Search

Purpose: The purpose of the current study was to define the incidence of minor and major complications following TTO at a tertiary-care institution, with determination of predictive factors related to the occurrence of a major complication., Study Design: Retrospective case series., Methods: Patients who underwent TTO from 2011 to 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up and revision cases were excluded. Complications classified as "major" included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, recurrent patellar instability, reoperation for other indications, readmission, and revision. Complications classified as minor included superficial infection, deep venous thrombosis, wound dehiscence, and postoperative neuropraxia. Chi-square tests were used for categorical variables, t-tests for continuous variables., Results: Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years (range 1 month-10 years). Patients were 68.5% female with average age 28.3 years (range 13-57 years). The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of TTOs, and minor complications in 8.4% of TTOs. Reoperation was required in 16.6% of TTOs at a mean of 14 months following the index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (OR) (5.0%). Prior ipsilateral surgery was identified as a significant independent predictor of major complication by regression analysis. Hardware removal was more common with headed screws. Arthrofibrosis requiring reoperation was more common in patients who underwent a concomitant cartilage restoration/repair procedure., Conclusion: The overall complication rate following tibial tubercle osteotomy was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and an overall reoperation rate of 16.6%. TTOs with major complications were performed at earlier years, in patients who were older, had a previous ipsilateral arthroscopic knee surgery, had an indication of cartilage lesion/arthritis, and had a steeper osteotomy cut angle. Hardware removal was found to be more common in patients with headed as compared to headless screws. Complications also varied based on timing after surgery., Competing Interests: Declaration of competing interest The 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., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Bone Marrow Lesions (BMLs) have a strong correlation to patient reported pain, functional limitations, joint deterioration, and rapid progression to total knee arthroplasty. The Subchondroplasty® (SCP) Procedure uses AccuFill®, a calcium phosphate bone substitute material (BSM), to treat bone defects such as microtrabecular fractures and BML., Methods: This observational, prospective, multicenter, cohort study evaluated the effect of the SCP Procedure at two-year follow-up for 70 patients with knee BML. Under arthroscopic and fluoroscopic guidance, the BML was injected with AccuFill®. Patient reported outcomes, including Visual Analog Scale (VAS) pain, Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and modified Knee Society Score (mKSS) were collected through 24 months postoperatively. Radiographs and magnetic resonance images (MRI) were performed at baseline and up to 24 months post-operatively. Patient selection was not limited based on degree of osteoarthritis (OA) as determined radiologically by Kellgren-Lawrence (K-L) grade. For a subset of subjects, patient reported outcomes were collected up to five years including pain evaluation, patient knee global assessment, and satisfaction with the procedure., Results: Pre-operative radiographs indicated moderate to severe osteoarthritis (K-L grades 2-4) in 65 subjects (92.8%). Significant improvements (p<0.0001) in mean VAS Pain, IKDC, mKSS and KOOS scores were observed compared with baseline. Kaplan-Meier survivorship free from conversion to knee arthroplasty was 76.2% at two years. The subset of subjects followed for five years demonstrated low pain scores and high procedure satisfaction., Conclusion: This study presents statistically significant and clinically meaningful evidence of improvement in clinical outcomes following SCP for BMLs of the knee after two years. The survivorship rate from arthroplasty at two years was 76.2%. SCP for BMLs can relieve pain with a minimally invasive procedure and may delay the need for knee arthroplasty., Competing Interests: Patrick Reischling was a paid employee of Zimmer Biomet at the time of the study and Jennifer Woodell-May is a current paid employee of Zimmer Biomet., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient reported outcomes., Methods: A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, sex, and follow-up time. Recurrent instability (including re-dislocation and subluxation), visual analog scale (VAS) for pain score, Kujala score, and satisfaction were evaluated., Results: There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311), or revision surgeries (10.2% vs. 10.2%) between groups., Conclusion: There was a low complication rate, excellent patient reported outcomes, and a low rate of recurrent patellar instability following TTO and MPFLR with allograft.

Background: Intra-articular (IA) injections of plateletrich plasma (PRP) have been increasingly used in the nonoperative treatment of knee osteoarthritis (OA) but have considerable heterogeneity in both formulation and clinical results. Alpha-2-macroglobulin (A2M) is a large plasma protein found in PRP that inhibits cartilage-degrading enzymes and could be an efficacious OA treatment independently. The purpose of this study was to compare the short-term clinical efficacy of IA injection of A2M-rich PRP concentrate to conventionally prepared PRP and corticosteroids in the management of symptomatic knee OA., Methods: This double-blinded, randomized, controlled clinical trial was conducted at a single medical center with enrollment from June 2018 to May 2019. Subjects with symptomatic Kellgren-Lawrence (KL) grade 2 or 3 knee OA were randomized to IA injection with A2M, PRP, or methylprednisolone (MP) and followed for 12 weeks post-injection. Knee pain and function were assessed at pre-treatment baseline and at 6-week and 12-week followup with patient-reported outcome (PRO) surveys including the visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner score., Results: Seventy-five subjects were enrolled in the trial, of whom 68 (90.7%) completed the 12-week follow-up. The majority of subjects (73%) were female with a mean age of 59 years (range: 37 to 75 years). There were no significant differences in age (p = 0.30), sex (p = 0.44), or KL grade (p = 0.73) between treatment groups. By 12 weeks postinjection, the A2M group showed significant improvement in VAS, WOMAC, KOOS, and Tegner (p < 0.05), the PRP group showed no significant improvement in any PROs (p > 0.05), and the MP group showed significant improvement in Lysholm only (p = 0.01). However, the changes in PRO scores between baseline and 12-week follow-up did not significantly differ between the three groups (p > 0.05)., Conclusions: Alpha-2-macroglobulin IA injection shows comparable efficacy to PRP and corticosteroids in the treatment of mild-to-moderate knee OA. Alpha-2-macroglobulin treatment resulted in modest improvement in knee pain and function at 6-week follow-up, albeit inconsistently across PRO measures and to a similar degree as PRP and corticosteroids. Given its non-superior short-term efficacy compared to established IA injections, as well as its increased cost of preparation, A2M may not be a justifiable option for routine treatment of knee OA.

Purpose: The purpose of this study is to investigate the anatomic distribution of bone marrow edema on MRI among patients who sustained a Segond fracture compared to those with an isolated ACL tear., Methods: A retrospective cohort study was performed of patients aged 18-40 years old who presented with an acute isolated ACL tear between January 2012 and May 2022. Two blinded readers reviewed all knee MRIs to assess bone marrow edema using the Whole-Organ Magnetic Resonance Imaging Score and the area of each sub-compartment was scored., Results: There were 522 patients in the final analysis, of which 28 patients (5.4%) were identified to have a Segond fracture. The Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central lateral femoral condyle, as well as the anterior, central, and posterior lateral tibial plateau. Furthermore, the Segond group demonstrated significantly greater rates of WORMS grades 2 and 3 in the central medial femoral condyle and the anterior medial tibial plateau. Bone edema at the central lateral femoral condyle (R = 0.034, p = 0.019) and central tibial plateau (R = 0.093, p = 0.033) were significantly correlated with lateral meniscus tears, while the edema in the posterior medial femoral condyle was correlated with medial meniscus tears (R = 0.127, p = 0.004)., Conclusion: Patients who present with ACL tear and a concomitant Segond fracture demonstrate significantly more extensive bone marrow edema in both the medial and lateral compartments of the knee compared to patients with an isolated ACL tear., Competing Interests: Declaration of competing interest The 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., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: As machine learning becomes increasingly utilized in orthopaedic clinical research, the application of machine learning methodology to cohort data from the Multicenter ACL Revision Study (MARS) presents a valuable opportunity to translate data into patient-specific insights., Purpose: To apply novel machine learning methodology to MARS cohort data to determine a predictive model of revision anterior cruciate ligament reconstruction (rACLR) graft failure and features most predictive of failure., Study Design: Cohort study; Level of evidence, 3., Methods: The authors prospectively recruited patients undergoing rACLR from the MARS cohort and obtained preoperative radiographs, surgeon-reported intraoperative findings, and 2- and 6-year follow-up data on patient-reported outcomes, additional surgeries, and graft failure. Machine learning models including logistic regression (LR), XGBoost, gradient boosting (GB), random forest (RF), and a validated ensemble algorithm (AutoPrognosis) were built to predict graft failure by 6 years postoperatively. Validated performance metrics and feature importance measures were used to evaluate model performance., Results: The cohort included 960 patients who completed 6-year follow-up, with 5.7% (n = 55) experiencing graft failure. AutoPrognosis demonstrated the highest discriminative power (model area under the receiver operating characteristic curve: AutoPrognosis, 0.703; RF, 0.618; GB, 0.660; XGBoost, 0.680; LR, 0.592), with well-calibrated scores (model Brier score: AutoPrognosis, 0.053; RF, 0.054; GB, 0.057; XGBoost, 0.058; LR, 0.111). The most important features for AutoPrognosis model performance were prior compromised femoral and tibial tunnels (placement and size) and allograft graft type used in current rACLR., Conclusion: The present study demonstrated the ability of the novel AutoPrognosis machine learning model to best predict the risk of graft failure in patients undergoing rACLR at 6 years postoperatively with moderate predictive ability. Femoral and tibial tunnel size and position in prior ACLR and allograft use in current rACLR were all risk factors for rACLR failure in the context of the AutoPrognosis model. This study describes a unique model that can be externally validated with larger data sets and contribute toward the creation of a robust rACLR bedside risk calculator in future studies., Registration: NCT00625885 (ClinicalTrials.gov identifier)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was funded by the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (grant 5R01-AR060846). See Supplemental Material for individual disclosures. 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) 2024.)

Purpose: There is limited clinical outcome data comparing fixation methods for tenodesis of the long head of the biceps tendon (LHBT), particularly button fixation. The purpose of this study was to compare clinical outcomes, patient-reported outcomes, and return to sport (RTS) between patients undergoing LHBT with bicortical versus unicortical button technique. The authors hypothesized these fixation methods would be similar for all outcomes., Methods: Patients who underwent LHBT using unicortical or bicortical button fixation with minimum 2-year follow-up were identified. Postoperative outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) questionnaire and visual analogue scale (VAS) pain score. A sports activity survey was collected to assess baseline sport participation and ability to return to pre-injury activities. Continuous variables were analyzed using the Mann-Whitney-U test. Categorical variables were analyzed using Chi-squared tests. Multivariable logistic and linear regression were performed to determine predictors of RTS and time to RTS., Results: Sixty-four subjects (19 unicortical and 45 bicortical button fixation) were included (average follow-up 3.5 (range: 2.0-7.8) years). There were no significant differences found between button groups for VAS pain score (1.5 vs. 1.2; p = 0.876), VAS pain during sport score (1.6 vs. 1.1, p = 0.398), and ASES score (66 vs. 71; p = 0.294). There were no significant differences in rate of RTS (75.0 vs. 77.4%; p = 0.885) or average time to return to sport (11.7 ± 7.3 vs. 7.0 ± 4.0 months; p = 0.081) between groups., Conclusion: There were no significant differences in clinical outcomes, pain, or return to sport between patients who underwent LHBT with unicortical or bicortical button fixation., Competing Interests: Declarations Conflict of interest All other authors have no competing interests to declare that are relevant to the content of this article., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: There are currently no guidelines on peri-arthroscopic management of immunosuppressive (IS) treatment in rheumatic disease patients., Purpose: The purpose of this study is to characterize the rheumatic disease patient population undergoing arthroscopy, compare the incidence of postoperative complications among patients who either remained on IS perioperatively, held IS perioperatively or were not on IS at baseline, and compare the incidence of postoperative complications by rheumatic disease type, medication type, and procedure., Methods: We conducted a retrospective review of all arthroscopic sports medicine surgeries in patients with a rheumatic disease diagnosis at our institution over an 11-year period. Patients on IS at baseline were grouped into those who remained on IS perioperatively or held all IS before the date of their surgery. These two groups were compared to patients who were not on IS at baseline. Incidence of postoperative complications was calculated for the three cohorts and by medication class, rheumatic disease type, and procedure risk. Analysis of variance (ANOVA), chi-squared, and Fisher's exact tests were used to determine the statistical significance of between-group differences in postoperative complication incidence., Results: We identified 1,316 rheumatic disease patients undergoing arthroscopy, with 214 of them taking IS medications at baseline. In total, 8.4% ( n  = 110) remained on IS perioperatively, 7.9% ( n  = 104) held IS perioperatively, and 83.7% ( n  = 1102) were not on IS at baseline. In all cohorts, seven patients experienced postoperative complications; six of whom experienced infections. Two (1.82%) occurred in patients remaining on IS perioperatively, zero infections occured in patients who held all IS, and four (0.36%) occured in patients who were not on any IS at baseline. There was no statistically significant difference in postoperative infections or complication rates among the three cohorts or further subgroups., Conclusion: The risk of postoperative complications including infectious, major, and minor complications in patients on IS at the time of arthroscopy is low and acceptable.

Background: Bone marrow stimulation (BMS) has been proposed to augment healing at the time of arthroscopic rotator cuff repair (ARCR) by creating several bone marrow vents in the footprint of the rotator cuff, allowing mesenchymal stem cells, platelets, and growth factors to cover the area as a "crimson duvet.", Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes after BMS and a control for those undergoing ARCR., Study Design: Meta-analysis; Level of evidence, 1., Methods: A literature search of 3 databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. RCTs comparing BMS and a control for ARCR were included. Clinical outcomes were compared, and a P value <.05 was considered to be statistically significant., Results: A total of 7 RCTs with 576 patients were included. Overall, 18.8% of patients treated with BMS and 21.0% of patients treated with a control had a retear ( I 2 = 43%; P = .61). With BMS, the mean Constant score was 88.2, and with the control, the mean Constant score was 86.7 ( P = .12). Additionally, there was no significant difference in the American Shoulder and Elbow Surgeons score (94.3 vs 93.2, respectively; P = .31) or visual analog scale score (0.9 vs 0.9, respectively; P = .89)., Conclusion: The level 1 evidence in the literature did not support BMS as a modality to improve retear rates or clinical outcomes after ARCR., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.D. has received support for education from SouthTech Orthopedics. L.M.J. has received support for education from Suvon Surgical, Gotham Surgical, and Arthrex and consulting fees from Flexion Therapeutics. R.M. has received consulting fees from Arthrex and compensation for services other than consulting from Empire Medical. J.F.D. has received support for education from SouthTech Orthopedics and Supreme Orthopedic Systems and compensation for services other than consulting from Arthrex. O.A. has received consulting fees from Exactech, Smith & Nephew, Medical Device Business Services, Bioventus, Lima, Responsive Arthroscopy, Encore Medical, and Stryker; support for education from Arthrex and SouthTech Orthopedics; and travel expenses from Wright Medical and Zimmer Biomet. C.K. has received consulting fees from Acumed, restor3d, and Smith & Nephew and holds stock or stock options in GE HealthCare, Johnson & Johnson, Merck, and Pfizer. 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.

Purpose: The purpose of this study was to identify sex differences in postoperative outcomes and return-to-sport rates after fasciotomy for treatment of chronic exertional compartment syndrome (CECS) of the lower leg. It was hypothesised that male CECS patients would have a higher rate of return to sport than female CECS patients., Methods: A retrospective cohort study was conducted involving patients who underwent primary fasciotomy of one to four leg compartments for treatment of CECS at a single centre from 2010 to 2020. Each affected leg was treated as a separate subject. Postoperative outcomes included CECS pain frequency and severity, return to sport and Tegner activity level. Multivariable regression was used to determine if sex was an independent predictor of outcomes after adjusting for demographic and clinical covariates. p < 0.05 were considered significant., Results: Eighty-one legs (44 M, 37 F) of 47 unique patients (34 of whom had bilateral symptoms) were included with a mean follow-up time of 51.5 ± 31.4 months. Male subjects were older (p < 0.001) and had higher body mass index (p < 0.001) compared to female subjects. Most subjects (84.0%) underwent two- or four-compartment fasciotomies. Female sex was found to be predictive of lower overall postoperative pain severity (p = 0.007), higher odds of return to sport (p = 0.04) and higher postoperative Tegner score (p = 0.005). However, female sex was not predictive of postoperative pain frequency, odds of reoperation or odds of return to sport to at least the presymptomatic level (all p < 0.05)., Conclusion: Female sex is independently predictive of reduced overall pain severity, higher odds of return to sport and higher postoperative improvement in Tegner score following fasciotomy for treatment of lower-limb CECS., Level of Evidence: III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Rheumatologists and orthopedic surgeons frequently collaborate on difficult decisions regarding perioperative management of immunosuppression in rheumatic disease patients, balancing risk of postoperative infection with risk of disease flares. Current evidence-based guidelines pertain specifically to arthroplasty, thus we sought to understand the trends and common practices regarding peri-arthroscopic use of immunosuppression., Methods: Rheumatologists and sports medicine surgeons, from a variety of New York hospitals and serving a broad range of demographics, were surveyed on immunosuppressive medication management in rheumatic disease patients undergoing arthroscopic surgeries. Physicians' preferences were elicited regarding the use of common anti-rheumatic medications with the lower risk meniscectomies and the higher risk anterior cruciate ligament (ACL) reconstructions and allografts. Physicians were asked specifically about peri-arthroscopic use of conventional synthetic diseasemodifying antirheumatic drugs (csDMARDs), biologics, and Janus kinase (JAK) inhibitors., Results: During the survey period, 25 rheumatologists and 19 sports medicine fellowship-trained orthopedic surgeons completed the questionnaire. For lower-risk arthroscopies, rheumatologists favored continuing various csDMARDs (72% to 100%), biologics (50% to 64%) and JAK inhibitors (57%), while a majority of surgeons concurred for all three drug classes (csDMARDs 63%; biologics 53%; and JAK inhibitors 58%). For higher-risk arthroscopies, most rheumatologists preferred that patients continue csDMARDs (63% to 100%) but fewer supported the use of biologics (28% to 39%) or JAK inhibitors (22%). Surgeons were more hesitant to endorse any class of immunosuppressive antirheumatic medications (22% to 27%) around these higher risk surgeries. The rheumatologists were most concerned about surgeries taking place too soon after the last dose of rituximab, recommending these higher risk surgeries not take place for 7.7 ± 8.8 weeks following the last infusion., Conclusion: For lower-risk arthroscopies, most rheumatologists but only about half of orthopedic surgeons preferred patients continuing csDMARDs. Approximately half of both groups preferred patients hold biologics and JAK inhibitors. In more involved arthroscopies, most rheumatologists but few orthopedists supported the continued use of csDMARDs, and the consensus was to hold all other immunosuppression when possible. While the duration medications were held perioperatively were somewhat reflective of the current guidelines for arthroplasty, there is a need for evidencebased guidelines specifically regarding peri-arthroscopy immunosuppression in rheumatic disease patients.

Purpose: Research surrounding the biomechanics and video analysis of anterior cruciate ligament (ACL) injuries at the professional level has emerged in recent years as a tool to screen athletes for potential biomechanical deficits. The purpose of this study was to analyze and discuss the most common mechanism, body position, and activity at the time of ACL injury among NBA players., Methods: Anterior cruciate ligament injuries over 10 consecutive NBA seasons (2009-2010 to 2019-2020) were reviewed from publicly available sources. A 10-question survey was developed and utilized to analyze each video clip. These questions were divided into three categories: 1. contact mechanism, 2. activity at the time of injury, and 3. position of the involved lower extremity at the time of injury. Two reviewers analyzed the videos individually, and differing answers were resolved via consensus review, with a senior author arbitrating in the case of any discrepancies., Results: Overall, 23 ACL ruptures were included. The most common injury mechanism was indirect contact with another player without knee contact (56.5%), and no patients had an ACL rupture as a result of direct knee contact with another player. The most common action at the time of injury was pivoting (47%), and the most common basketball action was dribbling (43.5%). Additionally, the vast majority of patients were injured while on offense (91.3%). The most common knee positions were early flexion (73.9%) and abduction (95.7%). The most common foot positions were abduction relative to the knee (82.6%), in eversion (73.9%), and dorsiflexion (56.5%). The most common hip position was early flexion (87%), and all hips were abducted (100%)., Conclusion: Our study found that the majority of ACL ruptures occurred during offensive play and over half were secondary to contact with an opposing player (but without a direct blow to the injured knee), indicating that such perturbations may alter the kinematics of the players' movement. Additionally, a large majority of ACL injuries occurred while the hip was abducted with the knee in abduction relative to the hip and while the knee was in early flexion from 0° to 45°.

Purpose: The purpose of this study is to assess the association between sagittal tibial tuberosity-trochlear groove (sTT-TG) distance and patellofemoral chondral lesion size in patients undergoing cartilage restoration procedures., Methods: A retrospective cohort analysis of patients who underwent an osteochondral allograft transplantation or matrix-induced autologous chondrocyte implantation in the patellofemoral compartment, from 2010 to 2020, were included if they had patellofemoral high-grade lesions, magnetic resonance imaging (MRI) and minimum 2-year follow-up. The preoperative sTT-TG distance was measured independently on axial T2-weighted MRI sequences by two authors, each at least two weeks apart. Intraoperative lesion size was reported according to operative report measurements by the attending surgeon. An interclass correlation coefficient (ICC) was calculated to assess intra- and inter-rater reliability, and categorical data analysis and linear regression models were used to assess the relationship between sTT-TG and lesion size., Results: A total of 80 patients (50 females) with a mean age of 31.5 ± 10.4 years, body mass index of 27.0 ± 5.9 kg/m 2 and follow-up of 61.5 ± 21.4 months were included. A total of 107 lesions were present: 63 patients with unipolar (patella = 41, trochlea = 22) and 22 with bipolar lesions. The mean MRI defect size was 1.6 ± 1.0 cm 2 and the mean intraoperative defect size was 3.8 ± 2.4cm 2 . Intra- (ICC: 0.99,0.98) and inter-rater reliability (ICC: 0.96) were excellent for both MRI defect size and sTT-TG measurements. The mean sTT-TG was -4.8 ± 4.9 mm and was significantly inversely related to MRI defect size (-0.45, p < 0.01), intraoperative patellar lesion size (-0.32, p = 0.01), total lesion area (-0.22, p = 0.04), but not trochlear lesion size (-0.09, p = 0.56). Multivariable regression demonstrated a more negative sTT-TG remained an independent variable correlated with larger MRI-measured patellofemoral defect sizes and intraoperative patellar lesions., Conclusion: A more negative sTT-TG was an independent variable correlated with larger patellofemoral lesions in patients undergoing patellofemoral cartilage restoration., Level of Evidence: Level III, Diagnostic., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Objectives: The purpose of this study was to compare clinical outcomes of medial quadriceps tendon-femoral ligament reconstruction (MQTFLR) and medial patellofemoral ligament reconstruction (MPFLR) among patients with recurrent lateral patellar instability., Methods: A retrospective matched-cohort study was conducted involving patients who underwent MQTFLR or MPFLR with or without tibial tubercle osteotomy (TTO) from 2019 to 2021. Subjects were matched 1:1 on age, concomitant osteochondral allograft (OCA), concomitant TTO, and follow-up time. Measured outcomes included 90-day complications, Visual Analog Scale (VAS) knee pain, return to sport/work, Kujala score, Tegner score, and MPFL-Return to Sport after Injury (MPFL-RSI) score. Outcomes were compared between groups using Mann-Whitney U-test for continuous variables and Fisher's exact test for categorical variables. P-values <0.05 were considered significant., Results: Ten MQTFLR patients (mean age 28.7 years, 80% female, mean follow-up 19.7 months) and ten MPFLR patients (mean age 29.1 years, 90% female, mean follow-up 28.3 months) were included in the study. One MQTFLR patient (10%) and three MPFLR patients (30%) underwent reoperation for postoperative arthrofibrosis. Postoperative VAS resting pain was not significantly different between the groups (MQTFLR mean 1.1, MPFLR mean 0.6, p ​= ​0.31). There were no significant differences in rates of recurrent subluxations (MQTFLR 20%, MPFLR 0%, p ​= ​0.47), return to sport (MQTFLR 50%, MPFLR 75%, p ​= ​0.61), return to work (MQTFLR 100%, MPFLR 88%, p ​= ​1.00), or MPFL-RSI pass rate (MQTFLR 75% vs. MPFLR 38%, p ​= ​0.31)., Conclusion: There were no significant differences in knee pain and function, return to work, and rates of recurrent patellar instability between patients who underwent MQTFLR versus MPFLR, though these results should be interpreted with caution given the small sample size and potential selection bias., Level of Evidence: III., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Eric J. Strauss reports a relationship with American Academy of Orthopaedic Surgeons that includes: board membership. Eric J. Strauss reports a relationship with American Orthopaedic Association that includes: board membership. Eric J. Strauss reports a relationship with Arthrex Inc that includes: speaking and lecture fees. Eric J. Strauss reports a relationship with Arthroscopy Association of North America that includes: board membership. Eric J. Strauss reports a relationship with Better PT that includes: equity or stocks. Eric J. Strauss reports a relationship with Cartiheal that includes: funding grants. Eric J. Strauss reports a relationship with Cartilage (journal) that includes: board membership. Eric J. Strauss reports a relationship with Bulletin of the Hospital for Joint Diseases that includes: board membership. Eric J. Strauss reports a relationship with Fidia that includes: funding grants. Eric J. Strauss reports a relationship with Flexion Therapeutics that includes: consulting or advisory. Eric J. Strauss reports a relationship with Jaypee Publishing that includes: funding grants. Eric J. Strauss reports a relationship with JRF Ortho that includes: consulting or advisory. Eric J. Strauss reports a relationship with Organogenesis Inc that includes: consulting or advisory, funding grants, and speaking and lecture fees. Eric J. Strauss reports a relationship with Smith and Nephew Inc that includes: consulting or advisory and speaking and lecture fees. Eric J. Strauss reports a relationship with Springer that includes: funding grants. Eric J. Strauss reports a relationship with Subchondral Solutions that includes: consulting or advisory. Eric J. Strauss reports a relationship with Vericel Corporation that includes: consulting or advisory and funding grants. Laith M. Jazrawi reports a relationship with Arthrex Inc that includes: funding grants and non-financial support. Laith M. Jazrawi reports a relationship with Bulletin of the Hospital for Joint Diseases that includes: board membership. Laith M. Jazrawi reports a relationship with JBJS Reviews that includes: board membership. Laith M. Jazrawi reports a relationship with Lazurite that includes: equity or stocks. Laith M. Jazrawi reports a relationship with DePuy Mitek Inc that includes: funding grants. Laith M. Jazrawi reports a relationship with Smith and Nephew Inc that includes: funding grants and non-financial support. Laith M. Jazrawi reports a relationship with Wolters Kluwer Lippincott Williams & Wilkins Pty Ltd that includes: funding grants. Michael J. Alaia reports a relationship with American Academy of Orthopaedic Surgeons that includes: board membership. Michael J. Alaia reports a relationship with Arthroscopy (journal) that includes: board membership. Michael J. Alaia reports a relationship with Arthroscopy Association of North America that includes: board membership. Michael J. Alaia reports a relationship with BodyCad that includes: consulting or advisory. Michael J. Alaia reports a relationship with Journal of Cartilage and Joint Preservation that includes: board membership. Michael J. Alaia reports a relationship with JRF Ortho that includes: consulting or advisory. Michael J. Alaia reports a relationship with DePuy Mitek Inc that includes: consulting or advisory. Michael J. Alaia reports a relationship with Orcosa Inc. that includes: funding grants and non-financial support. Michael J. Alaia reports a relationship with Springer that includes: funding grants. Kirk A. Campbell reports a relationship with American Academy of Orthopaedic Surgeons that includes: board membership. Kirk A. Campbell reports a relationship with Arthroscopy Association of North America that includes: board membership. Kirk A. Campbell reports a relationship with Stryker that includes: funding grants and non-financial support., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to determine whether significant differences exist when comparing posterior tibial slope (PTS) measured using increasing lengths of the tibia to determine the anatomical axis., Methods: Patients with full-length weight-bearing tibial radiographs were retrospectively identified from 2014 to 2022 at a single institution. Patients were excluded if there was any previous history of lower extremity fracture or osteotomy. The anatomical axis of the tibia was determined using the full length of tibial radiographs, and the "reference PTS" was measured using this axis. Using the same radiograph, the PTS was measured using four different anatomical axes at standardized tibial lengths. While the center of the proximal circle remained constant at 5-cm below the tibial plateau, the center of the distal circle was drawn at four points: a) overlapping circles; b) 10-cm distal to the tibial plateau; c) 15-cm distal to the tibial plateau; d) half the length of the tibia, measured from the tibial plateau to the tibial plafond. Bivariate correlation and frequency distribution analysis (measurements >2-degrees from reference PTS) were performed between the reference PTS and PTS measured at each of the four other lengths., Results: A total of 154 patients (39.8 ± 17.4 years old, 44.2% male) were included in the final analysis. Measurements at each of the four tibial lengths were all significantly different from the reference PTS (p < 0.001). The correlation strength improved with increasing tibial length (overlapping: R = 0.681, 10-cm: R = 0.821, 15-cm: R = 0.937, and half-tibia: R = 0.963). The number of PTS measurements >2-degree absolute difference from the reference PTS decreased with increasing tibial length (overlapping: 40.3%, 10-cm: 24.0%, 15-cm: 26.0%, and half-tibia: 18.8%)., Conclusion: Assessment of PTS is dependent on the length of the tibia utilized to obtain the anatomical axis. Accuracy and precision of PTS measurements improved with increasing length of tibia used to determine the anatomical axis., Study Design: Case series., Competing Interests: Declaration of competing interest The 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., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Open subpectoral biceps tenodesis (OSBT) with cortical button fixation has been shown to deliver acceptable results in the short and intermediate term for long head of the biceps (LHB) pathology with the benefit of smaller bone tunnel diameter and a reduced risk of postoperative humeral shaft fracture. The primary purpose of this study was to determine whether OSBT with cortical button fixation results in significant improvements in patient reported outcomes (PROs) from pre-operative to long-term final follow-up., Methods: A retrospective analysis of patients who underwent OSBT with cortical button fixation at a single institution between the years of 2012 and 2014 was conducted and PROs were collected in the intermediate (> 2 years follow-up) and long term (> 9 years follow-up). PROs were measured pre-operatively, at intermediate follow-up, and at long-term follow-up using three validated questionnaires: American Shoulder and Elbow Surgeons (ASES) score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, and Oxford Shoulder Score (OSS). Patients were additionally asked at final follow-up if they would undergo the same procedure again if they needed it., Results: Twenty-nine (29) patients with a mean age of 51.16 ± 9.06 years at the time of surgery were included in the study at final follow-up. Mean final follow-up time was 10.2 ± 0.5 years (range: 9.2-11.1 years). All PROs (ASES, OSS, and DASH) demonstrated statistically significant improvements from pre-operative to final follow-up with p < 0.01 for each. The proportions of patients exceeding established values for minimum clinically important difference (MCID) were 96.55%, 93.10%, and 75.86% for ASES, OSS, and DASH respectively. Only one patient had required re-operation as of final follow-up. None experienced humeral fractures post-operatively. A significant majority (89.66%; p < 0.01) of patients reported that they would undergo the same procedure again if they needed it. Fifty-three (53) patients were included in the study at intermediate follow-up with a mean follow-up time of 3.5 ± 1.4 years (range: 2-5.3 years). There were no statistically significant differences in any of the PRO measures from intermediate to long-term follow-up., Conclusion: This study reported a minimum 9-year follow-up of patients undergoing OSBT with cortical button fixation for the management of LHBT pathology in the setting of concomitant shoulder procedures. All patients had significantly improved functional outcomes assessed with ASES, OSS, and DASH and no obvious differences in median group scores were found between patients assessed at intermediate (mean 3.5 years) and final (mean 10.2 years) follow-up. No infections, fractures, or fixation failures were reported., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Purpose: To assess clinical outcomes and return to sport (RTS) rates among patients who undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI) or matrix-induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects., Methods: A retrospective review of patients who underwent an OCA or ACI/MACI from 2010 to 2020 was conducted. Patient-reported outcomes collected included visual analog scale for pain/satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and RTS. The percentage of patients that met the patient acceptable symptom state for KOOS was recorded. Logistic regression was used to identify predictors of worse outcomes., Results: A total of 95 patients were included (78% follow-up) with ACI or MACI performed in 55 cases (57.9%) and OCA in 40 (42.1%). A tibial tubercle osteotomy was the most common concomitant procedure for OCA (66%) and ACI/MACI (98%). Overall, KOOS pain was significantly poorer in OCA than ACI/MACI (74.7, 95% confidence interval 68.1-81.1 vs 83.6, 95% confidence interval 81.3, 88.4, P = .012), whereas the remaining KOOS subscores were nonsignificantly different (all P > .05). Overall, RTS rate was 54%, with no significant difference in return between OCA or ACI/MACI (52% vs 58%, P = .738). There were 26 (27%) reoperations and 5 (5%) graft failures in the entire group. Increasing age was associated with lower satisfaction in OCA and poorer outcomes in ACI/MACI, whereas larger lesion area was associated with lower satisfaction and poorer outcomes in ACI/MACI., Conclusions: Clinical and functional outcomes were similar in patients who underwent OCA or ACI/MACI for patellofemoral articular cartilage defects at a mean follow-up of 5 years. Patients who received OCA had a greater proportion of degenerative cartilage lesions and, among those with trochlear lesions, reported greater pain at final follow-up than their ACI/MACI counterparts. Overall, increasing age and a larger lesion size were associated with worse patient-reported outcomes., Level of Evidence: Level III, retrospective cohort study., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: K.C. reports board membership, American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, and Cartilage, Bulletin of the Hospital for Joint Diseases; and funding grants from Stryker. E.S. reports board membership, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, and Arthroscopy Association of North America; paid expert testimony from Arthrex; equity or stocks from Better Therapeutics; nonfinancial support from CartiHeal; funding grants from Fidia Pharma USA and Jaypee Publishing; consulting or advisory from JRF Ortho; consulting or advisory, funding grants, and paid expert testimony from Organogenesis; consulting or advisory and paid expert testimony from Smith & Nephew; funding grants from Springer Media BV; consulting or advisory from Subchondral Solutions; and consulting or advisory and paid expert testimony from Vericel Corporation. All other authors (J.T., A.H., N.R., Z.L., M.M., S.G., L.J., G.G-L.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: The purpose of this study was to compare the clinical outcomes of patients with patellofemoral osteoar-thritis (PFOA) treated non-operatively with those treated operatively with an unloading anteromedialization tibial tubercle osteotomy (TTO)., Methods: A retrospective chart review was performed to identify patients with isolated PFOA who were either managed non-operatively or surgically with a TTO and who had a minimum follow-up of 2 years. Patients were surveyed with the visual analog scale (VAS) for pain, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR), Anterior Knee Pain scale (Kujala), and Tegner Activity scale. Statistical analysis included two-sample t-testing, one-way ANOVA, and bivariate analysis., Results: The clinical outcomes of 49 non-operatively managed patients (mean age: 52.7 ± 11.3 years; mean follow-up: 1.7 ± 1.0 years) and 35 operatively managed patients (mean age: 31.8 ± 9.4 years; mean follow-up: 3.5 ± 1.7 years) were assessed. The mean VAS improved sig-nificantly in both groups [6.12 to 4.22 (non-operative), p < 0.0001; 6.94 to 2.45 (TTO); p < 0.0001], with operatively treated patients having significantly lower postoperative pain than non-operatively managed patients at the time of final follow-up [2.45 (TTO) vs. 4.22 (non-operative), p < 0.001]. The mean KOOS-JR score was significantly greater in the operative group at time of final follow-up [78.7 ± 11.6 (TTO) vs. 71.7 ± 17.8 (non-operative), p = 0.035]. There was no significant difference in Kujala or Tegner scores between the treatment groups. Additionally, there was no sig-nificant relationship between the number of intra-articular injections, duration of NSAID use, and number of physical therapy sessions on clinical outcomes in the non-operatively treated group (p > 0.05)., Conclusions: An unloading anteromedialization TTO provides significantly better pain relief and restoration of function compared to non-operative management in the treatment of symptomatic PFOA.

Objective: The purpose of this study was to compare the short-term clinical outcomes of matrix-induced autologous chondrocyte implantation (MACI) to those seen following traditional autologous chondrocyte implantation (ACI) in the management of symptomatic cartilage lesions of the knee., Methods: This was a retrospective cohort study of patients who underwent either ACI or MACI from January 2011 to March 2018. Patients with a minimum postoperative follow-up of 18 months were contacted. Demographic information, intraoperative findings, and patient-reported functional outcomes scores were collected. Comparisons were made between the two cell-based cartilage repair techniques., Results: Fifty-six patients were included in the study (39 ACI, 17 MACI). Visual analog scale (VAS) for pain scores improved significantly in both groups, with MACI patients demonstrating significantly lower postoperative pain scores compared to those treated with ACI. In the ACI group, there was a decrease in the Tegner Activity score compared to the preoperative baseline, while no significant difference was seen between pre- and postoperative activity levels in the MACI group. Patients were generally satisfied with the outcome of their procedures, and there was no significant difference in satisfaction between groups. No patients re-quired additional surgery during the follow-up period., Conclusion: Both ACI and MACI demonstrated good short-term postoperative clinical results with improved pain and activity levels compared to the preoperative baseline. Patients treated with the MACI technique demonstrated greater reductions in pain scores compared to ACI, and while ACI resulted in a decrease in levels of postoperative activity, activity levels for MACI remained stable.

Objective: To evaluate the effect of fear of reinjury on return to sport (RTS), return to work (RTW), and clinical outcomes following autologous chondrocyte implantation (ACI)., Design: A retrospective review of patients who underwent ACI with a minimum of 2 years in clinical follow-up was conducted. Patient-reported outcomes collected included the Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Kinesiophobia and pain catastrophizing was assessed using the Tampa Scale of Kinesiophobia-11 (TSK-11) and Pain Catastrophizing Scale (PCS), respectively. Patients were surveyed on their RTS and RTW status., Results: Fifty-seven patients (50.9% female) were included in our analysis. Twenty-two (38.6%) patients did not RTS. Of the 35 patients (61.4%) who returned, nearly half (48.6%) returned at a lower level of play. TSK-11 ( P = 0.003), PCS ( P = 0.001), and VAS pain scores ( P < 0.001) were significantly greater in patients that did not RTS than in those who returned. All KOOS subscores analyzed were significantly lower ( P < 0.001) in patients that did not RTS than in those who returned at the same level or higher. Of the 44 (77.2%) patients previously employed, 97.7% returned to work. Increasing TSK-11 scores were associated with lower odds of returning to sport ( P = 0.003)., Conclusion: Fear of reinjury decreases the likelihood that patients will return to sport after ACI. Patients that do not return to sport report significantly greater levels of fear of reinjury and pain catastrophizing and lower clinical knee outcomes. Nearly all patients were able to return to work after surgery., Level of Evidence: IV case series., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JT, NR, MB-L, AL, NDR, and JE report no conflict of interest. MJA is a board or committee member in AAOS, editorial or governing board member in Arthroscopy, board or committee member in Arthroscopy Association of North America, a paid consultant for BodyCad, editorial or governing board member of the Journal of Cartilage and Joint Preservation, paid consultant for JRF Ortho and Mitek, receives research support from Orcosa, Inc, and publishing royalties, financial, or material support from Springer. LMJ receives research support from Arthrex, Inc, is an editorial or governing board member of Bulletin for the Hospital for Joint Diseases, editorial or governing board member of JBJS Reviews, receives research support from Mitek and Smith & Nephew, publishing royalties, financial, or material support from Wolters Kluwer Health—Lippincott Williams & Wilkins. EJS is a board or committee member of AAOS and American Orthopedic Association, paid consultant, paid presenter, or speaker for Arthrex, Inc, board or committee member of Arthroscopy Association of North America, has stock or stock options in Better PT, receives research support from Cartiheal, is in the editorial or governing board of Cartilage and Bulletin of the Hospital For Joint Diseases, receives research support from Fidia, is a paid consultant for Flexion Therapeutics, receives publishing royalties, financial, or material support from Jaypee Publishing, is a paid consultant for Joint Restoration Foundation, is a paid consultant, paid presenter, or speaker and receives research support from Organogenesis, is a paid consultant, paid presenter, or speaker for Smith & Nephew, receives publishing royalties, financial, or material support from Springer, is a paid consultant for Subchondral Solutions, and is a paid consultant, paid presenter, or speaker for Vericel. KAC is a board or committee member for AAOS and Arthroscopy Association of North America and receives research support from Stryker.

Background: Elbow ulnar collateral ligament (UCL) reconstruction (UCLR) is the gold standard for operative treatment of UCL tears, with renewed interest in UCL repairs., Purpose: To (1) assess trends in rates of UCLR and UCL repair and (2) identify predictors of complications by demographic, socioeconomic, or surgical center volume factors., Study Design: Descriptive epidemiology study., Methods: Patients who underwent UCLR or UCL repair at New York State health care facilities between 2010 and 2019 were retrospectively identified; concomitant ulnar nerve procedures among the cohort were also identified. Surgical center volumes were classified as low (<99th percentile) or high (≥99th percentile). Patient information, neighborhood socioeconomic status quantified using the Area Deprivation Index, and complications within 90 days were recorded. Poisson regression analysis was used to compare trends in UCLR versus UCL repair. Multivariable regression was used to determine whether center volume, demographic, or socioeconomic variables were independent predictors of complications., Results: A total of 1448 UCL surgeries were performed, with 388 (26.8%) concomitant ulnar nerve procedures. UCLR (1084 procedures; 74.9%) was performed more commonly than UCL repair (364 procedures; 25.1%), with patients undergoing UCL repair more likely to be older, female, and not privately ensured and having undergone a concomitant ulnar nerve procedure (all P < .001). With each year, there was an increased incidence rate ratio for UCL repair versus UCLR (β = 1.12 [95% CI, 1.02-1.23]; P = .022). The authors identified 2 high-volume centers (720 UCL procedures; 49.7%) and 131 low-volume centers (728 UCL procedures; 50.3%). Patients undergoing UCL procedures at high-volume centers were more likely to be younger and male and receive workers' compensation (all P < .001). UCL repair and ulnar nerve-related procedures were both more commonly performed at low-volume centers ( P < .001). There were no significant differences in 3-month infection, ulnar neuritis, instability, arthrofibrosis, heterotopic ossification, or all-cause complication rates between low- and high-volume centers. The only significant predictor for all-cause complication was Medicaid insurance (OR, 2.91 [95% CI, 1.20-6.33]; P = .011)., Conclusion: A rising incidence of UCL repair compared with UCLR was found in New York State, especially among female patients, older patients, and nonprivate payers. There were no differences in 3-month complication rates between high- and low-volume centers, and Medicaid insurance status was a predictor for overall complications within 90 days of operation., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.S.R. has received education payments from Gotham Surgical and hospitality payments from Arthrex. L.M.J. has received education payments from Arthrex, consulting fees from Flexion Therapeutics, and hospitality payments from Horizon Therapeutics. B.J.E. has received grant support from Arthrex; education payments from Arthrex and Smith + Nephew; consulting fees from Arthrex, DePuy Synthes, and Pinnacle; nonconsulting fees from Arthrex; and hospitality payments from Linvatec 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) 2024.)

Purpose: To establish consensus statements on the diagnosis, nonoperative management, and labral repair for posterior shoulder instability., Methods: A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement., Results: Unanimous agreement was reached on the indications for nonoperative management and labral repair, which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient's preference to avoid or delay surgery. In addition, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization., Conclusions: The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for nonoperative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in nonoperative management, whether a posteroinferior portal is required., Level of Evidence: Level V, expert opinion., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.T.P. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, Society of Military Orthopaedic Surgeons, Society of Military Orthopaedic Surgeons, Arthrex, and SLACK Inc; editorial or governing board for Arthroscopy, Knee, and San Diego Shoulder Institute; IP royalties; paid consultant; research support for Arthrex; IP royalties from Arthrosurface; Publishing royalties, financial or material support from Elsevier; paid consultant Joint Restoration Foundation (AlloSource): and publishing royalties, financial, or material support from SLACK Inc. B.W. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America; other financial or material support and paid presenter or speaker from Arthrex; editorial or governing board, publishing royalties, and financial or material support from Arthroscopy; publishing royalties and financial or material support from Elsevier; paid consultant for FH Ortho: stock or stock options and unpaid consultant for Kaliber AI; other financial or material support from the Musculoskeletal Transplant Foundation and Smith & Nephew; paid presenter or speaker; stock or stock options; unpaid consultant for Sparta; paid presenter or speaker for Vericel; editorial or governing board for Video Journal of Sports Medicine; and stock or stock options from Vivorte. B.E. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, and American Shoulder and Elbow Surgeons; paid consultant for and research support from Arthrex; and research support from DePuy, A Johnson & Johnson Company, Linvatec, Smith & Nephew, and Stryker. C.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew; and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. A.I. reports board or committee member for AGA, DGOOC, DGOU, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine (ISAKOS); editorial or governing board for AOSSM, Archives of Orthopaedic and Trauma Surgery, Arthroscopy, Arthroskopie Springer, Journal of Shoulder and Elbow Surgery, Knee Surgery, Sports Traumatology, Arthroscopy, Knee Surgery, Sports Traumatology, Arthroscopy, and OOTR; IP royalties and research support from Arthrex; IP royalties from Arthrosurface: paid consultant for Arthrosurface, medi Bayreuth; and publishing royalties, financial or material support Saunders/Mosby-Elsevier and Springer, Thieme. B.O. reports editorial or governing board for Orthopedics and Orthopedics Today; editorial or governing board and publishing royalties, financial or material support from American Journal of Sports Medicine; board or committee member of the American Orthopaedic Society for Sports Medicine; research support from Arthrex; IP royalties and paid consultant for CONMED Linvatec; paid consultant and research support from Mitek; research support from Musculoskeletal Transplant Foundation; publishing royalties and financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Springer; paid consultant for Vericel; and stock or stock options from Vivorte. D.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; editorial or governing board of OJSM; IP royalties from DePuy, A Johnson & Johnson Company; research support from Smith & Nephew; and other financial or material support from Arthrex, Breg, DJOrtho, Mitek, and Smith & Nephew. A.T. reports board or committee member for American Orthopaedic Society for Sports Medicine; and other financial or material support from Arthrex, Breg, Mitek, Smith & Nephew, and Stryker. F.C. reports board or committee member for American Shoulder and Elbow Surgeons; IP royalties from and paid consultant for Arthrex; and publishing royalties, financial or material support from Saunders/Mosby-Elsevier and Wolters Kluwer Health - Lippincott Williams & Wilkins. P.M. reports IP royalties from, research support from, and paid consultant for Arthrex; research support from Canon, DJ Orthopaedics, Icarus Medical, Ossur, Siemens, Smith & Nephew, Stryker, SubioMed, and Wright Medical Technology; and stock or stock Options from VuMedi. B.M. reports board or committee member for Arthroscopy Association of North America; paid consultant for Arthrex; and paid presenter or speaker for Pendopharm. O.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. H.M. reports paid presenter or speaker for CONMED Linvatec and DJ Orthopaedics; and board or committee member for the Irish Orthopaedic Association. J.S-S. reports paid consultant for Acumed; board or committee member for American Shoulder and Elbow Surgeons; publishing royalties and financial or material support from Elsevier; paid consultant for Exactech; editorial or governing board and publishing royalties, financial or material support from the Journal of Shoulder and Elbow Surgery; publishing royalties and financial or material support from Oxford University Press; stock or stock options from Orthobullets, Precision OS, and posterior shoulder instability: Stock or stock Options; and IP royalties, paid presenter or speaker, research support from Stryker. P.D. reports board or committee member for American Shoulder and Elbow Surgeons and Arthroscopy Association of North America; IP royalties; paid consultant; paid presenter or speaker; research support for Arthrex; stock or stock options for Kaliber Labs and PT Genie; and editorial or governing board of Orthopedics Today. I.W. reports research support from Aesculap/B.Braun and Arthrex; editorial or governing board of the American Journal of Sports Medicine (AJSM) and Arthroscopy; board or committee member for the American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Canadian Orthopaedic Association, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, and International Society of Orthopaedic Surgery and Traumatology (Société Internationale de Chirurgie Orthopédique et de Traumatologie, SICOT); paid presenter or speaker for Bioventus and DePuy, A Johnson & Johnson Company; paid presenter or speaker and research support from Linvatec and Smith & Nephew. T.L. reports research support from Arthrex; other financial or material support from Lima; paid consultant for Stryker; and research support from Wright Medical Technology. R.M.F. reports board or committee member of AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, and Arthroscopy Association of North America, International Cartilage Restoration Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; editorial or governing board of the Journal of Shoulder and Elbow Surgery and Orthopedics Today; paid consultant; paid presenter or speaker for AlloSource and JRF; paid consultant, paid presenter or speaker, and research support from Arthrex; publishing royalties, financial or material support from Elsevier; paid presenter or speaker for Ossur, and research support from Smith & Nephew. G.A. reports board or committee member of American Shoulder and Elbow Surgeons; IP royalties from CONMED Linvatec, Exactech, and Wright Medical Technology; editorial or governing board of the Journal of Shoulder and Elbow Surgery; stock or stock options from Parvizi Surgical Innovation, PrecisionOS, and Reach Orthopedics; and IP royalties, paid consultant, and research support from Stryker. S.R. reports stock or stock options from Ortho RTI and paid consultant for Teladoc. J.Y.B. reports board or committee member of AAOS, Mid-American Orthopaedic Association, and Ohio Orthopaedic Society; research support from Arthrex; paid consultant for CONMED Linvatec and Stryker; and paid consultant for and Research support from Smith & Nephew. R.H.B. reports board or committee member of AAOS and American Orthopaedic Association; and editorial or governing board of the American Journal of Sports Medicine and Journal of the American Academy of Orthopaedic Surgeons. E.C. reports board or committee member of the European Society for Surgery of the Shoulder and Elbow and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid presenter or speaker for DePuy, A Johnson & Johnson Company, and Smith & Nephew; paid consultant for Johnson & Johnson; editorial or governing board of the Journal of Shoulder and Elbow Surgery; and paid presenter or speaker and research support from Stryker. C.C. reports paid consultant for Arthrex; research support from Major League Baseball; and publishing royalties and financial or material support from Springer. P.N.C. reports IP royalties, paid consultant, and paid presenter or speaker for DePuy, A Johnson & Johnson Company; paid consultant for DJ Orthopaedics; IP royalties from and paid consultant for Exactech; publishing royalties and financial or material support from the Journal of Shoulder and Elbow Surgery; IP royalties from Responsive Arthroscopy; paid consultant for Smith & Nephew; and stock or stock options for TitinKM Biomedical. R.A.D. reports unpaid consultant for Akunah; other financial or material support from Arthrex GmbH, Lynch Medical Supplies (Arthrex distributor), and Tekno Surgical (Stryker distributor); stock or stock options from Beemed; board or committee member of the Irish Shoulder and Elbow Society and Société Européenne pour la Chirurgie de l’Epaule et du Coude (SECEC); editorial or governing board of the Journal of the American Academy of Orthopaedic Surgeons; paid consultant for Precision OS; paid presenter or speaker for Smith & Nephew; and paid consultant and paid presenter or speaker for Stryker. X.A.D. reports board or committee member of the American Shoulder and Elbow Surgeons and Association of Bone and Joint Surgeons; editorial or governing board of Clinical Orthopaedics and Related Research; and paid presenter or speaker for Smith & Nephew; S.J.F. reports paid presenter or speaker for Anika Therapeutics; and paid consultant for Zimmer. M.T.F. reports board or committee member of the AAOS, American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; paid consultant for Biorez; research support and unpaid consultant for CONMED Linvatec; research support from Major League Baseball, National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases and Eunice Kennedy Shriver National Institute of Child Health and Human Development), and Regeneration Technologies; IP royalties, paid consultant, paid presenter or speaker, and research support from Smith & Nephew; stock or stock options and unpaid consultant for Sparta; and paid consultant for Tornier. D.E.G. reports IP royalties from Pattern Health. P.R.H. reports board or committee member of the AGA-German speaking Arthroscopy Association. G.H. reports research support from Arthrex; paid consultant and research support from DePuy, A Johnson & Johnson Company: editorial or governing board of the Journal of Science and Medicine in Sport and Shoulder and Elbow (Wiley): research support from Medartis; and board or committee member of the Shoulder Elbow Society of Australia. E.I. reports editorial or governing board of the American Journal of Sports Medicine and Journal of Shoulder and Elbow Surgery. B.C.L. reports board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; research support from Arthrex and Wright Medical Technology; and paid consultant for DePuy, A Johnson & Johnson Company, and Miach. R.M. reports stock or stock Options from Alignmed; and paid presenter or speaker for Arthrex. L.E.L. reports editorial or governing board of the American Journal of Sports Medicine and Arthroscopy, and Video Journal of Sports Medicine; and board or committee member of the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America. W.N.L. reports IP royalties from and unpaid consultant for Zimmer. E.C.M. reports board or committee member of the American Orthopaedic Society for Sports Medicine and research support from Arthrex. M.E.M. reports board or committee member of the American Shoulder and Elbow Surgeons and International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; IP royalties from and paid consultant for Biomet: paid consultant for Bioventus; research support for Breg, DJ Orthopaedics, Mitek, Ossur, and Smith & Nephew; publishing royalties, and financial or material support from Elsevier; editorial or governing board of Orthopedics Today and Orthopedics American Journal of Sports Medicine; and IP royalties from Zimmer. P.M. reports IP royalties and stock or stock options from Alyve Medical: IP royalties, paid presenter or speaker, and research support from Arthrex; and IP royalties from Medacta. L.N. reports paid consultant from; Arthrex board or committee member of the European Society for Shoulder and Elbow Surgery; stock or stock options from Sparta Biopharma and Statera; and IP royalties from and Paid consultant for Stryker. G.N. reports board or committee member of the American Shoulder and Elbow Surgeons and editorial or governing board of Obere Extremität/Springer; IP royalties from Anika and Innomed; paid presenter or speaker for Arthrosurface; paid consultant for AzurMed; IP royalties from and paid consultant for Stryker; and research support form Tornier. M.J.O. reports stock or stock options from Aevumed; board or committee member for the American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, and the Southern Orthopaedic Association; paid consultant for Exactech and Wright Medical Technology; and paid consultant for and research support from Smith & Nephew. S.A.P. reports board or committee member for the AAOS and American Shoulder and Elbow Surgeons; paid consultant for Arthrex and paid consultant for and research support from Exactech. J.P.S. reports editorial or governing board of Arthroscopy. N.A.T. reports paid presenter or speaker for DJ Orthopaedics. E.R.W. reports paid consultant for Acumed, Biomet, Osteoremedies, and Stryker and research support from Konica Minolta. J.R.W. reports board or committee member for the American Orthopaedic Society for Sports Medicine and Arthroscopy Association of North America; paid presenter or speaker for Arthrex and Vericel; paid consultant for Geistlich and ogy; editorial or governing board for Ortho Info; and stock or stock options for Viewfi. J.S.H. reports board or committee member for the American Shoulder and Elbow Surgeons and IP royalties and paid consultant for DJ Orthopaedics. L.M.J. reports research support from Arthrex, Mitek, and Smith & Nephew; editorial or governing board for the Bulletin for the Hospital for Joint Diseases and JBJS Reviews; stock or stock options from Lazurite: and publishing royalties, financial or material support from Wolters Kluwer Health - Lippincott Williams & Wilkins. A.L. reports paid consultant; paid presenter or speaker for Arthrex; stock or stock options from BeeMed and Follow Health; paid consultant; paid presenter or speaker; research support; stock or stock options from Medacta: board or committee member of the Société Francaise d'Arthroscopie; and IP royalties; paid consultant; paid presenter or speaker for Wright Medical Technology. G.E.G. reports stock or stock options from Aevumed, CultivateMD, Genesys, Patient IQ, ROM 3, and Sparta Biopharma; IP royalties; other financial or material support; paid consultant; paid presenter or speaker for DJ Orthopaedics: publishing royalties, financial or material support from Elsevier; paid consultant for Mitek; paid consultant; stock or stock options from Restor3d: and IP royalties from and paid consultant for Tornier. J.F.D. reports board or committee member for AAOS, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and Society of Military Orthopaedic Surgeons; and editorial or governing board for American Journal of Sports Medicine. S.N. reports paid consultant for ACI Clinical and Synthes; IP royalties; stock or stock options from Aevumed and MediFlix; board or committee member of American Shoulder and Elbow Surgeons and Philadelphia Orthopaedic Society; IP royalties; paid consultant; paid presenter or speaker for Biederman Motech; stock or stock options from CLEU Diagnostics, Coracoid Solutions, HealthExl, Parvizi Surgical Innovations, and SurgiWipe; IP royalties; paid consultant; paid presenter or speaker; research support from Enovis; editorial or governing board of the Journal of Bone and Joint Surgery - American and Shoulder & Elbow; publishing royalties, financial or material support from Saunders/Mosby-Elsevier, SLACK Inc, and Wolters Kluwer Health - Lippincott Williams & Wilkins: research support from Roche, Arthrex, DePuy, A Johnson & Johnson Company, Smith & Nephew, Stryker, and Zimmer; and IP royalties from Tigon. C.S.K. reports paid consultant for Acumed, Restore3d, and Smith & Nephew and stock or stock options from GE Healthcare, Johnson & Johnson, Merck, and Pfizer. O.A. reports paid consultant for Exactech, LIMA, Responsive Arthroscopy, and Smith & Nephew and stock or stock options from Suture Tech. Y.B-A. reports paid presenter or speaker from DJ Orthopaedics and stock or stock options from K2M. J.M.L. reports stock or stock options from Stryker and Zimmer. All other authors (E.T.H., Z.S.A., T.R.D., L.P., D.B.W., K.E.B., N.M.C., T.D., J.R.W., M.R., B.W.H., K.G.K., L.A.R., N.P., L.E., T.C., R.M.D., T.B.G.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Several risk factors have been identified for the development of postoperative shoulder stiffness, and there has been increasing interest in orthopedic literature regarding patient-reported allergy (PRA) as an identifiable risk factor for adverse outcomes. The purpose of this study is to determine whether PRAs are associated with subsequent rates of diagnosis of adhesive capsulitis (AC) or return to the operating room for postoperative shoulder stiffness within 2 years after arthroscopic rotator cuff repair (ARCR)., Methods: Current Procedural Terminology surgical billing codes were used to retrospectively identify patients who underwent ARCR at a single urban academic institution from January 2012 to December 2020 with minimum 2-year follow-up. Lysis of adhesions (LOA), manipulation under anesthesia (MUA), and AC of the shoulder were further queried within 2 years postoperatively for the ipsilateral shoulder. Patients were excluded if they had undergone ipsilateral MUA/LOA or received a diagnosis of AC before the index procedure. Demographic characteristics and medical comorbidities (hypertension, diabetes, hyperlipidemia, and hypothyroidism) were extracted from electronic medical records. Baseline characteristics were compared between patients with and without PRAs. Multivariate logistic regression analyses were performed to determine the association of the presence of PRAs overall, as well as the presence of 1, 2, or 3 or more PRAs, with subsequent MUA/LOA or diagnosis of AC within 2 years postoperatively., Results: Of 7057 patients identified in the study period, 6583 were eligible for the final analysis. The mean age was 56.6 ± 11.7 years, and the mean body mass index was 29.1 ± 5.6. Overall, 19.3% of patients (n = 1271) reported at least 1 allergy, and 7.1% (n = 469) had >1 PRA. A total of 44 patients (0.7%) underwent subsequent ipsilateral MUA/LOA within 2 years postoperatively, whereas 93 patients (1.4%) received a diagnosis of ipsilateral AC in the same time frame. PRAs were significantly associated with subsequent diagnosis of AC (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.45-3.92; P < .001), but not MUA/LOA (OR: 1.97, 95% CI: 1.26-3.61; P = .133). Patients with 2 PRAs had greater odds of being diagnosed with AC than patients with 1 PRA (OR: 2.74; 95% CI: 1.14-5.99; P = .012). Although this association was nonsignificant for MUA/LOA, patients with 2 PRAs (OR: 2.67; 95% CI: 0.96-8.80; P = .059) demonstrated a similar statistical trend., Conclusion: PRAs are associated with increased odds of receiving a diagnosis of AC within 2 years after ARCR but were not found to be associated with return to the operating room for postoperative stiffness., (Copyright © 2023 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%., Hypothesis: Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy., Study Design: Retrospective cohort study., Level of Evidence: Level 4., Methods: We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values <0.05 were considered significant., Results: A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest ( P = 0.05) and with daily activity ( P = 0.04), reduced postoperative improvement in Tegner scores ( P = 0.04), and lower odds of return to sport ( P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency ( P < 0.01), pain severity at rest ( P < 0.01) and with daily activity ( P = 0.04), and return to sport ( P = 0.04)., Conclusion: ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia., Clinical Relevance: Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy., Competing Interests: The following author declared potential conflicts of interest: L.M.J. received grants or has pending grants from Arthrex, Mitek, and Smith & Nephew; and received publishing royalties from Wolters Kluwer Health - Lippincott Williams & Wilkins.

Purpose: To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture., Methods: We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport., Results: There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001)., Conclusions: Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI., Level of Evidence: Level III, retrospective cohort study., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Recurrent patellar instability can significantly impact patients' quality of life and function. A large amount of research on patellar instability has been conducted in the past two decades, and a number of traditionally held principles of treatment have been challenged. This review addresses three current concepts and controversies in the treatment of patellar instability, specifically what factors lead to an increased tibial tubercle-trochlear groove distance and how to address them, when to add a tibial tubercle osteotomy to a medial patellofemoral ligament (MPFL) reconstruction, and which medial patellar stabilizers should be reconstructed. Based on current evidence, there are a few recommendations that can be made at this time. While trochleoplasty does have concerns with regard to reproducibility and complication risk, surgeons should consider this technique especially in cases with Dejour D trochlear dysplasia given high failure rates with other techniques. When evaluating whether to concomitantly perform a tibial tubercle osteotomy (TTO) with a MPFL, a TTO does appear to improve outcomes in the presence of maltracking or a positive J sign even with a tibial tuberosity-trochlear grove distance (TT-TG) of 18 to 20 mm, whereas patients without maltracking with a TT-TG of up to 25 mm may do well with an isolated MPFL reconstruction. Lastly, while MPFL reconstruction continues to have the most robust data supporting favorable outcomes, a number of biomechanical studies and short-term clinical studies have suggested promising results with medial quadriceps tendon femoral ligament and hybrid techniques.

Background: Previous research has found that the incidence of neurovascular injury is greatest among multiligamentous knee injuries (MLKIs) with documented knee dislocation (KD). However, it is unknown whether there is a comparative difference in functional recovery based on evidence of a true dislocation., Purpose: To determine whether the knee dislocation-3 (KD3) injury pattern of MLKI with documented tibiofemoral dislocation represents a more severe injury than KD3 MLKI without documented dislocation, as manifested by poorer clinical outcomes at long-term follow-up., Study Design: Cohort study; Level of evidence, 3., Methods: A multicenter retrospective cohort study was performed of patients who underwent surgical treatment for KD3 MLKI between May 2012 and February 2021. Outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, and visual analog scale (VAS) for pain. Documented dislocation was defined as a radiographically confirmed tibiofemoral disarticulation, the equivalent radiology report from outside transfer, or emergency department documentation of a knee reduction maneuver. Subgroup analysis was performed comparing lateral (KD3-L) versus medial (KD3-M) injuries. Multivariable linear regression was conducted to determine whether documented dislocation was predictive of outcomes., Results: A total of 42 patients (25 male, 17 female) were assessed at a mean 6.5-year follow-up (range, 2.1-10.7 years). Twenty patients (47.6%) were found to have a documented KD; they reported significantly lower IKDC (49.9 vs 63.0; P = .043), Lysholm (59.8 vs 74.5; P = .023), and Tegner activity level (2.9 vs 4.7; P = .027) scores than the patients without documented dislocation. VAS pain was not significantly different between groups (36.4 vs 33.5; P = .269). The incidence of neurovascular injury was greater among those with documented dislocation (45.0% vs 13.6%; P = .040). Subgroup analysis found that patients with KD3-L injuries experienced a greater deficit in Tegner activity level than patients with KD3-M injuries (Δ: -3.4 vs -1.2; P = .006) and had an increased incidence of neurovascular injury (41.7% vs 11.1%; P = .042). Documented dislocation status was predictive of poorer IKDC (β = -2.15; P = .038) and Lysholm (β = -2.85; P = .007) scores., Conclusion: Patients undergoing surgical management of KD3 injuries with true, documented KD had significantly worse clinical and functional outcomes than those with nondislocated joints at a mean 6.5-year follow-up. The current MLKI classification based solely on ligament involvement may be obscuring outcome research by not accounting for true dislocation., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: L.M.J. has received research support from Arthrex, Mitek, and Smith & Nephew; and support for education from Suvon Surgical, Gotham Surgical, Arthrex, and Flexion Therapeutics; L.M.J. also holds stocks or stock options in Lazurite. M.J.M. has received consulting fees from Smith & Nephew. M.J.A. has received consulting fees from BodyCad, JRF Ortho, Mitek, and DePuy Synthes; research support from Orcosa; and support for education from Gotham Surgical Solutions and Suvon Surgical. 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.

This review highlights the expanding use of knee-based osteotomies in the treatment of knee joint malalignment and joint preservation. Planning and outcomes of traditional high tibial osteotomies and distal femoral osteotomies are discussed in addition to some of the challenges encountered with these procedures. Lastly, the role of patient-specific instrumentation and three-dimensional guided templating in performing osteotomies is discussed with respect to procedures that involve biplanar corrections and those performed in combination with other joint preservation procedures.

Purpose: To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation., Methods: A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant., Results: Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P = .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P = .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P = .01)., Conclusions: The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR., Level of Evidence: Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Cannabidiol (CBD) has been shown recently to positively affect patient pain and satisfaction immediately after arthroscopic rotator cuff repair (ARCR). However, it is unclear whether the addition of CBD to a perioperative regimen could affect postoperative outcomes., Purpose: To evaluate patient-reported outcomes among patients who underwent ARCR and received buccally absorbed CBD or an identical placebo for early postoperative pain management at 1-year follow-up., Study Design: Randomized controlled trial; Level of evidence, 2., Methods: Eligible patients had previously participated in a multicenter, placebo-controlled, randomized, double-blinded trial that evaluated the analgesic effects of CBD in the immediate postoperative period after ARCR. The experimental group received 25 mg of CBD 3 times/day if <80 kg and 50 mg of CBD 3 times/day if >80 kg for 14 days, with the control group receiving an identical placebo. The following outcomes were assessed at minimum 1-year follow-up: visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE), and patient satisfaction. The rates of achievement of the Patient Acceptable Symptom State (PASS) were compared based on ASES at latest follow-up. Continuous and categorical variables were compared with the Mann-Whitney U test and Fisher exact test, respectively., Results: Follow-up was obtained from 83 of 99 patients (83.8%) who completed the original trial. There were no significant differences between the CBD and control groups with respect to age, sex, body mass index, rate of concomitant procedures, or number of anchors used intraoperatively. At 1-year follow-up, there were no significant differences between the CBD and control groups in VAS pain (0.8 vs 1.2, P  = .38), ASES (93.0 vs 91.1, P  = .71), SANE (87.6 vs 90.1, P  = .24), or satisfaction (97.4 vs 95.4, P  = .41). A majority of patients achieved the PASS (81.0% [CBD] vs 77.5% [control]; P  = .79)., Conclusion: Perioperative use of CBD for pain control among patients undergoing ARCR did not result in any significant deficits in pain, satisfaction, or patient-reported outcomes at 1-year postoperatively compared with a placebo control group. These findings suggest that CBD can be considered in a postoperative multimodal pain management regimen without detrimental effects on outcome., Registration: NCT04672252 (ClinicalTrials.gov identifier)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.J.A. has received research support from Arthrex and Orcosa; education payments from Arthrex; consulting fees from Arthrex, Mitek, and DePuy; and nonconsulting fees from Arthrex. G.G.-L. has received education payments from Gotham Surgical, nonconsulting fees from Arthrex, and hospitality payments from Smith & Nephew. A.S.R. has received education payments from Gotham Surgical and hospitality payments from Arthrex. L.M.J. has received education payments from Arthrex, consulting fees from Flexion Therapeutics, and hospitality payments from Horizon Therapeutics. K.M.K. has received education payments from Team 1, consulting fees from Arthrex, and holds stock in Orcosa. 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. Ethical approval for this study was obtained from NYU Langone Health (reference No. i19-01293)., (© The Author(s) 2024.)

Purpose: To investigate the rate of return to sports and sport psychological readiness between patients who underwent isolated MPFLR (iMPFLR) compared to a matched cohort of patients who underwent MPFLR with anteromedializing tibial tubercle osteotomy (MPFLR/TTO)., Methods: Patients who underwent primary MPFLR with or without TTO for recurrent patellar instability were retrospectively reviewed from 2012 to 2020 at a single institution. Preinjury sport and work information, Kujala, Tegner, Visual Analogue Score for pain, satisfaction and MPFL-Return to Sport after Injury (MPFL-RSI) score were collected. Two readers independently measured the tibial tuberosity-trochlear groove distance, Caton-Deschamps index and Dejour classification for trochlear dysplasia. Patients in iMPFLR and MPFLR/TTO groups were matched 1:1 on age, sex, body mass index and follow-up length. Multivariate regression analysis was performed to determine whether the MPFL-RSI was associated with a return to sport., Results: This study included 74 patients at mean follow-up of 52.5 months (range: 24-117). These groups returned to sport at similar rates (iMPFLR: 67.6%, MPFLR/TTO: 73.0%, not significant [ns]), though iMPFLR patients returned more quickly (8.4 vs. 12.8 months, p = 0.019). Rates of return to preinjury sport level were also similar (45.9% vs. 40.5%, ns). Patients with Dejour B/C took more time to return to sport compared to patients with mild/no trochlear pathology (13.8 vs. 7.9 months, p = 0.003). Increasing MPFL-RSI score was significantly predictive of the overall return to sport (odds ratio [OR]: 1.08, 95% confidence interval [CI] [1.03, 1.13], p < 0.001) and return to preinjury level (OR: 1.07, 95% CI [1.04, 1.13], p < 0.001). Most patients in iMPFLR and MPFLR/TTO groups resumed work (95.7% vs. 88.5%, ns), though iMPFLR patients who returned to preinjury work levels did so more quickly (1.7 vs. 4.6 months, p = 0.005)., Conclusion: Patients who underwent MPFLR with anteromedializing TTO demonstrated similar rates of return to sport and psychological readiness compared to an isolated MPFLR matched comparison group, though iMPFLRs returned more quickly. Patients with more severe trochlear pathology required more time to return to sports., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: Arthroscopic Bankart repair (ABR) may be more effective than nonoperative management for patients with anterior shoulder instability following first-time dislocation. The purpose of the study was to determine the most cost-effective treatment strategy by evaluating the incremental cost-effectiveness ratio (ICER) for ABR versus nonoperative treatment., Methods: This cost-effectiveness study utilized a Markov decision chain and Monte Carlo simulation. Probabilities, health utility values, and outcome data regarding ABR and nonoperative management of first-time shoulder instability derived from level I/II evidence. Costs were tabulated from Centers for Medicaid & Medicare Services. Probabilistic sensitivity analysis was performed using >100,000 repetitions of the Monte Carlo simulation. A willingness-to-pay (WTP) threshold was set at $50,000., Results: The expected cost for operative management higher than nonoperative management ($32,765 vs $29,343). However, ABR (5.48 quality-adjusted life years (QALYs)) was the more effective treatment strategy compared to nonoperative management (4.61 QALYs). The ICER for ABR was $3943. Probabilistic sensitivity analysis showed that ABR was the most cost-effective strategy in 100% of simulations., Discussion: ABR is more cost-effective than nonoperative management for first-time anterior shoulder dislocation. The threshold analysis demonstrated that when accounting for WTP, ABR was found to be the more cost-effective strategy., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KAC receives research support from Stryker and consulting fees from Mitek. EJS receives consulting fees from Arthrex, Cartiheal, Better PT, Flexion Therapeutics, Joint Restoration Foundation, Organogenesis, Smith & Nephew, Subchondral Solutions, Vericel. LMJ receives research support from Arthrex, Mitek, Smith & Nephew and receives publishing royalties from Wolters Kluwer Health., (© The Author(s) 2023.)

Background: The purpose of this study was to determine if any differences exist in patient satisfaction with office-based visits versus telemedicine visits following arthroscopic shoulder surgery. Methods: Patients undergoing shoulder arthroscopy were prospectively enrolled for 1 year. Patient demographic and clinical data (including complication events) and second postoperative visit satisfaction data were recorded and analyzed for statistical significance. Results: Ninety-six ( n  = 96) patients met inclusion criteria. Fifty-four patients (56.3%) participated in a traditional in-person office visit, and 42 participated in a video visit (43.8%). No significant differences were found between office and video appointments in terms of overall care satisfaction (9.46 ± 0.9 vs. 9.55 ± 1.0, p  = 0.67). Females were significantly less satisfied with their second postoperative visit compared with males (8.3 ± 2.3 vs. 9.3 ± 1.5, p  = 0.035). Significantly more females would also have preferred a traditional in person office visit compared with males (91% vs. 67%, p  = 0.009). Video appointment patients spent significantly more time with their surgeon than office visit patients (57.64 mean rank vs. 41.39 mean rank, p  = 0.003). Discussion: Video visit patients required significantly less time overall for their visit and spent significantly more time with their surgeon, although did not demonstrate differences in satisfaction.

Lateral patellar instability is one of the most common knee disorders among adolescents. Numerous anthropometric features, including trochlear dysplasia, patella alta, high tibial tubercle-to-trochlear groove distance, and coronal and rotational plane malalignment, are considered primary risk factors for patellar dislocation, and the understanding of their complex interplay is continuously evolving. Because of the multifactorial nature of patellar instability, there is a lack of consensus regarding many aspects of surgical intervention. Medial patellofemoral ligament reconstruction is considered to be the essential procedure in preventing recurrent instability. However, there is growing interest in addressing underlying anatomic risk factors that contribute to patellar instability. It is important to discuss the diagnosis and management of patellar instability, surgical considerations in medial patellofemoral ligament reconstruction, mitigation/correction of anatomic risk factors, and treatment of associated chondral lesions.

Background: Multi-ligamentous knee injuries (MLKI) are potentially devastating injuries, though existing prognostic research among older patients who sustain MLKI is limited. The purpose was to investigate clinical outcomes and rates of return to pre-injury activities following surgical treatment of MLKI in patients at least 40 years old., Methods: This study was a multi-center retrospective case series of patients who underwent surgical treatment for MLKI from 2013-2020 and were ≥ 40 years old at time of injury. Outcomes were assessed via e-mail and telephone using the International Knee Documentation Committee (IKDC) score, Lysholm score, Tegner activity scale, a satisfaction rating, and return to pre-injury sport and work surveys. Stepwise linear regression was used to assess the impact of preoperative characteristics on IKDC and Lysholm scores., Results: Of 45 patients eligible for inclusion, 33 patients (mean age: 48.6 years [range: 40-72]) were assessed at a mean follow-up of 59.1 months (range 24-133). The cohort reported a mean IKDC of 63.4 ± 23.5, Lysholm of 72.6 ± 23.6, and Tegner of 3.8 ± 2.0. There was a 41.2% rate of return to sports, and 82.1% returned to work. Documented knee dislocation was predictive of poorer IKDC (β:-20.05, p = 0.025) and Lysholm (β:-19.99, p = 0.030). Patients aged > 50 were more satisfied compared to those 40-50 years old (96.2 ± 4.9 vs 75.6 ± 23.3, p = 0.012)., Conclusions: Patients who sustained MLKI aged at least 40 at injury demonstrated fair clinical outcomes at a mean 5-year follow-up. Older patients who sustained MLKI reported a relatively high rate of return to work but were less likely to return to sports., Level of Evidence: IV, Case series., Competing Interests: Declaration of competing interest The 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., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Stem cell therapies have become widely popular in orthopaedic surgery, with a recent interest in adipose-derived therapeutics. Adipose-derived mesenchymal signaling cells (ADSCs) and micronized adipose tissue (MAT) are unique therapies derived from different processing methods. Characterizing the most influential studies in lipoaspirate research can help clarify controversies in definitions, identify core literature, and further collective knowledge for educational purposes. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched to identify the top 50 most cited publications (based on citation/year) on orthopaedic ADSCs or MAT research. Publication and study characteristics were extracted and reported using descriptive statistics. Level of evidence was assessed for applicable studies, and Spearman correlations were calculated to assess the relationship between citation data and level of evidence. The top 50 articles were published between the years 2003 and 2020, with 78% published in the year 2010 or later. The mean number of citations was 103.1 ± 81.1. The mean citation rate was 12.4 ± 6.0 citations per year. Of the 21 studies for which level of evidence was assessed, the majority were level III (10, 47.6%). The single study design most common among the top 50 cited articles was in vitro basic science studies (17 studies, 34%). Twenty-nine articles (58%) were classified as basic science or translational. Application to treat knee osteoarthritis was the most common focus of studies (14 studies, 28%), followed by in vitro analysis of growth factor and cell signaling markers (11 studies, 22%). No correlation was found between rank, citation rate, or year of publication and level of evidence. This study provides a current landscape on the most cited articles in lipoaspirates in orthopaedic surgery. With the expansion of ADSCs and MAT in the past two decades, this study provides the first historical landmark of the literature and a launching point for future research. Studies should explicitly state their processing methodology and whether their study investigates ADSCs or MAT to avoid misinformation., Competing Interests: A.S.B., H.C.H., and J.F.O. have no conflicts of interest to declare.J.G.K.: American Orthopaedic Foot and Ankle Society: board or committee member; Arthrex, Inc: paid consultant; Arthroscopy Association of North America: board or committee member; European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA); Ankle and Foot Associates (AFAS): board or committee member; International Society for Cartilage Repair of the Ankle: board or committee member; Isto Biologics: paid consultant, research support.L.M.J.: Arthrex, Inc: research support; Bulletin for the Hospital for Joint Diseases: editorial or governing board; JBJS Reviews: editorial or governing board; Mitek: research support; Smith & Nephew: research support; Wolters Kluwer Health - Lippincott Williams & Wilkins: publishing royalties, financial or material support. E. J. S: AAOS: board or committee member; American Orthopaedic Association: board or committee member; Arthrex, Inc: paid consultant, paid presenter or speaker; Arthroscopy Association of North America: board or committee member; Better PT: stock or stock options; Cartiheal: research support; Cartilage, Bulletin of the Hospital For Joint Diseases: editorial or governing board; Fidia: paid consultant, research support; Flexion Therapeutics: paid consultant; Jaypee Publishing: publishing royalties, financial or material support; Joint Restoration Foundation: paid consultant; Organogenesis: paid consultant, paid presenter or speaker, research support; Smith & Nephew: paid consultant, paid presenter or speaker; Springer: publishing royalties, financial or material support; Subchondral Solutions: paid consultant; Vericel: paid consultant; paid presenter or speaker.K.A.C: AAOS: board or committee member; Arthroscopy Association of North America: board or committee member; Mitek: paid consultant; Samumed: paid consultant; Stryker: research support., (Thieme. All rights reserved.)

It is important to highlight the use of patient-specific cutting guides for knee joint osteotomies. Rationale, pitfalls, and planning of conventional osteotomy techniques are examined. The benefits of using patient-specific guides focusing on the potential for improved accuracy, efficiency, and safety are reviewed. The versatility of guides to manipulate the slope in both the coronal and sagittal planes, as well as its ability to accommodate concomitant procedures, is discussed. The time and cost differentials between standard cutting guides and three-dimensional-guided templating are also discussed.

Purpose: To compare psychological readiness to return to sport (RTS), RTS rate, level of return, and time to return between patients who underwent bilateral anterior cruciate ligament reconstruction (ACLR) and those who underwent unilateral ACLR., Methods: The electronic medical record at a single academic medical center was queried for patients who underwent ACLR from January 2012 to May 2020. The inclusion criteria were skeletally mature patients who underwent either single or sequential bilateral ACLR and who had undergone either the primary ACLR or second contralateral ACLR at least 2 years earlier. Bilateral ACLRs were matched 1:3 to unilateral reconstructions based on age, sex, and body mass index. Psychological readiness to RTS was assessed using the validated ACL Return to Sport After Injury (ACL-RSI) scale. This, along with time to return and level of RTS, was compared between the 2 cohorts., Results: In total, 170 patients were included, of whom 44 underwent bilateral ACLR and 132 underwent unilateral ACLR. At the time of the first surgical procedure, patients in the unilateral cohort were aged 28.8 ± 9.4 years and those in the bilateral cohort were aged 25.7 ± 9.8 years ( P  = .06). The average time difference between the first and second surgical procedures was 28.4 ± 22.3 months. There was no difference in psychological readiness to RTS (50.5 in bilateral cohort vs 48.1 in unilateral cohort, P  = .66), RTS rate (78.0% in unilateral cohort vs 65.9% in bilateral cohort, P  = .16), percentage of return to preinjury sport level (61.2% in unilateral cohort vs 69.0% in bilateral cohort, P  = .21), or time to return (41.2 ± 29.3 weeks in unilateral cohort vs 35.2 ± 23.7 weeks in bilateral cohort, P  = .31) between the 2 cohorts., Conclusions: Compared with patients who undergo unilateral ACLR, patients who undergo bilateral ACLR are equally as psychologically ready to RTS, showing equal rates of RTS, time to return, and level of return., Level of Evidence: Level III, retrospective cohort study., 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., (© 2023 The Authors.)

Purpose: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction., Methods: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3., Results: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%., Conclusion: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstructionPurpose: The purpose of this study was to systematically review the evidence in the literature in order to evaluate the outcomes following medial patellofemoral ligament (MPFL) reconstruction with allograft compared to autograft reconstruction., Methods: A systematic literature search was performed based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Inclusion criteria for the study was clinical studies reporting on MPFL reconstruction with allograft. Recurrence rate, complications, rate of return-to-play, and functional outcomes including the Kujala, Tegner, and visual analog scale (VAS) scores were evaluated. Statistical analysis was performed using GraphPad Prism 8.3., Results: Our review identified 12 studies with a total of 336 patient knees meeting the inclusion criteria. The majority of patients were female (61.6%), with a mean age of 22.3 years and a mean follow-up of 43.4 months. The overall rate of recurrence of lateral patellar instability was 2.7% in the allograft cohort as compared to 7.8% in the autograft cohort (p = 0.01). The mean Kujala score was 91.8%, and the mean VAS score was 1.3 at final follow-up. Additionally, 81.5% of patients were able to return to play in the studies reporting this outcome measure. The overall complication rate was 1.4%., Conclusion: The overall rate of recurrence was lower following MPFL reconstruction with allograft as compared to autograft in the treatment of lateral patellar instability. Additionally, there were excellent patient reported outcomes and a low complication rate following the use of allograft for MPFL reconstruction.

A 50-year-old woman developed severe soft tissue atrophy of the hip following a triamincolone acetonide injection to the greater trochanteric bursa. Saline injection therapy was initially attempted without improvement and the defect was ultimately treated effectively with serial fat grafting. Adverse soft tissue reactions are rare but potentially devastating complications of corticosteroid injections, and the use of soluble steroid preparations and proper injection techniques can minimize the risk to surrounding tissue. Serial fat grafting represents a promising treatment option for severe cases of steroid-induced soft tissue atrophy.

Aims: The aim of this study was to establish consensus statements on the diagnosis, nonoperative management, and indications, if any, for medial patellofemoral complex (MPFC) repair in patients with patellar instability, using the modified Delphi approach., Methods: A total of 60 surgeons from 11 countries were invited to develop consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest within patellar instability. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered to be unanimous., Results: Of 27 questions and statements on patellar instability, three achieved unanimous consensus, 14 achieved strong consensus, five achieved consensus, and five did not achieve consensus., Conclusion: The statements that reached unanimous consensus were that an assessment of physeal status is critical for paediatric patients with patellar instability. There was also unanimous consensus on early mobilization and resistance training following nonoperative management once there is no apprehension. The statements that did not achieve consensus were on the importance of immobilization of the knee, the use of orthobiologics in nonoperative management, the indications for MPFC repair, and whether a vastus medialis oblique advancement should be performed., Competing Interests: D. Dejour reports royalties or licenses from Corin, Arthrex, and SBM and consulting fees from Smith & Nephew, all unrelated to this study. M. K. Mulcahey reports consulting fees from Arthrex, unrelated to this study. J. R. Wittstein reports consulting fees from Geistlich, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex and Vericel, stock or stock options from ViewFi Health, all unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, both related and unrelated to this study, royalties or licenses and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all unrelated to this study., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Concentrated bone marrow aspirate (cBMA) has garnered widespread and increasing attention in recent years. We aimed to characterize the most influential articles in cBMA research while clarifying controversies surrounding its use and clinical efficacy and identifying important areas on which to focus future research efforts. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched to identify the top 50 most cited publications on orthopaedic cBMA research. Publication and study characteristics were extracted, and Spearman's correlations were calculated to assess the relationship between citation data and level of evidence. The top 50 articles were published between the years 1996 and 2018, with 58% published in the year 2010 or later. Of the 29 studies for which level of evidence was assessed, the majority were Level IV (24, 83%). Twenty-one articles (42%) were classified as basic science or translational (9 cell culture, 8 animal study, and 4 using human blood samples). Application to treat cartilage defects was the most common focus of studies (17 studies, 34%), followed by analysis of cBMA composition (14 studies, 28%). No correlation was found between rank, citation rate, or year of publication and level of evidence. The most influential articles on cBMA are recent and consist of a majority low level of evidence studies. Cohort studies were the most common study type among the top 50 most cited articles, while basic science articles were relatively less common. These results suggest a rapidly evolving field with the potential to better explain inconsistent clinical results with improved understanding and documentation of basic science concepts in addition to large-scale, prospective clinical trials. Orthobiologics especially cBMA holds great promise for the future, and higher level clinical trials will help better define the best clinical uses for this treatment., Competing Interests: J.F.O., H.C.H., and A.S.B. have nothing to disclose.J.G.K. has the following disclosures: American Orthopaedic Foot and Ankle Society: board or committee member; Arthrex, Inc: paid consultant; Arthroscopy Association of North America: board or committee member; European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) Ankle and Foot Associates (AFAS): board or committee member; International Society for Cartilage Repair of the Ankle: board or committee member; Isto Biologics: paid consultant and research support. L.M.J. has the following disclosures: Arthrex, Inc: research support; Bulletin for the Hospital for Joint Diseases: editorial or governing board; Journal of Bone and Joint Surgery Reviews: editorial or governing board; MiTek: research support; Smith & Nephew: research support; Wolters Kluwer Health—Lippincott Williams & Wilkins: publishing royalties, financial or material support. E.J.S. has the following disclosures: AAOS: board or committee member; American Orthopaedic Association: board or committee member; Arthrex, Inc: paid consultant; paid presenter or speaker; Arthroscopy Association of North America: board or committee member; Better PT: stock or stock options; Cartiheal: research support; Cartilage, Bulletin of the Hospital For Joint Diseases: editorial or governing board; Fidia: paid consultant; research support; Flexion Therapeutics: paid consultant; Jaypee Publishing: publishing royalties, financial or material support; Joint Restoration Foundation: paid consultant; Organogenesis: paid consultant; paid presenter or speaker; research support; Smith & Nephew: paid consultant; paid presenter or speaker; Springer: publishing royalties, financial or material support; Subchondral Solutions: paid consultant; Vericel: paid consultant; paid presenter or speaker. K.A.C. has the following disclosures: AAOS: board or committee member; Arthroscopy Association of North America: board or committee member; MiTek: paid consultant; Samumed: paid consultant; Stryker: research support., (Thieme. All rights reserved.)

Background: Force plate-based jump testing may serve as a potential alternative to traditional return to sport (RTS) testing batteries. The purpose of our study was to identify force plate jump metrics that were predictive of RTS test findings in patients who were at least six months postoperative following anterior cruciate ligament reconstruction (ACLR)., Methods: We conducted a cross-sectional study of patients who underwent ACLR at our center and were at least six months postoperative. Subjects completed a multimodal Institutional RTS (IRTS) testing battery which included range of motion (ROM) testing and isokinetic quadriceps strength testing. Subjects also completed a countermovement jump testing protocol on a commercially-available force plate. Jump metrics predictive of IRTS test findings were identified using multivariable linear and logistic regression with stepwise selection. Model significance was assessed at α=0.002., Results: Sixteen patients (7M, 9F) were enrolled in our study with median age of 29 years (range 20-47). Relative concentric impulse was positively predictive of knee flexion active ROM (β=7.07, P=0.01) and passive ROM (β=9.79, P=0.003). Maximum power was positively predictive of quadriceps strength at 60 deg/s (β=3.27, P<0.001) and 180 deg/s (β=2.46, P<0.001). Center-of-pressure (COP) shift acceleration along the force plate X-axis was negatively predictive of Bunkie lateral test score (β=-945, P<0.001) and medial test score (β=-839, P=0.03)., Conclusions: Force plate-derived vertical jump testing metrics are predictive of certain components of a multimodal RTS physical assessment for ACLR patients, including knee flexion ROM, quadriceps strength on isokinetic testing, and Bunkie Test performance.