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Background: Free bone block (FBB) procedures for anterior shoulder instability have been proposed as an alternative to or bail-out for the Latarjet procedure. However, studies comparing the outcomes of these treatment modalities are limited. Purpose: To systematically review and perform a meta-analysis comparing the clinical outcomes of patients undergoing anterior shoulder stabilization with a Latarjet or FBB procedure. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: PubMed, Embase, and the Cochrane Library databases were systematically searched from inception to 2019 for human-participants studies published in the English language. The search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement including studies reporting clinical outcomes of patients undergoing Latarjet or FBB procedures for anterior shoulder instability with minimum 2-year follow-up. Case reports and technique articles were excluded. Data were synthesized, and a random effects meta-analysis was performed to determine the proportions of recurrent instability, other complications, progression of osteoarthritis, return to sports, and patient-reported outcome (PRO) improvement. Results: A total of 2007 studies were screened; of these, 70 studies met the inclusion criteria and were included in the meta-analysis. These studies reported outcomes on a total of 4540 shoulders, of which 3917 were treated with a Latarjet procedure and 623 were treated with an FBB stabilization procedure. Weighted mean follow-up was 75.8 months (range, 24-420 months) for the Latarjet group and 92.3 months (range, 24-444 months) for the FBB group. No significant differences were found between the Latarjet and the FBB groups in the overall random pooled summary estimate of the rate of recurrent instability (5% vs 3%, respectively; P =.09), other complications (4% vs 5%, respectively; P =.892), progression of osteoarthritis (12% vs 4%, respectively; P =.077), and return to sports (73% vs 88%; respectively, P =.066). American Shoulder and Elbow Surgeons scores improved after both Latarjet and FBB, with a significantly greater increase after FBB procedures (10.44 for Latarjet vs 32.86 for FBB; P =.006). Other recorded PRO scores improved in all studies, with no significant difference between groups. Conclusion: Current evidence supports the safety and efficacy of both the Latarjet and FBB procedures for anterior shoulder stabilization in the presence of glenoid bone loss. We found no significant differences between the procedures in rates of recurrent instability, other complications, osteoarthritis progression, and return to sports. Significant improvement in PROs was demonstrated for both groups. Significant heterogeneity existed between studies on outcomes of the Latarjet and FBB procedures, warranting future high-quality, comparative studies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4)., Setting: Recreational kiteboarding., Design: Retrospective cohort., Participants: Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study., Independent Variables: Age, sex, experience, and the use of protective gear., Main Outcome Measures: Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data., Results: The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction., Conclusions: The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To define the time to achievement of clinically significant outcomes (CSOs) after primary gluteus medius and/or minimus (GM) repair and to identify factors associated with delayed CSO achievement., Methods: Patients who underwent primary GM repair between January 2012 and June 2021 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) were retrospectively identified. Cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated. The time to achievement of MCID and PASS was analyzed using Kaplan-Meier survival analysis. Median time to MCID and PASS achievement was recorded. Multivariate stepwise Cox regressions were used to identify factors associated with delayed CSO achievement., Results: Fifty GM repairs were identified (age 59.4 ± 9.7 years, body mass index 27.9 ± 6.2, 94% female). Tears were grade 1 in 39 cases, grade 2 in 7 cases, and grade 3 in 4 cases. Endoscopic repair was performed in 35 cases, and open repair was performed in 15 cases. Labral debridement and repair were each performed in 15 cases. Median time to CSO achievement was 5.7 months for MCID and 11.0 months for PASS. The 2-year cumulative probability of MCID and PASS achievement was 92.7% and 66.7%, respectively. Preoperative hip abduction weakness on physical examination was associated with delayed achievement of MCID (hazard ratio 2.27, confidence interval 1.067-7.41, P = .039) and PASS (hazard ratio 3.89, confidence interval 1.341-11.283, P = .012)., Conclusions: This study demonstrated that in patients undergoing repair of primarily grade 1 GM tears, most achieved MCID by 6 months, and more than one half achieved PASS by 12 months. Preoperative hip abduction weakness on physical examination was associated with delayed CSO achievement., Level of Evidence: Level IV, retrospective case series., Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: S.J.N. reports intellectual property royalties from Ossur and Stryker, outside the submitted work; consulting fees from Stryker, outside the submitted work; board or committee member for the Arthroscopy Association of North America and the American Orthopaedic Society for Sports Medicine; and research support from Mitek and Stryker, outside the submitted work. All other authors (M.J.V., K.J., A.B.A., R.G., J.W.E.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: Acute septic arthritis of the knee joint is an orthopedic emergency, potentially devastating, which can lead to high morbidity and may even be life-threatening. While any synovial joint can be infected, the knee is the most often affected joint and is involved in about 50 % of the cases. The infection is usually caused by a gram-positive bacteria. The diagnosis is made by synovial fluid aspiration, microbiological analysis and hematological investigations of inflammatory measures. Treatment requires emergency irrigation and debridement of the joint, and intravenous antibiotics. Surgical debridement can be performed either arthroscopically or via open arthrotomy. In recent years, arthroscopic treatment demonstrated more favorable outcomes with better functional outcomes, shorter operative time and hospital stays.

Purpose: To determine the short-term outcomes following microfracture augmented with cartilage allograft extracellular matrix for the treatment of symptomatic focal cartilage defects of the adult knee., Methods: Forty-eight patients enrolled by 8 surgeons from 8 separate institutions were included in this study. Patients underwent microfracture augmented by cartilage allograft extracellular matrix (BioCartilage; Arthrex, Naples, FL) and were followed at designated time points (3, 6, 12, and 24 months) to assess patient-reported outcomes (PROs), clinically significant outcomes (CSOs), and failure and complication rates. Magnetic resonance imaging (MRI) was offered at 2 years postoperatively regardless of symptomatology, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) 2.0 score was documented., Results: PRO compliance was 81.3% at 6 months, 72.9% at 12 months, and 47.9% at 2 years. All joint-specific and function-related PROs significantly improved compared to baseline at 3, 6, 12, 18, and 24 months of follow-up (P < .01), apart from Marx activity scale, which demonstrated a significant decline in postoperative scores at 2 years (P = .034). The percentage of patients achieving CSOs (as defined for microfracture) at 2 years was 90% for minimal clinically important difference and 85% for patient acceptable symptomatic state. Patient factors including age, sex, body mass index, symptoms duration, smoking, presence of a meniscal tear, lesion size, and location were not associated with CSO achievement at 2 years. One patient (2.1%) failed treatment 9.5 months postoperatively due to graft delamination and required a reoperation consisting of arthroscopic debridement. One complication (2.1%) consisting of complaints of clicking, grinding, and crepitus 15 months following the index procedure was reported. Two-year postoperative MRI demonstrated a mean 40.5 ± 22.9 MOCART 2.0 score., Conclusions: In this preliminary study, we found cartilage allograft extracellular matrix to be associated with improvement in functional outcomes, high rates of CSO achievement, and low failure and complication rates at 2-year follow-up., Level of Evidence: Level III, prospective multicenter cohort study., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

In recent years, orthobiologics have been of increasing clinical interest in the treatment of shoulder and elbow pathology. In some conditions, such as rotator cuff injury and lateral epicondylitis, there have been high-quality trials that support the use of platelet-rich plasma in reducing pain, restoring functionality, and improving clinical outcomes. However, as the numbers of both cellular-based biologics and the conditions being augmented by biologics continue to expand, there is a substantial need for high-quality investigations to support their routine use in most shoulder and elbow conditions. The purpose of this review is to summarize the current evidence of orthobiologics in the management of shoulder and elbow injury, as nonoperative treatment and as augments to operative treatment., (© 2020 Published by Elsevier Inc. on behalf of American Shoulder & Elbow Surgeons.)

Meniscal allograft transplantation (MAT) has become an acceptable surgical treatment for select symptomatic and relatively young (<50 years of age) patients with a meniscal deficiency. MAT may also be considered in meniscal-deficient patients undergoing anterior cruciate ligament reconstruction and/or articular cartilage repair procedure in the ipsilateral compartment. Contraindications to MAT include asymptomatic patients, severe osteoarthritis, uncorrectable malalignment or instability, irreparable chondral damage, active infection, or inflammatory arthropathy. Most institutions prefer the use of fresh-frozen allografts, whereas the use of fresh-viable grafts is limited by their availability, and the use of cryopreserved and lyophilized grafts has gone out of favor. Donor allografts are size-matched to the recipient using x-rays or magnetic resonance imaging measurements. To date, no particular surgical technique has demonstrated superiority. Therefore, there are several used approaches (mini-open or arthroscopic), horns-fixation techniques (soft-tissue, bone-plugs, or bone-bridge), and peripheral suture techniques (inside-out or all-inside). Ipsilateral malalignment, instability, and/or chondral defects should be corrected or repaired if MAT is being performed. MAT survival rates are estimated at 73.5% at 10 years and 60.3% at 15 years. Mean time-to-failure is ∼8.2 and ∼7.6 years for a medial and lateral meniscus transplant, respectively. Significant improvement in patient-reported outcomes is expected following MAT, and 90% of patients will attest they will undergo the procedure again. Reoperation rates are estimated at 32%, with the most common complication being a tear of the meniscal allograft. Many studies reporting on outcomes of MAT are flawed because of low-quality, the use of non-fresh-frozen preservation techniques, and heterogeneity of patients and concomitant procedures. As our knowledge regarding patient selection, graft preparation, and techniques continue to develop, we expect MAT outcomes to improve much further., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)