Bulk Osteochondral Allograft for a Firearm Injury to the Medial Femoral Condyle in a Military Service Member: A Case Report.

A 27-year-old U.S. military active duty male sustained an accidental, self-inflicted left knee gunshot injury with an unsalvageable medial femoral condyle injury. The patient underwent bulk osteochondral allograft transplantation. Nine months post-operation, the patient was fit for full military duties with no reported functional limitations and remained on active duty. Severe knee medial femoral condyle bone loss after accidental firearm injury is uncommon. Bulk knee osteochondral allograft transplantation to the medial femoral condyle provided a successful treatment option for an active duty U.S. military member with multicompartment osteochondral defects and severe medial femoral condyle bone loss due to a gunshot injury.

The Student You Know: Orthopedic Surgery Home Program Match Rates and Geographic Relationships Before and After COVID-19.

OBJECTIVE: In March 2020, COVID-19 was declared a pandemic by the World Health Organization. This led to the outright cancellation of away rotations and in person residency interviews for the class of 2021. This study aims to identify the geographic relationships in the orthopedic match and further explore COVID-19's effect on these geographic relationships. Furthermore, we aim to compare the home program match rates before and after COVID-19. SETTING: Southern Illinois University School of Medicine, Department of Orthopedic Surgery (tertiary, university-based). DESIGN AND PARTICIPANTS: Residency websites and social media sites were used to record basic residency information as well as each resident's year, matriculated medical school, and matriculated medical school geographic data. This information was used to evaluate the proportion of orthopedic residents from "home program" medical schools and evaluate the geographic relationship of matched orthopedic residents. 202 Orthopedic residencies were initially identified and 134 allopathic and nonmilitary residency programs met the inclusion criteria. In all, 3253 of the 3931 (82.7%) current U.S orthopedic residents were included in the analysis. RESULTS: In the 4 orthopedic surgery residency classes before the pandemic (2017-2020), 21.8% of residency slots were filled by home program students. During the pandemic match cycle (2021), this number jumped to 28.2% (p < 0.0006). The increase was observed consistently across residency subgroup analysis: class size, doximity rank, and doximity research rank. Correspondingly, there was a statistically significant increase from 34.7% (2017-2020) to 39.3% (2021) (p = 0.0318) in residencies matching with same state medical students. Regional trends stayed consistent. Our study showed that residency programs matched applicants who went to same region medical schools during the 2020 to 2021 cycle at nearly the exact same rate as they did pre-pandemic (63.6%, up from 63.3%). CONCLUSIONS: Our study demonstrates that despite widespread virtual away rotations and virtual open houses, residency programs showed an increased preference for their home program students. This trend was significant and widespread, highlighting the generalized nationwide hesitation of both residency programs and students on the virtual interview process.

Bilateral Knee Dislocations in an Active Duty Service Member: A Case Report.

This case highlights a staged operative approach for a patient who sustained bilateral knee dislocations and subsequent staged operative treatment and rehabilitation. This patient underwent bilateral multiligamentous knee reconstructions and left-sided peroneal nerve allografting because of complete peroneal nerve palsy. The initial treatment was bilateral medial collateral ligament reconstructions, posterolateral corner reconstructions, and capsular repairs with left leg peroneal nerve allografting and repair of avulsed biceps femoris tendon. The patient underwent physical therapy following the first stage procedure until he regained appropriate motion and soft tissue healing occurred. Subsequently, combined anterior cruciate and posterior cruciate ligament reconstructions were performed in a staged fashion to allow one leg to fully bear weight for rehabilitation purposes. With the help of a multidisciplinary surgical and rehabilitation team, the patient has regained the stability of his knees and achieved acceptable functional outcomes. A staged systematic approach to multiligamentous bilateral knee reconstruction can provide optimal pain management, obtain initial joint stability, minimize complications, and achieve acceptable functional outcomes. Surgical techniques to first restore medial and lateral structures can be utilized to provide initial valgus and varus stability while allowing for knee mobilization and, eventually, in-line ambulation, before staged anterior and posterior cruciate ligament reconstructions. This case demonstrates a multistaged approach to bilateral knee dislocations with favorable outcomes in a 23-year-old active duty patient.

The Military Orthopedics Tracking Injuries and Outcomes Network: A Solution for Improving Musculoskeletal Care in the Military Health System.

INTRODUCTION: Musculoskeletal injuries are an endemic amongst U.S. Military Service Members and significantly strain the Department of Defense's Military Health System. The Military Health System aims to provide Service Members, military retirees, and their families the right care at the right time. The Military Orthopedics Tracking Injuries and Outcomes Network (MOTION) captures the data that can optimize musculoskeletal care within the Military Health System. This report provides MOTION structural framework and highlights how it can be used to optimize musculoskeletal care. MATERIALS AND METHODS: MOTION established an internet-based data capture system, the MOTION Musculoskeletal Data Portal. All adult Military Health System patients who undergo orthopedic surgery are eligible for entry into the database. All data are collected as routine standard of care, with patients and orthopedic surgeons inputting validated global and condition-specific patient reported outcomes and operative case data, respectively. Patients have the option to consent to allow their standard of care data to be utilized within an institutional review board approved observational research study. MOTION data can be merged with other existing data systems (e.g., electronic medical record) to develop a comprehensive dataset of relevant information. In pursuit of enhancing musculoskeletal injury patient outcomes MOTION aims to: (1) identify factors which predict favorable outcomes; (2) develop models which inform the surgeon and military commanders if patients are behind, on, or ahead of schedule for their targeted return-to-duty/activity; and (3) develop predictive models to better inform patients and surgeons of the likelihood of a positive outcome for various treatment options to enhance patient counseling and expectation management. RESULTS: This is a protocol article describing the intent and methodology for MOTION; thus, to date, there are no results to report. CONCLUSIONS: MOTION was established to capture the data that are necessary to improve military medical readiness and optimize medical resource utilization through the systematic evaluation of short- and long-term musculoskeletal injury patient outcomes. The systematic enhancement of musculoskeletal injury care through data analyses aligns with the National Defense Authorization Act (2017) and Defense Health Agency's Quadruple Aim, which emphasizes optimizing healthcare delivery and Service Member medical readiness. This transformative approach to musculoskeletal care can be applied across disciplines within the Military Health System.

A High-Sensitivity International Knee Documentation Committee Survey Index From the PROMIS System: The Next-Generation Patient-Reported Outcome for a Knee Injury Population.

BACKGROUND: Patient-reported outcomes (PROs) measure progression and quality of care. While legacy PROs such as the International Knee Documentation Committee (IKDC) survey are well-validated, a lengthy PRO creates a time burden on patients, decreasing adherence. In recent years, PROs such as the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference surveys were developed as computer adaptive tests, reducing time to completion. Previous studies have examined correlation between legacy PROs and PROMIS; however, no studies have developed effective prediction models utilizing PROMIS to create an IKDC index. While the IKDC is the standard knee PRO, computer adaptive PROs offer numerous practical advantages. PURPOSE: To develop a nonlinear predictive model utilizing PROMIS Physical Function and Pain Interference to estimate IKDC survey scores and examine algorithm sensitivity and validity. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: The MOTION (Military Orthopaedics Tracking Injuries and Outcomes Network) database is a prospectively collected repository of PROs and intraoperative variables. Patients undergoing knee surgery completed the IKDC and PROMIS surveys at varying time points. Nonlinear multivariable predictive models using Gaussian and beta distributions were created to establish an IKDC index score, which was then validated using leave-one-out techniques and minimal clinically important difference analysis. RESULTS: A total of 1011 patients completed the IKDC and PROMIS Physical Function and Pain Interference, providing 1618 complete observations. The algorithms for the Gaussian and beta distribution were validated to predict the IKDC (Pearson = 0.84-0.86; R2 = 0.71-0.74; root mean square error = 9.3-10.0). CONCLUSION: The publicly available predictive models can approximate the IKDC score. The results can be used to compare PROMIS Physical Function and Pain Interference against historical IKDC scores by creating an IKDC index score. Serial use of the IKDC index allows for a lower minimal clinically important difference than the conventional IKDC. PROMIS can be substituted to reduce patient burden, increase completion rates, and produce orthopaedic-specific survey analogs.

Time Series Modelling and Simulating the Lockdown Scenarios of COVID-19 in Kurdistan Region of Iraq.

INTRODUCTION: Since the first published cases of the Coronavirus disease known as COVID-19 in the city of Wuhan Hubei Province in China, up until to the time of preparation of this report in mid-September 2020, more than 30 million people have been infected all over the world. In March 2020, more than 300,000 cases have been reported all over Iraq. This study aims to represent data analysis, modelling and forecasting approaches to the presented data in the Kurdistan Region of Iraq. METHODOLOGY: The project involves mathematical models for forecasting and artificial simulations using particles. In the study, time series models including Simple Exponential Model, Holt's Method and Brown's Models have been used for the forecasting of the future potential rates in the area. A series of simulations have been conducted to observe the possibilities of virus spread rates in a virtual world which represents a quarter of Erbil. RESULTS: The outcome of the study shows how the disease have spread in Kurdistan, and what are the current rates to compare with neighbour regions. The modelling clearly shows that with cases still sporadically appearing, the risk of second and third waves of infections is high. CONCLUSIONS: Therefore, the regional government must reduce unnecessary gatherings to the lowest possible level. A scientific registry system of disease statistics must be put in place and rigorously updated all the times. We recommend the officials use a nationwide database provided to the public to monitor movement of every infected individual, to prevent further spread.

Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden.

BACKGROUND: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. PURPOSE: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using "leave 1 out" techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. RESULTS: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. CONCLUSION: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online (https://osf.io/ctmnd/), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians.

Atlantic Coast Conference Mandatory College Football Medical Observer. A Necessary Addition to the Preexisting Medical Team?

Background: Some NCAA conferences now require a press box-based Medical Observer for all football games to identify injuries missed by on-field providers. The objective of this study was to determine whether a Medical Observer identified injuries missed by the on-field medical personnel. Methods: This was a comparative observational study of injury identification methods which was done at nine NCAA football games. The athletes on a single institution's varsity football team participated. Eight games and one bowl game were studied. Observers were sports medicine Fellows (Orthopaedic, Primary Care). Injury logs were kept by the Medical Observer to document game day injuries. The athletic training staff collected injury reports in the days following games. These were compared with game day injury logs to identify any injuries that were not reported to the medical staff during competition. Results: A total of 41 game injuries were identified (4.56 injuries/ game). 29 injuries (29/41; 71%) were identified by both the sideline medical providers and the Observer, 12 (12/41; 29%) were identified by only the sideline medical providers and no injuries were identified by only the Observer. A total of 95 game-related injuries were evaluated in the training room on the day after each game. 27 injuries (27/95; 28%) had been identified during the game (9 [33%] by the sideline medical team and 18 [67%] by both the sideline medical team and the Observer). Fourteen game injuries were not severe enough to require care the following day. There were 68 (68/95; 72%) delayed self-reported injuries treated by the training room staff the next day. Conclusions: A press box-based Medical Observer did not identify any injuries missed by the on-field medical staff. This study did, however, identify a large number of unreported game-day injuries that were treated the following day.Level of Evidence: II.

Return to Sport Activity After Meniscal Allograft Transplantation: At What Level and at What Cost? A Systematic Review and Meta-analysis.

CONTEXT:: Meniscal injuries are common among both sport- and non-sport-related injuries, with over 1.7 million meniscal surgeries performed worldwide every year. As meniscal surgeries become more common, so does meniscal allograft transplantation (MAT). However, little is known about the outcomes of MAT in active patients who desire to go back to preinjury activities. OBJECTIVE:: The purpose of this systematic review and meta-analysis was to evaluate return to sport, clinical outcome, and complications after MAT in sport-active patients. DATA SOURCES:: A systematic search of MEDLINE, EMBASE, and CINAHL electronic databases was performed on February 25, 2018. STUDY SELECTION:: Studies of level 1 through 4 evidence looking at MAT in physically active patients with reported return to activity outcomes and at least 2-year follow-up were included. STUDY DESIGN:: Systematic review and meta-analysis. LEVEL OF EVIDENCE:: Level 4. DATA EXTRACTION:: Details of sport-related outcomes and reoperations were extracted and pooled in a meta-analysis. RESULTS:: Nine studies were included in this systematic review. A majority (77%) of athletes and physically active patients were able to return to sport after MAT; two-thirds were able to perform at preinjury levels. Graft-related reoperations were reported in 13% of patients, while the joint replacement rate with partial or total knee prosthesis was 1.2%. CONCLUSION:: Physical activity after MAT appears possible, especially for low-impact sports. However, because of the limited number of studies, their low quality, and the short-term follow-up, the participation recommendation for high-impact and strenuous activities should be considered with caution until high-quality evidence of long-term safety becomes available.

Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis.

BACKGROUND: Surgical management of rotator cuff tears is controversial and complex, ranging from nonoperative management to reverse shoulder arthroplasty. PURPOSE: To systematically review and evaluate the outcomes of graft augmentation or interposition versus rotator cuff repair (RCR) alone and evaluate via meta-analysis whether the use of a graft leads to superior outcomes versus RCR alone. STUDY DESIGN: Systematic review and meta-analysis. METHODS: An electronic literature search (Medline, Embase, CINAHL) was conducted. Studies with a minimum follow-up of 1 year and minimum sample size of 10 that provided clinical results of RCR or rotator cuff reconstruction using any type of augmentation tissue or matrix were included. Methodological quality was evaluated by assessment of the risk of bias in the included studies. Studies comparing outcomes of RCR with graft augmentation or interposition versus repair alone (control group) were subjected to meta-analysis. RESULTS: The authors identified 774 articles and included 36 in the systematic review; 5 of the 36 studies underwent meta-analysis. Except for one outcome measure in a single study, all surgical interventions (RCR alone, RCR with augmentation, and RCR with interposition) improved clinical scores and outcome measures. Because of variability in study outcomes, no graft option was found to be superior. Compared with RCR alone, graft augmentation or interposition provided significantly lower retear rates ( P = .05) and higher American Shoulder and Elbow Surgeons (ASES) scores ( P = .005), but improvements in UCLA (University of California, Los Angeles) scores ( P = .29) and pain scores ( P = .1) did not reach statistical significance. CONCLUSION: In the meta-analysis, graft augmentation or interposition appeared to provide a lower retear rate and improved ASES scores when compared with RCR alone. Future prospective, randomized, controlled, and appropriately powered trials are needed for more definitive recommendations.

Genetic correlation between multiple myeloma and chronic lymphocytic leukaemia provides evidence for shared aetiology.

The clustering of different types of B-cell malignancies in families raises the possibility of shared aetiology. To examine this, we performed cross-trait linkage disequilibrium (LD)-score regression of multiple myeloma (MM) and chronic lymphocytic leukaemia (CLL) genome-wide association study (GWAS) data sets, totalling 11,734 cases and 29,468 controls. A significant genetic correlation between these two B-cell malignancies was shown (Rg = 0.4, P = 0.0046). Furthermore, four of the 45 known CLL risk loci were shown to associate with MM risk and five of the 23 known MM risk loci associate with CLL risk. By integrating eQTL, Hi-C and ChIP-seq data, we show that these pleiotropic risk loci are enriched for B-cell regulatory elements and implicate B-cell developmental genes. These data identify shared biological pathways influencing the development of CLL and, MM and further our understanding of the aetiological basis of these B-cell malignancies.

Open Reduction Internal Fixation of Isolated Chondral Fragments Without Osseous Attachment in the Knee: A Case Series.

BACKGROUND: Isolated chondral fractures of the knee are a rare and challenging problem, typically occurring with an acute traumatic event such as dislocation of the patella or ligamentous injury. Historically, repair of unstable chondral fragments without osseous attachment has not been recommended due to concerns about the limited healing potential of cartilage. PURPOSE: To describe a technique for fixation of large isolated chondral fractures of the knee and present 3 cases where large chondral fragments without osseous attachment were fixed successfully with chondral darts and biologic adhesive. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The senior author reviewed his case logs for all patients on whom he performed open reduction and internal fixation on large isolated cartilage fragments without osseous attachment. Three were extracted from his review. The clinical and radiographic outcomes were retrospectively reviewed. RESULTS: Successful results and complete healing was obtained in all 3 patients. This procedure can be done in the setting of concurrent injury, such as anterior cruciate ligament tear, using single- or multistaged chondral repair and ligament reconstruction techniques. CONCLUSION: Isolated chondral fragment repair techniques provide the orthopaedic surgeon an additional option for treating these challenging injuries. Primary fixation can be accomplished for what have been historically considered "unsalvageable" fragments.

Genome-wide association analysis of chronic lymphocytic leukaemia, Hodgkin lymphoma and multiple myeloma identifies pleiotropic risk loci.

B-cell malignancies (BCM) originate from the same cell of origin, but at different maturation stages and have distinct clinical phenotypes. Although genetic risk variants for individual BCMs have been identified, an agnostic, genome-wide search for shared genetic susceptibility has not been performed. We explored genome-wide association studies of chronic lymphocytic leukaemia (CLL, N = 1,842), Hodgkin lymphoma (HL, N = 1,465) and multiple myeloma (MM, N = 3,790). We identified a novel pleiotropic risk locus at 3q22.2 (NCK1, rs11715604, P = 1.60 × 10-9) with opposing effects between CLL (P = 1.97 × 10-8) and HL (P = 3.31 × 10-3). Eight established non-HLA risk loci showed pleiotropic associations. Within the HLA region, Ser37 + Phe37 in HLA-DRB1 (P = 1.84 × 10-12) was associated with increased CLL and HL risk (P = 4.68 × 10-12), and reduced MM risk (P = 1.12 × 10-2), and Gly70 in HLA-DQB1 (P = 3.15 × 10-10) showed opposing effects between CLL (P = 3.52 × 10-3) and HL (P = 3.41 × 10-9). By integrating eQTL, Hi-C and ChIP-seq data, we show that the pleiotropic risk loci are enriched for B-cell regulatory elements, as well as an over-representation of binding of key B-cell transcription factors. These data identify shared biological pathways influencing the development of CLL, HL and MM. The identification of these risk loci furthers our understanding of the aetiological basis of BCMs.

Surgical Management and Treatment of the Anterior Cruciate Ligament/Medial Collateral Ligament Injured Knee.

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee. The anterior cruciate ligament (ACL) is the most commonly injured ligament in conjunction with the MCL. Most MCL injuries can be treated nonoperatively, whereas the ACL often requires reconstruction. A good physical examination is essential for diagnosis, whereas radiographs and MRI of the knee confirm diagnosis and help guide treatment planning. Preoperative physical therapy should be completed before surgical management to allow for return of knee range of motion and an attempt at MCL healing.

Magnetic resonance imaging after anterior cruciate ligament reconstruction: A practical guide.

Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic procedures performed worldwide. In this regard, magnetic resonance imaging (MRI) represents a useful pre-operative tool to confirm a disruption of the ACL and to assess for potential associated injuries. However, MRI is also valuable post-operatively, as it is able to identify, in a non-invasive way, a number of aspects and situations that could suggest potential problems to clinicians. Graft signal and integrity, correct tunnel placement, tunnel widening, and problems with fixation devices or the donor site could all compromise the surgical outcomes and potentially predict the failure of the ACL reconstruction. Furthermore, several anatomical features of the knee could be associated to worst outcomes or higher risk of failure. This review provides a practical guide for the clinician to evaluate the post-surgical ACL through MRI, and to analyze all the parameters and features directly or indirectly related to ACL reconstruction, in order to assess for normal or pathologic conditions.

Colorectal Cancer Screening: Stool DNA and Other Noninvasive Modalities.

Colorectal cancer screening dates to the discovery of precancerous adenomatous tissue. Screening modalities and guidelines directed at prevention and early detection have evolved and resulted in a significant decrease in the prevalence and mortality of colorectal cancer via direct visualization or using specific markers. Despite continued efforts and an overall reduction in deaths attributed to colorectal cancer over the last 25 years, colorectal cancer remains one of the most common causes of malignancy-associated deaths. In attempt to further reduce the prevalence of colorectal cancer and associated deaths, continued improvement in screening quality and adherence remains key. Noninvasive screening modalities are actively being explored. Identification of specific genetic alterations in the adenoma-cancer sequence allow for the study and development of noninvasive screening modalities beyond guaiac-based fecal occult blood testing which target specific alterations or a panel of alterations. The stool DNA test is the first noninvasive screening tool that targets both human hemoglobin and specific genetic alterations. In this review we discuss stool DNA and other commercially available noninvasive colorectal cancer screening modalities in addition to other targets which previously have been or are currently under study.

Characteristics of genitourinary injuries associated with pelvic fractures during operation Iraqi Freedom and operation Enduring Freedom.

OBJECTIVES: Pelvic fractures are markers of severe injury and are often associated with lower genitourinary injuries. The purpose of this study was to investigate the incidence of lower genitourinary injuries and complaints associated with pelvic fractures sustained in combat among nonsurvivors and survivors. METHODS: The Armed Forces Medical Examiner System and The Joint Theater Trauma Registry databases were searched to identify survivors and nonsurvivors who sustained a pelvic fracture in combat in 2008. Survivor and autopsy data consisted of injury mode and mechanism and associated organ and extremity injuries. Pelvic fractures were classified using the Tile system. RESULTS: The database search yielded 91 nonsurvivors and 10 survivors with pelvic fractures. Forty-one patients (40%) sustained 61 genitourinary injuries. The majority of genitourinary injuries in nonsurvivors were associated with Tile C pelvic fractures (70%). Twenty percent of survivors had genitourinary injuries, all of which were associated with Tile A fractures. CONCLUSIONS: A higher incidence of genitourinary injuries in patients with combat-related pelvic fractures (60%) was found than that of their civilian counterparts. Of the survivors, 100% of those with genitourinary injuries were being treated for erectile dysfunction at their last follow-up. Continued collaboration between orthopaedic surgeons and urologist is needed to address these concurrent injuries.

Glenoid bone loss in the setting of an anterior labroligamentous periosteal sleeve avulsion tear.

BACKGROUND: Glenoid bone loss is a factor that has been inversely associated with the success of shoulder instability repair. Recently, patients with an anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesion have also been identified as having a higher failure rate after surgical repair. PURPOSE: To determine differences in the amount of glenoid bone loss and to compare demographic factors of instability in patients with and without ALPSA tears. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Over a 3-year period, all patients (N = 83) who were treated for anterior shoulder instability at a single institution were reviewed retrospectively. A total of 39 (47%) were identified as having an ALPSA lesion and 44 (53%) as having no ALPSA tear. Glenoid bone loss was determined in 2 ways: (1) radiographically by 3-dimensional computed tomography (3D CT) (humeral head digitally subtracted by 3 blinded observers) and (2) with arthroscopic techniques at the time of surgery. Demographic data such as the time from the initial instability event to advanced imaging and surgery were noted. These data were then analyzed with the Student t test to determine any significant differences between the 2 groups. RESULTS: The patients with an ALPSA lesion had more preoperative instability events than those without (8.2 vs 3.6, respectively; P = .04). The mean glenoid bone loss measured by 3D CT was 12.7% (range, 0%-22.3%) for those with ALPSA tears versus 6.25% (range, 0%-23.1%) for those without (P = .002). The mean duration of total instability for those with ALPSA tears was 42.9 months versus 46.3 months for those without (P = .95). Lastly, the mean bone loss based on arthroscopic measures was 11.4% for patients with ALPSA tears and 4.3% for those without ALPSA tears (P = .017). From the existing magnetic resonance imaging/arthrography scans reviewed, 82% of patients could be correctly identified as having an ALPSA lesion. CONCLUSION: Patients with anterior shoulder instability who have an ALPSA lesion have nearly twice the amount of glenoid bone loss as those with a standard Bankart tear (no ALPSA lesion). Patients with ALPSA lesions had statistically more instability events, and this may be an additional factor in either developing an ALPSA lesion or glenoid bone loss or both.