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Dan Guttmann

Publications and source records attributed to Dan Guttmann.

11 recordsLinked to original sources
PubMed2006

Interference screw technique for arthroscopic reduction and internal fixation of compression fractures of the tibial plateau.

Arthroscopic reduction and internal fixation (ARIF) is recommended as state-of-the-art treatment for patients with pure compression fracture of the tibial plateau. We describe a new technique for ARIF of pure compression tibial plateau fractures that uses a cannulated, bioabsorbable interference screw. After a guide pin is placed in the center of the compressed fragment and a tamp is used to elevate the fracture (with bone grafting as desired), the interference screw is advanced over the guide pin, resulting in both elevation and buttressing of the fracture. As compared with previously described techniques in which percutaneous buttress screws were used, ARIF attained with an interference screw via the tibial metaphyseal window allows substantially improved efficiency of surgical steps, improved preservation of the soft tissue envelope, definitive articular reduction under arthroscopic visualization, use of a bioabsorbable implant, and elimination of the need for fluoroscopy.

Arthroscopy↗
PubMed2006

Complications in the treatment of medial and lateral sided injuries of the knee joint.

Complications may result from nonoperative and surgical management of medial or lateral sided knee injuries. Because these injuries are often associated with injury to the medial or lateral meniscus and the anterior or posterior cruciate ligaments (ACL and PCL, respectively), injury to these structures will also be considered. We group these complications in 3 categories: (1) complications associated with either operative or nonoperative management, (2) intraoperative complications, and (3) postoperative complications. Greater understanding of complications of medial and lateral knee ligament injuries may result in improved clinical outcomes.

Anterior Cruciate Ligament Injuries↗
PubMed2005

Part II: arthroscopic treatment of tibial plateau fractures: intercondylar eminence avulsion fractures.

Arthroscopic reduction and internal fixation (ARIF) of tibial intercondylar eminence fractures is the emerging state-of-the-art. ARIF is recommended for displaced type III fractures and should be considered for all cases of displaced type II fractures. Fractures without displacement after closed reduction require careful evaluation to rule out meniscal entrapment. Subjective results of ARIF are uniformly excellent, despite reports of objective anteroposterior laxity. Early range-of-motion exercises are essential to prevent loss of extension. Repair using nonabsorbable suture fixation, when of adequate strength to allow early range-of-motion, has the advantages of eliminating the risks of comminution of the fracture fragment, posterior neurovascular injury, and need for hardware removal, compared with ARIF using screws.

Anterior Cruciate Ligament↗
PubMed2005

Arthroscopic rotator cuff repair: the learning curve.

PURPOSE: The purpose of this study was to answer the question: How many cases are required for a surgeon to become proficient in performing arthroscopic rotator cuff repair? We hypothesize that as surgical experienced is gained, learning can be quantitatively shown by a significant decrease in operative time. TYPE OF STUDY: Prospective case series. METHODS: Rotator cuff repair time (RCRT) in minutes (as well as other time components comprising total surgical time) was recorded for 100 consecutive patients having arthroscopic rotator cuff repair performed by a single surgeon beginning with his first case in private practice. Mean RCRTs for consecutive blocks of 10 cases were compared. Learning is graphically represented by plotting the RCRT by case number and generating a logarithmic trend curve. A best-fit linear equation (y = mx + b) allows comparison of the initial 10 cases with the subsequent 90 cases, where m , the slope, represents the rate of decrease in RCRT (learning). RESULTS: Mean RCRT decreased significantly (P < .05) from the first block of 10 cases to the second block of 10 cases. There were no significant changes in mean RCRT when comparing other consecutive blocks of 10 cases. The slope of the line fitting the first block of 10 cases is -8.75; the slope (m) of the line fitting the subsequent 90 cases is -0.23. There is no significant difference in mean RCRT when cases are stratified by tear size. CONCLUSIONS: Graphic representation of RCRT by case number generates a learning curve whereby learning is quantitatively shown as a significant decrease in operative time as surgical experience is gained. CLINICAL RELEVANCE: Qualification of the learning curve for arthroscopic rotator cuff repair provides a guide for orthopaedic surgeons contemplating the expected time line for acquiring proficiency in this technique.

Arthroscopy↗
PubMed2005

Video informed consent improves knee arthroscopy patient comprehension.

PURPOSE: The purpose of this study was to test the hypothesis that video informed consent improves knee arthroscopy patient comprehension and satisfaction compared with traditional verbal informed consent. TYPE OF STUDY: Prospective, randomized controlled trial. METHODS: Consecutive patients having informed consent in preparation for knee arthroscopy by a single surgeon were stratified by educational level < or =12th grade or greater than 12th grade, then randomized to video or traditional verbal informed consent groups. Immediately after the informed consent process, patients completed an outcome questionnaire evaluating comprehension and satisfaction. RESULTS: Patients in the video group showed significantly higher comprehension (78.5%) than patients in the verbal group (65.4%) (P = .00001). In the subgroup with < or = 12th grade education level, the video patients scored 73.1% comprehension and the verbal patients only 54.2% (P = .0011). In the subgroup with greater than 12th grade education level, the video patients scored 82.3% and the verbal patients scored 72.2% (P = .0002). There was no significant difference in subjective self-assessment of satisfaction between groups. CONCLUSIONS: Video informed consent improves knee arthroscopy patient comprehension compared with traditional verbal informed consent. LEVEL OF EVIDENCE: Level I.

Adolescent↗
PubMed2004

Arthroscopic visualization of the posterior compartments of the knee.

PURPOSE: The purpose of this study is to test the hypothesis that the efficacy of routine arthroscopic evaluation of the posterior compartments of the knee outweighs the morbidity or inefficiency. TYPE OF STUDY: Prospective cohort analysis. METHODS: One hundred consecutive knees underwent posteromedial and posterolateral evaluation according to an algorithm designed to maximize efficiency of technique. Loose bodies were defined as expected when preoperative imaging or arthroscopy of the rest of the knee revealed loose bodies. The number of attempts required for visualization or visualization not accomplished, morbidity (subjective femoral condylar scuffing or complications associated with the technique), and findings were recorded. RESULTS: With regard to posteromedial, directly inserting the camera (as opposed to an obdurator) resulted in instrument breakage. In this study, 82% of posteromedial compartments were visualized on the first attempt, and 3% were not visualized. We found that 66% of femoral condyles had no damage, 28% mild, 3% moderate, and 3% severe. Loose bodies were found in 4 of 11 (36%) when expected and 0 of 86 when not expected, a significant difference. Five other posteromedial positive findings were observed. With regard to posterolateral, 93% of compartments were visualized on the first attempt, directly with the camera via the anterolateral portal. All were visualized. We found that 96% of femoral condyles had no damage, 4% mild, and 0% moderate or severe. Damage occurred significantly less frequently than with posteromedial. No findings were noted. CONCLUSIONS: Despite inefficiency, we recommend an obdurator for posteromedial visualization via the anterolateral portal. Posteromedial visualization was associated with morbidity but was efficacious in some cases and is strongly recommended when loose bodies are expected. Posterolateral visualization directly with the camera and via the anterolateral portal is efficient and associated with minimal morbidity but was not efficacious in the cohort evaluated. LEVEL OF EVIDENCE: Level II.

Adolescent↗
PubMed2004

Minimally invasive surgery-total knee arthroplasty.

Minimally invasive surgery-total knee arthroplasty (MIS-TKA) requires a skin incision of < or =5 inches (measured with the knee in full extension). A mini midvastus approach limits surgical dissection and resultant soft tissue trauma. The patella is subluxated laterally but not everted . MIS-TKA is technically challenging and instrument dependent. The design of cutting guides, sizers, and retractors must continue to evolve. Prospective, randomized controlled trials are required to test the hypothesis that MIS-TKA results in decreased patient morbidity and outcome equal to or better than traditional TKA. The purpose of this article is to describe the MIS-TKA technique.

Arthroplasty, Replacement↗
PubMed2004

Part I: Arthroscopic management of tibial plateau fractures.

Arthroscopy is a valuable tool for the assessment of tibial plateau fractures and is the treatment of choice for associated intra-articular pathology. In addition, (all)-arthroscopic reduction and internal fixation (ARIF) is recommended for type III fractures and is a consideration for types I, II, and IV. Published outcome studies of ARIF of tibial plateau fractures describe results that appear to equal outcomes of open reduction and internal fixation, but these studies suffer from susceptibility bias.

Arthroscopy↗
PubMed2003

The skier's knee.

Knee injuries in skiers have unique epidemiology and distinct mechanisms. Conversely, evaluation and treatment of the skier's knee is similar to evaluation and treatment of knee injuries in other athletes. A greater understanding of the epidemiology and mechanisms of knee injuries in skiers may aid arthroscopic clinicians and related researchers treating or investigating knee injuries in both skiers and in other athletes.

Athletic Injuries↗