Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes

1198 Pages·2009·7.2 MB·English

by  Frank R. Noyes MD

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NOYES’KNEEDISORDERS:SURGERY,REHABILITATION, ISBN:978-1-4160-5474-0
CLINICALOUTCOMES
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ThePublisher
LibraryofCongressCataloging-in-PublicationData
Kneedisorders:surgery,rehabilitation,clinicaloutcomes/editor,
FrankR.Noyes;associateeditor,SueD.Barber-Westin.--1sted.
p.;cm.
Includesbibliographicalreferences.
ISBN978-1-4160-5474-0
1.Knee--Surgery.2.Knee--Surgery--Patients--Rehabliitation.I.
Noyes,FrankR.II.Barber-Westin,SueD.
[DNLM:1.KneeInjuries--surgery.2.JointDiseases--rehabilitation.
3.JointDiseases--surgery.4.KneeInjuries--rehabilitation.5.Knee
Joint--surgery.WE870K67342009]
RD561.K57452009
617.5’82059--dc22 2009007993
AcquisitionsEditor:KimberlyMurphy
DevelopmentalEditor:AnneSnyder
DesignDirection:StevenStave
PrintedinChina
Lastdigitistheprintnumber:9 8 7 6 5 4 3 2 1
DEDICATION
To JoAnne, my loving and precious wife,
and to all our families.
Contributors
Thomas P. Andriacchi,PhD and Treatment of Knee Arthrofibrosis; The Cincinnati Knee
Professor, Stanford University, Stanford; Research Career Rating System; The International Knee Documentations
Scientist, VA Palo Alto Research and Development, Bone Committee Rating System; Rating of Athletic and Daily
and Joint Research Center, Palo Alto, California Functional Activities after Knee Injuries and Operative
Human Movement and Anterior Cruciate Ligament Function: Procedures; Articular Cartilage Rating Systems
Anterior Cruciate Ligament Deficiency and Gait Mechanics
Asheesh Bedi,MD
John Babb,MD
Fellow, Shoulder Surgeryand SportsMedicine, Hospital for
Staff Orthopedic Surgeon, Mid-America Orthopedics,
Special Surgery, New York, New York
Wichita, Kansas
Biology of Anterior Cruciate Ligament Graft Healing
Medial and Anterior Knee Anatomy
Geoffrey A. Bernas,MD
Sue D. Barber-Westin,BS
Clinical Assistant Professor of Orthopaedic Surgery,
Director, Clinical and Applied Research, Cincinnati
Department of Orthopaedic Surgery, University at Buffalo,
Sportsmedicine Research and Education Foundation,
Buffalo; University Sports Medicine, Orchard Park,
Cincinnati, Ohio
New York
AnteriorCruciateLigamentPrimaryandRevisionReconstruction:
Management of Acute Knee Dislocation before Surgical
Diagnosis,OperativeTechniques,andClinicalOutcomes;Scientific
Intervention
Basis of Rehabilitation after Anterior Cruciate Ligament
Autogenous Reconstruction; Rehabilitation of Primary and
RevisionAnteriorCruciateLigamentReconstructions;RiskFactors Lori Thein Brody,PT,PhD,SCS,ATC
for Anterior Cruciate Ligament Injuries in the Female Athlete; Graduate Program Director, Orthopaedic and Sports
LowerLimbNeuromuscularControlandStrengthinPrepubescent Physical Therapy, Rocky Mountain University of Health
and Adolescent Male and Female Athletes; Decreasing the Risk of Professions, Provo, Utah; Senior Clinical Specialist, UW
AnteriorCruciateLigamentInjuriesinFemaleAthletes;Function Health, Madison, Wisconsin
of the Posterior Cruciate Ligament and Posterolateral Ligament Aquatic Therapy for the Arthritic Knee
Structures; Posterior Cruciate Ligament: Diagnosis, Operative
Techniques, and Clinical Outcomes; Posterolateral Ligament William D. Bugbee,MD
Injuries:Diagnosis,OperativeTechniques,andClinicalOutcomes; Associate Professor, University of California, San Diego;
Rehabilitation of Posterior Cruciate Ligament and Posterolateral Attending Orthopaedic Surgeon, and Director, Cartilage
Reconstructive Procedures; Medial and Posteromedial Ligament Transplant Program, Scripps Clinic, La Jolla, California
Injuries:Diagnosis,OperativeTechniques,andClinicalOutcomes; Valgus Malalignment: Diagnosis, Osteotomy Techniques, and
Rehabilitation of Medial Ligament Injuries; Meniscus Tears: Clinical Outcomes; Osteochondral Grafts: Diagnosis, Operative
Diagnosis, Repair Techniques, and Clinical Outcomes; Meniscus Techniques, and Clinical Outcomes
Transplantation: Diagnosis, Operative Techniques, and Clinical
Outcomes; Rehabilitation of Meniscus Repair and Transplantation Terese L. Chmielewski,PhD,PT,SCS
Procedures; Primary, Double, and Triple Varus Knee Syndromes: Assistant Professor, Department of Physical Therapy, and
Diagnosis, Osteotomy Techniques, and Clinical Outcomes; Affiliate Assistant Professor, Department of Orthopaedics
Rehabilitation after Tibial and Femoral Osteotomy; Correction of and Rehabilitation, University of Florida, Gainesville,
Hyperextension Gait Abnormalities: Preoperative and Florida
Postoperative Techniques; Operative Options for Extensor Neuromuscular Retraining after Anterior Cruciate Ligament
Mechanism Malalignment and Patellar Dislocation; Prevention Reconstruction
vii
viii Contributors
A. Lee Dellon,MD,PhD Procedures; Rehabilitation after Tibial and Femoral Osteotomy;
Professor of Plastic Surgery and Professor of Neurosurgery, Correction of Hyperextension Gait Abnormalities: Preoperative
Johns Hopkins University; Director, The Dellon Institutes and Postoperative Techniques
for Peripheral Nerve Surgery, Baltimore, Maryland
Knee Pain of Neural Origin Susan Jordan,MD
Assistant Professor of Orthopaedic Surgery, University of
Alvin Detterline,MD Pittsburgh School of Medicine; University of Pittsburgh
Orthopaedic Surgeon, Sports Medicine, Towson Medical Center, Pittsburgh, Pennsylvania
Orthopaedic Associates, Baltimore, Maryland Scientific and Clinical Basis for Double-Bundle Anterior Cruciate
Medial and Anterior Knee Anatomy Ligament Reconstruction in Primary and Revision Knees
Eric W. Fester,MD Anastassios Karistinos,MD
Assistant Professor of Surgery, Uniformed Services Assistant Professor, Baylor College of Medicine; Physician/
University of the Health Sciences, Bethesda, Maryland; Surgeon, Veterans Administration Hospital, and Ben Taub
Clinical Assistant Professor of Orthopaedic Surgery, Wright General Hospital, Houston, Texas
State University, Dayton, Ohio; Chief, Orthopaedic Sports Graft Options for Anterior Cruciate Ligament Revision
Medicine, Wright-Patterson Medical Center, Wright- Reconstruction
Patterson Air Force Base, Ohio
Lateral, Posterior, and Cruciate Knee Anatomy Jennifer Kreinbrink,BS
Research Technician Associate, Orthopaedic Surgery,
Freddie Fu,MD University of Michigan Health System, Ann Arbor,
ChairmanandDavidSilverProfessorofOrthopedicSurgery, Michigan
University of Pittsburgh School of Medicine; Chief of Gender Differences in Muscular Protection of the Knee
Orthopaedics, Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Scott Lephart,PhD,ATC
Pennsylvania Associate Professor, University of Pittsburgh; Director,
Scientific and Clinical Basis for Double-Bundle Anterior Cruciate Neuromuscular Research Laboratory, Pittsburgh,
Ligament Reconstruction in Primary and Revision Knees Pennsylvania
Differences in Neuromuscular Characteristics between Male and
Simon Go¨rtz,MD Female Athletes
Research Fellow, Department of Orthopaedic Surgery,
University of California, San Diego, La Jolla, California Thomas Lindenfeld,MD
Valgus Malalignment: Diagnosis, Osteotomy Techniques, and Adjunct Professor, Department of Biomedical Engineering,
Clinical Outcomes; Osteochondral Grafts: Diagnosis, Operative and Volunteer Instructor Professor, Department of
Techniques, and Clinical Outcomes Orthopaedics, University of Cincinnati; Associate Director,
Cincinnati Sportsmedicine and Orthopaedic Center, and
Edward S. Grood,PhD Cincinnati Sportsmedicine Research and Education
Director,BiomechanicsResearch,CincinnatiSportsmedicine Foundation, Cincinnati, Ohio
Research and Education Foundation; Professor Emeritus, Diagnosis and Treatment of Complex Regional Pain Syndrome
Department of Biomedical Engineering, Colleges of
Medicine and Engineering, University of Cincinnati, Frank R. Noyes,MD
Cincinnati, Ohio Chairman and CEO, Cincinnati Sportsmedicine and
The Scientific Basis for Examination and Classification of Knee Orthopaedic Center; President and Medical Director,
Ligament Injuries; Knee Ligament Function and Failure Cincinnati Sportsmedicine Research and Education
Foundation; Clinical Professor (Volunteer), Department of
Timothy P. Heckmann,PT,ATC Orthopaedic Surgery, University of Cincinnati College of
Co-Director of Rehabilitation, Cincinnati Sportsmedicine Medicine; Previous Adjunct Professor, Noyes Tissue
and Orthopaedic Center; Rehabilitation Consultant, Engineering and Biomechanics Laboratory, Department of
Cincinnati Sportsmedicine Research and Education BiomedicalEngineering,UniversityofCincinnatiCollegeof
Foundation, Cincinnati, Ohio Engineering, Cincinnati, Ohio
ScientificBasisofRehabilitationafterAnteriorCruciateLigament Medial and Anterior Knee Anatomy; Lateral, Posterior, and
Autogenous Reconstruction; Rehabilitation of Primary and CruciateKneeAnatomy;TheScientificBasisforExaminationand
Revision Anterior Cruciate Ligament Reconstructions; ClassificationofKneeLigamentInjuries;KneeLigamentFunction
Rehabilitation of Posterior Cruciate Ligament and Posterolateral and Failure; Anterior Cruciate Ligament Primary and Revision
Reconstructive Procedures; Rehabilitation of Medial Ligament Reconstruction: Diagnosis, Operative Techniques, and Clinical
Injuries; Rehabilitation of Meniscus Repair and Transplantation Outcomes;ScientificBasisofRehabilitationafterAnteriorCruciate
Contributors ix
Ligament Autogenous Reconstruction; Rehabilitation of Primary Scott A. Rodeo,MD
and RevisionAnteriorCruciateLigamentReconstructions;Risk Professor and Co-Chief, Shoulder and Sports Medicine
FactorsforAnteriorCruciateLigamentInjuriesintheFemale Service, Hospital for Special Surgery; Professor, Weill
Athlete;LowerLimbNeuromuscularControlandStrengthin Cornell Medical College, New York, New York
PrepubescentandAdolescentMaleandFemaleAthletes;Decreasing Biology of Anterior Cruciate Ligament Graft Healing
theRiskofAnteriorCruciateLigamentInjuriesinFemaleAthletes;
FunctionofthePosteriorCruciateLigamentandPosterolateral
David L. Saxton,MD
LigamentStructures;PosteriorCruciateLigament:Diagnosis,
Clinical Faculty, University of Oklahoma Health Sciences
OperativeTechniques,andClinicalOutcomes;Posterolateral
Center, Oklahoma City, Oklahoma
LigamentInjuries:Diagnosis,OperativeTechniques,andClinical
Diagnosis and Treatment of Complex Regional Pain Syndrome
Outcomes;RehabilitationofPosteriorCruciateLigamentand
PosterolateralReconstructiveProcedures;MedialandPosteromedial
Sean F. Scanlan,MS
LigamentInjuries:Diagnosis,OperativeTechniques,andClinical
Stanford University, Stanford; Postdoctoral Fellow, VA Palo
Outcomes;RehabilitationofMedialLigamentInjuries;Meniscus
Alto Research and Development, Bone and Joint Research
Tears:Diagnosis,RepairTechniques,andClinicalOutcomes;
Center, Palo Alto, California
MeniscusTransplantation:Diagnosis,OperativeTechniques,and
Human Movement and Anterior Cruciate Ligament Function:
ClinicalOutcomes;RehabilitationofMeniscusRepairand
Anterior Cruciate Ligament Deficiency and Gait Mechanics
TransplantationProcedures;Primary,Double,andTripleVarusKnee
Syndromes:Diagnosis,OsteotomyTechniques,andClinicalOutcomes;
RehabilitationafterTibialandFemoralOsteotomy;Correctionof Robert C. Schenck, Jr.,MD
HyperextensionGaitAbnormalities:PreoperativeandPostoperative Professor and Chair, Department of Orthopaedic Surgery,
Techniques;OperativeOptionsforExtensorMechanism University of New Mexico School of Medicine; Head Team
MalalignmentandPatellarDislocation;PreventionandTreatmentof Physician, Department of Athletics, University of New
KneeArthrofibrosis;DiagnosisandTreatmentofComplexRegional Mexico, Albuquerque, New Mexico
PainSyndrome;TheCincinnatiKneeRatingSystem;The Classification of Knee Dislocations
InternationalKneeDocumentationsCommitteeRatingSystem;
RatingofAthleticandDailyFunctionalActivitiesafterKneeInjuries Timothy Sell,PhD,PT
andOperativeProcedures;ArticularCartilageRatingSystems Assistant Professor, University of Pittsburgh; Associate
Director, Neuromuscular Research Laboratory, Pittsburgh,
Lonnie E. Paulos,MD Pennsylvania
ResearchAssociate,DepartmentofHealth,Leisureand Differences in Neuromuscular Characteristics between Male and
ExerciseScience,UniversityofWestFlorida;MedicalDirector, Female Athletes
andPhysician/Surgeon,Andrews-PaulosResearchand
EducationInstitute,GulfBreezeHospital,AndrewsInstitute Wei Shen,MD,PhD
SurgicalCenter,PensacolaBeach,Florida Post-doctoral Associate, University of Pittsburgh,
GraftOptionsforAnteriorCruciateLigamentRevisionReconstruction Pittsburgh, Pennsylvania
Scientific and Clinical Basis for Double-Bundle Anterior Cruciate
Lars Peterson,MD,PhD Ligament Reconstruction in Primary and Revision Knees
Professor of Orthopaedics, University of Goteborg;
Department of Orthopaedics, Sahlgrenska University Justin P. Strickland,MD
Hospital, Gothenburg, Sweden Physician’s Clinic of Iowa, Cedar Rapids, Iowa
Autologous Chondrocyte Implantation Lateral, Posterior, and Cruciate Knee Anatomy
Michael M. Reinold,PT,DPT,ATC,CSCS Robert A. Teitge,MD
Rehabilitation Coordinator and Assistant Athletic Trainer, Professor, Wayne State University, Detroit; Chief,
BostonRedSox;CoordinatorofRehabilitationResearchand Orthopaedic Surgery, DMC Surgery Hospital, Madison
Education, Division of Sports Medicine, Department of Heights, Michigan
Orthopedic Surgery, Massachusetts General Hospital, Patellofemoral Disorders: Correction of Rotational Malalignment
Boston, Massachusetts of the Lower Extremity
Rehabilitation after Articular Cartilage Procedures
Kelly L. Vander Have,MD
Dustin L. Richter,BS Assistant Professor, University of Michigan, Ann Arbor,
Medical Student, University of New Mexico School of Michigan
Medicine, Albuquerque, New Mexico Anterior Cruciate Ligament Reconstruction in Skeletally
Classification of Knee Dislocations Immature Patients
x Contributors
C. Thomas Vangsness, Jr.,MD Birmingham, Alabama; Rehabilitation Consultant, Tampa
Professor, Keck School of Medicine, University of Southern Bay Rays, Tampa, Florida
California, Los Angeles, California Neuromuscular Retraining after Anterior Cruciate Ligament
Allografts: Graft Sterilization and Tissue Banking Safety Issues Reconstruction; Rehabilitation after Articular Cartilage
Procedures
Daniel C. Wascher,MD
Professor, Department of Orthopaedics, University of New Edward M. Wojtys,MD
Mexico, Albuquerque, New Mexico Professor, Department of Orthopaedic Surgery, Chief,
Classification of Knee Dislocations Sports Medicine Service, and Medical Director, MedSport,
University of Michigan, Ann Arbor, Michigan
Kevin E. Wilk,DPT,PT Anterior Cruciate Ligament Reconstruction in Skeletally
Adjunct Assistant Professor, Marquette University, Immature Patients; Gender Differences in Muscular Protection of
Milwaukee, Wisconsin; Vice President, Education, and the Knee; Management of Acute Knee Dislocation before Surgical
Associate Clinical Director, Physiotherapy Associates, Intervention
Preface
I am grateful to all of the contributors to this book on Knee statistics, and validated clinical outcome instruments always
Disorders,whichisappropriatelysubtitled“Surgery,Rehabilita- remain as our light-posts for patient treatment decisions. For
tion,ClinicalOutcomes.”Thechaptersreflect thewritingsand thisreason,thereisamplespacedevotedinchapterstothesesci-
teachings of the scientific and clinical disciplines required for entificdisciplines.Equally,thedescriptionofsurgicaltechniques
the modern treatment of clinical afflictions of the knee joint. is presented in a step-by-step approach, with precise details by
Thegoalofthewritersofeachchapteristopresentrationalevi- experienced surgeons on the critical points for each surgical
dence-based treatment programs based on published basic technique to achieve a successful patient outcome. It is hoped
science and clinical outcomes to achieve the most optimal out- that surgeons in training will appreciate the necessity for the
comes forourpatients. basic science and anatomic approach that, combinaed with sur-
The “KEY” to understanding the different disorders of the gical and rehabilitation principles, is required to become a true
kneejointencounteredinclinicalpracticetrulyrestsonamulti- “masterofkneesurgeryandrehabilitation”.
pledisciplinarianapproachandincludesacomprehensiveunder- Thereisaspecialemphasisplacedineachofthemajorbook
standing of knee anatomy, biomechanics, kinematics, and sections on rehabilitation principles and techniques including
biologyofsofttissuehealing.Restorationofkneefunctionthen pre-operative assessment, postoperative protocols, and func-
requiresaprecisediagnosisofthefunctionalabnormalityofthe tional progression programs to restore lower limb function.
involvedkneestructures,asurgicaltechniquethatispreciseand We have published comprehensive rehabilitation protocols in
successful,andarehabilitationprogramdirectedbyskilledpro- this book that have been used and continually modified over
fessionals to restore function and avoid complications. Each many years which direct the postoperative treatment of our
chapter follows a concise outline of indications, contraindica- patients. My co-author on these sections, Tim Heckmann, is a
tions, physical examination and diagnosis, step-by-step open superb physical therapist. We have worked together treating
and arthroscopic surgical procedures, clinical outcomes, and patients in a wonderful harmonious relationship for nearly
analysis ofrelevantpublishedstudies. 30 years. In addition, there are special programs for the female
The first two chapters comprise an anatomic description of athlete to reduce the risk of an ACL injury. Sportsmetrics, a
the structures of the knee joint. The photographs and illustra- non-profit neuromuscular training and conditioning program
tionsrepresenttheresultofmanycadavericdissectionstodocu- developedatourFoundation,isoneofthelargestwomen’sknee
mentkneeanatomicstructures.Itwasapleasuretohavefourof injurypreventionprogramsintheUnitedStatesandhasbeenin
our fellows (class of 2008-2009) involved in these dissections existence for over 15 years. A number of scientists, therapists,
whichresultedintwosuperbinstructionalanatomicvideosthat athletic trainers, and physicians at our Foundation have been
already have received awards and are included in the DVD. involvedintheresearcheffortsandpublicationsofthisprogram.
Numerous anatomic textbooks and publications were consulted Allcenterstreatingkneeinjuriesinathletesareremindedofthe
during the course of these dissections to provide to the best of importance of preventive neuromuscular and conditioning pro-
ourabilityaccurateanatomicdescriptions,realizingthereisstill gramswhoseneedhasbeenwellestablishedbymanypublished
ambiguityinthenomenclatureusedforcertainkneestructures. studies.
SpecialthankstoJoeChovanwhoisawonderfulandhighlytal- TheentirestaffatCincinnatiSportsmedicineandOrthopae-
ented professional medical illustrator. Joe attended anatomic dicCenterandtheFoundationfunctionsinateameffort,work-
dissections and worked hand-in-hand with us to produce the ing together in various clinical, research, and rehabilitation
finalanatomicillustrations.JoeandIheldweeklytobi-monthly programs. The concept of a team approach is given a lot of
longworkingsessionsforovertwoyearsthatresultedintheana- attention; and those who have visited our Center have seen the
tomic and medical illustrations throughout this book that are actual programs in place. This team effort is appreciated by all
unique, highly detailed, and believed to be anatomically including patients, staff, surgeons, physical therapists, athletic
accurate. trainers, administrative staff, and clinical research staff. Our
All surgeons appreciate that surgical procedures come and administrative staff, directed by a superb clinical operations
go, replaced by newer techniques that are more successful as manager Linda Raterman, manages five major MD-PT-ATC
techniques are discarded that may have proven inadequate by orthopediccenters.AsthePresidentandCEO,Ihavebeenfreed
long-termclinicaloutcomestudies.Iamremindedthatthebasic ofmanyoftheoperationaladministrative dutiesbecauseofthis
knowledge of anatomy, biomechanics, kinematics, biology, excellent staff, allowing time required for clinical and research
xi
xii Preface
responsibilities. I have been blessed to be associated with a MedicalResearchLaboratorieswiththeUnitedStatesAirForce
highly dedicated group of orthopedic partners who, besides in Dayton, Ohio. The facilities and veterinary support for bio-
providingexcellentpatientcareandlivelydiscussionsatouraca- mechanical knee studies were unheralded and it was here that
demic meetings, have donated a definedincome“tithing” every some of the first high strain-rate experiments on mechanical
year for funding research and clinical education programs at properties of knee ligaments were performed using the unique
our Foundation. laboratory testing equipment available. I am indebted to Victor
Nearly all of the patients treated at the Knee Institute are Frankel and Albert Burstein, the true fathers of biomechanics
entered into prospective clinical studies by a dedicated clinical intheUnitedStates,astheyguidedmeintheseformativeyears
researchgroupdirectedbySueBarber-WestinandCassieFleck- ofmycareer.Iwasparticularlyfortunatetohaveacloseassoci-
enstein. The staff meticulously tracks patients over many years ation with Al Burstein who mentored me in the discipline of
to obtain in published studies a 90 to 100% follow-up. I invite orthopedic biomechanics. This research effort also included
you to read the forward of Sue Barber-Westin who has per- professorsandstudentsattheAirForceInstituteofTechnology.
formed such an admirable and dedicated job in bringing our Iamgratefultoallofthemforinstructingmeintheearlyyears
clinical outcome studies to publication. It is only through her ofmyresearchtraining.Asbiomechanicswasjustinitsinfancy,
effortsthatwehavebeensuccessfulinlargeprospectiveclinical itwasobviousthatsubstantiveresearchwasonlypossiblewitha
outcome studies. In each chapter, the results of these outcome combinedMD-PhDteamapproach.
studies are rigorously compared with other authors’ publica- Oneofthemostfortunateblessingsinmyprofessionallifeis
tions. Theresearch andeducationalstaffworkwithfellows and the relationship I have had with Edward S. Grood, Ph.D. I
students from many different disciplines including physicians, establishedacloseworkingrelationshipwithEdndwecurrently
therapists, trainers and biomedical students. There have been have the longest MD-PhD (or PhD-MD) team that I know of
125OrthopedicandSportsmedicineFellowswhohavereceived whichisstillactivetodayasweconductthenextroundofknee
trainingatourCenter.Thescientificcontributionoffellowship ligament functionstudies usingsophisticated three-dimensional
researchprojectsareacknowledgednumeroustimesinthechap- robotic methodologies. We worked together in establishing
ters.Ourstaffenjoysthementoringprocessandfromapersonal one of the first Biomechanical and Bioengineering programs in
note,thishasbeenoneof mygreatestprofessional joys. thecountryattheUniversityofCincinnatiCollegeofEngineer-
Inregardtomentoring,onemightaskwherethespecialtyof ing,andIgreatlyappreciatedthatitwasnamedtheNoyesBio-
orthopedics (or any medical specialty) would be today without mechanics and Tissue Engineering Laboratory. This initial
the professional mentoring “system” that trains new surgeons effort expanded with leadership and dedicated faculty and
andadvancesourspecialty,providingforacontinuumofpatient resulted in a separate Bioengineering Department within the
treatmentapproachesandadvances.Theinformaldedicationof CollegeofEngineeringwithacompleteprogramforundergrad-
theteachertothestudent,oftenprovidingwisdomandguidance uateandgraduatestudents.Dr.Groodpioneeredthiseffortwith
overmanyyears,isactuallycontrarytocapitalisticprinciplesas other faculty and developed the educational curriculum for the
the hours of dedication are rarely if ever compensated. It is the five-year undergraduate program. Many students of this pro-
gift from one generation to another and I mention this specifi- gram have completed important research advances that are
callyasIhopethatIhavebeenabletorepayinpartthementors referenced in this book. David Butler, Ph.D. joined this effort
who provided this instruction and added time and interest for initsearlyyearsandcontributedimportantanduniqueresearch
my career.Igraduated from the Universityof Utah witha phi- works that are also credited throughout the chapters. This col-
losophydegreewhichprovidedanunderstandingofthewritings laborative effort of many scientists and physicians resulted in
and wisdom of the great scientists and “thinkers” of our times, threeKappaDeltaawards,theOrthopedicResearchandEduca-
taught by superb educators in premedical courses and philoso- tionClinicalResearchaward,AOSSMResearchAwards,andthe
phy. I received an M.D. degree from George Washington supportofnumerousgrantsfromNIH,NSF,andotherorgani-
University and am thankful to the dedicated teachers who laid zations. Thomas Andriacchi, Ph.D. collaborated on important
asolidmedicalfoundationfortheirstudentsandtaughttheseri- clinicalstudiesthatprovidedanunderstandingofjointkinemat-
ous dedication and obligation that physicians have in treating ics and gait abnormalities. It has been an honor to have Tom
patients. I was fortunate to be accepted for internship and resi- associatedwithoureffortsthroughouttheyears.
dencyattheUniversityofMichiganandremembertheopportu- My finest mentors were my parents, a dedicated and loving
nity to be associated with truly outstanding clinicians and father,MarionB.Noyes, M.D.whowas a truerenaissance sur-
surgeons. Under the mentorship of the chairman William S. geon entirely comfortable doing thoracic, general surgery, and
Smith, M.D., I and my fellow residents knew one of the finest orthopedicsandwho,asChiefSurgeon,traineddecadesofsur-
orthopedic surgeons and dedicated teachers one could be asso- gical residents. Early in my life, I read through classic Sobotta
ciated with who was a truly humble man that inspired decades anatomic textbooks and orthopedic textbooks which remain in
of orthopedic residents. Many graduates of this program have my library with his writings and notations along side. Later in
continued as orthopedic educators and researchers, which is a mytraining,Iwasfortunatetoscrubwithhimonsurgicalcases.
great tribute to Bill Smith and his mentorship. My fellow resi- My loving mother, a nurse by training, was truly God’s gift to
dents remember one of his many favorite sayings provided to ourfamilyformanygenerationsassheprovidedunqualifiedlove
remind residents of the need for humility. After a particularly andsageandexpertadvicetoourentirefamilywithknowledge,
enthusiastic lecture or presentation by a prominent surgeon wisdom,andtheadmiration ofallofuslivingintohernineties.
andglowingstatementsofadmiration,BillSmithwouldsaywith Sheexpectedexcellence,performance,andadherencetoarigor-
a wink and smile, “He puts his pants on one leg at a time just ousvaluesystem.Thesearealsotheattributesofthemostwon-
likeyoudo”. derfulgiftofall,theopportunitytogothroughlifewithaloving
After orthopedic residency, I accepted a four-year combined and true soul mate, my wife JoAnne Noyes that I remain eter-
clinical and research biomechanics position at the Aerospace nally grateful and devoted. Our family includes a fabulous
Preface xiii
daughter and son-in-law, two wonderful grandchildren, my In closing I wish to specially thank Kim Murphy, the Pub-
devoted son who graduated in Physics and mentors me in lishing Director of Elsevier and their staff who are true profes-
nuclear and atomic matters outside my reach, and a third won- sionals and were a joy to work with in completing this
derful and dedicated son and daughter-in-law with three addi- textbook.Givenallthedecisionsthatmustbemadeinbringing
tional grand-children. Together, with JoAnne and all our atextbooktopublication,attheendoftheprocesstheElsevier
brothersandsisters,weenjoywonderfulfamilyeventstogether. team made everything work in a harmonious manner always
As I look back on my career, it is the closeness of family and strivingforthehighestqualitypossible.
friendsthathasprovided thegreatestenrichment.
FRANKR.NOYES,MD