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A lesser tuberosity osteotomy (LTO) is commonly performed during total shoulder arthroplasty to access the glenohumeral joint. Healing of the LTO is critical to optimizing the outcome of the procedure and is enhanced by a repair that provides stability and compression across the osteotomy site. The purpose of this article is to describe a technique that uses a tensionable suture construct to repair the LTO during anatomic total shoulder arthroplasty using a stemless humeral component. The technique involves passing a row of high-tensile sutures through bone tunnels lateral to the osteotomy site (transosseous sutures) and another row of sutures through the humeral implant (implant sutures). One limb of each bone tunnel suture is then tied to its corresponding limb of implant suture and the remaining free strands of the tied sutures are manually tensioned and tied to each other. This technique is an efficient and reproducible method for creating compression and stability across the osteotomy site that facilitates bony healing.

Background: Humeral fractures (HF) are common orthopedic pathologies. Reviewing the content and quality of influential literature over time is important to advance scientific research regarding a specific topic. This study aims to explore and appraise the fifty most cited HF studies that had been published in orthopedic literature. Methods: The Web of Science database was used to conduct a systematic search for articles pertaining to HF. Articles were sorted out in descending order of citations and were included based on their relevance to HF. Data and metrics of the included studies were recorded. The methodological quality of the studies was assessed using the Modified Coleman Methodology Score (MCMS) and the Methodological Index for Non-randomized Studies criteria. Statistical analysis was conducted to explore any significant relationships between the date of publication and other relevant variables. Results: Included articles (N = 50) were published between 1959 and 2015, with a total of 14,864 accumulated citations. Europe and North America contributed to all but one of the included studies. The Journal of Bone and Joint Surgery contributed to the highest number of included articles with 27 articles (54%). The proximal humerus was the most commonly explored HF location in our study (72%). The average MCMS and Methodological Index for Non-randomized Studies scores were reported to be 64.6 and 10.4, respectively, and the majority of articles (52%) were considered level four case series. Year of publication was found to have a positive correlation with increasing level of evidence(r = −0.301, P = .044), citation density (r = 0.734, P < .001), and MCMS score (r = 0.41, P = .01). Conclusion: The level of evidence, MCMS scores, and citation density of influential HF literature has been increasing with time, reflecting the increasing effort and work being put in that field. While the findings seem encouraging, additional high-quality research is needed to help achieve better treatment strategies and outcomes.

Background: Chondral injuries in the knee are commonly discovered during knee arthroscopy procedures. Due to the poor restoration potential and avascular nature of cartilage, large defects are commonly treated with such surgical procedures. Treatment utilizing an osteochondral allograft (OCA) transplant for symptomatic focal cartilage defects in the patellofemoral joint has demonstrated strong, lasting clinical and radiographic outcomes. Indications: Active and otherwise healthy patients are indicated for surgery when presenting with significant joint-line pain and a large focal chondral defect verified on advanced imaging after an extensive course of nonoperative management. Technique Description: Beginning with diagnostic arthroscopy to confirm the large defect of the medial femoral condyle, we proceeded with OCA transplantation. A small medial peripatellar arthrotomy is performed. The fat pad is removed for visualization and retractors are placed both medially and laterally to appropriately visualize the defect. The defect is then sized according to the appropriate sizing guide. The guide is then placed perpendicular to the defect, and a central guide pin is drilled. A scoring reamer is used to carefully cut the size of the defect followed by a central reamer to prepare the defect. Any debris is removed, and the incision is thoroughly irrigated. The defect is then carefully measured in all four quadrants to match the donor. Any underlying bone is impacted for a stable base. A drill is then used for appropriate marrow venting underneath the defect. The corresponding donor site is selected and reamed with continuous irrigation to prevent thermal necrosis. The plug is removed and carefully measured to match the recipient site. The plug is thoroughly irrigated with pulse lavage to remove marrow elements. The graft is carefully inserted with gentle manual pressure until it is seated perfectly flush with the surrounding cartilage. Results: Clinical research has demonstrated good-to-excellent long-term survivorship of OCA transplantation. Long-term return to sport rates for recreational and competitive athletes are upward of 75%. Discussion/Conclusion: As surgical techniques continue to develop, surgeons should consider utilizing OCA transplants to treat large chondral defects in the patellofemoral joint. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Purpose: To use the top 100 articles pertaining to the shoulder labrum to understand the impact that social medial platforms have on the dissemination of shoulder research and to highlight bibliometric factors associated with Altmetric Attention Scores (AAS) to offer insight into the impact that social media platforms have on the dissemination, attention, and citation of shoulder research publications. Methods: This was a cross-sectional study. In January 2023, the Altmetric database was searched using the PubMed Medical Subject Headings terms “shoulder labrum.” Articles with the greatest AAS were screened to exclude other topics unrelated to the labrum of the shoulder. The top 100 articles that met inclusion criteria were used in the final analysis. Bibliometric factors pertaining to each study were collected for further analysis of article characteristics in accordance with previous studies. Results: The Altmetric Database query yielded 619 studies. The top 100 articles with highest AAS were identified, mean Attestation Score was 24.85 ± 55.51, with a range of 7 to 460. The included articles represented 35 journals, with 57 articles attributed to 3 journals: American Journal of Sports Medicine (AJSM; 29%), Arthroscopy: The Journal of Arthroscopic & Related Surgery (Arthroscopy; 19%), and the Journal of Shoulder and Elbow Surgery (JSES; 9%). There was a significant increase in AAS for every decrease in the numerical Level of Evidence value for a study (P = .011) but no association between score and citation rate (P > 005). Conclusions: Top articles on the shoulder labrum, as defined by high AAS score, are most commonly original clinical research published in 1 of 3 sports medicine journals and performed in the United States or Europe. A decreased numerical Level of Evidence is associated with an increase in AAS score, but there is no association between AAS score and citation rate. Clinical Relevance: The increasing amount of science and health information shared freely through open-access journals, online servers, and numerous social media channels makes it difficult to measure the impact of research. Using measures such as the Altmetric Attention Score, in isolation or addition to measures of researcher or journal impact, has the potential to provide comprehensive information about the impact of research in the modern world.

Background: Transosseous rotator cuff repair provides robust fixation and broad footprint compression without the risk of foreign body reaction that may be seen with suture anchors. We present our technique for anchorless transosseous repair using a modern device to efficiently create bone tunnels and assist in suture passage. Indications: Tears of the supraspinatus tendon, with or without extension to the infraspinatus, in patients with acute or chronic tears, with good bone quality, and who fail appropriate nonoperative management. Technique: The beach-chair position with an articulating arm holder is preferred for this procedure. A glenohumeral diagnostic arthroscopy is performed, and intra-articular pathology is addressed as needed. The arthroscope is brought into the subacromial space, and a lateral viewing portal is established. A thorough bursectomy with or without acromioplasty is performed to attain visualization of the cuff. After the tear is identified, the tendon edges are debrided. It is critical to determine the tear pattern, the reduction maneuvers necessary, and the number of bone tunnels that are warranted. The desired location of the bone tunnel is marked with a pilot hole. The device is positioned over the pilot hole and a power drill is advanced through the lateral cortex. The device assists in creating a bone tunnel through the greater tuberosity and passes a nitinol loop through the tunnel. The loop is retrieved by the device and is brought to the lateral portal. Sutures are loaded into the loop and are brought through the bone tunnel. The sutures are then passed through the tendon using a curved retrograde suture passer in simple fashion and are tied to secure the tendon to the footprint. For larger tears, 2 or 3 tunnels may be used to widen the area for footprint compression. The specific configuration used will depend on the tear size, pattern, and surgeon preference. Results: Arthroscopic transosseous repairs have yielded promising results. Healing rates are comparable to anchor-based techniques, with the benefit of avoiding foreign bodies at the footprint. Discussion: Anchorless transosseous rotator cuff repair may be reproducibly performed with the use of a modern device for bone tunnel creation and suture passage. However, this technique should be used with caution in patients with osteoporosis or poor bone quality due to theoretical concerns of greater tuberosity fracture or suture pullout through the tunnels. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.