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BackgroundRamp lesions are peripheral tears of the posterior horn of the medial meniscus that involve the meniscocapsular attachments or red-red zone and typically occur in conjunction with anterior cruciate ligament (ACL) ruptures.PurposeTo identify the prevalence of, and risk factors for, ramp lesions in a large cohort of patients undergoing primary and revision ACL reconstruction.Study designCase series; Level of evidence, 4.MethodsWe queried our institutional registry of patients who underwent primary or revision surgical treatment for an ACL injury. Those who underwent preoperative magnetic resonance imaging (MRI) at our facility were included in the study. Clinical details were extracted and verified using electronic records. All preoperative MRI scans were reviewed by a musculoskeletal radiologist for the presence of a ramp lesion. Stable ramp lesions were defined as a peripheral posterior horn medial meniscal tear identified on MRI but either not identifiable with viewing and probing from the anterior portals or, if identified, not displaceable with anteriorly directed probing. Unstable ramp lesions were defined as peripheral posterior horn medial meniscal tears at the meniscocapsular junction that were identifiable at the time of surgery and displaced into the medial compartment with probing. The prevalence of stable and unstable ramp lesions was calculated. Demographic, injury, and imaging parameters were determined using univariate statistics.ResultsA total of 372 patients were included. The overall prevalence of ramp lesions was 42% (155/372). Unstable ramp lesions were present in 73 (20%) patients, and stable ramp lesions were present in 82 (22%) patients. The presence of any ramp lesion (stable or unstable) was associated with bone marrow edema of the posteromedial tibia on MRI (odds ratio [OR], 3.0; P < .0001), a contact injury mechanism (OR, 1.8; P = .02), and a concurrent lateral meniscal tear (OR, 1.7; P = .02). No demographic, injury, surgical, or radiological variable was associated with a stable versus unstable ramp lesion.ConclusionThe overall prevalence of a ramp lesion in patients treated for ACL ruptures at our institution was 42%. The presence of bone marrow edema of the posteromedial tibia, a contact injury mechanism, or a lateral meniscal tear should alert surgeons to the potential presence of a medial meniscal ramp lesion.

BackgroundPrior to the annual National Football League (NFL) Draft, the top college football prospects are evaluated by medical personnel from each team at the NFL Scouting Combine. On the basis of these evaluations, each athlete is assigned an orthopaedic grade from the medical staff of each club, which aims to predict the impact of an athlete's injury history on his ability to participate in the NFL.Purpose(1) To identify clinical predictors of signs, symptoms, and subsequent professional participation associated with football-related injuries identified at the NFL Combine and (2) to assess the methodological quality of the evidence currently published.Study designSystematic review; Level of evidence, 3.MethodsA systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We reviewed all studies that examined musculoskeletal injuries identified among athletes at the NFL Combine and associated outcomes. Data on signs, symptoms, and subsequent NFL participation were collected, and the methodological quality of the studies was assessed.ResultsOverall, 32 studies, including 30 injury-specific studies, met the inclusion criteria. Twenty studies analyzed data collected at the NFL Combine from 2009 and later. When compared with matched controls, athletes with a history of a cervical or lumbar spine injury, rotator cuff repair, superior labrum anterior-posterior repair, anterior cruciate ligament reconstruction, full-thickness chondral lesions of the knee, or Lisfranc injury played in significantly fewer games early in their NFL careers. Additionally, athletes with a history of a cervical or lumbar spine injury, rotator cuff repair, and navicular injury had decreased career lengths versus controls. Defensive players and linemen were found to have decreased participation in the NFL for several injuries, including prior meniscectomy, anterior cruciate ligament reconstruction, and shoulder instability. Career length follow-up, measures of athletic participation, and matching criteria were highly variable among studies.ConclusionFor medical professionals caring for professional football athletes, this information can help guide orthopaedic grading of prospects at the NFL Combine and counseling of athletes on the potential impact of prior injuries on their professional careers. For future studies, improvements in study methodology will provide greater insight into the efficacy of current treatments and areas that require further understanding.

Orthobiologic therapies show significant promise to improve outcomes for patients with musculoskeletal pathology. There are considerable research efforts to develop strategies that seek to modulate the biological environment to promote tissue regeneration and healing and/or provide symptomatic relief. However, the regulatory pathways overseeing the clinical translation of these therapies are complex, with considerable worldwide variation. The introduction of novel biologic treatments into clinical practice raises several ethical dilemmas. In this review, we describe the process for seeking approval for biologic therapies in the United States, Europe, and Japan. We highlight a number of ethical issues raised by the clinical translation of these treatments, including the design of clinical trials, monitoring outcomes, biobanking, "off-label" use, engagement with the public, marketing of unproven therapies, and scientific integrity., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by the Orthoregeneration Network. J.C. has received education payments from Arthrex and Smith & Nephew; consulting fees from DePuy, Linvatec, and Smith & Nephew; speaking fees from Linvatec; and hospitality payments from Medical Device Business Services, Medwest, and Stryker. N.S.P. has received research support from Zimmer Biomet Holdings and RegenLab. R.M.F. has received grant support from Arthrex, education payments from Arthrex and Smith & Nephew, nonconsulting fees from Arthrex, and hospitality payments from Joint Restoration Foundation. J.H. has received education payments from Gemini Mountain. B.M. has received speaking fees from Arthrex and consulting fees from Arthrex, Biomarin Pharmaceutical, DePuy, and Exactech. J.L.D. has received grant support from Terumo BCT; consulting fees from Arthrex, Bioventus, DePuy, RTI Surgical, and Zimmer; and nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Understanding specific risk profiles for each patient and their propensity to experience clinically meaningful improvement after anterior cruciate ligament reconstruction (ACLR) is important for preoperative patient counseling and management of expectations., Purpose: To develop machine learning algorithms to predict achievement of the minimal clinically important difference (MCID) on the International Knee Documentation Committee (IKDC) score at a minimum 2-year follow-up after ACLR., Study Design: Case-control study; Level of evidence, 3., Methods: An ACLR registry of patients from 27 fellowship-trained sports medicine surgeons at a large academic institution was retrospectively analyzed. Thirty-six variables were tested for predictive value. The study population was randomly partitioned into training and independent testing sets using a 70:30 split. Six machine learning algorithms (stochastic gradient boosting, random forest, neural network, support vector machine, adaptive gradient boosting, and elastic-net penalized logistic regression [ENPLR]) were trained using 10-fold cross-validation 3 times and internally validated on the independent set of patients. Algorithm performance was assessed using discrimination, calibration, Brier score, and decision-curve analysis., Results: A total of 442 patients, of whom 39 (8.8%) did not achieve the MCID, were included. The 5 most predictive features of achieving the MCID were body mass index ≤27.4, grade 0 medial collateral ligament examination (compared with other grades), intratunnel femoral tunnel fixation (compared with suspensory), no history of previous contralateral knee surgery, and achieving full knee extension preoperatively. The ENPLR algorithm had the best relative performance (C-statistic, 0.82; calibration intercept, 0.10; calibration slope, 1.15; Brier score, 0.068), demonstrating excellent predictive ability in the study's data set., Conclusion: Machine learning, specifically the ENPLR algorithm, demonstrated good performance for predicting a patient's propensity to achieve the MCID for the IKDC score after ACLR based on preoperative and intraoperative factors. The femoral tunnel fixation method was the only significant intraoperative variable. Range of motion and medial collateral ligament integrity were found to be important physical examination parameters. Increased body mass index and prior contralateral surgery were also significantly predictive of outcome., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.S.R. has received research support from DePuy and Stryker; consulting fees from Ceramtec, Medtronic, Moximed, Smith & Nephew, and Stryker; speaking fees from Ceramtec, Medtronic, Smith & Nephew, and Stryker Mako; and royalties from DePuy, Saunders/Mosby–Elsevier, Springer, and Stryker Mako and has stock/stock options in ConforMIS and Enhatch. R.J.W. has received research support from Histogenics; consulting fees from Arthrex, JRF Ortho, and Lipogems; royalties from Arthrex; hospitality payments from Stryker and has stock/stock options in BICMD, Cymedica, Engage Surgical, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. A.A.A. has received consulting fees from Arthrex and has stock/stock options in Pristine Surgical and Rom3. B.U.N. has received royalties from Remote Health. D.D. has received consulting fees and royalties from Zimmer Biomet. A.K. has received education payments from Arthrex. B.K. has received consulting and nonconsulting fees and royalties from Arthrex and speaking fees from Synthes GmbH. M.M. has received education payments from Arthrex. S.S. has received consulting fees from DePuy, Flexion Therapeutics, Pfizer, and Vericel and honoraria from JRF Ortho and Vericel. S.C. has received education payments from Pinnacle, consulting fees from Stryker, and nonconsulting fees from Smith & Nephew. J.H. has received hospitality payments from Smith & Nephew. R.W. has received royalties from Zimmer Biomet and nonconsulting fees from Arthrex. S.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet and is a paid associate editor for The American Journal of Sports Medicine. S.F. has received royalties from Encore Medical. J.S.D. has received consulting fees from Arthrex, Merck Sharp & Dohme, Trice Medical, and Wright Medical; speaking fees from Arthrex; and royalties from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Anterior cruciate ligament (ACL) injuries are occurring with increasing frequency in the adolescent population. Outcomes after ACL reconstruction (ACLR) are inconsistently reported in homogeneous patient populations., Purpose/hypothesis: To evaluate outcomes after bone-patellar tendon-bone (BTB) autograft ACLR in competitive high school-aged athletes by examining return to sport (RTS), patient satisfaction, and reinjury rates. Our hypothesis was that RTS rates and satisfaction will be high and reinjury rates will be low., Study Design: Case series; Level of evidence, 4., Methods: An institutional ACL registry was utilized to identify competitive high school-aged athletes (14-18 years old) who underwent primary ACLR using BTB autograft with a minimum 2-year follow-up. A postoperative questionnaire was administered to determine rates and types of RTS, quality of sports performance, reinjury, and satisfaction. Uni- and multivariable analyses were used to identify demographic, sport-specific, and clinical factors related to RTS., Results: A total of 53 patients were included (mean ± SD age at the time of surgery, 16.6 ± 1.34 years). Mean follow-up was 3.78 ± 0.70 years (range, 2.60-4.94 years). The overall ipsilateral ACL retear rate was 7.5% (n = 4). There were 10 subsequent ACL tears to the contralateral knee (19%). Forty-four (83%) patients successfully returned to at least their prior level of sport at a mean 10.5 ± 8.7 months (range, 3-48 months). Overall satisfaction was high, with 91% of patients very satisfied with the outcome. Higher confidence levels regarding performance of the reconstructed knee were associated with increased probability of RTS on multivariate analysis., Conclusion: BTB autograft ACLR results in high rates of RTS and satisfaction and low rates of subsequent ipsilateral ACL injuries in competitive high school-aged athletes. Patients with higher confidence in performance of the reconstructed knee are more likely to return to at least their prior level of sport., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.U.N. has received grants and education payments from Arthrex; education payments from Smith & Nephew; hospitality payments from Stryker, Wright Medical, and Zimmer Biomet Holdings; and royalties from Remote Health. R.J.W. has received research support from Histogenics; consulting fees from Arthrex, JRF Ortho, and Lipogems; royalties from Arthrex; and hospitality payments from Stryker. R.J.W. also has stock or stock options in BICMD, Cymedica, Engage Surgical, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. J.S.D. has received research support and nonconsulting fees from Arthrex; consulting fees from Arthrex, Linvatec, Merck Sharp & Dohme, Trice Medical, and Wright Medical; and royalties from Linvatec, Thieme, and Wolters Kluwer Health–Lippincott Williams & Wilkins. D.W.A. has received consulting fees from Stryker Corp and hospitality payments from Arthrex. A.P. has received education payments from Arthrex; consulting fees from Exactech, Zimmer Biomet, and Stryker; nonconsulting fees from Smith & Nephew; and royalties Zimmer Biomet. A.A. has received consulting fees from Arthrex. D.D. has received consulting fees and royalties from Zimmer Biomet. A.R. has received nonconsulting fees from Arthrex and Smith & Nephew; education payments from Arthrex; consulting fees from Arthrex, Smith & Nephew, Stryker, and Flexion; and royalties from ConforMIS. A.K. has received education payments from Arthrex. B.K. has received consulting fees, nonconsulting fees, and royalties from Arthrex and faculty/speaker fees from Synthes GmbH. M.M. has received education payments from Arthrex. S.S. has received consulting fees from Flexion Therapeutics, Vericel, DePuy, and Pfizer and honoraria from Vericel and JRF Ortho. J.H. has received hospitality payments from Smith & Nephew. S.C. has received consulting fees and royalties from Stryker Corp, nonconsulting fees from Smith & Nephew, and education payments from Pinnacle. R.W. has received royalties from Arthrex and Zimmer Biomet and nonconsulting fees from Arthrex. S.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet and is a paid associate editor for The American Journal of Sports Medicine. S.F. has received royalty payments from Encore. T.W. has royalty payments from Stryker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Interest and research in biologic approaches for tissue healing are exponentially growing for a variety of musculoskeletal conditions. The recent hype concerning musculoskeletal biological therapies (including viscosupplementation, platelet-rich plasma, and cellular therapies, or "stem cells") is driven by several factors, including demand by patients promising regenerative evidence supported by substantial basic and translational work, as well as commercial endeavors that complicate the scientific and lay understanding of biological therapy outcomes. While significant improvements have been made in the field, further basic and preclinical research and well-designed randomized clinical trials are needed to better elucidate the optimal indications, processing techniques, delivery, and outcome assessment. Furthermore, biologic treatments may have potential devastating complications when proper methods or techniques are ignored. For these reasons, an association comprising several scientific societies, named the Biologic Association (BA), was created to foster coordinated efforts and speak with a unified voice, advocating for the responsible use of biologics in the musculoskeletal environment in clinical practice, spearheading the development of standards for treatment and outcomes assessment, and reporting on the safety and efficacy of biologic interventions. This article will introduce the BA and its purpose, provide a summary of the 2020 first annual Biologic Association Summit, and outline the future strategic plan for the BA., Competing Interests: One or more of the authors has declared a potential conflict of interest or source of funding: see supplemental material for details. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Osteochondral allograft (OCA) transplantation has evolved into a first-line treatment for large chondral and osteochondral defects, aided by advancements in storage protocols and a growing body of clinical evidence supporting successful clinical outcomes and long-term survivorship. Despite the body of literature supporting OCAs, there still remains controversy and debate in the surgical application of OCA, especially where high-level evidence is lacking., Purpose: To develop consensus among an expert group with extensive clinical and scientific experience in OCA, addressing controversies in the treatment of chondral and osteochondral defects with OCA transplantation., Study Design: Consensus statement., Methods: A focus group of clinical experts on OCA cartilage restoration participated in a 3-round modified Delphi process to generate a list of statements and establish consensus. Questions and statements were initially developed on specific topics that lack scientific evidence and lead to debate and controversy in the clinical community. In-person discussion occurred where statements were not agreed on after 2 rounds of voting. After final voting, the percentage of agreement and level of consensus were characterized. A systematic literature review was performed, and the level of evidence and grade were established for each statement., Results: Seventeen statements spanning surgical technique, graft matching, indications, and rehabilitation reached consensus after the final round of voting. Of the 17 statements that reached consensus, 11 received unanimous (100%) agreement, and 6 received strong (80%-99%) agreement., Conclusion: The outcomes of this study led to the establishment of consensus statements that provide guidance on surgical and perioperative management of OCAs. The findings also provided insights on topics requiring more research or high-quality studies to further establish consensus and provide stronger evidence., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.G. has received education payments from Arthrex and Goode Surgical, consulting fees from JRF, and honoraria from JRF and Vericel. D.G.J. has received education payments from Arthrex; consulting fees from Acumed, Amniox Medical, Aastrom BioSciences, and Medical Device Business Services; speaking fees from Aastrom BioSciences and Linvatec; honoraria from Flexion, Musculoskeletal Transplant Foundation, and Vericel; and hospitality payments form Aesculap and Zimmer Biomet. J.D.P. has received education payments from Pylant Medical. D.C.C. has received consulting fees from Arthrosurface and DePuy, honoraria from JRF, and hospitality payments from Steelhead Surgical. W.D.B. has received consulting fees from Arthrex, Encore Medical, JRF, DePuy/Medical Device Business Services, and Orthalign; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Orthalign. B.J.C. has received education payments from Medwest; consulting fees from Acumed, Aesculap Biologics, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Smith & Nephew, Vericel, and Zimmer Biomet; speaking fees from Arthrex and Lifenet Health; hospitality payments from GE Healthcare; honoraria from Vericel; and royalties from Arthrex and DJO. J.F. has received education payments from Crossroads Orthopedics; consulting fees from Aastrom Biosciences, Aesculap, Arthrex, Collagen Matrix, Exactech, DePuy, Organogenesis, and RTI Surgical; nonconsulting fees from Arthrex and Vericel; honoraria from JRF and Vericel; royalties from DePuy and Organogenesis; and hospitality payments from Skeletal Kinetics. J.E.F. has received education payments from Peerless Surgical, Linvatec, and Zimmer Biomet and consulting and nonconsulting fees from Smith & Nephew. A.H.G. has received consulting fees from Aastrom, Flexion, JRF, Smith & Nephew, and Vericel; nonconsulting fees from Aastrom and LifeNet Health; honoraria from Fidia Pharma, JRF, and Vericel; and royalties from Organogenesis. A.J.K. has received grant support from Exactech; consulting fees from Arthrex, JRF, and Responsive Arthroscopy; honoraria from JRF, MTF, and Vericel; and royalties from Arthrex. C.L. has received consulting fees from Aastrom, Sanofi-Aventis, Vericel, and Zimmer Biomet; nonconsulting fees from Aesculap, Arthrosurface, and Vericel; and honoraria from Arthrosurface, JRF, and Vericel. B.R.M. has received education payments from Arthrex; consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; and nonconsulting fees from Arthrex. P.R.M. has received hospitality payments from Arthrex. R.M. has received education payments from Arthrex and SportsTek Medical, nonconsulting fees from Arthrex, and royalties from Zimmer Biomet. T.S.M. has received education support from Arthrex and consulting fees and honoraria from JRF. M.T.P. has received consulting fees, speaking fees, and royalties from Arthrex; royalties from Arthrosurface; honoraria from Flexion; and consulting fees and honoraria from JRF. S.A.R. has received consulting fees from Flexion Therapeutics, nonconsulting fees from Smith & Nephew, honoraria from Fidia Pharma, and royalties from Zimmer Biomet. E.D.S. has received education payments from Arthrex and hospitality payments from Axogen and Liberty Surgical. C.J.W. has received consulting fees and nonconsulting fees from Smith & Nephew, royalties from Arthrosurface, and hospitality payments from Arthrex and Stryker. R.J.W. has received education payments, nonconsulting fees, consulting fees, and royalties from Arthrex. A.B.Y. has received education payments from Arthrex and Medwest, consulting fees from Aastrom Biosciences and Olympus, and honoraria from JRF. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology., Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique., Study Design: Consensus statement., Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document., Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%., Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.C. has received research support and consulting fees from Arthrex, Conmed, and Smith & Nephew. B.B.H. has received research support from Arthrex and educational support from Arthrex and Elite Orthopaedics. A.B.Y. has received research support from Arthrex, Orthogenesis, Medwest, and Vericel; educational support from Arthrex, Medwest, and Smith & Nephew; and consulting fees from Aastrom Biosciences, JRF Ortho, Olympus, PatientIQ, Smith & Nephew, and Sparta Biomedical. J.F. has received consulting fees from Osiris Therapeutics, Zimmer Biomet, ISTO Technologies, Ceterix Orthopaedics, Biomet, Genzyme, MedShape, and Sanofi-Aventis; has received speaking fees from Arthrex and Zimmer Biomet; has received royalties from Arthrex, DePuy, Organogenesis, Springer, and Thieme Medical Publishers; and has stock/stock options in MedShape and Ortho Regenerative Technologies. W.D.B. has received consulting fees from Arthrex, DePuy, Insight Medical, JRF Ortho, OrthAlign, and Smith & Nephew; has received royalties from DePuy, Smith & Nephew, and Zimmer Biomet; and has stock/stock options in Insight Medical, Moximed, and OrthAlign. B.J.C. has received research support from Aesculap/B. Braun, Arthrex, and Regentis Biomaterials; has received educational support from Medwest; has received consulting fees from Acumed, Anika Therapeutics, Arthrex, Bioventus, Flexion Therapeutics, Geistlich Pharma, Genzyme, Pacira Pharmaceuticals, Regentis Biomaterials, Smith & Nephew, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Carticept Medical, LifeNet Health, and Pacira Pharmaceuticals; has received hospitality payments from GE Healthcare; has received royalties from Arthrex, DJO, Elsevier, and Operative Techniques in Sports Medicine; and has stock/stock options in BandGrip, Ossio, and Regentis Biomaterials. D.C.C. has received research support from Histogenics, JRF Ortho, Moximed, and Zimmer Biologics and consulting fees from Arthrosurface, DePuy, Histogenics, JRF Ortho, and Moximed. J.E.F. has received research support from Arthrex and Smith & Nephew; educational support from Linvatec, Peerless Surgical, and Zimmer Biomet; and consulting fees and speaking fees from Smith & Nephew. A.G. has received research support from Aesculap/B. Braun, Arthrex, DePuy, Eupraxia Pharmaceuticals, Musculoskeletal Transplant Foundation, Ossur, and Smith & Nephew; consulting fees from Collagen Solutions, Olympus, Ossur, and Smith & Nephew; speaking fees from Conmed Linvatec, Ossur, and Smith & Nephew; and royalties from Smith & Nephew. A.H.G. has received research support from JRF Ortho and Vericel; consulting fees from Aesculap, Geistlich Pharma, Genzyme, JRF Ortho, Moximed, Smith & Nephew, and Vericel; speaking fees from Aastrom Biosciences, LifeNet Health, and Vericel; and royalties from Organogenesis. S.G. has received educational support from Arthrex and Goode Surgical and honoraria from Vericel. A.E.G. has received consulting fees, speaking fees, and royalties from Zimmer Biomet and has stock/stock options in Intellijoint Surgical. D.G.J. has received research support from Genzyme and Sanofi-Aventis; has received educational support from Arthrex; has received consulting fees from Aastrom Biosciences, Acumed, Amniox Medical, DePuy/Medical Device Business Services, Flexion, Genzyme, Vericel, and Zimmer Biomet; has received speaking fees from Arthrex, Conmed Linvatec, Flexion, Genzyme, Mitek, Musculoskeletal Transplant Foundation, TissueTech, Vericel, and Zimmer Biomet; and is a board or committee member of the Musculoskeletal Transplant Foundation. A.J.K. has received research support from Aesculap/B. Braun, Arthrex, Ceterix Orthopaedics, and Histogenics; has received consulting fees from Arthrex, DePuy, JRF Ortho, and Vericel; has received speaking fees from Arthrex; and is a board or committee member of the Musculoskeletal Transplant Foundation. C.L. has received honoraria from Arthrosurface; consulting fees from Aastrom Biosciences, Genzyme, JRF Ortho, Samumed, Sanofi-Aventis, Vericel, and Zimmer Biomet; and speaking fees from Vericel. B.R.M. has received consulting fees from Arthrex, BioMarin Pharmaceutical, DePuy, and Exactech; speaking fees from Arthrex; and royalties from Arthrex. R.M. has received research support from Arthrex and DJO, has received educational support from Arthrex, has received speaking fees from Arthrex, has received royalties from Zimmer Biomet, and has stock/stock options in AlignMed. T.S.M. has received research support from JRF Ortho, educational support from Arthrex, consulting fees from JRF Ortho and MicroAire Surgical Instruments, and speaking fees from JRF Ortho. J.D.P. has received research support from Ossur, Sanofi-Aventis, and Vericel; consulting fees from JRF Ortho; and speaking fees from DePuy. M.T.P. has received consulting fees from Arthrex and JRF Ortho (AlloSource), speaking fees from Arthrex, and royalties from Arthrex and SLACK. S.A.R. has received consulting fees from Flexion, has received speaking fees from Smith & Nephew, has received honoraria from Fidia Pharma, has received royalties from Zimmer Biomet, and has stock/stock options in Ortho Regenerative Technologies. O.S. has received research support from DePuy and consulting fees from Zimmer Biomet. S.L.S. has received consulting fees and research support from Arthrex Inc; is a paid consultant for Ceterix Orthopaedics, CONMED Linvatec, Flexion Therapeutics, GLG Consulting, JRF Ortho, Moximed, Olympus, Vericel, Linvatec, and RTI Surgical; has received hospitality payments from Linvatec and Smith & Nephew; and has received a grant (indirect) from DJO. E.D.S. has received research support from CartiHeal, Fidia Pharma, and NuTech; consulting fees from Arthrex, Fidia Pharma, Flexion, JRF Ortho, Organogenesis, Smith & Nephew, and Vericel; speaking fees from Arthrex, Organogenesis, and Vericel; and royalties from Jaypee Brothers Medical Publishers. C.J.W. has received consulting fees from Arthrosurface and Smith & Nephew and speaking fees from Arthrex, Arthrosurface, and Smith & Nephew. R.J.W. has received research support from Histogenics; has received consulting fees from Arthrex, JRF Ortho, and Lipogems; has received speaking fees from Arthrex; has received royalties from Arthrex; and has stock/stock options in CyMedica Orthopedics, Gramercy Extremity Orthopedics, Pristine Surgical, and RecoverX. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2020.)