Anterior Cruciate Ligament Reconstruction using Bone-Tendon-Bone Allograft: Surgical Technique Using Augmentation with Bio-Composite Scaffold.

Anterior cruciate ligament (ACL) rupture rates remain high; the incidence of isolated ACL ruptures is 68.6 per 100,000. This Technical Note introduces a technique for ACL reconstruction (ACLR) using a bone-tendon-bone (BTB) allograft augmented with BioBrace, a biocomposite scaffold. The BioBrace scaffold is sutured onto the BTB allograft to reinforce the ligament and accelerate healing. Graft preparation with BioBrace, ACLR, and graft passage is described. This technique aims to reduce re-rupture risk, enhance graft healing, and improve patient-reported outcomes. BioBrace offers advantages over other augmentation approaches and synthetic materials, providing improved remodeling, biologic integration, and increased mechanical strength. Feasibility and efficacy have been demonstrated in animal models and human applications. This technique presents a promising approach to enhance ACLR outcomes.

Anchor-Based Meniscal Ramp Repair.

Ramp lesions of the medial meniscus are underdiagnosed because of difficulty in visualizing via magnetic resonance imaging and during arthroscopy. They most often occur simultaneously with anterior cruciate ligament (ACL) injury but may also be associated with posterior plateau contusions, steeper medial tibial plateau slope, and excess varus alignment. Upwards of 24% of ACL reconstructions have concomitant ramp lesions. Failure to repair the ramp lesion is associated with increased rotational laxity, tibial translocation, persistent pivot shift, and poorer outcomes after ACL reconstruction. The purpose of this article is to describe an all-suture anchor-based repair of a meniscal ramp lesion, which confers several advantages over traditional repair techniques.

Obesity does not impact complications and conversion to total knee arthroplasty after high tibial osteotomy: A systematic review.

PURPOSE: The purpose of this systematic review is to consolidate outcomes of obese patients undergoing high tibial osteotomy and to investigate the effect of obesity on postoperative outcomes, including symptomatic relief and time to conversion to arthroplasty. METHODS: Medline, Embase and Cochrane Library were searched from database inception up to April 2023 according to PRISMA guidelines by two reviewers. Search terms including 'obesity', 'BMI', 'osteotomy' and 'high tibial osteotomy (HTO)' were included to identify all relevant articles. Only studies that explicitly reported outcomes for obese patients were included. Disagreements in study inclusion or quality assessment were resolved by a senior third reviewer. Metrics compared include time to arthroplasty, preoperative and postoperative mechanical tibiofemoral angle (mTFA), patient-reported satisfaction scores and postoperative complications. RESULTS: Nine studies comparing 973 patients were included. The mean age was 52.7 ± 4.2 years old and 38.4% were male. Six studies performed the medial opening-wedge HTO, and three utilized the medial wedge closing technique. Most studies indicated significant improvement following surgical intervention with satisfactory outcomes in obese and nonobese patients. In addition, differences in complication rates were minimal between obese and nonobese patients (n.s.), while functional scores did not vary significantly. Conversion to total knee arthroplasty was not found to increase in obese patients (n.s.). CONCLUSION: Obesity does not appear to carry a greater complication risk or worse outcomes following high tibial osteotomies, and surgeons should consider HTO a viable option for young obese patients with symptomatic unicompartmental chondral wear with coronal limb malalignment. LEVEL OF EVIDENCE: Level IV.

Posterior lateral meniscal overhang is associated with ACL tears: A retrospective case-control study.

Introduction: There have been several described imaging findings that correlate with anterior cruciate ligament (ACL) injuries. The investigators in this study observed a higher frequency of posterior translation of the lateral meniscus beyond the posterior border of the tibial plateau in patients with ACL tears. The purpose of this study was to assess the frequency and degree of posterior lateral meniscal overhang (LMO) of the lateral meniscus in patients with ACL tears compared to uninjured controls. Materials and methods: Magnetic resonance imaging (MRI) was analyzed in 117 knees with ACL tears and compared to a control group of 89 knees without injury. Lateral meniscus diameter, LMO, knee flexion angle, and lateral tibial plateau diameter were measured and compared between the two groups. Exclusion criteria included displaced and macerated lateral meniscus tears, multi-ligamentous knee injuries, and periarticular fractures. Difference in mean lateral meniscal overhang between ACL injured and control groups was tested using a paired T-test (alpha = 0.01). Assumptions for normality and variance were tested prior to analysis. Results: In patients with ACL tears, average LMO was significantly greater compared to the control group (0.95 mm vs. 0.08 mm; p < 0.001). Additionally, measurable LMO was found in 42.7 % of patients with ACL tears compared to 4.5 % uninjured knees (p < 0.001). Conclusion: Patients with ACL injury show higher incidence of LMO compared to uninjured controls. Future studies are necessary to better understand its clinical significance.

Impact of irradiation on load-to-failure in bone-patellar tendon-bone allografts: A systematic review and meta-analysis.

Introduction: To evaluate the impact various levels of irradiation have on bone-patellar tendon-bone (BTB) allograft load-to-failure. Materials and methods: Pubmed, Google Scholar and Embase were searched for studies reporting load-to-failure measurements of BTB allografts following gamma or eBeam irradiation. All systematic reviews, editorials, as well as studies that utilized animal models and/or other graft sources (achilles, hamstring, quadriceps) were excluded. Meta-analysis was performed to compare the impact of low dose (19 ≤ kGy), intermediate (20-49 kGy) and high dose (>50 kGy) gamma and eBeam radiation on load-to-failure. Results: Twelve studies, containing a total of 429 BTB allografts (159 controls, 270 irradiated), were identified. Load-to-failure of BTB allograft was significantly decreased at intermediate (20-49 kGy) doses of radiation, while low (≤19 kGy) and high (>50 kGy) doses did not significantly change load-to-failure. Conclusions: Intermediate doses of radiation may negatively impact the biomechanical integrity of BTB allograft in vitro. Future studies are required to examine clinical outcomes at varying irradiation levels.

Reanalysis of the Posterior Oblique Ligament: Quantitative Anatomy, Radiographic Markers, and Biomechanical Properties.

Background: The posterior oblique ligament (POL) is the largest structure of the posteromedial knee that is at risk of injury in conjunction with the medial collateral ligament (MCL). Its quantitative anatomy, biomechanical strength, and radiographic location have not been assessed in a single investigation. Purpose: To evaluate the 3-dimensional and radiographic anatomy of the posteromedial knee and the biomechanical strength of the POL. Study Design: Descriptive laboratory study. Methods: Ten nonpaired fresh-frozen cadaveric knees were dissected and medial structures were elevated off bone, leaving the POL. The anatomic locations of the related structures were recorded with a 3-dimensional coordinate measuring machine. Anteroposterior and lateral radiographs were taken with radiopaque pins inserted into the pertinent landmarks, and the distances between the collected structures were calculated. Each knee was then mounted to a dynamic tensile testing machine, and pull-to-failure testing was performed to record the ultimate tensile strength, stiffness, and failure mechanism. Results: The POL femoral attachment was a mean of 15.4 mm (95% CI, 13.9-16.8 mm) posterior and 6.6 mm (95% CI, 4.4-8.8 mm) proximal to the medial epicondyle. The tibial POL attachment center was a mean of 21.4 mm (95% CI, 18.1-24.6 mm) posterior and 2.2 mm (95% CI, 0.8-3.6 mm) distal to the center of the deep MCL tibial attachment and a mean of 28.6 mm (95% CI, 24.4-32.8 mm) posterior and 41.9 mm (95% CI, 36.8-47.0 mm) proximal to the center of the superficial MCL tibial attachment. On lateral radiographs, the femoral POL was a mean of 17.56 mm (95% CI, 14.83-21.95 mm) distal to the adductor tubercle and 17.32 mm (95% CI, 14.6-21.7 mm) posterosuperior to the medial epicondyle. On the tibial side, the center of the POL attachment was a mean of 4.97 mm (95% CI, 3.85-6.79 mm) distal to the joint line on anteroposterior radiographs and 6.34 mm (95% CI, 5.01-8.48 mm) distal to the tibial joint line on lateral radiographs, at the far posterior tibial aspect. The biomechanical pull-to-failure demonstrated a mean ultimate tensile strength of 225.2 ± 71.0 N and a mean stiffness of 32.2 ± 13.1 N. Conclusion: The anatomic and radiographic locations of the POL and its biomechanical properties were successfully recorded. Clinical Relevance: This information is useful to better understand POL anatomy and biomechanical properties as well as to clinically address an injury with repair or reconstruction.

Gender Disparities Among Professional Team Sports Medicine Physicians.

OBJECTIVE: Although recent trends from the Accreditation Council for Graduate Medical Education (ACGME) present encouraging growth of female representation in sports medicine, the field is still lagging behind other specialties. This study investigates gender disparities among physicians providing care for professional sports teams in male and female sports leagues. DESIGN: Information regarding physicians providing sports medicine care to professional teams obtained by database queries (May 2021). Chi-square analysis compared gender data of orthopaedic team physicians with American Orthopaedic Society for Sports Medicine (AOSSM) and American Academy of Orthopaedic Surgeons (AAOS) membership, residency, and fellowship census data. Primary care sports medicine physicians were compared with American Medical Society for Sports Medicine (AMSSM) and primary-care sports medicine fellowship census data. SETTING: Professional sports health care. STUDY POPULATION: Professional league physicians. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Gender, residency, and fellowship training of professional league physicians. RESULTS: Among a total of 608 team physicians, 572 (93.5%) were male and 40 (6.5%) were female. Orthopedic surgeons comprised 64.7% of the physicians. Fourteen (3.6%) team orthopedic surgeons were female. Thirty-five percent of team physicians were primary care sports medicine physicians. Twenty-six primary care sports medicine physicians (11.6%) were female. Orthopaedic female team physician representation overall was comparable with AOSSM and AAOS membership but significantly less than orthopaedic surgery residents and sports medicine fellows ( P < 0.01). Women's National Basketball Association orthopaedic team physicians were more represented than female membership among AOSSM, AAOS, and orthopaedic sports medicine fellows ( P < 0.01). Except for the WNBA, Premiere Hockey Federation, National Women's Soccer League, and United States Football League, female primary care sports medicine physicians were underrepresented in professional sports compared with AMSSM membership and primary care sports fellows ( P < 0.01). CONCLUSION: Overall, female representation is poor among orthopaedic surgeons and primary care physicians providing sports medicine care to professional teams. Leagues encompassing female athletes tend to have better representation of female physicians. LEVEL OF EVIDENCE: IV.

Elective Hand Surgery Is Delayed among Private Insurance Holders.

OBJECTIVES: Patients with private healthcare plans often defer nonemergent or elective procedures toward the end of the year once they have met their deductible. No previous studies have evaluated how insurance status and hospital setting may affect surgical timing for upper extremity procedures. Our study aimed to evaluate the influence of insurance and hospital setting on end-of-the-year surgical cases for elective carpometacarpal (CMC) arthroplasty, carpal tunnel, cubital tunnel, and trigger finger release, and nonelective distal radius fixation. METHODS: Insurance provider and surgical dates were gathered from two institutions' electronic medical records (one university, one physician-owned hospital) for those undergoing CMC arthroplasty, carpal tunnel release, cubital tunnel release, trigger finger release, and distal radius fixation from January 2010 to December 2019. Dates were converted into corresponding fiscal quarters (Q1-Q4). Using the Poisson exact test, comparisons were made between the case volume rate of Q1-Q3 and Q4 for private insurance and then for public insurance. RESULTS: Overall, case counts were greater in Q4 than the rest of the year at both institutions. There was a significantly greater proportion of privately insured patients undergoing hand and upper extremity surgery at the physician-owned hospital than the university center (physician owned: 69.7%, university: 50.3%; P < 0.001). Privately insured patients underwent CMC arthroplasty and carpal tunnel release at a significantly greater rate in Q4 compared with Q1-Q3 for both institutions. Publicly insured patients did not experience an increase in carpal tunnel releases during the same period at both institutions. CONCLUSIONS: Privately insured patients underwent elective CMC arthroplasty and carpal tunnel release procedures in Q4 at a significantly greater rate than publicly insured patients. This finding suggests private insurance status, and potentially deductibles, influence surgical decision making and timing. Further work is needed to evaluate the impact of deductibles on surgical planning and the financial and medical impact of delaying elective surgeries.

Extensor Mechanism Reconstruction for Chronic Patellar Tendon Tears.

OBJECTIVES: Reconstruction for a chronic patellar tendon rupture in a native knee is an uncommon surgical procedure. Although there have been case series investigating patient-reported outcomes, there is no systematic review of these studies to date. The purpose of this review is to synthesize the literature on this procedure to better understand its outcomes, complications, and surgical technique options. METHODS: A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify studies that reported outcomes and techniques of patellar tendon reconstruction for chronic disruption in native knees. Searches were conducted through MEDLINE using PubMed, Cochrane Database of Systematic Reviews, and clinicaltrials.gov. RESULTS: Ten studies with 103 patients and 105 knees were included. Results for nonnative (arthroplasty) knees were excluded. The mean patient age was 40.3 years, and the mean postsurgical follow-up time was 53.8 months. Of the 105 knees, 75% received a hamstring tendon graft, whereas 13% received a bone-tendon-bone graft and 7% received a whole extensor mechanism allograft. The mean preoperative range of motion was 113.8°, which improved to 126.0° postoperatively. The mean preoperative Lysholm score was 58.6, which improved to 86.0 postoperatively; 100% of patients returned to their normal work activities and 76% returned to their prior level of physical activity. There were no major complications reported in any of the included studies. CONCLUSIONS: Chronic patellar tendon disruption in a native knee is an uncommon injury that can result in significant limitations for patients. Although more research is needed to better elucidate which graft is best, outcomes after patellar tendon reconstruction for chronic tears appear to be satisfactory with current techniques.

Repair of a Radial Tear of the Meniscus Augmented With a Biocomposite Scaffold.

Meniscal tears are a common musculoskeletal pathology in the United States, affecting 61 in every 100,000 people. Surgical repair is indicated for certain tear patterns to reduce the risk of joint degeneration, normalize contact forces in the knee, and help restore normal knee kinematics. However, radial meniscus tear repairs fail to completely heal 38% of the time due to tear characteristics, biology, surgical technique, and inadequate rehabilitation. Recent efforts have incorporated biological augmentation to enhance the healing potential of the meniscus. The BioBrace is a biocomposite scaffold designed to mechanically reinforce tissue and biologically enhance healing. The purpose of this article is to describe an all-inside, meniscal radial tear repair augmented with BioBrace.

Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft: Surgical Technique Using Augmentation With a Biocomposite Scaffold.

Anterior cruciate ligament (ACL) reconstruction augmentation continues to be widely studied. Both biologic and synthetic augments have been employed to enhance ACL healing and provide early protection. The BioBrace is a biocomposite scaffold that both mechanically reinforces the graft while biologically enhancing graft healing. The purpose of this article is to describe augmentation of an ACL reconstruction with BioBrace.

Bioactive Knee Sleeve for Osteoarthritis: A Small Cohort Study.

OBJECTIVES: Osteoarthritis (OA) is one of the most prevalent musculoskeletal ailments worldwide. Numerous conservative therapies exist, but evidence for such treatments remains conflicting. Recently, there has been growing interest surrounding bioactive sleeves for managing knee arthritis; however, the literature on their efficacy for relieving pain and improving function in the setting of knee OA is limited. As such, we sought to investigate the effect of a bioactive sleeve on patient-reported outcome measures in a small cohort of patients with OA. METHODS: Patients with knee OA were given a bioactive sleeve (Reparel, Chico, CA) and asked to refrain from lifestyle modifications and intraarticular corticosteroid injections. Lysholm Knee Score, Oxford Knee Score, Knee Injury and OA Outcome Score (KOOS), Single Assessment Numeric Evaluation, and Visual Analog Scale score were obtained at baseline, 2 weeks, 6 weeks, and 3 months. OA severity was evaluated using the Kellgren and Lawrence (KL) classification system. The Wilcoxon signed rank test was used to compare baseline patient-reported outcomes with 2-week, 6-week, and 3-month time points. Bivariate correlation was used to evaluate the relation between patient-reported outcome measures and KL classification. RESULTS: The cohort was composed of 14 participants-4 males and 10 females-with a mean age of 62.2 ± 13.2 years and a body mass index of 33.7 ± 5.8. The average KL grade was 2.9 (range 2-4). KOOS pain, symptoms, activities of daily living, and quality of life increased significantly at 2 weeks, 6 weeks, and 3 months. KOOS sport and recreation significantly increased at 3 months. The Oxford Knee Score was significantly greater at 2 weeks, 6 weeks, and 3 months. The Lysholm Knee Score was significantly greater at 6 weeks and 3 months. The Single Assessment Numeric Evaluation attained significant improvement at 3 months, and the Visual Analog Scale improvement was significant at 2 weeks. No statistically significant difference was attained with University of California at Los Angeles activity score. Outcome scores did not correlate with KL classification. CONCLUSIONS: These data suggest that a bioactive sleeve may improve patient-reported pain, symptoms, and function in the setting of knee OA. Further research is needed to better understand the role of bioactive sleeves for patients with knee arthritis.

Anterior to Posterior Bone Plug Suture Tunnels Provide Optimal Biomechanics for Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Graft.

Purpose: To evaluate different bone-patellar tendon-bone (BPTB) plug suture configurations for pull through strength, stiffness, and elongation at failure in a biomechanical model of suspensory fixation. Methods: Forty nonpaired, fresh-frozen human cadaveric BPTB allografts with an average age of 65.6 years were tested. Tensile testing was performed with the use of a custom-designed fixture mounted in a dynamic tensile testing machine. A preload of 90 N was applied to the graft and held for 5 minutes. Following this, a tensile load-to-failure test was performed. The ultimate failure load, elongation at failure, and mode of failure were recorded, and the resulting load-elongation curve was documented. Results: The drill tunnel through the cortical surface (anterior to posterior) was found to be significantly stronger than the drill tunnel through the cancellous surface (medial to lateral). There were no significant differences found when comparing the strength of the suture augmentation through the tendon and the drill tunnel alone (P = .13 among cancellous groups, P = .09 among cortical groups). The cortical drill tunnel with suture augmentation through the tendon showed significantly greater elongation values (13.7 ± 3.2) at failure when compared with either the cancellous or cortical drill tunnel only test groups (P = .0003 compared with cancellous alone, P = .009 when compared with cortical alone). Conclusions: The BPTB suture configuration with an anterior to posterior-directed suture tunnel without a suture through tendon augmentation provides the optimal strength and stiffness while minimizing graft elongation after fixation in a biomechanical model. This configuration is best for preventing suture pull through and failure when passing sutures through the BPTB plug. Clinical Relevance: This study biomechanically evaluates the optimal suture configuration in the proximal bone plug for suspensory fixation in the setting of BPTB grafts.

Functional Activity After Flatfoot Reconstruction With Lateral Column Lengthening.

BACKGROUND: The objective of this study was to evaluate return to activity following flatfoot reconstruction with lateral column lengthening (LCL) by assessing functional postoperative data and identifying patient characteristics associated with poor function following surgery. METHODS: Consecutive patients that underwent operative flatfoot correction including LCL and other necessary procedures from 2014 to 2019 by 3 fellowship trained foot and ankle orthopedic surgeons were retrospectively administered Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and FAAM Sports questionnaires with no preoperative scoring available. Patient demographic factors, comorbidities, and radiographic features were evaluated as predictors of outcome scores to simulate return to activity. Statistical analysis, including student's t-tests and analysis of variance, was performed. RESULTS: A total of 54 patients were included. A body mass index (BMI) of 30 kg/m2 or greater was associated with a lower ADL score (P = .002) and Sports score (P = .002). Preoperative hindfoot valgus of 9° or higher was associated with higher ADL scores (P = .040). Neither age nor any flatfoot radiographic parameters yielded significant differences in functional scores. CONCLUSION: This study demonstrated relatively high average FAAM scores in both the ADL and the sports subscales, consistent with previous studies. This study also identified lower BMI and greater preoperative hindfoot valgus as potential predictors of improved functional outcome following reconstruction. LEVEL OF EVIDENCE: Level III: Retrospective case control.

Shoulder Arthroscopy in Conjunction With an Open Latarjet Procedure Can Identify Pathology That May Not Be Accounted for With Magnetic Resonance Imaging.

Purpose: To review arthroscopic findings at the time of open Latarjet procedures to determine whether preoperative magnetic resonance imaging reports (MRRs) correlate with arthroscopic findings, as well as whether the arthroscopic findings critically affected surgical interventions performed at the time of a Latarjet procedure. Methods: This was a retrospective case series of all patients who received a Latarjet procedure between 2006 and 2018. Patients were excluded if they had inadequate records or underwent revision of a bony reconstruction procedure. Both primary Latarjet procedures and Latarjet procedures for revision of a failed arthroscopic procedure were included. MRRs, arthroscopic findings, and diagnoses were collected, and differences were noted. A "critical difference" was one that affected the surgical intervention in a significantly anatomic or procedural fashion or that affected rehabilitation. Results: In total, 154 of 186 patients (83%) were included. Of these, 96 of 154 (62%) underwent revision Latarjet procedures. The average bone loss percentage reported was 20.6% (range, 0%-40%). A critical difference between MRR and arthroscopic findings was noted in 60 of 154 patients (39%), with no difference between Latarjet procedures and revision Latarjet procedures. Of 154 patients, 29 (19%) received an additional 52 intra-articular procedures for diagnoses not made on magnetic resonance imaging, with no difference between primary and revision procedures. This included biceps and/or SLAP pathology requiring a tenodesis, debridement, or repair; rotator cuff pathology requiring debridement or repair; complex (>180°) labral tears requiring repair; loose bodies; and chondral damage requiring debridement or microfracture. Patients undergoing revision Latarjet procedures were less likely to have bone loss mentioned or quantified in the MRR. Conclusions: Diagnostic imaging may not reliably correlate with diagnostic arthroscopic findings at the time of a Latarjet procedure from both a bony perspective and a soft-tissue perspective. In this series, diagnostic arthroscopy affected the surgical plan in addition to the Latarjet procedure in 19% of cases. We recommend performing a diagnostic arthroscopy prior to all Latarjet procedures to identify and/or treat all associated intra-articular shoulder pathologies. Level of Evidence: Level IV, diagnostic case series.

Arthroscopic Characterization, Treatment, and Outcomes of Glenoid Labral Articular Disruption Lesions.

BACKGROUND: The pathoanatomy of glenoid labral articular disruption (GLAD) lesions has been inconsistently and poorly defined in the literature. PURPOSE/HYPOTHESIS: The purpose was to characterize GLAD lesions as they pertain to the pathoanatomy of labrum, cartilage, and bony structures, and to correlate findings with patient-reported outcomes (PROs). We hypothesized that greater degrees of bony and cartilaginous involvement would correlate with worse outcomes. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients with a diagnosis of a GLAD lesion or a reverse GLAD (RGLAD) lesion at the time of diagnostic arthroscopy (January 2006-February 2019) were included in this study. Patients with ≥13.5% bone loss or previous ipsilateral shoulder surgery were excluded. Patient charts and operative reports/photos were used to identify the location of injury, extent of injury (labral, chondral, and bony), associated injuries, demographic factors, and treatment performed. Three injury patterns were identified: small (type 1), with no chondral defect after labral repair; large (type 2), with residual chondral defect after labral repair; and bony (type 3), with associated glenoid bone loss amenable to labral repair. Characterizations were cross-referenced to PROs at a mean follow-up of 5.5 years (range, 2.6-10.5 years): American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, shortened version of Disabilities of the Arm, Shoulder and Hand, and patient satisfaction. RESULTS: In total, 50 patients were included, with 40 having GLAD and 10 having RGLAD lesions (mean age, 34.7 and 33.2 years, respectively). There were 14 (35%) type 1, 22 (55%) type 2, and 4 (10%) type 3 GLAD injuries. All PROs improved without any differences in the 3 subgroups postoperatively (ASES, 95.1 vs 91.3 vs 98.8, type 1, 2, and 3, respectively). RGLAD injuries were majority type 2 (7/10; 70%) with the remainder being type 1 (3/10; 30%). CONCLUSION: With GLAD and RGLAD injuries, 3 distinct injury patterns can be observed correlating with the presence/absence of chondral loss after labral repair or the presence of associated bone loss. This descriptive characterization can facilitate arthroscopic treatment decisions. Future large studies are needed to determine if this is prognostic in nature.

High rate of return to sport and excellent patient-reported outcomes after an open Latarjet procedure.

HYPOTHESIS: The purpose of this study was to report return to sport, patient-reported outcomes (PROs), subjective outcomes, and complications or failures in patients who underwent open Latarjet surgery. METHODS: Patients who underwent open Latarjet surgery performed by 2 fellowship-trained surgeons between August 2006 and November 2018 were included. Prospectively collected data were reviewed. Recurrent instability and revision surgical procedures were recorded. Subjective outcomes included return to sport and fear of reinjury or activity modification as a result of patients' instability history. PROs included the American Shoulder and Elbow Surgeons (ASES) score, Short Form 12 Physical Component Summary score, Single Assessment Numeric Evaluation score, Quick Disabilities of the Arm, Shoulder and Hand score, and satisfaction. Age, sex, sports participation, pain, primary vs. revision surgery (prior failed arthroscopic or open Bankart repair), dislocation number, glenoid bone loss, glenoid track concept, and projected glenoid track were evaluated. Failure was defined as an ASES score <70, recurrent dislocation, or revision instability surgery. RESULTS: A total of 126 shoulders (125 patients) met the inclusion criteria, with a mean age of 28.1 years (range, 15-57 years). Of 126 shoulders, 7 (5.5%) underwent additional procedures prior to final follow-up and were excluded from outcome analyses; failure occurred in 6 of these shoulders. Mean follow-up data at 3.7 years (range, 2-9.3 years) were attained in 86.6% of patients (103 of 119). All PROs significantly improved from preoperative baseline (ASES score, from 69.7 to 90.2; Single Assessment Numeric Evaluation score, from 55.8 to 85.9; and Quick Disabilities of the Arm, Shoulder and Hand score, from 28.4 to 10.5). PROs did not differ based on sex, sports participation type, dislocation with or without sports, primary vs. revision procedure, and preoperative dislocation number. No correlations existed between PROs and age, glenoid bone loss, or number of previous surgical procedures. On-track lesions (50 of 105, 47.6%) and projected on-track lesions (90 of 105, 85.7%) correlated with better patient satisfaction but not PROs. Despite not having recurrences, 63 of 99 patients (63.6%) reported activity modifications and 44 of 99 patients (44.4%) feared reinjury. These groups had statistically worse PROs, although the minimal clinically important difference was not met. Return to sport was reported by 97% of patients (86 of 89), with 74% (66 of 89) returning at the same level or slightly below the preinjury level. Revision stabilization surgery was required 6 of 126 cases (4.8%), and 6 of 103 shoulders (5.8%) had ASES scores <70. CONCLUSION: The open Latarjet procedure led to significant improvements in all PROs, and overall, 97% of patients returned to sport. Fear of reinjury and activity modifications were common after open Latarjet procedures but did not appear to affect clinical outcomes. On-track and projected on-track measurements correlated with better patient satisfaction but not improved PROs.

Results of arthroscopic rotator cuff repair for calcific tendonitis: a comparative analysis.

BACKGROUND: Outcomes following arthroscopic excision of calcific tendonitis and arthroscopic rotator cuff repair (CT-ARCR) are relatively limited without comparison analysis to standard arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate patient-reported outcomes (PROs) after CT-ARCR compared against a matched cohort who received standard ARCR. METHODS: An institutional review board-approved retrospective review was performed for patients aged 18-80 years receiving CT-ARCR by a single surgeon from 2006-2018. These were matched 1:3 with patients receiving ARCR. Patients with concurrent labral repair, subscapularis repair, or glenohumeral joint arthritis procedures; refusal to participate; deceased; inadequate contact information; or those with inadequate records were excluded. PROs included Short Form-12 Physical Component Summary (SF-12 PCS) score; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Single Assessment Numeric Evaluation (SANE); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH); patient satisfaction; activity level/symptoms; and sport participation scores. RESULTS: 21 CT-ARCR patients (mean age 50 years, range 36-62) and 54 ARCR patients (mean age 52 years, range 19-77) were included. Minimum 2-year follow-up was obtained in 18 of 21 (86%) CT-ARCR (mean 5.9 years) and 45 of 54 (83%) ARCR patients (mean 5.6 years). CT-ARCR patients improved pre- to postoperation in mean SF-12 PCS (41.1 to 50.0), ASES (54.2 to 94.0), and QuickDASH (54.2 to 94.0). SANE score improvements (57.6 to 82.8) were not significant. ARCR controls improved pre- to postoperation in mean SF-12 PCS (41.4 to 49.0), ASES (59.4 to 88.0), QuickDASH (35.1 to 13.8), and SANE scores (52.6 to 80.8). Pre- to postoperative pain during recreation and sport participation similarly improved in both groups. The only postoperative difference observed between CT-ARCR and ARCR was better patient satisfaction with CT-ARCR (9.7 vs. 8.3). CONCLUSION: CT-ARCR results in excellent PROs, activity symptoms, and sports participation at final follow-up. CT-ARCR results were comparable to patients who received conventional ARCR for similar-sized rotator cuff tears that did not have calcific tendonitis.

Arthroscopic Segmental Medial Meniscus Allograft Transplant Using Three Fixation Techniques.

Partial meniscectomy or failed meniscus repair can lead to pain, dysfunction, and cartilage degradation due to increased contact forces. Meniscus transplantation can lead to favorable outcomes and cartilage preservation with careful patient selection. Limited data exist on segmental meniscus allograft transplantation, with promising results using synthetic grafts and early animal and biomechanical studies on segmental allograft transplantation, showing similar results to full meniscus allograft transplantation. This article presents a technique for arthroscopic segmental medial meniscus allograft transplant and a brief review of the literature.

Effect of Meniscal Treatment on Functional Outcomes 6 Months After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Meniscal injuries are commonly associated with anterior cruciate ligament (ACL) tears. Treatment of meniscal injuries can impart delayed weightbearing and range of motion restrictions, which can affect the rehabilitation protocol. The effect of meniscal treatment and subsequent restrictions on strength recovery after ACL reconstruction is unclear. PURPOSE/HYPOTHESIS: The purpose of this study was to compare strength, jumping performance, and patient-reported outcomes between patients who underwent isolated ACL reconstruction (ACLR) and those who underwent surgical intervention for meniscal pathology at the time of ACLR. Our hypothesis was that patients who underwent concurrent meniscal repair (MR) would have lower strength recovery owing to postoperative restrictions. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Patients with ACLR were stratified into isolated ACLR, ACLR and meniscectomy (ACLR-MS), or ACLR-MR groups and were compared with healthy controls. The ACLR-MR group was restricted to partial weightbearing and to 90° of knee flexion for the first 6 weeks postoperatively. All participants completed patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]) and underwent bilateral isokinetic and isometric strength tests of the knee extensor and flexor groups as part of a return-to-sports test battery at 5 to 7 months postoperatively. RESULTS: A total of 165 patients with ACLR (50 with isolated ACLR, 44 with ACLR-MS, and 71 with ACLR-MR) and 140 healthy controls were included in the study. Follow-up occurred at a mean of 5.96 ± 0.47 months postoperatively. The control group demonstrated higher subjective knee function, unilateral peak extensor torque, and limb symmetry than did the ACLR-MS and ACLR-MR groups combined (P < .001 for all). There were no differences in IKDC, KOOS subscales, or unilateral or limb symmetry measures of peak knee extensor or flexor torque among the isolated ACLR, ACLR-MS, and ACLR-MR groups. CONCLUSION: Persistent weakness, asymmetry, and reduced subjective outcome scores at 6-month follow-up after ACLR were not influenced by meniscal treatment. These findings suggested that the weightbearing and range of motion restrictions associated with meniscal repair recovery do not result in loss of early strength or worse patient-reported outcomes.