“It is an honor to receive the Health Care Heroes Lifetime Achievement Award. It has special meaning for me, as it recognizes my accomplishments in improving orthopedic care for people on Long Island and my work in educating many orthopedic surgeons now practicing here,” Dr. Dines said. “It represents a wonderful affirmation that I've been able to make a difference in the lives of many Long Islanders over the years.”

Over his 45-year career, Dr. Dines earned a reputation as a skilled and meticulous orthopedic surgeon; a brilliant thought leader; and an inspirational mentor to hundreds of medical students, orthopedic residents and fellows. He has provided the highest quality care to thousands of Long Islanders to help them overcome pain and return to active, healthy lifestyles.

Dr. Dines is a member of the Sports Medicine Institute at HSS and sees patients at HSS Long Island in Uniondale. He serves as medical director of the HSS Education Institute and has held the position of co-chief of the highly regarded shoulder fellowship at HSS since 2017. 

Considered one of the foremost authorities in shoulder replacement surgery worldwide, Dr. Dines has pioneered innovative techniques and surgical implants. Known for his work with professional athletes, he has served as medical director of the Association of Tennis Professionals (ATP) Tour since 2000. He was a team physician for the Long Island Ducks baseball team from 2000 to 2020, and for the New York Mets from 1992 to 1996. 

Dr. Dines has received a number of awards over the years. In 2024, the Middle Atlantic Shoulder and Elbow Society honored him with its Lifetime Achievement Award. He continues to conduct research to advance the field of joint replacement surgery.  

The glenoid is the socket part of the shoulder joint that connects to the ball of the upper arm bone. Glenoid bone loss can occur due to severe arthritis, traumatic injury or repetitive overuse in sports like baseball or swimming. It can also occur as a result of failed previous surgery. Symptoms associated with glenoid bone loss include inflammation, pain and decreased shoulder function.

“Shoulder arthroplasty to address glenoid deficiency is a very hot topic right now as we’re seeing more patients with arthritis and younger patients with complex anatomical issues,” said Dr. Dines. “Up to 10 or 15 years ago, we didn’t have much to offer. Today, we have advanced surgical techniques and a range of implant options for restoring mobility and improving patients’ quality of life.”

During the session, eight cases of varying levels of glenoid bone deficiency were presented for consideration by session attendees divided into groups at discussion tables. Members of an international panel of leading shoulder surgeons from the United States, France and Italy guided discussions at each table as participants formulated potential surgical approaches for each case. After groups shared their proposed approaches in a round-robin format, it was presented how HSS treated the cases. Attendees then had an opportunity to discuss and critique the solutions.

Session participants learned about the latest innovations for addressing glenoid bone loss, starting with advanced diagnostic imaging and pre-op planning systems used at HSS, one of the institutions with this capability.

Surgical approaches presented included two bone grafting techniques: bony increased offset-total shoulder arthroplasty (BIO-TSA) and bony increased offset-reverse shoulder arthroplasty (BIO-RSA). The latter reverses the ball and socket components of the joint for increased stability. Another case illustrated an augmented glenoid implant, which uses a metal or polyethylene wedge or a larger metal plate to replace bone loss. HSS has been at the forefront of developing augmented glenoid implants, Dr. Dines said.

Three complex cases of significant bone loss highlighted the use of patient-specific implants, the latest innovation in the field pioneered at HSS by Dr. Dines and colleagues. Known as the glenoid vault reconstruction system (VRS), it is used for patients with significant loss of bone and supporting joint structure. “We create a customized implant for each patient, based on 2D and 3D CT scans,” he explained. “The VRS works well to address severe bone loss in patients with advanced rheumatoid arthritis, after tumor removal or for revisions.” Dr. Dines said he looks forward to presenting results on treating about 75 HSS patients with the VRS at next year’s AAOS annual meeting.

“It’s an exciting time for advances in shoulder arthroplasty,” he concluded. “Our interactive session sparked many fruitful discussions that I hope will lead to increased shared learning and the development of more innovations for improving patient outcomes.”

A new retrospective study from Hospital for Special Surgery (HSS) evaluated 72 patients who underwent arthroscopic SCR with dermal allograft to treat symptomatic irreparable rotator cuff tears. All patients were operated on at HSS between 2012 and 2017. Nearly 42% of the patients had a history of failed rotator cuff repair.

After surgery, the overwhelming majority of patients demonstrated significant improvements in forward elevation, abduction and external rotation through their pre- and post-operative active range of motion. At follow-up appointments, patients completed various patient-reported outcome surveys including Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Surgeons (ASES), and University of California at Los Angeles (UCLA). Patient scores were high, averaging 80%, 78% and 85%, respectively.

Five patients required a second operation – no other complications were recorded.

“This technique has proven to be effective for patients with irreparable tears,” said Joshua S. Dines, MD, HSS sports medicine surgeon and senior study author. “As we continue to do more outcomes research, we become more precise at predicting the best candidates for each technique. While not for everyone, this has emerged as a great option for patients who may not be right for a reverse shoulder replacement.”

The authors look to perform future research evaluating the long-term outcomes and results.

This study is available online as part of the AAOS 2020 Virtual Education Experience.

Abstract Title: Clinical Outcomes following Arthroscopic Shoulder Superior Capsular Reconstruction

Authors: Daniel Hurwit, MD, Justin Chan, Michael Fu, MD, John Apostolakos, MD, Stephen Fealy, MD, Frank Cordasco, MD, David Dines, MD, Lawrence Gulotta, MD, Joshua Dines, MD.

Reconstruction is the current standard of care surgical treatment for tears of the anterior cruciate ligament (ACL). This procedure typically uses a graft, or a piece of tissue, placed in the knee minimally invasively, using small incisions. About 300,000 ACL reconstructions are performed annually in the United States with well documented rates of success.

ACL repair is an older technique that involved suturing (sewing) torn ACL tissue, not rebuilding it with a graft. ACL repair was performed in the 1970s at select institutions, including Hospital for Special Surgery, but was abandoned due to unacceptably high failure rates of up to 50%.

Today, ACL repair has been modernized and can be performed through a minimally invasive approach. Proponents suggest that modern ACL repair techniques may be performed safely and may lead to a quicker recovery than ACL reconstruction. However, the limited studies to date raise questions that must be discussed in detail with your surgeon.

1. It is critically important to get ACL surgery right the first time.

When ACL surgery fails, surgeons must do a revision procedure to correct or revise the problems that were not fully addressed the first time. Revision requires reconstructive ACL surgery with a graft. (ACL repairs cannot be done as revisions.) Redoing ACL surgery may result in higher rates of failure, lower rates of return to sports, and increased risk of osteoarthritis.

The importance of successful initial ACL surgery holds true for people of all ages, but it is particularly critical for young athletes, for whom a failed surgery can have devastating consequences, including years lost from sport in the short term as well as chronic pain and loss of function in the long term.

2. Failure rates for ACL repair appear to be significantly higher than those for ACL reconstruction in people of all ages.

Current studies suggest that modern ACL repair techniques have a failure rate that may be five to ten times higher than that of ACL reconstruction^1,2,3. One major recent study in a prominent sports medicine journal found that arthroscopic ACL repair has unacceptable outcomes in young athletes, with short-term failure rates of close to 50%².

It has been suggested that ACL repair may be appropriate for older adults who have a type of ACL tear called a proximal avulsion and who do not participate in “cutting and pivoting” sports such as basketball, volleyball, and soccer. For these patients, failure rates in the short term appear to be much higher than ACL reconstruction in this age group^1,2,3.

3. There is still much we don’t know about ACL repair.

There has been no scientific evidence that shows a difference in postoperative pain between ACL repair and reconstruction. Rehabilitation and return-to-play protocols for ACL repair have not yet been established. Proper guidelines for rehabilitation and return to sports are essential to keep people safe from re-injury.
 

Andrew D. Pearle, MD

Chief, HSS Sports Medicine Institute

Bryan T. Kelly, MD

HSS Surgeon-in-Chief and Medical Director

Answorth A. Allen, MD

David W. Altchek, MD

Struan H. Coleman, MD, PhD

Frank A. Cordasco, MD, MS

David M. Dines, MD

Joshua S. Dines, MD

Stephen Fealy, MD

Andreas H. Gomoll, MD

Lawrence V. Gulotta, MD

Jo A. Hannafin, MD, PhD

Anne M. Kelly, MD

John D. MacGillivray, MD

Robert G. Marx, MD, MSc, FRCSC

Michael J. Maynard, MD

Moira M. McCarthy, MD

Danyal H. Nawabi, MD, FRCS

Stephen J. O’Brien, MD, MBA

Anil S. Ranawat, MD

Scott A. Rodeo, MD

Howard Anthony Rose, MD

Beth E. Shubin Stein, MD

Sabrina M. Strickland, MD

Karen M. Sutton, MD

Samuel A. Taylor, MD

Russell F. Warren, MD

Thomas L. Wickiewicz, MD

Riley J. Williams III, MD

References

1. Jonkergouw A, van der List J, DiFelice G. Arthroscopic primary repair of proximal ACL tears: outcomes of the first 56 consecutive patients and the role of additional internal bracing. Knee Surg Sports Traumatol Arthrosc. 2019 Jan;27(1):21-28.

2. Gagliardi AG, Carry PM, Parikh HB, Traver JL, Howell DR, Albright JC. ACL repair with suture ligament augmentation is associated with a high failure rate among adolescent patients. Am J Sports Med. 2019 Mar;47(3):560-566.

3. Wright RW et al. Risk of tearing the intact ACL in the contralateral knee and rupturing the ACL graft during the first 2 years after ACLR: A prospective MOON cohort study. Am J Sports Med. 2007 Jul;35(7):1131-4.

For more information visit https://www.hss.edu/condition-list_torn-acl.asp.