Bio

Clinical Focus


  • Orthopaedic Surgery and Sports Medicine
  • Orthoped Surg/Sports Med

Academic Appointments


Administrative Appointments


  • President, Leroy C. Abbott Orthopaedic Society (UC San Francisco) (2011 - Present)
  • President, Northern California Chapter of the Western Orthopaedic Association (NCCWOA) (2011 - Present)
  • Board of Directors, Northern California Chapter of the Western Orthopaedic Association (NCCWOA) (2009 - Present)
  • Board of Directors, Leroy C. Abbott Orthopaedic Society (UC San Francisco) (2008 - Present)
  • Medical Director, Graduate School of Athletic Training, San Jose State University (2008 - Present)
  • Adunct Professor, Graduate School of Athletic Training, San Jose State University (2007 - Present)
  • Team Physician, San Jose State University Athletics (2006 - Present)
  • Adjunct Professor, Department of Kinesiology, San Jose State University (2006 - Present)
  • Admissions Committee, University of California, San Francisco (UCSF) School of Medicine (1995 - 1998)

Honors & Awards


  • Research Award, Arthroscopy Association of North America (AANA) (2006)
  • Award for Outstanding Contribution to Arthroscopic Shoulder Surgery, Smith & Nephew Endoscopy (2005)
  • Award for Excellence in Basic Science Research, Leroy C. Abbott Orthopaedic Society, University of California, San Francisco (UCSF) (2004)
  • Research Poster of the Year, Arthroscopy Association of North America (AANA) (2003)
  • Award for Excellence in Basic Science Research, Leroy C. Abbott Orthopaedic Society, University of California, San Francisco (UCSF) (2002)
  • Research Fellowship, Arthroscopy Association of North America (AANA) (2002)
  • Alumni Scholarship for Academic Excellence, University of California, San Francisco (UCSF) School of Medicine (1997)
  • Firestone Honorary Research Fellowship, University of California, San Francisco (UCSF) School of Medicine (1995)
  • Departmental Honors, Stanford University, Department of Biological Sciences (1994)

Professional Education


  • Residency:University of California San Francisco (2004) CA
  • Internship:University of California San Francisco (1999) CA
  • Medical Education:University of California San Francisco (1998) CA
  • Fellowship:Harvard Medical School (2005) MA
  • Fellowship, University of Zurich, Balgrist Hospital, Shoulder and Elbow Surgery (2005)
  • Fellowship, University of California, San Francisco (UCSF), Department of Orthopaedic Surgery, Cartilage Injury, Apoptosis (2002)
  • B.S. with Honors, Stanford University, Biological Sciences (1994)

Community and International Work


  • Orthopaedic Overseas, South Africa, Central and South America

    Topic

    Orthopaedic Surgery Volunteerism

    Partnering Organization(s)

    Health Volunteers Overseas

    Populations Served

    Third World

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Dr. Costouros specializes in the arthroscopic and open treatment of shoulder and elbow disorders derived from sports injuries, arthritis, fractures, compressive neuropathies, and failed prior surgeries. He has made significant award-winning research discoveries in the molecular etiology and treatment of arthritis and cartilage injuries.

He has special expertise in the reverse total shoulder replacement, management of massive and irreparable rotator cuff tears, revision surgery, tendon transfers, fractures of the shoulder girdle, and the treatment of sports-related disorders and instability of the shoulder in overhead athletes using arthroscopic techniques.

His research focuses on improving our understanding of cartilage injury and arthritis at the cellular level, specifically the development of methods to modulate programmed cell death or apoptosis. He also is involved in the development of cell-based strategies in improving outcomes following rotator cuff repair and better understanding the causes of rotator cuff disease.

Dr. Costouros continues to be interested in the development of instruments to analyze surgical outcomes and the creation of registries which allow surgeons to better understand patient-specific outcomes, implant longevity, wear mechanisms, and how surgeons can consistently deliver the best results following shoulder and elbow surgery.

Teaching

2013-14 Courses


Postdoctoral Advisees


Publications

Journal Articles


  • Risk of Thromboembolism in Shoulder Arthroplasty: Effect of Implant Type and Traumatic Indication CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Navarro, R. A., Inacio, M. C., Burke, M. F., Costouros, J. G., Yian, E. H. 2013; 471 (5): 1576-1581

    Abstract

    Prior research about symptomatic venous thromboembolism (VTE) after shoulder arthroplasty has not determined whether procedure type (hemiarthroplasty, total shoulder arthroplasty, or reverse shoulder arthroplasty) or surgical indication (traumatic or elective) represent risk factors for VTE after shoulder replacement.We therefore asked whether the risk of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty was influenced by (1) procedure type, and (2) surgical indication (traumatic or elective).We performed a retrospective database review of symptomatic VTE events and mortality within 90 days of shoulder arthroplasty in a large (30-hospital) integrated healthcare system over a 5-year period, from January 2005 to December 2009. We compared the likelihood of VTE and death in patients undergoing reverse shoulder arthroplasties (RSAs), total shoulder arthroplasties (TSAs), and hemiarthroplasties (HAs), and we compared the likelihood of VTE and death in patients who underwent elective shoulder arthroplasties with those who underwent shoulder arthroplasty in the setting of acute trauma.In the 2574 eligible shoulder arthroplasties identified during the study period, VTE developed in 1.01% of patients (deep vein thrombosis 0.51% and pulmonary embolism 0.54%). With the numbers available, no differences were observed in rates of VTE or mortality by procedure type. A trend toward increased VTE occurred more frequently in patients having surgery for traumatic indications than after elective surgery (1.71% versus 0.80%; p = 0.055). A higher likelihood of 90-day mortality was observed in trauma patients compared with elective (odds ratio = 7.4; 95% CI, 2.4-25.2).VTE occurred infrequently in this study sample. These data support future risk and benefit assessment of routine pharmacologic VTE prophylaxis in the perioperative treatment of patients undergoing shoulder arthroplasty, especially in all RSA and traumatic HA subsets, where the risk of VTE may be higher.

    View details for DOI 10.1007/s11999-013-2829-6

    View details for Web of Science ID 000316959100026

    View details for PubMedID 23392993

  • Total shoulder arthroplasty with an uncemented soft-metal-backed glenoid component JOURNAL OF SHOULDER AND ELBOW SURGERY Fucentese, S. F., Costouros, J. G., Kuehnel, S., Gerber, C. 2010; 19 (4): 624-631

    Abstract

    Loosening associated with cemented polyethylene glenoid components is a major concern following total shoulder arthroplasty (TSA). The purpose of this study was to investigate the clinical and radiographic results associated with use of a novel uncemented soft-metal-backed glenoid component (SMBG), with a minimum follow-up of 2 years.Twenty-two patients (19 women) underwent TSA using a uncemented SMBG. The mean age was 68.5 years (range, 49-84). Mean follow-up was 50 months (range, 24-89). Indications for TSA were primary osteoarthritis (10), post-traumatic osteoarthritis (8), steroid-induced avascular necrosis (2), crystalline arthropathy (1), and arthritis secondary to systemic lupus erythematodes (1). Subjective and objective parameters were assessed. Loosening and polyethylene wear were evaluated.Mean absolute Constant scores improved from 29.1 to 65.9 points (P < .001), age- and sex-adjusted Constant scores improved from 40.1 to 87.7% (P < .001), and subjective shoulder values improved from 35% to 75.2% (P < .001). Mean pain scores improved from 4.2 points to 13.1 (P < .001). Three cases had a fractured glenoid component. Only these 3 had a definite loosening. Polyethylene wear was found in 2 cases.Use of an uncemented SMBG component yields controversial results. Osteointegration appears possible and loosening signs have virtually not been observed. Conversely, the current implant can be associated with a high failure rate (13.6%) because of implant fractures despite short follow-up. As loosening seems absent or minimal but implant stability insufficient, design changes need to be performed and tested in view of solving the implant failure problem while preserving the actually excellent bone-implant interface characteristics.

    View details for DOI 10.1016/j.jse.2009.12.021

    View details for Web of Science ID 000278901500022

    View details for PubMedID 20382040

  • Static posterior humeral head subluxation and total shoulder arthroplasty JOURNAL OF SHOULDER AND ELBOW SURGERY Gerber, C., Costouros, J. G., Sukthankar, A., Fucentese, S. F. 2009; 18 (4): 505-510

    Abstract

    Static posterior subluxation of the humeral head (PSH) is often associated with glenohumeral arthritis. It may persist following total shoulder arthroplasty (TSA) and lead to accelerated polyethylene wear and glenoid component loosening. The factors which lead to PSH are poorly understood. The purpose of this study was to test the hypothesis that operative correction of glenoid version during shoulder arthroplasty re-centers the glenohumeral joint; therefore, glenoid replacement may be considered even in cases of osteoarthritis associated with posterior humeral head subluxation.Thirty-three of 124 (27%) consecutive shoulders undergoing primary TSA had static preoperative PSH with a subluxation index of at least 65% determined on standardized computer tomographic scans. Twenty-three of these 33 shoulders were available for clinical and computed tomography follow-up after a minimum of 24 and average of 42 months. Mean preoperative glenoid retroversion was -18 [range, 0 degrees - (-40 degrees)], the subluxation index averaged 71% (range, 65-81%). Glenoid morphology, according to Walch et al, was type B1 in 9 patients, type B2 in 5 patients, and type C in 9 patients. A conventional total shoulder replacement was performed through a deltopectoral interval. Using corrective glenoid reaming, restoration of glenoid version to between 0 degrees and 10 degrees of retroversion was attempted in addition to standard soft tissue release. Humeral head retroversion was replicated from the diseased humeral head as closely as possible.PSH was reversed in 21/23 patients following TSA with an average final subluxation index of 50% (range, 40-68%; P = .001). There was no significant correlation statistically between PSH and preoperative or postoperative glenoid version, humeral torsion, glenoid morphology, or acromio-humeral distance. Mean absolute Constant scores improved from 39 to 78 points, age-adjusted Constant scores improved from 49% to 95% and subjective shoulder values improved from 40% to 89%, which were all statistically significant (P < .0001).PSH is frequently present in shoulders with osteoarthritis. It can be corrected in the majority of shoulders undergoing total shoulder replacement; however, re-centering is not correlated with glenoid version or its correction.Level 4; Case series, treatment study.

    View details for DOI 10.1016/j.jse.2009.03.003

    View details for Web of Science ID 000267812400002

    View details for PubMedID 19481961

  • Teres minor integrity predicts outcome of latissimus dorsi tendon transfer for irreparable rotator cuff tears JOURNAL OF SHOULDER AND ELBOW SURGERY Costouros, J. G., Espinosa, N., Schmid, M. R., Gerber, C. 2007; 16 (6): 727-734

    Abstract

    In patients with irreparable rotator cuff tears, latissimus dorsi tendon transfer (LDTT) can be effective in improving pain and function. However, the results are variable, and the factors that predict good outcomes are poorly understood. The purpose of this study was to investigate whether the integrity of the teres minor musculotendinous unit is predictive of outcome following LDTT. Twenty-two consecutive patients who underwent LDTT for massive, irreparable posterosuperior rotator cuff tears were retrospectively reviewed. Sixteen men and 6 women with a mean age of 58 years (range, 40-68) were analyzed at an average follow-up of 34 months (range, 24-57). Standardized MRI images of all patients were reviewed by 3 independent reviewers. Fatty infiltration of the teres minor was Goutallier stage 0 in 5 patients; stage 1 in 6; stage 2 in 4; stage 3 in 6; and stage 4 in 1. Eleven patients (50%) had partial tears and 2 (9%) had complete tears of the teres minor tendon. Following LDTT, the mean absolute constant score improved from 48 to 62 points (P = .003), age-adjusted constant score improved from 56% to 72% (P = .002), and the subjective shoulder value improved from 24% to 68% (P < .001). Fatty infiltration of the teres minor less than or equal to stage 2 was associated with a better postoperative constant score (67 vs 53, P = .015); age-adjusted constant score (78% vs 59%, P = .012); active external rotation (36 degrees vs 16 degrees , P = .016); and active elevation (143 degrees vs 115 degrees , P = .012) relative to patients with fatty infiltration greater than stage 2. The presence or absence of a tear of the tendon had no significant effect on outcome. In conclusion, when performing LDTT for massive irreparable posterosuperior rotator cuff tears, fatty infiltration of the teres minor should be considered prior to surgery, as it is predictive of outcome.

    View details for DOI 10.1016/j.jse.2007.02.128

    View details for Web of Science ID 000251767800009

    View details for PubMedID 17980629

  • Reversal of suprascapular neuropathy following arthroscopic repair of massive supraspinatus and infraspinatus rotator cuff tears ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Costouros, J. G., Porramatikul, M., Lie, D. T., Warner, J. J. 2007; 23 (11): 1152-1161

    Abstract

    The purpose of this study was to study the prevalence of suprascapular neuropathy (SSN) in the setting of massive rotator cuff tears and to determine if arthroscopic rotator cuff repair, even if partial, was associated with reversal of SSN and clinical improvement in pain and function.Over a 13-month period, 26 of 216 patients with rotator cuff tears treated operatively were identified to have massive tears associated with retraction and moderate to severe fatty infiltration of the supraspinatus and infraspinatus muscles. All patients had pain and marked weakness in abduction and external rotation which did not improve with conservative treatment. Electrodiagnostic electromyographic/nerve conduction velocity (EMG/NCV) evaluation, as well as pre- and postoperative questionnaire and physical examination, were performed. An arthroscopic repair, either partial or complete, was performed on patients identified to have a massive rotator cuff tear in association with SSN.Fourteen of 26 patients with massive rotator cuff tears (54%) were identified to have a peripheral nerve injury. Seven of these 26 (38%) had isolated suprascapular nerve injury, 4 had axillary nerve injury, 2 had an associated upper trunk brachial plexus injury, and 1 had a cervical radiculopathy. All 7 patients with isolated suprascapular injury underwent arthroscopic treatment, 1 of which was not technically reparable at the time of surgery. In the 6 patients who underwent either partial or complete arthroscopic repair, follow-up EMG/NCV after 6 months demonstrated partial or full recovery of the suprascapular nerve palsy that correlated with complete pain relief and marked improvement in function.SSN is found in a significant proportion of patients with massive rotator cuff tears, and is associated with pain and dysfunction. Arthroscopic rotator cuff repair can result in reversal of SSN, which may correlate with substantial improvement in pain and function.Level IV, case series.

    View details for DOI 10.1016/j.arthro.2007.06014

    View details for Web of Science ID 000251145800003

    View details for PubMedID 17986401

  • Preventing chondrocyte programmed cell death caused by iatrogenic injury KNEE Costouros, J. G., Kim, H. T. 2007; 14 (2): 107-111

    Abstract

    Cartilage repair technology is advancing at a rapid pace. However, all techniques share a common weakness-unintentional chondrocyte cell death resulting from cartilage injury that occurs during preparation of the defect site. The loss of chondrocytes at the edge of host cartilage is likely to contribute to failed integration of regenerated tissue or grafts to the surrounding cartilage. Recent studies have demonstrated that "apoptosis", or programmed cell death (PCD), may be responsible for much of the cell death caused by cartilage injury. Theoretically, inhibitors of key pathways responsible for PCD could rescue chondrocytes and improve the results of cartilage repair surgery. The purpose of this study was to test the hypothesis that short-term, intra-articular PCD inhibitor treatment can limit chondrocyte death in vivo following simulated preparation of host cartilage for a repair procedure. A microcurette was used to create full-thickness articular cartilage injuries to the femoral condyles of adult New Zealand White rabbits. Animals received daily intra-articular injections either with a potent PCD inhibitor or with vehicle alone. Treatment with the inhibitor resulted in a significant reduction in the percentage of chondrocytes undergoing PCD compared to controls [treated=10.1+/-2.4%; controls=26.5+/-3.6%; (p=0.0013)]. These results provide proof of concept for the use of PCD inhibitors to enhance the results of cartilage repair surgeries.

    View details for DOI 10.1016/j.knee.2006.10.013

    View details for Web of Science ID 000245307300005

    View details for PubMedID 17174553

  • Trans-cuff portal for arthroscopic posterior capsulorrhaphy ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Costouros, J. G., Clavert, P., Warner, J. J. 2006; 22 (10)

    Abstract

    Arthroscopic repair of posterior shoulder instability is becoming an accepted method of treatment. Most surgeons perform this procedure with the patient in a lateral decubitus position to facilitate access to the posterior glenoid. We have developed an accessory portal placed through the midportion of the rotator cuff that allows easy and complete viewing of the posterior glenohumeral joint when the patient is in a beach chair position and does not require the use of traction. This portal provides a superior-to-inferior view of the posterior glenoid rim and capsule and allows use of anterior and posterior routine portals for posterior Bankart repair. In this study, the technique of posterior labral repair in the beach chair position with use of the trans-cuff portal is described, and preliminary results in 5 patients at an average follow-up of 24 months are presented. Through this approach, we were able to place 3 anchors, with the lowest at the 7 o'clock position (for a right shoulder), in all patients. Mean American Shoulder Elbow Surgeons (ASES) score improved from 53 +/- 15 preoperatively to 87 +/- 8 postoperatively (P < .01). All patients had an excellent result with complete resolution of pain and instability.

    View details for DOI 10.1016/j.arthro.2006.05.013

    View details for Web of Science ID 000241722700021

    View details for PubMedID 17027417

  • Comparison of chondrocyte apoptosis in vivo and in vitro following acute osteochondral injury JOURNAL OF ORTHOPAEDIC RESEARCH Costouros, J. G., Dang, A. C., Kim, H. T. 2004; 22 (3): 678-683

    Abstract

    The objective of the present study was to directly compare levels of chondrocyte apoptosis produced by osteochondral injury in vivo and in vitro. Adult New Zealand White rabbits underwent 2 mm osteochondral drilling of the medial and lateral femoral condyles of a single hind limb. Animals were euthanized, and specimens were harvested at 0, 2, 4, 7, 10, and 14 days following injury. At the time of euthanasia, identical injuries were created in the femoral condyles of the contralateral hind limb. These condyles were maintained in vitro under standard tissue culture conditions until harvesting at time points corresponding to the in vivo specimens (i.e. after 0, 2, 4, 7, 10 and 14 days in culture). The extent of apoptosis in the in vivo and in vitro specimens was quantified by TUNEL analysis. The amount and distribution of TUNEL positive cells followed similar patterns in both in vivo and in vitro specimens with a maximal percentage of apoptotic chondrocytes observed on post-injury day 4. On post-injury day 4, in vivo specimens displayed a statistically significant increased overall level of apoptosis compared to in vitro specimens [in vivo=32.5+/-8.6%; in vitro=22.2+/-4.8%; (p=0.03)]. These experiments suggest that the majority of programmed cell death observed after osteochondral injury can be attributed to processes intrinsic to the cartilage itself; however, additional factors present within the acutely traumatized joint also appear to potentiate chondrocyte apoptosis following injury.

    View details for DOI 10.1016/j.orthres.2003.10.008

    View details for Web of Science ID 000221200800032

    View details for PubMedID 15099652

  • Congenital diplopodia PEDIATRIC RADIOLOGY Brower, J. S., Wootton-Gorges, S. L., Costouros, J. G., Boakes, J., Greenspan, A. 2003; 33 (11): 797-799

    Abstract

    Diplopodia, or duplicated foot, is a rare congenital anomaly. It differs from polydactyly in that supernumerary metatarsal and tarsal bones are present as well as extra digits. Only a few cases of this anomaly have been reported in the literature to date. We present a newborn male without intrauterine teratogen exposure who was born with a duplicate foot of the left lower extremity and imperforate anus.

    View details for DOI 10.1007/s00247-003-1017-3

    View details for Web of Science ID 000186038600011

    View details for PubMedID 12961041

  • Inhibition of chondrocyte apoptosis in vivo following acute osteochondral injury OSTEOARTHRITIS AND CARTILAGE Costouros, J. G., Dang, A. C., Kim, H. T. 2003; 11 (10): 756-759
  • Return of motion after simultaneous repair of displaced bucket-handle meniscal tears and anterior cruciate ligament reconstruction ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Costouros, J. G., Raineri, G. R., Cannon, W. D. 1999; 15 (2): 192-196

    Abstract

    Patients with displaced bucket-handle (DBH) meniscal tears in anterior cruciate ligament (ACL)-deficient knees are prone to flexion contracture following meniscal repair and simultaneous ACL reconstruction. It has been suggested that ACL reconstruction be delayed until full range of motion has returned after the meniscal repair. A retrospective analysis was performed comparing the return of extension in patients undergoing simultaneous ACL reconstruction and repair of DBH tears (group A) versus a control group of patients with non-DBH tears (group B). Age, sex, body mass index, duration of time from injury to surgery, and preoperative extension were also compared between groups and evaluated for their significance as risk factors. Patients in group A achieved recovery to -5 degrees and 0 degrees of extension 22% and 35% more slowly, respectively, when compared with group B. These differences were not statistically significant. Female patients tended to heal more rapidly in both groups. We conclude that a one-stage procedure is sufficient in allowing patients with DBH tears in ACL-deficient knees to regain a functional knee to within 5 degrees of full extension.

    View details for Web of Science ID 000079016400013

    View details for PubMedID 10210078

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