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Purpose: To systematically review the reporting of clinically significant outcome measure (CSO) thresholds and methods for calculating thresholds following anterior cruciate ligament (ACL) reconstruction., Methods: A systematic review of PubMed, Embase, and Web of Science databases was conducted to identify articles that met inclusion criteria from January 1, 2015, to July 7, 2024. Inclusion criteria included studies reporting CSO thresholds including minimal clinically important difference (MCID), substantial clinical benefit (SCB), or patient acceptable symptomatic state (PASS) for patients following ACL reconstruction with minimum 12-month follow-up. The MINORS criteria was used to assess study quality. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and method of CSO calculation were collected., Results: A total of 56 studies (n=52,292 patients) met the final inclusion criteria. Reported PROMs included International Knee Documentation Committee (IKDC) (n=35 studies), Knee Injury and Osteoarthritis Outcome score (KOOS) (n=33 studies), Tegner (n=20 studies) and Lysholm (n=19 studies) scores. The PASS was reported in 35 studies, MCID in 30, and SCB in 4. Among the studies that reported PASS, the most used threshold calculation was the ROC-Youden index (71.4%, n=25/35). In the studies reporting MCID, the most used threshold calculation was the 0.5 standard deviation (SD) of mean change method (36.7%, n=11/30). The most reported threshold calculation among the SCB studies was the ROC curve analysis (75%, n=3/4). In studies independently calculating CSOs, the most common methods were 0.5 standard deviations (SD) of mean change for MCID (50%, n=10/20), the ROC-Youden index for PASS (73.3%, n=11/15), and ROC curve analysis (75.0%, n=3/4) for SCB. Descriptions of anchor questions were reported in 22 studies (39.3%)., Conclusion: Substantial variability exists in the reporting and calculation of MCID, SCB, and PASS for various PROMs following ACL reconstruction., (Copyright © 2025. Published by Elsevier Inc.)

Anterior cruciate ligament (ACL) tears in National Football League (NFL) players are devastating injuries that take nearly a year to recover. Players that do return to sport have worse overall performance compared to pre-ACL tear. NFL players typically play regular season games on Sunday with the next game played on the following Sunday, allowing for 6 days between games. Deviation from the usual 6-day rest week has been proposed as a potential risk for ACL tear. The main objective of this study was to evaluate the risk of decreased rest or increased rest on ACL tear rates in NFL players. ACL injury data of NFL players from the 2012 to 2013 season and 2022 to 2023 season were gathered from publicly available sources. Player demographic data, position, age at time of injury, seasons played, injury mechanism, and playing surface type were recorded. Injuries were characterized as short, normal, or long week injuries. ACL tears that occurred during the preseason, postseason, or during week 1 were excluded. Descriptive statistics were calculated to report means, ranges, and percentages. Data were analyzed to determine statistically significant differences using Fisher's exact, chi-square, or one-way analysis of variance tests. A total of 524 ACL tears were recorded in NFL players during the study window. Note that 304 ACL tears were excluded and 220 fit inclusion criteria. Twenty-four ACL tears occurred during short weeks, 68 during long weeks, and 128 during normal weeks. Players were 1.8 times more likely to tear their ACL during a long week compared to a normal week ( p  < 0.001), and 1.5 times more likely to tear their ACL during a short week compared to a normal week ( p  = 0.02). The findings from this study suggest that deviation from the normal 7-day NFL week increases the risk of an ACL tear in NFL players when increasing or decreasing rest time. Further research exploring the impact of short and long rest times on player injury risk should be conducted to prevent season-ending injuries., Competing Interests: None declared., (Thieme. All rights reserved.)

Purpose: To evaluate how both annual surgeon and facility volume affect the cost and outcomes of anterior cruciate ligament reconstruction surgery. We also aimed to identify trends in how surgeon caseload predicts graft selection., Methods: The 2014 State Ambulatory and Surgical Database from Florida was used. Every case with Current Procedural Terminology code 29888 ("Arthroscopic anterior cruciate ligament reconstruction") was selected. Surgeon and facility identifiers were used to separate high- and low-volume groups, defined as >25 cases for surgeons and >125 cases for facilities. Univariate analysis was performed for patient demographics and surgical characteristics. Multivariate analysis was performed on significant factors to determine how these variables impact cost and odds of allograft usage, postoperative admission, and meniscal repair., Results: There were 7905 cases performed between January 1, 2014, and December 31, 2014 after excluding same-year revisions. High-volume surgeons had $6155 lower total charges, were 1.949 times more likely to use an autograft, and had 54.5% lower odds of postoperative admission (all P < .001). They were also 1.196 times more likely to perform a meniscal repair (P = .017). In patients younger than 18, low-volume surgeons were 3.7 times more likely to use an allograft (P < .001). Concomitant multiligamentous procedures were also performed at greater rates in the high-volume group. Postoperative admission added $18,698, and allografts added $9174 (both P < .001)., Conclusions: We found that high-volume surgeons were more likely to perform a meniscal repair and less likely to have their patients admitted postoperatively, which was the second largest cost driver of anterior cruciate ligament reconstruction. They were also significantly less likely to use an allograft, especially in patients younger than the age of 18 years. High-volume surgeons had lower costs despite greater rates of concomitant procedures., Level of Evidence: III, retrospective cohort study., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Rotator cuff tears are a common cause of shoulder pain and dysfunction. Recent and historical reports suggest that a sizable percentage of patients may experience a retear of the rotator cuff despite surgical intervention. Multiple biological and mechanical factors can influence outcomes after rotator cuff surgery, including patient age, rotator cuff tear size, chronicity, and rotator cuff tissue quality. Given this, there remains significant interest in modalities that can minimize surgical failure and improve patient outcomes after this procedure. Allograft augmentation is one option for rotator cuff augmentation in patients with large complex tears or impaired tissue quality. This technical note describes our surgical technique for arthroscopic dermal allograft augmentation of a massive rotator cuff repair with the shoulder kite technique., (© 2024 The Authors.)

Anterior cruciate ligament (ACL) injuries and subsequent surgical reconstruction are exceedingly common orthopaedic procedures. Surgical technique and graft preparation techniques continue to evolve as surgeons seek to increase surgical outcomes and decrease recovery time. As such, there is significant interest in identifying tools and techniques that may enhance the surgical process for patients undergoing an ACL reconstruction. Recently, there has been significant interest in evaluating biologic scaffolds that may augment graft healing. This Technical Note describes our technique for the preparation of a bone-patellar tendon-bone ACL graft with a BioBrace biocomposite scaffold augmentation., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: C.W.N. received financial support from the 10.13039/501100001702AO Foundation, 10.13039/100007307Arthrex, Guidepoint Consulting, and Vericel and is a board member of the American Association of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America. S.F.D. received financial support from 10.13039/100001473AO North America, 10.13039/100007307Arthrex, and Springer and is a board member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America. All other authors (P.B., L.O.O.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

» In the last decade, significant progress has been made in understanding hip pain, especially related to femoroacetabular impingement (FAI) and hip dysplasia (HD), which collectively affect over 20% of the population.» Preoperative imaging, including plain radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US), plays a pivotal role in diagnosing FAI and HD. Imaging precision, standardized techniques, and accurate interpretation are crucial for effective treatment planning.» The continual advancements in imaging techniques, especially seen in MRI (arthrograms, application of leg traction, and delayed gadolinium-enhanced MRI of cartilage), represent important strides in the precise assessment of pathology associated with FAI and HD.» By incorporating these advancements into routine imaging protocols, healthcare providers can ensure a comprehensive understanding of hip joint dynamics, enabling more accurate diagnosis and effective management strategies for patients with FAI and HD, ultimately leading to improved clinical outcomes., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B117)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: In 2020, the American Society of Shoulder and Elbow Therapists (ASSET) published an evidence-based consensus statement outlining postoperative rehabilitation guidelines following anatomic total shoulder arthroplasty (TSA)., Purpose: The purpose of this study was to (1) quantify the variability in online anatomic TSA rehabilitation protocols, and (2) assess their congruence with the ASSET consensus guidelines., Methods: This study was a cross-sectional investigation of publicly available, online rehabilitation protocols for anatomic TSA. A web-based search was conducted in April 2022 of publicly available rehabilitation protocols for TSA. Each collected protocol was independently reviewed by two authors to identify recommendations regarding immobilization, initiation, and progression of passive (PROM) and active range of motion (AROM), as well as the initiation and progression of strengthening and post-operative exercises and activities. The time to initiation of various components of rehabilitation was recorded as the time at which the activity or motion threshold was permitted by the protocol. Comparisons between ASSET start dates and mean start dates from included protocols were performed., Results: Of the 191 academic institutions included, 46 (24.08%) had publicly available protocols online, and a total of 91 unique protocols were included in the final analysis. There were large variations seen among included protocols for the duration and type of immobilization post-operatively, as well as for the initiation of early stretching, PROM, AROM, resistance exercises, and return to sport. Of the 37 recommendations reported by both the ASSET and included protocols, 31 (83.78%) were found to be significantly different between groups (p\<0.05)., Conclusion: Considerable variability was found among online post-operative protocols for TSA with substantial deviation from the ASSET guidelines. These findings highlight the lack of standardization in rehabilitation protocols following anatomic TSA., Level of Evidence: 3b., Competing Interests: There are no financial biases or conflicts of interest for any author related to this study. The study was exempt from International Review Board approval as no identifiable patient information was used., (© The Author(s).)

Purpose: To characterize the epidemiology, mechanism (contact vs noncontact), management, and return-to-play (RTP) times for quarterbacks in the National Football League (NFL) who experienced ulnar collateral ligament (UCL) injuries., Methods: Using the Pro Sports Transactions Archive, NFL quarterbacks who sustained UCL injuries between 1991 and 2023 were identified. Age at time of injury, mechanism of injury (contact vs noncontact), management strategy, and RTP time were recorded. In addition, player performance metrics including games played, quarterback rating, completion percentage, touchdowns, and interceptions were examined for the season before injury through the second season after injury. Player performance analysis was assessed using principal component analysis, which is a dimensionality reduction statistical method that compresses the several performance metrics into a single value, the first principal component., Results: A total of 21 injuries in 20 players were identified. The mean age of quarterbacks at time of injury was 28.7 years (± 4.6 years standard deviation). Ten injuries occurred during contact with another player, and 11 injuries were noncontact. Most (n = 13) of UCL injuries were managed nonoperatively. Sixteen players achieved RTP, 4 of whom underwent repair or reconstruction (UCLR). Overall, the mean RTP time was 165.6 days (± 178.8 days standard deviation), but players who underwent UCLR had a longer average RTP time (359.0 days vs 98.25 days, P  = .014). Injuries sustained after 2006 were associated with improved postinjury performance ( P  = .041), but older age at time of injury was associated with diminished postinjury performance ( P  = .048)., Conclusions: NFL quarterbacks sustain more noncontact UCL injuries and are undergoing UCLR at greater rates than previously reported. Although RTP rates are high and players demonstrate improved postinjury performance for injuries sustained after 2006, older age at the time of injury is associated with worse postinjury performance., Level of Evidence: Level IV, therapeutic case series., Competing Interests: The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2024 The Authors.)

Background: The ankle is one of the anatomic sites most frequently injured in National Football League (NFL) players. Ankle injuries have previously been shown to have long-lasting negative impacts, and have been associated with impaired athletic performance. The aim of this study was to use fantasy football points as a metric to evaluate the impact of ankle injuries on NFL offensive skill player performance., Methods: An open-access online database was used to identify NFL players who sustained ankle injuries from 2009 to 2020. Another public online database was used to determine fantasy points and other performance metrics for injured offensive skill players in the seasons before and after their ankle injury. Injured players were matched to a healthy control by position, age, and BMI. Paired T-tests were performed to evaluate performance metrics before and after the ankle injury. An ANCOVA was performed to assess the effect of return to play (RTP) time and injury type on fantasy performance., Results: 303 players with ankle injuries were included. Fantasy output, including average points per game (PPG) and total fantasy points accrued in one season, significantly decreased in the season following a player's ankle injury (p < 0.0001). In running backs, tight ends, and wide receivers, performance significantly decreased in every metric evaluated (p < 0.0001). In quarterbacks, there was no significant change in performance, except for a decrease in the number of games played (p = 0.0033) and in the number of interceptions thrown (p = 0.029)., Conclusion: Assessing fantasy football output revealed a decrease in player performance in the season following an ankle injury, especially in route-running players. These results can be used to inform injury prevention and rehabilitation practices in the NFL., (© 2024 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Isolated posterior shoulder instability accounts for approximately 10% of shoulder instability cases. Patients may present after an acute trauma or with insidious onset and associated posterior shoulder pain. Knotless and all-suture anchor devices have become increasing popular and are often used in arthroscopic shoulder instability cases to avoid knot stacks and allow for the ability to re-tension the fixation. This technical note describes our technique for 2-portal posterior labral repair using knotless all-suture anchors with the patient in the lateral decubitus position., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: S.F.D. reports board membership with the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; receives speaking and lecture fees from AO North America; receives funding grants from 10.13039/100007307Arthrex; is on the editorial or governing board of Arthroscopy; and receives publishing royalties and financial or material support from Springer. C.W.N. reports board membership with the 10.13039/100009885American Academy of Orthopaedic Surgeons, 10.13039/100011549American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America; reports a relationship with AO Foundation; receives speaking and lecture fees from 10.13039/100007307Arthrex and Vericel; has a consulting or advisory relationship with Guidepoint Consulting; is on the editorial or governing board of Arthroscopy; and receives publishing royalties and financial or material support from Arthroscopy. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Treatment of osteochondritis dissecans (OCD) lesions poses a significant challenge for orthopaedic surgeons and can cause debilitating limitations on the activity of patients. Timing of intervention, surgical technique, and selection of graft when needed are all key elements of treatment that need to be considered carefully and discussed with patients. Primary fixation of an OCD fragment with intact subchondral bone has been shown to be beneficial in some cases. There is limited literature, however, on how to approach large chondral lesions in young patients without a large subchondral base attached to the fragment. Treatment of large OCD lesions of the knee with an all-arthroscopic approach provides several benefits, including limited dissection for exposure, improved ability to assess the stability of the OCD lesion during articulation after fixation, and an expedited recovery compared to an open approach. The purpose of this technical note is to detail a technique of performing an all-arthroscopic bone grafting and primary fixation of a medial femoral condyle OCD lesion., (© 2023 The Authors.)

Meniscal root pathology has garnered increased attention over the past decade. Meniscal root tears are considered to essentially represent a meniscus-deficient state, which has led to a rise in the surgical fixation of this pathology. Meniscus root tears are classified as either radial tears within 1 cm of the root insertion, or a direct avulsion of meniscal root. These injuries are important to recognize because they contribute to impaired joint mechanics and rapid articular cartilage degeneration. Given this, there remains significant interest in identifying novel surgical techniques that may facilitate better surgical repair and enhance patient outcomes. The purpose of this technical note is to describe a surgical technique for a medial meniscus root ripstop repair with cannulated drilling. This technique is simple and reproducible, while also allowing for the augmentation of potentially poor tissue quality., (© 2023 The Authors.)

Background: Treatment of glenohumeral osteoarthritis (GHOA) may include conservative management with use of intraarticular injections, prior to considering total shoulder arthroplasty (TSA). The purpose of this study was to assess trends in the use of preoperative cortisone (CO) and hyaluronic acid (HA) injections, as well as investigate the relationship between injection use and infection or revision arthroplasty following TSA., Methods: Pearl Driver was used to identify all patients undergoing TSA for GHOA between 2010 and 2018. Patients were categorized based on the type and number of injections they received. Outcomes of interest included post-operative opioid use, post-operative infection, and risk of revision surgery within 1 year of the index procedure., Results: The incidence of patients receiving a CO or HA injections within 1 year of their TSA decreased by 83% and 54%, respectively. Patients who had received 1 or more steroid injections had higher odds of prolonged opiate use following surgery. Patients that received 1 or 2 CO injection prior to TSA had an increased risk of needing revision surgery., Discussion: Use of intraarticular injections for the management of GHOA has declined. Patients receiving preoperative injections had increased odds of prolonged opiate use and the need for revision surgery., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue., (© 2023 The Authors.)

Osteoarthritis is a common cause of morbidity in an increasingly aging population. Although the weight-bearing joints of the leg and foot are frequently affected by osteoarthritis, degenerative changes in the joints of the upper extremity are likewise common and can be both particularly debilitating for affected individuals and uniquely challenging for the health care providers managing it. The present review seeks to overview the epidemiology, anatomy, diagnosis, and management of osteoarthritis in the joints of the shoulder, elbow, and hand with the intent of providing accessible and relevant information to the range of medical professionals involved in patient care., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Bipolar "floating" clavicle injuries are infrequent upper-extremity injuries that occur secondary to a high-energy trauma, which can cause dislocation at the sternoclavicular (SC) and acromioclavicular joints. Given the rarity of this injury, there is not a consensus regarding clinical management. Although anterior dislocations can be managed nonoperatively, posterior dislocations may pose a threat to chest-wall structures and typically are managed surgically. Here, we present our preferred technique for concomitant management of a locked posterior SC joint dislocation with associated grade 3 acromioclavicular joint dislocation. Reconstruction of both ends of the clavicle was performed in this case, using a figure-of-8 gracilis allograft and nonabsorbable suture reconstruction for the SC joint, and an anatomic acromioclavicular joint and coracoclavicular ligament reconstruction with semitendinosus allograft and nonabsorbable suture., (© 2023 The Authors.)

Purpose: To (1) characterize hamstring injury (HSI) recurrence rates across the 2009-2010 to 2019-2020 NFL seasons and (2) to identify HSI recurrence risk factors among positions and determine the weekly return to play (RTP) recurrence risk. We hypothesized that older players, skill position players, and players returning to play faster were most at risk., Methods: Public data from the 2009-2010 to 2019-2020 seasons were reviewed to identify HSIs. Player characteristics were collected before and two seasons following injury. A week-by-week analysis of recurrence risk was evaluated with linear and logarithmic trendlines of the best fit., Results: A total of 2075 HSI were identified with a mean age of 26.2 years (20.0-43.0), BMI of 29.6 (22.7-43.5), and 3.4 seasons of experience (0-17), with 1826 strains (88.0%), 236 partial tears (11.3%), and 13 complete tears (0.63%). Of the 2075 injuries, 796 (38.4%) were recurrent, with 247 (11.9%) being a same-season reinjury. Logistic regression found that fewer weeks before RTP, in-game injury, and lower BMI were risk factors for same-season recurrence. For any recurrence, logistic regression identified more recent year of injury, lower BMI, and longer playing experience as significant risk factors. Wide receivers were found to be at risk for same-season recurrence. For any-season recurrence, defensive backs, linebackers, running backs, tight ends, and wide receivers were at risk. Week-by-week recurrence analysis determined the greatest risk to be when players returned within 2 weeks (13.4%)., Conclusions: There is a high rate of HSI recurrence in the NFL. Risk factors for same-season injury include shorter time to RTP, in-game injury, lower BMI, and playing wide receiver. Risk factors for any-season recurrence were more recent year of injury, lower BMI, longer playing experience, and playing defensive back, linebacker, running back, tight end, or wide receiver. The greatest risk factor for HSI recurrence was RTP within 2 weeks.

➢: Arthroscopic hip labral reconstruction is a complex procedure which is growing in use as indications, techniques, and surgical expertise advance., ➢: Graft selection is an important component of labral reconstruction based on relative advantages and disadvantages of available types of autografts and allografts., ➢: The ideal graft should mimic the native acetabular labrum form and function while also being affordable, readily available, and associated with low morbidity., ➢: High rates of patient satisfaction and positive patient-reported outcomes have been reported after labral reconstruction using several graft types., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A879)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

➢: Certain anatomic factors, such as patella alta, increased tibial tubercle-trochlear groove distance, rotational deformity, and trochlear dysplasia, are associated with an increased risk of recurrent patellar instability., ➢: The presence of a preoperative J-sign is predictive of recurrent instability after operative management., ➢: Isolated medial patellofemoral ligament reconstruction may be considered on an individualized basis, considering whether the patient has anatomic abnormalities such as valgus malalignment, trochlear dysplasia, or patella alta in addition to the patient activity level., ➢: More complex operative management (bony or cartilaginous procedures) should be considered in patients with recurrent instability, malalignment, and certain anatomic factors., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A881)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Purpose: To perform a systematic review of return to play (RTP) and return to previous level of performance (RPP) in competitive overhead athletes after SLAP repair to identify factors associated with failure to RTP., Methods: Systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Review was registered with PROSPERO International prospective register of systematic reviews (CRD42020215488). Inclusion criteria were literature reporting RTP or RPP following SLAP repair in overhead athletes were run in the following databases: PubMed/MEDLINE, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar. Categories for data collection for each full article included (1) article information; (2) patient demographics; (3) surgical techniques; (4) level of competition; (5) rotator cuff treatment; (6) player position; (7) patient-reported outcome measures; and (8) RTP and RPP rates. The Methodological Index for Non-randomized Studies checklist was used to evaluate quality of all included studies., Results: Eight studies with 333 subjects were identified. Overall RTP and RPP rates were 50% to 83.6% and 35.3% to 64%, respectively. Patients with surgically treated rotator cuff pathology had lower RTP (12.5%-64.7%) rates compared with those without (80.0%-83.6%). Professional athletes had similar RTP rates (62.5%-81.5%) compared with high-school (75.0%-90.0%) and college athletes (12.5%-83.3%). However, professional athletes demonstrated the lowest relative range of reported RPP rates (27.7%-55.6%). Pitchers had lower RTP (62.5%-80.0%) and RPP (52.0%-58.9%) compared with position players (91.3% RTP, 76.3%-78.2% RPP)., Conclusions: Studies reviewed reported moderate RTP and RPP rates following SLAP repairs in competitive overhead athletes. Those with associated rotator cuff tear requiring treatment, and baseball pitchers were less likely to RTP and RPP. Professional athletes had similar RTP to an amateur; however, they were less likely to RPP., Level of Evidence: Level IV, systematic review of Level III-IV studies., (Copyright © 2022. Published by Elsevier Inc.)

Focal cartilage defects of the knee are painful and difficult to treat, especially in younger patients 1 . Seen in up to 60% of patients who undergo knee arthroscopy 2 , chondral lesions are most common on the patella and medial femoral condyle 3 . Although the majority of lesions are asymptomatic, a variety of treatment options exist for those that are symptomatic; however, no clear gold-standard treatment has been established. In recent years, osteochondral allograft transplantation has been increasingly utilized because of its versatility and encouraging outcomes 4-7 . The procedure entails replacing damaged cartilage with a graft of subchondral bone and cartilage from a deceased donor. Indications for this procedure include a symptomatic, full-thickness osteochondral defect typically ≥2 cm 2 in size in someone who has failed conservative management. Relative indications include patient age of <40 years and a unipolar defect 8,9 ., Description: Osteochondral allograft transplantation requires meticulous planning, beginning with preoperative radiographs to evaluate the patient's alignment, estimate the lesion size, and aid in matching of a donor femoral condyle. The procedure begins with the patient supine and the knee flexed. A standard arthrotomy incision is performed on the operative side. Once exposure is obtained, a bore is utilized to remove host tissue from the lesion typically to a depth of 5 to 8 mm. Measurements are taken and the donor condyle is appropriately sized to match. A coring reamer is utilized to create the plug from donor tissue, which is trimmed to the corresponding depth. After marrow elements are removed via pulse lavage, the allograft plug is placed within the femoral condyle lesion through minimal force., Alternatives: Nonoperative treatment involves a reduction in high-impact activities and physical therapy. Surgical alternatives include chondroplasty, microfracture, and osteochondral autograft transplantation; however, these options are typically performed for smaller lesions (<2 cm). For larger lesions (≥2 cm), matrix-induced autologous chondrocyte implantation (MACI) can be utilized, but requires 2 surgical procedures., Rationale: Osteochondral allograft transplantation is selected against other procedures for various reasons related to patient goals, preferences, and expectations. Typically, this procedure is favored over microfracture or autograft transplantation when the patient has a large lesion. Allograft transplantation might be favored over MACI because of patient preference for a single surgical procedure instead of 2., Expected Outcomes: To our knowledge, there are currently no Level-I or II trials comparing osteochondral allograft transplantation against other treatments for cartilage defects. There are, however, many systematic reviews of case studies and cohorts that report on outcomes. A 2016 review of 291 patients showed significantly improved patient-reported outcomes at a mean follow-up of 12.3 years 5,9 . The mean survival of grafts was 94% at 5 years and 84% at 10 years 5 . Overall, data on long-term survival are lacking because interest in and use of this procedure have only increased over the past few decades 10 . Finally, the rate of return to sport is promising, with the systematic review by Campbell et al. showing rates as high as 88% with an average time to return to sport of 9.6 months 11 . Postoperatively, patients can expect to immediately begin passive range of motion. Progression of heel-touch weight-bearing begins at 6 weeks, and patients may return to sport-specific activity after 8 months, as tolerated., Important Tips: Ensure that the allograft is of adequate quality and is size-matched prior to performing the surgical procedure.The cannulated cylinder should be perpendicular to both the host lesion and graft tissue in order to ensure symmetric estimations of size.Save subchondral bone shavings when preparing the host lesion. These can be utilized to take up space if your graft depth is not sufficient to fill the host defect.Utilize saline solution irrigation judiciously when reaming out the host tissue and graft plug., Acronyms & Abbreviations: AAROM = active-assisted range of motionACI = autologous chondrocyte implantationAP = anteroposteriorBMI = body mass indexCPM = continuous passive range of motionGlut/glutes = gluteal musclesHTO = high tibial osteotomyICRS = International Cartilage Repair SocietyLFC = lateral femoral condyleLTP = lateral tibial plateauMACI = matrix-induced autologous chondrocyte implantationMFC = medial femoral condyleMobs = mobilizationMRI = magnetic resonance imagingNSAIDs = non-steroidal anti-inflammatory drugsOAT = osteochondral allograft transplantationPROM = passive range of motionQuad = quadriceps musclesROM = range of motionSLR = straight leg raise., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSEST/A387)., (Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs)., Methods: 40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed., Results: In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively ( p  < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population ( p  < 0.0001). Resilience was associated with return to activity ( p  = 0.017). A past history of anxiety/depression was associated with lower resilience ( p  = 0.039)., Conclusions: This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.

Child abuse is common in the United States but is often undetected. The incidence of this form of abuse is difficult to quantify, but children with a history of abuse are at risk of chronic health conditions. Medical providers are in the unique position of triaging trauma patients and differentiating unintentional from abusive trauma, as well as having the important position of being a mandated reporter of abuse in all states. Obtaining a detailed history and screening for risk factors can help identify children at risk of abuse. Certain orthopedic injuries may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through medical provider education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. This review evaluates current literature regarding the orthopedic manifestations of child abuse in hopes of increasing medical provider awareness. IMPACT: Child abuse is common in the United States but often remains undetected. Medical professionals are in the unique position of evaluating trauma patients and identifying concerns for abusive injuries. Certain orthopedic injuries may raise concern for abuse triggering clinical suspicion and further workup or intervention., (© 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc.)

Background: High ankle sprains and syndesmotic injuries are commonly sustained by National Football League players, yet there is apaucity of literature reporting the incidence, risk factors and return to play (RTP) rates for these injuries. The purpose of this study is to examine the epidemiology and trends in incidence of high ankle sprains across 11 NFL seasons., Methods: Publicly available data from the 2009-2010 through 2019-20 seasons were reviewed to identify injuries and collect player characteristics and return to play. Incidence of high ankle injuries was calculated per 10,000 athlete-exposures. Linear regression was performed for incidence of injuries. Risk factors for failure to RTP were identified through multivariate logistic regression, controlling foryear of injury, player position, body mass index (BMI), age at injury, and years of experience before injury., Results: A total of 533 high ankle sprains were identified in 498 players at an average age of 25.8 ± 3.1 and average BMI of 31.8 ± 4.6. The annual incidence of high ankle sprains in the NFL increased at alinear rate of 0.067per 10,000 player exposures (R 2  = 0.3357) in 2009, to 1.75per 10,000 player exposures to 2.49 in 2019-20. Most injuries were in offensive players (304/533 injuries, 57.0%). Overall, 89.7% (478/533) of players returned to play; average RTP time was 80.5 ± 132.9 days. Defensive players had afaster RTP (68.1 ± 114.6 days) compared to offensive players (90.1 ± 144.8 days) (p = 0.084). Higher age at injury was found to increase the risk of failure to RTP (p = 0.0088)., Conclusion: RTP rate was high following high ankle sprain aamongNFL players at 90%, with an average recovery period of 11 weeks. Defensive players experience RTP faster than offensive players. Future studies are needed to determine performance outcomes following RTP, along with which patients might benefit from surgery.

Background: Lytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described., Purpose: To describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting., Study Design: Cohort study; Level of evidence, 3., Methods: A total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics., Results: A total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group ( P ≤ .001). Patients who required 2-stage grafting had more previous ACLRs ( P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure ( P ≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft ( P ≤ .008) and less likely to receive a soft tissue autograft ( P ≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) ( P ≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group., Conclusion: Tunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting.

Background: It is unclear if native glenohumeral anatomic features predispose young patients to instability and if such anatomic risk factors differ between males and females. The purpose of this study was to compare glenoid and humeral head dimensions between patients with a documented instability event without bone loss to matched controls and to evaluate for sex-based differences across measurements. The authors hypothesized that a smaller glenoid width and glenoid surface area would be significant risk factors for instability, whereas humeral head width would not., Methods: A prospectively maintained database was queried for patients aged <21 years who underwent magnetic resonance imaging (MRI) for shoulder instability. Patients with prior shoulder surgery, bony Bankart, or glenoid or humeral bone loss were excluded. Patients were matched by sex and age to control patients who had no history of shoulder instability. Two blinded independent raters measured glenoid height, glenoid width, and humeral head width on sagittal MRI. Glenoid surface area, glenoid index (ratio of glenoid height to width), and glenohumeral mismatch ratio (ratio of humeral head width to glenoid width) were calculated., Results: A total of 107 instability patients and 107 controls were included (150 males and 64 females). Among the entire cohort, there were no differences in glenoid height, glenoid width, glenoid surface area, humeral head width, or glenoid index between patients with instability and controls. Overall, those with instability had a greater glenohumeral mismatch ratio (P = .029) compared with controls. When stratified by sex, female controls and instability patients showed no differences in any of the glenoid or humerus dimensions. However, males with instability had a smaller glenoid width by 3.5% (P = .017), smaller glenoid surface area by 5.2% (P = .015), and a greater glenohumeral mismatch ratio (P = .027) compared with controls., Conclusion: Compared with controls, males with instability were found to have smaller glenoid width and surface area, and a glenoid width that was proportionally smaller relative to humeral width. In contrast, bony glenohumeral morphology did not appear to be a significant risk factor for instability among females. These sex-based differences suggest that anatomic factors may influence risk of instability for male and female patients differently., (Copyright © 2022 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Individual contributions of the rotator cuff (RC) and superior capsule (SC) to prevent superior translation of the humerus are not well understood., Purpose: To evaluate the relative contributions of the SC and RC to normal and pathologic shoulder biomechanics by determining their independent effects on superior humeral translation., Study Design: Controlled laboratory study., Methods: Twelve cadaveric shoulders were tested at 0º, 45º, and 90º of abduction under 5 conditions: intact RC/SC, RC sectioned first, SC sectioned first, both structures sectioned, and RC repair. Matched pairs were randomly assigned to the second or third testing condition (RC or SC sectioned first). Specimens were tested under 2 static conditions (40-N deltoid load [balanced load], 80-N deltoid load [superiorly directed load]) and 1 dynamic condition during active abduction. A mixed-design 2-way repeated-measures analysis of variance with Bonferroni adjustments was performed to compare testing conditions. Paired t tests were used to compare specimens in the intact state versus the repaired state. Significance was set at P < .05., Results: During balanced deltoid loading at 0° and 45º, there was significantly greater humeral translation when both structures were sectioned as compared with the intact state and with both isolated sectioned states ( P < .05 for all). No significant differences were observed between or within groups at 90º of abduction. These effects remained consistent with superiorly directed loading. Dynamic testing of both groups showed a significant increase in superior translation for specimens in which the RC was deficient versus the intact state ( P = .027), with no difference when the SC was sectioned. The RC repair state returned translation to values similar to the intact state at all abduction angles and loading conditions ( P > .05)., Conclusion: In this cadaveric study, the SC and RC played an important role in preventing superior humeral translation; however, dynamic testing suggested preferential contribution of the RC. RC repair was effective in preventing superior humeral translation, even with a sectioned SC at the level of the glenohumeral joint., Clinical Relevance: RC repair was effective in preventing superior humeral translation, even in the presence of a sectioned SC at the level of the glenohumeral joint in this cadaveric model. Our data lay the groundwork for future studies investigating the clinical effect of RC repair in an SC sectioned state.

Background: Electrocautery is a common surgical technique and is often used during shoulder arthroplasty to elevate or transect the subscapularis tendon. The relative amount of tissue damage caused by cautery as opposed to sharp transection is not currently known. The purpose of this study was to examine local tissue damage resulting from electrocautery vs. sharp transection with a scalpel. We hypothesized that the electrosurgical unit would cause higher collateral tissue damage and cell death compared with sharp transection., Methods: Twelve cadaveric ovine shoulders were randomized to either the electrosurgical or sharp transection group. The infraspinatus tendon was isolated, and a partial-thickness transection was made using either a monopolar electrosurgical device (Bovie) or No. 10 scalpel blade. Tendon explants were then visualized with confocal microscopy to evaluate tissue architecture. A live/dead assay was performed using microscopy imaging analysis software. Comparisons between Bovie and scalpel transection were made using the Mann-Whitney U test, and the cell death percentage at standardized distances from the transection site was compared between groups using a mixed-model analysis. Significance was defined at P < .05., Results: The cellular and tendon fibril architecture was well maintained beyond the scalpel transection site, whereas Bovie transection disrupted the architecture beyond its transection path. The percentage of dead cells in the Bovie group (74.9% ± 31.2%) was significantly higher than that in the scalpel group (27.6% ± 29.9%, P = .0004). Compared with the transection site, the cell death percentage after Bovie transection significantly declined at 2.5 mm whereas that after scalpel transection significantly declined at 1 mm from the transection site., Conclusion: There was a significantly higher dead cell percentage in the Bovie transection group, indicating extensive damage beyond the local incision site, compared with sharp transection. Electrosurgical transection of the ovine infraspinatus tendon ex vivo caused higher cell death and greater tissue architecture disruption compared with sharp scalpel transection., (Copyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Concussions have received national attention in collision sports such as football, soccer, and hockey, but less focus has been placed on basketball., Purpose: To determine return-to-play (RTP) and player performance in the first and second season after concussion in National Basketball Association (NBA) players., Study Design: Descriptive epidemiology study., Methods: An online database of publicly available NBA athlete injuries was queried for instances of "concussion" between 2010 and 2018. The age at injury, team, position, height, weight, body mass index, NBA experience, date of concussion, date of return, and seasons played postconcussion was recorded for each player. Regular-season statistics (games started, games played, minutes played, and player efficiency rating [PER]) were compiled for the season before, and 2 seasons immediately after, injury. Kaplan-Meier survivorship plots were computed for athlete RTP and retirement endpoints., Results: A total of 81 injuries were identified from 2010 to 2018, with a rate of 2.0 concussions per 100 player-years. Overall RTP was 100% after concussion, with nearly all (88%) returning in the season of injury; 12% of players experienced a season-ending concussion. RTP averaged 37.3 days after injury, varying widely (range, 2-291 days). Compared with preinjury season (78.0%), athletes played in significantly fewer overall games in the season of injury (36.6%; P < .0001), as well as 1 (69.5%; P = .0229) and 2 seasons postinjury (73.2%; P = .3192). PER scores were not significantly different across the study period. Each point increase in a player's preinjury PER score was associated with a 2.4% decrease in PER from the preinjury season to season of injury ( P = .0016) and a 3.1% decrease from preinjury to season after injury ( P = .0053). Each increasing year of age or year of experience was associated with 5% decline in PER score at 1 season after injury., Conclusion: NBA players had a high RTP after concussion, with most returning in the same season as the injury. Players sustaining concussions played significantly fewer games for at least 2 seasons after injury. Performance via PER did not change across the entire cohort; however, players with higher preinjury PER, and older players were more likely to sustain a greater decline in performance after injury., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.F.D. has received grant support from Arthrex, education payments from Medwest and Smith & Nephew, and hospitality payments from Medical Device Business Services and Zimmer Biomet. D.D.P. has received education payments from Medical Device Business Services. B.D.O. has received consulting fees from DePuy/Medical Device Business Systems, Linvatec, Musculoskeletal Transplant Foundation, and Vericel; honoraria from Vericel; royalties from Linvatec; and is a paid associate editor for The American Journal of Sports Medicine. 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.)

"Weekend warriors" are recreational athletes who compress their physical activity into 1-2 weekly exercise sessions. These individuals are generally older than the conventionally discussed athlete, and can live otherwise sedentary lifestyles that contribute to limited opportunities for regular exercise. The combination of high-energy physical activity with relative deconditioning, as well as older age and a potential history of competitive athletic play, can predispose these weekend warriors to a plethora of sports injuries. The shoulder and elbow are dynamically involved in a multitude of common recreational sports, such as baseball, softball, tennis, golf, and volleyball, and forms of casual exercise, such as swimming or climbing. A lack of proper conditioning and supplemental training in weekend warriors, particularly in comparison to elite athletes in these respective sports, can contribute to the development of both acute and chronic conditions of the shoulder and elbow. Inconsistency in physical activity can minimize the prominence of symptoms, leading patients to delayed presentations with injuries that severely impact their ability to engage in their exercise of choice, and therefore remain active at all. This narrative review aims to present the etiology, presentation, and management of common shoulder and elbow injuries that may afflict this patient population. Prevention strategies will also be discussed., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Despite advances in techniques designed to make arthroscopic sports medicine procedures simple, complications still arise in the operating room; even in the most trained hands. However, what marks a skilled surgeon is not just the ability to steer the ship amidst smooth seas, but a knack for getting out of trouble once things deviate from the set course. Each surgical case presents a unique challenge, and no 2 are the same. For this reason, a true expert surgeon must know how to deal with "complications" ranging from a mild swell to a raging storm. In this review we present strategies to prevent and navigate some of the most common, and fearsome complications a sports medicine surgeon may face during surgery. A great surgeon is one that acknowledges that throughout their career it is not a question of "if" these situations will arise, but "when"; and preparation is the key to success., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Baseball is unique in its multiple facets: pitching, hitting, base rounding, and fielding are distinct activities that require different athletic skills to perform at a high level. Likewise, these different aspects of the game can contribute to a multitude of varying injuries. While high-velocity overhead throwing, along with batting, can produce a plethora of upper extremity injuries that often garner attention, injuries to the lower extremity can severely impact a player's performance and ability to compete. The rigors of the short, explosive sprinting required for base running, as well as the dynamic movement required for fielding, create ample opportunity for lower limb injury, and even subtle pathology can affect a pitcher's ability to perform or increase their long-term risk of injury. Chronic injury from conditions such as femoroacetabular impingement and hip labral tears can also occur. The purpose of the present review is to summarize the relevant epidemiology, pathophysiology, and treatment of lower extremity injuries in baseball athletes, with reference to current research into the prevention and management of such injuries., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Knee braces continue to be a widely utilized piece of medical equipment, ranging from simple over the counter sleeves to more complex functional braces, with the ability to provide electrical stimulation to muscle groups. Despite their popularity, alternatives to knee braces exist for patients who find braces to be ineffective, uncomfortable, cumbersome, or overly expensive. While high-quality studies are lacking for modalities such as neoprene sleeves, compression stockings, and kinesiotaping, there is promising evidence that these interventions can confer an element of stability and pain relief for a variety of knee pathologies both with regard to acute and chronic injuries as well as in the postoperative rehabilitation period. While no "holy grail" exists for the ideal brace, or bracing alternative, it is important for providers to be aware of the options available to patients as well as the current evidence for these various modalities, so that the provider can best guide musculoskeletal care., Competing Interests: None declared., (Thieme. All rights reserved.)

The ability to return to sport (RTS) after articular cartilage injury is of vital importance to athletes. Discussing the likelihood of returning to sport with patients is necessary, yet patients should be informed of the heterogeneous nature of the variables associated with successful RTS and the methodologic limitations behind current RTS rate estimates. Patient-specific factors affecting RTS are numerous and, in most cases, their isolated effect on RTS rates have yet to be examined and will remain difficult to do so. The purpose of this review is to discuss current RTS rates, explore factors leading to successful RTS, and examine the variability in physical therapy protocols after cartilage procedures, including microfracture, osteochondral allograft transplantation (OCA), autologous chondrocyte implantation (ACI), and meniscal allograft transplantation (MAT). The senior author's postoperative protocols will also be presented, as with a discussion on using RTS as a metric of patient and procedural success. Overall, there is significant variation in reported RTS rates among procedures examined, and providers must continue managing patient expectations when discussing treatment options., (© 2021 The Authors.)

Rotator cuff tears are one of the most common causes of shoulder pain and dysfunction seen by orthopaedic surgeons. Although rotator cuff repair (RCR) has been shown to provide optimal outcomes, retear rates average roughly 60% and have been reported to exceed 90%. Retear after RCR is especially prevalent in patients with large, multitendon tears with poor tissue quality. Allograft augmentation of RCR may reinforce anatomically reparable tears, particularly in patients with poor tissue quality. Although various techniques of patch augmented RCR have been described, the procedure remains challenging. This Technical Note describes RCR augmented with acellular dermal allograft using the CuffMend system (Arthrex Inc, Naples, FL), which significantly decreases surgeon demand and helps avoid the pitfalls common with this procedure., (© 2021 The Authors.)

The lateral patellofemoral complex is an important stabilizer to medial and lateral displacement of the patella. Soft tissue abnormalities can range from pathologic tightness to laxity, presenting with symptoms related to patellar instability, anterior knee pain, or arthritis. Clinical evaluation should be performed to confirm patellar dislocation, assess the integrity of the lateral and medial soft tissues, and explore other pathoanatomic factors that may need to be addressed. Lateral retinacular lengthening is recommended over lateral release owing to the potential of iatrogenic medial instability with release, and a lateral patellofemoral ligament reconstruction can be performed to effectively treat medial instability., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Improper pitching mechanics are a risk factor for arm injuries. While 3-dimensional (3D) motion analysis remains the gold standard for evaluation, most pitchers and clinicians do not have access to this costly technology. Recent advances in 2-dimensional (2D) video technology provide acceptable resolution for clinical analysis. However, no systematic assessment tools for pitching analysis exist., Purpose: To determine the reliability of the Assessment of biomeChanical Efficiency System (ACES) screening tool using 2D video analysis to identify common biomechanical errors in adolescent pitchers., Study Design: Cross-sectional., Methods: Adolescent baseball pitchers underwent analysis using 2D video in indoor settings. Observational mechanics were collected using a 20-item scoring tool (ACES) based on 2D video analysis. Fleiss' kappa, interclass correlation coefficients (ICC), and frequencies were used to examine intra-/interrater reliability based on common pitching errors., Results: Twenty asymptomatic pitchers ages 12-18 years were included. Total ACES scores ranged from 1 to 13, normally distributed. ACES total score demonstrated excellent intra-rater reliability within each rater (ICC for rater 1 = 0.99 (95% CI; 0.98, 0.99); ICC for rater 2 = 0.94; 95% CI: 0.84, 0.97); ICC for rater 3 = 0.98 (95% CI: 0.96, 0.99)). There was excellent interrater reliability across the trials and raters (ICC = 0.91; 95% CI: 0.82, 0.96). The ACES tool demonstrated acceptable kappas for individual items and strong ICC 0.91 (95% CI: 0.82, 0.96) for total scores across the trials. Regarding identification of biomechanical errors, "front side position" was rated erroneous in 84/120 ratings (70%), stride length in 52/120 ratings (43.3%) and lead hip position in 53/120 ratings (44.2%)., Conclusions: The 20-item ACES scoring tool with 2D video analysis demonstrated excellent intra- and interrater reliability when utilized by raters of different musculoskeletal disciplines. Future studies validating 2D vs. 3D methodology are warranted before ACES is widely disseminated and utilized for adolescent pitchers. ACES is a practical and reliable clinical assessment tool utilizing 2D video analysis for coaches, instructors, and sports medicine providers to screen adolescent pitchers for common biomechanical errors., Level of Evidence: 3b., Competing Interests: The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Management of cartilage lesions of the knee can be complex, time consuming, and controversial, especially without a widely agreed upon "gold-standard" management. The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of cartilage lesions specified by Current Procedure Terminology (CPT) codes: 29877, chondroplasty; 29879, microfracture/drilling; 29866, arthroscopic osteochondral autograft; 29867, arthroscopic osteochondral allograft; 27412, autologous chondrocyte implantation (ACI); 27415, open osteochondral allograft; or 27416, open osteochondral autograft. Procedures were categorized as palliative (chondroplasty), microfracture/drilling , or restorative (arthroscopic osteochondral autograft; arthroscopic osteochondral allograft; ACI; open osteochondral allograft; or open osteochondral autograft). Linear regression was performed to determine the significance of yearly trend across each procedure.From 2007 to 2016, a total of 35,506 surgical procedures were performed. The average yearly incidence was 7.8 per 10,000 patients. Overall, palliative techniques (chondroplasty) were more common (1.8:1 ratio for chondroplasty to microfracture and 34:1 ratio chondroplasty to restoration procedure). There was a trend of decreasing incidence of palliative procedures seen by a significant decrease in the ratio of palliative to microfracture /restorative procedures of 0.2512 each year from 2007 to 2016 ( p  < 0.001). This decrease followed a linear trend ( R 2  = 0.9123). In 2013, the number and incidence of the palliative procedures declined below that of microfracture procedures, with microfracture being most common from 2013 to 2016. Palliative chondroplasty was no longer the most commonly performed procedure for cartilage lesions in the United States from 2007 to 2016, as more surgeons opted for microfracture procedures instead. Restorative procedures (ACI, osteochondral autograft transfer system) remained unchanged over the study period, in accordance with the sports medicine literature; however, early functional outcomes studies do show the equivalency and in some cases superiority compared with microfracture. This is Level III study., Competing Interests: B.D.O. is a consultant for Mitek, and MTF/CONMED. B.D.O. is an Editor for AJSM. D.S.Y. is a consultant for Stryker, Spineart, and Orthofix and has received clinical or research support from Orthofix, and receives royalties from Springer., (Thieme. All rights reserved.)

Background: Accurate assessment of osseous morphology is imperative in the evaluation of patients with femoroacetabular impingement syndrome (FAIS) and hip dysplasia. Through use of computed tomography (CT), 3-dimensional (3D) reconstructed hip models may provide a more precise measurement for overcoverage and undercoverage and aid in the interpretation of 2-dimensional radiographs obtained in the clinical setting., Purpose: To describe new measures of acetabular coverage based on 3D-reconstructed CT scan bone models., Study Design: Cross-sectional study; Level of evidence, 3., Methods: Preoperative CT scans were acquired on the bilateral hips and pelvises of 30 patients before arthroscopic surgical intervention for FAIS. Custom software was used for semiautomated segmentation to generate 3D osseous models of the femur and acetabulum that were aligned to a standard coordinate system. This software calculated percentage of total acetabular coverage, which was defined as the surface area projected onto the superior aspect of the femoral head. The percentage of coverage was also quantified regionally in the anteromedial, anterolateral, posteromedial, and posterolateral quadrants of the femoral head. The acetabular clockface was established by defining 6 o'clock as the inferior aspect of the acetabular notch. Radial coverage was then calculated along the clockface from the 9-o'clock to 5-o'clock positions., Results: The study included 20 female and 10 male patients with a mean age of 33.6 ± 11.7 years and mean body mass index of 27.8 ± 6.3. The average percentage of total acetabular coverage for the sample was 57% ± 6%. Acetabular coverages by region were as follows: anteromedial, 78% ± 7%; anterolateral, 18% ± 7%, posterolateral, 33% ± 13%, and posteromedial, 99% ± 1%. The acetabular coverage ranged from 23% to 69% along the radial clockface from 9 to 5 o'clock., Conclusion: This study demonstrated new 3D measurements to characterize acetabular coverage in patients with FAIS and elucidated the distribution of acetabular coverage according to these measurements., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.F.D. has received education payments from Medical Device Business Services and hospitality payments from Zimmer Biomet. F.L. is an employee of Stryker. J.C. has received education payments from Arthrex and Smith & Nephew; consulting fees from Arthrex, DePuy, Linvatec, Ossur, and Smith & Nephew; nonconsulting fees from Linvatec; and hospitality payments from Medwest Associates and Stryker. S.J.N. has received research support from Allosource, Arthrex, Athletico, DJO, Linvatec, Miomed, Smith & Nephew, and Stryker; education payments from Elite Orthopedics; consulting fees from Ossur and Stryker; and royalties from Ossur, Stryker, and Springer. 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: Several fixation methods have been reported for the operative treatment of tibial eminence fractures. Previous biomechanical studies have demonstrated that suture fixation may be a stronger construct; however, the maturity status of these specimens was not scrutinized., Purpose: To examine if suture fixation remains a biomechanically superior fixation method to screw fixation in both skeletally mature and immature specimens., Study Design: Controlled laboratory study., Methods: Sixteen total matched porcine (Yorkshire) knees (8 skeletally immature knees and 8 skeletally mature knees) were procured, and a standardized tibial eminence fracture was created. In each age-matched group of knees, 4 knees underwent randomization to fixation with 2 screws while 4 knees were randomized to fixation using a dual-suture technique. Once fixation was complete, the specimens underwent cyclic loading (200 cycles) in the anteroposterior plane of the tibia and load-to-failure testing, both with the knee positioned at 30° of flexion. Relevant measurements were recorded, and data were analyzed., Results: Among mature specimens, load to failure was 1.9 times higher in the suture fixation group compared with the screw fixation group (1318.84 ± 305.55 vs 711.66 ± 279.95 N, respectively; P = .03). The load to failure was not significantly different between the groups in immature specimens (suture: 470.00 ± 161.91 N vs screw: 348.79 ± 102.46; P = .08)., Conclusion: These findings suggest that suture fixation may represent a better construct choice for fixation of tibial eminence fractures in the skeletally mature population. However, in the skeletally immature population, fixation with screws or suture may be equivalent. Displacement after cyclic loading did not appear to differ by fixation method, nor did stiffness., Clinical Relevance: A stronger fixation construct may be beneficial and allow for earlier range of motion to help potentially decrease postoperative stiffness. Clinical studies are warranted to see if these results may be replicated in humans., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding for this study was obtained from the Rhode Island Orthopedic Foundation and the National Institutes of Health (NIGMS P30-GM122732 to the Bioengineering Core of the COBRE Centre for Skeletal Health and Repair). A.P.T. has received hospitality payments from Stryker. B.C. has received grant support from Arthrex and education payments from Medical Device Business Services and Smith & Nephew. B.D.F. has received education payments from Smith & Nephew, consulting fees from New York R&D Center for Translational Medicine and Therapeutics, and royalties from Springer; he is a paid associate editor for The American Journal of Sports Medicine; and he is the founder of Miach Orthopaedics, and his spouse has an equity interest and serves as a consultant for the company. B.D.O. has received research support from Arthrex, Mitek, and MTF; consulting fees from DePuy, ConMed, MTF, Miach, and Vericel; royalties from ConMed; and honoraria from Vericel; he is a paid associate editor for The American Journal of Sports Medicine. 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.)

Meniscal root repair is becoming more common with increasing knowledge regarding the function of the meniscal root and its role in long-term joint preservation, as well as improved surgical techniques and instrumentation. Despite this, adequate visualization of the posterior horn of the medial meniscus may be challenging, particularly in those with tight medial compartments. Instrument handling and attempt to visualize and repair the meniscal tear may lead to iatrogenic chondral injuries in these instances. We describe our preferred technique for improved visualization via mini-open release of the distal medial collateral ligament that allows for increased joint distension, increased access to the posterior horn of the medial meniscus, and the ability to repair the released medial collateral ligament., (© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.)

Background: The influence of femoral torsion on clinically significant outcome improvement after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has not been well-studied., Purpose: To quantify femoral torsion in FAIS patients using magnetic resonance imaging (MRI) and explore the relationship between femoral torsion and clinically significant outcome improvement after hip arthroscopy., Study Design: Cohort study; Level of evidence, 3., Methods: Included were patients who underwent hip arthroscopy for FAIS between January 2012 and August 2018 and had 2-year follow-up and preoperative MRI scans containing transcondylar slices of the knee. Participants were categorized as having severe retrotorsion (SR; <0°), normal torsion (NT; 0°-25°), and severe antetorsion (SA; >25°) as measured on MRI. Patient-reported outcomes (PROs) included the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, modified Harris Hip Score, 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction. Achievement of Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were analyzed among cohorts., Results: Included were 183 patients (SR, n = 13; NT, n = 154; SA, n = 16) with a mean age, body mass index, and femoral torsion of 30.6 ± 12.1 years, 24.0 ± 4.4 kg/m 2 , and 12.55° ± 9.58°, respectively. The mean torsion was -4.5° ± 2.6° for the SR, 12.1° ± 6.8° for the NT, and 31.0° ± 3.6° for the SA group. There were between-group differences in the proportion of patients who achieved PASS and SCB on the iHOT-12, pain VAS, and any PRO ( P < .05). Post hoc analysis indicated that the SA group achieved lower rates of PASS and SCB on the iHOT-12 and pain VAS, and lower rates of PASS on any PRO versus the SR group ( P < .05); the SR group achieved higher rates of PASS and SCB on pain VAS scores versus the NT group ( P = .003)., Conclusion: The orientation and severity of femoral torsion during hip arthroscopy influenced the propensity for clinically significant outcome improvement. Specifically, patients with femoral retrotorsion and femoral antetorsion had higher and lower rates of clinically significant outcome improvement, respectively., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.F.D. has received education payments from Medical Device Business Services and Zimmer Biomet. J.C.W. has received consulting fees from DePuy, speaking fees from Synthes GmbH, honoraria from Allergan, and hospitality payments from Zimmer Biomet. S.J.N. has received education payments from Elite Orthopedics; research support from Allosource, Athletico, DJO, Linvatec, Miomed, Ossur, Smith & Nephew, and Stryker; consulting fees from Ossur and Stryker; and royalties from Ossur, Springer, and 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.)

Background: A paucity of literature exists regarding trajectories of functional and sports-specific recovery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS)., Purpose: To determine if subgroups of patients exist based on the recovery trajectory of patient-reported outcomes (PROs) after hip arthroscopy for FAIS in the short-term period and to determine clinical predictors for these subgroups of patients., Study Design: Case-control study; Level of evidence, 3., Methods: A prospectively maintained repository was queried for patients who had undergone primary hip arthroscopy for the treatment of FAIS between January 2012 and May 2018. Patients who completed the preoperative, 1-year, and 2-year International Hip Outcome Tool-12 (iHOT-12) or the Hip Outcome Score Sports Subscale (HOS-SS) were included. The latent class growth analysis (LCGA) and growth mixture models (GMMs) were used to identify subgroups of patients based on trajectories of recovery for the iHOT-12 and the HOS-SS utilizing preoperative, 1-year, and 2-year follow-ups. LCGA and GMM models using 1 to 6 classes for each PRO were performed, and the best-fit model for each PRO was selected. After final model selection, a multivariable multinomial logistic regression was performed, with the largest class being the reference group to determine clinical predictors of subgroup membership., Results: A total of 443 and 556 patients were included in the iHOT-12 and HOS-SS analyses, respectively. For the iHOT-12, we identified the following 3 subgroups: early progressors (70%), late regressors (22.3%), and late progressors (7.7%). Predictors of late regression were workers' compensation status, psychiatric history, preoperative chronic pain, and lower preoperative iHOT-12 scores; and late progressors were less likely to participate in sports. For the HOS-SS, we identified the following 4 subgroups: early progressors (47.7%), late regressors (17.4%), late progressors (6.8%), and steady progressors (28.1%). Predictors of less favorable recovery trajectories (late regressors and late progessors) were older age, male sex, back pain, psychiatric history, preoperative chronic pain, greater alpha angle, and lower preoperative HOS-SS scores., Conclusion: Using the growth mixture modeling, 3 natural courses of health-related quality of life (early progression, late regression, and late progression) and 4 natural courses of recovery of athletic function (steady progression, late regression, late progression, and early progression) were identified. Preoperative psychiatric conditions, chronic pain, workers' compensation status, and lower iHOT-12 scores were predictive of less than favorable trajectories of recovery according to the iHOT-12, and male sex, older age, back pain, preoperative narcotic use, and lower preoperative HOS-SS were predictors of less favorable recovery trajectories according to the HOS-SS.

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy., Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair., Study Design: Cohort study; Level of evidence, 3., Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary labral repair and who had preoperative and minimum 2-year postoperative outcome scores. Patients diagnosed with concomitant partial LT tear were identified and matched 1:3 according to age, sex, and body mass index (BMI) to patients without LT pathology. The following clinical outcomes were compared between groups: modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Subscale, International Hip Outcome Tool, and visual analog scale for pain and satisfaction. Achievement of the minimal clinically important difference and patient acceptable symptomatic state was also compared between groups., Results: This study included 124 patients with FAIS with labral tear and concomitant partial LT tear and 372 patients with labral tear and no LT pathology. The age, BMI, and sex of the matched cohort were 38.0 ± 12.0 years (mean ± SD), 24.3 ± 3.6 kg/m 2 , and 62.0% female, respectively. No significant difference in age, BMI, sex, workers' compensation status, or duration of pain was observed at baseline. Analysis of radiographic parameters indicated that patients who underwent isolated labral repair had a lower preoperative Tönnis angle (4.8° ± 4.4° vs 6.3° ± 5.4°; P = .006). There were no significant differences between groups on any pre- or postoperative outcome measure, and there were no significant differences in the proportion of patients who achieved the minimal clinically important difference or patient acceptable symptomatic state on any outcome measure., Conclusion: Patients with labral tear and concomitant partial LT tear experienced similar preoperative scores and achieved similar outcomes as patients with isolated labral tears after hip arthroscopy., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: S.F.D. has received education payments from Medical Device Business Services and Zimmer Biomet. A.B.W. has received consulting fees from Stryker and Arthrex. D.S.C. has received education payments from Pylant Medical; consulting fees from Biomet, DePuy, and Linvatec; nonconsulting fees from Wright Medical and Biomet; royalties from Linvatec; and hospitality payments from Arthrex, Smith & Nephew, and Stryker. J.J.C. has received education payments from Mid-Atlantic Surgical and Pylant Medical and consulting fees, nonconsulting fees, and royalties from Arthrex. D.K.M. has received consulting fees from Zimmer Biomet, nonconsulting fees from Pacira, and royalties from Smith & Nephew and Zimmer Biomet. J.P.S. has received education payments from Liberty Surgical and consulting fees from Stryker. B.R.K. has received consulting fees from Kilo and speaking fees from Performance Dynamics. S.J.N. has received research support from Allosource, Arthrex, Athletico, DJO, Linvatec, Miomed, Smith & Nephew, and Stryker; education payments from Elite Orthopaedics; consulting fees from Ossur and Stryker; and royalties from Springer and 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.)

The acetabular labrum is essential for stability during physiologic motion of the hip. Labral repairs frequently are attempted in cases of primary tears, although labral reconstruction is an important alternative in the revision setting or in the primary setting when the tissue is unsalvageable. Labral reconstruction has been shown to restore the hip's suction-seal and fluid pressurization to that of the premorbid state, and cohort studies have demonstrated significantly improved patient-reported outcomes at midterm follow-up. Notably, the cost is of consideration during any reconstruction, and techniques have been described using both allograft and autograft sources. Autograft sources include the iliotibial band, ligamentum teres, gracilis tendon, and hip capsule. A previously described technique using the capsule was noted to hinder routine capsular closure. We present an alternative method for labral reconstruction using hip capsular tissue that is easily performed and allows for routine capsular closure., (© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.)

Purpose: To evaluate the agreeability between the mobile application-based International Hip Outcome Tool-12 (iHOT-12) survey with the paper version, as well as compare the time it takes patients each of the versions, and patient preferences between the two., Methods: Patients seen with symptomatic femoroacetabular impingement syndrome were prospectively enrolled in February 2019 and completed both the paper and application-based iHOT-12, in randomized order. Outcomes scores and time to completion were recorded for each version, and patients were also asked which they preferred. Intraclass correlation coefficient was calculated to assess for absolute agreement between the 2 versions. Bland-Altman plots were constructed to evaluate the agreeability between paper and application-based iHOT-12 scores. Bland-Altman plots were evaluated to identify systematic bias and data stratification was performed to identify sequence bias between the application and paper-based collection modalities., Results: Twenty-nine patients (aged15-56 years) completed both the paper and application-based versions of the iHOT-12. Between the application-based and paper versions, the intraclass correlation coefficient was 0.98, and Bland-Altman analysis showed agreement without bias between versions. There was no sequence bias. Accounting for completion order, the application-based iHOT-12 was faster for patients when compared to the paper version (61.4 ± 20.3 vs 71.9 ± 23.6 seconds, P  = .02). Twenty-two patients reported a version preference where 19 of 22 (86%) chose application-based ( P < .001)., Conclusions: The application-based iHOT-12 demonstrated absolute agreement with the paper iHOT-12, and is faster for patients to complete. Patients preferred using the application-based iHOT-12 over the paper-based version. Application-based PROs allow for collection of patient data at more frequent time points, which may be helpful in tracking the recovery progress of patients and predicting outcomes., Clinical Relevance: As electronic-based outcome surveys become more common, it is important to know how the results may differ from traditional paper-based surveys., (© 2021 by the Arthroscopy Association of North America. Published by Elsevier Inc.)

Background: Comminuted inferior pole patellar fractures can be treated in numerous ways. To date, there have been no studies comparing the biomechanical properties of transosseous tunnels versus suture anchor fixation for partial patellectomy and tendon advancement of inferior pole patellar fractures., Hypothesis: Suture anchor repair will result in less gapping at the repair site. We also hypothesize no difference in load to failure between the groups., Study Design: Controlled laboratory study., Methods: Ten cadaveric knee extensor mechanisms (5 matched pairs; patella and patellar tendon) were used to simulate a fracture of the extra-articular distal pole of the patella. The distal simulated fracture fragment was excised, and the patellar tendon was advanced and repaired with either transosseous bone tunnels through the patella or 2 single-loaded suture anchors preloaded with 1 suture per anchor. Load to failure and elongation from cycles 1 to 250 between 20 and 100 N of force were measured, and modes of failure were recorded. Statistical analysis was performed using a paired 2-tailed Student t test., Results: The suture anchor group had less gapping during cyclic loading as compared with the transosseous tunnel group (mean ± SD, 6.83 ± 2.23 vs 13.30 ± 5.74 mm; P = .047). There was no statistical difference in the load to failure between the groups. The most common mode of failure was at the suture-anchor interface in the suture anchor group (4 of 5) and at the knot proximally on the patella in the transosseous tunnel group (4 of 5)., Conclusion: Suture anchors yielded similar strength profiles and less tendon gapping with cyclic loading when compared with transosseous tunnels in the treatment of comminuted distal pole of the patellar fractures managed with partial patellectomy and patellar tendon advancement., Clinical Relevance: Suture anchors may offer robust repair and earlier range of motion in the treatment of fractures of the distal pole of the patella. Clinical randomized controlled trials would help clinicians better understand the difference in repair techniques and confirm the translational efficacy in clinical practice., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: D.F.W. has received hospitality payments from Stryker. B.D.O. is a paid consultant for Medical Device Business Systems, MTF/ConMed, Mitek, and Linvatec; has received honoraria from Vericel; and is a paid associate editor for The American Journal of Sports Medicine. S.F.D. has received hospitality payments from Medical Device Business Services and Zimmer Biomet. 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.)