Theodore A. Blaine, MD

Professor of Orthopaedics and Rehabilitation; Interim Chairman, Department of Orthopaedics and Rehabilitation; Chief of Shoulder and Elbow Surgery; Director of Orthopaedic Fellowship Education

Research Interests

Arthritis; Tendons; Inflammation Mediators

Research Organizations

Orthopaedics & Rehabilitation: Shoulder & Elbow Surgery

Faculty Research

Research Summary

My research interests and activities include both basic science and clinical topics. Molecular biologic investigations include the pathophysiology of rotator cuff disease, mechanisms of healing and repair in shoulder instability, and augmentation of healing using growth factors and platelet rich plasma. Biomechanical research studies involve strength of biceps tenodesis and animal models of shoulder instability. Clinical topics include glenohumeral arthritis and shoulder replacement, injections for tennis elbow, and outcomes of rotator cuff repair.

Extensive Research Description

My research interests and activities include both basic science and clinical topics. Molecular biologic investigations include the pathophysiology of rotator cuff disease, mechanisms of healing and repair in shoulder instability, and augmentation of healing using growth factors and platelet rich plasma. Biomechanical research studies involve strength of biceps tenodesis and animal models of shoulder instability. Clinical topics include glenohumeral arthritis and shoulder replacement, injections for tennis elbow, and outcomes of rotator cuff repair.

A major line of research at Yale involves the pathophysiology of shoulder instability. Although Blundell Bankart described the anatomy and pathology of this injury in 1923, no further investigations have been performed to explain why this tear in the glenoid labrum does not heal. We have recently developed a new model for shoulder instability by creating a labral injury and assessing the healing potential using both biomechanical and immunohistochemical techniques. These initial studies have been presented at the American Academy of Orthopaedic Surgeons Meeting. Additional studies in our laboratory have shown that labral healing may be altered by commonly used anti-inflammatory agents (NSAIDs). The ultimate goal of these investigations is to determine which factors are important for labral healing. With this information, we may be able to devise pharmacologic agents to augment labral healing that may obviate the need for surgical reconstruction in patients with shoulder instability.

Another line of research involves rotator cuff healing and repair. Although rotator cuff disease is one of the most common musculoskeletal problems, the molecular pathophysiology of rotator cuff disease is still unclear. With grant support from an NIH COBRE grant and with funds from both the OREF and ASES, we have studied the role of the subacromial bursa in the pathology of rotator cuff disease. We were the first to characterize stromal derived factor-1 (SDF-1) in human subacromial bursa tissue, and quantified SDF-1 mRNA and protein levels in subacromial bursa. With these studies, we also found that commonly used pharmacologic agents (non steroidal anti-inflammatory drugs and corticosteroids) reduced the expression of SDF-1 in subacromial bursal cells. These results provided biologic evidence for the use of NSAIDs and steroids in the treatment of subacromial bursitis and rotator cuff disease.

Due to the deleterious side effects of NSAIDs and steroids on rotator cuff healing, subsequent studies have focused on the identification of new anti-inflammatory agents to treat subacromial inflammation. Using an in vitro model of subacromial inflammation, we have discovered that SDF-1 receptor (CXCR4) inhibitors may have a role in the treatment of subacromial bursitis. Stromal derived factor 1 (SDF-1alpha) inhibition and CXCR4 blockade as a treatment for bursitis, musculoskeletal inflammation, tendonitis, and tendon injury.) Recent studies have used animal models to test the ability of these agents to reduce inflammation without affecting rotator cuff healing.


Grants:

  1. (Pending) NIH R01 Grant Submission: Molecular Pathophysiology of Painful Periarticular Shoulder Inflammation in response to NIH initiative, PA #: PA-16-160, Research Project Grant (Parent R01), Feb 2, 2017. Funding request: $2,093,750.00
  2. (Active) US Lacrosse Sports Science and Safety Research Grant: A Biomechanical Analysis of the Protective Effect of Shoulder Pads in Preventing Major Shoulder Injury in Mens Lacrosse. Principal Investigator. Funding Period 2016-2017, $32,987.
  3. (Active) Principal Investigator, Tornier Pyrocarbon Multicenter IDE Study, Funding Period 2016-present.

Selected Publications

  • SHOULDER ARTHROSCOPY SHOULDER ARTHROSCOPY, Ed.: Blaine, TA, American Academy of Orthopaedic Surgeons Monograph Series, 2006
  • MINIMALLY INVASIVE SHOULDER AND ELBOW SURGERY MINIMALLY INVASIVE SHOULDER AND ELBOW SURGERY, Eds.: Levine W, Blaine TA, and Ahmad CS. Informa Healthcare USA, New York, NY, 2007.
  • Lateral epicondylitis Packer, JD., Nguyen, D., Kippe, MA., and Blaine, TA: Lateral epicondylitis, in THE ATHLETE’S ELBOW, AAOS Monograph Series 39, pps. 17-25, 2008.
  • Minimally invasive approach for shoulder arthroplasty Edwards, S, Blaine TA, Bell, JE, Marion CJ, and Bigliani LU: Minimally invasive approach for shoulder arthroplasty in MINIMALLY INVASIVE SURGERY IN ORTHOPAEDICS, Eds: Scuderi G., Tria A., and Berger R., pps. Springer 2010.
  • Non-operative management of idiopathic adhesive capsulitis

    Levine WN, Kashyap, CP, Bak, SF, Ahmad, CS, Blaine, TA, and Bigliani, LU: Non-operative management of idiopathic adhesive capsulitis, J SHOULDER ELBOW SURG., 16 (5): 569-73, 2007. Epub 2007 May 24.

  • The Low Prevalence of Early Radiolucencies About A Pegged Glenoid Component Using Cement Pressurization

    Barwood S, Blaine TA, Setter KJ, Lee, J., Levine, WN, Wiater JM, and Bigliani LU: The Low Prevalence of Early Radiolucencies About A Pegged Glenoid Component Using Cement Pressurization, J SHOULDER ELBOW SURG., 17: 703-708, 2008.

  • Treatment of persistent shoulder pain with sodium hyaluronate: a randomized, controlled trial. A multicenter study.

    Blaine TA, Moskowitz R, Udell J, Skyhar M, Levin R, Friedlander J, and Altman R, on behalf of the HUPS Clinical Study Group: Treatment of persistent shoulder pain due to osteoarthritis, rotator cuff tear, and/or adhesive capsulitis with HYALGAN: A randomized, controlled trial. JOURNAL BONE AND JOINT SURG.90A: 970-979, May 2008.

  • Superior Results with Non-operative Management of Superior Labral Tears

    Edwards SL, Packer JD, Lee JA, Bell JE, Ahmad CS, Levine WN, Bigliani LU, Blaine TA: Superior Results with Non-operative Management of Superior Labral Tears. AMERICAN JOURNAL OF SPORTS MEDICINE, 38:1456-61, 2010.

  • IL1- beta induces Expression of Stromal Derived Factor-1 in Subacromial Bursal Cells

    Blaine TA; Cote M; Proto A; Mulcahey M; Lee FY; and Bigliani LU: IL1- beta induces Expression of Stromal Derived Factor-1 in Subacromial Bursal Cells, J. ORTHOPAEDIC RESEARCH, 29: n/a. doi: 10.1002/jor.21416, 20:11, 1695-99, 2011.

  • .Clinical and Radiographic Outcomes of the Simpliciti Canal-Sparing Shoulder Arthroplasty System: A Prospective Two-Year Multicenter Study. Churchill RS, Chuinard C, Wiater JM, Friedman R, Freehill M, Jacobson S, Spencer E Jr, Holloway GB, Wittstein J, Lassiter T, Smith M, Blaine TA, Nicholson GP. J BONE JOINT SURG AM. 2016 Apr 6;98(7):552-60.
  • Three Step Arthroscopic ECRB release Kennedy G, Gowda A, Garver J, and Blaine TA. ORTHOPEDIC REVIEWS, 8(6081): 117-119, 2016.
  • Shoulder and Labral Injuries in Men’s Lacrosse Gardner L, Sutton K, Chan, W, and Blaine TA. AMERICAN JOURNAL SPORTS MED. 2016, Oct;44(10):2675-2681.
  • Current Trends in Orthobiologics and Shoulder Surgery Wiseman, S, Nelson SJ, Tyagi V, Kovacevic D, and Blaine TA. CURRENT ORTHOPAEDIC PRACTICE, 2017
  • Revision Strategies for Reverse Shoulder Arthroplasty Mata-Fink, Ana, Garver, JM, Gallacher S, Javier F, D Zhu, J Young, and Blaine TA. J SHOULDER AND ELBOW ARTHROPLASTY

Full List of PubMed Publications

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Contact Info

Theodore A. Blaine, MD
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Yale Orthopaedics - MilfordOrthopaedics - Milford
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