The Pull String Method: Optimizing Visualization for Arthroscopic Femoroplasty.

Capsular management during hip arthroscopy represents an important component to access, visualization, and restoration of hip stability. In the setting of femoroacetabular impingement, the peripheral compartment represents access to the femoral neck where abnormal morphology is commonly addressed with arthroscopic femoroplasty. While various techniques have been described for peripheral compartment visualization, difficulty can arise in creating a wide display of the femoral neck while minimizing subsequent impairment of the capsule. In order to obtain an unobstructed view of the femoral neck, the hip capsule must be managed skillfully. The use of hip flexion to relax the capsule for visualization of the peripheral compartment is a nearly universal practice for hip surgeons. However, differences in management of the capsule have previously included traction sutures and further capsulotomies. In this technical note, we describe our Pull String method for peripheral compartment access using an interportal capsulotomy with strategic traction suture placement and choreography of suture tensioning. This enables full view of the femoral neck for successful femoroplasty, while still allowing for complete capsule repair to help restore stability.

Suture Anchor Repair with V-Y Plasty and Achilles Allograft Augmentation for Chronic Quadriceps Tendon Injury.

Despite an overall incidence that remains low, quadriceps tendon injuries represent a common disorder of the knee extensor mechanism. Persistent pain, weakness, and loss of terminal extension can lead to poor clinical outcomes and significant functional impairment. In the acute setting, approach to management often includes primary repair of the injured tendon that can lead to excellent clinical outcomes. However, a delayed or missed diagnosis can bring forth a clinical scenario that can be difficult to manage thereafter. In the chronically injured tendon, challenges can be linked to limited tendon excursion, poor tissue quality, and increased risk of reinjury.

Osteochondral Allograft Transplantation of the Knee in Patients with an Elevated Body Mass Index.

OBJECTIVE: To characterize the graft survivorship and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee in patients with an elevated body mass index (BMI). DESIGN: Prospective data on 38 consecutive patients with a BMI ≥30 kg/m2 treated with OCA from 2000 to 2015 were reviewed. Complications, reoperations, and patient responses to validated outcome measures were examined. Failures were defined by any removal/revision of the allograft or conversion to arthroplasty. RESULTS: Thirty-one knees in 31 patients (mean age, 35.4 years [range, 17-61 years]; 87% male) met the inclusion criteria. Mean BMI was 32.9 kg/m2 (range, 30-39 kg/m2). Mean chondral defect size was 6.4 cm2 (range, 1.0-15.3 cm2). Prior to OCA, 23 patients (74%) had undergone previous surgery to the ipsilateral knee. Mean duration of follow-up was 4.1 years (range, 2-11 years). After OCA, 5 knees (13%) underwent conversion to unicompartmental (1) or total (4) knee arthroplasty. Two- and 5-year graft survivorship were 87% and 83%, respectively. At final follow-up, clinically significant improvements were noted in the pain (49.3-72.6) and physical functioning (52.9-81.3) subscales of the Short Form-36 ( P ≤ 0.001), International Knee Documentation Committee subjective form (43.5-67.0; P = 0.002), Knee Outcome Survey-Activities of Daily Living (58.2-80.4; P = 0.002), and overall condition subscale of the Cincinnati Knee Rating System (4.7-6.9; P = 0.046). CONCLUSIONS: OCA can be a successful midterm treatment option for focal cartilage defects of the knee in select patients with a BMI ≥30 kg/m2.

Hitting the Mark: Optimizing the Use of Calcium Phosphate Injections for the Treatment of Bone Marrow Lesions of the Proximal Tibia and Distal Femur.

Increased contact pressures of the osteoarthritic joint can lead to underlying osseous injury, with resultant marrow edema changes of the subchondral bone. These osteoarthritis-related bone marrow lesions can subsequently lead to persistent pain and further disability. Limited joint preservation treatment options exist to alleviate symptoms or potentially alter the natural history of the affected joint; however, recent success with injectable calcium phosphate has provided early pain relief and may provide a scaffold for endogenous repair mechanisms. In this Technical Note, a comprehensive surgical approach using injectable calcium phosphate to target bone marrow lesions of the proximal tibia and distal femur is presented. Critical technique considerations include the use of magnetic resonance and fluoroscopic imaging to target the area of the subchondral bone while refraining from overfilling and/or forced pressurization during delivery and the use of postinjection arthroscopy to prevent potential injurious sequelae.

The Cliff Sign: A New Radiographic Sign of Hip Instability.

BACKGROUND: The preoperative diagnosis of hip microinstability is challenging. Although physical examination maneuvers and magnetic resonance imaging findings associated with microinstability have been described, there are limited reports of radiographic features. In patients with microinstability, we observed a high incidence of a steep drop-off on the lateral edge of the femoral head, which we have named the "cliff sign." PURPOSE: (1) To determine the relationship of the cliff sign and associated measurements with intraoperative microinstability and (2) to determine the interobserver reliability of these measurements. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A total of 115 consecutive patients who underwent hip arthroscopy were identified. Patients with prior hip surgery, Legg-Calve-Perthes disease, fractures, pigmented villonodular synovitis, or synovial chondromatosis were excluded, resulting in the inclusion of 96 patients in the study. A perfect circle around the femoral head was created on anteroposterior pelvis radiographs. If the lateral femoral head did not completely fill the perfect circle, it was considered a positive cliff sign. Five additional measurements relating to the cliff sign were calculated. The diagnosis of microinstability was made intraoperatively by the (1) amount of traction required to distract the hip, (2) lack of hip reduction after initial traction release following joint venting, or (3) intraoperative findings consistent with hip microinstability. Continuous variables were analyzed through use of unpaired t tests and discrete variables with Fisher exact tests. Interobserver reliability (n = 3) was determined for each measurement. RESULTS: Overall, 89% (39/44) of patients with microinstability had a cliff sign, compared with 27% of patients (14/52) without instability (P < .0001). Conversely, 74% of patients with a cliff sign had microinstability, while only 12% of patients without a cliff sign had instability (P < .0001). In women younger than 32 years with a cliff sign, 100% (20/20) were diagnosed with instability. No differences were found in any of the 5 additional measurements. Excellent interobserver reliability was found for the presence of a cliff sign and the cliff angle measurement. CONCLUSION: We have identified a radiographic finding, the cliff sign, that is associated with the intraoperative diagnosis of hip microinstability and has excellent interobserver reliability. Results showed that 100% of young women with a cliff sign had intraoperative microinstability. The cliff sign may be useful in the preoperative diagnosis of hip microinstability.

Tendon Excision Following Distal Semitendinosus Injury in the Elite Athlete: A Surgical Technique.

BACKGROUND: Hamstring injuries can present in numerous forms, some of which can lead to persistent pain, loss of function, and delay in return to sport. Although most are treated conservatively, proximal and distal tendon avulsion injuries have become more commonly treated with surgery. Distal semitendinosus avulsion injuries have been largely reported in the elite athlete population. While conservative management has been utilized, failure in this group can significantly impact a future career. PURPOSE: The purpose of the manuscript is to describe our approach of surgical tendon excision for distal semitendinosus injury in an elite athlete. METHODS: We highlight a two-incision technique to isolate the avulsed tendon, followed by exteriorization and tendon excision. In addition, we provide insight on clinical and imaging findings to help guide management. RESULTS: This technique provides a reliable and effective surgical option for managing these rare injuries of the distal semitendinosus, along with outlining rehabilitation goals in the postoperative period. CONCLUSION: In this setting, we present a detailed surgical technique to excise the injured distal semitendinosus tendon to promote recovery and potentially allow for earlier return to play.

What is the fate of scientific abstracts presented at the International Society for Hip Arthroscopy meetings?

Publication rates for general sports medicine society meetings have been studied but little is known about the publication rate for subspecialty sports medicine meetings. The purpose of this study was to determine the publication rates of abstracts presented at the annual meeting of the International Society for Hip Arthroscopy (ISHA) from 2011 to 2014. A database of abstracts presented at the annual meetings of ISHA was compiled. Abstracts that reached manuscript publication were determined using a PubMed search of the Medline database and Google Scholar. Statistical analyses were primarily descriptive. A total of 220 podium abstracts and 454 posters were presented at ISHA annual meetings from 2011 to 2014. Of the 220 podium presentations, 118 (53.6%) were eventually published with 91.5% of these being published within 3 years. Of the 454 posters, 182 (40.1%) were published with 95.6% being published in 3 years. Podium presentations had a significantly higher publication rate (P < 0.001). Published podium and poster presentations were most frequently published in the Journal of Arthroscopy and Related Research (podium: 24.6%; poster: 28.6%). The overall publication rate of scientific abstracts presented at the Annual ISHA meeting approximates that of general sports medicine society meetings. Podium presentations are significantly more likely to be published than scientific research presented as poster. These findings may highlight the scientific and educational merit of content presented. Continued attention is needed to maintain and improve the quality of abstracts presented at ISHA meetings.

The Association of Vitamin D Status in Lower Extremity Muscle Strains and Core Muscle Injuries at the National Football League Combine.

PURPOSE: To evaluate the association between serum vitamin D level and the prevalence of lower extremity muscle strains and core muscle injuries in elite level athletes at the National Football League (NFL) combine. METHODS: During the 2015 NFL combine, all athletes with available serum vitamin D levels were included for study. Baseline data were collected, including age, race, body mass index, position, injury history specific to lower extremity muscle strain or core muscle injury, and Functional Movement Screen scores. Serum 25-hydroxyvitamin D was collected and defined as normal (≥32 ng/mL), insufficient (20-31 ng/mL), and deficient (<20 ng/mL). Univariate regression analysis was used to examine the association of vitamin D level and injury history. Subsequent multivariate regression analysis was used to examine this relation with adjustment for collected baseline data variables. RESULTS: The study population included 214 athletes, including 78% African American athletes and 51% skilled position players. Inadequate vitamin D was present in 59%, including 10% with deficient levels. Lower extremity muscle strain or core muscle injury was present in 50% of athletes, which was associated with lower vitamin D levels (P = .03). Athletes with a positive injury history also showed significantly lower vitamin D levels as compared with uninjured athletes (P = .03). African American/black race (P < .001) and injury history (P < .001) was associated with lower vitamin D. Vitamin D groups showed no differences in age (P = .9), body mass index (P = .9), or Functional Movement Screen testing (P = .2). Univariate analysis of inadequate vitamin D levels showed a 1.86 higher odds of lower extremity strain or core muscle injury (P = .03), and 3.61 higher odds of hamstring injury (P < .001). Multivariate analysis did not reach an independent association of low vitamin D with injury history (P = .07). CONCLUSIONS: Inadequate vitamin D levels are a widespread finding in athletes at the NFL combine. Players with a history of lower extremity muscle strain and core muscle injury had a higher prevalence of inadequate vitamin D. LEVEL OF EVIDENCE: Level IV, retrospective study-case series.

Defining the "Substantial Clinical Benefit" After Arthroscopic Treatment of Femoroacetabular Impingement.

BACKGROUND: The minimal clinically important difference (MCID) has been defined in orthopaedics and is the smallest change that a patient considers meaningful. Less is known about improvements that the patient perceives as clinically considerable, or the substantial clinical benefit (SCB). For the young, highly functioning patient cohort with femoroacetabular impingement (FAI), the SCB is an important measure of clinical success. PURPOSE: To derive the SCB for FAI treatment and identify outcome score thresholds and patient variables predictive of the SCB. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: The modified Harris Hip Score (mHHS), the Hip Outcome Score activities of daily living (HOS-ADL) and sport (HOS-Sport) subscales, and the international Hip Outcome Tool (iHOT-33) were prospectively administered to 364 patients with a minimum 1-year follow-up. At 1 year postoperatively, patients graded their hip function based on several anchor responses such as "no change" and "much improved." The SCB was defined as the change on each outcome tool that equated to the difference between "no change" and "much improved" on the health transition question. Receiver operating characteristic analysis with area under the curve (AUC) was used to identify optimal values that were most representative of the SCB. Multivariable analysis identified patient variables predictive of the SCB. RESULTS: The net change in outcome scores corresponding to the SCB for the mHHS, HOS-ADL, HOS-Sport, and iHOT-33 was 19.8, 10.0, 29.9, and 24.5, respectively. The following postoperative outcome scores demonstrated excellent distinction (AUC >0.8) between "no change" and "much improved" and thus were considered absolute values for the postoperative SCB: 82.5 (mHHS), 93.3 (HOS-ADL), 84.4 (HOS-Sport), and 63.5 (iHOT-33). Preoperative scores on the HOS-ADL (83.3) and HOS-Sport (50.0) were significant threshold cutoffs, above which attaining the SCB became less likely. Younger age and lower Outerbridge grade were predictive of achieving the SCB. CONCLUSION: The SCB has not been previously defined in the hip preservation literature and is complementary to the MCID as the upper bound for clinically significant improvement. We identified predictive preoperative and diagnostic postoperative outcome scores for the SCB that can be used to manage patient expectations and grade outcomes. These findings are objective criteria for defining clinical success after arthroscopic FAI treatment.

Avoiding Tommy John Surgery: What Are the Alternatives?

The number of ulnar collateral ligament (UCL) reconstructions being performed has risen sharply in recent years, most notably in the young amateur athlete. While successful outcomes have been reported with reconstruction, the surgery and the associated rehabilitation timeline may be difficult for the nonelite athlete to incur. Return-to-play expectations, along with level of competition, should help guide surgeons in exploring management options. While reconstruction remains a mainstay, focused research exploring nonreconstructive options has expanded. This review discusses the clinical approach to those with UCL injury, including current support for rehabilitation, biologic strategies, and available repair or augmentation alternatives.

Foot Progression Angle Walking Test: A Dynamic Diagnostic Assessment for Femoroacetabular Impingement and Hip Instability.

BACKGROUND: Determining an accurate clinical diagnosis for nonarthritic hip pain may be challenging, as symptoms related to femoroacetabular impingement (FAI) or hip instability can be difficult to elucidate with current testing methods. In addition, commonly utilized physical examination maneuvers are static and do not include a dynamic or weightbearing assessment to reproduce activity-related symptoms. Therefore, implementing a dynamic assessment for FAI and hip instability could help to improve diagnostic accuracy for routine clinical examinations of patients with nonarthritic hip pain. PURPOSE: To assess the efficacy of a novel diagnostic foot progression angle walking (FPAW) test for identifying hip pathology related to FAI or hip instability. STUDY DESIGN: Prospective cohort study; Level of evidence, 3. METHODS: This prospective study included 199 consecutive patients who were evaluated for unilateral hip pain and who underwent FPAW testing along with standard physical examination testing. Demographic data, including age, sex and hip laterality, were collected from each patient. FPAW testing was performed with directed internal and external foot progression angles from their baseline measurements, with a positive test reproducing pain and/or discomfort. Comparisons were then made with flexion adduction internal rotation (FADIR) and flexion abduction external rotation (FABER) tests as the designated diagnostic standard examinations for FAI and hip instability, respectively. Sensitivity and specificity, along with the McNemar chi-square test for group comparison, were used to generate summary statistics. In addition, areas under the combined receiver operating characteristic curves (AUC) of test performance were calculated for both FPAW and the designated standard examination tests (FADIR, FABER). Radiographic imaging was used subsequently to confirm the diagnosis. RESULTS: The average age of the study cohort was 35.4 ± 11.8 years, with 114 patients being female (57%). Positive internal FPAW testing demonstrated 61% sensitivity and 56% specificity for an FAI diagnosis, compared with the 96% sensitivity and 11% specificity seen with FADIR testing. Internal FPAW was less sensitive, yet more specific compared with FADIR (P < .001). Combined testing had improved accuracy (AUC = 0.58; P < .05) compared with FADIR (AUC = 0.52; P = .21) or FPAW (AUC = 0.57; P = .057) alone. Positive external FPAW revealed 67% sensitivity and 70% specificity for hip instability, while FABER testing was 54% sensitive and 90% specific. External FPAW was significantly more specific but had similar sensitivity to FABER. Combined testing had greater accuracy (AUC = 0.77) compared with FABER (AUC = 0.70) or FPAW (AUC = 0.67) alone (P < .001). CONCLUSION: The FPAW examination can be used as an adjunct examination to assist and improve the accuracy of the clinical diagnosis for FAI and hip instability.

Publication Rates of Podium Presentation Abstracts at the Arthroscopy Association of North America Annual Meetings 2004-2012.

PURPOSE: To determine the publication rates of podium presentation abstracts at the Arthroscopy Association of North America (AANA) annual scientific meetings from 2004 to 2012. METHODS: A database of podium presentation abstracts at the annual meetings of the AANA was compiled. Abstract presentations that reached manuscript publication were determined by a PubMed search of the MEDLINE database and Google Scholar. The journal and publication date were then recorded for all identified published abstracts. RESULTS: A total of 658 abstracts were selected for podium presentations at AANA annual meetings from 2004-2012 (range, 53-102 per year). Of these 658 abstracts, 443 (67.3%) went on to eventual publication in peer-reviewed journals. The mean time from the meeting to publication was 20.0 months. Most abstracts were published within 3 years of the meeting (n = 380, 85.8%), with a significant number of published abstracts reaching publication before the time of the meeting (n = 41, 9.3%). Published abstracts were most frequently published in Arthroscopy (n = 186, 42.0%), The American Journal of Sports Medicine (20.3%), and The Journal of Bone and Joint Surgery (6.1%). CONCLUSIONS: The overall publication rate of podium presentations at AANA annual meetings (67.3%) was similar to publication rates for other major orthopaedic annual meetings. Most published abstracts (85.8%) were published within 3 years, and the mean time to publication was 20.0 months. CLINICAL RELEVANCE: The rates of publication of podium presentations at AANA annual meetings show the impact and importance of these meetings in the advancement of orthopaedic research.

Tenotomy, Tenodesis, Transfer: A Review of Treatment Options for Biceps-Labrum Complex Disease.

Biceps-labrum complex (BLC) disease is a well recognized source of shoulder pain. The BLC can be divided into 3 anatomical zones: inside, junction, and bicipital tunnel. Despite our evolving understanding, diagnosis of BLC pathology through physical examination, standard imaging techniques, and standard diagnostic glenohumeral arthroscopy can be challenging. Selection of the most appropriate surgical technique in refractory cases should take into account decompression of the extra-articular bicipital tunnel. In this article we review the recent literature regarding diagnosis and treatment options for BLC disease.

Surgical management of isolated popliteus tendon injuries in paediatric patients.

Isolated popliteus avulsion injuries are a rare occurrence, especially in the skeletally immature population. Two cases of isolated popliteus tendon avulsion injuries in paediatric patients were identified and successfully managed with suture anchor reattachment of the avulsed fragment in the anatomic position. The objective of this case report is to raise awareness of orthopaedic surgeons to the rarely encountered isolated popliteus tendon injury that can occur in paediatric patients. Level of evidence Expert opinion, Level V.

Arthroscopic Versus Open Treatment of Femoroacetabular Impingement: A Systematic Review of Medium- to Long-Term Outcomes.

BACKGROUND: Surgical treatment of symptomatic femoroacetabular impingement (FAI) aims to improve symptoms and potentially delay initiation of hip osteoarthritis and prevent progression to end-stage hip osteoarthritis and possible total hip arthroplasty (THA). Hip arthroscopy and open surgical hip dislocations are the 2 most common surgical approaches used for this condition. PURPOSE: To perform a comparative systematic review to determine whether there is a significant difference in clinical outcomes and progression to THA between hip arthroscopy and open surgical hip dislocation treatment for FAI at minimum medium-term follow-up. STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review of the MEDLINE database by use of the PubMed interface was performed. Minimum mean follow-up for included studies was set at 36 months. English-language studies with a minimum mean medium-term time frame evaluating outcome after arthroscopic or open treatment of FAI were included. Independent t tests, Kaplan-Meier survival analysis, and weighted mean pooled cohort statistics were performed. RESULTS: A total of 16 studies met inclusion criteria. There were 9 open surgical hip dislocation studies and 7 hip arthroscopy studies. Open studies included 600 hips at a mean follow-up of 57.6 months (4.8 years; range, 6-144 months). Arthroscopic studies included 1484 hips at a mean follow-up of 50.8 months (4.2 years; range, 12-97 months). With THA as an outcome endpoint, there was an overall survival rate of 93% for open and 90.5% for arthroscopic procedures (P = .06). Advanced age and preexisting chondral injury were risk factors for progression to THA after both treatments. Direct comparison among disease-specific outcome instruments between the 2 procedures was limited by outcome measure heterogeneity; however, both treatments demonstrated good outcomes in their respective scoring systems. Notably, hip arthroscopy was associated with a higher general health-related quality of life (HRQoL) score on the 12-Item Short-Form Survey physical component score (P < .001). CONCLUSION: Both hip arthroscopy and open surgical hip dislocation showed excellent and equivalent hip survival rates at medium-term follow-up with hip-specific outcome measures, demonstrating equivalence between groups. However, hip arthroscopy was shown to have superior results regarding general HRQoL in comparison to open treatment. An increased understanding of the natural history of FAI remains warranted, with further studies needed to assess long-term outcomes for patients with FAI.

Posterior Humeral Avulsion of the Glenohumeral Ligament and Associated Injuries: Assessment Using Magnetic Resonance Imaging.

BACKGROUND: Lesions associated with posterior humeral avulsion of the glenohumeral ligament (HAGL) can lead to persistent symptoms related to posterior shoulder instability and can be commonly missed or delayed in diagnosis. PURPOSE: To identify and characterize the MRI findings in patients with a posterior HAGL lesion. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: This retrospective case series included 27 patients (28 shoulders) identified by search through the senior authors' databases, with cross-reference to their institutional radiologic communication system for MRI review. Baseline patient demographic data were collected, including age and sex. All posterior HAGL lesions were identified on MRI and characterized as partial, complete, or floating lesions. All acute glenohumeral pathologic changes concurrent with the posterior HAGL were documented. Chondrolabral retroversion of the injured shoulder was measured on axial MRI. RESULTS: The average age of the identified cohort was 33.6 years (range, 15-81 years), and 23 patients were male (86%). Posterior HAGL injuries were found to be complete tears (71%), partial tears (25%), and floating lesions (4%); concomitant bony HAGL avulsion was found in 7% of injuries. Additional traumatic glenohumeral disorders occurred in 93% of cases. The most common concurrent injuries were reverse Hill-Sachs lesions (36%), anterior Bankart lesions (29%), and posterosuperior rotator cuff tears (25%). Notably, concomitant anterior labral or capsular injury was found in 50% of patients, signifying bidirectional disruption of the capsule. In addition, increased chondrolabral version was found in this cohort (10.2° ± 3.7° retroversion). CONCLUSION: This study depicts the high association of combined injury with posterior HAGL lesions and increased chondrolabral retroversion. Findings on MRI related to a posterior HAGL injury could potentially be masked by additional injury and may occur with mechanisms that also lead to anterior glenohumeral disorders.

Increased Lateral Tibial Slope Is a Risk Factor for Pediatric Anterior Cruciate Ligament Injury: An MRI-Based Case-Control Study of 152 Patients.

BACKGROUND: Increased posterior tibial slope is associated with increased risk of anterior cruciate ligament (ACL) injury in adults. A similar association has not been rigorously examined in children and adolescents. PURPOSE: To determine whether alterations in posterior tibial slope are associated with ACL tears in pediatric and adolescent patients and to quantify changes in tibial slope by age. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Magnetic resonance imaging (MRI) studies of the knee were reviewed by 3 raters blinded to each other in a 1:1 sample of cases and age- and sex-matched controls. A total of 76 skeletally immature ACL-injured knees were compared with 76 knees without ACL injury; the mean age of the study population was 14.8 ± 1.3 years. The posterior slope of the articular surface of the medial tibial plateau and lateral tibial plateau was measured by use of a method similar to that used in previous studies in adult populations. The current study technique differed in that the slope was measured on the cartilage surface, not the subchondral bone. Comparisons between knees were made with t tests, and Spearman correlation analysis was used to assess changes in tibial slope with advancing age. RESULTS: Increased slope of the lateral tibial plateau (LTS) was significantly increased in ACL-injured patients compared with controls (5.7° ± 2.4° vs 3.4° ± 1.7°; P < .001). There was no statistically significant difference in the slope of the medial tibial plateau (MTS) in the ACL-injured and control knees (5.4° ± 2.2° vs 5.1° ± 2.3°; P = .42). There was no difference in LTS between male and female patients (4.46° vs 4.58°; P = .75). Receiver operating characteristic (ROC) analysis of the LTS revealed that a posterior tibial slope cutoff of >4° resulted in a sensitivity of 76% and a specificity of 75% for predicting ACL tears in this cohort. Spearman correlation analysis revealed that MTS and LTS decreased, or flattened, by 0.31° (P = .028, correlation coefficient r = -0.18) and 0.37° (P = .009, correlation coefficient r = -0.21) per year, respectively, as adolescents age. CONCLUSION: The LTS was significantly associated with an increased risk of ACL injury in pediatric and adolescent patients. The MTS was not associated with risk of injury. Posterior slope was found to decrease, or flatten, with age. A cutoff of >4° for the posterior slope of the lateral compartment is 76% sensitive and 75% specific for predicting ACL injury in this cohort. The LTS did not influence the incidence of ACL injury differently between sexes.

Arthroscopy skills development with a surgical simulator: a comparative study in orthopaedic surgery residents.

BACKGROUND: Surgical simulation has become increasingly relevant to orthopaedic surgery education and could translate to improved operating room proficiency in orthopaedic surgery trainees. PURPOSE: To compare the arthroscopic performance of junior orthopaedic surgery residents who received training with a knee and shoulder arthroscopy surgical simulator with those who received didactic training. STUDY DESIGN: Controlled laboratory study. METHODS: Fourteen junior orthopaedic surgery residents at a single institution were randomized to receive knee and shoulder arthroscopy training with a surgical simulator (n = 8) or didactic lectures with arthroscopy models (n = 6). After their respective training, performance in diagnostic knee and shoulder arthroscopy was assessed using a cadaveric model. Time to completion and assessment of arthroscopic handling using a subjective injury grading index (scale, 1-10) was then used to evaluate performance in final cadaveric testing. RESULTS: Orthopaedic surgery residents who trained with a surgical simulator outperformed the didactic-trained residents in shoulder arthroscopy by time to completion (-35%; P = .02) and injury grading index (-35%; P = .01). In addition, a trend toward improved performance of knee arthroscopy by the simulator-trained group was found by time to completion (-36%; P = .09) and injury grading index (P = .08). CONCLUSION: In this study, junior orthopaedic surgery residents who trained with a surgical simulator demonstrated improved arthroscopic performance in both knee and shoulder arthroscopy. However, future validation of surgical simulator training for orthopaedic surgery residents remains warranted. CLINICAL RELEVANCE: Surgical skill development with an arthroscopy surgical simulator could translate to improved arthroscopy performance in the operating room.