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Purpose: The purpose of this study was to determine if patients who have undergone prior open or arthroscopic shoulder surgery and develop distal mononeuropathy (DMN) achieve the same clinical benefit after nerve release compared with those who did not have a prior shoulder procedure., Methods: Patients were identified by Current Procedural Terminology code for shoulder arthroplasty, shoulder stabilization, and rotator cuff repair and if they had an ensuing nerve release (cubital or carpal tunnel) within 2 years of shoulder surgery. Another cohort that underwent nerve release surgery for DMN with no prior history of shoulder surgery was identified and subsequently matched to the first cohort by a 3:1 (control:case) ratio. Patients were included if they were over the age of 18 years. Chart reviews and surveys stored using REDCap were used to collect demographics, surgical history, EMG/nerve conduction velocity results, postoperative symptoms, and patient-reported outcomes with a minimum 2-year follow-up., Results: In total, 120 patients were included in this analysis (28 cases, 92 controls). The most common nerve release for DMN across both cohorts was open carpal tunnel release. Following nerve release, the case group had more postoperative persistent numbness/tingling than the control group. Both groups were similar with regard to postoperative pain, weakness, or patient-reported outcome measures. Residual postoperative numbness following nerve release was more likely to occur in the forearm for the case group than the control group., Conclusions: Patients with a history of arthroscopic rotator cuff repair and reverse total shoulder replacement shoulder surgery before the presentation of DMN are more likely to experience persistent numbness or tingling after nerve release surgery as well as experience symptoms in the forearm than those without prior shoulder surgery., Type of Study/level of Evidence: Symptom prevalence retrospective study III., Competing Interests: Conflicts of Interest No benefits in any form have been received or will be received related directly to this article., (Copyright © 2024 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Objective: Despite an equal willingness to participate in clinical trials, there is evidence that several minority populations are systematically under-represented in studies. One potential cause and frequently used exclusionary criterion in orthopedic trials is patients with active workman's compensation (WC) insurance claims. The purpose of this study is to determine demographic differences in patients undergoing arthroscopic rotator cuff repair with commercial and government insurance vs workers compensation claims., Methods: This was a retrospective review of patients who underwent primary arthroscopic rotator cuff repair at a single institution in the northeastern United States from 2018 to 2019. Patients undergoing revision cases were excluded. Chart review was used to extract demographic data such as age, gender, insurance, and reported race., Results: A total of 4553 patient records were reviewed and included. There were 742 WC patients and 3811 non-WC patients. Two hundred and forty-four patients did not report their race. Overall, WC patients differed from non-WC with respect to race ( P  < 0.001). One hundred and eleven (15.0%) of WC and 293 (7.7%) non-WC patients reported being 'Black' or 'African American' ( P  = 0.002). This compares to 368 (49.6%) WC and 2788 (73.2%) non-WC patients who reported 'White' ( P  < 0.001). About 16.8% of WC patients were identified as 'Hispanic or Latino,' compared to 5.2% of non-WC ( P  < 0.001)., Conclusion: African American and Hispanic/Latino patients are over-represented in workman's compensation patient populations relative to non-workman's compensation. Conversely, white patients are over-represented in non-WC patient populations, which serve as the basis for the majority of clinical study populations. Excluding workman's compensation patients from clinical trials may lead to an underrepresentation of African American and Hispanic/Latino patient populations in orthopedic clinical trials. In doing so, the generalizability of the results of rotator cuff repair clinical outcomes research to all races and ethnicities may be compromised.

Purpose: To compare osteochondral defect size measurements and characteristics across magnetic resonance imaging (MRI) and arthroscopy and at the time of osteochondral allograft (OCA) transplantation or autologous chondrocyte implantation (ACI)., Methods: Patients who underwent ACI and OCA transplantation at a single institution between 2015 and 2019 were retrospectively identified. Patients were excluded if they had severe osteoarthritis, MRI scans were not available for review, surgical records did not include defect sizing necessary for analysis, or operative reports were not available. Osteochondral lesion characteristics including size were collected preoperatively by MRI and arthroscopy and at the time of definitive open surgical intervention. Subgroup analysis was performed comparing measurement techniques depending on the corrective surgical approach used, as well as depending on the mechanism of chondral injury, to determine whether these factors had any effect on the ability of arthroscopy or MRI to predict graft size., Results: Overall, 136 chondral lesions were addressed, with restoration procedures in 117 patients (mean age, 32.5 years). The average difference between the final graft size and the lesion area measured with index arthroscopy was 116 mm 2 , whereas the average difference between the final graft size and the lesion size measured with preoperative MRI was 182 mm 2 ( P < .001). Depending on surgical technique, measurements with MRI were more similar to the final graft size when a patient underwent OCA transplantation versus ACI ( P  = .007). Depending on the mechanism of injury, MRI measurements of lesions were closer to the graft area when lesions resulted from trauma ( P  = .047)., Conclusions: Chondral lesion size as determined by preoperative MRI is less accurate than arthroscopic measurement. The mechanism of injury leading to chondral damage and degree of damage may influence the ability of MRI and arthroscopy to accurately measure chondral lesions and predict the final graft size used in surgical correction., Level of Evidence: Level III, retrospective cohort study., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: B.S.T. receives funding grants from GID; reports a consulting or advisory relationship with DePuy Synthes, Mitek, DePuy, and Pacira BioSciences; receives lecture fees from Mitek and DePuy; owns equity or stocks in Johnson & Johnson; and receives nonfinancial support from Mitek and Knee Creations. K.B.F. reports a consulting or advisory relationship with DePuy Synthes, Vericel, and Innocoll Biotherapeutics and reports board membership with 10.13039/100011549American Orthopaedic Society for Sports Medicine. All other authors (A.J.H., A.R.P., H.D., M.P.C., A.L., D.F., J.P.) declare 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.

Background: Since various social determinants of health (SDOH) have the potential to impact the utilization and postoperative outcomes of rotator cuff repair (RCR), a review of the literature is warranted. Therefore, the purpose of this systematic review was to evaluate the effects of SDOH on RCR utilization and postoperative outcomes in order to recognize external factors that may influence patients' access to RCR and optimal clinical outcomes., Methods: Search terms related to RCR, utilization, outcomes, and SDOH were used to identify studies that reported associations between any SDOH (as defined by the World Health Organization) and RCR utilization, access, cost, or postoperative outcomes. Articles that did not isolate RCR or did not evaluate an SDOH were excluded. Nonrandomized studies were evaluated for study quality using the Methodological Index for Nonrandomized Studies score. Due to the heterogeneity of the reported data, only qualitative analysis was possible., Results: Overall, 842 articles were considered for inclusion and 14 studies were included in qualitative analysis. The average Methodological Index for Nonrandomized Studies score of included studies was 14.1 ± 5.0. The SDOH most frequently evaluated were insurance status and race/ethnicity. Non-White race is associated with lower odds of surgery and physical therapy (PT) utilization, as well as delayed treatment. Similarly, public insurance is associated with lower PT and surgery utilization rates and decreased acceptance for postoperative PT. Postoperatively, public insurance is associated with worse patient-reported outcome scores and lower return to work rates., Conclusion: Various SDOH can influence access, utilization, and outcomes of RCR. Orthopedic surgeons should be aware of how factors of race and insurance type can influence a patient's treatment and recovery after RCR., (© 2024 The Author(s).)

Background: The purpose of this study was to evaluate the effects of different quantities of prescribed opioid tablets on patient opioid utilization, postoperative pain and function, and satisfaction after anterior cruciate ligament reconstruction (ACLR)., Methods: This was a prospective, randomized trial enrolling patients undergoing primary ACLR. Patients were assigned to 1 of 3 prescription groups: 15, 25, or 35 tablets containing 5-mg oxycodone. Patients completed visual analog scale (VAS) pain and medication logs, opioid medication satisfaction surveys, and International Knee Documentation Committee (IKDC) questionnaires postoperatively., Results: Among the 180 patients included in the analysis, there was no significant difference in VAS pain scores (p > 0.05), IKDC scores (p > 0.05), morphine milligram equivalents (MMEs) (p = 0.510) consumed, or patient satisfaction with regard to pain control (p = 0.376) between treatment groups. Seventy-two percent of opioids were consumed in the first 3 days postoperatively, and 83% of patients in the 15-tablet cohort felt that they received the "right amount" of or even "too many" opioids., Conclusions: The prescription of 15 opioid tablets resulted in equivalent pain control, patient satisfaction, and short-term functional outcomes as prescriptions of 25 or 35 opioid tablets after ACLR. Lower prescription quantities of opioid medication may provide equivalent postoperative pain and help to minimize the number of unused opioid doses at risk for possible diversion after ACLR., Level of Evidence: Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/H859 )., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Study Design: Retrospective Cohort Study., Objectives: The objective of this study was to assess the impact of diet liberalization on short-term outcomes in patients undergoing anterior interbody lumbar fusion (ALIF)., Methods: A retrospective review was performed for patients undergoing ALIF at our tertiary care center institution from 2010 to 2022. Electronic medical records were reviewed for demographics, surgical characteristics, and 90-day postoperative outcomes., Results: We included 515 patients in this study with 102 patients receiving a full diet on the same day as their operation. All other patients had a delay of at least 1 day (average 1.6 days) until a full diet was provided. This group was found to have a higher rate of postoperative ileus (10.2% vs 2.9%) and urinary retention (16.0% vs 3.9%). The readmission rate and percent of patients presenting to the emergency department within 90 days postoperatively were similar. On multivariate regression analysis, same-day, full-diet patients had decreased odds of developing urinary retention (OR = .17) and a shorter length of hospital stay (Estimate: -.99). Immediate full diet had no impact on the development of ileus (OR: .33)., Conclusions: An immediate postoperative full diet following an anterior approach to the lumbar spine was not found to be associated with an increased risk of postoperative ileus in patients deemed appropriate for early diet liberalization. Moreover, an early full diet was found to reduce length of hospitalization and risk of postoperative urinary retention. Reconsideration of postoperative diet protocols may help optimize patient outcomes and recovery., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Central sensitization (CS) involves amplified central nervous system (CNS) signaling and several biochemical changes which lead to pain hypersensitivity. Data on the effects of CS are limited in orthopaedics and has been associated with reported levels of postoperative pain after hip arthroscopy., Methods: Patients over the age of 18 who underwent hip arthroscopy with preoperative as well as 2-year postoperative functional outcome scores were identified through the Multicenter Arthroscopic Study of the Hip (MASH) database. Patient demographics, procedure information, as well as patient reported outcome measures (PROMs) were collected along with CS index scores., Results: 34 patients met inclusion criteria for our study. Preop MCS and iHOT as well as Postop MCS, showed moderate to strong negative correlations with CSI scores (-0.607, -0.573, and -0.756, respectively). VAS, PCS and MSC scores were significantly different preoperatively to postoperatively, ensuring alleviation of pain after hip arthroscopy. Subgroup analysis by stratifying CSI scores into 1 SD below the mean, within 1 SD of the mean, and above 1 SD showed significant differences across all 3 groups for preoperative MCS (p < 0.001), postoperative MCS (p = 0.001), and PSEQ2 (p = 0.015). Postoperative VAS pain approached significance but did not meet criteria of p < 0.05 (p = 0.062)., Conclusion: Increased postoperative CSI scores directly correlated with decreased preoperative and postoperative MCS scores and worse preoperative resilience. Recognizing the influence of CS on pain perception and resilience on coping with adversity in the recovery period may guide orthopaedic surgeons in developing comprehensive treatment plans to continue to improve surgical outcomes in hip arthroscopy., Level of Evidence: IV., (© 2023 Professor P K Surendran Memorial Education Foundation. Published by Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to evaluate patient outcomes and satisfaction after arthroscopic portal closure with absorbable versus nonabsorbable sutures after knee arthroscopy., Methods: Patients undergoing primary knee arthroscopy were identified during procedure scheduling. Exclusion criteria included revision procedures, concomitant ligament reconstruction, or meniscal repair surgery. Before surgery, enrolled patients were randomly assigned to undergo closure with either 3-0 Monocryl absorbable or 3-0 nylon non-absorbable sutures. Postoperative evaluation at 2, 6, and 12 weeks included a Visual Analogue Cosmesis scale, a 10-point visual analogue scale (VAS) for pain, patient scar assessment, and customized questionnaire assessing scar satisfaction., Results: Between January 2019 and August 2022, 247 were included for analysis: 145 in the absorbable group and 129 in the non-absorbable group. There was no significant difference between groups in terms of age, sex, body mass index, race, smoking status, or laterality of procedure. Patients in the nonabsorbable group reported higher overall satisfaction at week 6 follow-up (9.12 ± 1.85 vs 8.44 ± 2.49, P  = .019) and week 12 follow-up (9.13 ± 1.76 vs 8.54 ± 2.50, P  = .048). There was no difference in pain, swelling, itching, numbness, incisional pain, or burning at any time. Patients in the nonabsorbable group observed more skin discoloration at 2 weeks (3.00 ± 2.33 vs 2.41 ± 1.80, P  = .026) and 6 weeks (3.74 ± 2.82 vs 2.98 ± 2.45, P  = .032) follow-up with no significant difference at 12 weeks., Conclusion: In this study, patients were more satisfied with nonabsorbable sutures for portal wound closure after knee arthroscopy despite early reporting of increased skin discoloration relative to absorbable sutures., Level of Evidence: Level I, randomized controlled trial., (© 2023 The Authors.)

Background: Orthopaedic surgery has seen improvement in its representation of women, whereas the representation of racial/ethnic minorities has remained stagnant over the past decade. Overall, the surgical field lags behind other specialties in sex and racial/ethnic parity. Although demographic disparities within orthopaedics have been analyzed for both residents and faculty members, information for adult reconstruction fellows remains limited., Methods: Sex and race/ethnicity demographics for adult reconstruction orthopaedic fellowship matriculants were collected via a database published by the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021. Statistical analyses, including descriptive statistics and significance testing, were performed., Results: During the 14-year time frame, men trainees remained high with an overall average percentage of 88% and demonstrated increasing representation (P trend = .012). White non-Hispanics, Asians, Blacks, and Hispanics represented on average 54%, 11%, 3%, and 4%, respectively. White non-Hispanics (P trend = .039) and Asians (P trend = .030) saw increasing and decreasing representation, respectively. Women, Blacks, and Hispanics remained relatively stagnant throughout the observation period as no trends were appreciable (P trend >.05, each)., Conclusion: Using publicly available demographic data from the Accreditation Council for Graduate Medical Education (ACGME) from 2007 to 2021, we found relatively limited progress in the representation of women and those from traditionally marginalized groups seeking additional training in adult reconstruction. Our findings mark an initial step in measuring the demographic diversity among adult reconstruction fellows. Further research is needed to ascertain specific factors likely to attract and retain members from minoritized groups into orthopaedics., (Published by Elsevier Inc.)

Study Design: Descriptive., Objective: The objective of this study is to analyze trends in racial, ethnic, and gender diversity in orthopedic spine surgery fellowship trainees., Summary of Background Data: Orthopedic surgery has consistently been labeled as one of the least diverse fields in Medicine. Although some effort has been made to combat this in recent years at the residency level, it is uncertain whether spine fellowships have had any changes in fellow demographics., Materials and Methods: Fellowship demographic data were collected through the Accreditation Council for Graduate Medical Education. Data collected included gender (male, female, and not reported) and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007 to 2008 to 2020 to 2021. A χ 2 test for trend (Cochran-Armitage test) was done to determine whether there was a significant change in percentages of each race and gender during the study period. The results were considered statistically significant at P <0.05., Results: White, Non-Hispanic males represent the largest proportion of orthopedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in the representation of any race or gender of orthopedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be under-represented in orthopedic spine fellowship., Conclusions: Orthopedic spine surgery fellowship programs have not made substantial progress in diversifying its population. More attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field., Level of Evidence: 1., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Treatment of large articular cartilage lesions of the knee includes surgical options one of which includes cartilage replacement therapies. Among these therapies include osteochondral allograft (OCA) transplantation, which can be performed utilizing a BioUni® (Arthrex BioUni® Instrumentation System; Arthrex, Naples, FL) replacement and a 'snowman' technique of repair., Hypothesis/purpose: To compare clinical and radiographic outcomes in patients who have undergone multiplug OCA transplantations utilizing a BioUni® replacement and a 'snowman' technique of repair., Methods: Patients who underwent OCA transplantation utilizing a snowman technique or BioUni® replacement between January 1 st , 2012 and December 31 st , 2018, and who had a minimum 1-year follow-up at the same institution were identified for inclusion in this study via current procedural terminology (CPT) codes. Charts of included patients were reviewed for injury and treatment details as well as demographic information. Imaging studies and operative reports were reviewed and pre and postoperative subjective and objective outcome measures were recorded., Results: Twenty-eight patients underwent OCA transplantation with either BioUni® replacement (n=5) or with snowman technique repair (n=23). Defects in both groups had similar characteristics including size, area, location, and classifications. Patient-reported outcomes using the Knee Injury and Osteoarthritis Outcome Score-Joint Replacement (KOOS-JR), International Knee Documentation Committee (IKDC), and Physical Health Composite Score (PCS-12) were similar at baseline and increased post-operatively for both groups with no significant differences between techniques after a mean follow-up of 2.77 ± 0.83. Although it did not reach significance, the snowman group had higher rates of knee-related complications (13%) and need for revision surgery (22%) when compared to BioUni® (0% and 0%, respectively)., Conclusion: The use of both BioUni® and snowman techniques for large, unicondylar articular cartilage lesions of the femoral condyle demonstrate improved patient-reported outcomes at short-term follow-up. The use of the snowman technique presents relatively higher rates of revision similar to previous studies with no statistical difference in patient-reported outcomes when compared to those of a single plug OCA using a BioUni® system., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2023, Coladonato et al.)

Purpose: There is a paucity of research on the demographic trends of orthopedic and plastic hand surgery fellows. The purpose of this study was to ascertain the current state of racial and gender demographic trends in hand surgery fellowship from 2007 to 2021., Methods: We analyzed fellowship demographic data from the Accreditation Council for Graduate Medical Education public database from 2007-2008 through 2020-2021. The gender of hand surgery fellows was categorized as male, female, or not reported and their race/ethnicity as White, Non-Hispanic; Asian or Pacific Islander, Hispanic; Black, Non-Hispanic; American Indian or Alaskan Native; other; or unknown. We extracted the number of fellows per year for each category and calculated the percentage equivalents and average percentages. We performed the chi-square test for trend (Cochran-Armitage test) to identify any significant changes in the percentages of gender and race/ethnicity between 2007 and 2021., Results: There was a significant increase in the percentage of hand surgery fellows who are women (20.7% to 30.7%) and Asian or Pacific Islander (13.3% to 25.3%). There was no significant change in the percentage of Hispanic or Black, Non-Hispanic fellows., Conclusions: Although there have been some increases, hand surgery fellows continue to be underrepresented by women and minorities, consistent with the demographic of orthopedic and plastic surgery residents. There have been increasing trends in the number of women and minorities in medical schools, which leaves room for improvement from the downstream prospective applicant pool., Clinical Relevance: The physician-patient relationship can potentially be strengthened by race and gender concordance; however, many minority and female hand surgery patients do not have physicians who are women or of the same ethnic background. Patient satisfaction, trust, and potential health outcomes may be improved with a physician workforce that reflects the diversity of their patients., (Copyright © 2023 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

Background: The coronavirus disease-2019 (COVID-19) pandemic led to disruptions in care for orthopaedic patients who underwent surgery just before the outbreak, rendering some unable to participate in standard postoperative care. Many of these patients underwent clinical follow-up and physical therapy via telehealth., Purpose: To evaluate the methods of postoperative care in patients who underwent arthroscopic rotator cuff repair (RCR) and had follow-ups during the height of the pandemic versus those who received prior standard of care. We aimed to compare the 1-year outcomes between these cohorts., Study Design: Cohort study; Level of evidence, 3., Methods: A retrospective chart review was used to identify patients who underwent primary RCR in February and March 2020 (COVID cohort) and the same period in 2019 (control cohort) at a single institution. Excluded were patients who underwent revision RCR, used workers' compensation, or were incarcerated or deceased. The included patients reported the postoperative care received, their satisfaction with care, physical therapy appointment type (in person, home based, telehealth, or self-guided), satisfaction with physical therapy, and minimum 1-year postoperative American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn Shoulder Score (PSS) outcomes., Results: Overall, 428 patients were included for final analysis--199 in the COVID cohort and 229 controls. Follow-up data were collected for 160 patients in the COVID group (80.4%) and 169 control patients (73.8%). In the COVID group, 110 patients (68.8%) had ≥1 clinical visit conducted via telehealth, compared with zero in the control group. There were no differences between the COVID and control groups in the ASES (84.2 ± 16.5 vs 86.5 ± 17; P = .27 ), SANE (83.9 ± 15.4 vs 84.8 ± 17.5; P = .66), PSS (84.8 ± 15.3 vs 87.1 ± 15.1; P = .22), or patient satisfaction with the care received (81.7 ± 22.6 vs 86.3 ± 23.5; P = .09). Satisfaction with physical therapy was significantly higher in the control group (88.3 ± 18.9 vs 81.9 ± 22.5; P = .01)., Conclusion: Despite disruptions in care, RCR patients had comparable 1-year outcomes during the pandemic versus before the pandemic. Telehealth clinical follow-up appointments did not adversely affect patient-reported outcome measures and may be appropriate for RCR patients beyond the pandemic., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: F.P.T. has received research support from Smith & Nephew and consulting fees from DePuy and has stock/stock options in Franklin/Keystone Biosciences and Trice Medical. 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) 2023.)

Purpose: The purpose of this study was to determine whether a preoperative Caton-Deschamps index (CDI) ≥ 1.30, as measured by magnetic resonance imaging, is associated with rates of postoperative instability, revision knee surgery, and patient-reported outcomes in patients undergoing isolated medial patellofemoral ligament (MPFL) reconstruction., Methods: Patients who underwent primary medial patellofemoral ligament reconstruction (MPFLR) between 2015 and 2019 at a single institution were assessed. Only those with at least 2 year follow up were included. Patients who had undergone a previous ipsilateral knee surgery, concomitant tibial tubercle osteotomy and/or ligamentous repair/reconstruction at the time of MPFL reconstruction were excluded from the study. CDIs were evaluated by three investigators based on magnetic resonance imaging measurement. Patients with a CDI ≥ 1.30 were included in the patella alta group, while those with a CDI between 0.70 and 1.29 served as controls. A retrospective review of clinical notes was used to evaluate the number of postoperative instability episodes and revisions. Functional outcomes were measured by the International Knee Documentation Committee (IKDC) and 12-Item Short Form Health Survey (SF-12) physical and mental scores., Results: Overall, 49 patients (50 knees, 29 males, 59.2%) underwent isolated MPFLR. Nineteen (38.8%) patients had a CDI ≥ 1.30 (mean: 1.41, range: 1.30-1.66). The patella alta group was significantly more likely to experience a postoperative instability episode (36.8% vs 10.0%; P  = .023) and was more likely to return to the operating room for any reason (26.3% vs 3.0%; P  = .022) compared to those with normal patellar height. Despite this, the patella alta group had significantly greater postoperative IKDC (86.5 vs 72.4; P  = .035) and SF-12 physical (54.2 vs 46.5; P  = .006) scores. Pearson's correlation showed a significant association between CDI and postoperative IKDC ( R 2  = 0.157; P  = .022) and SF-12P ( R 2  = .246; P  = .002) scores. There was no difference in postoperative Lysholm (87.9 vs 85.1; P  = .531). and SF-12M (48.9 vs 52.5; P  = .425) scores between the groups., Conclusion: Patients with preoperative patella alta, as measured by CDI had higher rates of postoperative instability and return to the OR with isolated MPFL reconstruction for patellar instability. Despite this, higher preoperative CDI was associated with greater postoperative IKDC scores and SF-12 physical scores in these patients., Level of Evidence: Retrospective cohort study, Level IV., (© 2023 The Authors.)

Background: Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome., Purpose: To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research., Study Design: Cross-sectional study., Methods: We performed a keyword search of the Institute for Scientific Information's Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence., Results: The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%)., Conclusion: This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: L.D.K. has received education payments from Southern Edge Othopaedics and speaking fees and royalties from Arthrex. M.G.B. has received education payments, consulting fees, and speaking fees from Arthrex and hospitality payments from Smith & Nephew. 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.)