaffold and survive. PCR results demonstrated an increase in type II
collagen (COL2) gene expression over time, which is indicative of hyaline cartilage differentiation. Upon gross
examination, the scaffolds were able to retain the shape of the original mold over time.

Conclusions:
These findings demonstrate the feasibility of using a 3D printer to create a specifically shaped scaffold for tissue
engineering. Live/Dead staining, histology, PCR results show the ability of a solid alginate/chitosan scaffold to
support cell survival and differentiation into a hyaline cartilage phenotype. The ultimate goal is to translate these
findings into clinical practice by creating precisely shaped cartilage that is customized to fit individual patients’
unique defects.

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5-Aminolevulinic Acid Photodynamic Therapy for Myxofibrosarcoma and Chordoma: In
Vitro Cellular Destruction Visualized Via Time-Lapse Confocal Microscopy

Kenan, S1; Liang, H2; Goodman, H1, Grande, D2; Levin, A3
From the Department of Orthopaedics, North Shore-Long Island Jewish Hospital, Northwell Health Medical
Center, New Hyde Park, NY1, Orthopaedic Research Laboratory, The Feinstein Institute for Medical Research,
Manhasset, NY2, The Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine,
Baltimore, MD3

Level of Evidence: IV

Introduction:
Five-aminolevulinic acid (5-ALA), an endogenous intermediary involved in the heme biosynthesis pathway, is a
known compound used in photodynamic therapy (PDT) to treat various malignancies. 5-ALA
is preferentially converted to protoporphyrin IX (PpIX) within the mitochondria of malignant cells, which then
leads to oxidative damage and cell death when exposed to light of sufficient energy and wavelength.
Prior studies performed on myxofibrosarcoma (MUG-Myx1) and chordoma (MUG-Chor1) cells have indirectly
documented cell death using flow cytometry, however cellular destruction has never been directly visualized. The
purpose of this study was to analyze the selective cytotoxic effects of 5-ALA on MUG-Myx1 and MUG-Chor1
cells under direct visualization using confocal time-lapse microscopy.

Methods:
MUG-Myx1, MUG-Chor1, and control adipose derived stromal (ADS) cells that had been exposed to 3 hours of 5-
ALA were visualized using a confocal laser scanning microscope with a 10× objective at 405-nm excitation and
emission at 603-738–nm wavelength. Time-lapse images of live cells were captured using bright field and 405-nm
laser every second for 15 minutes. The captured frames were then visualized sequentially at 50× speed.

Results:
Initially, the affected myxofibrosarcoma and chordoma cells can be seen fluorescing red at an emission
wavelength of 602–738-nm in response to the 405-nm excitation laser exposure. As time progressed, increased
intracellular swelling was noted, with concomitant rapid formation of multiple vesicles exiting from the cellular
membrane. In contrast, the control ADS cells remained intact without any evidence of vesicle formation or
swelling under the same conditions. Of note, fluorescence was markedly lower in the ADS than the
myxofibrosarcoma and chordoma cells at all time points.

Conclusion:
The results of this study demonstrate the selective cytotoxic effects of 5-ALA photodynamic therapy (PDT) against
myxofibrosarcoma and chordoma cells. The PDT time-lapse videos dramatically reveal this effect, a display that to
the author’s knowledge, has not been described elsewhere. These findings are most likely attributable to
intracellular accumulation of the photosensitizer PpIX within malignant cells, as a consequence of impaired 5-ALA
metabolism.
5-ALA driven PDT offers many advantages over traditional chemotherapeutic agents, including lack of
immunosuppression, a favorable side effect profile and reduced long term morbidity. Additionally, 5-ALA has been
used for “tumor paint” enabling tumor margin assessment during resections. 5-ALA, with its two-pronged
applications of selective tumor identification and kill has the potential of transforming our surgical and medical
approach to treating soft tissue sarcomas.

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Control ADS MUG-Myx1 MUG-Chor1

Time:
0 min

Time:
15min

Table 1: Still frames of the three experimental groups from left to right (ADS- adipose derived stromal cells,
MUG-Myx1- myxofibrosarcoma cells, MUG-Chor1- chordoma cells). Upper row represents the start of the
experiment (time: 0). Lower row represents the end of the experiment (time: 15 min). Vesicle formation and
swelling in response to 5-ALA exposure was only seen in the cancer cell lines, while sparing the benign control
cells.

- 43 -

Biomechanical Analysis of an Interference Screw vs a Novel Twist Lock Screw Design
for Bone Graft Fixation

Mullen, J; Asnis, S; Asnis, PD; Sgaglione, N; LaPorta, T; Grande, D.A.; Chahine N.O.
Introduction:
Malpositioning of an anterior cruciate ligament graft during reconstruction can occur during screw fixation. The
purpose of this study is to compare the fixation biomechanics of a conventional interference screw with a novel
Twist Lock Screw, a rectangular shaped locking screw that is designed to address limitations of graft positioning
and tensioning.
Methods:
Synthetic bone (10, 15, 20 pounds per cubic foot) were used simulating soft, moderate, and dense cancellous
bone. Screw push-out and graft push-out tests were performed using conventional and twist lock screws.
Maximum load and torque of insertion were measured.
Results:
Max load measured in screw push out with twist lock screw was 64%, 60%, 57% of that measured with
conventional screw in soft, moderate and dense material, respectively. Twist lock max load was 78% and 82% of
that with conventional screw in soft and moderate densities. In the highest bone density, max loads were
comparable in the two systems. Torque of insertion with twist lock was significantly lower than with
conventional interference screw.
Conclusions:
Based on geometric consideration, the twist lock screw is expected to have 35% the holding power of a
cylindrical screw. Yet, results indicate that holding power was greater than theoretical consideration, possibly
due to lower friction and lower preloaded force. During graft push out in the densest material, comparable max
loads were achieved with both systems, suggesting that fixation of higher density bone, which is observed in
young athletes that require reconstruction, can be achieved with the twist lock screw.

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Chief Residents

Immediate plans after completion of the program

Yonah Heller, MD James Mullen, MD Shachar Kenan, MD

Fellowship: Fellowship: Fellowship:
Adult Reconstruction Hand & Upper Extremity Orthopaedic Oncology
Johns Hopkins New York University Hospital Memorial Sloan Kettering
Baltimore, Maryland for Joint Diseases Cancer Center
Robert Sterling, MD New York, New York New York, New York
Martin Posner, MD Patrick Boland, MD

“When you do nothing, you feel overwhelmed and powerless. But when you get involved, you
feel the sense of hope and accomplishment that comes from knowing you are working to
MAKE THINGS BETTER”
- Albert Einstein

- 45 -

Northwell Health Physician Partners

Nicholas A. Sgaglione, MD
Chairman, Orthopaedic Surgery, Northwell Health
Senior Vice President, Orthopaedic Service Line
Executive Director, Northwell Health Orthopaedic Institute
Chair & Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Sports Medicine

Thomas M. Mauri, MD
Vice Chairman, Orthopaedic Surgery, North Shore University Hospital & Long Island Jewish Medical Center
Vice President Clinical Services, Orthopaedic Service Line
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Spine Surgery

Jeff Silber, MD
Associate Chairman, Orthopaedic Surgery, Long Island Jewish Medical Center
Chief, Orthopaedic Spine Surgery, Long Island Jewish Medical Center
Associate Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Spine Surgery

Lewis B. Lane, MD
Chief, Hand Surgery, North Shore University Hospital & Long Island Jewish Medical Center
Residency Program Director, Orthopaedic Surgery, Long Island Jewish Medical Center
Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Hand Surgery

Stanley E. Asnis, MD
Chairman Emeritus
Chief, Adult Joint Reconstruction, North Shore University Hospital
Associate Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Joint Reconstruction

Terry Amaral, MD
Associate Chief, Pediatric Orthopaedic Surgery, Steven and
Alexandra Cohen Children’s Medical Center of New York
Specialty: Pediatric Orthopaedic Surgery

Richard M. Bochner, MD
Medical Director, Schwartz Ambulatory Center
Assistant Professor, Orthopaedic Surgery, The Donald and
Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: General Orthopaedics

Sreevathsa Boraiah, MD Shachar Kenan MD (2018); Richard Bochner MD;
Assistant Professor, Orthopaedic Surgery, The Donald and Geoffrey Phillips MD
Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Joint Reconstruction - 46 -

Russell Camhi, DO ATC
Specialty: Primary Care Sport Medicine

Jonathan Danoff, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Joint Reconstruction

Jon-Paul DiMauro, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Pediatric Orthopaedic Surgery

David Essig, MD
Director, Orthopaedic Spine Surgery, Long Island Jewish Forest Hills
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Spine Surgery

David Galos, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Orthopaedic Trauma

Ariel Goldman, MD
Chief, Orthopaedic Trauma, North Shore University Hospital, Long Island Jewish Medical Center
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Orthopaedic Trauma

Howard Goodman, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Musculoskeletal Oncology

Andrew Goodwillie, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Sports Medicine

Samuel Kenan, MD
Chief, Musculoskeletal Oncology, Long Island Jewish Medical Center & North Shore University Hospital; Steven and
Alexandra Cohen Children’s Medical Center of New York
Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Musculoskeletal Oncology

Francisco LaPlaza, MD
Specialty: Pediatric Orthopaedic Surgery

John E. Morrison, MD
Clinical Assistant Professor of Surgery, Cornell University Medical College
Specialty: Spine Surgery

- 47 -

Kate Nellans, MD, MPH
Associate Program Director, Orthopaedic Surgery Residency, Long Island Jewish Medical Center
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Hand Surgery
Geoffrey Phillips, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Foot and Ankle Surgery
Vijay Rasquinha, MD
Chief, Adult Joint Reconstruction, Long Island Jewish Medical Center
Associate Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Joint Reconstruction
Steven E. Rokito, MD
Chief, Sports Medicine, Long Island Jewish Medical Center & North Shore University Hospital
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Sports Medicine
Vishal Sarwahi, MBBS
Chief, Pediatric Orthopaedic Surgery, Steven and Alexandra Cohen Children’s Medical Center of New York
Specialty: Pediatric Orthopaedic Surgery
Rohit Verma, MD
Assistant Professor, Orthopaedic Surgery, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Specialty: Spine Surgery

- 48 -

Faculty

Long Island Jewish Medical Center & North Shore University Hospital

 Michael J Angel, MD  Stuart J Hershon, MD  Jahanshah Roofeh, MD

 Kevin A Cassidy, MD  Jeffrey Kaplan, MD  Michael C Schwartz, MD

 Richard J D’Agostino, MD  Gus Katsigiorgis, DO  Bruce A Seideman, MD

 Philip M D’Ambrosio, MD  Barry M Katzman, MD  Jeffrey F Shapiro, MD

 David M Dines, MD  James M Kipnis, MD  Raymond Shebairo, MD

 William A Facibene, MD  Scott J Koenig, MD  Wei Shen, MD

 John M Feder, MD  Stelios Koutsoumbelis, MD  Peter D Stein, MD

 Barry Fisher, MD  Ronald A Light, MD  Jonathan B Ticker, MD

 Andrew S Greenberg, MD  Hamid R Mostafavi, MD  David V Tuckman, MD

 Matthew J Goldstein, MD  Brian R Neri, MD  Neil F Watnik, MD

 Maury Harris, MD  Steven J Ravich, MD

 Peyton L Hays, MD  Jeffrey H Richmond, MD

Shachar Kenan MD (2018); Adam Levin MD (2010);
Janice Vetrano; Stelios Koutsoumbelis MD (2015)

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