Introducing Foundations of Arthroscopy Techniques.

Arthroscopy Techniques is home to technical notes with video on all methods and procedures arthroscopic or related at https://www.arthroscopytechniques.org and https://www.youtube.com/@ArthroscopyTechniques. ATech publications run the gamut from classic to innovative, but where to start if one is a trainee, new in practice, or wishing to expand the breadth of one's practice? To fill this "gap," we introduce the Foundations of Arthroscopy Techniques Collection featuring technical notes with video detailing the essential fundamentals required to perform arthroscopy of the Shoulder, Elbow, Wrist, Hip, Knee, and Foot & Ankle.

The Fragility Index Is Typically Misinterpreted and of Low Value: Clinical Trials Are Designed to Be Fragile.

The Fragility Index (FI) is defined as the number of patients whose outcome would need to change to reverse a statistically significant finding to a nonsignificant finding. The FI is nothing more than a repackaging of statistical significance based on the P value, perpetuating the (1) ignoring of results that are "not" statistically significant; (2) treating results that are statistically significant as certain; and (3) distracting from evaluation of clinical significance. A well-designed trial includes a sample size calculation to determine the minimum number of patients required to observe a difference between study groups (if a difference exists). By including this minimum number, clinical trials are designed to be fragile, yet subsequently criticized as such, leading readers to the incorrect conclusion that the studies are flawed. It's time to move past systematic reviews focused on the FI.

No Clinically Significant Differences in Outcomes after Anterior Cruciate Ligament Reconstruction When Comparing Quadriceps, Bone Patellar Tendon Bone, and Hamstring Autografts of 9mm or Greater.

PURPOSE: The purpose of this study was to determine if there are patient-reported outcome differences in bone-patellar-tendon-bone (BTB), quadriceps tendon (QT), and hamstring (HS) grafts of comparable size. METHODS: We performed a retrospective analysis of global registry data to include all patients that had an ACL reconstruction with BTB, QT, or HS autograft of at least 9mm diameter between 2010 and 2021 with complete 1- and 2-year outcome scores. We compared 1- and 2-year postoperative outcome scores (VAS, KOOS pain, MARS, VR-12) between BTB, QT and HS of the same size graft. RESULTS: 2318 subjects were included in the analysis and all graft types showed improved PROMs at 1- and 2-years postoperatively when compared to baseline. The KOOS pain score for the BTB group was significantly better than the HS (between-group difference = 2.71, p<0.01) and QT (between-group difference = 2.51, p<0.01) groups at 1-year, and the BTB group was better than HS (between-group difference = 1.88, p<0.01) at 2-years. However, the differences were small and not clinically meaningful. When comparing graft type there were no differences in the percentage of patients who reached MCID, or clinical scores VAS, MARS at 2-years follow-up. CONCLUSION: There is no clinically meaningful difference in KOOS-pain, VR-12, VAS, and MARS at 1- and 2-years postoperatively in patients having anterior cruciate ligament reconstruction with BTB, HS or QT if graft size is at least 9mm in diameter. LEVEL OF EVIDENCE: III (Retrospective Comparative Study).

Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes.

Purpose: To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear. Methods: This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB). Results: Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up. Conclusions: At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients. Level of Evidence: Level IV, therapeutic case series.

Obesity is associated with muscle atrophy in rotator cuff tear.

Objective: The primary goal of this study is to evaluate the relationship between Body Mass Index (BMI) and muscle atrophy in individuals with rotator cuff tears. Methods: This study consists of patients with rotator cuff tears identified by MRI from two independent cohorts, the Rotator Cuff Outcomes Workgroup (ROW) and the Multicenter Orthopaedic Outcomes Network (MOON). Presence of atrophy (yes/no) and severity of atrophy (as an ordinal variable) were assessed on MRI by expert physicians. We used multivariable regression models to evaluate the relationship between BMI and muscle atrophy while adjusting for age and sex in each study, conducted sensitivity analyses for full-thickness tear and combined results using inverse variance-weighted meta-analysis. Results: A total of 539 patients (MOON=395, ROW=144) from the combined cohorts had MRI data available on muscle atrophy. Among these patients, 246 (46%) had atrophy of at least one of the muscles of the rotator cuff and 282 (52%) had full-thickness tears. In meta-analysis across both cohorts, each 5 kg/m2 increase in BMI was associated with a 21% (aOR=1.21, 95% CI=1.02, 1.43) increased odds of having muscle atrophy among individuals with any tear size, and 36% (aOR=1.36, 95% CI=1.01-1.81) increased odds among individuals with full-thickness tear. Conclusions: Higher BMI was associated with significantly higher odds of muscle atrophy in patiens with rotator cuff tears. More study is needed to unders1tand why and how this relationship exists, as well as whether interventions to reduce BMI may help improve outcomes for these patients. Level of Evidence: III.

Costs and Timing of Surgery in the Management of Meniscal Tears.

Background: Treatment strategies for meniscal tears range from nonoperative management to surgical intervention. However, national trends in cost-related outcomes and patient factors related to the failure of nonoperative management remain poorly understood. Purpose: To describe the costs associated with nonoperative versus operative management of meniscal tears in the 2 years after diagnosis and examine the relationship between patient characteristics and timing of surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study was conducted using the MarketScan databases. Patients diagnosed with a meniscal tear without concomitant knee osteoarthritis between January 1 and December 31, 2017, were included. The primary outcome was the total cost of meniscal tear-related procedures-including insurance deductibles, coinsurance, and net insurance payments-in the 2 years after diagnosis. Procedures included were as follows: (1) surgery-including meniscectomy or meniscal repair; (2) physical therapy; (3) medication-including nonsteroidal anti-inflammatories, opioids, and acetaminophen; (4) intra-articular injections-including professional fee, hyaluronic acid, and corticosteroids; (5) imaging; and (6) clinic visits to orthopaedic specialists. Patients were grouped as having undergone early surgery (ES) (≤3 months of diagnosis), late surgery (LS) (>3 months after diagnosis), or no surgery (NS). Multivariate logistic regression was performed to determine the likelihood of undergoing surgery early and failing nonoperative treatment. Results: The study population included 29,924 patients with a mean age of 43.9 ± 12.9 years (ES: n = 9507 (31.8%); LS: n = 2021 (6.8%); NS: n = 18,396 (61.5%)). Complex (36.6%) and medial (58.8%) meniscal tears were the most common type and location of injuries, respectively. The mean cost of management per patient was $3835 ± $4795. Costs were lower in the NS group ($1905 ± $3175) compared with the ES group ($6759 ± $5155), while the highest costs were observed in the LS group ($7649 ± $5913) (P < .001). Patients who were men, >40 years, and with a bucket-handle or lateral meniscal tear were more likely to undergo surgery early. Patients who were men, <30 years, and with a complex tear or tear to the lateral meniscus were more likely to fail nonoperative management. Conclusion: Nonoperative management had the lowest cost burden and should be recommended for patients with appropriate indications. However, if surgery is necessary, it should be performed earlier.

Patient Acceptable Symptomatic State and Substantial Clinical Benefit Matter Most to Patients and Must Be Reported Correctly.

Despite a push for a focus on clinical rather than "statistical" significance and an emphasis on reporting of outcome thresholds such as the patient acceptable symptomatic state (PASS) and substantial clinical benefit (SCB), the PASS and SCB are rarely reported and, when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple . . . just ask them. The questions are known as anchor questions. Obviously, different patients have different PASS and SCB thresholds, and reliance on previously published literature for values of these thresholds can result in error-thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and they must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand maximum outcome improvement. In contrast, the minimal clinically important difference is a less-than-ideal measure; patients do not desire "minimal" improvement. Journals must do a better job of publishing patient-reported outcome measures that matter most to patients: satisfaction and substantial benefit.

AANA24 Delivers Knowledge and a Sense of Purpose.

The 2024 Annual Meeting of the Arthroscopy Association of North America in Boston was our largest ever. The program was innovative, and attendees departed with a sense of purpose and new knowledge. Besides intellectual exchange, the meeting fostered connections that will shape arthroscopy in years to come. We look forward to AANA25 in Washington, DC.

Disaggregation of Medical Research Data Reveals Outcome Differences in Demographic Groups and Presents Opportunity to Improve Patient Care.

Disaggregation, in the medical literature, means separation into demographic groups. This results in an opportunity to discover differences in outcomes by group, which could improve future treatments and provide outcome data, by group, that could be included in future systematic reviews. In research, the term disaggregation is most often used in reference to addressing inequities. We support the Sex and Gender Equity Research (SAGER) guidelines and encourage authors to examine how sex and gender are taken into account in their study and ensure adequate representation by sex and gender. (We respect that not all studies can or are designed to capture data by sex and gender, and that gender is "complex" and "fluid.") Disaggregation is encouraged, when possible, for other demographic variables allowing evaluation of all marginalized (as well as nonmarginalized) populations, so that we can better care for patients.

Decreased Fertility Awareness Amongst Surgeons and Surgical Trainees and Potential Role of Formal Fertility Education.

OBJECTIVE: Compared to the general population, physicians tend to have children later in life, increasing rates of infertility, obstetrical complications, and the need for assisted reproductive technology (ART). The aim of this study is to systematically review the literature to determine the level of fertility and ART knowledge amongst United States surgeons and surgical trainees, and analyze the impact of the medical career on family planning goals and outcomes. DESIGN: A systematic literature search of articles published between 2014 to 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to, Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The primary outcome measures included fertility and ART knowledge, childbearing decision-making factors, and current education. Secondary outcomes included evaluation of institutional support, postpartum, and infertility. PARTICIPANTS: Sixteen studies with a total of 6983 partici- pants (908 men and 5162 women) were included in this systematic review. RESULTS: Sixteen studies with a total of 6983 participants (908 men and 5162 women) were included in this systematic review. Though most participants were aware of the presence of age-related fertility decline, most were lacking in fertility and ART knowledge, and most likely did not receive formal education in these topics. The vast majority elected to delay childbearing due to career aspirations, with many facing subsequent pregnancy complications, infertility challenges, and a lack of institutional support in the postpartum period. CONCLUSIONS: Our study demonstrates that medical students, trainees, and physicians overall are lacking in knowledge and awareness regarding age-related fertility decline and ART, indicating the necessity for a formal educational curriculum. Additionally, female physicians opt to delay childbearing longer than their male counterparts, while also experiencing increased complications and institutional challenges. This study clearly demonstrates a need for parental leave policy expansion, transparency of the policies in place, and financial and time allowance support for elective oocyte cryopreservation in the medical community.

The Purpose of Journal Peer Review Is to Make Articles Better.

Authors may have the misconception that the purpose of peer review is to serve as an arbiter or referee, or in other words, to make a binary, Accept After Revision versus Reject, decision whether an article will be published in our journal. In truth, although making that difficult decision is part of the process, it is only a part. The principal goal of peer review is to make articles better.

Bilateral Subacromial-Subdeltoid Rice Bodies in the Shoulder: A Surgical Case Report.

Introduction: Rice bodies (RBs) are pale and glossy appearing small fibrinous nodules that form due to synovial or tenosynovial joint inflammation. RBs are significant as they are common in orthopedic practices causing nonspecific symptoms such as pain, swelling, range of motion limitations, crepitus, and catching sensations. These loose bodies occur often within the bursa as a symptom of chronic bursitis and are commonly associated with rheumatoid, inflammatory, or tuberculous arthritis. Reports on RBs are present; however, few bilateral cases within the shoulder appear in the literature. Case Presentation. This case demonstrates an unusual bilateral, subacromial-subdeltoid presentation of rice bodies (RBs) in a 41-year-old Caucasian female patient with a history of rheumatoid arthritis. We describe treatment with right shoulder arthroscopy to remove the loose bodies. One-year postoperative patient-reported outcomes (PROMs) show improvement in symptoms, pain, and overall function. Conclusion: Formation of RBs occurs as a symptom of an inflammatory response in synovial joints. This provokes multiple small fibrin aggregates to collect within synovial bursae and occasionally tendon sheaths. RBs are rarely seen bilaterally. Arthroscopic removal of RBs is an appropriate treatment method for symptom improvement.

Very Few ACGME-accredited Orthopaedic Surgery Residency Programs Have Web-accessible Leave Policies Dedicated to Parental Leave for Residents, Despite ACGME Requirements.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires that all graduate medical education (GME) programs provide at least 6 paid weeks off for medical, parental, and caregiver leave to residents. However, it is unclear whether all orthopaedic residency programs have adapted to making specific parental leave policies web-accessible since the ACGME's mandate in 2022. This gap in policy knowledge leaves both prospective and current residents in the dark when it comes to choosing residency programs, and knowing what leave benefits they are entitled to when having children during training via birth, surrogacy, adoption, or legal guardianship. QUESTIONS/PURPOSES: (1) What percentage of ACGME-accredited orthopaedic surgery residency programs provide accessible parental leave policies on their program's website, their GME website, and through direct contact with their program's administration? (2) What percentage of programs offer specific parental leave policies, generic leave policies, or defer to the Family and Medical Leave Act (FMLA)? METHODS: As indicated in the American Medical Association's 2022 Freida Specialty Guide, 207 ACGME-accredited orthopaedic residency programs were listed. After further evaluation using previous literature's exclusion criteria, 37 programs were excluded based on osteopathic graduate rates. In all, 170 ACGME-accredited allopathic orthopaedic surgery residency programs were identified and included in this study. Three independent reviewers assessed each program website for the presence of an accessible parental leave policy. Each reviewer accessed the program's public webpage initially, and if no parental leave policy was available, they searched the institution's GME webpage. If no policy was found online, the program administrator was contacted directly via email and phone. Available leave policies were further classified into five categories by reviewers: parental leave, generic leave, deferred to FMLA, combination of parental and FMLA, and combination of parental and generic leave. RESULTS: Our results demonstrated that 6% (10 of 170) of orthopaedic residency programs had policy information available on their program's main orthopaedic web page. Fifty nine-percent (101 of 170) of orthopaedic residency programs had a clearly stated policy on their institution's GME website. The remaining 35% (59 of 170) had no information on their public website and required direct communication with program administration to obtain policy information. After directly contacting program administration, 12% (21 of 170) of programs responded to researchers request with a PDF explicitly outlining their policy. Twenty-two percent (38 of 170) of programs did not have an accessible policy available. Of the programs that had available policies, a total of 53% (70 of 132) of programs were categorized as offering explicit parental leave policies, 9% (12 of 132) were categorized as offering general leave policies, and 27% (36 of 132) deferred to FMLA. Seven percent (9 of 132) offered combined parental leave policies with FMLA, and 4% (5 of 132) offered combined general leave policies with FMLA. CONCLUSION: Although most ACGME-accredited allopathic orthopaedic surgery residency programs met the ACGME requirement of written parental leave policies in 2023, a small minority of programs have clear, accessible parental leave policies provided on their webpage. CLINICAL RELEVANCE: Parental leave policies should be easily accessible to prospective and current trainees and should clearly state compensation and length of leave. Ensuring orthopaedic surgery residency programs provide accessible and transparent parental leave policies is important for maintaining diversity in prospective applicants and supporting the work-life balance of current residents.

Pregnancy and infertility in orthopedics: A review of the current state.

BACKGROUND: Orthopedic surgery continues to have one of the lowest rates of female trainees among all medical specialties in the United States. Barriers to pursuing a surgical residency include the challenges of family planning and work-life balance during training. METHODS: A systematic literature search of articles published between June 2012 and December 2022 in the MEDLINE, EMBASE, and Cochrane databases was performed in January 2023 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). Studies were included if they evaluated pregnancy and peripartum experience and/or outcomes amongst orthopedic surgeons or trainees. RESULTS: Eighteen studies were included. Up to 67.3% of female orthopedic surgeons and trainees and 38.7% of their male counterparts delayed childbearing during residency. The most reported reasons for this delay included career choice as an orthopedic surgeon, residency training, and reputational concerns among faculty or co-residents. Infertility ranged from 17.0% to 30.4% in female orthopedic surgeons and up to 31.2% suffered obstetric complications. Assisted Reproductive Technology (ART) resulted in 12.4%-56.3% of successful pregnancies. Maternity and paternity leaves ranged from 1 to 11 weeks for trainees with more negative attitudes associated with maternal leave. CONCLUSIONS: Female orthopedic trainees and attending delay childbearing, experience higher rates of obstetric complications, and more stigma associated with pregnancy compared to their male colleagues. Program and institutional policies regarding maternity and paternity leave are variable across programs, and therefore, attention should be directed toward standardizing policies.

Preoperative Low Resilience Is Associated With Female Patients, Whereas High Resilience Is Associated With Improved Mental Health Scores During Anterior Cruciate Ligament Reconstruction.

PURPOSE: To evaluate the relationship between resilience, as measured by the Brief Resilience Scale (BRS), and patient-reported outcome measures (PROMs) after primary anterior cruciate ligament reconstruction (ACLR). METHODS: A cohort of 72 patients undergoing primary ACLR were followed for a minimum of 2 years. Preoperative BRS scores were collected, and patients were categorized into low resilience (LR), normal resilience (NR), and high resilience (HR). PROMs including the visual analog scale (VAS), measuring overall pain level from 0 to 10, the Veterans Rand (VR) 12-Item Health Survey Physical Component and Mental Components, Knee Injury and Osteoarthritis Outcomes Score, and Marx Activity Rating Scale were collected preoperatively as well as up to 2 years postoperatively and compared among the various resilience groups. RESULTS: BRS scores were significantly associated with VAS, VR 12-Item Health Survey Mental Component, and KOOS outcome scores. There was a significant difference among all 3 resilience groups (P = .0382) in change of VAS score from baseline to 2 years postoperatively, with a mean difference of 2.5 points, 1.1 points, and 0.7 points for LR, NR, and HR groups, respectively. There was a significant association of greater VR 12-Item Health Survey Mental Component scores, with greater resilience scores preoperatively (P < .0001) and at both 1 (P = .0034) and 2 years (P = .0235) postoperatively. Greater resilience scores were associated with greater KOOS scores at 1 year postoperatively (P = .0270). Female patients were more likely to fall into the LR group (80%). CONCLUSIONS: In this cohort of patients undergoing ACLR, low resilience is positively associated with greater improvement in pain, and female patients tend to fall more into the LR group. At 1 year postoperatively, greater resilience scores were positively associated with greater aggregated KOOS scores. At 1 and 2 years postoperatively, greater resilience was positively associated with improved VR-12M scores. LEVEL OF EVIDENCE: Level II, prospective cohort study.

The Second Annual Musculoskeletal Biologics Special Issue Highlights Evidence-Based Therapies.

Orthopaedic biologics continues to hold great promise. The editors of Arthroscopy; Arthroscopy Techniques; and Arthroscopy, Sports Medicine, and Rehabilitation once again Call for Papers and invite authors to submit clinical musculoskeletal biologics original scientific research and technical notes with video. Our top articles are awarded inclusion in the Annual Musculoskeletal Biologics Special Issue.

Editorial Commentary: When Managing Patellofemoral Instability, Mind Your P's and Q's: Medial Patellofemoral Ligament Versus Medial Quadriceps Tendon Femoral Ligament Versus Medial Patellofemoral Complex.

Our understanding of patellar instability and the medial patellofemoral complex (MPFC) has evolved over the past 15 years. Despite advancements and appreciation of the anatomy and biomechanics of the MPFC, the best surgical treatment for recurrent patellar instability has yet to be determined. The goals of medial patellofemoral ligament (MPFL), medial quadriceps tendon femoral ligament (MQTFL), or MPFC reconstructions (with grafts from both the patella and quad to the femur) are to return patients back to activity and avoid complications such as recurrent instability, overconstraint, secondary arthrosis, and potential patellar fracture from surgical drill holes. Other considerations when managing recurrent instability include patella alta, hypermobility, and whether an osteotomy procedure is indicated. Although we always need to make good choices and mind our P's and Q's, the big question remains: Is MPFL, MQTFL, or MPFC the best choice for our patients?

Preoperative Predictors of Arthroscopic Partial Meniscectomy Outcomes: The APM Index Score.

BACKGROUND: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. PURPOSE: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. RESULTS: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. CONCLUSION: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively.

Increased patient resilience scores are related to positive postoperative outcomes in rotator cuff repairs.

HYPOTHESIS: We sought to determine whether patients' preoperative resilience scores predict postoperative outcomes in arthroscopic rotator cuff repair surgery. METHODS: Patients were prospectively enrolled and underwent data collection preoperatively and at 3, 6, 12, and 24 months postoperatively. Data collected included demographic characteristics and the Brief Resilience Scale (BRS) score, visual analog scale score, Veterans RAND 12-Item Health Survey scores (mental component [VR-12M] and physical component [VR-12P]), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Single Assessment Numeric Evaluation score, and Simple Shoulder Test (SST) score. RESULTS: In total, 131 patients had complete 1- or 2-year postoperative outcome measures. Female patients comprised 56.5% of our sample, and the average age was 57.6 years. Between the low, normal, and high resilience groups, there were significant differences in the VR-12M scores at 0, 12, and 24 months postoperatively (P < .01 for all). The VR-12P scores at 12 months were 44.2, 47.4, and 49.8 in the low, normal, and high resilience groups, respectively, showing a trend upward, but this failed to reach the level of significance (P = .08). The SST scores of the low, normal, and high resilience groups at 12 months were 69.1, 79.9, and 85.1, respectively, again showing a trend upward, but this failed to reach the level of significance (P = .07). The SST scores at 0 and 24 months did not differ between groups. There were no significant differences in American Shoulder and Elbow Surgeons, visual analog scale, and Single Assessment Numeric Evaluation scores at 0, 12, or 24 months postoperatively. We found a significant positive correlation between the BRS score and SST score at 12 months (R = 0.18), VR-12M score at 12 months (R = 0.38), VR-12M score at 24 months (R = 0.31), and VR-12P score at 12 months (R = 0.21). CONCLUSIONS: Our study provides evidence that BRS scores in patients undergoing arthroscopic rotator cuff repair are related to postoperative outcomes, measured through the VR-12M and SST scores at 2-year follow-up.