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To determine the incidence of ramp lesions and posteromedial tibial plateau (PMTP) bone bruising on magnetic resonance imaging (MRI) in patients with multiligament knee injuries (MLKIs) and an intact anterior cruciate ligament (ACL).A retrospective review of consecutive patients surgically treated for MLKIs at 2 level I trauma centers between January 2001 and March 2021 was performed. Only MLKIs with an intact ACL that received MRI scans within 90 days of the injury were included. All MLKIs were diagnosed on MRI and confirmed with operative reports. Two musculoskeletal radiologists retrospectively rereviewed preoperative MRIs for evidence of medial meniscus ramp lesions (MMRLs) and PMTP bone bruises using previously established classification systems. Intraclass correlation coefficients were used to calculate the reliability between the radiologists. The incidence of MMRLs and PMTP bone bruises was quantified using descriptive statistics.A total of 221 MLKIs were identified, of which 32 (14.5%) had an intact ACL (87.5% male; mean age of 29.9 ± 8.6 years) and were included. The most common MLKI pattern was combined injury to the posterior cruciate ligament and posterolateral corner (n = 27, 84.4%). PMTP bone bruises were observed in 12 of 32 (37.5%) patients. Similarly, MMRLs were diagnosed in 12 of 32 (37.5%) patients. A total of 8 of 12 (66.7%) patients with MMRLs demonstrated evidence PMTP bone bruising.Over one-third of MLKI patients with an intact ACL were diagnosed with MMRLs on MRI in this series. PMTP bone bruising was observed in 66.7% of patients with MMRLs, suggesting that increased vigilance for identifying MMRLs at the time of ligament reconstruction should be practiced in patients with this bone bruising pattern.Level IV, retrospective case series.

To compare complication rates and 5-year reoperation rates between open debridement (OD) and arthroscopic debridement (AD) for lateral epicondylitis.The PearlDiver MUExtr database (2010-2019) was reviewed for patients diagnosed with lateral epicondylitis (queried by International Classification of Diseases, Ninth Revision and International Classification of Diseases, Tenth Revision [ICD-10] codes) undergoing OD or AD of the common extensor tendon without repair (queried by Current Procedural Terminology codes). Patients were stratified into 2 cohorts: those who underwent AD and those who underwent OD. Nonoperative treatment modalities were reported for both groups within 1 year before index procedure. The rates of 90-day postoperative complications were compared, and multivariate logistic regression analysis was used to identify risk factors for complications. The 5-year reoperation rates, using laterality-specific ICD-10 codes, were also compared between the 2 groups.In total, 19,280 patients (OD = 17,139, AD = 2,141) were analyzed in this study. The most common nonoperative treatments for patients who underwent OD or AD were corticosteroid injections (49.5% vs 43.2%), physical therapy (24.8% vs 25.7%), bracing (2.8% vs 3.2%), and platelet-rich plasma injections (1.3% vs 1.0%). There were no significant differences in radial nerve injuries, hematomas, surgical site infections, wound dehiscence, and sepsis events between the 2 procedures (P = .50). The 5-year reoperation rate was not significantly different between the AD (5.0%) and OD (3.9%) cohorts (P = .10).For lateral epicondylitis, both AD and OD of the extensor carpi radialis brevis (without repair) were found to have low rates of 90-day adverse events, with no significant differences between the 2 approaches. Similarly, the 5-year reoperation rate was low and not statistically different for those treated with OD or AD.Level III, cross-sectional study.

Introduction Patients who undergo total shoulder arthroplasty (TSA) may experience substantial postoperative pain, which may negatively impact patient satisfaction, lead to greater narcotic consumption, and impair early rehabilitation. The purpose of this study was to perform a systematic review of randomized controlled trials (RCTs) to evaluate the effect of analgesia methods on postoperative (1) pain, (2) opioid use, (3) length of stay (LOS), and (4) adverse events in patients undergoing TSA, reverse TSA, and hemiarthroplasty. Methods A systematic review was performed by querying PubMed, Web of Science, and Cochrane Controlled Register of Trials for studies on analgesic interventions following shoulder arthroplasty. Data pertaining to pain scores, narcotic requirements, LOS, and complications were extracted. Results Eight studies (67%) included continuous interscalene block (CISB) with an indwelling catheter, six studies (50%) included a single-injection interscalene block (ISB), five studies (42%) included local infiltration with liposomal bupivacaine, four studies (33%) included local infiltration with anesthetics other than liposomal bupivacaine, one study (8%) included brachial plexus blocks other than ISB. ISB provided better pain relief than local infiltration in the immediate postoperative period (0-8 hours) as seen in 5/7 (71.4%) studies, but pain levels became similar subsequently. CISB may be superior to single-injection ISB for pain control at the 24-hour time point. The lowest narcotic requirement was seen in the CISB groups postoperatively but was variable. No pain management modalities significantly impacted LOS. A greater number of adverse events were seen with CISB. Discussion Single-injection ISB and CISB appear to offer greater pain relief in the immediate postoperative period compared to local infiltration with liposomal bupivacaine or other anesthetics. CISB provided sustained pain relief at 24 hours compared to other modalities. Analgesic benefit of CISB should be considered in the context of greater cost and potential for more frequent adverse events. Level of Evidence Level I; Systematic Review

To compare social media attention and citation rates between infographics (visual abstracts) and original research articles.All infographics in 2019 from electronic versions of Arthroscopy were matched by topic to articles in the "Original Research" section of the journal in a 4:1 ratio within the same year. The primary outcome was the Altmetric Attention Score (AAS), a cumulative measure of social media attention from various platforms such as Twitter and Facebook. Secondary outcomes included citation rates, article characteristics, and number of shares on social media platforms. Independent t tests and χA total of 60 matched research articles (n = 48, 80.0%) and infographics (n = 12, 20.0%) published in 2019 in Arthroscopy were included. The mean AAS among all infographics was 29.75 ± 32.84 (range, 3-118), whereas the mean AAS among all control research articles was 5.75 ± 8.90 (range, 0-41), representing a statistically significant difference (P.001). Infographics had significantly more Twitter mentions (100% vs 70.8%, P.001) and Facebook mentions (75% vs. 6.2%, P.001) compared with original articles. Multivariate linear regression analysis demonstrated a statistically significant and positive association between AAS and article type, with an additional mean increase in the AAS of 33.7 (95% confidence interval 11.6-50.6; P = .003) for every infographic article compared with an original research article. The mean citation rate among all infographics was 2.4 ± 2.4 (range, 0-7), whereas the mean citation rate among all control research articles was 2.2 ± 4.0 (range, 0-27), which was not a significant difference (P = .69).Infographics resulted in significantly greater AAS and social media attention in comparison with original research articles of similar topics. We recommend the routine creation of infographics by journals to increase the social media attention that their research and chosen topics of interest receive. However, viewers of infographics should read them out of interest but turn their attention toward the original article or a source of more detailed information before making changes in clinical decision-making or practice, as they can be oversimplified.Infographics are an increasingly used by journals as a form of depicting research findings from select studies. By producing infographics, journals may increase the amount of social media attention received for a particular study or topic of interest.

Anterior cruciate ligament (ACL) tears are routinely treated with an ACL reconstruction. This is based on historical literature reporting high failure rates after ACL repairs in addition to the limited healing potential of the ACL. Recently, improved understanding of pathophysiology of ligamentous healing has led to increasing interest in treating proximal avulsions with excellent tissue quality in the acute setting, as this technique allows for ACL healing. Potential advantages of ACL repair include preservation of native proprioceptive and kinematics of the knee, avoidance of graft harvesting morbidity and the possibility to perform a primary ACL reconstruction in case of failure. As a consequence, several techniques for ACL repair have been proposed that can be performed in isolation or with suture augmentation. The primary aim of this technical note is to describe step-by-step the ACL repair technique with and without suture augmentation. The secondary aim of the current study is to review the indications, patient selection and advantages of the technique.

Background : Previous research has investigated the percentage of maximal outcome improvement (MOI) for the American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores after reverse total shoulder arthroplasty (rTSA); however, few other outcome scores have been validated. The purpose of this study was to establish thresholds of MOI percentage for the Single Assessment Numeric Evaluation (SANE) and subjective Constant-Murley (Constant) scores associated with patient satisfaction at two-years following rTSA. Methods : A retrospective review of institutional registry data for all patients who underwent primary rTSA between 09/2016 and 02/2018 was performed. All patients completed the ASES, SANE, and Constant outcome measures preoperatively and at a minimum of two-years postoperatively. Changes were assessed with Wilcoxon signed-rank tests. MOI percentage was defined as the score improvement from baseline divided by the highest possible improvement from baseline based on the maximum value of the outcome score used. Receiver operating characteristic (ROC) analyses were used to determine optimal MOI percentage thresholds associated with postoperative satisfaction. Stepwise multivariate logistic regression was performed to identify variables associated with achieving the MOI. Results : A total of 105 patients were included in the final analysis, with a mean (±standard deviation) age of 70.0±7.5 years and BMI of 28.9±5.6 kg/m2. The majority of patients were satisfied postoperatively (81.0%). Statistically significant increases were observed from baseline to two-years postoperatively for the outcome measures assessed (P Conclusion : Achieving 66.9%, 71.0%, and 37.5% of the MOI for the ASES, SANE, and Constant scores is associated with postoperative satisfaction following rTSA. Comorbid diabetes and diagnosis of rotator cuff arthropathy were significantly associated with a decreased likelihood of MOI achievement. Level of Evidence : Level III; Retrospective Case Series (Prognostic)

Artificial intelligence (AI), including machine learning (ML), has transformed numerous industries through newfound efficiencies and supportive decision-making. With the exponential growth of computing power and large datasets, AI has transitioned from theory to reality in teaching machines to automate tasks without human supervision. AI-based computational algorithms analyze "training sets" using pattern recognition and learning from inputted data to classify and predict outputs that otherwise could not be effectively analyzed with human processing or standard statistical methods. Though widespread understanding of the fundamental principles and adoption of applications have yet to be achieved, recent applications and research efforts implementing AI have demonstrated great promise in predicting future injury risk, interpreting advanced imaging, evaluating patient-reported outcomes, reporting value-based metrics, and augmenting telehealth. With appreciation, caution, and experience applying AI, the potential to automate tasks and improve data-driven insights may be realized to fundamentally improve patient care. The purpose of this review is to discuss the pearls, pitfalls, and applications associated with AI.

Background Femoral stem subsidence is a known cause of early implant failure, increasing the risk for aseptic loosening and periprosthetic fracture. Overall survivorship and subsidence in a novel porous tantalum-coated femoral prosthesis have not been well-studied. Methods Consecutive patients undergoing primary total hip arthroplasty with a porous tantalum-coated femoral prosthesis between January 2008 and January 2015 with minimum 5-year follow-up were included. Clinical and radiographic data were obtained from hospital and office records. Multivariate logistic regression analyses were used to determine predictors of subsidence and clinical outcomes. Kaplan-Meier survivorship curves were performed to illustrate primary failure endpoints of (1) all-cause revision and (2) femoral prosthesis revision. Results A total of 398 patients with a mean (±standard deviation) age of 61.0 ± 11.5 years, body mass index (BMI) 32.8 ± 8.0 kg/m2, and follow-up of 6.9 (range 5.0-11.2 years) were included. Survivorship at 5 years was 94.9% for all-cause revision and 98.0% for femoral component revision. Average subsidence was 1.8 ± 1.3 mm (range 0-15.5), with 8.1% patients experiencing subsidence >5 mm. Statistically significant mean improvements were observed at latest follow-up in the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (40.6 ± 11.5 vs 85.2 ± 10.1, P 3 mm. BMI was a statistically significant and independent predictor of subsidence >5 mm (OR 1.25, P 7 mm (OR 1.25, P Conclusion The trabecular metal taper femoral prosthesis conferred excellent clinical outcome improvement and survivorship. Increasing BMI was independently associated with an increased risk of subsidence in these patients and caution is recommended in utilizing this implant in obese, morbidly obese, and super morbidly obese populations.

To (1) compare the Altmetric Attention Score (AAS) and citation rates between orthopaedic and nonorthopaedic randomized controlled trials (RCTs) from 5 high-impact medical journals and (2) identify general characteristics of these articles associated with greater exposure on social media platforms.Articles published in The New England Journal of Medicine (NEJM), Lancet, The Journal of the American Medical Association (JAMA), Annals of Internal Medicine, and Archives of Internal Medicine between January 2011 and December 2016 were analyzed. These journals were selected based on retaining high impact factors with rigorous publication standards and availability of the AAS for their publications. The queried time frame was chosen to balance the inception of the AAS with an optimal period for citation accrual. A total of 14 article characteristics, in addition to number of Tweets, Facebook shares, news mentions, and the AAS, were extracted. Inclusion criteria were orthopaedic RCTs reporting on outcomes after surgical intervention. Linear regression was used to assess the relationship between publication characteristics and the AAS and social media attention.A total of 9 orthopaedic and 59 nonorthopaedic RCTs were included. The mean AASs were significantly different (574 ± 565.7 versus 256.9 ± 222.3, P = .003), whereas citation rate was not (192.2 ± 117.1 versus 382.3 ± 560.3, P = .317). Orthopaedic RCTs had a significantly greater number of mentions on Twitter and Facebook (P.001). A higher AAS significantly associated with a greater number of citations (β = 0.75, P = .019) for orthopaedic RCTs. The mean AAS of orthopaedic RCTs favoring nonoperative management (809.6 ± 676.3) was greater than those favoring operative treatment (292.0 ± 248.9) but was not statistically significant (P = .361).Orthopaedic RCTs published in 5 high-impact general medical journals had a significantly greater mean AAS relative to nonorthopaedic RCTs, with no differences in citation rates. Additionally, there was a strong association between the AAS and citation rate of orthopaedic RCTs. Orthopaedic RCTs had greater social media exposure on both Twitter and Facebook.Orthopaedic surgeons, researchers, and providers who publish RCTs in high-impact medical journals can anticipate extensive social media attention for their articles relative to other nonorthopaedic RCTs in the same journals. Social media attention may be related to operative versus nonoperative management topics. This study provides further evidence for the increasing use of the AAS and its association with citation accrual.

To present the results of a mid-term follow-up study on sleep quality at a minimum of 2 years after hip arthroscopy for femoroacetabular impingement syndrome.Original inclusion criteria were consecutive patients undergoing primary hip arthroscopy for cam/pincer correction between March 1, 2017, and July 1, 2017, who did not respond to nonoperative management, whereas exclusion criteria were revision arthroscopy, gluteus medius repair, contralateral procedure during the follow-up period, and known sleep disorders. Patients who had followed up at 6 months were contacted at a minimum of 2 years following their surgery. In total, 37 of 55 (67.3%) were available for follow-up. New Pittsburgh Sleep Quality Index (PSQI) scores were obtained and compared with previously reported scores at preoperative and 6-month time points. The PSQI ranges from 0 to 21, with a score of ≥5 indicating poor sleep quality. Point biserial correlations and χPreoperatively, 94.5% of patients (52/55) had a PSQI of ≥5 with a mean PSQI score of 9.8 ± 4.2. Statistically significant improvements were observed at both 6 (PSQI: 2.2 ± 0.2, P.001) and 24 months (PSQI: 4.3 ± 3.9) postoperatively compared to baseline (P.001, both). The mean PSQIs at 2 years and 6 months postoperatively were not statistically different (P = .06). A total of 21.7% (10/46) of patients continued to experience poor sleep quality at 6 months postoperatively, whereas a total of 29.7% (11/37) did so at 2 years postoperatively (P = .36). No preoperative factors were associated with poor sleep quality (P.05 all).The early improvements in sleep quality observed 6 months postoperatively from an original small cohort were maintained at a mean 2.8-year follow-up in those who responded. However, approximately 30% of hip arthroscopy patients still experience poor sleep quality.IV, therapeutic case series.

Purpose To (1) determine the diagnostic efficacy of artificial intelligence (AI) methods for detecting anterior cruciate ligament (ACL) and meniscus tears and to (2) compare the efficacy to human clinical experts. Methods PubMed, OVID/Medline, and Cochrane libraries were queried in November 2019 for research articles pertaining to AI use for detection of ACL and meniscus tears. Information regarding AI model, prediction accuracy/area under the curve (AUC), sample sizes of testing/training sets, and imaging modalities were recorded. Results A total of 11 AI studies were identified: 5 investigated ACL tears, 5 investigated meniscal tears, and 1 investigated both. The AUC of AI models for detecting ACL tears ranged from 0.895 to 0.980, and the prediction accuracy ranged from 86.7% to 100%. Of these studies, 3 compared AI models to clinical experts. Two found no significant differences in diagnostic capability, whereas one found that radiologists had a significantly greater sensitivity for detecting ACL tears (P = .002) and statistically similar specificity and accuracy. Of the 5 studies investigating the meniscus, the AUC for AI models ranged from 0.847 to 0.910 and prediction accuracy ranged from 75.0% to 90.0%. Of these studies, 2 compared AI models with clinical experts. One found no significant differences in diagnostic accuracy, whereas one found that the AI model had a significantly lower specificity (P = .003) and accuracy (P = .015) than radiologists. Two studies reported that the addition of AI models significantly increased the diagnostic performance of clinicians compared to their efforts without these models. Conclusions AI prediction capabilities were excellent and may enhance the diagnosis of ACL and meniscal pathology; however, AI did not outperform clinical experts. Clinical Relevance AI models promise to improve diagnosing certain pathologies as well as or better than human experts, are excellent for detecting ACL and meniscus tears, and may enhance the diagnostic capabilities of human experts; however, when compared with these experts, they may not offer any significant advantage.

Background: Patients with a history of degenerative joint disease secondary to an acute or remote episode of septic arthritis of the native knee or hip present a unique challenge for the orthopaedic surgeon. This study describes our experience with two-stage primary arthroplasty for such patients. Methods: We reviewed 42 patients with a history of septic arthritis treated with two-stage primary arthroplasty between 2008 and 2018. Patients were evaluated using modified Harris Hip Score, Knee Society Score (KSS), and KSS functional component (KSSF). Paired t-tests were used to compare changes for continuous variables within cohorts. Multivariate linear and logistic regression models were constructed to determine predictors of outcomes and complications. Results: At a mean of 3.3-year follow-up, there were 14 (33.3%) complications and the infection cure rate was 95.2%. On average, patients improved in the modified Harris Hip Score (42.9 ± 11.8 vs 83.3 ± 11.1, P < .001), KSS (35.9 ± 16.9 vs 80.1 ± 16.6, P < .001), KSSF (38.0 ± 15.1 vs 71.5 ± 24.0, P < .001), knee flexion (90.9 ± 14.9 vs 100.5 ± 17.1), and hip flexion (73.8 ± 21.2 vs 102.1 ± 11.8, P < .001). Age (β: −0.78, P = .004) was independently associated with lower Harris Hip Score in the hip cohort. There were no independent predictors of the KSS or KSSF. The erythrocyte sedimentation rate (odds ratio: 1.07, P = .043) and C-reactive protein (odds ratio: 1.43, P = .018) at stage 2 were independently associated with a higher likelihood of complications at the final follow-up. Conclusions: Patients with a history of native septic arthritis of the hip and knee, and secondary end-stage degenerative joint disease, showed significant postoperative improvements and a high rate of complications after two-stage primary total joint arthroplasty. Despite improvements, some patients may necessitate a third operation because of the incidence of reinfection and spacer exchange. This information should be used to counsel patients who present with this challenging clinical scenario.

Background Proposed benefits of modularity for femoral revisions in total hip arthroplasty (THA) include more precise biomechanical restoration and improved stability, but this has not been proven with use of a splined, tapered design. This study’s purpose is to compare (1) complication rates, (2) functional outcomes, and (3) radiographic measures of subsidence, offset, and leg length discrepancy with the use of modular vs monoblock splined, tapered titanium stems in revision THA. Methods We retrospectively reviewed 145 femoral revisions with minimum 2-year follow-up (mean, 5.12 years; range, 2-17.3 years). Patients receiving a modular (67) or monoblock (78) splined, tapered titanium stem for femoral revision were included. Results There were no statistically significant differences in rates of reoperation (22.3% vs 17.9%; P = .66), intraoperative fracture (9.0% vs 3.8%; P = .30), postoperative fracture (3.0% vs 1.3%; P = .47), dislocation (11.9% vs 5.1%; P = .23), or aseptic loosening (4.5% vs 6.4%; P = .73) between the modular and monoblock cohorts, respectively. There were similar results regarding subsidence >5 mm (10.4% vs 12.8%; P = .22), LLD >1 cm (35.8% vs 38.5%; P = .74), restoration of hip offset (−5.88 ± 10.1 mm vs −5.07 ± 12.1 mm; P = .67), and Harris Hip Score (70.7 ± 17.9 vs 73.9 ± 19.7; P = .36) between groups. Multivariate regression showed no differences in complications (P = .44) or reoperations (P = .20) between groups. Conclusion Modular and monoblock splined, tapered titanium stems demonstrated comparable complication rates, functional outcomes, and radiographic parameters for femoral revisions. However, a limited number of patients with grade IIIB or IV femoral bone loss received a monoblock stem. Future investigations are required to determine whether modularity is beneficial for more complex femoral defects.

Purpose To compare knotted and knotless transosseous equivalent (TOE) rotator cuff repair (RCR) techniques and evaluate their imaging-diagnosed retear rates. Methods The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008 to 2019), EMBASE (2008 to 2019), and Medline (2008 to 2019) were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, with the following search terms: rotator cuff repair AND (knotless OR knotted) AND transosseous; rotator cuff repair AND (knotless OR knotted or transosseous); rotator cuff repair AND (“suture bridge” OR “suture bridging”). Data pertaining to demographic characteristics, surgical techniques, retears, and patient-reported outcomes were extracted from each study. Rates and locations of retear were reported using ranges, and risks of bias and heterogeneity for each study were assessed. Results A total of 7 studies (552 shoulders) were included. Patients had a weighted mean (± standard deviation) age of 60.5 ± 2.4 years with 27.8 ± 7.9-month follow-up. The incidence of retears ranged from 5.1% to 33.3% in patients treated with knotless TOE RCR, and the incidence for patients treated with knotted TOE RCR ranged from 7.5% to 25%. The incidence of type I retears ranged from 42.9% to 100% for patients treated with knotless TOE RCR and 20% to 100% for patients treated with knotted TOE RCR. The incidence of type II retears ranged from 0% to 57.1% in patients treated with knotless TOE RCR and 0% to 100% in patients treated with knotted TOE RCR. Conclusions The incidence and location of retears after knotless and knotted TOE RCR appear to be similar.

Purpose To determine the influence of corticosteroid injections (CSIs) before or after primary rotator cuff repair (RCR) on the risk of (1) revision RCR, (2) retears, and (3) infections. Methods The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and MEDLINE databases were queried in accordance with the 2009 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Data pertaining to the use of CSIs before or after primary RCR and adverse events were extracted. A subjective synthesis of these outcomes and bias was performed. Results A total of 10 studies including 240,976 patients were identified; 20.0% received a perioperative CSI. Of the 48,235 patients who received a CSI, 66.2% did so preoperatively whereas 33.8% did so postoperatively. A total of 78 patients received both preoperative and postoperative CSIs. Three studies examined the influence of preoperative CSIs on revision RCR; the incidence ranged from 3.8% to 10.5% with preoperative CSIs and from 3.2% to 3.4% for controls. Two of these studies analyzed outcomes of patients from the same databases over the same period. Five studies examined the influence of postoperative CSI use on retears; the incidence ranged from 5.7% to 19.0% in patients who received postoperative CSIs and from 10.0% to 18.4% for controls. Three studies examined the influence of CSI use on infection; 2 studies examined the risk of infection after postoperative CSI use, which ranged from 0.0% to 6.7% with CSIs and from 0.0% to 0.5% for controls. Conclusions The use of preoperative CSIs could be associated with an increased risk of revision RCR. There were no conclusive data to suggest an increased risk of retear or infection with CSI use based on a subjective synthesis of ranges. There is currently poor-quality literature surrounding this topic. Given that the current literature is limited and heterogeneous, no definitive recommendations can be made on perioperative CSI use for RCR. Level of Evidence Level III, systematic review of Level I and III studies.

To evaluate the reliability and educational content of YouTube videos concerning the menisci.YouTube was queried using the keyword "meniscus." The first 50 videos were evaluated. Eleven video characteristics were extracted, and videos were categorized by source and content. Video reliability was assessed using the Journal of the American Medical Association (JAMA) benchmark criteria (score range, 0-5). Video educational content was assessed using the Global Quality Score (GQS; score range, 0-4) and a meniscus-specific score (MSS; score range, 0-20).The mean video duration was 551.44 ± 1,046.04 seconds (range, 75-7,282 seconds). The mean number of views was 288,597.7 ± 735,275.9. Collectively, the 50 videos accrued 14,141,285 views. The mean JAMA score, GQS, and MSS were 1.55, 2.12, and 3.67, respectively. The video source was predominately non-physician based (24.49% of source uploaders), whereas video content was predominately concerned with disease information (37.50% of content). Significant between-group effects were observed for the JAMA score and video content (P = .0155), with videos concerning disease information, exercise training, and nonsurgical intervention having the highest mean JAMA scores. Significant between-group effects were also observed for the JAMA score based on video upload source (P.001), with videos uploaded by physicians receiving the highest mean JAMA scores. The mean GQS and MSS were significantly greater for videos categorized as having disease-specific content (P = .0377 and P = .0404, respectively) and for physician video uploaders (P = .0133 and P = .0100, respectively). The number of video dislikes was a negative independent predictor of the JAMA score (β = -0.007, P = .003). Disease-specific content was a positive independent predictor of the GQS (β = 1.13, P = .042). There were no independent predictors of the MSS.Information on the meniscus found in YouTube videos is of low quality and reliability.Orthopaedic health practitioners should caution patients about the inaccuracy of YouTube videos regarding the meniscus given the low quality of content. These health care providers should make efforts to provide patients with higher-quality alternatives.

To determine clinical outcomes of patients undergoing revision hip arthroscopy for failure to improve with magnetic resonance imaging (MRI) and intraoperative evidence of a capsular incompetency as compared with (1) patients undergoing revision hip arthroscopy without evidence of a capsular incompetency and (2) patients undergoing primary surgery for femoroacetabular impingement syndrome (FAIS) at a minimum follow up of 2 years.Data from consecutive patients undergoing revision hip arthroscopy with MRI/arthrogram-confirmed capsular incompetency between January 2012 and June 2016 were analyzed. All revision patients with capsular incompetency was matched 1:1 by age and body mass index to FAIS revision patients without capsular incompetency and primary FAIS patients. Outcomes included the Hip Outcome Score (HOS)-Activities of Daily Living (ADL), HOS-Sports Subscale (SS), Modified Harris Hip Score (mHHS), pain, and satisfaction. The minimal clinically important difference was calculated for HOS-ADL, HOS-SS, and mHHS.In total, 49 patients (54.4%) of 90 undergoing revision hip arthroscopy had MRI evidence of a capsular incompetency. Most patients were female (79.6%), with a mean age of 30 ± 10.5 years and body mass index of 25.7 ± 5.5. The difference among pre- and postoperative HOS-ADL, HOS-SS, mHHS, and visual analog scale score for pain were all statistically significant (P.05). Analysis of reported outcomes among matched groups demonstrated statistically significant differences, with the group undergoing primary surgery having the greatest 2-year outcomes. Only 66.7% of patients undergoing revision surgery with capsular incompetency achieved a minimal clinically important difference; however, there was no significant difference when compared with revision patients without capsular incompetency. When compared with patients undergoing primary surgery, the difference in frequency was statistically significant (66.7% vs 91.3%; P.001).More than one half of patients undergoing revision hip arthroscopy had MRI and intraoperative evidence of capsular incompetency. Revision arthroscopy for capsular incompetency results in significantly improved 2-year outcomes. However, patients undergoing revision for capsular incompetency and intact capsule revision patients reported significantly lower outcomes compared with primary patients.Level III, Retrospective Comparative Study.

Osteochondromas of the femoral neck are a rare but challenging problem because of their distal location, which is difficult to access arthroscopically. Traditional methods of osteochondroma resection used invasive open approaches to manage these lesions. More recently, advances in hip arthroscopy have allowed expanded treatment of extra-articular hip conditions with a minimally invasive approach. Reports have described the use of hip arthroscopy for osteochondroma removal; however, surgical techniques for the procedure have yet to be described. We describe a technique for arthroscopic resection of a femoral neck osteochondroma using an extended capsulotomy and osteochondroplasty with subsequent capsular plication. This technique uses contemporary hip arthroscopic techniques and constitutes a safe and effective approach to addressing this rare intra-articular pathology of the hip.

Background As the number of total knee arthroplasty (TKA) procedures continues to rise in the context of bundled payment models, patients dissatisfied postoperatively that require additional care will impose additional cost to the healthcare system. The purpose of this study is to internally validate a predictive model for postoperative patient satisfaction after TKA. Methods In total, 484 consecutive primary TKA patients between January 2014 and January 2016 were included. Patients were stratified into 4 risk tiers based on scores of a retrospectively applied, 11-component novel knee survey for postoperative satisfaction: low risk (>96.5), mild risk (75-96.4), moderate risk (60-74.9), and high risk ( Results The mean (±standard deviation) age was 66.3 ± 9.2 years (range 31.7-100.1) and mean body mass index was 34.2 ± 8.2 kg/m2 (range 16.2-68.4). A knee survey score of 96.5 conferred a 97.5% sensitivity and 95.7% negative predictive value for satisfaction. Patients with higher knee survey scores had greater odds (odds ratio 1.03, 95% confidence interval 1.01-1.06, P = .003) of postoperative satisfaction. Increasing risk tier was significantly associated with decreased satisfaction (low risk 95.7%, mild risk 93.8%, moderate risk 86.4%, and high risk 80.4%; P = .007). The knee survey was not significantly correlated with complications (r = −0.43, P = .32). Conclusion This novel knee survey conferred a 97.5% sensitivity and 95.7% negative predictive value in identifying at-risk patients for postoperative dissatisfaction after primary TKA.

Purpose To describe the prevalence of abnormal sleep quality in patients with femoroacetabular impingement syndrome and to determine whether arthroscopic hip preservation surgery with cam/pincer correction, labral preservation, and capsular plication can improve sleep quality postoperatively. Methods All patients undergoing primary hip arthroscopy for cam/pincer correction who failed nonoperative management between March 1, 2017, and July 1, 2017, were administered a validated sleep quality questionnaire—the Pittsburgh Sleep Quality Index (PSQI)—preoperatively and at 3, 6, 12, and 24 weeks postoperatively. Exclusion criteria included patients undergoing revision arthroscopy, gluteus medius repair, or a contralateral procedure during the follow-up period and those with known sleep disorders. A global (total) PSQI score >5 indicates poor sleep quality. The Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Specific Subscale, modified Harris Hip Score, and International Hip Outcome Tool-12 were used to assess functional outcomes. A repeated measures analysis of variance with post hoc Greenhouse-Geisser and Bonferroni corrections was conducted to determine statistically significant changes in sleep patterns. Results A total of 52 patients (94.6%) were included in the final analysis. The mean (± standard error) patient age was 37.8 ± 1.9 years, and body mass index was 27.6 ± 0.7. Preoperatively, 49 (94.2%) of patients experienced poor sleep quality, defined as a global PSQI score >5, with a mean PSQI score of 9.8 ± 0.6. At 24 weeks postoperatively, 10 (21.7%) of patients experienced poor sleep quality with a mean PSQI score of 2.2 ± 0.2. All patients had significant improvements in all hip outcome instruments at 24 weeks postoperatively (P Conclusions Preoperatively, patients with femoroacetabular impingement syndrome have a high prevalence of sleep disturbance. These patients experience subsequent improvement in sleep disturbance after arthroscopic hip surgery early in the postoperative period. Level of Evidence Level IV, case series.

To develop a machine learning algorithm to predict total charges after ambulatory hip arthroscopy and create a risk-adjusted payment model based on patient comorbidities.A retrospective review of the New York State Ambulatory Surgery and Services database was performed to identify patients who underwent elective hip arthroscopy between 2015 and 2016. Features included in initial models consisted of patient characteristics, medical comorbidities, and procedure-specific variables. Models were generated to predict total charges using 5 algorithms. Model performance was assessed by the root-mean-square error, root-mean-square logarithmic error, and coefficient of determination. Global variable importance and partial dependence curves were constructed to show the impact of each input feature on total charges. For performance benchmarking, the best candidate model was compared with a multivariate linear regression using the same input features.A total of 5,121 patients were included. The median cost after hip arthroscopy was $19,720 (interquartile range, $12,399-$26,439). The gradient-boosted ensemble model showed the best performance (root-mean-square error, $3,800 [95% confidence interval, $3,700-$3,900]; logarithmic root-mean-square error, 0.249 [95% confidence interval, 0.24-0.26]; RThe gradient-boosted ensemble model effectively predicted total charges after hip arthroscopy. Few modifiable variables were identified other than anesthesia type; nonmodifiable drivers of total charges included duration of care less than 12 hours or more than 15 hours, operating room time more than 100 minutes, age younger than 30 years, performance of a labral repair, and ECI greater than 0. Stratification of patients based on the ECI highlighted the increased financial risk borne by physicians via flat reimbursement schedules given variable degrees of comorbidities.Level III, retrospective cohort study.

The biomechanical and clinical importance of the meniscus is now well-accepted. In accordance with this understanding, recent focus has shifted toward techniques that preserve the meniscus, including repair and meniscal allograft transplantation (MAT). Although MAT is a technically challenging procedure, evidence has suggested that it restores knee kinematics and tibiofemoral contact pressures, which may subsequently delay or prevent cartilage degeneration. Recent literature has reported concerns as to the high rate of reoperations after MAT, bringing into question the clinical utility of this procedure and its place in the realm of knee preservation. However, reoperations do not necessarily equal failure. MAT is a temporizing procedure that, when aligned with patient expectations, is valuable.

Knee pathology including osteoarthritis and chondral defects continue to account for a large burden of health care visits and significant dysfunction among patients. Injectable biologics have become a focus of greater interest as treatment to mitigate symptoms and potentially restore function or structure. In particular, bone marrow derived treatments, such as aspirated bone marrow aspirate concentrate (commonly referred to as BMAC) have attracted attention as one of the few options that may contain viable autologous stem and progenitor cells that are compliant with Federal Drug Administration regulations. However, recent literature has reported significant shortcomings including variability in the preparation methods, quality reporting, and outcome measures used to assess BMAC efficacy. This manuscript provides a comprehensive review of the most recent recommendations for processing and reporting BMAC in clinical trials with special focus on knee pathology, and presents an evidence-based discussion of the most recent studies reporting on patient outcomes.

As cartilage restoration procedures continue to be more widely performed, an associated increase in the number of patients who “fail” is inevitable. While the goal of preventing progression towards arthroplasty remains elusive, cartilage repair can delay the need for arthroplasty and improve pain and function in young and active patients, thus, at a minimum, serving as a bridging procedure. Although cartilage preservation procedures are perceived to result in high rates of failure, when examined in the context of other common orthopedic procedures such as total knee arthroplasty and anterior cruciate ligament reconstruction, the rates of unsatisfactory outcomes are relatively similar. Furthermore, despite criticism of high rates of failure after cartilage repair surgery, how this failure is defined remains rather ambiguous. Current definitions of failure often do not incorporate patient-specific outcome trajectories, and rarely consider clinically significant improvements relative to each patient's baseline level of function and goals. The purpose of the current review is to present both an objective understanding of how failure is currently defined and widely understood in the realm of cartilage repair surgery, as well as a discussion of the goals of cartilage repair, and potential definitions of success and failure of cartilage repair.

Focal chondral and subchondral injuries of the knee are increasingly recognized and treated pathologies. Many operative approaches to these injuries have been established, including both reparative and reconstructive procedures. More recently, biologic approaches such as platelet rich plasma, bone marrow aspirate concentrate, and stem cells have been studied as potential adjuncts following joint preserving procedures. However, outcomes of biologic injections are mixed and evolving, which may partially be due to the underappreciated role of the subchondral bone in regulating the physiologic response of cartilage to stresses. The current review provides a comprehensive synopsis of the current literature with regards to the use of intra-articular biologics following cartilage preservation surgery as well as the use of biologics in treating subchondral and bone marrow lesions.

With the exponential increase in the arthroscopic treatment of medial patellar instability through lateral sided “capsular” releases, the iatrogenic upsurge of lateral patellar dislocations has become more evident. Although few reports exist detailing the occurrence of this phenomenon due to traumatic or idiopathic etiologies, the vast majority (over 90%) are iatrogenic. Originally described by Kaplan and later by Reider, the lateral patellofemoral ligament (LPFL) constitutes one of the main stabilizers for medial patellar translation. Thus, understanding the anatomy and biomechanics of the LPFL is of utmost importance as reconstruction can potentially restore patellar instability and improve function in cases when this mechanism is compromised. However, few studies have sought to thoroughly describe the intricate anatomy and biomechanics of the LPFL to this end. The purpose of this article was to review the evidence on the anatomy of the LPFL and the lateral retinaculum, its biomechanical behavior, and previously reported surgical approaches to LPFL reconstruction.

Purpose To evaluate the safety and efficacy of hip arthroscopy for femoroacetabular impingement syndrome by assessing complications, comprehensive procedure survivorship, and the influence of labral and capsular management on procedure survivorship. Methods A systematic review of multiple medical databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. All clinical outcome studies that reported on the presence or absence of reoperation after hip arthroscopy for femoroacetabular impingement syndrome were eligible for inclusion. Data pertaining to patient demographic characteristics, surgical technique (specifically labral and capsular management), patient-reported outcomes, complications, reoperation, and conversion to arthroplasty were extracted from each study. Results A total of 68 studies (7,241 hips) were included. Most were Level IV studies (63%). Complications occurred in 1.9% of cases. The most common complications were neurologic (53%), heterotopic ossification (24%), infection (15%), and thromboembolic (7%). Conversion to total hip arthroplasty (456 cases) was the most common reason for reoperation, followed by revision hip arthroscopy (226 cases) and periacetabular osteotomy (7 cases). The rate of arthroplasty conversion was lower than 10% in 43 of 59 studies reporting this outcome. The average interval to arthroplasty conversion was 58 months. Between 2009 and 2017, the performance of labral repair increased from 19% to 81% of cases and capsular closure increased from 7% to 58% of cases. Conclusions Arthroplasty conversion occurred in fewer than 10% of cases in the clear majority of series. Labral repair (compared with labral debridement) and capsular closure (compared with unrepaired capsulotomy) were associated with a lower risk of conversion to arthroplasty. Throughout the study interval, there were shifts in surgical technique favoring labral repair over debridement and capsular repair over unrepaired capsulotomy. The study is limited by selection bias because cases in which labral and capsular repair was performed may have had superior tissue that was more amenable to repair. Level of Evidence Level IV, systematic review.