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Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clinics in sports medicine Gire, J. D., Yao, J. 2020; 39 (2): 313?37
Abstract

The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.

View details for DOI 10.1016/j.csm.2019.12.001

View details for PubMedID 32115087
Long-Term Outcomes for Arthroscopic Thermal Treatment for Scapholunate Ligament Injuries. Journal of wrist surgery Burn, M. B., Sarkissian, E. J., Yao, J. 2020; 9 (1): 22?28
Abstract

Background Arthroscopic electrothermal treatment of low-grade Geissler's scapholunate interosseous ligament (SLIL) tears has shown clinical benefit at short-term follow-up. Questions/Purpose This study aims to evaluate the long-term functional outcomes in patients undergoing this treatment. Patients and Methods A retrospective review of all patients treated between 2005 and 2013 was performed. Patients were excluded with less than 5 years of follow-up, the presence of static SLIL injuries, prior wrist surgery, and concomitant denervation. Symptom resolution, return to activity, postoperative complications, range of motion, grip strength, and subsequent treatment were recorded. Each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Mayo Wrist (MMW), and Patient-Rated Wrist Evaluation (PRWE) questionnaires. Results Nine patients underwent treatment for Geissler's grade I, II, and III SLIL injuries with a mean 7 years (range: 5-11 years) of follow-up. Mean grip strength was 99% of the nonsurgical extremity. Wrist motion was near symmetric with a mean of 76 (�14), 74 (�8), 21 (�13), and 40 degrees (�13) for wrist flexion, extension, radial deviation, and ulnar deviation. QuickDASH improved significantly by a mean 39 points (50 (preoperative)-11 [postoperative], p =0.009). Postoperative MMW and PRWE scores were 83 and 14, respectively. Visual analog scale (VAS) score was 1.4. A total of 90% was returned to their preinjury level of function or higher. Conclusions Arthroscopic electrothermal treatment of low-grade Geissler's SLIL tears demonstrates excellent objective and subjective outcomes at a minimum 5-year follow-up, providing evidence that this is an effective, safe, and, most importantly, durable-therapeutic modality. Level of Evidence This is a Level IV, case series study.

View details for DOI 10.1055/s-0039-1693973

View details for PubMedID 32025350
Development of a Reproducible Upper Limb Swelling Model. The journal of hand surgery Asian-Pacific volume Muraoka, K., Kleimeyer, J., Yao, J. 2019; 24 (4): 452?55
Abstract

Background: The purpose of this study was to develop a reproducible upper limb swelling model and quantify the efficacy of changing elevation posture in swelling reduction using this model. Methods: A manual sphygmomanometer was applied to healthy volunteers' upper arms while in a dependent position for 25 minutes to create venous congestion and swelling. Seven different levels of pressure (250, 120, 100, 80, 50, 40 and 30 mmHg) were tested. Every 5 minutes, the level of swelling was measured using the volumetric method. Any complications were recorded. We then compared the swelling reduction potential among 3 limb postures (arm on head, elevation brace, and simple sling). The significance level was set at p < .05. Results: Thirty to forty milliliters of swelling was created for all pressure levels except the 250 and 30 mmHg. All complications including transient nerve palsy, pain and petechiae were severe at 250 and 120 mmHg, less severe at 100 mmHg, mild at 80 mmHg, and absent below 40 mmHg. Both the on head and elevated brace limb postures markedly and significantly decreased swelling greater than the simple sling posture. Conclusions: We found that 20 ml or greater swelling can be reliably created with a blood pressure cuff inflated to 40 mmHg on the upper limb. The on head and elevated brace postures demonstrated a greater degree of swelling reduction than the simple sling posture.

View details for DOI 10.1142/S2424835519500589

View details for PubMedID 31690206
The Effect of Mesenchymal Stem Cell Sheets on Early Healing of the Achilles Tendon in Rats. Tissue engineering. Part A Maruyama, M., Le, W., Thio, T., Storaci, H., Ueda, Y., Yao, J. 2019
Abstract

Bone marrow-derived mesenchymal stem cells (BMSCs) have potential to accelerate flexor tendon healing and allow for earlier rehabilitation. The ideal BMSC construct and delivery method to the repair site remains unknown. We investigated the efficacy of interposed scaffold-free BMSC sheets on early Achilles tendon healing in rats. BMSCs were isolated from the femora and tibias of male Sprague-Dawley rats aged 8 to 12 weeks and BMSC sheets were produced on temperature-responsive culture dishes. Ninety-five male Sprague-Dawley rats aged 8 to 12 weeks were utilized. A bilateral Achilles tendon repair model was created. One side was randomly selected, and the tendon was repaired with the interposed BMSC sheet (BMSC group). The other side was repaired without BMSCs (control group). The bilateral tendons were harvested at 5, 6, 7, 10 and 14 days postoperatively for biomechanical analysis, measurement of the gene expression level of tendon markers scleraxis and/or tenomodulin by real-time polymerase chain reaction, and histological evaluation. The BMSC group had significantly higher maximum load to failure and stiffness at 5 and 6 days compared to the control group. Moreover, the BMSC group showed significantly increased gene expression of scleraxis and/or tenomodulin at all timepoints. The cross sectional areas in the BMSC group were significantly larger at 5, 6 and 14 days. However, Hematoxylin and Eosin staining of the central part of the repair site revealed no significant differences at all timepoints These results suggest that the increased biomechanical strength afforded by BMSC sheet implantation into tendon repair sites may allow for the earlier onset of rehabilitation and improved clinical outcomes in flexor tendon surgery.

View details for DOI 10.1089/ten.TEA.2019.0163

View details for PubMedID 31608794
Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair. Journal of wrist surgery Sarkissian, E. J., Burn, M. B., Yao, J. 2019; 8 (5): 403?7
Abstract

Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20-64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3-10.9 years). Mean range of motion of the wrist revealed flexion of 76�11 degrees and extension of 73�12 degrees. Mean grip strength was 98�15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9�8, 80�6, and 12�12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.

View details for DOI 10.1055/s-0039-1688949

View details for PubMedID 31579550
Complications of Wrist and Hand Arthroscopy HAND CLINICS Ahsan, Z. S., Yao, J. 2017; 33 (4): 831-+
Abstract

Arthroscopy of the wrist continues to evolve and advance as a valuable clinical technique in hand surgery. This article aims to address safety of wrist arthroscopy and provide an overview of the known iatrogenic complications. Ultimately, the likelihood of associated injuries during wrist arthroscopy is dependent on the surgeon's ability and understanding of the equipment. Case volume and duration of experience directly correlate with mitigating iatrogenic injury and optimizing patient outcomes.

View details for PubMedID 28991593
A Biomechanical Analysis of 2 Constructs for Metacarpal Spiral Fracture Fixation in a Cadaver Model: 2 Large Screws Versus 3 Small Screws. The Journal of hand surgery Eu-Jin Cheah, A., Behn, A. W., Comer, G., Yao, J. 2017
Abstract

PURPOSE: Surgeons confronted with a long spiral metacarpal fracture may choose to fix it solely with lagged screws. A biomechanical analysis of a metacarpal spiral fracture model was performed to determine whether 3 1.5-mm screws or 2 2.0-mm screws provided more stability during bending and torsional loading.METHODS: Second and third metacarpals were harvested from 12 matched pairs of fresh-frozen cadaveric hands and spiral fractures were created. One specimen from each matched pair was fixed with 2 2.0-mm lagged screws whereas the other was fixed with 3 1.5-mm lagged screws. Nine pairs underwent combined cyclic cantilever bending and axial compressive loading followed by loading to failure. Nine additional pairs were subjected to cyclic external rotation while under a constant axial compressive loadand were subsequently externally rotated to failure under a constant axial compressive load. Paired t tests were used to compare cyclic creep, stiffness, displacement, rotation, and peak load levels.RESULTS: Average failure torque for all specimens was 7.2 � 1.7 Nm. In cyclic torsional testing, the group with 2 screws exhibited significantly less rotational creep than the one with 3 screws. A single specimen in the group with 2 screws failed before cyclic bending tests were completed. No other significant differences were found between test groups during torsional or bending tests.CONCLUSIONS: Both constructs were biomechanically similar except that the construct with 2 screws displayed significantly less loosening during torsional cyclic loading, although the difference was small and may not be clinically meaningful.CLINICAL RELEVANCE: Because we found no obvious biomechanical advantage to using 3 1.5-mm lagged screws to fix long spiral metacarpal fractures, the time efficiency and decreased implant costs of using 2-2.0 mm lagged screws may be preferred.

View details for PubMedID 28888569
Evidence-Based Medicine: Surgical Management of Flexor Tendon Lacerations PLASTIC AND RECONSTRUCTIVE SURGERY Kamal, R. N., Yao, J. 2017; 140 (1): 130E?139E
Abstract

After reading this article, the participant should be able to: 1. Accurately diagnose a flexor tendon injury. 2. Develop a surgical approach with regard to timing, tendon repair technique, and rehabilitation protocol. 3. List the potential complications following tendon repair.Flexor tendon lacerations are complex injuries that require a thorough history and physical examination for accurate diagnosis and management. Knowledge of operative approaches and potential concomitant injuries allows the surgeon to be prepared for various findings during exploration. Understanding the biomechanical principles behind tendon lacerations and repair techniques aids the surgeon in selecting the optimal repair technique and postoperative rehabilitation.

View details for PubMedID 28654614
The Effect of Myostatin (GDF-8) on Proliferation and Tenocyte Differentiation of Rat Bone Marrow-Derived Mesenchymal Stem Cells. The journal of hand surgery Asian-Pacific volume Le, W., Yao, J. 2017; 22 (2): 200-207
Abstract

The future in flexor tendon surgery involves tissue engineering approaches directed toward increasing early repair strength to accelerate tendon healing and to allow for earlier onset of rehabilitation. Previous work has shown that pluripotential mesenchymal stem cells may be successfully delivered to a tendon repair site using a suture carrier. The current work describes the use of Myostatin (GDF-8) to help guide these delivered pluripotential stem cells to differentiate down a tenocyte lineage to potentially maximize the reparative effects of these cells at the tendon repair site.Primary rat bone marrow mesenchymal stem cells isolated from the long bones of male Sprague-Dawley rats were treated with 500 ng/ml myostatin for 24 h, 48 h, and 72 h. Collagen 1 A, scleraxis (Scx), and tenomodulin (Tnmd) expression, indicative of tenogenesis, was analyzed using real time PCR and immunohistochemistry staining. A migration assay was performed to assess the functional activity of BMSCs after they were treated with myostatin.Compared to the control cells (without treatment), the cells treated with 500 ng/ml myostatin for 72 h exhibited higher expression of Col 1A, Scx, and Tnmd. The mRNA expression of Col1A, Scx, Tnmd increased 15.3, 13 and 7 times respectively. Immunohistochemistry staining showed Scx and Tnmd were expressed in the cellular cytoplasm. In response to myostatin, the cells also showed a tendency to proliferate and migrate more than the control cells.Myostatin (GDF-8) has the ability to increase rat bone marrow mesenchymal stem cell growth and differentiation toward a tenocyte lineage. This information could be useful for future studies regarding tendon repair.

View details for DOI 10.1142/S0218810417500253

View details for PubMedID 28506172
Mean 5-Year Follow-up for Suture Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. journal of hand surgery Yao, J., Cheah, A. E. 2017
Abstract

Suture button suspensionplasty (SBS) has been used to treat thumb carpometacarpal joint osteoarthritis (CMC joint OA). Although promising short-term outcomes have been reported, no outcomes beyond 4 years have been published. The aim of this article is to report intermediate outcomes of SBS.We reviewed the charts of 14 patients who underwent 16 SBS procedures for symptomatic thumb CMC joint OA. We recorded demographic data, preoperative Eaton stage, length of follow-up, Quick-Disabilities of the Arm, Shoulder, and Hand questionnaire scores, as well as pinch strength, grip strength, range of motion, and metacarpal subsidence. Operative time and postoperative complications were documented.Average age was 64 years. There were 12 women and 2 men. Preoperative Eaton stages were III and IV in 8 thumbs each. Mean operative time was 93 minutes. Mean follow-up was 64 months with mean Quick-Disabilities of the Arm, Shoulder, and Hand score improvement of 58.2. Mean palmar and radial abduction were 105% and 97%, respectively, of the nonsurgical thumb. Kapandji scores for all operated thumbs were either 9 or 10. Pinch and grip strength were 107% and 102%, respectively, of the nonsurgical side. Mean trapezial space height was 71%. One patient underwent removal of a symptomatic implant and 2 patients had transient neuropraxia of the dorsal radial sensory nerve.Favorable outcomes (improvement in range of motion and pain relief) of SBS remain durable over time. Our results show that improvement in strength may also be expected over time when using SBS after trapeziectomy for the treatment of thumb CMC joint OA.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2017.03.011

View details for PubMedID 28412189
Simple Assessment of Global Bone Density and Osteoporosis Screening Using Standard Radiographs of the Hand. journal of hand surgery Schreiber, J. J., Kamal, R. N., Yao, J. 2017
Abstract

Osteoporosis and fragility fractures have consequences both at the individual level and to the overall health care system. Although dual-energy x-ray absorptiometry (DXA) is the reference standard for assessing bone mineral density (BMD), other, simpler tools may be able to screen bone quality provisionally and signal the need for intervention. We hypothesized that the second metacarpal cortical percentage (2MCP) calculated from standard radiographs of the hand or wrist would correlate with hip BMD derived from DXA and could provide a simple screening tool for osteoporosis.Two hundred patients who had hand or wrist radiographs and hip DXA scans within 1 year of each other were included in this series. Mid-diaphyseal 2MCP was calculated as the ratio of the cortical diameter to the total diameter. We assessed the correlation between 2MCP and total hip BMD. Subjects were stratified into normal, osteopenic, and osteoporotic cohorts based on hip t scores, and thresholds were identified to optimize screening sensitivity and specificity.Second metacarpal cortical percentage correlated significantly with BMD and t scores from the hip. A 2MCP threshold of less than 60% optimized sensitivity (88%) and specificity (60%) for discerning osteopenic subjects from normal subjects, whereas a threshold of less than 50% optimized sensitivity (100%) and specificity (91%) for differentiating osteoporotic from normal subjects.By demonstrating that global BMD may be assessed from 2MCP, these data suggest that radiographs of the hand and wrist may have a role in accurately screening for osteopenia and osteoporosis. This simple investigation, which is already used ubiquitously for patients with hand or wrist problems, may identify patients at risk for fragility fractures and allow for appropriate referral or treatment.Diagnostic II.

View details for DOI 10.1016/j.jhsa.2017.01.012

View details for PubMedID 28242242
Microfracture for Ulnar Impaction Syndrome: Surgical Technique and Outcomes with Minimum 2-Year Follow-up. Journal of wrist surgery Kaufman, D., Etcheson, J., Yao, J. 2017; 6 (1): 60-64
Abstract

Purpose?The purpose of this study is to assess functional and patient-reported outcomes after lunate microfracture for management of lunate chondral lesions in the setting of ulnar impaction syndrome. Methods?This was a retrospective review of all patients undergoing wrist arthroscopy for triangular fibrocartilage complex pathology by one surgeon from 2007 until 2010. Disabilities of the arm, shoulder, and hand (DASH) scores were assessed preoperatively and at minimum 2-year follow-up. Patient-rated wrist evaluation and bilateral wrist range of motion, grip strength, and key pinch strength were assessed at final follow-up. Results?A total of 22 patients underwent microfracture of the carpus during the study period, of which 7 met all inclusion and exclusion criteria. Mean DASH scores improved significantly (p?
View details for DOI 10.1055/s-0036-1586496

View details for PubMedID 28119797

View details for PubMedCentralID PMC5258120
Relative ratios of collagen composition of periarticular tissue of joints of the upper limb. journal of hand surgery, European volume Cheah, A., Harris, A., Le, W., Huang, Y., Yao, J. 2016: 1753193416674324-?
Abstract

We investigated the relative ratios of collagen composition of periarticular tissue of the elbow, wrist, metacarpophalangeal, proximal and distal interphalangeal joints. Periarticulat tissue, which we defined as the ligaments, palmar plate and capsule, was harvested from ten fresh-frozen cadaveric upper limbs, yielding 50 samples. The mean paired differences (95% confidence interval) of the relative ratios of collagen between the five different joints were estimated using mRNA expression of collagen in the periarticular tissue. We found that the relative collagen composition of the elbow was not significantly different to that of the proximal interphalangeal joint, nor between the proximal interphalangeal joint and distal interphalangeal joint, whereas the differences in collagen composition between all the other paired comparisons of the joints had confidence intervals that did not include zero.

View details for DOI 10.1177/1753193416674324

View details for PubMedID 28486835
Radial Nerve Tendon Transfers. Hand clinics Cheah, A. E., Etcheson, J., Yao, J. 2016; 32 (3): 323-338
Abstract

Radial nerve palsy typically occurs as a result of trauma or iatrogenic injury and leads to the loss of wrist extension, finger extension, thumb extension, and a reduction in grip strength. In the absence of nerve recovery, reconstruction of motor function involves tendon transfer surgery. The most common donor tendons include the pronator teres, wrist flexors, and finger flexors. The type of tendon transfer is classified based on the donor for the extensor digitorum communis. Good outcomes have been reported for most methods of radial nerve tendon transfers as is typical for positional tendon transfers not requiring significant power.

View details for DOI 10.1016/j.hcl.2016.03.003

View details for PubMedID 27387076
Hand Fractures: Indications, the Tried and True and New Innovations JOURNAL OF HAND SURGERY-AMERICAN VOLUME Cheah, A. E., Yao, J. 2016; 41 (6): 712-722
Abstract

Hand fractures are the second most common fracture of the upper extremity, and management of patients with these injuries is common for most hand surgery practices. In this article, we outline the principles of management of these injuries with a special focus on those that are common or complex. We also highlight recent innovations in the context of these injuries. From this cross-section of contemporary evidence on phalangeal and metacarpal fracture treatment, we have noted a trend toward minimally invasive surgery with immediate postoperative mobilization, the use of wide-awake anesthesia, as well as sustained investigation and innovation in the biomechanics and treatment of proximal interphalangeal joint fracture dislocations.

View details for DOI 10.1016/j.jhsa.2016.03.007

View details for Web of Science ID 000377846600007

View details for PubMedID 27113910
Effect of Electrothermal Treatment on Nerve Tissue Within the Triangular Fibrocartilage Complex, Scapholunate, and Lunotriquetral Interosseous Ligaments ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Pirolo, J. M., Le, W., Yao, J. 2016; 32 (5): 773-778
Abstract

To evaluate the effect of thermal treatment on neural tissue in the triangular fibrocartilage complex (TFCC), scapholunate interosseous ligament (SLIL), and lunotriquetral interosseous ligament (LTIL).The intact TFCC, SLIL, and LTIL were harvested from cadaveric specimens and treated with a radiofrequency probe as would be performed intraoperatively. Slides were stained using a triple-stain technique for neurotrophin receptor p75, pan-neuronal marker protein gene product 9.5 (PGP 9.5), and 4',6-diamidino-2-phenylindole for neural identification. Five TFCC, 5 SLIL, and 4 LTIL specimens were imaged with fluorescence microscopy. Imaging software was used to measure fluorescence signals and compare thermally treated areas with adjacent untreated areas. A paired t test was used to compare treated versus untreated areas. P < .05 was considered significant.For the TFCC, a mean of 94.9% � 2.7% of PGP 9.5-positive neural tissue was ablated within a mean area of 11.7 � 2.5�mm(2)�(P�= .02). For the SLIL treated from the radiocarpal surface, 97.4% � 1.0% was ablated to a mean depth of 2.4 � 0.3�mm from the surface and a mean horizontal spread of 3.4 � 0.5�mm�(P�= .01). For the LTIL, 96.0% � 1.5% was ablated to a mean depth of 1.7 � 0.7�mm and a mean horizontal spread of 2.6 � 1.0�mm�(P�= .02). Differences in the presence of neural tissue between treated areas and adjacent untreated areas were statistically significant for all specimens.Our study confirms elimination of neuronal markers after thermal treatment of the TFCC, SLIL, and LTIL in cadaveric specimens. This effect penetrates below the surface to innervated collagen tissue that is left structurally intact after treatment.Electrothermal treatment as commonly performed to treat symptomatic SLIL, LTIL, and TFCC tears eliminates neuronal tissue in treated areas and may function to relieve pain through a denervation effect.

View details for DOI 10.1016/j.arthro.2015.11.050

View details for Web of Science ID 000377370900010

View details for PubMedID 26947354
ScaphoLunate Axis Method (vol 5, pg 59, 2016) JOURNAL OF WRIST SURGERY Yao, J., Zlotolow, D. A., Lee, S. K. 2016; 5 (2): 169
Abstract

[This corrects the article DOI: 10.1055/s-0035-1570744.].

View details for PubMedID 27104088

View details for PubMedCentralID PMC4838464
ScaphoLunate Axis Method. Journal of wrist surgery Yao, J., Zlotolow, D. A., Lee, S. K. 2016; 5 (1): 59-66
Abstract

Background?Treating chronic scapholunate ligament injuries without the presence of arthritis remains an unsolved clinical problem facing wrist surgeons. This article highlights a technique for reconstructing the scapholunate ligament using novel fixation, the ScaphoLunate Axis Method (SLAM). Materials and Methods?In a preliminary review of the early experience of this technique, 13 patients were evaluated following scapholunate ligament reconstruction utilizing the SLAM technique. Description of Techinque?The scapholunate interval is reconstructed utilizing a palmaris longus autograft passed between the scaphoid and lunate along the axis of rotation in the sagittal plane. It is secured in the lunate using a graft anchor and in the scaphoid utilizing an interference screw. The remaining graft is passed dorsally to reconstruct the dorsal scapholunate ligament. Results?At an average follow-up of 11 months, the mean postoperative scapholunate gap was 2.1 mm. The mean postoperative scapholunate angle was 59 degrees. The mean postoperative wrist flexion and extension was 45 and 56 degrees, respectively. The mean grip strength was 24.9 kg, or 62% of the contralateral side. The mean pain score (VAS) was 1.7. There was 1 failure with recurrence of the pathologic scapholunate gap and the onset of pain. Conclusion?While chronic scapholunate ligament instability remains an unsolved problem facing wrist surgeons, newer techniques are directed toward restoring the normal relationships of the scaphoid and lunate in both the coronal and sagittal planes. The SLAM technique has demonstrated promise in preliminary clinical studies.

View details for DOI 10.1055/s-0035-1570744

View details for PubMedID 26855838
Variations in Postoperative Immobilization Following Common Hand Surgery Procedures. Hand (New York, N.Y.) Diaz, R., Ebramzadeh, E., Yao, J. 2016; 11 (1): 45-49
Abstract

The aim was to investigate variations in the duration of postoperative immobilization for common hand surgery procedures and to determine whether there is any correlation between surgeon experience and duration of postoperative immobilization.An anonymous cross-sectional survey was sent to the American Society for Surgery of the Hand asking the following questions: (1) number of years in practice and (2) duration of immobilization for 16 common hand surgery procedures. A Pearson's correlation coefficient was used to determine correlations between surgeon experience and duration of immobilization. Box plots were created to display the distribution and variability in postoperative immobilization per procedure among surgeons.A total of 1126 respondents completed the survey, yielding a response rate of 40%. Procedures with a greater average duration of immobilization demonstrated the greatest variability. The largest variability overall was observed in intercarpal ligament repair with the majority of responses distributed between 4 and 10 weeks of immobilization. The smallest variability was observed following De Quervain's release and Dupuytren's fasciectomy. Only small correlations between surgeon experience and duration of immobilization were observed. Specifically, all Pearson correlation coefficients were less than .20.This study supports the hypothesis that large variations exist in the duration of immobilization following common hand surgery procedures. Only small correlations were found between surgeon experience and average duration of immobilization. The study suggests that there is a lack of evidence to guide postoperative immobilization for common hand surgery procedures and that prolonged immobilization may not be necessary for certain hand procedures.

View details for DOI 10.1177/1558944715617221

View details for PubMedID 27418888

View details for PubMedCentralID PMC4920519
Surgical Approaches to the Proximal Interphalangeal Joint JOURNAL OF HAND SURGERY-AMERICAN VOLUME Cheah, A. E., Yao, J. 2016; 41 (2): 294-305
Abstract

The proximal interphalangeal (PIP) joint may be affected by many conditions such as arthropathy, fractures, dislocations, and malunions. Whereas some of these conditions may be treated nonsurgically, many require open surgical intervention. Open interventions include implant arthroplasty or arthrodesis for arthropathy, open reduction internal fixation, or hemi-hamate arthroplasty for dorsal fracture-dislocations. Volar plate arthroplasty and corrective osteotomy for malunion about the PIP joint are also surgeries that may be required. The traditional approach to the PIP joint has been dorsal, which damages the delicate extensor apparatus with subsequent development of an extensor lag. This has led surgeons to explore volar and lateral approaches to the PIP joint. In this article, we describe each of these surgical approaches, discuss their advantages and disadvantages, and provide some guidance on which approach to choose based on the surgery that is to be performed.

View details for DOI 10.1016/j.jhsa.2015.11.013

View details for Web of Science ID 000369777400020

View details for PubMedID 26708513
Nuts and Bolts: Dimensions of Commonly Utilized Screws in Upper Extremity Surgery JOURNAL OF HAND SURGERY-AMERICAN VOLUME Douglass, N., Yao, J. 2015; 40 (2): 368-382
Abstract

A plethora of screw designs and sizes are available from multiple companies for use in upper extremity surgery. Knowing the dimensions of screws is critical in the treatment of bone of varying dimensions for fractures, osteotomies, or arthrodeses. Although many screws are named by their major thread diameter, this is not always true. Because of this confusing nomenclature and vast number of options, we sought to review the most commonly used screws and codify their dimensions into a readily available article and reference chart. This article highlights the basic dimensions of commonly used headless screws, stand-alone lag screws, non-locking and locking screws for plating, and biocomposite screws. Commonly described treatments using these screws include fixation of elbow, wrist, carpal, metacarpal, and phalangeal fractures and osteotomies, as well as arthrodeses of upper extremity joints. This article and its tables are by no means exhaustive of all commercially available implants. The focus is on the most commonly used implants in the United States as of 2014.

View details for DOI 10.1016/j.jhsa.2014.11.012

View details for Web of Science ID 000349515400030

View details for PubMedID 25617959
Surgical techniques for the treatment of carpal ligament injury in the athlete. Clinics in sports medicine Paci, G. M., Yao, J. 2015; 34 (1): 11-35
Abstract

Treatment of intercarpal ligament injuries in the athlete requires special attention due to several practical and biomechanical considerations. Optimally, the athlete will maintain as much function and range of motion as possible with return to high-impact and load-bearing activity in a timely fashion. Several cutting-edge techniques have arisen in treatment. This article discusses injury patterns in the athlete with scapholunate injury, lunotriquetral injury, scaphotrapezial-trapezoidal injury, and extrinsic ligamentous injury, and the various approaches to addressing these injuries, with a review of the classic as well as newer, innovative techniques.

View details for DOI 10.1016/j.csm.2014.09.010

View details for PubMedID 25455394
Arthroscopic dorsal wrist ganglion excision with color-aided visualization of the stalk: minimum 1-year follow-up. Hand (New York, N.Y.) Ahsan, Z. S., Yao, J. 2014; 9 (2): 205-208
Abstract

Dorsal wrist ganglia (DWG) are a common, benign soft-tissue mass of the wrist. Excision of DWG is a common procedure performed by hand surgeons and may be performed using either open or arthroscopic techniques. This study aims to evaluate the frequency of stalk visualization with intralesional injection of inert dye in the course of arthroscopic excision along with incidence of recurrence with a minimum of 1-year follow-up.Upon IRB approval, a retrospective chart review was performed identifying 27 patients who had consecutively undergone arthroscopic excision of a DWG with the color-aided technique at our institution with a minimum follow-up duration of 12�months. Intraoperative findings were reviewed. Patients were contacted to investigate for incidence of recurrence.Of the 27-patient cohort, the ganglion stalk was identified in 100�% of the color-aided arthroscopic DWG excisions. Ganglion recurrence was identified in one patient, an incidence of 3.7�%.The color-aided technique for arthroscopic DWG visualization was found to be a safe and valuable tool for surgeons performing arthroscopic DWG resection. The intraarticular ganglion stalk was identified in 100�% of cases and patients responded well with a low incidence of recurrence.

View details for DOI 10.1007/s11552-013-9570-1

View details for PubMedID 24839422

View details for PubMedCentralID PMC4022959
Thumb basal joint: Utilizing new technology for the treatment of a common problem JOURNAL OF HAND THERAPY Yao, J., Lashgari, D. 2014; 27 (2): 127-133
Abstract

New technology has the potential to greatly impact the medical field because it may lead to a greater quality of life, decreased pain, or increased function for our patients. This manuscript will discuss the introduction of one such advance in hand surgery and hand therapy. Utilizing the Mini-Tightrope? (Arthrex, Naples, FL) for suspension of the thumb metacarpal following trapeziectomy is a new technique for treating thumb carpometacarpal (CMC) arthritis. This technique is described as an example of the advantages of considering new techniques and technologies when treating established problems. This article discusses the responsibility of health professionals in considering the adoption of new technologies over current ones in the context of describing a new type of CMC suspensionplasty procedure. Further, a description of the surgical technique, the hand therapy postoperatively, and a case study to demonstrate some of the features of the Tightrope suspensionplasty procedure is presented. In the author's experience, the reduced healing time, reduced weeks of immobility, and fewer therapy visits following the procedure suggest that the Tightrope procedure should be considered as an option for patients needing thumb CMC arthroplasty.

View details for DOI 10.1016/j.jht.2013.12.012

View details for Web of Science ID 000335093900008

View details for PubMedID 24491585
Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. journal of hand surgery Lee, S. K., Zlotolow, D. A., Sapienza, A., Karia, R., Yao, J. 2014; 39 (4): 643-650
Abstract

To compare the biomechanical characteristics of 3 methods of scapholunate (SL) ligament reconstruction, including 1 that provides a biological central axis tether.Twelve fresh-frozen cadaver limbs were mounted on a jig that allowed for wrist and finger motion by tendon loading. The specimens were randomized to receive the SL axis method (SLAM) reconstruction, the Blatt capsulodesis (BC), or the modified Brunelli tenodesis (MBT). Fluoroscopic images were taken to measure the SL interval and SL angle in�various positions. The specimens were evaluated in 4 states: intact, with the SL and radioscaphocapitate ligaments cut, after reconstruction, and after reconstruction followed by 100�cycles of simulated motion.After cycling, the MBT and the SLAM reconstructions performed significantly better than the BC in recreating the intact SL interval in a clenched fist posture. The SLAM SL interval trended to be closer to the intact state than the MBT SL interval. The SLAM reconstruction also trended toward greater restoration of the native SL angle in the clenched fist posture than either the MBT or the BC.The SL ligament reconstruction that uses a 2-tailed tendon autograft placed along the axis of rotation of the SL joint and secured both at the scaphoid and the lunate minimized creep and reconstructed the critical dorsal SL ligament. The SLAM achieved improved the SL interval and SL angle correction compared with conventional techniques of SL ligament reconstruction.The SLAM method may be a useful alternative for SL ligament reconstruction.

View details for DOI 10.1016/j.jhsa.2013.12.033

View details for PubMedID 24559758
The wrist insufflation test: a confirmatory test for detecting�intercarpal ligament and triangular fibrocartilage�complex tears. Arthroscopy Lee Master, D., Yao, J. 2014; 30 (4): 451-455
Abstract

The purpose of this study was to determine the accuracy of the wrist insufflation test based on mean radiocarpal and midcarpal joint space volumes.Twenty-nine patients underwent 3-4 portal radiocarpal and radial midcarpal portal insufflation before wrist arthroscopy. The volume remaining in the radiocarpal space at equilibrium was recorded, and the contour of the dorsal wrist and distal radioulnar joint was palpated for a fluid wave. After insufflation, wrist arthroscopy was performed and diagnoses were recorded. The mean volumes of the intact radiocarpal and midcarpal spaces were then compared with those of the compromised radiocarpal and midcarpal spaces to determine the overall sensitivity and specificity of the test.A total of 29 patients (18 male and 11 female) underwent wrist insufflation before wrist arthroscopy. The mean age of the patients was 42 years (range, 17 to 69 years). Intact radiocarpal spaces accepted a mean of 3.5 � 0.16 mL of fluid, whereas compromised radiocarpal spaces accepted a mean of 5.5 � 0.48 mL of fluid (P < .01; 95% confidence interval, 2.87 to 3.30). Intact midcarpal spaces accepted a mean of 2.5 � 0.18 mL, whereas compromised midcarpal spaces accepted a mean of 5.6 � 0.38 mL (P < .01; 95% confidence interval, 1.70 to 2.30). The overall sensitivity of the test was 83.3%, and the overall specificity was 100%.Complete scapholunate interosseous ligament and triangular fibrocartilage complex tears can be detected when there is an increased radiocarpal joint space volume with insufflation through the 3-4 portal combined with a fluid wave over the radial midcarpal space or the distal radioulnar joint. Complete scapholunate interosseous ligament and lunotriquetral interosseous ligament tears can also be detected when there is an increased midcarpal space volume with insufflation through the radial midcarpal portal combined with a fluid wave over the radial radiocarpal space or the ulnar radiocarpal space.Level IV, therapeutic case series.

View details for DOI 10.1016/j.arthro.2013.12.017

View details for PubMedID 24680305
Prospective randomized comparison of single-incision and two-incision carpal tunnel release outcomes. Hand (New York, N.Y.) Castillo, T. N., Yao, J. 2014; 9 (1): 36-42
Abstract

This study analyzes both the subjective and objective symptom and functional outcomes of patients who underwent either traditional single-incision or two-incision carpal tunnel release (CTR).From 2008 to 2009, patients with isolated carpal tunnel syndrome were randomized to undergo either single-incision or two-incision CTR by a single surgeon at a university medical center. Pre-operatively, participants completed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ), as well as grip and pinch strength and Semmes-Weinstein monofilament sensation testing. At 2�weeks, 6�weeks and at least 6�months post-operatively, these measurements were repeated along with assessment of scar tenderness and pillar pain. Data were analyzed using SPSS version 20 software to perform non-parametric tests and Pearson's correlations. Significance was set at p?=?0.05.There was no statistically significant difference between the single- and two-incision CTR groups with respect to pre- and post-operative DASH scores, BWCTQ scores, grip strength, pinch strength, scar tenderness, or pillar pain. The only statistically significant difference was improved sensation by Semmes-Weinstein in the single-incision group in the second finger at 6�weeks post-operatively and in the third finger at 6�months post-operatively.The preservation of the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences may account for reports of less scar tenderness and pillar pain among recipients of two-incision CTR compared to single-incision CTR in the early post-operative period. However, there is similar post-operative recovery and improvement in grip and pinch strength and sensation after 6+ months post-operatively.

View details for DOI 10.1007/s11552-013-9572-z

View details for PubMedID 24570635

View details for PubMedCentralID PMC3928372
Minimally Invasive Approaches to Ulnar-Sided Wrist Disorders HAND CLINICS Pirolo, J. M., Yao, J. 2014; 30 (1): 77-?
Abstract

Ulnar-sided wrist pain is a common cause of pain and disability, which has long been a diagnostic and therapeutic dilemma for hand surgeons. A thorough understanding of the anatomy, clinical examination, and radiographic evaluation is essential to establish a focused differential diagnosis, with the cause of disability often being multifactorial. Arthroscopy is particularly well suited to both directly visualize and treat multiple causes of ulnar-sided wrist pain, including pathology of the TFCC, UIS, LTIL tears, and hamate arthrosis.

View details for DOI 10.1016/j.hc1.2013.09.001

View details for Web of Science ID 000329087000012

View details for PubMedID 24286746
Incidence of Failure of Continuous Peripheral Nerve Catheters for Postoperative Analgesia in�Upper Extremity Surgery. journal of hand surgery Ahsan, Z. S., Carvalho, B., Yao, J. 2014; 39 (2): 324-329
Abstract

To explore the incidence of failure of continuous peripheral nerve blockade (CPNB) after upper extremity operations.Patient data regarding postoperative CPNB were retrospectively obtained from our institution's regional anesthesia database. Documented information on the first postoperative day included pain assessment ratings (numerical verbal pain scale, patient-reported breakthrough pain upon perceived return of sensation, appearance of the catheter site, complications, time of return of sensation, day of return of sensation, residual blockade, patient satisfaction with the block, and whether patient would receive the block again).A total of 207 patients received CPNB for postoperative analgesia. The failure rate on the first postoperative day for infraclavicular (133 patients) and supraclavicular (58 patients) CPNB was 19% and 26%, respectively. Interscalene CPNB (16 patients) yielded 3 incidences of failure. No significant difference was found between supraclavicular and infraclavicular block techniques. In addition, no significant differences were found between the incidences of CPNB failures with potentially more painful surgeries involving bone compared with potentially less painful soft tissue procedures.The CPNB technique used for hand surgery postoperative analgesia was associated with nontrivial failure rates. The potential of CPNB failure and resulting breakthrough pain upon recovery from the primary nerve block is important to help establish patient expectations.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2013.11.011

View details for PubMedID 24480691
Plating of metacarpal fractures with locked or nonlocked screws, a biomechanical study: how many cortices are really necessary? Hand (New York, N.Y.) Barr, C., Behn, A. W., Yao, J. 2013; 8 (4): 454-459
Abstract

Dorsal plate and screw fixation is a popular choice for metacarpal stabilization. The balance between construct stability and soft tissue dissection remains a surgical dilemma. Historically, six cortices of bone fixation on either side of a fracture were deemed necessary. This study aims to elucidate whether four cortices of locked fixation on either side of the fracture is equivalent to the current gold standard of six cortices of nonlocked fixation on either side of the fracture. If so, less dissection to insert shorter plates with fewer screws could be used to stably fix these fractures.With biomechanical testing-grade composite Sawbones, a comminuted metacarpal fracture model was used to test two fixation constructs consisting of a standard dorsal plate and either six bicortical nonlocking screws (three screws per segment) or four bicortical locking screws (two screws per segment). Thirty specimens were tested to failure in cantilever bending and torsion.There was statistical equivalence between the locking and nonlocking constructs in cantilever bending stiffness, torsional stiffness, maximum bending load, and maximum torque.The tested metacarpal fracture model had equivalent biomechanical properties when fixed with a standard dorsal plate and either six bicortical nonlocking screws or four bicortical locking screws. By utilizing fewer cortices of fixation, there will be less dissection and less soft tissue stripping during fixation of metacarpal fractures. This will also be of benefit in very proximal or distal fractures as multiple cortices of fixation are often difficult to obtain during stabilization of these challenging fractures.

View details for DOI 10.1007/s11552-013-9544-3

View details for PubMedID 24426966

View details for PubMedCentralID PMC3840765
The Fragmented Proximal Pole Scaphoid Nonunion Treated With Rib Autograft: Case Series and Review of the Literature JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Read, B., Hentz, V. R. 2013; 38A (11): 2188-2192
Abstract

Nonunions of the proximal pole of the scaphoid are a challenge to treat given the limited vascular supply. This challenge is potentiated when the proximal pole is unsalvageable. When�the proximal pole of the scaphoid is fragmented or otherwise unsalvageable, traditional reconstructive procedures such as vascularized or nonvascularized bone grafting are not possible. Salvage procedures such as proximal row carpectomy or scaphoid excision and partial wrist fusion would not be ideal in the case of an unsalvageable proximal pole scaphoid nonunion in the absence of radiocarpal arthrosis. In this relatively uncommon circumstance, we favor the use of rib osteochondral autograft reconstruction of the proximal pole of the�scaphoid. We report 3 cases with greater than 2-years of follow-up evaluation and also review the literature.

View details for DOI 10.1016/j.jhsa.2013.08.093

View details for Web of Science ID 000326553200015
The fragmented proximal pole scaphoid nonunion treated with rib autograft: case series and review of the literature. journal of hand surgery Yao, J., Read, B., Hentz, V. R. 2013; 38 (11): 2188-2192
Abstract

Nonunions of the proximal pole of the scaphoid are a challenge to treat given the limited vascular supply. This challenge is potentiated when the proximal pole is unsalvageable. When�the proximal pole of the scaphoid is fragmented or otherwise unsalvageable, traditional reconstructive procedures such as vascularized or nonvascularized bone grafting are not possible. Salvage procedures such as proximal row carpectomy or scaphoid excision and partial wrist fusion would not be ideal in the case of an unsalvageable proximal pole scaphoid nonunion in the absence of radiocarpal arthrosis. In this relatively uncommon circumstance, we favor the use of rib osteochondral autograft reconstruction of the proximal pole of the�scaphoid. We report 3 cases with greater than 2-years of follow-up evaluation and also review the literature.

View details for DOI 10.1016/j.jhsa.2013.08.093

View details for PubMedID 24055132
Outcomes of ulnar shortening osteotomy fixed with a dynamic compression system. journal of hand surgery Ahsan, Z. S., Song, Y., Yao, J. 2013; 38 (8): 1520-1523
Abstract

To evaluate the outcomes of patients with ulnar impaction syndrome treated with a jig-facilitated, oblique, diaphyseal ulnar shortening osteotomy and fixed with a TriMed (Santa Clarita, CA) ulnar osteotomy compression plate.A retrospective chart review of patients with ulnar impaction syndrome identified 38 patients who had had ulnar shortening osteotomy and fixation with the TriMed dynamic compression system. The following clinical data were obtained: patient age, sex, follow-up range of motion, grip strength, and complications. After a minimum of 2 years after surgery, patients reported complications and completed a Disabilities of the Arm, Shoulder, and Hand questionnaire.Eight patients were lost to follow-up. Compared to the opposite limb at an average of 8 months after surgery, the remaining 30 patients attained 92% to 97% of wrist and forearm motion and 71% of grip strength. The average Disabilities of the Arm, Shoulder, and Hand score was 12 after a minimum of 2 years after surgery. Four patients required plate removal due to irritation. Two patients reported persistent ulnar-sided pain, and 2 other patients developed atrophic nonunions and required autologous bone grafting. There were no infections.Ulnar shortening osteotomy using the TriMed system yielded good clinical outcomes that are comparable to those previously documented using other systems.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2013.04.040

View details for PubMedID 23830678
Outcomes of Ulnar Shortening Osteotomy Fixed With a Dynamic Compression System JOURNAL OF HAND SURGERY-AMERICAN VOLUME Ahsan, Z. S., Song, Y., Yao, J. 2013; 38A (8): 1520-1523
Abstract

To evaluate the outcomes of patients with ulnar impaction syndrome treated with a jig-facilitated, oblique, diaphyseal ulnar shortening osteotomy and fixed with a TriMed (Santa Clarita, CA) ulnar osteotomy compression plate.A retrospective chart review of patients with ulnar impaction syndrome identified 38 patients who had had ulnar shortening osteotomy and fixation with the TriMed dynamic compression system. The following clinical data were obtained: patient age, sex, follow-up range of motion, grip strength, and complications. After a minimum of 2 years after surgery, patients reported complications and completed a Disabilities of the Arm, Shoulder, and Hand questionnaire.Eight patients were lost to follow-up. Compared to the opposite limb at an average of 8 months after surgery, the remaining 30 patients attained 92% to 97% of wrist and forearm motion and 71% of grip strength. The average Disabilities of the Arm, Shoulder, and Hand score was 12 after a minimum of 2 years after surgery. Four patients required plate removal due to irritation. Two patients reported persistent ulnar-sided pain, and 2 other patients developed atrophic nonunions and required autologous bone grafting. There were no infections.Ulnar shortening osteotomy using the TriMed system yielded good clinical outcomes that are comparable to those previously documented using other systems.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2013.04.040

View details for Web of Science ID 000322925700009
Suture-button suspensionplasty for thumb carpometacarpal arthritis: a minimum 2-year follow-up. journal of hand surgery Yao, J., Song, Y. 2013; 38 (6): 1161-1165
Abstract

To retrospectively review the results at a minimum of 2 years of suture-button plasty with partial or full trapeziectomy and suture-button suspensionplasty.We evaluated 21 patients who received suture-button suspensionplasty at least 2 years after surgery. We measured postoperative pinch strength, grip strength, range of motion, and metacarpal height. All patients also completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.At an average follow-up of 2.8 � 0.7 years, the mean Quick Disabilities of the Arm, Shoulder, and Hand score was 10 � 9. Pinch and grip strengths were 86% and 89% of the contralateral limb, respectively. Average first trapezial height was 74% of the contralateral trapezial height. There were no major complications.The favorable results of the suture-button suspensionplasty procedure confirm its usefulness in treating thumb carpometacarpal arthritis with minimal risk of complications, ineffective fixation, or loss of function. Subjective and objective outcomes measures are similar to previously described techniques. The benefit of this technique results from the implanted nature of the suspensionplasty elements that require no time to heal, so rehabilitation is begun as early as 10 days postoperatively.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2013.02.040

View details for PubMedID 23647637
Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis: A Minimum. 2-Year Follow-Up JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Song, Y. 2013; 38A (6): 1161-1165
Abstract

To retrospectively review the results at a minimum of 2 years of suture-button plasty with partial or full trapeziectomy and suture-button suspensionplasty.We evaluated 21 patients who received suture-button suspensionplasty at least 2 years after surgery. We measured postoperative pinch strength, grip strength, range of motion, and metacarpal height. All patients also completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.At an average follow-up of 2.8 � 0.7 years, the mean Quick Disabilities of the Arm, Shoulder, and Hand score was 10 � 9. Pinch and grip strengths were 86% and 89% of the contralateral limb, respectively. Average first trapezial height was 74% of the contralateral trapezial height. There were no major complications.The favorable results of the suture-button suspensionplasty procedure confirm its usefulness in treating thumb carpometacarpal arthritis with minimal risk of complications, ineffective fixation, or loss of function. Subjective and objective outcomes measures are similar to previously described techniques. The benefit of this technique results from the implanted nature of the suspensionplasty elements that require no time to heal, so rehabilitation is begun as early as 10 days postoperatively.Therapeutic IV.

View details for DOI 10.1016/j.jhsa.2013.02.040

View details for Web of Science ID 000320342500016
The thumb carpometacarpal joint: anatomy, hormones, and biomechanics. Instructional course lectures Ladd, A. L., Weiss, A. C., Crisco, J. J., Hagert, E., Wolf, J. M., Glickel, S. Z., Yao, J. 2013; 62: 165-179
Abstract

Although there are many surgical options to treat thumb carpometacarpal (CMC) arthritis, a precise etiology for this common disorder remains obscure. To better understand the physiology of the thumb CMC joint and treat pathology, it is helpful to examine the biomechanics, hormonal influences, and available surgical treatment options, along with the evolutionary roots of the thumb; its form and function, its functional demands; and the role of supporting ligaments based on their location, stability, and ultrastructure. It is important to appreciate the micromotion of a saddle joint and the role that sex, age, and reproductive hormones play in influencing laxity and joint disease. Minimally invasive surgery is now challenging prevailing treatment principles of ligament reconstruction and plays a role in thumb CMC joint procedures.

View details for PubMedID 23395023
Treatment of thumb carpometacarpal arthritis with arthroscopic hemitrapeziectomy and interposition arthroplasty. Orthopedics Park, M. J., Lee, A. T., Yao, J. 2012; 35 (12): e1759-64
Abstract

The carpometacarpal joint of the thumb is a common site of degenerative arthritis. Several surgical treatments exist, but arthroscopic management offers the potential benefit of earlier recovery. The current study evaluated the early clinical outcomes of a procedure involving arthroscopic hemitrapeziectomy with Artelon spacer (Artimplant, V�stra Fr�lunda, Sweden) interposition arthroplasty into the newly created carpometacarpal space.A chart review of 9 patients treated with thumb carpometacarpal arthroscopic hemitrapeziectomy and Artelon spacer interposition arthroplasty between September 2005 and January 2009 was performed for postoperative complications, range of motion, and pinch strength (percentage of the contralateral limb). Subjective outcomes were analyzed by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Patient-rated Wrist Evaluation. Mean follow-up was 23.4 months (range, 13-33 months). All patients maintained full range of motion. By the 1-year follow-up, mean pinch strength returned to 59%� 19.1% of the contralateral limb strength. The Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-rated Wrist Evaluation scores were 12.3 � 7.6 and 26.8 � 23.5, respectively. No significant complications occurred, and 1 patient with symptoms of synovitis was successfully treated with a corticosteroid injection. This study revealed excellent short-term results at the minimum 1-year follow-up for a less invasive treatment option that is appropriate for select patients with moderate thumb carpometacarpal arthritis (Eaton stages 2 and 3). The authors demonstrated a comparably good outcome of arthroscopic hemitrapeziectomy with Artelon spacer interposition arthroplasty with no evidence of foreign-body reaction. The authors also demonstrated the potential role of corticosteroid injections in the setting of a postoperative inflammatory reaction.

View details for DOI 10.3928/01477447-20121120-21

View details for PubMedID 23218633
Treatment of Thumb Carpometacarpal Arthritis With Arthroscopic Hemitrapeziectomy and Interposition Arthroplasty ORTHOPEDICS Park, M. J., Lee, A. T., Yao, J. 2012; 35 (12): E1759-E1764
Abstract

The carpometacarpal joint of the thumb is a common site of degenerative arthritis. Several surgical treatments exist, but arthroscopic management offers the potential benefit of earlier recovery. The current study evaluated the early clinical outcomes of a procedure involving arthroscopic hemitrapeziectomy with Artelon spacer (Artimplant, V�stra Fr�lunda, Sweden) interposition arthroplasty into the newly created carpometacarpal space.A chart review of 9 patients treated with thumb carpometacarpal arthroscopic hemitrapeziectomy and Artelon spacer interposition arthroplasty between September 2005 and January 2009 was performed for postoperative complications, range of motion, and pinch strength (percentage of the contralateral limb). Subjective outcomes were analyzed by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and the Patient-rated Wrist Evaluation. Mean follow-up was 23.4 months (range, 13-33 months). All patients maintained full range of motion. By the 1-year follow-up, mean pinch strength returned to 59%� 19.1% of the contralateral limb strength. The Quick Disabilities of the Arm, Shoulder, and Hand and the Patient-rated Wrist Evaluation scores were 12.3 � 7.6 and 26.8 � 23.5, respectively. No significant complications occurred, and 1 patient with symptoms of synovitis was successfully treated with a corticosteroid injection. This study revealed excellent short-term results at the minimum 1-year follow-up for a less invasive treatment option that is appropriate for select patients with moderate thumb carpometacarpal arthritis (Eaton stages 2 and 3). The authors demonstrated a comparably good outcome of arthroscopic hemitrapeziectomy with Artelon spacer interposition arthroplasty with no evidence of foreign-body reaction. The authors also demonstrated the potential role of corticosteroid injections in the setting of a postoperative inflammatory reaction.

View details for DOI 10.3928/01477447-20121120-21

View details for Web of Science ID 000209678400012
Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis HAND CLINICS Yao, J. 2012; 28 (4): 579-?
Abstract

Trapeziectomy has been regaining popularity in treatment of thumb carpometacarpal (CMC). Current approaches to trapeziectomy use Kirschner wire fixation to prevent subsidence of the thumb metacarpal into the newly created trapeziectomy space. This fixation method requires at least 4 weeks of strict immobilization of the thumb. A technique using a suture-button device to suspend the thumb allows for earlier mobilization of the thumb and potentially leads to a faster overall recovery. Preliminary results are promising, but further studies must be conducted to confirm the long-term efficacy of this suture-button suspensionplasty.

View details for DOI 10.1016/j.hcl.2012.08.013

View details for Web of Science ID 000311875800014

View details for PubMedID 23101608
The importance of pronator quadratus repair in the treatment of distal radius fractures with volar plating. Hand (New York, N.Y.) Ahsan, Z. S., Yao, J. 2012; 7 (3): 276-280
Abstract

Open reduction internal fixation (ORIF) of distal radius fractures via a volar approach involves surgical release of the overlying pronator quadratus (PQ) muscle. Complete repair of the PQ, defined as full and stable replacement of the periphery of the PQ back to its original anatomic location, is not always possible upon conclusion of the operation. Postoperative consequences of incomplete PQ repair with regards to range of motion (ROM), grip strength, and complications are not well documented. It was hypothesized that the completeness of PQ repair would yield no significant difference in the postoperative ROM, grip strength, and incidence of complications.A retrospective review was performed of 110 repairs of distal radius fractures with ORIF via placement of a volar locking plate. The following clinical data were extracted: complete or incomplete PQ repair, patient age, gender, follow-up ROM/grip strength, and incidence of postoperative complications.No significant difference in ROM, grip strength, and postoperative complications was detected between the complete and incomplete PQ repair groups. Complications consisted of two incidences of malunion requiring revision surgery and one occurrence of complex regional pain syndrome. There were no tendon ruptures. No statistical difference in ROM/grip strength or incidence of postoperative complications was detected between the complete and incomplete PQ repair groups. Regardless of the level of injury sustained by the PQ, surgeons should make an effort to cover the distal aspect of the volar plate during closure following distal radius fracture ORIF. Coverage of the distal aspect of the plate with the PQ (at a minimum) provides adequate results in ROM and grip strength, as well as protection against flexor tendon injury.Therapeutic Level III: Retrospective Comparative Study.

View details for DOI 10.1007/s11552-012-9420-6

View details for PubMedID 23997732
The effect of suture coated with mesenchymal stem cells and bioactive substrate on tendon repair strength in a rat model. journal of hand surgery Yao, J., Woon, C. Y., Behn, A., Korotkova, T., Park, D., Gajendran, V., Smith, R. L. 2012; 37 (8): 1639-1645
Abstract

Exogenously administered mesenchymal stem cells and bioactive molecules are known to enhance tendon healing. Biomolecules have been successfully delivered using sutures that elute growth factors over time. We sought to evaluate the histologic and biomechanical effect of delivering both cells and bioactive substrates on a suture delivery vehicle in comparison with sutures coated with bioactive substrates alone.Bone marrow-derived stem cells were harvested from Sprague-Dawley rat femurs. Experimental cell and substrate-coated, coated suture (CS) group sutures were precoated with intercellular cell adhesion molecule 1 and poly-L-lysine and seeded with labeled bone marrow-derived stem cells. Control (substrate-only [SO] coated) group sutures were coated with intercellular cell adhesion molecule 1 and poly-L-lysine only. Using a matched-paired design, bilateral Sprague-Dawley rat Achilles tendons (n = 105 rats) were transected and randomized to CS or SO repairs. Tendons were harvested at 4, 7, 10, 14, and 28 days and subjected to histologic and mechanical assessment.Labeled cells were present at repair sites at all time points. The CS suture repairs displayed statistically greater strength compared to SO repairs at 7 days (12.6 � 5.0 N vs 8.6 � 3.7 N, respectively) and 10 days (21.2 � 4.9 N vs 16.4 � 4.8 N, respectively). There was no significant difference between the strength of CS suture repairs compared with SO repairs at 4 days (8.1 � 5.1 N vs 6.6 � 2.3 N, respectively), 14 days (22.8 � 7.3 N vs 25.1 � 9.7 N, respectively), and 28 days (40.9 � 12.4 N vs 34.6 � 15.0 N, respectively).Bioactive CS sutures enhanced repair strength at 7 to 10 days. There was no significant effect at later stages.The strength nadir of a tendon repair occurs in the first 2 weeks after surgery. Bioactive suture repair might provide a clinical advantage by jump-starting the repair process during this strength nadir. Improved early strength might, in turn allow earlier unprotected mobilization.

View details for DOI 10.1016/j.jhsa.2012.04.038

View details for PubMedID 22727924
The Effect of Suture Coated With Mesenchymal Stem Cells and Bioactive Substrate on Tendon Repair Strength in a Rat Model JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Woon, C. Y., Behn, A., Korotkova, T., Park, D., Gajendran, V., Smith, R. L. 2012; 37A (8): 1639-1645
Abstract

Exogenously administered mesenchymal stem cells and bioactive molecules are known to enhance tendon healing. Biomolecules have been successfully delivered using sutures that elute growth factors over time. We sought to evaluate the histologic and biomechanical effect of delivering both cells and bioactive substrates on a suture delivery vehicle in comparison with sutures coated with bioactive substrates alone.Bone marrow-derived stem cells were harvested from Sprague-Dawley rat femurs. Experimental cell and substrate-coated, coated suture (CS) group sutures were precoated with intercellular cell adhesion molecule 1 and poly-L-lysine and seeded with labeled bone marrow-derived stem cells. Control (substrate-only [SO] coated) group sutures were coated with intercellular cell adhesion molecule 1 and poly-L-lysine only. Using a matched-paired design, bilateral Sprague-Dawley rat Achilles tendons (n = 105 rats) were transected and randomized to CS or SO repairs. Tendons were harvested at 4, 7, 10, 14, and 28 days and subjected to histologic and mechanical assessment.Labeled cells were present at repair sites at all time points. The CS suture repairs displayed statistically greater strength compared to SO repairs at 7 days (12.6 � 5.0 N vs 8.6 � 3.7 N, respectively) and 10 days (21.2 � 4.9 N vs 16.4 � 4.8 N, respectively). There was no significant difference between the strength of CS suture repairs compared with SO repairs at 4 days (8.1 � 5.1 N vs 6.6 � 2.3 N, respectively), 14 days (22.8 � 7.3 N vs 25.1 � 9.7 N, respectively), and 28 days (40.9 � 12.4 N vs 34.6 � 15.0 N, respectively).Bioactive CS sutures enhanced repair strength at 7 to 10 days. There was no significant effect at later stages.The strength nadir of a tendon repair occurs in the first 2 weeks after surgery. Bioactive suture repair might provide a clinical advantage by jump-starting the repair process during this strength nadir. Improved early strength might, in turn allow earlier unprotected mobilization.

View details for DOI 10.1016/j.jhsa.2012.04.038

View details for Web of Science ID 000307260200018
Complications of Wrist Arthroscopy ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Ahsan, Z. S., Yao, J. 2012; 28 (6): 855-859
Abstract

The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought.Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study.Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation.This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques.Level IV, systematic review of Levels I-V studies.

View details for DOI 10.1016/j.arthro.2012.01.008

View details for Web of Science ID 000304444200016

View details for PubMedID 22483733
New and emerging technology in the treatment of the upper extremity. Hand clinics Yao, J. n. 2012; 28 (4): xiii-xiv
View details for PubMedID 23101612
All-Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears Using FasT-Fix HAND CLINICS Yao, J. 2011; 27 (3): 237-?
Abstract

Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity.

View details for DOI 10.1016/j.hcl.2011.05.004

View details for Web of Science ID 000295232400002

View details for PubMedID 21871346
Optimization of volar percutaneous screw fixation for scaphoid waist fractures using traction, positioning, imaging, and an angiocatheter guide. journal of hand surgery Zlotolow, D. A., Knutsen, E., Yao, J. 2011; 36 (5): 916-921
Abstract

Percutaneous screw fixation of nondisplaced or reducible scaphoid fractures has become more popular as techniques and implants have improved. Many authors have advocated for the dorsal approach, citing difficulties with adequate screw placement from the volar approach. We have developed a straightforward and reproducible technique for volar percutaneous scaphoid screw fixation that mitigates most of the drawbacks of the approach. The wrist is held in extension and ulnar deviation with traction through the thumb. A 14-gauge angiocatheter needle is then used to localize the starting point and as a cannula for the guide wire. Specific fluoroscopic views help to confirm optimal guide wire placement.

View details for DOI 10.1016/j.jhsa.2011.02.017

View details for PubMedID 21527146
All-Arthroscopic Repair of Palmer 1B Triangular Fibrocartilage Complex Tears Using the FasT-Fix Device JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Lee, A. T. 2011; 36A (5): 836-842
Abstract

The FasT-Fix device (Smith and Nephew Endoscopy, Andover, MA), initially developed for knee meniscal tears, is described for all-arthroscopic triangular fibrocartilage complex (TFCC) repairs. Potential benefits of this technique are ease of use, the lack of prominent suture knots, and strength of repair. This case series evaluates the early clinical outcomes of this technique.We conducted a retrospective review of patients with TFCC Palmer type 1B injuries treated by 1 hand surgeon from 2005 to 2009. The patients' charts were reviewed for postoperative complications, range of motion, grip strength (percentage of contralateral), and return to full activity. In addition, each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires.Twelve patients had all-arthroscopic peripheral (1B) TFCC repairs using the FasT-Fix suture device. The mean follow-up period was 17.5 months (range, 11-27). Mean supination was 78� (� 14�), and mean grip strength was 64% (�16%) of the nonsurgical extremity by 3 months after surgery. All other range of motion was full. The mean QuickDASH score was 11 (�12), and the mean PRWE score was 19 (�14). Average time to full activity was 5 months. There were no surgical complications of the procedure. One patient complained of persistent ulnar-sided wrist pain 12 months after surgery and had an ulnar shortening osteotomy. Arthroscopy at the time of the osteotomy revealed that the TFCC was stable.At mean 1-year follow-up, 11 out of 12 patients achieved excellent subjective outcomes based on QuickDASH and PRWE questionnaires. Although range of motion and grip strength were slightly decreased compared to prior case series reports, the short-term results indicate that the FasT-Fix all-arthroscopic, all-inside technique is a safe and effective technique for repair of Palmer type 1B TFCC tears.

View details for DOI 10.1016/j.jhsa.2011.01.005

View details for Web of Science ID 000290185700012
Optimization of Volar Percutaneous Screw Fixation for Scaphoid Waist Fractures Using Traction, Positioning, Imaging, and an Angiocatheter Guide JOURNAL OF HAND SURGERY-AMERICAN VOLUME Zlotolow, D. A., Knutsen, E., Yao, J. 2011; 36A (5): 916-921
Abstract

Percutaneous screw fixation of nondisplaced or reducible scaphoid fractures has become more popular as techniques and implants have improved. Many authors have advocated for the dorsal approach, citing difficulties with adequate screw placement from the volar approach. We have developed a straightforward and reproducible technique for volar percutaneous scaphoid screw fixation that mitigates most of the drawbacks of the approach. The wrist is held in extension and ulnar deviation with traction through the thumb. A 14-gauge angiocatheter needle is then used to localize the starting point and as a cannula for the guide wire. Specific fluoroscopic views help to confirm optimal guide wire placement.

View details for DOI 10.1016/j.jhsa.2011.02.017

View details for Web of Science ID 000290185700026
All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. journal of hand surgery Yao, J., Lee, A. T. 2011; 36 (5): 836-842
Abstract

The FasT-Fix device (Smith and Nephew Endoscopy, Andover, MA), initially developed for knee meniscal tears, is described for all-arthroscopic triangular fibrocartilage complex (TFCC) repairs. Potential benefits of this technique are ease of use, the lack of prominent suture knots, and strength of repair. This case series evaluates the early clinical outcomes of this technique.We conducted a retrospective review of patients with TFCC Palmer type 1B injuries treated by 1 hand surgeon from 2005 to 2009. The patients' charts were reviewed for postoperative complications, range of motion, grip strength (percentage of contralateral), and return to full activity. In addition, each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires.Twelve patients had all-arthroscopic peripheral (1B) TFCC repairs using the FasT-Fix suture device. The mean follow-up period was 17.5 months (range, 11-27). Mean supination was 78� (� 14�), and mean grip strength was 64% (�16%) of the nonsurgical extremity by 3 months after surgery. All other range of motion was full. The mean QuickDASH score was 11 (�12), and the mean PRWE score was 19 (�14). Average time to full activity was 5 months. There were no surgical complications of the procedure. One patient complained of persistent ulnar-sided wrist pain 12 months after surgery and had an ulnar shortening osteotomy. Arthroscopy at the time of the osteotomy revealed that the TFCC was stable.At mean 1-year follow-up, 11 out of 12 patients achieved excellent subjective outcomes based on QuickDASH and PRWE questionnaires. Although range of motion and grip strength were slightly decreased compared to prior case series reports, the short-term results indicate that the FasT-Fix all-arthroscopic, all-inside technique is a safe and effective technique for repair of Palmer type 1B TFCC tears.

View details for DOI 10.1016/j.jhsa.2011.01.005

View details for PubMedID 21458928
Color-Aided Visualization of Dorsal Wrist Ganglion Stalks Aids in Complete Arthroscopic Excision ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Yao, J., Trindade, M. C. 2011; 27 (3): 425-429
Abstract

Dorsal wrist ganglia are the most common mass of the upper extremity. Treatment modalities include benign neglect, aspiration, and surgical excision. Arthroscopic excision is a less invasive surgical alternative to open resection with the benefit of visualizing and treating other intra-articular pathology, fewer potential complications, earlier return to activities, and possibly, a more complete resection. This may lead to a lower rate of recurrence, although this has not been proven in the literature. Recurrence depends in part on adequate ganglion stalk visualization and resection. This is often difficult in open and arthroscopic ganglionectomy. This work describes a new technique with improved arthroscopic stalk visualization and ganglion resection using intralesional injection of an inert dye.

View details for DOI 10.1016/j.arthro.2010.10.017

View details for Web of Science ID 000287693200019

View details for PubMedID 21353171
Viability and proliferation of pluripotential cells delivered to tendon repair sites using bioactive sutures--an in vitro study. journal of hand surgery Yao, J., Korotkova, T., Smith, R. L. 2011; 36 (2): 252-258
Abstract

We evaluated the fate of pluripotential stem cells adherent to a suture carrier after being passed through tendon tissue in vitro.FiberWire suture segments were coated with poly-L-lysine (PLL) and a 2 � 10(6) C3H10T1/2 (a mouse embryo pluripotential cell line) cell suspension. The sutures were incubated for 7 days, passed through two 1-cm segments of acellularized rabbit Achilles tendons and tied (horizontal mattress). The repairs were frozen and sectioned (6 ?m). The sections were stained with 4',6-diamidino-2-phenylindole and a live/dead viability/cytotoxicity (calcein/ethidium homodimer) kit and examined with fluorescent microscopy to evaluate cell presence and viability. Alamar Blue was used in parallel to assess metabolic activity.PLL-coated sutures showed a 3-fold increase in fluorescence when compared with the phosphate-buffered saline-coated controls. At day 3, fluorescence was 2.2 times greater. At day 5, a 2-fold increase was found, and at day 8 there was no significant difference in values. Furthermore, after delivery of the cells into tendon, fluorescence readings for the samples (n = 19) showed 9450 compared with the positive control at 21,218. At 96 hours the mean was 27,609 compared with 34,850 for the positive control. The difference in fluorescence means at 48 hours and 96 hours were significant (p < .001). Live-dead and DAPI staining confirmed the presence of live cells at the tendon repair site.Sutures seeded with pluripotential embryonic cells deliver cells to a tendon repair site. The cells deposited at the repair site survive the trauma of passage and remain metabolically active, as seen in staining and metabolic assay studies. Use of bioactive sutures leads to repopulation of the acellular zone surrounding sutures within the tendon.

View details for DOI 10.1016/j.jhsa.2010.10.004

View details for PubMedID 21186083
Viability and Proliferation of Pluripotential Cells Delivered to Tendon Repair Sites Using Bioactive Sutures-An In Vitro Study JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Korotkova, T., Smith, R. L. 2011; 36A (2): 252-258
Abstract

We evaluated the fate of pluripotential stem cells adherent to a suture carrier after being passed through tendon tissue in vitro.FiberWire suture segments were coated with poly-L-lysine (PLL) and a 2 � 10(6) C3H10T1/2 (a mouse embryo pluripotential cell line) cell suspension. The sutures were incubated for 7 days, passed through two 1-cm segments of acellularized rabbit Achilles tendons and tied (horizontal mattress). The repairs were frozen and sectioned (6 ?m). The sections were stained with 4',6-diamidino-2-phenylindole and a live/dead viability/cytotoxicity (calcein/ethidium homodimer) kit and examined with fluorescent microscopy to evaluate cell presence and viability. Alamar Blue was used in parallel to assess metabolic activity.PLL-coated sutures showed a 3-fold increase in fluorescence when compared with the phosphate-buffered saline-coated controls. At day 3, fluorescence was 2.2 times greater. At day 5, a 2-fold increase was found, and at day 8 there was no significant difference in values. Furthermore, after delivery of the cells into tendon, fluorescence readings for the samples (n = 19) showed 9450 compared with the positive control at 21,218. At 96 hours the mean was 27,609 compared with 34,850 for the positive control. The difference in fluorescence means at 48 hours and 96 hours were significant (p < .001). Live-dead and DAPI staining confirmed the presence of live cells at the tendon repair site.Sutures seeded with pluripotential embryonic cells deliver cells to a tendon repair site. The cells deposited at the repair site survive the trauma of passage and remain metabolically active, as seen in staining and metabolic assay studies. Use of bioactive sutures leads to repopulation of the acellular zone surrounding sutures within the tendon.

View details for DOI 10.1016/j.jhsa.2010.10.004

View details for Web of Science ID 000286951900008
Arthroscopic repair of the scapholunate interosseous ligament. Techniques in hand & upper extremity surgery Stuffmann, E. S., McAdams, T. R., Shah, R. P., Yao, J. 2010; 14 (4): 204-208
Abstract

Scapholunate injuries are the most frequent of the intercarpal ligament injuries in the wrist. Current repair methods generally involve an open approach the dorsal capsule of the wrist. Arthroscopic repair of the dorsal portion of the scapholunate interosseus ligament would carry the advantages of less stiffness and would preserve the important dorsal capsular stabilizers. In the development of this technique, we first sought to determine the anatomic location and accessibility of the dorsal scapholunate ligament and the site in which a suture anchor would be placed. Ten fresh-frozen cadaver limbs were used. With the arthroscope in the 4 to 5 portal, the most dorsal portion of the SLIL was visualized in each specimen. K-wires were inserted through the 3 to 4 portal into the scaphoid adjacent to most distal portion of the dSLIL visualized. All limbs were dissected and the location of the wires relative to the prominence on the scaphoid directly adjacent to the central portion of the dSLIL was measured. The location of the prominence relative to the dSLIL was studied through magnified photography of a stained section of a cadaveric scaphoid. The mean distance of these wires distal to the center of the dSLIL is presented. Then the technique of arthroscopic repair of the dSLIL was developed using additional cadaveric wrist specimens. The technique is described.

View details for DOI 10.1097/BTH.0b013e3181df0a93

View details for PubMedID 21107214
Suture Button Compared With K-Wire Fixation for Maintenance of Posttrapeziectomy Space Height in a Cadaver Model of Lateral Pinch JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Zlotolow, D. A., Murdock, R., Christian, M. 2010; 35A (12): 2061-2065
Abstract

Hematoma distraction arthroplasty has regained popularity as a treatment for thumb carpometacarpal arthritis with reports of satisfactory results. Our goal was to investigate the use of a suture button device to maintain the posttrapeziectomy space height of the thumb metacarpal. Our hypothesis is that a suture button that suspends the thumb metacarpal from the second metacarpal, when applied to the hematoma distraction arthroplasty technique, would provide subsidence resistance comparable to traditional K-wire fixation.Ten fresh frozen matched pairs of human cadaveric arms were used. After open trapeziectomy, suspension of the thumb metacarpal was performed with either a 1.4-mm (0.045-inch) K-wire advanced through the base of the thumb metacarpal into the second metacarpal shaft or a suture button device that suspended the thumb metacarpal from the second metacarpal shaft. Cyclic pinch was simulated by using a lateral pinch model previously described and validated. Lateral pinch is simulated by loading the extensor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis longus in a 1:5:6:10 ratio. Dynamic pinch is achieved with cyclic unloading of the abductor pollicis brevis, adductor pollicis, and flexor pollicis longus tendons. Measurements were made of the height of excised trapeziums, the distance from the metacarpal base to the scaphoid after trapeziectomy (trapeziectomy space height) at time zero, both loaded and unloaded, and at sequential loading cycles of 1,000, 2,000, 3,000, 4,000, 5,000, and 10,000 cycles.Student t-test evaluation showed no significant differences between the groups in initial trapeziectomy space height (p = .10), postfixation trapeziectomy space height (p = .10), or loss of trapeziectomy space height between precycling and after 10,000 cycles (p = .80).Suture button fixation maintains similar posttrapeziectomy space height and prevents subsidence of the thumb metacarpal when compared with K-wire fixation in this model. This technique may allow for earlier range of motion after the hematoma distraction arthroplasty.

View details for DOI 10.1016/j.jhsa.2010.09.007

View details for Web of Science ID 000285371300023
Suture button compared with K-wire fixation for maintenance of posttrapeziectomy space height in a cadaver model of lateral pinch. journal of hand surgery Yao, J., Zlotolow, D. A., Murdock, R., Christian, M. 2010; 35 (12): 2061-2065
Abstract

Hematoma distraction arthroplasty has regained popularity as a treatment for thumb carpometacarpal arthritis with reports of satisfactory results. Our goal was to investigate the use of a suture button device to maintain the posttrapeziectomy space height of the thumb metacarpal. Our hypothesis is that a suture button that suspends the thumb metacarpal from the second metacarpal, when applied to the hematoma distraction arthroplasty technique, would provide subsidence resistance comparable to traditional K-wire fixation.Ten fresh frozen matched pairs of human cadaveric arms were used. After open trapeziectomy, suspension of the thumb metacarpal was performed with either a 1.4-mm (0.045-inch) K-wire advanced through the base of the thumb metacarpal into the second metacarpal shaft or a suture button device that suspended the thumb metacarpal from the second metacarpal shaft. Cyclic pinch was simulated by using a lateral pinch model previously described and validated. Lateral pinch is simulated by loading the extensor pollicis longus, adductor pollicis, abductor pollicis brevis, and flexor pollicis longus in a 1:5:6:10 ratio. Dynamic pinch is achieved with cyclic unloading of the abductor pollicis brevis, adductor pollicis, and flexor pollicis longus tendons. Measurements were made of the height of excised trapeziums, the distance from the metacarpal base to the scaphoid after trapeziectomy (trapeziectomy space height) at time zero, both loaded and unloaded, and at sequential loading cycles of 1,000, 2,000, 3,000, 4,000, 5,000, and 10,000 cycles.Student t-test evaluation showed no significant differences between the groups in initial trapeziectomy space height (p = .10), postfixation trapeziectomy space height (p = .10), or loss of trapeziectomy space height between precycling and after 10,000 cycles (p = .80).Suture button fixation maintains similar posttrapeziectomy space height and prevents subsidence of the thumb metacarpal when compared with K-wire fixation in this model. This technique may allow for earlier range of motion after the hematoma distraction arthroplasty.

View details for DOI 10.1016/j.jhsa.2010.09.007

View details for PubMedID 21134614
The rate of triangular fibrocartilage injuries requiring surgical intervention. Orthopedics Park, M. J., Jagadish, A., Yao, J. 2010; 33 (11): 806-?
Abstract

Triangular fibrocartilage complex injuries are one of the most common causes of ulnar-sided wrist pain. Although pain and discomfort may improve with simple immobilization for a short period of time, a significant number of patients eventually require surgical intervention. The purpose of this study was to investigate the incidence of surgical intervention on patients with a clinical diagnosis of a triangular fibrocartilage complex injury. A retrospective chart review was performed to identify patients with ulnar-sided wrist pain identified with the appropriate ICD-9 code from September 2005 to September 2007. All patients were evaluated and treated by a board-certified, fellowship-trained hand surgeon. Any patients with associated pathology were excluded from the study. All patients were initially treated with a minimum of 4 weeks of either a volar wrist splint worn all the time or a short-arm cast. Magnetic resonance images were obtained on patients without symptomatic relief, and in these cases, surgical arthroscopy was performed. Of the 84 patients identified, 36 patients required surgical intervention. All 36 patients had evidence of triangular fibrocartilage complex injury during arthroscopy. All patients had symptomatic improvement postoperatively. The use of short-arm cast versus a splint did not affect the rate of surgical intervention (P=.38). Among the patients with clinical diagnosis of triangular fibrocartilage complex injury, the rate of surgical intervention required after a minimum 4 weeks of immobilization was 43%. The use of a short-arm cast or volar wrist splint did not affect the rate of surgical intervention.

View details for DOI 10.3928/01477447-20100924-03

View details for PubMedID 21053893
Comparison of Longitudinal Open Incision and Two-Incision Techniques for Carpal Tunnel Release JOURNAL OF HAND SURGERY-AMERICAN VOLUME Castillo, T. N., Yao, J. 2010; 35A (11): 1813-1819
Abstract

This study analyzes the long-term postoperative symptoms and functional outcomes of patients who underwent either traditional open (single-incision) or 2-incision carpal tunnel release (CTR). Because 2-incision CTR preserves the superficial nerves and subcutaneous tissue between the thenar and hypothenar eminences, it may account for fewer postoperative symptoms and improved functional recovery.A retrospective chart review identified patients who underwent either open or 2-incision CTR for isolated carpal tunnel syndrome between 2005 and 2008 by a single surgeon. Patients with a history of hand trauma or confounding comorbidities were excluded. We mailed a Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire and a Brigham and Women's Carpal Tunnel Questionnaire (BWCTQ) to all eligible participants. Data from the completed questionnaires were analyzed using independent t-tests and Pearson's correlation. Significance was set at p = .05.A total of 82 patients (106 hands; 27 men and 55 women; mean age, 60.5 y) were eligible to participate. Of these, 51 patients (63 hands; 20 men and 31 women; mean age, 61.1 y) responded (62% response rate). The mean duration of follow-up was 22 months (range, 12-37 mo; SD 7.3 mo). The 2-incision group mean BWCTQ Symptom Severity Scale score (1.13, SD 0.25) was significantly lower than the open group mean Symptom Severity Scale score (1.54, SD 0.70, p = .001). The 2-incision group mean BWCTQ Functional Status Scale score (1.24, SD 0.51) was significantly lower than the open group mean Functional Status Scale score (1.71, SD 0.76, p = .008). The 2-incision group mean DASH score (5.10, SD 12.03) was significantly lower than the open group mean DASH score (16.28, SD 19.98, p = .01).Patients treated with 2-incision CTR reported statistically significantly less severe long-term postoperative symptoms and improved functional status compared with patients treated with traditional open CTR. Future prospective studies with objective measures are needed to further investigate the difference in outcomes found between these 2 CTR techniques.Therapeutic III.

View details for DOI 10.1016/j.jhsa.2010.08.027

View details for Web of Science ID 000284031400012
Suture Button Suspensionplasty After Arthroscopic Hemitrapeziectomy for Treatment of Thumb Carpometacarpal Arthritis ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Cox, C. A., Zlotolow, D. A., Yao, J. 2010; 26 (10): 1395-1403
Abstract

A myriad of techniques for reconstruction of the arthritic thumb carpometacarpal joint have been described. In the modern era, there has been a push, driven by both clinicians and patients, for more rapid rehabilitation after these procedures. A majority of the historically described techniques require pinning of the thumb ray for 4 weeks. Suture button placement between the thumb and index ray metacarpals has been shown in biomechanical studies to effectively resist subsidence of the thumb ray. We describe a novel technique of using a suture button for suspensionplasty of the thumb ray after arthroscopic partial trapeziectomy. This technique allows for early mobilization and may offer a potential improvement on current techniques. Early results of use of this technique are encouraging, but well-conducted follow-up studies are necessary.

View details for DOI 10.1016/j.arthro.2010.07.006

View details for Web of Science ID 000282366300022

View details for PubMedID 20887938
All-Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears OPERATIVE TECHNIQUES IN SPORTS MEDICINE Yao, J. 2010; 18 (3): 168-172
View details for DOI 10.1053/j.otsm.2010.03.006

View details for Web of Science ID 000281653900008
Tourniquet usage in upper extremity surgery. journal of hand surgery Cox, C., Yao, J. 2010; 35 (8): 1360-1361
View details for DOI 10.1016/j.jhsa.2010.03.016

View details for PubMedID 20537807
Electrocautery Use in Hand Surgery: History, Physics, and Appropriate Usage JOURNAL OF HAND SURGERY-AMERICAN VOLUME Cox, C., Yao, J. 2010; 35A (3): 489-490
View details for DOI 10.1016/j.jhsa.2009.09.016

View details for Web of Science ID 000277092800023
Perioperative steroid dosing in patients receiving chronic oral steroids, undergoing outpatient hand surgery. journal of hand surgery Fleager, K., Yao, J. 2010; 35 (2): 316-318
View details for DOI 10.1016/j.jhsa.2009.10.001

View details for PubMedID 19942359
Referring Physicians' Knowledge of Hand Surgery Hand (NY) Curtin C, Yao J 2010; 5 (3): 278-285
Clinical Assessment of the Wrist The Wrist: Diagnosis and Operative Treatment Yao J, Skirven T, Osterman AL, Culp RW 2010
Monteggia fracture-dislocation associated with proximal and distal radioulnar joint instability. A case report. journal of bone and joint surgery. American volume Cheung, E. V., Yao, J. 2009; 91 (4): 950-954
View details for DOI 10.2106/JBJS.H.00269

View details for PubMedID 19339581
All-Arthroscopic Triangular Fibrocartilage Complex Repair: Safety and Biomechanical Comparison With a Traditional Outside-in Technique in Cadavers JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J. 2009; 34A (4): 671-676
Abstract

To compare the biomechanical strength and safety of an all-arthroscopic triangular fibrocartilage (TFCC) repair technique with an outside-in technique in cadavers.Ten matched pairs of fresh-frozen cadaveric wrists were used for this study. The control group TFCC tears were treated with an outside-in technique using 2-0 polydioxane (PDS) sutures. The experimental group was treated with two FasT-Fix suture devices. I measured the location of the implants in relation to the neurovascular structures using a digital caliper. The strength of the repairs was then determined using a tensile testing machine with the load placed across the repair site. I compared results using the Student's t-test.The most volar FasT-Fix block averaged 1.8 cm from the ulnar neurovascular bundle, whereas the PDS knots averaged 1.9 cm from it. The most dorsal FasT-Fix averaged 17.1 mm from the dorsal branch of the ulnar nerve, whereas the PDS knot was 4.6 mm. The average load to failure for the FasT-Fix repairs was 3.7 N, compared with 2.4 N for the PDS repairs (p < .05). The mode of failure for the FasT-Fix implants was the suture cutting through the TFCC tissue. The mode of failure for the PDS controls varied between the suture cutting through the tissue and the knots untying. One extensor carpi ulnaris tendon was injured by the PDS technique. No tendons were injured with the FasT-Fix technique.This all-arthroscopic technique of TFCC repair is faster and stronger than the inside-out technique and is equally safe. Benefits of this repair are decreased operative time, reduced postoperative immobilization, and decreased irritation from prominent suture knots below the skin. For these reasons, it may be desirable to perform this technique to improve patient satisfaction.

View details for DOI 10.1016/j.jhsa.2009.01.014

View details for Web of Science ID 000264998800010
Arthroscopic Treatment of Triangular Fibrocartilage Wrist Injuries in the Athlete 34th Annual Meeting of the American-Orthopaedic-Society-for-Sports-Medicine McAdams, T. R., Swan, J., Yao, J. SAGE PUBLICATIONS INC. 2009: 291?97
Abstract

Triangular fibrocartilage (TFC) injuries are an increasingly recognized cause of ulnar-sided wrist pain and can be particularly disabling in the competitive athlete. Previous studies show that arthroscopic debridement or repair can improve symptoms, but the results of arthroscopic treatment of TFC injuries in high-level athletes have not yet been reported.Arthroscopic debridement or repair of wrist TFC injury will allow a high rate of return to full function in the elite athlete.Case series; Level of evidence, 4.Between 2001 and 2005, 16 competitive athletes (mean age, 23.4 years) with wrist TFC injuries underwent arthroscopic surgery. Repair was performed in unstable tears, and all others underwent debridement alone. Presurgery and post-surgery mini-DASH (Disabilities of the Arm, Shoulder, and Hand) scores were recorded for each athlete through medical record review and clinical evaluation. The mean duration of follow-up was 32.8 months (range, 24-51 months).The TFC was repaired in 11 (68.8%) and debrided in 5 (31.3%) patients. The tear was ulnar-sided in 12 (75%), radial-sided in 2 (12.5%), combined radial-ulnar in 1, and central-sided in 1 patient. Mean mini-DASH scores improved from 47.3 (range, 25-65.9) to 0 (all patients) (P = .002), and the mean mini-DASH sports module improved from 79.7 (range, 68.8-100) to 1.95 (range, 0-18.8) (P = .002). Return to play averaged 3.3 months (range, 3-7 months). Associated conditions in the 2 patients unable to return to play at 3 months were distal radioulnar joint (DRUJ) instability with ulnar-carpal abutment (n = 1) and extensor carpi ulnaris (ECU) tendinosis (n = 1).Arthroscopic debridement or repair of wrist TFC injury provides predictable pain relief and return to play in competitive athletes. Return to play may be delayed in athletes with concomitant ulnar-sided wrist injuries.

View details for DOI 10.1177/0363546508325921

View details for PubMedID 19059892
All-arthroscopic triangular fibrocartilage complex repair: safety and biomechanical comparison with a traditional outside-in technique in cadavers. The Journal of hand surgery Yao, J. n. 2009; 34 (4): 671?76
Abstract

To compare the biomechanical strength and safety of an all-arthroscopic triangular fibrocartilage (TFCC) repair technique with an outside-in technique in cadavers.Ten matched pairs of fresh-frozen cadaveric wrists were used for this study. The control group TFCC tears were treated with an outside-in technique using 2-0 polydioxane (PDS) sutures. The experimental group was treated with two FasT-Fix suture devices. I measured the location of the implants in relation to the neurovascular structures using a digital caliper. The strength of the repairs was then determined using a tensile testing machine with the load placed across the repair site. I compared results using the Student's t-test.The most volar FasT-Fix block averaged 1.8 cm from the ulnar neurovascular bundle, whereas the PDS knots averaged 1.9 cm from it. The most dorsal FasT-Fix averaged 17.1 mm from the dorsal branch of the ulnar nerve, whereas the PDS knot was 4.6 mm. The average load to failure for the FasT-Fix repairs was 3.7 N, compared with 2.4 N for the PDS repairs (p < .05). The mode of failure for the FasT-Fix implants was the suture cutting through the TFCC tissue. The mode of failure for the PDS controls varied between the suture cutting through the tissue and the knots untying. One extensor carpi ulnaris tendon was injured by the PDS technique. No tendons were injured with the FasT-Fix technique.This all-arthroscopic technique of TFCC repair is faster and stronger than the inside-out technique and is equally safe. Benefits of this repair are decreased operative time, reduced postoperative immobilization, and decreased irritation from prominent suture knots below the skin. For these reasons, it may be desirable to perform this technique to improve patient satisfaction.

View details for PubMedID 19345869
Surgical treatment of thumb carpometacarpal joint arthritis: a single institution experience from 1995-2005. Hand (New York, N.Y.) Park, M. J., Lichtman, G., Christian, J. B., Weintraub, J., Chang, J., Hentz, V. R., Ladd, A. L., Yao, J. 2008; 3 (4): 304-310
Abstract

There are numerous techniques for the surgical management of thumb carpometacarpal (CMC) joint arthritis. The four senior authors of this study employ three such techniques: trapeziectomy with hematoma distraction arthroplasty, hemitrapeziectomy with osteochondral allograft, and ligament reconstruction tendon interposition (LRTI). This study examines the three commonly utilized procedures at a single institution. This study examines the 10-year experience from 1995-2005 with a minimum 3-month follow-up. Disabilities of the arm, shoulder, and hand (DASH) scores, pre-and postoperative pinch strength, and operative time were examined. After approval from the institutional review board of our institution was obtained, all patients treated surgically by three of the senior authors were contacted via mail and phone. Each patient was asked to complete and return a DASH questionnaire. Of the 115 patients treated during that period, 60 participated in this study. Each patient's final postoperative pinch measurement was obtained from occupational therapy and clinic records. This pinch strength was compared to the preoperative pinch and contralateral pinch strength. Lastly, the total operative time for each procedure was obtained from the operative record. The only significant finding in this study was a shorter mean operative time with the trapeziectomy group (76.90 min) and osteochondral allograft group (90.45 min) when compared to the LRTI group (139.00 min; p = 0.001 and p = 0.001, respectively). We found no significant difference between groups in terms of DASH score and pinch strength. There was no difference between the techniques in terms of postoperative pinch strength and patient satisfaction measured by DASH scores. The operative times for trapeziectomy and hematoma interposition as well as the osteochondral allograft were significantly shorter than that of the LRTI. This presents further evidence that potentially, "less is more" in the treatment of thumb CMC arthritis. We used a retrospective study design to evaluate potential differences between the three surgical techniques described above, therapeutic, levels III-IV.

View details for DOI 10.1007/s11552-008-9109-z

View details for PubMedID 18780018
Bioactive sutures for tendon repair: assessment of a method of delivering pluripotential embryonic cells. journal of hand surgery Yao, J., Korotkova, T., Riboh, J., Chong, A., Chang, J., Smith, R. L. 2008; 33 (9): 1558-1564
Abstract

Pluripotential embryonic cells may be seeded onto sutures intended for tendon repair. These cells may be influenced to adhere to suture material using adhesion substrates, and furthermore, these cells may remain in culture attached to those sutures. These cell-impregnated sutures may be useful for promoting healing of tendon repairs.Ten-centimeter segments of 4-0 sutures (FiberWire) were coated overnight with 10 microg/mL fibronectin, 10 microg/mL poly-l-lysine, or phosphate-buffered saline. The sutures were placed in dishes and covered with a suspension of C3H10T1/2 cells at concentrations of 1 x 10(6), 2 x 10(6), or 4 x 10(6) cells for 24 hours. The sutures were then placed into low adhesion polypropylene tubes with Dulbecco's modified Eagle's medium and 10% fetal bovine serum for 7 days. The presence of viable cells on these sutures was assessed by the colorimetric Alamar blue cell proliferation assay. Spectrophotometry was used to quantify the relative amount of cell proliferation across the experimental groups. The sutures were also visually inspected using phase-contrast light microscopy.Our results show that at all seeding densities (1 x 10(6), 2 x 10(6), and 4 x 10(6) cells), the suture segments coated with poly-l-lysine and fibronectin showed a significant increase in C3H10T1/2 cell adhesion. Coating the suture with poly-l-lysine increased the adherent cell number to 17% of the initial seeding concentration compared with 2% for the control. Fibronectin coating increased the number of adherent viable cells present to 6.6%.Pluripotential embryonic cells may be seeded onto sutures, adhere, and survive in culture. Coating sutures with poly-l-lysine and fibronectin offers significant improvement in retention of viable cells. This technique may be a useful adjunct for future tendon healing studies.

View details for DOI 10.1016/j.jhsa.2008.06.010

View details for PubMedID 18984338
Bioactive Sutures for Tendon Repair: Assessment of a Method of Delivering Pluripotential Embryonic Cells JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J., Korotkova, T., Riboh, J., Chong, A., Chang, J., Smith, R. L. 2008; 33A (9): 1558-1564
Abstract

Pluripotential embryonic cells may be seeded onto sutures intended for tendon repair. These cells may be influenced to adhere to suture material using adhesion substrates, and furthermore, these cells may remain in culture attached to those sutures. These cell-impregnated sutures may be useful for promoting healing of tendon repairs.Ten-centimeter segments of 4-0 sutures (FiberWire) were coated overnight with 10 microg/mL fibronectin, 10 microg/mL poly-l-lysine, or phosphate-buffered saline. The sutures were placed in dishes and covered with a suspension of C3H10T1/2 cells at concentrations of 1 x 10(6), 2 x 10(6), or 4 x 10(6) cells for 24 hours. The sutures were then placed into low adhesion polypropylene tubes with Dulbecco's modified Eagle's medium and 10% fetal bovine serum for 7 days. The presence of viable cells on these sutures was assessed by the colorimetric Alamar blue cell proliferation assay. Spectrophotometry was used to quantify the relative amount of cell proliferation across the experimental groups. The sutures were also visually inspected using phase-contrast light microscopy.Our results show that at all seeding densities (1 x 10(6), 2 x 10(6), and 4 x 10(6) cells), the suture segments coated with poly-l-lysine and fibronectin showed a significant increase in C3H10T1/2 cell adhesion. Coating the suture with poly-l-lysine increased the adherent cell number to 17% of the initial seeding concentration compared with 2% for the control. Fibronectin coating increased the number of adherent viable cells present to 6.6%.Pluripotential embryonic cells may be seeded onto sutures, adhere, and survive in culture. Coating sutures with poly-l-lysine and fibronectin offers significant improvement in retention of viable cells. This technique may be a useful adjunct for future tendon healing studies.

View details for DOI 10.1016/j.jhsa.2008.06.010

View details for Web of Science ID 000260725900015
Early treatment of degenerative arthritis of the thumb carpometacarpal joint HAND CLINICS Yao, J., Park, M. J. 2008; 24 (3): 251-?
Abstract

Degenerative arthritis of the thumb carpometacarpal (CMC) joint is a common disorder that may affect anyone but most frequently affects the postmenopausal female population. Because of its high prevalence, the management of the condition has been a popular topic among hand surgeons and therapists worldwide. There are many decisions to consider when devising the appropriate treatment plan for each patient. In particular, early stages of thumb CMC joint arthritis may be treated nonoperatively or with less invasive surgical techniques to relieve symptoms, restore function and strength, stop the progression of the disease, and even potentially reverse the process. This article explores treatment options at the disposal of primary care physicians and hand surgeons for early thumb CMC arthritis.

View details for DOI 10.1016/j.hcl.2008.03.001

View details for Web of Science ID 000258826800005

View details for PubMedID 18675716
Update on the Triangular Fibrocartilage Complex Current Orthopaedic Practice, Zlotolow D (Ed) Lee AT, Yao J 2008; 19 (5): 509-514
A novel technique of all-inside arthroscopic triangular fibrocartilage complex repair ARTHROSCOPY-THE JOURNAL OF ARTHROSCOPIC AND RELATED SURGERY Yao, J., Dantuluri, P., Osterman, A. L. 2007; 23 (12)
Abstract

Peripheral triangular fibrocartilage complex (TFCC) tears are amenable to repair. Limitations of current repair techniques include prolonged recovery and button or knot intolerance. We present a novel technique of an all-inside repair using existing technology (FasT-Fix; Smith & Nephew Endoscopy, Andover, MA) to circumvent these complications. This technique is faster, easily performed, safe, and potentially stronger than current repairs. Earlier motion and rehabilitation are instituted after this repair. The tear is debrided to stimulate angiogenesis. The FasT-Fix is inserted through the 3-4 portal with the arthroscope in the 6R portal. The first poly-L-lactic acid block is deposited peripheral to the tear. Upon penetration of the wrist capsule, a distinct decrease in resistance is felt. The introducer is withdrawn, depositing the block outside the capsule. The trigger on the introducer advances the second block into the deployment position. It is advanced and deposited central to the tear, forming a vertical mattress configuration. The introducer is removed, leaving the pre-tied suture. The knot is tightened and cut by use of the knot pusher/cutter. Multiple implants may be inserted to complete the repair. Postoperative care involves a sugartong splint for 2 weeks followed by a short arm cast for 4 weeks. Range of motion is begun thereafter with strengthening started at 10 weeks.

View details for DOI 10.1016/j.arthro.2007.02.010

View details for Web of Science ID 000252189700019

View details for PubMedID 18063183
Tumours of the hand LANCET ONCOLOGY Hsu, C. S., Hentz, V. R., Yao, J. 2007; 8 (2): 157-166
Abstract

Hand tumours of soft-tissue and bony origin are frequently encountered, and clinicians must be able to distinguish typical benign entities from life-threatening or limb-threatening malignant diseases. In this Review, we present a diagnostic approach to hand tumours and describe selected cancers and their treatments. Soft-tissue tumours include ganglion cysts, giant-cell cancers and fibromas of the tendon sheath, epidermal inclusion cysts, lipomas, vascular lesions, peripheral-nerve tumours, skin cancers, and soft-tissue sarcomas. Bony tumours encompass enchondromas, aneurysmal bone cysts, osteoid osteomas, giant-cell lesions of bone, bone sarcomas, and metastases. We look at rates of recurrence and 5-year survival, and recommendations for adjunct chemotherapy and radiotherapy for malignant lesions.

View details for Web of Science ID 000244103100028

View details for PubMedID 17267330
Arthroscopic Treatment of Thumb Carpometacarpal Joint Arthritis Master Skills in Wrist and Elbow Arthroscopy and Reconstruction. Trumble TE, Budoff JE, eds. American Society for Surgery of the Hand. Yao J, Culp RW 2007: 315-322
Late Reconstruction for Ulnar Nerve Palsy Hand Clinics Tse, R., Hentz VR, Yao J 2007; 23 (3): 373-392
Arthroscopic Techniques for Wrist Arthritis (Radial Styloidectomy and Proximal Pole Hamate Excisions Hand Clinics Yao J, Osterman AL 2005; 21 (4): 519-526
Engaging Patients to Ask More Questions: What's the Best Way? A Pragmatic Randomized Controlled Trial. The Journal of hand surgery Roe, A. K., Eppler, S. L., Shapiro, L. M., Satteson, E. S., Yao, J., Kamal, R. N. 2021
Abstract

PURPOSE: Hand conditions are common, and often require a discussion of the tradeoffs of different treatment options. Our goal was to evaluate whether providing patients with a Question Prompt List (QPL) for common hand conditions improves their perceived involvement in care compared with providing patients with 3 generic questions.METHODS: We performed a prospective, single-center, pragmatic randomized controlled trial. We created a QPL pamphlet for patients with common hand conditions. New patients with common hand conditions were enrolled between April 2019 and July 2019 and were randomized into either the QPL group (with 35 hand-specific questions) or the AskShareKnow group (3 generic questions: [1] What are my options? [2] What are the possible benefits and harms of those options? [3] How likely are each of these benefit and harms to happen to me?). Both groups received the questions prior to meeting with their surgeon. We used the Perceived Involvement in Care Scale (PICS), a validated instrument designed to evaluate patient participation in decision-making, as our primary outcome. The maximum PICS score is 13, and a higher score indicates higher perceived involvement.RESULTS: One hundred twenty-six patients participated in the study, with 63 patients in the QPL group and 63 patients in the AskShareKnow group. The demographic characteristics were similar in the 2 groups. The mean AskShareKnow group PICS score was 8.3 � 2.2 and the mean QPL PICS score was 7.5 � 2.8, which was not deemed clinically significant.CONCLUSIONS: The QPLs do not increase perceived involvement in care in patients with hand conditions compared with providing patients with 3 generic questions.CLINICAL RELEVANCE: Various approaches have been evaluated to help improve patient involvement in their care. In hand surgery, 3 generic questions were no different than a lengthy QPL with respect to patient involvement in their care.

View details for DOI 10.1016/j.jhsa.2021.02.001

View details for PubMedID 33775464
The Importance of Concordance Between Patients and Their Subspecialists ORTHOPEDICS Shah, R. F., Mertz, K., Gil, J. A., Eppler, S. L., Amanatullah, D., Yao, J., Chou, L., Steffner, R., Safran, M., Hu, S. S., Kamal, R. N. 2020; 43 (5): 315-+
Abstract

Concordance, the concept of patients having shared demographic/socioeconomic characteristics with their physicians, has been associated with improved patient satisfaction and outcomes in primary care but has not been studied in subspecialty care. The objective of this study was to investigate whether patients value concordance with their specialty physicians. The authors assessed the importance of concordance in subspecialist care in 2 cohorts of participants. The first cohort consisted of patients seeking care at a multispecialty orthopedic clinic. The second cohort consisted of volunteer participants recruited from an online platform. Each participant completed a survey scored on an ordinal scale which characteristics of their physicians they find important for their primary care physician (PCP) and a specialist. The characteristics included age, sex, ethnicity, sexual orientation, primary language spoken, and religion. The difference in concordance scores for PCPs and specialists were compared with paired t tests with a Bonferroni correction. A total of 118 patients were recruited in clinic, and a total of 982 volunteers were recruited online. In the clinic cohort, the level of importance for patient-physician concordance of age, ethnicity, language, and religion was not significantly different between PCPs and specialists. In the volunteer cohort, the level of importance for concordance of age, sex, national origin, language, and religion was not significantly different between PCPs and specialists. The volunteers recruited online had significantly higher concordance scores than the patients recruited in clinic for most variables. Patients find patient-physician concordance as important in specialty care as they do in primary care. This may have similar effects on patient outcomes in specialty care. [Orthopedics. 2020;43(5):315-319.].

View details for DOI 10.3928/01477447-20200818-01

View details for Web of Science ID 000608158400032

View details for PubMedID 32931591
A Simple Goal Elicitation Tool Improves Shared Decision Making in Outpatient Orthopedic Surgery: A Randomized Controlled Trial. Medical decision making : an international journal of the Society for Medical Decision Making Mertz, K., Shah, R. F., Eppler, S. L., Yao, J., Safran, M., Palanca, A., Hu, S. S., Gardner, M., Amanatullah, D. F., Kamal, R. N. 2020: 272989X20943520
Abstract

Introduction. Shared decision making involves educating the patient, eliciting their goals, and collaborating on a decision for treatment. Goal elicitation is challenging for physicians as previous research has shown that patients do not bring up their goals on their own. Failure to properly elicit patient goals leads to increased patient misconceptions and decisional conflict. We performed a randomized controlled trial to test the efficacy of a simple goal elicitation tool in improving patient involvement in decision making. Methods. We conducted a randomized, single-blind study of new patients presenting to a single, outpatient surgical center. Prior to their consultation, the intervention group received a demographics questionnaire and a goal elicitation worksheet. The control group received a demographics questionnaire only. After the consultation, both groups were asked to complete the Perceived Involvement in Care Scale (PICS) survey. We compared the mean PICS scores for the intervention and control groups using a nonparametric Mann-Whitney Wilcoxon test. Secondary analysis included a qualitative content analysis of the patient goals. Results. Our final cohort consisted of 96 patients (46 intervention, 50 control). Both groups were similar in terms of demographic composition. The intervention group had a significantly higher mean (SD) PICS score compared to the control group (9.04 [2.15] v. 7.54 [2.27], P < 0.01). Thirty-nine percent of patient goals were focused on receiving a diagnosis or treatment, while 21% of patients wanted to receive education regarding their illness or their treatment options. Discussion. A single-step goal elicitation tool was effective in improving patient-perceived involvement in their care. This tool can be efficiently implemented in both academic and nonacademic settings.

View details for DOI 10.1177/0272989X20943520

View details for PubMedID 32744134
Development and Testing of a Question Prompt List for Common Hand Conditions: An Exploratory Sequential Mixed-Methods Study. The Journal of hand surgery Satteson, E. S., Roe, A. K., Eppler, S. L., Yao, J., Shapiro, L. M., Kamal, R. N. 2020
Abstract

PURPOSE: A question prompt list (QPL) is a tool that lists possible questions a patient may want to ask their surgeon. Its purpose is to improve patient-physician communication and increase patient engagement. Although QPLs have been developed in other specialties, one does not exist for hand conditions. We sought to develop a QPL for use in the hand surgery clinic using a mixed-methods design.METHODS: We drafted a QPL based on prior work outside of hand surgery and then used an exploratory sequential mixed-methods design (both qualitative and quantitative methods) to finalize the QPL. Qualitative evaluation included both a written questionnaire completed by a patient advisory board, hand therapists, and hand surgeons, as well as cognitive interviews conducted with clinic patients using the tool. Revisions to the QPL were made after each phase of qualitative analysis. The final QPL was then evaluated quantitatively using the system usability score (SUS) questionnaire to assess its usability.RESULTS: A patient advisory board consisting of 6 patients, 5 hand therapists, and 6 hand surgeons completed the written questionnaire. Thirteen patients completed a cognitive interview of the QPL. We completed a content analysis of the qualitative data and incorporated the findings into the QPL. Twenty patients then reviewed the final QPL pamphlet and completed the SUS questionnaire. The resulting SUS score of 78.8 indicated above-average usability of the QPL tool.CONCLUSIONS: The QPL developed in this study, from the perspective of multiple stakeholders, provides a usable tool to engage and prompt patients in asking questions during their visit with their hand surgeon with the potential to improve communication and patient-centered care.CLINICAL RELEVANCE: This study provides clinicians with a QPL developed for use in the hand surgery clinic setting, aimed at facilitating more thorough patient-provider discussion.

View details for DOI 10.1016/j.jhsa.2020.05.015

View details for PubMedID 32693988
Single Assessment Numeric Evaluation (SANE) in Hand Surgery: Does a One-Question Outcome Instrument Compare Favorably? The Journal of hand surgery Gire, J. D., Koltsov, J. C., Segovia, N. A., Kenney, D. E., Yao, J., Ladd, A. L. 2020
Abstract

PURPOSE: Patient-reported outcome measures are increasingly used to measure patient status, impairments, and disability, but often require lengthy surveys and place a considerable burden on patients. We hypothesized that the Single Assessment Numeric Evaluation (SANE), composed of a single question, would be a valid and responsive instrument to provide a global assessment of hand function.METHODS: The SANE, Patient-Reported Outcomes Measurement Information System-Upper Extremity (PROMIS-UE), and Quick-Disabilities of the Arm, Shoulder, and Hand (QuickDASH) data are routinely collected electronically in our hand and upper-extremity center. To identify our cohort, we used Current Procedural Terminology codes to query our electronic medical record research data repository for the 7 most common hand surgery procedures performed over 2 years from December 2016 to 2018. These procedures included carpal tunnel release, trigger finger release, thumb carpometacarpal arthroplasty, wrist arthroscopy, distal radius fracture fixation, first dorsal compartment release, and cubital tunnel release. Patients undergoing a single isolated procedure with questionnaires obtained in the preoperative and/or postoperative period were included in the analysis. Convergent validity, coverage, and responsiveness for each instrument were assessed.RESULTS: We identified 214 patients for inclusion. The SANE score had a moderate to strong correlation with the QuickDASH and PROMIS-UE. Floor and ceiling effects for the SANE were less than 10% at baseline and follow-up. Overall, the QuickDASH was the most responsive, followed by SANE and PROMIS-UE; all 3 instruments exceeded the acceptable thresholds for responsiveness and demonstrated significant changes before to after surgery. Responsiveness of the SANE varied by procedure and was acceptable for carpal tunnel release, carpometacarpal arthroplasty, wrist arthroscopy, and trigger finger release.CONCLUSIONS: The single-item SANE is a reasonable measure of global function in patients undergoing common hand procedures and demonstrates psychometric properties comparable to those of the PROMIS-UE and QuickDASH outcome scores.CLINICAL RELEVANCE: The SANE score is a reasonable outcome measure of global hand function that may have utility in demonstrating response to treatment in a practice setting and may provide a useful adjunct to multiple-item measures in clinical research studies.

View details for DOI 10.1016/j.jhsa.2020.03.024

View details for PubMedID 32482496
Morphology at the Distal Radioulnar Joint: Identifying the Prevalence of Reverse Obliquity. Journal of wrist surgery O'Shaughnessy, M. n., Shapiro, L. M., Schultz, B. n., Retzky, J. n., Finlay, A. K., Yao, J. n. 2020; 9 (5): 417?24
Abstract

Background ?Recent advances in the understanding of ulnar-sided wrist pathologies such as ulnar abutment syndrome (UAS) have brought increased attention to the anatomy of the distal radioulnar joint (DRUJ). Previous work established three anatomical variants of the sigmoid notch (parallel, oblique, and reverse oblique). The reverse oblique DRUJ poses theoretical risk of increased contact forces following ulnar shortening osteotomy, a common method of treating UAS. Purpose ?As prevalence of reverse oblique morphology has been under-reported, this study aims to better define the prevalence of reverse oblique morphology in the adult population. Methods ?Institutional Review Board-approved review of 1,000 radiographs over a 2-year period was performed. Demographic data and radiographic measurements were recorded (ulnar variance, notch inclination, and presence of arthritis). Correlation tests, a test of proportions, a t -test, and linear and logic regression tests were used to examine associations between ulnar variance, sigmoid inclination, sex, age, and presence of arthritis. Results ?One thousand radiographs were analyzed revealing prevalence rates of: parallel-68%, oblique-26%, and reverse oblique-6%. Females were significantly more likely to have reverse inclination. No significant correlation was noted for morphology by age. Ulna positive variance was negatively correlated with reverse inclination. DRUJ arthritis was noted in 14% of patients. Higher sigmoid inclination was associated with higher odds of presence of arthritis, adjusting for sex and age. Higher incidence of arthritis was noted among patients with the oblique (20.8%) or reverse oblique (24.6%) compared with parallel (10.5%) morphology. Conclusion ?This series of 1,000 radiographs demonstrates a 6% overall prevalence of reverse obliquity. This large dataset allows for better quantification of the prevalence of DRUJ morphologies and determination of correlations that have clinical implications for patients with ulnar-sided wrist pathology. Level of Evidence ?This is a Level IV study.

View details for DOI 10.1055/s-0040-1713158

View details for PubMedID 33042645

View details for PubMedCentralID PMC7540646
Technical Errors in the Implantation of the Scapholunate Axis Method (SLAM) Resulting in Avascular Necrosis of the Lunate. The Journal of hand surgery Zlotolow, D. A., Lee, S. K., Yao, J. n. 2020
View details for DOI 10.1016/j.jhsa.2020.03.012

View details for PubMedID 32327335
Prevalence of Ganglion Cyst Formation After Wrist Arthroscopy: A Retrospective Longitudinal Analysis of 2420 Patients. Hand (New York, N.Y.) Rochlin, D. H., Perrault, D. n., Sheckter, C. C., Fox, P. n., Yao, J. n. 2020: 1558944720939203
Abstract

Dorsal wrist ganglion cysts arise from the leakage of synovial fluid through tears in the scapholunate ligament and/or dorsal wrist capsule. An analogous disruption of the dorsal capsule is created with routine portal placement during wrist arthroscopy. We hypothesized that wrist arthroscopy would predispose to wrist ganglions.Using the Truven MarketScan Outpatient Services Database from 2015 to 2016, patients who underwent wrist arthroscopy and developed an ipsilateral wrist ganglion were identified. Exclusion criteria included ganglion diagnosis preceding arthroscopy and bilateral pathology. Postoperative ganglion diagnosis was modeled with logistic regression. Predictor variables included age, gender, comorbidities, and arthroscopic procedure.In all, 2420 patients underwent wrist arthroscopy. Thirty (1.24%) were diagnosed with an ipsilateral wrist ganglion at a mean time of 4.0 months (standard deviation: 2.4, range: 0.2-9.0). Significant predictors of ganglion diagnosis included female gender (odds ratio [OR]: 4.0, P < .01) and triangular fibrocartilage complex and/or joint debridement (OR: 0.13, P < .01). By comparison, among all 24,718,751 outpatients who had not undergone wrist arthroscopy, 39,832 patients had a diagnosis of a wrist ganglion cyst (0.16%).Wrist arthroscopy is associated with a postoperative rate of ganglion cyst formation that is nearly 8 times the rate in the general population. Additional studies are needed to investigate techniques that minimize the risk of this complication.

View details for DOI 10.1177/1558944720939203

View details for PubMedID 32935572
Financial Distress Is Associated With Delay in Seeking Care for Hand Conditions. Hand (New York, N.Y.) Zhuang, T., Eppler, S. L., Shapiro, L. M., Roe, A. K., Yao, J., Kamal, R. N. 2019: 1558944719866889
Abstract

Background: As medical costs continue to rise, financial distress due to these costs has led to poorer health outcomes and patient cost-coping behavior. Here, we test the null hypothesis that financial distress is not associated with delay of seeking care for hand conditions. Methods: Eighty-seven new patients presenting to the hand clinic for nontraumatic conditions completed our study. Patients completed validated instruments for measuring financial distress, pain catastrophizing, and pain. Questions regarding delay of care were included. The primary outcome was self-reported delay of the current hand clinic visit. Results: Patients who experience high financial distress differed significantly from those who experience low financial distress with respect to age, race, annual household income, and employment status. Those experiencing high financial distress were more likely to report having delayed their visit to the hand clinic (57% vs 30%), higher pain catastrophizing scores (17.7 vs 7.6), and higher average pain in the preceding week (4.5 vs 2.3). After adjusting for age, sex, and pain, high financial distress (adjusted odds ratio [OR] = 4.90) and pain catastrophizing score (adjusted OR = 0.96) were found to be independent predictors of delay. Financial distress was highly associated with annual household income in a multivariable linear regression model. Conclusions: Patients with nontraumatic hand conditions who experience higher financial distress are more likely to delay their visit to the hand clinic. Within health care systems, identification of patients with high financial distress and targeted interventions (eg, social or financial services) may help prevent unnecessary delays in care.

View details for DOI 10.1177/1558944719866889

View details for PubMedID 31409138
The Association of Financial Distress With Disability in Orthopaedic Surgery. The Journal of the American Academy of Orthopaedic Surgeons Mertz, K., Eppler, S. L., Thomas, K., Alokozai, A., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. N. 2019; 27 (11): e522?e528
Abstract

INTRODUCTION: Increased out-of-pocket costs have led to patients bearing more of the financial burden for their care. Previous work has shown that financial burden and distress can affect outcomes, symptoms, satisfaction, and adherence to treatment. We asked the following questions: (1) Does patients' financial distress correlate with disability in patients with nonacute orthopaedic conditions? (2) Do patient demographic factors affect this correlation?METHODS: We conducted a cross-sectional, observational study of new patients presenting to a multispecialty orthopaedic clinic with a nonacute orthopaedic complication. Patients completed a demographics questionnaire, the InCharge Financial Distress/Financial Well-Being Scale, and the Health Assessment Questionnaire Disability Index. Statistical analysis was done using Pearson's correlation.RESULTS: The mean score for financial distress was 4.10 (SD, 2.09; scale 1 [low distress] to 10 [high distress]; range, 1.13 to 10.0), and the mean disability score was 0.54 (SD, 0.65; scale 0 to 3; range, 0 to 2.75). A moderate positive correlation exists between financial distress and disability (r = 0.43; P < 0.01). Financial distress and disability were highest for poor, uneducated, Medicare patients.CONCLUSIONS: A moderate correlation exists between financial distress and disability in patients with nonacute orthopaedic conditions, particularly in patients with low socioeconomic status. Orthopaedic surgeons may benefit from identifying patients in financial distress and discussing the cost of treatment because of its association with disability and potentially inferior outcomes. Further investigation is needed to test whether decreasing financial distress decreases disability.LEVEL OF EVIDENCE: Level III prospective cohort.

View details for DOI 10.5435/JAAOS-D-18-00252

View details for PubMedID 31125323
Bony Incarceration of the Extensor Pollicis Longus Tendon Mimicking Rupture. Journal of wrist surgery Barrera, J. n., Ryu, J. n., Yao, J. n. 2019; 8 (3): 245?49
Abstract

Background ?Distal radius fractures are a relatively common injury, and rupture of the extensor pollicis longus (EPL) has been known to occur in a small number of nondisplaced distal radius fractures. In contrast, bony incarceration of the EPL tendon is an exceedingly rare occurrence and warrants special attention. Case Description ?Here we present a case of bony incarceration of the EPL tendon following distal radius fracture that mimicked tendon rupture. Following EPL release, the patient had improved function and pain in the wrist. Literature Review ?We identified three case reports of EPL tendon entrapment following distal radius fracture, and compared and contrasted the clinical features of tendon rupture versus bony entrapment. Clinical Relevance ?Our results suggest that both the type of fracture (displaced vs. nondisplaced) and the chronicity of symptoms may provide important diagnostic clues for the hand surgeon managing distal radius fracture patients presenting with EPL dysfunction.

View details for DOI 10.1055/s-0038-1675562

View details for PubMedID 31192048

View details for PubMedCentralID PMC6546488
Management of Isolated Capitate Nonunion: A Case Series and Literature Review. Journal of wrist surgery Jethanandani, R. G., Rancy, S. K., Corpus, K. T., Yao, J., Wolfe, S. W. 2018; 7 (5): 419?23
Abstract

Background Isolated capitate nonunion is rare. No consensus on the appropriate treatment for this condition exists. Case Description We reported two cases of capitate fracture nonunion presenting several months after untreated high-impact wrist trauma. Treatment was delayed as both patients' nonunions were missed on conventional radiographs. Both were ultimately diagnosed with advanced imaging and successfully treated with internal fixation and autogenous bone grafting. The relevant literature pertaining to capitate nonunion was reviewed. Literature Review Immobilization and internal fixation with bone grafting for capitate nonunion have been described in the literature. Loss of vascular supply and progression to avascular necrosis is a concern after capitate nonunion. Clinical Relevance We present two cases and review the literature on the diagnosis and treatment of this rare injury to guide management. Internal fixation with autogenous bone grafting could play a role in management for this rare condition.

View details for PubMedID 30349757
The Effect of Growth Differentiation Factor 8 (Myostatin) on Bone Marrow-Derived Stem Cell-Coated Bioactive Sutures in a Rabbit Tendon Repair Model. Hand (New York, N.Y.) Muraoka, K., Le, W., Behn, A. W., Yao, J. 2018: 1558944718792708
Abstract

BACKGROUND: We have reported that bioactive sutures coated with bone marrow-derived mesenchymal stem cells (BMSCs) enhance tendon repair strength in an in vivo rat model. We have additionally shown that growth differentiation factor 8 (GDF-8, also known as myostatin) simulates tenogenesis in BMSCs in vitro. The purpose of this study was to determine the possibility of BMSC-coated bioactive sutures treated with GDF-8 to increase tendon repair strength in an in vivo rabbit tendon repair model.METHODS: Rabbit BMSCs were grown and seeded on to 4-0 Ethibond sutures and treated with GDF-8. New Zealand white rabbits' bilateral Achilles tendons were transected and randomized to experimental (BMSC-coated bioactive sutures treated with GDF-8) or plain suture repaired control groups. Tendons were harvested at 4 and 7 days after the surgery and subjected to tensile mechanical testing and quantitative polymerase chain reaction.RESULTS: There were distinguishing differences of collagen and matrix metalloproteinase RNA level between the control and experimental groups in the early repair periods (day 4 and day 7). However, there were no significant differences between the experimental and control groups in force to 1-mm or 2-mm gap formation or stiffness at 4 or 7 days following surgery.CONCLUSIONS: BMSC-coated bioactive sutures with GDF-8 do not appear to affect in vivo rabbit tendon healing within the first week following repair despite an increased presence of quantifiable RNA level of collagen. GDF-8's treatment efficacy of the early tendon repair remains to be defined.

View details for PubMedID 30079783
Patient Perceptions Correlate Weakly With Observed Patient Involvement in Decision-making in Orthopaedic Surgery. Clinical orthopaedics and related research Mertz, K., Eppler, S., Yao, J., Amanatullah, D. F., Chou, L., Wood, K. B., Safran, M., Steffner, R., Gardner, M., Kamal, R. 2018
Abstract

BACKGROUND: Shared decision-making between patients and physicians involves educating the patient, providing options, eliciting patient preferences, and reaching agreement on a decision. There are different ways to measure shared decision-making, including patient involvement, but there is no consensus on the best approach. In other fields, there have been varying relationships between patient-perceived involvement and observed patient involvement in shared decision-making. The relationship between observed and patient-perceived patient involvement in decision-making has not been studied in orthopaedic surgery.QUESTIONS/PURPOSES: (1) Does patient-perceived involvement correlate with observed measurements of patient involvement in decision-making in orthopaedic surgery? (2) Are patient demographics associated with perceived and observed measurements of patient involvement in decision-making?METHODS: We performed a prospective, observational study to compare observed and perceived patient involvement in new patient consultations for eight orthopaedic surgeons in subspecialties including hand/upper extremity, total joint arthroplasty, spine, sports, trauma, foot and ankle, and tumor. We enrolled 117 English-literate patients 18 years or older over an enrollment period of 2 months. A member of the research team assessed observed patient involvement during a consultation with the Observing Patient Involvement in Decision-Making (OPTION) instrument (scaled 1-100 with higher scores representing greater involvement). After the consultation, we asked patients to complete a questionnaire with demographic information including age, sex, race, education, income, marital status, employment status, and injury type. Patients also completed the Perceived Involvement in Care Scale (PICS), which measures patient-perceived involvement (scaled 1-13 with higher scores representing greater involvement). Both instruments are validated in multiple studies in various specialties and the physicians were blinded to the instruments used. We assessed the correlation between observed and patient-perceived involvement as well as tested the association between patient demographics and patient involvement scores.RESULTS: There was weak correlation between observed involvement (OPTION) and patient-perceived involvement (PICS) (r = 0.37, p < 0.01) in decision-making (mean OPTION, 28.7, SD 7.7; mean PICS, 8.43, SD 2.3). We found a low degree of observed patient involvement despite a moderate to high degree of perceived involvement. No patient demographic factor had a significant association with patient involvement.CONCLUSIONS: Further work is needed to identify the best method for evaluating patient involvement in decision-making in the setting of discordance between observed and patient-perceived measurements. Knowing whether it is necessary for (1) actual observable patient involvement to occur; or (2) a patient to simply believe they are involved in their care can inform physicians on the best way to improve shared decision-making in their practice.LEVEL OF EVIDENCE: Level II, therapeutic study.

View details for PubMedID 29965894
Anatomy and Biomechanics of the Finger Proximal Interphalangeal Joint HAND CLINICS Pang, E., Yao, J. 2018; 34 (2): 121-+
Abstract

A complete understanding of the normal anatomy and biomechanics of the proximal interphalangeal joint is critical when treating pathology of the joint as well as in the design of new reconstructive treatments. The osseous anatomy dictates the principles of motion at the proximal interphalangeal joint. Subsequently, the joint is stabilized throughout its motion by the surrounding proximal collateral ligament, accessory collateral ligament, and volar plate. The goal of this article is to review the normal anatomy and biomechanics of the proximal interphalangeal joint and its associated structures, most importantly the proper collateral ligament, accessory collateral ligament, and volar plate.

View details for PubMedID 29625632
Ex-vivo Tendon Repair Augmented with Bone Marrow Derived Mesenchymal Stem Cells Stimulated with Myostatin for Tenogenesis JOURNAL OF HAND SURGERY-ASIAN-PACIFIC VOLUME Le, W., Cheah, A., Yao, J. 2018; 23 (1): 47?57
Abstract

To investigate the effect of myostatin (GDF-8) stimulation of bone marrow derived mesenchymal stem cells (BMSCs) on tenogenesis in the setting of tendon repair. GDF-8 has demonstrated the ability to augment tenogenesis and we sought to identify if this effect could lead to the focused differentiation of pluripotential stem cells down a tenocyte lineage ex vivo.Cadaveric upper limb flexor tendons were harvested, decellularized and divided into 1 cm segments. Sutures seeded with stem cells were passed through tendon segments to simulate repair. The repaired tendons were then cultured either with or without myostatin for 3, 5, and 7 days. The experiment was also repeated with non-decellularized tendons for a total of 4 groups. The tendons were then evaluated for the expression of scleraxis and tenomodulin, two biomarkers for tendon.Myostatin stimulation led to an increase in expression of tenomodulin and scleraxis at 5 and 7 days in both the decellularized and non-decellularized tendons. Myostatin increased the differentiation of BMSCs into tenocytes and/or led to the upregulation of tenomodulin and scleraxis production by the native tenocytes present within the non-decellularized tendons.The addition of myostatin to BMSCs leads to tenocyte differentiation as evidenced by the expression of tenocyte biomarkers, scleraxis and tenomodulin. This effect is maintained in an ex vivo tendon repair model suggestive that these cells survive the passage through tendon tissue and remain metabolically active.

View details for PubMedID 29409426
Fracture Fixation Plastic Surgery: Hand Volume Cox C, Yao J ; Chang, ed: Pub Pending
Proximal Pole Scaphoid Nonunions Treated with Rib Autograft The Scaphoid Yao J, Read B ; Slutsky ed: Pub Pending
Elbow Instability Musculoskeletal Examination of the Elbow Wrist and Hand Park MJ, Yao J ; Culp, ed.: Pub Pending
Diagnosis and Treatment of DRUJ/TFCC Injuries Musculoskeletal Examination of the Elbow, Wrist and Hand Park MJ, Yao J ; Culp, ed.: Pub Pending
Incidence of Posterior Interosseous Nerve Trauma During Creation of the 3-4 Wrist Arthroscopy Portal in Cadavers. Arthroscopy Cheah, A. E., Le, W., Yao, J. 2017
Abstract

To describe histologic evidence of nerve trauma during the creation and use of the 3-4 portal.Fourteen fresh-frozen cadaveric wrists were mounted on a custom-built frame that simulated a wrist arthroscopy traction tower. After the 3-4 portal was created in the usual manner, the skin was dissected off to identify possible trauma to the posterior interosseous nerve (PIN). Specimens were categorized into those where there was clearly no trauma to the PIN and those where trauma was possible. In the cases where trauma was possible, we harvested the PIN with a cuff of the proximal edge of the portal and examined the cross-sectional histology of the most distal sections for the presence of neural tissue.There was clearly no trauma to the PIN in 3 of the wrists during the creation of the 3-4 portal. In the remaining 11 wrists with possible trauma to the PIN, we identified axonal�tissue on histologic examination at the proximal edge of the 3-4 portal in 7 of these specimens. In summary, 50% (7 of 14) of our specimens had visual and histologic evidence of trauma to the PIN.Based on the findings of this study, there may be more instances of trauma to the PIN during routine wrist arthroscopy than have been previously reported.Findings suggest that transection or injury to this nerve may not lead to any clinical sequelae. However, if there is an instance where a patient has persistent, otherwise unexplained, dorsal wrist pain after a wrist arthroscopy procedure, iatrogenic neuroma of the PIN may be responsible and should be considered.

View details for DOI 10.1016/j.arthro.2017.01.010

View details for PubMedID 28237081
Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU). Current reviews in musculoskeletal medicine Pang, E. Q., Yao, J. 2017
Abstract

The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes.Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients. In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.

View details for DOI 10.1007/s12178-017-9384-9

View details for PubMedID 28185125

View details for PubMedCentralID PMC5344855
Quality Measures That Address the Upper Limb JOURNAL OF HAND SURGERY-AMERICAN VOLUME Kamal, R. N., Ring, D., Akelman, E., Ruch, D. S., Richard, M. J., Ladd, A., Got, C., Blazar, P., Yao, J., Kakar, S. 2016; 41 (11): 1041-1048
Abstract

Physicians, health care systems, and payers use quality measures to judge performance and monitor the outcomes of interventions. Practicing upper-limb surgeons desire quality measures that are important to patients and feasible to use, and for which it is fair to hold them accountable.Nine academic upper-limb surgeons completed a RAND/University of California-Los Angeles Delphi Appropriateness process to evaluate the importance, feasibility, and accountability of 134 quality measures identified from systematic review. Panelists rated measures on an ordinal scale between 1 (definitely not valid) and 9 (definitely valid) in 2 rounds (preliminary round and final round) with an intervening face-to-face discussion. Ratings from 1 to 3 were considered not valid, 4 to 6 were equivocal or uncertain, and 7 to 9 were valid. If no more than 2 of the 9 ratings were outside the 3-point range that included the median (1-3, 4-6, or 7-9), panelists were considered to be in agreement. If 3 or more ratings of a measure were within the 1 to 3 range whereas 3 or more ratings were in the 7 to 9 range, panelists were considered to be in disagreement.There was agreement that 58 of the measures are important (43%), 74 are feasible (55%), and surgeons can be held accountable for 39 (29%). All 3 thresholds were met for 33 measures (25%). A total of 36 reached agreement for being unimportant (48%) and 57 were not suited for surgeon accountability (43%).A minority of upper-limb quality measures were rated as important for care, feasible to complete, and suitable for upper-limb surgeon accountability.Before health systems and payers implement quality measures, we recommend ensuring their importance and feasibility to safeguard against measures that may not improve care and might misappropriate attention and resources.

View details for DOI 10.1016/j.jhsa.2016.07.107

View details for Web of Science ID 000387632600001

View details for PubMedID 27577525
Quality Measurement: A Primer for Hand Surgeons JOURNAL OF HAND SURGERY-AMERICAN VOLUME Kamal, R. N., Kakar, S., Ruch, D., Richard, M. J., Akelman, E., Got, C., Blazar, P., Ladd, A., Yao, J., Ring, D. 2016; 41 (5): 645-651
Abstract

As the government and payers place increasing emphasis on measuring and reporting quality and meeting-specific benchmarks, physicians and health care systems will continue to adapt to meet regulatory requirements. Hand surgeons' involvement in quality measure development will help ensure that our services are appropriately assessed. Moreover, by embracing a culture of quality assessment and improvement, we will improve patient care while demonstrating the importance of our services in a health care system that is transitioning from a fee-for-service model to a fee-for-value model. Understanding quality and the tools for its measurement, and the application of quality assessment and improvement methods can�help�hand surgeons continue to deliver high-quality care that aligns with national priorities.

View details for DOI 10.1016/j.jhsa.2015.10.002

View details for PubMedID 26576831
Quality Measures in Upper Limb Surgery. journal of bone and joint surgery. American volume Kamal, R. N., Ring, D., Akelman, E., Yao, J., Ruch, D. S., Richard, M., Ladd, A., Got, C., Blazar, P., Kakar, S. 2016; 98 (6): 505-510
Abstract

Quality measures are now commonplace and are increasingly tied to financial incentives. We reviewed the existing quality measures that address the upper limb and tested the null hypothesis that structure (capacity to deliver care), process (appropriate care), and outcome (the result of care) measures are equally represented.We systematically reviewed MEDLINE/PubMed, Embase, Google Scholar, the American Academy of Orthopaedic Surgeons Clinical Practice Guidelines, the National Quality Forum, the Agency for Healthcare Research and Quality, and the Physician Quality Reporting System for quality measures addressing upper limb surgery. Measures were characterized as structure, process, or outcome measures and were categorized according to their developer and their National Strategy for Quality Improvement in Health Care (National Quality Strategy) priority as articulated by the U.S. Department of Health & Human Services.We identified 134 quality measures addressing the upper limb: 131 (98%) process and three (2%) outcome measures. The majority of the process measures address the National Quality Strategy priority of effective clinical care (90%), with the remainder addressing communication and care coordination (5%), person and caregiver-centered experience and outcomes (4%), and community/population health (1%).Our review identified opportunities to develop more measures in the structure and outcome domains as well as measures addressing patient and family engagement, public health, safety, care coordination, and efficient use of resources. The most common existing measures-process measures addressing care-might not be the best measures of upper limb surgery quality given the relative lack of evidence for their use in care improvement.

View details for DOI 10.2106/JBJS.15.00651

View details for PubMedID 26984919
Hand Therapy Modalities for Proximal Interphalangeal Joint Stiffness JOURNAL OF HAND SURGERY-AMERICAN VOLUME Comer, G. C., Clark, S. J., Yao, J. 2015; 40 (11): 2293-2296
View details for DOI 10.1016/j.jhsa.2015.06.118

View details for Web of Science ID 000364804100030

View details for PubMedID 26272795
Hand Therapy Modalities Following Extensor Mechanism Surgery. journal of hand surgery Comer, G. C., Gordon, C., Yao, J. 2015; 40 (10): 2081-2084
View details for DOI 10.1016/j.jhsa.2015.04.043

View details for PubMedID 26209562
Perioperative Management of Diabetic Patients Undergoing Hand Surgery JOURNAL OF HAND SURGERY-AMERICAN VOLUME Kang, J. R., Yao, J. 2015; 40 (5): 1028?31
View details for PubMedID 25911211
Failure of artelon interposition arthroplasty after partial trapeziectomy: a case report with histologic and immunohistochemical analysis. American journal of orthopedics (Belle Mead, N.J.) Huang, Y., Jazayeri, L., Le, W., Yao, J. 2015; 44 (4): E117?22
Abstract

Artelon is a degradable biomaterial used for the treatment of osteoarthritis in the carpometacarpal joint of the thumb. The device reportedly works through 2 modes of action-stabilization of the carpometacarpal joint by augmentation of the joint capsule and by formation of a new articular surface at the trapeziometacarpal interface. We present a patient with late failure of arthroscopic hemitrapeziectomy and Artelon interposition that required surgical excision of the Artelon implant and trapeziectomy 4 years postoperatively. Gross and histologic evaluation of the explanted Artelon implant and remaining trapezium revealed lack of articular resurfacing by hyaline ingrowth.

View details for PubMedID 25844594
Advances in Hand and Wrist Arthroscopy PLASTIC AND RECONSTRUCTIVE SURGERY Park, M. J., Yao, J. 2014; 134 (5): 758E-765E
Abstract

Hand and wrist arthroscopy has gained popularity over the past few decades. Arthroscopy is a valuable diagnostic tool in cases where clinical and radiographic findings do not show a clear picture of the patient's pathologic condition. Arthroscopy also allows care providers to perform therapeutic interventions in a less invasive manner than would have been possible with a standard open approach. Over the past three decades, there have been substantial advances in the techniques and outcomes in hand and wrist arthroscopy. With this article, the authors aim to introduce the application of newer arthroscopic techniques in the hand and wrist that may be of diagnostic and/or therapeutic value.

View details for DOI 10.1097/PRS.0000000000000593

View details for Web of Science ID 000344546000012
In reply. journal of hand surgery Carvalho, B., Ahsan, Z. S., Yao, J. 2014; 39 (9): 1888-1889
View details for DOI 10.1016/j.jhsa.2014.06.124

View details for PubMedID 25154582
Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty for the Treatment of Geriatric Distal Humerus Fractures: A Systematic Review and Meta-Analysis JOURNAL OF ORTHOPAEDIC TRAUMA Githens, M., Yao, J., Sox, A. H., Bishop, J. 2014; 28 (8): 481-488
Abstract

The purpose of this systematic review and meta-analysis was to pool and analyze outcomes and complication rates in elderly patients with intraarticular distal humerus fractures being treated with either total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) with locking plates.PubMed, Embase, and the Cochrane databases were used. The search included publications up to June 2013. Article selection was independently performed by 2 authors and disagreements were resolved by consensus.Studies meeting criteria for inclusion were observational cohort studies or randomized controlled trials evaluating functional and radiographic outcomes and complications in elderly patients treated for distal humerus fractures with either primary TEA or ORIF with locking plates. Studies with mean age <60 years, indications for TEA other than acute fracture, and those including nonlocked plates were excluded.Standardized data extraction was performed. A quality assessment tool was used to evaluate individual study methodology.Descriptive statistics for functional outcomes were reported. Meta-analysis and regression analysis were performed for complication rates.A systematic review and meta-analysis revealed that TEA and ORIF for the treatment of geriatric distal humerus fractures produced similar functional outcome scores and range of motion. Although there was a trend toward a higher rate of major complications and reoperation after ORIF, this was not statistically significant. The quality of study methodology was generally weak. Ongoing research including prospective trials and cost analysis is indicated to better define the roles of ORIF versus TEA in the management of these injuries.

View details for Web of Science ID 000340149400019
Open Reduction and Internal Fixation Versus Total Elbow Arthroplasty for the Treatment of Geriatric Distal Humerus Fractures: A Systematic Review and Meta-Analysis. Journal of orthopaedic trauma Githens, M., Yao, J., Sox, A. H., Bishop, J. 2014; 28 (8): 481-488
Abstract

The purpose of this systematic review and meta-analysis was to pool and analyze outcomes and complication rates in elderly patients with intraarticular distal humerus fractures being treated with either total elbow arthroplasty (TEA) or open reduction and internal fixation (ORIF) with locking plates.PubMed, Embase, and the Cochrane databases were used. The search included publications up to June 2013. Article selection was independently performed by 2 authors and disagreements were resolved by consensus.Studies meeting criteria for inclusion were observational cohort studies or randomized controlled trials evaluating functional and radiographic outcomes and complications in elderly patients treated for distal humerus fractures with either primary TEA or ORIF with locking plates. Studies with mean age <60 years, indications for TEA other than acute fracture, and those including nonlocked plates were excluded.Standardized data extraction was performed. A quality assessment tool was used to evaluate individual study methodology.Descriptive statistics for functional outcomes were reported. Meta-analysis and regression analysis were performed for complication rates.A systematic review and meta-analysis revealed that TEA and ORIF for the treatment of geriatric distal humerus fractures produced similar functional outcome scores and range of motion. Although there was a trend toward a higher rate of major complications and reoperation after ORIF, this was not statistically significant. The quality of study methodology was generally weak. Ongoing research including prospective trials and cost analysis is indicated to better define the roles of ORIF versus TEA in the management of these injuries.

View details for DOI 10.1097/BOT.0000000000000050

View details for PubMedID 24375273
Ulnar shortening osteotomy utilizing a TriMed ulnar osteotomy system. Techniques in hand & upper extremity surgery Pouliot, M., Yao, J. 2014; 18 (2): 72?76
Abstract

Ulnar impaction syndrome (UIS) is a degenerative condition of the ulnar wrist typically seen in patients with static or dynamic ulnar-positive variance. Impaction of the distal ulna on the proximal lunate and triquetrum leads to degeneration of the triangular fibrocartilage complex and/or the chondral surfaces of the lunate and triquetrum. Patients with UIS present with pain in the ulnar aspect of the wrist. In cases of UIS refractory to nonoperative treatment, several surgical techniques have been described, including arthroscopic triangular fibrocartilage complex debridement, arthroscopic wafer procedure, and ulnar shortening osteotomy (USO). USO has gained favor as a reliable technique to offload the forces seen at the ulnar wrist extra-articularly while preserving the distal radioulnar joint stabilizing structures. We describe a technique utilizing a jig-facilitated, oblique, diaphyseal USO and fixed with a TriMed ulnar osteotomy compression plate. This system allows for precise measured ulnar shortening and reliable compression across the osteotomy site, and has been shown to decrease operative times and achieve to high union rates. Plate prominence is minimized by utilizing the volar surface of the ulna, although plate prominence and subsequent need for hardware removal remain a relatively common complication.

View details for PubMedID 24614866
MRI detection of forearm soft tissue injuries with radial head fractures. Hand (New York, N.Y.) McGinley, J. C., Gold, G., Cheung, E., Yao, J. 2014; 9 (1): 87-92
Abstract

This study aims to evaluate the incidence of forearm soft tissue abnormalities associated with radial head fracture severity based on the Mason classification system.Eighteen patients (age 18-45 years) were prospectively evaluated with elbow radiographs and magnetic resonance imaging (MRI) following longitudinal forearm trauma. MRI was performed within 10 days of the initial injury. Radiographs and MR images were evaluated in a blinded fashion by two musculoskeletal radiologists.Thirteen of 18 patients presented with Mason type I radial head fractures. In all patients with Mason type I fractures, the interosseous membrane (IOM) was intact. Two patients had Mason type II fractures with associated partial and compete tearing of the IOM and three patients had Mason type III fractures with complete tearing of the IOM. Edema was noted in the pronator quadratus in six of 13 type I injuries and seen in all type II and III injuries. No structural forearm soft tissue abnormalities were present in patients with Mason type I injuries. The presence of edema within the pronator quadratus correlated with distal forearm pain.The severity of radial head fracture correlates with longitudinal forearm injury evidenced by the presence of IOM tearing. The findings suggest patients with Mason type II or III fractures of the radial head should undergo further evaluation of the forearm for associated soft tissue injuries. Edema within the pronator quadratus was present following forearm trauma regardless of the severity of fracture and was related to symptomatic forearm pain.

View details for DOI 10.1007/s11552-013-9561-2

View details for PubMedID 24570643
Biomechanical Comparison of Volar Locked Plate Constructs Using Smooth and Threaded Locking Pegs ORTHOPEDICS Yao, J., Park, M. J., Patel, C. S. 2014; 37 (2): E169-E173
Abstract

The goal of this study was to determine whether there is any biomechanical difference in terms of construct strength with axial loading between volar fixed-angle locking plates with threaded locking vs smooth locking pegs. The control group comprised 7 cadaveric specimens with threaded locking pegs, and the test group comprised 7 cadaveric specimens from the same donor with smooth locking pegs. The DVR plate (Biomet, Warsaw, Indiana) was applied to the volar surface. A 15-mm dorsal wedge osteotomy was created near the level of Lister's tubercle. The radii were potted in polymethylmethacrylate for biomechanical testing. The loading protocol consisted of 3 parts: ramp loading, cyclic loading, and failure loading. The outcome measures of stiffness and failure were used to test the plates fixed with threaded and smooth locking pegs. When comparing each cycle, the difference in mean stiffness between threaded and smooth locking pegs was as follows: 122 N/mm, -9.09 N/mm, -14.7 N/mm, 49.4 N/mm, 57.4 N/mm, 71.9 N/mm, 52.3 N/mm, 35.8 N/mm. The difference in mean failure load between the threaded and smooth locking pegs was -11.3 N. There was no difference in stiffness throughout all cycles. Failure analysis showed no significant difference between the smooth (962 N) and threaded (951 N) locking pegs. The difference in stiffness between the 2 constructs (smooth minus threaded locking pegs) in ramp loading ranged from -122 to 15 N/mm. The results of this study showed no significant differences in stiffness and failure load between constructs consisting of threaded locking pegs or smooth locking pegs in the distal rows of the DVR distal radius volar locking plate. Based on the results of this study, there may be no benefit to using threaded locking pegs vs smooth locking pegs when treating distal radius fractures with a volar locking plate.

View details for DOI 10.3928/01477447-20140124-21

View details for Web of Science ID 000331879300012
Advances in hand and wrist arthroscopy. Plastic and reconstructive surgery Park, M. J., Yao, J. n. 2014; 134 (5): 758e?765e
Abstract

Hand and wrist arthroscopy has gained popularity over the past few decades. Arthroscopy is a valuable diagnostic tool in cases where clinical and radiographic findings do not show a clear picture of the patient's pathologic condition. Arthroscopy also allows care providers to perform therapeutic interventions in a less invasive manner than would have been possible with a standard open approach. Over the past three decades, there have been substantial advances in the techniques and outcomes in hand and wrist arthroscopy. With this article, the authors aim to introduce the application of newer arthroscopic techniques in the hand and wrist that may be of diagnostic and/or therapeutic value.

View details for PubMedID 25347651
Synthesis and characterization of novel elastomeric poly(D,L-lactide urethane) maleate composites for bone tissue engineering EUROPEAN POLYMER JOURNAL Mercado-Pagan, A. E., Kang, Y., Ker, D. F., Park, S., Yao, J., Bishop, J., Yang, Y. P. 2013; 49 (10): 3337-3349
Abstract

Here, we report the synthesis and characterization of a novel 4-arm poly(lactic acid urethane)-maleate (4PLAUMA) elastomer and its composites with nano-hydroxyapatite (nHA) as potential weight-bearing composite. The 4PLAUMA/nHA ratios of the composites were 1:3, 2:5, 1:2 and 1:1. FTIR and NMR characterization showed urethane and maleate units integrated into the PLA matrix. Energy dispersion and Auger electron spectroscopy confirmed homogeneous distribution of nHA in the polymer matrix. Maximum moduli and strength of the composites of 4PLAUMA/nHA, respectively, are 1973.31 � 298.53 MPa and 78.10 � 3.82 MPa for compression, 3630.46 � 528.32 MPa and 6.23 � 1.44 MPa for tension, 1810.42 � 86.10 MPa and 13.00 � 0.72 for bending, and 282.46 � 24.91 MPa and 5.20 � 0.85 MPa for torsion. The maximum tensile strains of the polymer and composites are in the range of 5% to 93%, and their maximum torsional strains vary from 0.26 to 0.90. The composites exhibited very slow degradation rates in aqueous solution, from approximately 50% mass remaining for the pure polymer to 75% mass remaining for composites with high nHA contents, after a period of 8 weeks. Increase in ceramic content increased mechanical properties, but decreased maximum strain, degradation rate, and swelling of the composites. Human bone marrow stem cells and human endothelial cells adhered and proliferated on 4PLAUMA films and degradation products of the composites showed little-to-no toxicity. These results demonstrate that novel 4-arm poly(lactic acid urethane)-maleate (4PLAUMA) elastomer and its nHA composites may have potential applications in regenerative medicine.

View details for DOI 10.1016/j.eurpolymj.2013.07.004

View details for Web of Science ID 000325233800049

View details for PubMedCentralID PMC4012890
Suture button suspension following trapeziectomy in a cadaver model. Hand (New York, N.Y.) Song, Y., Cox, C. A., Yao, J. 2013; 8 (2): 195-200
Abstract

The safety and the effects of different trajectories on thumb motion of suture-button suspensionplasty post-trapeziectomy are not known.In a cadaveric model, thumb range of motion, trapeziectomy space height, and distance between the device and nerve to the first dorsal interosseous muscle (first DI) were measured for proximal and distal trajectory groups. Proximal trajectory was defined as a suture button angle directed from the thumb metacarpal to the second metacarpal at a trajectory less than 60� from the horizontal; distal trajectory was defined as a suture button angle directed from the thumb metacarpal to the second metacarpal at a trajectory of greater than 60� from the horizontal (Fig.�1).There were no significant differences in range of motion and trapeziectomy space height between both groups. The device was significantly further away from the nerve to the first DI in the proximal trajectory group compared to the distal trajectory group, but was still safely away from the nerve in both groups (greater than 1�cm).These results suggest that the device placement in either a proximal or distal location on the second metacarpal will yield similar results regarding safety and thumb range of motion.

View details for DOI 10.1007/s11552-012-9473-6

View details for PubMedID 24426918

View details for PubMedCentralID PMC3652989
Thumb carpometacarpal ligaments inside and out: a comparative study of arthroscopic and gross anatomy from the robert a. Chase hand and upper limb center at stanford university. Journal of wrist surgery Zhang, A. Y., Van Nortwick, S., Hagert, E., Ladd, A. L. 2013; 2 (1): 55-62
Abstract

Purpose?We propose to identify and correlate arthroscopic internal ligaments with external ligaments, providing an accurate roadmap for arthroscopic ligament and joint anatomy. Ligamentous laxity is considered an important risk factor in developing the common basilar arthritis of the thumb. Controversy exists as to the precise ligamentous anatomy of the thumb carpometacarpal (CMC) joint (CMC-I); description of the internal arthroscopic anatomy is limited. Methods?We performed CMC-I joint arthroscopy using the 1-Ulnar (1U) and thenar portals in five cadavers, seeking to identify the following seven ligaments arthroscopically: the superficial anterior oblique ligament (sAOL), deep anterior oblique ligament (dAOL), ulnar collateral ligament (UCL), dorsal trapeziometacarpal ligament (DTM-1), posterior oblique ligament (POL), dorsal central ligament (DCL), and dorsal radial ligament (DRL). After grading articular changes of the trapezium, we passed Kirschner wires (K-wires) (0.028) outside-in to mark the arthroscopic insertion of each ligament on the trapezium. Gross dissection was performed to confirm the wire placement; the anatomic identity and position of joint stabilizing ligaments, and the location of frequently used portals. Results?The volar ligaments-the sAOL, dAOL, and UCL-were highly variable in their arthroscopic appearance and precise location. The sAOL is a thin veil of membranous tissue that variably drapes across the anterior joint capsule. The reported dAOL and UCL, in our study, correlated to a thickened portion of this veil around the volar beak and was not consistently identified with gross dissection. In contrast, the arthroscopic appearance and location of the dorsal ligaments-DTM-I, POL, DCL, and DRL-were consistent in all specimens. Conclusion?Our study further defines and correlates the arthroscopic and external ligamentous anatomy of the CMC-I joint.

View details for DOI 10.1055/s-0033-1333683

View details for PubMedID 24436790

View details for PubMedCentralID PMC3656572
Preface HAND CLINICS Yao, J. 2012; 28 (4): XIII-XIV
View details for DOI 10.1016/j.hcl.2012.09.001

View details for Web of Science ID 000311875800001
The Effect of Suture Coated With Mesenchymal Stem Cells and Bioactive Substrate on Tendon Repair Strength in a Rat Model: A Complementary Mechanism Reply JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J. 2012; 37A (10): 2203-2204
View details for DOI 10.1016/j.jhsa.2012.08.023

View details for Web of Science ID 000309846700045
Titanium integration with bone, welding, and screw head destruction complicating hardware removal of the distal radius: report of 2 cases. journal of hand surgery Van Nortwick, S. S., Yao, J., Ladd, A. L. 2012; 37 (7): 1388-1392
Abstract

Increasingly, surgeons treat distal radius fractures with locking plate systems. Recent case reports have focused on technical insertion errors resulting in removal difficulties: poor drilling orientation or cross-threading, destruction of the screw head, and filling of the screw recess with tissue. We report 2 complications of titanium locked plate removal secondary to in vivo reactions including titanium integration with bone and mechanical binding between the titanium screw and plate. We clarify and discuss terminology relevant to implant removal, including cold-welding, galling, fretting, and anodization. Even with optimal technique, in situ reactions can complicate titanium implant removal.

View details for DOI 10.1016/j.jhsa.2012.04.027

View details for PubMedID 22652178
Titanium Integration With Bone, Welding, and Screw Head Destruction Complicating Hardware Removal of the Distal Radius: Report of 2 Cases JOURNAL OF HAND SURGERY-AMERICAN VOLUME Van Nortwick, S. S., Yao, J., Ladd, A. L. 2012; 37A (7): 1388-1392
Abstract

Increasingly, surgeons treat distal radius fractures with locking plate systems. Recent case reports have focused on technical insertion errors resulting in removal difficulties: poor drilling orientation or cross-threading, destruction of the screw head, and filling of the screw recess with tissue. We report 2 complications of titanium locked plate removal secondary to in vivo reactions including titanium integration with bone and mechanical binding between the titanium screw and plate. We clarify and discuss terminology relevant to implant removal, including cold-welding, galling, fretting, and anodization. Even with optimal technique, in situ reactions can complicate titanium implant removal.

View details for DOI 10.1016/j.jhsa.2012.04.027

View details for Web of Science ID 000310670700013
Trapezial metastasis as the first indication of primary non-small cell carcinoma of the lung. journal of hand surgery Song, Y., Yao, J. 2012; 37 (6): 1242-1244
Abstract

Metastasis to the bones of the hand and wrist is not common, and its discovery may reveal an advanced primary tumor located centrally. Clinically, hand metastasis is hard to differentiate from other more common hand pathologies. Its rarity, coupled with a lack of unique clinical manifestations, makes hand and wrist metastasis difficult to diagnose. However, its diagnosis is critical to initiate an appropriate course of treatment. We present a patient in whom lung carcinoma metastasis to the trapezium was definitively diagnosed upon surgical management of symptoms that were consistent with thumb carpometacarpal arthritis.

View details for DOI 10.1016/j.jhsa.2012.03.006

View details for PubMedID 22537586
Trapezial Metastasis as the First Indication of Primary Non-small Cell Carcinoma of the Lung JOURNAL OF HAND SURGERY-AMERICAN VOLUME Song, Y., Yao, J. 2012; 37A (6): 1242-1244
Abstract

Metastasis to the bones of the hand and wrist is not common, and its discovery may reveal an advanced primary tumor located centrally. Clinically, hand metastasis is hard to differentiate from other more common hand pathologies. Its rarity, coupled with a lack of unique clinical manifestations, makes hand and wrist metastasis difficult to diagnose. However, its diagnosis is critical to initiate an appropriate course of treatment. We present a patient in whom lung carcinoma metastasis to the trapezium was definitively diagnosed upon surgical management of symptoms that were consistent with thumb carpometacarpal arthritis.

View details for DOI 10.1016/j.jhsa.2012.03.006

View details for Web of Science ID 000304977600023
Lunate fractures in the face of a perilunate injury: an uncommon and easily missed injury pattern. journal of hand surgery Brise�o, M. R., Yao, J. 2012; 37 (1): 63-67
Abstract

Lunate fractures are rare and are usually associated with high-energy trauma. Typically, they are described in isolation or with associated carpal injuries such as scaphoid, capitate, or radial styloid fractures. We report a case of a complex lunate fracture in combination with a perilunate dissociation injury.

View details for DOI 10.1016/j.jhsa.2011.09.009

View details for PubMedID 22051228
ELBOW INSTABILITY MUSCULOSKELETAL EXAMINATION OF THE ELBOW, WRIST, AND HAND: MAKING THE COMPLEX SIMPLE Park, M., Yao, J., Culp, R. W., Jacoby, S. M. 2012: 139?58
View details for Web of Science ID 000303780300007
ULNAR WRIST TRIANGULAR FIBROCARTILAGE COMPLEX AND DISTAL RADIO-ULNAR JOINT MUSCULOSKELETAL EXAMINATION OF THE ELBOW, WRIST, AND HAND: MAKING THE COMPLEX SIMPLE Park, M., Yao, J., Culp, R. W., Jacoby, S. M. 2012: 228?51
View details for Web of Science ID 000303780300011
Lunate Fractures in the Face of a Perilunate Injury: An Uncommon and Easily Missed Injury Pattern JOURNAL OF HAND SURGERY-AMERICAN VOLUME Briseno, M. R., Yao, J. 2012; 37A (1): 63-67
Abstract

Lunate fractures are rare and are usually associated with high-energy trauma. Typically, they are described in isolation or with associated carpal injuries such as scaphoid, capitate, or radial styloid fractures. We report a case of a complex lunate fracture in combination with a perilunate dissociation injury.

View details for DOI 10.1016/j.jhsa.2011.09.009

View details for Web of Science ID 000298967500011
The use of smartphones in hand surgery. journal of hand surgery Barr, C., Yao, J. 2012; 37 (1): 168-170
View details for DOI 10.1016/j.jhsa.2011.10.036

View details for PubMedID 22196296
Hand Made: From Mutilated Hand to Artist to Nurse JOURNAL OF HAND SURGERY-AMERICAN VOLUME Yao, J. 2011; 36A (9): 1515-1515
View details for DOI 10.1016/j.jhsa.2011.03.045

View details for Web of Science ID 000294585000014
Perioperative Steroid Dosing in Patients Receiving Chronic Oral Steroids, Undergoing Outpatient Hand Surgery JOURNAL OF HAND SURGERY-AMERICAN VOLUME Fleager, K., Yao, J. 2010; 35A (2): 316-318
View details for DOI 10.1016/j.jhsa.2009.10.001

View details for Web of Science ID 000277092700025
Soft Tissue Tumors of the Wrist The Principles and Practice of Wrist Surgery Lee A, Yao J 2010; Slutsky ed: 649-658
Electrocautery use in hand surgery: history, physics, and appropriate usage. The Journal of hand surgery Cox, C. n., Yao, J. n. 2010; 35 (3): 489?90
View details for PubMedID 19942358
Delivered growth factor therapy to improve healing after rotator cuff repair. Stem cells and cloning : advances and applications Cheung, E. V., Silverio, L., Yao, J. 2010; 3: 135-144
Abstract

Degenerative rotator cuff tears are a significant cause of shoulder pain in the aging population. Rotator cuff repair surgery may be more successful when growth factors are delivered to the repair site. This study was designed to determine the cellular processes involved in normal bone-to-tendon healing and the current approaches used for biologic augmentation of rotator cuff repair.This review focuses on animal studies of rotator cuff repair and early human trials.Regular bone-to-tendon healing forms a fibrous junction between tendon and bone that is markedly different from the original bone-to-tendon junction. Tendon augmentation with cellular components serves as scaffolding for endogenous fibroblastic cells and a possible source of growth factors and fibroblastic cells. Extracellular matrices provide a scaffold for incoming fibroblastic cells. However, research in extracellular matrices is not conclusive due to intermanufacturer variation and the lack of human subject research. Growth factors and platelet-rich plasma are established in other fields of research and show promise, but have not yet been rigorously tested in rotator cuff repair augmentation.Rotator cuff repair can benefit from biologic augmentation. However, research in this field is still young and has not yet demonstrated that the benefits in healing rates are significant enough to merit regular clinical use. Randomized controlled trials will elucidate the use of biologic augmentation in rotator cuff repairs.

View details for DOI 10.2147/SCCAA.S7359

View details for PubMedID 24198519
Soft Tissue Coverage of Fingertip Amputations Operative Techniques in Orthopaedic Surgery Ford C, Yao J 2010; Hunt, ed.: 2932-2940
Perilunate and Lunate Dislocations and Greater Arc Injuries The Prinicples and Practice of Wrist Surgery Jagadish A, Yao J 2010; Slutsky ed: 473-486
Surgical Treatment of Acute and Chronic Paronychia and Felons Operative Techniques in Orthopaedic Surgery Stuffmann E, Yao J 2010; Hunt, ed.: 2906-2911
Surgical Treatment of Deep Space Infections of the Hand Operative Techniques in Orthopaedic Surgery Stuffmann E, Yao J 2010; Hunt, ed: 2912-2916
Monteggia Fracture-Dislocation Associated with Proximal and Distal Radioulnar Joint Instability A Case Report JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Cheung, E. V., Yao, J. 2009; 91A (4): 950-954
View details for DOI 10.2106/JBJS.H.00269

View details for Web of Science ID 000264829700025
The History of Distal Radius Fractures Fractures and Injuries of the Distal Radius and Carpus: The Cutting Edge. Imrie M, Yao J 2009; Slutsky ed (Elsevier): 3-10
Distal Radius Fracture Fixation Systems The Fractured Wrist Mudgal C, Yao J 2008; Ring ed. (May)
Late reconstruction for ulnar nerve palsy HAND CLINICS Tse, R., Hentz, V. R., Yao, J. 2007; 23 (3): 373-?
Abstract

Long term paralysis of the ulnar nerve is associated with an array of specific deficits and deformities. The numerous options for reconstruction are reviewed, as well as the specific patient considerations in selecting a strategy. An approach to late reconstruction for late ulnar nerve palsy is presented based upon the authors' experience and the available literature.

View details for DOI 10.1016/j.hcl.2007.05.003

View details for Web of Science ID 000249886700011

View details for PubMedID 17765589
Reduction of high-grade isthmic and dysplastic spondylolisthesis in 5 adolescents. American journal of orthopedics (Belle Mead, N.J.) Lonner, B. S., Song, E. W., Scharf, C. L., Yao, J. 2007; 36 (7): 367-373
Abstract

Treatment of high-grade isthmic and dysplastic spondylolisthesis in children and adolescents remains a challenge. Surgical treatment of spondylolisthesis has been recommended in adolescents with pain refractory to nonoperative modalities, slippage progression, or > 50% slippage on presentation. Controversy exists as to the optimal surgical approach for high-grade spondylolisthesis. In this report, we describe 5 cases of high-grade isthmic and dysplastic spondylolisthesis in adolescents and review the literature on surgical treatment for this entity. Operative records, charts, x-rays, and Scoliosis Research Society outcome questionnaires (SRS-22) were retrospectively evaluated for 5 consecutive patients diagnosed with and treated for high-grade spondylolisthesis. Each patient received treatment consisting of decompression, reduction, and circumferential fusion with transpedicular and segmental fixation from a posterior approach. Two patients had transient L5 nerve root deficit, which resolved within 3 months. Reduction benefits include a decrease in shear stresses (and resulting decreased rates of postoperative pseudarthrosis and slip progression), restoration of sagittal alignment and lumbosacral spine balance, and improvement in clinical deformity.

View details for PubMedID 17694184
Arthroscopic Treatment of Radial-Sided TFCC Lesions Wrist and Hand Arthroscopy - A Practical Approach, Slutsky DJ, ed. Weintraub JL, Osterman AL, Yao J 2007: 32-41
Bone Grafts and Bone Graft Substitutes in Distal Radius Fractures Hand Surgery Update 4 Ladd AL, Pliam N, Yao J 2007: 165-186
The use of bone grafts and bone graft substitutes in distal radius fractures. Atlas of Hand Clinics Yao J, Ladd AL 2006; 11 (2): 243-249
Thumb Carpometacarpal Joint Arthroscopy and Hemitrapeziectomy Online protocols, International Federation of Societies for Surgery of the Hand (IFSSH) Yao J, Culp RW 2006
Double Crush Syndrome Peripheral Nerve Surgery: Practical Applications in the Upper Extremity. Slutsky DJ & Hentz VR, eds. Elsevier. Yao J, Osterman AL 2006: 277-283
Surgical Arthroplasty Options for Rotator Cuff Tear Arthropathy Techniques in Shoulder and Elbow Surgery Yao J, Dines D, Warren R 2003; 4 (1): 26-34
Diagnosis of Acute Cholecystitis: Sensitivity of Sonography, Cholescintigraphy and Combined Sonography-Cholescintigraphy Journal of the American College of Surgeons Kalimi R, Gecelter GR, Caplin D, Yao J, Simms HH, Marini, CP 2001; 193 (6): 609-613
Seroswitch : Adenovirus-mediated in vivo Gene Transfer : Circumvention of Anti-Adenovirus Humoral Immune Defenses Against Repeat Adenovirus Vector Administration by Changing the Adenovirus Serotype Human Gene Therapy Mastrangeli A, Harvey BG, Yao J, Crystal RG 1996; 7: 79-87

Jeffrey Yao, MD

Professor of Orthopaedic Surgery at the Stanford University Medical Center

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