Pearls and Pitfalls in the Management of Cam-Type Femoroacetabular Impingement: Deformity and Approach.

The arthroscopic treatment of cam-type femoroacetabular impingement (FAI) is a technically demanding surgery, which has been shown to yield successful clinical outcomes, and improved hip biomechanics and range of motion and may also favorably alter the natural history of FAI-induced osteoarthritis. Assessing the presenting symptoms, clinical history, and physical examination findings can help to confirm the diagnosis of symptomatic cam-type FAI. Appropriate preoperative imaging studies are important in the characterization of cam-type deformities and often guide the decision between open and arthroscopic management. Although most cam-type FAI can be successfully managed using an arthroscopic approach, certain complex deformity patterns might best be addressed with surgical dislocation. Command of intraoperative techniques for exposure and instrumentation, as well as effective use of fluoroscopy, allows for consistent and reproducible cam deformity correction while minimizing complications.

The Role of Mesenchymal Stromal Cells in the Management of Knee Chondral Defects.

➤: Mesenchymal stromal cells (MSCs) are a subset of progenitor cells that help to promote tissue healing and regeneration through the secretion of various cytokines and growth factors. Although technically pluripotent, MSCs in vivo rarely repair damaged tissue through direct differentiation and engraftment. ➤: Augmentation of traditional marrow stimulation techniques with MSCs has been theorized to improve repair tissue quality and defect fill. Clinical trials evaluating this technique are limited but have shown modest improvements compared with isolated marrow stimulation. ➤: Various scaffolds also have been utilized in combination with MSCs to treat focal chondral defects. Although the techniques described are heterogeneous, many have shown promising early clinical outcomes. ➤: Newer techniques involving 3-dimensional bioprinted scaffolds seeded with MSCs allow for the recreation of complex architecture, more closely resembling articular cartilage. These techniques are evolving and have not yet been studied in human clinical trials.

Reported Technical Aspects of Type II SLAP Lesion Repairs in Athletes.

PURPOSE: To systematically review the available literature to further describe and report the available data on SLAP repair techniques and the association with outcomes. METHODS: A systematic review of literature was performed on manuscripts describing type II SLAP repairs in athletes. Selection criteria included studies reporting exclusively type II SLAP tears without concomitant pathology, minimum 2-year postoperative follow-up, use of anchor fixation, and return to previous level of play data available. We extracted patient outcome as well as surgical construct details from each article. Average outcomes and return to play rates were calculated and substratified further by athlete type. Return to play rates were compared by repair constructs with the Student t test. RESULTS: Initial search resulted in 107 articles. After exclusion criteria were applied, 17 articles were included in the final analysis. Overall, 84% of patients had good-to-excellent results. Of all athletes, 66% returned to previous level of play. There was significant variation in reported technique in terms of anchor number, location, material, suture type, and knotless versus knotted constructs. No significant difference was reported in outcomes in comparison of suture type (P-value .96) or knotted versus knotless constructs (P-value .91). Given the significant variability in reporting, no statistical analysis was felt able to be performed on anchor location and number. CONCLUSIONS: Repair of type II SLAP tears in athletes is a difficult problem to treat with overall low return to play despite a high rate of "good" outcomes when assessed by outcome measures. Significant variability exists in surgical technique, as well as reporting of surgical technique, potentially limiting the ability to define the best or most effective technique for SLAP repair. LEVEL OF EVIDENCE: IV, systematic review of level III and level IV studies.