KSF Orthopaedic

Ethics in Sports Medicine

noemail@ksfortho.com — Tue, 01 May 2007 15:00:00 GMT

(ABSTRACT) Physicians have struggled with the medical ramifications of athletic competition since ancient Greece, where rational medicine and organized athletics originated. Historically, the relationship between sport and medicine was adversarial because of conflicts between health and sport. However, modern sports medicine has emerged with the goal of improving performance and preventing injury, and the concept of the "team physician" has become an integral part of athletic culture. With this distinction come unique ethical challenges because the customary ethical norms for most forms of clinical practice, such as confidentiality and patient autonomy, cannot be translated easily into sports medicine. The particular areas of medical ethics that present unique challenges in sports medicine are informed consent, third parties, advertising, confidentiality, drug use, and innovative technology. Unfortunately, there is no widely accepted code of sports medicine ethics that adequately addresses these issues.

American Journal of Sports Medicine 2007, May;35(5):840-4. Epub 2007 Jan 11.

1-May-07 10:00 AM

Suture Anchors in Arthroscopic Rotator Cuff Repair

noemail@ksfortho.com — Fri, 30 Mar 2007 19:00:00 GMT

(ABSTRACT)

The use if suture anchors in shoulder surgery has facilitated the rapid advancement of arthroscopic rotator cuff repair techniques. Innumerable anchor types have been developed which allow stronger, rapid, more effective arthroscopic rotator cuff repairs. Abundant research has been performed to maximize the efficacy of suture anchors in arthroscopic rotator cuff repair. The article reviews the literature regarding implant designs, technical considerations, clinical results, and complications of suture anchors in the arthroscopic treatment of rotator cuff tears.

Operative Techniques in Sports Medicine: Vol. 12, Iss.4; October 2004 (210-214)

30-Mar-07 2:00 PM

Locked knee caused by meniscal subluxation: magnetic resonance imaging and arthroscopic verification.

noemail@ksfortho.com — Fri, 30 Mar 2007 17:00:00 GMT

(ABSTRACT)

Subluxation or dislocation of an intact lateral meniscus is a controversial and rarely reported cause of knee pain and locking. We report a case of knee locking caused by lateral meniscal subluxation in the absence of a meniscal tear or true discoid meniscus, with both magnetic resonance imaging (MRI) and arthroscopic verification. A 9.5-year-old child experienced multiple episodes of locking in full flexion of the knee. After 6 months of symptoms, arthroscopy was performed and showed no meniscal tear or a discoid meniscus. The patient's knee locking recurred after arthroscopy. MRI was performed when the patient presented acutely with the knee locked. MRI showed anterior dislocation of the posterior horn of the lateral meniscus with the knee in the locked position. The MRI was immediately repeated after the author reduced (manipulated) the locked knee into extension. On the repeat MRI, the lateral meniscus had returned to a normal position. On repeat arthroscopy, the posterior horn of the lateral meniscus was hypermobile and could be displaced into the notch and did not show a frank tear. The meniscus was repaired to the capsule with sutures. At the 2-year follow-up evaluation, the patient had no complaints and no clinical signs of locking.

Arthroscopy. 2003 Oct;19(8):885-8

30-Mar-07 12:00 PM

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture.

noemail@ksfortho.com — Fri, 30 Mar 2007 16:00:00 GMT

The Sauve-Kapandji procedure and the Darrach procedure for distal radio-ulnar joint dysfunction after Colles' fracture. (ABSTRACT)

This retrospective study evaluated the results of the Darrach procedure and the Sauve-Kapandji procedure for the treatment of distal radio-ulnar joint derangement following malunion of dorsally displaced, unstable, intraarticular fractures of the distal radius in patients under 50 years of age. Twelve of 18 possible patients in the Sauve-Kapandji group completed the disabilities of the arm, shoulder, and hand survey at a mean of 4 years postoperatively and nine of the 18 returned for a follow-up examination at a mean of 2 years. Twenty-one of 30 possible patients in the Darrach group completed the disabilities of the arm, shoulder, and hand survey at a mean of 6 years postoperatively and 13 of these 30 returned for follow-up examination at a mean of 4 years. The Darrach procedure and the Sauve-Kapandji procedure yielded comparable and unpredictable results with respect to both subjective and objective parameters.

Journal of Hand Surgery (Br). 2004 Dec;29(6):608-13

J Hand Surg [Br]. 2004 Dec;29(6):608-13

30-Mar-07 11:00 AM

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction (Abstract)

Failed anterior cruciate ligament (ACL) reconstruction presents a difficult clinical challenge. Successful revision ACL reconstruction depends on identifying the causes of failure and correcting technical or diagnostic errors. Failed ACL reconstruction may be either traumatic or atraumatic. Atraumatic failures may be attributable to technical errors, diagnostic errors, or failure of graft incorporation. Published outcomes of revision ACL reconstruction have been worse than for primary ACL reconstruction. The preoperative evaluation, surgical techniques, and clinical outcomes of revision ACL reconstruction are reviewed.

American Journal of Sports Medicine:2006 Dec;34(12):2026-37.

29-Mar-07 8:00 AM

Shoulder Impingement Syndrome

noemail@ksfortho.com — Thu, 29 Mar 2007 13:00:00 GMT

Shoulder Impingement Syndrome (Abstract)

Subacromial impingement syndrome is a common cause of shoulder pain. The purpose of this article is to review the clinical presentation, physical examination findings, and differential diagnosis of impingement syndrome. Using an evidence-based approach, we propose an algorithm for the management of subacromial impingement syndrome including indications for nonoperative management, advanced imaging, and operative management.

American Journal of Medicine:2005 May;118(5):452-5.

29-Mar-07 8:00 AM

Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review

noemail@ksfortho.com — Tue, 27 Mar 2007 15:00:00 GMT

George MS, Huston LJ, Spindler KP. "Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review." Clinical Orthopaedics and Related Research 2007 Feb;455:158-61

Vanderbilt University Medical Center, Nashville, TN 37232-8774, USA.

Anterior cruciate ligament reconstruction is commonly performed using the all-endoscopic (also known as all-inside or single-incision) method or the rear-entry (also known as outside-in or two-incision) method. We report a systematic review of four prospective, randomized clinical trials comparing these two operative techniques. Operative time was shorter in the all-endoscopic groups in two studies. A higher percentage of patients in the rear-entry group had a difference of 3 mm or less on the KT-2000 arthrometer, although the two surgical techniques were similar in the other studies. A higher rate of return to full activity was achieved in patients undergoing the rear-entry technique in one study. All four studies were similar in pain medication used, progression of rehabilitation, range of motion, quadriceps or hamstring strength, patellofemoral pain, one-leg hop test, Lysholm, Tegner, and International Knee Documentation Committee scores. Overall, these studies show similar outcomes comparing the all-endoscopic and rear-entry anterior cruciate ligament reconstruction techniques.

27-Mar-07 10:00 AM

Shoulder Labral Tears

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

SHOULDER LABRAL TEARS
   The shoulder joint is composed of a ball (humeral head) and a socket (glenoid). The glenoid has a greater radius of curvature than the humeral head, making the shoulder inherently unstable.
   A rim of fibrous tissue (labrum) surrounds the socket and acts as a bumper to help keep the shoulder joint stable. The labrum also serves as the attachment of the biceps tendon as well as several stabilizing ligaments of the shoulder. Injuries to the shoulder such as dislocations and falling on the outstretched arm can cause the labrum to tear off of the bone.

What are the symptoms?
Tears in the front of the socket are called Bankart tears and lead to recurrent instability of the shoulder. This leads to shoulder weakness and a feeling that the joint is slipping out of place.
    Tears at the top of the labrum near the biceps tendon attachment are called SLAP tears, which stands for Superior Labrum Anterior to Posterior. SLAP tears can cause pain with lifting and overhead reaching, as well as popping, catching, or clicking.
   X-rays can show bony injuries that may contribute to the shoulder pain and instability, although the labrum cannot be seen on xray. On physical exam, special tests are performed to determine the cause of the shoulder symptoms.MRI is used to visualize the soft tissues of the shoulder including the labrum and the rotator cuff.

How are they Treated?
   In some cases, physical therapy and anti-inflammatory medications may help relieve the symptoms. When a labral tear is present and conservative treatment has not improved the symptoms, surgery may be necessary. In the past, operative treatment of shoulder instability consisted of open surgery with large, painful incisions and slow recovery.
Recent advancements in shoulder arthroscopy have allowed Bankart and SLAP repairs to be performed via small, arthroscopic incisions, which speed recovery and minimize postoperative pain and stiffness. The labrum is re-attached with sutures that also repair the torn shoulder ligaments and tendons. Rehabilitation after surgery is aimed at strengthening the muscles around the shoulder to aid in the overall strength and stability of the shoulder.

14-Mar-07 10:00 AM

Patellofemoral Syndrome

noemail@ksfortho.com — Wed, 14 Mar 2007 15:00:00 GMT

PATELLOFEMORAL SYNDROME
   Patellofemoral syndrome (formerly known as chondromalacia patellae) is a dysfunction of the mechanics of the patella (knee cap). The patella normally rides in a groove in the femur known as the trochlea. The quadriceps muscle in the front of the thigh and the hamstring muscle in the back of the thigh control the motion of the patella. When the muscles become imbalanced, the patella does not ride normally in the trochlea, causing pain and sometimes a feeling of instability around the patella.

Where is the pain?
   Patellofemoral pain is typically most pronounced in the front of the knee or behind the patella, although pain in the back of the knee and in the muscles around the knee is also frequently seen. The pain tends to be worse with running, going up and down stairs, and when the knee muscles are tight.

How is it treated?
   Physical therapy is aimed at rebalancing the muscles that control the patella by stretching the quadriceps and hamstring muscles and strengthening the specific muscles around the knee that centralize the patella. Braces and anti-inflammatory medications may also be beneficial. If conservative treatment is unsuccessful, surgery is rarely necessary to realign the patella.

14-Mar-07 10:00 AM

Tennis or Golfer's Elbow

noemail@ksfortho.com — Wed, 14 Mar 2007 14:00:00 GMT

Lateral Epicondylitis (Tennis Elbow)
   Epicondulititis is an irritation or inflammation of the tendons around the elbow joint. Lateral Epicondylitis (tennis elbow) is a painful condition on and around the bony prominence (epicondyle) on the outside (lateral side) of the elbow. Pain may radiate down your arm. Gripping or extending your wrist may intensify the pain.

Medial Epicondylitis (golfer’s elbow) describes a similar condition. The pain focus is the knobby bump on the inside of the elbow closest to the body (the medial side).
   Both tennis elbow and golfer’s elbow typically result from repetitive arm movement. Over-using the muscles in your arm can lead to tiny tears (micro tears) in the tendons that attach the muscles in your forearms to the epicondyles.
   If you continue to do the activity without allowing the tears to heal, the tendons can become inflamed and very painful.
   This condition can be caused by excessive use of your arm such as long sessions practicing your golf swing or tennis stroke and in many other activities including painting, raking, pitching, rowing, hammering and using a screwdriver.

Treatment may involve:
   • Rest, which allows the micro- tears to heal. If the symptoms are sports-related, you might
examine your technique and equipment. You may need to take breaks during work or play; avoid activities or movements which cause pain; and limit heavy lifting, pushing, or pulling.

   • Ice Pack, applied to painful area for approximately 20 minutes 3 times a day, to decrease inflammation and pain. (Do not place ice directly on the skin)

   • Anti-inflammatory medication, an oral medication to help relieve inflammation and pain.

• Steroid injection, a locally acting injection to help decrease inflammation and pain.

• Counterforce brace (elbow cuff) worn during the day hours to help support the inflamed tendon.

• Cock-up wrist splint (wrist brace) worn during the night hours to help rest the tendon.

   • Physical Therapy (3 times a week for approximately 6 weeks) initially to decrease pain and inflammation, maintain muscle strength, and finally to increase strength and endurance.

   • Surgery – if all else fails.

14-Mar-07 9:00 AM

New KSF Location!

noemail@ksfortho.com — Mon, 17 Dec 2007 19:00:00 GMT

KSF Orthopaedic Center, P.A. is pleased to announce the opening of a new facility to help serve patients in the Northwest Houston area. For over 30 years, KSF has been providing Houston area residents with cutting-edge orthopaedic care. Our board-certified physicians have participated in city, state and nationwide programs in out continued efforts to provide excellent care of all orthopaedic patients.

This new office is located in Suite 200 in the Methodist Hospital at Willowbrook, on the second floor. The new clinic is triple the size of our previous space and will offer expanded services. These services include physical therapy, hand therapy, medical equipment and bracing and a state-of-the-art digital imaging x-ray. The facility also provides expanded electrodiagnostic testing.

Map to the New KSF office

If you any questions or wish to schedule an appointment, please contact us at

(832) 912-7804.

KSF Orthopaedic Surgery Center

Mon, 21 Jul 2008 19:48:29 GMT

KSF Orthopaedic Surgery Center offers a new level of convenience and comfort in surgery. During your brief stay with us you will find the highest quality of care rendered by a concerned, expertly trained staff. You will also find warm, friendly surroundings, easy access, ample parking and a degree of personal attention unlike that available in a hospital environment. We encourage questions during your stay so that we can put you at ease about your complete recovery. Recovery begins at KSF Orthopaedic Surgery Center, but it actually takes place at home, within the security of family and friends. Thank you for choosing KSF Orthopaedic Surgery Center. We are deeply honored you trust us to meet your healthcare needs. Before you get here: After your doctor has scheduled a time and date for your procedure, a member of our staff will contact you. During this pre-admission interview, you will be given a list of instructions to follow to ensure a safe procedure and recovery. You...

Travis W. Hanson, MD

Tue, 08 Jul 2008 14:07:37 GMT

Foot and Ankle Surgery & General Orthopaedics Read Dr. Hansons complete CV here. Dr. Travis Hanson graduated cum laude from Rice University with a degree in biochemistry. He was named the outstanding premedical student of his graduating class at Rice. He received his medical degree from Washington University School of Medicine in St. Louis, Missouri and was elected to the Alpha Omega Alpha medical honor society. He went on to complete his internship and residency in orthopaedic surgery at the University of California, Los Angeles. Following his residency, Dr. Hanson completed a one year fellowship in foot and ankle surgery in Houston, Texas. Dr. Hanson has a specific interest in disorders of the foot and ankle. His original research regarding surgical management of ankle arthritis has been published in scientific journals. He has written multiple book chapters discussing foot and ankle problems found in athletes. He has received extensive training in the non-surgical and...

Patient Registration Forms

Mon, 07 Jul 2008 20:28:31 GMT

The following forms will help to make your registration process faster and eliminate some of the paperwork you would normally fill out in the office before seeing the doctor. Please click on the link for each form. Print the form(s), complete each one and bring it with you to your appointment. If you forget to bring the forms with you, you will have to fill them out in the office before the doctor can see you. You will need to have Adobe Acrobat Reader installed on your computer to get the forms. If you dont have Adobe Acrobat Reader installed, click the Click on your doctors name below and complete all the forms that apply to you. Alianell | Cartwright | Cuellar | Dean | Fitzgerald | George Hanson | Jafarnia | Kant | Nash | Rosen | Sepulveda HIPAA Privacy Practices Dr. Alianell New non-Work Comp patients, or patients who have not been seen in the past year Patient Information New patients, or patients who...

Home Page

Mon, 07 Jul 2008 16:11:26 GMT

Case Studies Testimonials ...

Mon, 07 Jul 2008 15:15:15 GMT

CURRICULUM VITAE TRAVIS W. HANSON, M.D. PERSONAL DATA: Place of Birth: Albuquerque, New Mexico Date of Birth: November 18, 1970 EDUCATION: High School: Bedford High School Bedford, Massachusetts Graduated 1989 Valedictorian College: Rice University Houston, Texas 1989 to 1993 B.A., Biochemistry Medical School: Washington University School of Medicine St. Louis, Missouri August, 1993 to May, 1997 PROFESSIONAL TRAINING: Internship: The University of California Los Angeles Medical Center, Los Angeles, California General Surgery June, 1997 – July, 1998 Orthopaedic Surgery Residency: The University of California Los Angeles Medical Center, Los Angeles, California July, 1998 – July, 2002 Foot and Ankle...

Dr. George Published Articles

Thu, 26 Jun 2008 20:23:38 GMT

George MS. Arthroscopic Biceps Tenodesis Incorporated Into Rotator Cuff Repair Using Suture Anchors. Orthopedics 2008; 31:552-555 Dunn WR, George MS, Spindler, KP Ethics in Sports Medicine American Journal of Sports Medicine, May 2007; 35 (5): 840-4. George MS. Fractures of the greater tuberosity of the humerus. Journal of the American Academy of Orthopaedic Surgeons. Oct. 2007;15 (10): 607-13. George MS, Huston LJ, Spindler KP. Endoscopic versus Rear-Entry ACL Reconstruction: A systematic Review. Clinical Orthopaedics and Related Research 2007 Feb;455:158-61 Spindler KP, George MS, Kaeding CC, Amendola AA. Stress Fractures in Athletes. Johnson D, Pedowitz R, ed. Practical Orthopaedic Sports Medicine and Arthroscopy. Philadelphia ; Lippincott Williams and Wilkins 2007 George MS, Dunn WR, Spindler KP. Current Concepts Review: Revision Anterior Cruciate Ligament Reconstruction. American Journal of Sports Medicine. 2006 Dec;34(12):2026-37 Koester MC, George...

Community Involvement

Tue, 27 May 2008 18:52:52 GMT

KSF Orthopaedic Center, P.A. has been involved in Northwest Houston for over 30 years. During our years in the community we have built strong relationships with many organizations around the area. Listed below are some of the projects and organizations we have been a part of.

Sports physicals for athletes at area schools:

Eisenhower High School

Kingwood High School

Spring High School

Westfield High School

Klein Forest High School

Nimitz High School

Teague Middle School

Stovall Middle School

Orthopaedic providers for area sports teams:

   Pursuit Soccer
    Houston Blazers Basketball
    International Gymnastics Academy
   Texas Copperheads (AFL2)

Nimitz High School

Volunteers for Houston area hospitals:

Shriners Hospital

Northwest Houston Chamber of Commerce

Advisors to national prosthetic replacement companies.

Staff Leadership roles at local hospitals include:
(Dr. Travis Hanson) Chairman of Surgery at Methodist Willowbrook Hospital

(Dr. Michael George) Chairman (Elect) of Surgery at Methodist Willowbrook Hospital

(Dr. Korsh Jafarnia) Chief of staff elect & Former Chairman of Surgery at Willowbrook Methodist Hospital

Korsh Jafarnia, MD

Wed, 14 May 2008 19:17:35 GMT

Hand & Upper Extremity Surgery & General Orthopaedics Dr. Korsh Jafarnia completed his undergraduate degree and medical school at the University of Texas and trained in orthopaedic surgery at Baylor College of Medicine, where he won both a teaching excellence and an outstanding resident award. During his residency, Dr. Jafarnia studied at the French Institute for Surgery of the Hand in Paris learning innovative practices for hand surgery. This was followed by a fellowship in Hand and Upper Extremity surgery at the Massachusetts General Hospital at Harvard Medical School. Dr. Jafarnia is certified by the American Board of Orthopaedic Surgeons and he as also earned a Certificate of Added Qualification in hand surgery. He is a member of the American Society for Surgery for the Hand, the American Academy of Orthopaedic Surgeons, the Texas Medical Association, Harris County Medical Society, the Texas Orthopaedic Association, and The Houston Orthopaedic Society. Dr. Jafarnia is a...

Thomas J. Cartwright, MD

Wed, 14 May 2008 18:28:53 GMT

Spine Surgery & General Orthopaedics Dr. Thomas Cartwright embarked on his medical career in the summer between high school graduation and college, when he took a job restocking anesthesia carts in the operating rooms at Houston Northwest Medical Center. That made a big impression on me, he says. Thats when I knew I wanted to be a doctor. He went on to get his medical degree from the University of Texas Medical Branch in Galveston, Texas. He completed his internship at John Peter Smith in Fort Worth, and his orthopaedic residency at New York City Catholic Medical Center. After his residency, Dr. Cartwright completed two fellowships to further his expertise on injuries and diseases affecting the human spine; the first at the Texas Back Institute in Plano, Texas, and the second at The Center for Spinal Studies at Queens Medical Center in Nottingham, England. Dr. Cartwright is board certified by the American Board of Orthopaedic...

Alan Rosen, MD

Wed, 14 May 2008 18:14:18 GMT

Hand & Upper Extremity Surgery, Sports Injuries Dr. Alan Rosen was an intern and resident in Orthopaedic Surgery at Stanford University in the San Francisco Bay Area. He completed his Fellowship in Hand and Microvascular Surgery at the Hospital for Special Surgery at Cornell University in New York City. Prior to immigrating to the United States, Dr. Rosen attended Medical School at the University of Witwatersrand in Johannesburg, South Africa. He also taught Anatomy at the University of California, San Francisco Medical School where he received several teaching awards. Dr. Rosen is a Diplomate of the American Board of Orthopaedic Surgery and a Fellow of the American Academy of Orthopaedic Surgeons. He is a member of the American Society for Surgery of the Hand with Certification of Added Qualification in Surgery of the Hand and Upper Extremity. In addition he is also a member of the Texas Orthopaedic Association, the Houston Orthopaedic Society, the Texas Medical Association...

Patient Satisfaction

noemail@ksfortho.com — Tue, 28 Mar 2006 20:00:00 GMT

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