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Background: It remains unclear which subset of patients with recurrent patellofemoral instability would benefit from a concomitant bony realignment procedure in addition to a medial patellofemoral ligament (MPFL) reconstruction. Purpose: To provide midterm results for patients who underwent an isolated MPFL reconstruction as part of an ongoing prospective trial. Study Design: Case series; Level of evidence, 4. Methods: Patients with recurrent patellar instability were prospectively enrolled in an institutional registry beginning in March 2014. Exclusion criteria included history of a previous surgery for patellar instability, an off-loadable (inferior/lateral) chondral defect, anterior knee pain ≥50% of their chief complaint, and a "jumping J" sign. All patients underwent primary, unilateral, isolated MPFL reconstruction regardless of their bony anatomic characteristics. Patient-reported outcome measures (PROMs), episodes of recurrent instability, and ability to return to sport were obtained annually. Radiographic measurements of baseline radiographs and MRI were obtained at baseline. Results: A total of 138 patients underwent isolated MPFL reconstruction between March 2014 and December 2019. The mean radiographic measurements were tibial tubercle–trochlear groove, 15.1 ± 4.9 mm; Caton-Deschamps index, 1.14 ± 0.16; patellar trochlear index, 46.9% ± 15.1%; trochlear depth index, 2.5 ± 1.2 mm; tibial tubercle to lateral trochlear ridge, −8.4 ± 5.7 mm; and patellar tendon to lateral trochlear ridge, 5.7 ± 6.2 mm. Trochlear dysplasia, defined as a trochlear depth index <3 mm, was present in 79/125 (63%) patients. A total of 50 patients reached ≥5 years, of whom 40 (80%) completed follow-up PROMs. A total of 119 patients reached ≥2 years, of whom 89 (75%) completed follow-up PROMs. Six patients (5%) reported recurrent instability with a mean time of 2.97 years after surgery. All PROMs improved over time except for the Pediatric Functional Activity Brief Scale (Pedi-FABS), which had no change. At 2 years, the mean changes from baseline for Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscale (QOL), Pedi-FABS, International Knee Documentation Committee (IKDC) score, KOOS Physical Function Short Form (PS), and Kujala score were 42.1, 0.6, 35.1, –23.5, and 32.3, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P >.999. At 5 years, the mean changes from baseline for KOOS-QOL, Pedi-FABS, IKDC, KOOS-PS, and Kujala score were 42.6, –2.8, 32.6, –21.5, and 31.6, respectively. All changes had P values <.001 except for Pedi-FABS, which showed no change and had P >.453. In total, 89% of patients returned to sport with a mean of 9.1 months. Conclusion: Midterm outcomes for patients who underwent isolated MPFL reconstruction were favorable and were maintained at 5 years. Outcomes for the expanded cohort of patients with a minimum 2-year follow-up support previously published results. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current “anatomic” ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood. Purpose: The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel. Study Design: Controlled laboratory study. Methods: Male rats (N = 120) underwent unilateral ACL reconstruction with a soft tissue flexor tendon autograft. ACL graft force was modulated by different femoral tunnel positions at the time of surgery to create different graft force patterns with knee motion. External fixators were used to eliminate graft load during cage activity. A custom knee flexion device was used to deliver graft load through controlled daily knee motion. Graft-tunnel healing was then assessed via biomechanical, micro–computed tomography, and histological analyses. Results: ACL graft-tunnel healing was sensitive to dynamic changes in graft forces with postoperative knee motion. High ACL graft force with joint motion resulted in early inferior ACL graft load to failure as compared with knees that had low-force ACL grafts and joint motion and knees that were immobilized (mean ± SD: 5.50 ± 2.30 N vs 9.91 ± 3.54 N [P = .013] and 10.90 ± 2.8 N [P = .001], respectively). Greater femoral bone volume fraction was seen in immobilized knees and knees with low-force ACL grafts when compared with high-force ACL grafts at 3 and 6 weeks. Conclusion: The authors were able to demonstrate that ACL graft-tunnel incorporation is sensitive to dynamic changes in ACL graft force with joint motion. Early high forces on the ACL graft appear to impair graft-tunnel osseointegration. Clinical Relevance: Current “anatomic” techniques of ACL reconstruction may result in greater graft excursion and force with knee motion. Our results suggest that the postoperative rehabilitation regimen may need to be modified during the early phase of healing to protect the reconstruction. [ABSTRACT FROM AUTHOR]

Background: Treatment of large chondral defects of the knee among patients aged ≥40 years remains a difficult clinical challenge owing to preexisting joint degeneration and the lack of treatment options short of arthroplasty. Purpose: To characterize the survivorship, predictors of failure, and clinical outcomes of osteochondral allograft transplantation (OCA) of the knee among patients aged ≥40 years. Study Design: Case series; Level of evidence, 4. Methods: Prospectively collected data were reviewed for 54 consecutive patients aged ≥40 years who were treated with OCA. Preoperative levels of osteoarthritis (according to Kellgren-Lawrence classification) and meniscal volume and quality were graded from review of radiographs and magnetic resonance imaging. Complications, reoperations, and patient responses to validated outcome measures were reviewed. A minimum follow-up of 2 years was required for analysis. Failure was defined by any removal or revision of the allograft or conversion to arthroplasty. Results: Among 51 patients (mean age, 48 years; range, 40-63 years; 65% male), a total of 52 knees had symptomatic focal cartilage lesions (up to 2 affected areas) that were classified as Outerbridge grade 4 at the time of OCA and did not involve substantial bone loss requiring shell allografts or additional bone grafting. Mean duration of follow-up was 3.6 years (range, 2-11 years). After OCA, 21 knees (40%) underwent reoperation, including 14 failures (27%) consisting of revision OCA (n = 1), unicompartmental knee arthroplasty (n = 5), and total knee arthroplasty (n = 8). Mean time to failure was 33 months, and 2- and 4-year survivorship rates were 88% and 73%, respectively. Male sex (hazard ratio = 4.18, 95% CI = 1.12-27.13) and a higher number of previous ipsilateral knee operations (hazard ratio = 1.70 per increase in 1 surgical procedure, 95% CI = 1.03-2.83) were predictors of failure. A higher Kellgren-Lawrence osteoarthritis grade on preoperative radiographs was associated with higher failure rates in the Kaplan-Meier analysis but not the multivariate model. At final follow-up, clinically significant improvements were noted in the pain (mean score, 47.8 to 67.6) and physical functioning (56.8 to 79.1) subscales of the Short Form-36, as well as the International Knee Documentation Committee subjective form (45.0 to 63.6), Knee Outcome Survey–Activities of Daily Living (64.5 to 80.1), and overall condition statement (4.5 to 6.8) (P < .001). No significant changes were noted for the Marx Activity Rating Scale (5.1 to 3.9, P = .789). Conclusion: A higher failure rate was found in this series of patients aged ≥40 years who were treated with OCA as compared with other studies of younger populations. However, for select older patients, OCA can be a good midterm treatment option for cartilage defects of the knee. [ABSTRACT FROM AUTHOR]

Background: Microfracture is the most common cartilage-reparative procedure for the treatment of osteochondral lesions of the talus (OLTs). Damage to the subchondral bone (SCB) during microfracture may irreversibly change the joint-loading support of the ankle, leading to reparative fibrocartilage degradation over time. Purpose: To investigate the morphological change in the SCB after microfracture for OLT by developing a novel magnetic resonance imaging (MRI) scoring system specifically for evaluating the SCB. Furthermore, this study assesses the influence of the morphological changes of the SCB on clinical outcomes based on the new score. Study Design: Case series; Level of evidence, 4. Methods: Forty-two patients who underwent microfracture for OLT were included. An SCB Health (SCBH) scoring system was developed according to the amount of edema, subchondral cyst diameter, and qualitative and thickness change in the SCB, with a total score of 12 indicating normal SCB. MRI was obtained postoperatively from 6 months to 1 year, 1 to 2 years, 2 to 4 years, and 4 to 6 years. The Foot and Ankle Outcome Score (FAOS) was evaluated preoperatively and at 2 years and final follow-up. Results: The mean patient age was 38.4 ± 15.6 years, with a mean follow-up of 51.7 ± 22.8 months. The mean FAOS improved significantly from 57.8 ± 14.4 preoperatively to 84.3 ± 7.2 at 24 months (P < .001) and decreased to a final mean value of 77.1 ± 12.6 (P < .001). The mean SCBH score decreased from 8.6 ± 1.9 preoperatively to 7.1 ± 1.8 on the first follow-up MRI (P < .001) and significantly decreased to 5.9 ± 2.3 on the fourth follow-up MRI (P < .001). Subchondral cysts were noticeably worse at the fourth follow-up MRI than at the first and second (P < .001, P = .006, respectively). There was a positive correlation between the final FAOS and the SCBH score on the third and fourth follow-up MRI (r = 0.55, P < .001; r = 0.70, P < .001, respectively), but no correlation was found on the first and second follow-up. Conclusion: The SCBs following microfracture for OLT were not restored at midterm follow-up. There was a significant decrease of the overall SCBH score over time. Noticeably, subchondral cysts deteriorated over time consistently. In addition, the SCBH score at midterm follow-up was positively correlated with clinical outcomes. Lasting morphological changes in the SCB may be indicative of longer-term failure of the microfracture procedure. [ABSTRACT FROM AUTHOR]

Background: Static anterior tibial subluxation after an anterior cruciate ligament (ACL) injury highlights the abnormal relationship between the tibia and femur in patients with ACL insufficiency, although causal factors including injuries to secondary stabilizers or the time from injury to reconstruction have not been examined. Purpose: To determine static relationships between the tibia and femur in patients with various states of ACL deficiency and to identify factors associated with anterior tibial subluxation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients treated for ACL injuries were identified from an institutional registry and assigned to 1 of 4 cohorts: intact ACL, acute ACL disruption, chronic ACL disruption, and failed ACL reconstruction (ACLR). Anterior tibial subluxation of the medial and lateral compartments relative to the femoral condyles were measured on magnetic resonance imaging (MRI), and an MRI evaluation for meniscal tears, chondral defects, and injuries to the anterolateral ligament (ALL) was performed. Results: One hundred eighty-six ACL-insufficient knees met inclusion criteria, with 26 patients without an ACL injury utilized as a control group. In the lateral compartment, the mean anterior tibial subluxation measured 0.78 mm for the control group (n = 26), 2.81 mm for the acute ACL injury group (n = 74), 3.64 mm for the chronic ACL injury group (n = 40), and 4.91 mm for the failed ACLR group (n = 72). In the failed ACLR group, 37.5% of patients demonstrated lateral compartment anterior subluxation ≥6 mm, and 11.1% of this group had anterior subluxation of the lateral compartment ≥10 mm. Multivariate regression revealed that the presence of both medial and lateral chondral defects was associated with a mean 1.09-mm increase in subluxation of the medial compartment (P = .013). The combination of medial and lateral meniscal tears was an independent predictor of increased lateral tibia subluxation by 1.611 mm (P = .0022). Additionally, across all knee states, an injury to the ALL was associated with increased anterior tibial subluxation in both the medial compartment (P = .0438) and lateral compartment (P = .0046). In 29.4% of knees with ALL injuries, lateral tibial subluxation was ≥6 mm, but with multivariate regression analysis, an ALL injury was not an independent predictor of anterior subluxation of the lateral compartment. Conclusion: Knees with failed ACLR are associated with more anterior tibial subluxation than those with primary ACL deficiency. Using previously reported thresholds of 6 to 10 mm of lateral compartment subluxation for a positive pivot shift, between 11.1% and 37.5% of knees with failed ACLR may be in a “resting pivoted position.” In primary ACL-deficient knees, anterior tibial subluxation is associated with chondral injuries and meniscal tears but not injury chronicity. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated detailed 3-dimensional lower extremity kinematics during baseball pitching in adolescent athletes during extended play. Changes in these parameters may affect performance outcomes. Purpose: To investigate whether adolescent baseball pitchers experience changes in lower extremity kinematics and event timing during a simulated game-length pitching bout. Study Design: Descriptive laboratory study. Methods: Twelve male adolescent pitchers (aged 14-16 years) threw 6 sets of 15 fastball pitches from an artificial pitching mound to a target at regulation distance. Joint angles and angular velocities at the hip, knee, and ankle of both legs were collected throughout the phases of the pitching cycle as well as stride length, pelvis orientation, pitch duration, timing of foot contact and ball release, ball speed, and pitching accuracy. Paired t tests (P < .05) were used to compare the dependent variables between the last 5 pitches of the second (baseline) and sixth (final) sets. Results: During the stride phase, decreased maximum angular excursions for hip extension (baseline: 14.7° ± 9.8°; final: 11.6° ± 10.3°; P < .05) and ankle plantar flexion (baseline: 30.2° ± 14.5°; final: 24.2° ± 15.3°; P < .05) as well as maximum angular velocity for knee extension (baseline: 144.9 ± 63.3 deg·s-1; final: 121.7 ± 62.0 deg·s-1; P < .05) were observed between sets in the trailing leg. At foot contact, pitchers had decreased hip flexion (baseline: 69.5° ± 10.1°; final: 66.5° ± 11.8°; P < .05) and increased hip abduction (baseline: 20.7° ± 8.9°; final: 25.4° ± 6.0°; P < .05) in the leading leg in the final set. Compared with the baseline set, ball speed significantly decreased in the final set (29.5 ± 2.5 m·s-1 vs 28.3 ± 2.5 m·s-1, respectively; P < .05). Conclusion: Kinematic changes and decreased ball speeds observed in the final set suggest that adolescent pitchers are unable to maintain lower extremity kinematics and performance as a result of extended play. Clinical Relevance: The results from this study may warrant further investigation into how altered lower extremity kinematics may affect trunk and upper extremity function, performance, and risk of injuries during pitching in adolescent athletes, particularly during actual game play. [ABSTRACT FROM AUTHOR]

Background: Quantitative magnetic resonance (qMR) can be used to measure macromolecules in tissues and is a potential method of observing early cartilage changes in the development of posttraumatic osteoarthritis. Hypothesis/Purpose: We hypothesized that specific patient and surgical factors affecting cartilage matrix composition after anterior cruciate ligament (ACL) reconstruction (ACLR) can be detected using T1&#961 and T2 relaxation times. Our purpose was to demonstrate this ability in a multicenter feasibility study. Study Design: Case series; Level of evidence, 4. Methods: A total of 54 patients who underwent ACLR underwent bilateral MRI at baseline before surgery and 6 months postoperatively. Operative findings were recorded. T1&#961 and T2 relaxation times were calculated for 6 cartilage regions: the medial femur, lateral femur, medial tibia, lateral tibia, patella, and trochlea. A paired t test compared relaxation times at baseline and 6 months, univariate regression identified regions that influenced patient-reported outcome measures, and analysis of covariance was used to determine the surgical factors that resulted in elevated relaxation times at 6 months. Results: The injured knee had significantly prolonged T1&#961 and T2 relaxation times in the tibiofemoral compartment at baseline and 6 months but had shorter values in the patellofemoral compartment compared with the uninjured knee. Prolonged T1&#961 and T2 times at 6 months were noted for both the injured and uninjured knees. At 6 months, prolongation of T1&#961 and T2 times in the tibial region was associated with lower patient-reported outcome measures. ACLR performed within 30 days of injury had significantly shorter T1&#961 times in the tibial regions, and lateral meniscal tears treated with repair had significantly shorter T1&#961 times than those treated with excision. Conclusion: Prolonged relaxation times in multiple regions demonstrate how the injury affects the entire joint after an ACL tear. Changes observed in the uninjured knee may be caused by increased loading during rehabilitation, especially in the patellofemoral articular cartilage and distal femur. Relaxation times in the tibial regions may be predictive of patient symptoms at 6 months. These same regions are affected by surgical timing as early as 30 days after injury, but this may partially be reflective of the severity of the preoperative injury and the choice of treatment of meniscal tears. [ABSTRACT FROM AUTHOR]

Background: Epidemic levels of shoulder and elbow injuries have been reported recently in youth and adolescent baseball players. Despite the concerning frequency of these injuries, no instrument has been validated to assess upper extremity injury in this patient population. Purpose/Hypothesis: The purpose of this study was to validate an upper extremity assessment tool specifically designed for young baseball players. We hypothesized that this tool will be both reliable and valid. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The Youth Throwing Score (YTS) was constructed by an interdisciplinary team of providers and coaches as a tool to assess upper extremity injury in youth and adolescent baseball players (age range, 10-18 years). The psychometric properties of the test were then determined. Results: A total of 223 players completed the final survey. The players' mean age was 14.3 ± 2.7 years. Pilot analysis showed that none of the 14 questions received a mean athlete importance rating less than 3 of 5, and the final survey read at a Flesch-Kincaid level of 4.1, which is appropriate for patients aged 9 years and older. The players self-assigned their injury status, resulting in a mean instrument score of 59.7 ± 8.4 for the 148 players "playing without pain," 42.0 ± 11.5 for the 60 players "playing with pain," and 40.4 ± 10.5 for the 15 players "not playing due to pain." Players playing without pain scored significantly higher than those playing with pain and those not playing due to pain (P < .001). Psychometric analysis showed a test-retest intraclass correlation coefficient of 0.90 and a Cronbach alpha intra-item reliability coefficient of 0.93, indicating excellent reliability and internal consistency. Pearson correlation coefficients of 0.65, 0.62, and 0.31 were calculated between the YTS and the Pediatric Outcomes Data Collection Instrument sports/physical functioning module, the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow score, and the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score, respectively. Injured players scored a mean of 9.4 points higher after treatment (P < .001), and players who improved in their self-assigned pain categorization scored 16.5 points higher (P < .001). Conclusion: The YTS is the first valid and reliable instrument for assessing young baseball players' upper extremity health. [ABSTRACT FROM AUTHOR]

Background: Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. Purpose: To perform a clinical comparison of the single-incision CB and double-incision BT techniques. Study Design: Cohort study; Level of evidence, 3. Methods: Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients .1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). Results: Patients in the CB group (n = 20) were older (52 ± 9.5 vs 43.7 ± 8.7 years; P = .008), had a shorter interval from surgery to evaluation (17.7 ± 5 vs 30.8 ± 16.5 months; P = .001), and were less likely to smoke (0% vs 28.5%; P = .02) compared with the BT patients (n = 21). DASH scores were similar between groups (4.46 ± 4.4 [CB] vs 5.7 ± 7.5 [BT]; P = .65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n = 6) experienced a complication compared with those in the BT group (4.8%; n = 1) (P = .04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. Conclusion: Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve. [ABSTRACT FROM AUTHOR]

The article focuses on the potential of in-season athletes who underwent treatment for treatment for anterior should instability to return to sport, with a focus on the role played by injury factors and patient-reported outcome scores. Topics discussed include the methodology and results of the author's cohort study of 45 contact intercollegiate athletes including percentage of athletes who were able to return to play and the state of their shoulder after their return.

The article presents research which examined the risk factors for anterior glenohumeral instability. Topics covered include the prevalence of this condition in young athletes as well as lack of studies about the injury. Also mentioned is the measurement of the condition by examining glenoid height, glenoid version, glenoid depth as well as rotator interval height.

The article presents research which compared the effectiveness of suture-only fixation and bone plug in meniscal grafts. Topics covered include the use of meniscus allograft transplantation (MAT) in relieving symptoms of meniscal injuries as well as the application of physiological loads in mimic gait. Also mentioned is the isolation of the outcomes of fixation technique in meniscal grafts.

The article discusses a study that evaluated the effect of low-magnitude load and delayed loading on the healing of tendon-to-bone injury in a rat model. Unilateral patellar tendon detachment were conducted on 192 rats then were repaired and external fixator placed with the loading controlled for immobilized rats. Conclusions indicated stronger tendon-bone complex, organized tendon-bone interface and less scar tissue with immobilization than with other loading regimens.

The article discusses a study that determined the effects of team sport membership and sex of dancer on the biomechanics of a single-legged droplanding as to anterior cruciate ligament (ACL) injury risk factors. Recorded were kinetics and kinematics of 40 ballet and modern dancers and 40 team sport dancers, the multivariate analysis of variance (MANOVA) and the pairwise t tests. Results showed greater trunk stability among dancers than athletes and greater peak knee valgus in female athletes.

The article discusses a study on implication and influence of fatigue on anterior cruciate ligament (ACL) injuries as to single-legged drop landing biomechanics of male and female athletes and dancers. Recorded were kinematics and kinetics of subjects in a 30-centimeter, single-legged drop landing after a fatigue protocol of vertical jumps and step-ups. Results showed dancers taking longer to reach fatigue state than athletes and high ACL risks due to change in landing parameters with fatigue.

Background:While posterior glenohumeral instability is becoming increasingly common among young athletes, little is known of the risk factors for injury.Purpose:To determine the modifiable and nonmodifiable risk factors for posterior shoulder instability in a high-risk cohort.Study Design:Case-control study (prognosis); Level of evidence, 2.Methods:A prospective cohort study in which 714 young athletes were followed from June 2006 through May 2010 was conducted. Baseline testing included a subjective history of instability, instability testing by a sports medicine fellowship–trained orthopaedic surgeon, range of motion, strength measurement with a handheld dynamometer, and bilateral noncontrast magnetic resonance imaging of the shoulder. A musculoskeletal radiologist measured glenoid version, height, depth, rotator interval (RI) height, RI width, RI area, and RI index. Participants were followed to document all acute posterior shoulder instability events during the 4-year follow-up period. The time to the posterior shoulder instability event during the follow-up period was the primary outcome of interest. Univariate and multivariable Cox proportional hazards regression models were used to analyze the data.Results:Complete data on 714 participants were obtained. During the 4-year surveillance period, 46 shoulders sustained documented glenohumeral instability events, of which only 7 were posterior in direction. The baseline factors that were associated with subsequent posterior instability during follow-up were increased glenoid retroversion (P < .0001), increased external rotation strength in adduction (P = .029) and at 45° of abduction (P = .015), and increased internal rotation strength in adduction (P = .038).Conclusion:This is the largest known prospective study to follow healthy participants in the development of posterior shoulder instability. Posterior instability represents 10% of all instability events. The most significant risk factor was increased glenoid retroversion. While increased internal/external strength was also associated with subsequent instability, it is unclear whether these strength differences are causative or reactive to the difference in glenoid anatomy. This work confirms that increased glenoid retroversion is a significant prospective risk factor for posterior instability. [ABSTRACT FROM AUTHOR]

The article presents a study on the development and validation of a concise and comprehensive activity rating scale for athletically active children and adolescents who are 10 to 18 years old. It cites the lack of outcome measures necessary for conducting outcomes research in orthopaedic surgery. The Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) can be used to evaluate activity level as a prognostic variable for clinical research.

Background: Biomarkers of cartilage turnover and joint metabolism have a potential use in detecting early degenerative changesafter a traumatic knee joint injury; however, no study has analyzed biomarkers before an anterior cruciate ligament (ACL) injuryand again after injury or in comparison with a similar group of uninjured controls.Hypothesis: Changes in serum biomarker levels and the ratio of cartilage degradation to synthesis, from baseline to follow-up,would be significantly different between ACL-injured patients and uninjured controls.Study Design: Case-control study; Level of evidence, 3.Methods: This case-control study was conducted to examine changes in serum biomarkers of cartilage turnover following ACLinjury in a young athletic population. Specifically, 2 markers for type II collagen and aggrecan synthesis (CPII and CS846, respectively)and 2 markers of types I and II degradation and type II degradation only (C1,2C and C2C, respectively) were studied. Preinjurybaseline serum samples and postinjury follow-up samples were obtained for 45 ACL-injured cases and 45 uninjuredcontrols matched for sex, age, height, and weight.Results: Results revealed significant decreases in C1,2C (P = .042) and C2C (P = .006) over time in the ACL-injured group whencompared with the controls. The change in serum concentrations of CS846 from baseline to follow-up was also significantly differentbetween the ACL-injured patients and uninjured controls (P = .002), as was the change between groups in the ratio ofC2C:CPII over time (P = .013). No preinjury differences in the ratio of C1,2C:CPII or C2C:CPII were observed between groups;however, postinjury differences were observed for both ratios.Conclusion: Changes in biomarker concentrations after an ACL injury suggest an alteration in cartilage turnover and joint metabolismin those sustaining ACL injuries compared with uninjured matched controls. [ABSTRACT FROM AUTHOR]

The article reports a study which evaluated the validity and reliability of the Arthroscopic Surgery Skill Evaluation Tool (ASSET). The results revealed that the ASSET is a feasible, valid, and reliable tool for assessment of diagnostic knee arthroscopic surgery skill. Studies are underway to assess its generalization to other procedures in both the operating room and simulation laboratory.

The article discusses a study that focused on adult anterior cruciate ligament (ACL) reconstruction techniques and the ability of the all-epiphyseal (AE) and over-the-top (OT) reconstruction techniques in restoring knee kinematics. The study concluded that while OT and AE provided anterior and rotational stability and decreased posterior joint contact stresses compared with the ACL-deficient knee, they could not restore the contact mechanics and kinematics of the ACL-intact knee.

The article discusses the prevalence of bilateral arthroscopic treatment for femoroacetabular impingement (FAI) and the identification of predictive patient demographics and radiographic findings for bilateral, symptomatic disease. It includes a study conducted on patients classified into unilateral and bilateral groups. It highlights the factors such as sex, younger age, and higher alpha angles as an indicator for the requirement of bilateral surgery for symptomatic FAI.

The article reports a study which researches the potential effect of specific injuries on the round drafted into the WNBA by evaluating the spectrum of injuries in athletes entering the Women's National Basketball Association (WNBA) combine. The results revealed that, reconstruction is the most common surgery in elite female athletes participating in the WNBA combine. Therefore the history of injury or surgery does not affect the round drafted or career length.

The article discusses a study conducted on United States Military Academy students to find Normative Values for the Knee Injury and Osteoarthritis Outcome Score(KOOS) and Western Ontario and McMaster universities Osteoarthritis Index(WOMAC) in a Young Athletic Population. It describes the method used for calculating also taking into consideration sex and injury history of participants. Results showed, participants with knee ligament injury had significantly lower KOOS and WOMAC scores.

The article reports a study which was conducted to identify patient characteristics and compartment pressure values in patients with chronic exertional compartment syndrome (CECS) that lead to improved postoperative outcomes. The results revealed that high school and college patients and isolated anterior compartment release were associated with improved subjective function and satisfaction after fasciotomy. High school and college patients had improved postoperative satisfaction.

The article discusses a study which examines the contact pressure on lateral tibial compartment of knee, after simulated posterior horn detachment (PHD) of the lateral meniscus and bone repair. This was performed using a conductive ink pressure sensing system for collecting dynamic pressure data on each knee, and an acute anterior cruciate ligament (ACL) tunnel guide to analyze the repair of PHD site. The result shows anatomic reduction of peak pressure of the PHD lesion with its repair to bone.

The article discusses a study investigating the fluid seal properties of hip labral repair and reconstruction techniques, based on the hypothesis that hip labral repair preserves the acetabular labral fluid seal greater than labral tear, partialresection, and reconstruction conditions. Findings suggested the hip labral repair as the better option than others but it could not restore fluid seal characteristics as effectively as in the labrum-intact condition.

The article reports a study determining the mRNA biomarkers and histological characteristics of repaired rotator cuffs that healed or developed persistent defects as determined by postoperative ultrasound. The results show that gene expression related to tissue remodeling, in particular MMP-1 and MMP-9, differs between rotator cuffs that healed and those that failed to heal after arthroscopic repair. The overexpression of these two genes could contribute to poor cuff healing.

Background: There is recent evidence that use of allograft tendons for anterior cruciate ligament (ACL) reconstruction in young patients may result in increased failure rates compared with autologous grafts.Hypothesis: Allograft ACL reconstruction will result in higher failure rates in young athletes compared with autograft reconstruction.Study Design: Cohort study; Level of evidence, 2.Methods: A prospective cohort study of cadets at the United States Military Academy (USMA) was performed to assess performance of ACL reconstructions performed before entrance to service. Members of the classes of 2007 through 2013 who had undergone prior ACL reconstruction were identified through the Department of Defense Medical Evaluation Review Board reporting and waiver process and evaluated on the first day of matriculation. These participants were followed during their tenure at the academy with revision ACL reconstruction as the primary outcome measure of interest. Kaplan-Meier survival analysis was performed for all graft types using STATA with significance set as P < .05.Results: A total of 120 cadets underwent 122 ACL reconstructions (2 bilateral) before matriculation and compose the prospective cohort. This cohort included 30 female and 90 male cadets. Of these 122 knees with prior ACL reconstructions, the grafts used were 61 bone–patellar tendon–bone (BTB), 45 hamstring, and 16 allograft. A total of 20 failures occurred among this cohort at an average of 545 days from matriculation. Of the failures requiring revision, 7 were BTB (11% of all BTB), 7 were allograft (44% of all allograft), and 6 were hamstring (13% of all hamstring). There was no significant difference in the graft failure between the BTB and hamstring autograft groups. In contrast, those who entered the USMA with an allograft were 7.7 times more likely to experience a subsequent graft failure during the follow-up period when compared with the BTB autograft group (hazard ratio = 7.74; 95% confidence interval [CI], 2.67-22.38; P < .001). When allografts were compared with all autografts combined, a similar increase failure was noted in the allograft group (hazard ratio = 6.71; 95% CI, 2.64-17.06; P < .001).Conclusion: In this young active cohort, individuals having undergone an allograft ACL reconstruction were significantly more likely to experience clinical failure requiring revision reconstruction compared with those who underwent autologous graft reconstruction. The authors recommend the use of autograft in ACL reconstruction in young athletes. [ABSTRACT FROM PUBLISHER]

Background: Proximal tibial slope has been shown to influence anteroposterior translation and tibial resting point in the posterior cruciate ligament (PCL)–deficient knee. The effect of proximal tibial slope on rotational stability of the knee is unknown.Hypothesis: Change in proximal tibial slope produced via osteotomy can influence both static translation and dynamic rotational kinematics in the PCL/posterolateral corner (PLC)–deficient knee.Study Design: Controlled laboratory study.Methods: Posterior drawer, dial, and mechanized reverse pivot-shift (RPS) tests were performed on hip-to-toe specimens and translation of the lateral and medial compartments measured utilizing navigation (n = 10). The PCL and structures of the PLC were then sectioned. Stability testing was repeated, and compartmental translation was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5° or −5° of tibial slope variation, after which stability testing was repeated (n = 10). Analysis was performed using 1-way analysis of variance (ANOVA; α = .05).Results: Combined sectioning of the PCL and PLC structures resulted in a 10.5-mm increase in the posterior drawer, 15.5-mm increase in the dial test at 30°, 14.5-mm increase in the dial test at 90°, and 17.9-mm increase in the RPS (vs intact; P < .05). Increasing the posterior slope (high tibial osteotomy [HTO] +5°) in the PCL/PLC-deficient knee reduced medial compartment translation by 3.3 mm during posterior drawer (vs deficient; P < .05) but had no significant effect on the dial test at 30°, dial test at 90°, or RPS. Conversely, reversing the slope (HTO −5°) caused a 4.8-mm increase in medial compartment translation (vs deficient state; P < .05) during posterior drawer and an 8.6-mm increase in lateral compartment translation and 9.0-mm increase in medial compartment translation during RPS (vs deficient state; P < .05).Conclusion: Increasing posterior tibial slope diminished static posterior instability of the PCL/PLC-deficient knee as measured by the posterior drawer test but had little effect on rotational or dynamic multiplanar stability as assessed by the dial and RPS tests, respectively. Conversely, decreasing posterior slope resulted in increased posterior instability and a significant increase in the magnitude of the RPS.Clinical Relevance: These results suggest that increasing posterior tibial slope may improve sagittal stability in the PCL/PLC-deficient knee. Moreover, a knee with diminished posterior tibial slope may demonstrate greater multiplanar instability in this setting. Consequently, proximal tibial slope should be considered when treating combined PCL/PLC injuries of the knee. [ABSTRACT FROM PUBLISHER]

Background: Anterior compartment pressures of the leg as well as kinematic and kinetic measures are significantly influenced by running technique. It is unknown whether adopting a forefoot strike technique will decrease the pain and disability associated with chronic exertional compartment syndrome (CECS) in hindfoot strike runners.Hypothesis: For people who have CECS, adopting a forefoot strike running technique will lead to decreased pain and disability associated with this condition.Study Design: Case series; Level of evidence, 4.Methods: Ten patients with CECS indicated for surgical release were prospectively enrolled. Resting and postrunning compartment pressures, kinematic and kinetic measurements, and self-report questionnaires were taken for all patients at baseline and after 6 weeks of a forefoot strike running intervention. Run distance and reported pain levels were recorded. A 15-point global rating of change (GROC) scale was used to measure perceived change after the intervention.Results: After 6 weeks of forefoot run training, mean postrun anterior compartment pressures significantly decreased from 78.4 ± 32.0 mm Hg to 38.4 ± 11.5 mm Hg. Vertical ground-reaction force and impulse values were significantly reduced. Running distance significantly increased from 1.4 ± 0.6 km before intervention to 4.8 ± 0.5 km 6 weeks after intervention, while reported pain while running significantly decreased. The Single Assessment Numeric Evaluation (SANE) significantly increased from 49.9 ± 21.4 to 90.4 ± 10.3, and the Lower Leg Outcome Survey (LLOS) significantly increased from 67.3 ± 13.7 to 91.5 ± 8.5. The GROC scores at 6 weeks after intervention were between 5 and 7 for all patients. One year after the intervention, the SANE and LLOS scores were greater than reported during the 6-week follow-up. Two-mile run times were also significantly faster than preintervention values. No patient required surgery.Conclusion: In 10 consecutive patients with CECS, a 6-week forefoot strike running intervention led to decreased postrunning lower leg intracompartmental pressures. Pain and disability typically associated with CECS were greatly reduced for up to 1 year after intervention. Surgical intervention was avoided for all patients. [ABSTRACT FROM PUBLISHER]

Background: Fresh-stored osteochondral allografts have been used successfully to resurface large chondral and osteochondral defects of the knee. However, there are limited data available for the return to athletic activity.Purpose: To review the rate of return to athletic activity after osteochondral allograft transplantation in the knee and to identify any potential risk factors for not returning to sport.Study Design: Case series; Level of evidence, 4.Methods: Forty-three athletes were treated with fresh-stored osteochondral allograft transplantation for symptomatic large chondral or osteochondral defects of the knee from 2000 to 2010. The average age of the athletes (30 men, 13 women) was 32.9 years (range, 18-49 years). Patients were prospectively evaluated by International Knee Documentation Committee (IKDC), activities of daily living scale of the Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx Activity Rating Scale, and Cincinnati Sports Activity Scale scores. A multivariable regression analysis was performed to identify potential risk factors for failure to return to sport at the preinjury level.Results: At an average 2.5-year follow-up, limited return to sport was possible in 38 of 43 athletes (88%), with full return to the preinjury level achieved in 34 of 43 athletes (79%). In these 34 athletes, time to return to sport was 9.6 ± 3.0 months. Age ≥25 years (P = .04) and preoperative duration of symptoms greater than 12 months (odds ratio, 37; P = .003) negatively affected the ability to return to sport. In the athletes who returned to their previous level of competition, IKDC (P < .001), KOOS (P = .02), and Marx Activity Rating Scale (P < .001) scores were all significantly greater than in those athletes who did not return to sport.Conclusion: Osteochondral allograft transplantation in an athletic population for chondral and osteochondral defects in the knee allows for a high rate of return to sport. Risk factors for not returning to sport included age ≥25 years and preoperative duration of symptoms ≥12 months. [ABSTRACT FROM PUBLISHER]

Background: Anterior cruciate ligament (ACL) tears have been implicated in the development of osteoarthritis. Limited data exist on longitudinal follow-up of isolated ACL injury.Hypotheses: All isolated ACL tears are associated with some degree of cartilage injury that will deteriorate over time. There is a threshold of magnetic resonance imaging (MRI)–detectable cartilage injury that will correlate with adverse change in subjective patient-reported outcome measures.Study Design: Cohort study, Level of evidence, 2.Methods: The authors conducted a prospective, observational analysis of 42 knees in 40 patients with acute, isolated ACL injury (14 treated nonoperatively, 28 by reconstruction) with imaging at the time of injury and yearly follow-up for a maximum of 11 years. Morphologic MRI and quantitative T2 mapping was performed with validated outcome measures.Results: All patients sustained chondral damage at initial injury. The adjusted risk of cartilage loss doubled from year 1 for the lateral compartment and medial femoral condyle (MFC) and tripled for the patella. By years 7 to 11, the risk for the lateral femoral condyle was 50 times baseline, 30 times for the patella, and 19 times for the MFC. There was increased risk of cartilage degeneration over the medial tibial plateau (MTP) (P = .047; odds ratio = 6.23; 95% confidence interval [CI], 1.03-37.90) and patella (P = .032; odds ratio = 4.88; 95% CI, 1.14-20.80) in nonsurgical patients compared with surgically treated patients. Size of the bone-marrow edema pattern was associated with cartilage degeneration from baseline to year 3 (P = .001 to .039). Each increase in the MFC Outerbridge score resulted in a 13-point decrease in the International Knee Documentation Committee subjective knee score (P = .0002). Each increase in the MTP resulted in a 2.4-point decrease in the activity rating scale (P = .002).Conclusion: All patients with acute, traumatic ACL disruption sustained a chondral injury at the time of initial impact with subsequent longitudinal chondral degradation in compartments unaffected by the initial “bone bruise,” a process that is accelerated at 5 to 7 years’ follow-up. [ABSTRACT FROM PUBLISHER]

Background: There are few long-term studies evaluating functional outcomes and rates of arthrosis after arthroscopic Bankart repair with bioabsorbable tacks.Purpose: We evaluated the clinical and radiographic results of arthroscopic Bankart repair using intra-articular bioabsorbable tacks at a minimum of 10 years’ follow-up.Study Design: Case series; Level of evidence, 4.Methods: Thirty-two consecutive patients were retrospectively identified. Twenty patients (63%) were evaluated at a mean follow-up of 13.5 years (range, 10.75-17.5 years) and average age of 43 years (range, 28-73 years). The surgical shoulder (SS) was compared with a healthy control shoulder (CS) in 15 of 20 patients. Outcome tools included the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of the Shoulder, Arm, and Hand (DASH). Blinded, independent evaluators performed physical examinations and reviewed radiographs.Results: Thirteen patients (65%) had stable shoulders, 5 of 7 (25%) failed by dislocation, and 2 of 7 (10%) failed by signs of anterior instability on examination. Three patients underwent revision stabilization surgery. Average time to failure was 4.2 years (range, 0.25-14.7 years). Average WOSI and DASH scores were 80% and 7.3, respectively. The CS faired better than SS in WOSI scores (97% vs 83%, respectively; P = .008), main DASH scores (0.39 vs 6.79, respectively; P = .024), and the DASH sports module (0.00 vs 10.94, respectively; P = .043). Patients lost 5.9° of passive forward flexion (P = .031) and 4.3° of passive external rotation (P = .001). Forty percent returned to their preoperative sports level. Higher grades of arthrosis were seen in the SS (20% absent, 40% mild, 25% moderate, and 15% severe) versus CS (P = .002).Conclusion: At long-term follow-up, 65% of patients treated with an arthroscopic Bankart repair using bioabsorbable tacks had a well-functioning, stable shoulder. Disability scores were greatest with sports; however, the majority of patients had well-preserved ranges of motion and good functional WOSI scores. Despite this, 40% had evidence of moderate to severe glenohumeral arthrosis. [ABSTRACT FROM PUBLISHER]

The article discusses simple method of Glenoid Bone Loss calculation using Ipsilateral Magnetic Resonance Imaging. It also discusses method and gives various results. It was concluded that significant differences in glenoid height and width were found by sex but the relationship between height and width was similar. It states that the formula allows for easy calculation of the amount of glenoid bone loss with only a ruler and an MRI of the injured shoulder.