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This multicenter, randomized, double-blind, placebo-controlled clinical study assessed the efficacy and safety of ezetimibe administered with lovastatin in primary hypercholesterolemia. After dietary stabilization, a 2- to 12-week washout period, and a 4-week single-blind placebo lead-in period, 548 patients with low-density lipoprotein (LDL) cholesterol > or =145 mg/dl (3.75 mmol/L) and < or =250 mg/dl (6.47 mmol/L) and triglycerides < or =350 mg/dl (3.99 mmol/L) were randomized to one of the following, administered daily for 12 weeks: ezetimibe 10 mg; lovastatin 10, 20, or 40 mg; ezetimibe 10 mg plus lovastatin 10, 20, or 40 mg; or placebo. The primary efficacy variable was percentage decrease in direct LDL cholesterol from baseline to end point for pooled ezetimibe plus lovastatin versus pooled lovastatin alone. Ezetimibe plus lovastatin significantly improved concentrations of LDL cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides compared with lovastatin alone (p <0.01). The coadministration of ezetimibe provided an incremental 14% LDL cholesterol decrease, a 5% HDL cholesterol increase, and a 10% decrease in triglycerides compared with pooled lovastatin alone. Ezetimibe plus lovastatin provided mean LDL cholesterol decreases of 33% to 45%, median triglyceride decreases of 19% to 27%, and mean HDL cholesterol increases of 8% to 9%, depending on the statin dose. The coadministration of ezetimibe 10 mg plus the starting dose of lovastatin (10 mg) provided comparable efficacy to high-dose lovastatin (40 mg) across the lipid profile (LDL cholesterol, HDL cholesterol, and triglycerides). Ezetimibe plus lovastatin was well tolerated, with a safety profile similar to both lovastatin alone and placebo. The coadministration of ezetimibe and lovastatin may offer a new treatment option in lipid management of patients with hypercholesterolemia. [ABSTRACT FROM AUTHOR]

Combination therapy is increasingly recommended for patients with multiple lipid disorders, especially those at high risk for coronary events. We investigated the long-term safety and effectiveness of a new drug formulation containing once-daily extended-release niacin and lovastatin. A total of 814 men and women (mean age 59 years) with dyslipidemia were enrolled in a 52-week multicenter, open-label study. We used 4 escalating doses (niacin/lovastatin in milligrams): 500/10 for the first month, 1,000/20 for the second, 1,500/30 for the third, and 2,000/40 for the fourth month through week 52. Dose-dependent effects were observed for all major lipid parameters. At week 16, mean low-density lipoprotein (LDL) cholesterol and triglycerides were reduced by 47% and 41%, respectively; mean high-density lipoprotein (HDL) cholesterol was increased by 30% (all p <0.001). LDL/HDL cholesterol and total/HDL cholesterol ratios were also decreased by 58% and 48%, respectively. These effects persisted through week 52, except for the mean increase in HDL cholesterol, which had increased to 41% at 1 year. Lipoprotein (a) and C-reactive protein also decreased in a dose-related manner (by 25% and 24%, respectively, on 2,000/40 mg; p <0.01 vs baseline). Treatment was generally well tolerated. The most common adverse event was flushing, which caused 10% of patients to withdraw. Other adverse events included gastrointestinal upset, pruritus, rash, and headache. Drug-induced myopathy did not occur in any patient. The incidence of elevated liver enzymes to >3 times the upper limit of normal was 0.5%. Once-daily niacin/lovastatin exhibits substantial effects on multiple lipid risk factors and represents a significant new treatment option in the management of dyslipidemia. [ABSTRACT FROM AUTHOR]

Background: Long-term follow-up for anterior cruciate ligament reconstruction (ACLR) is limited due to heterogeneity in the number of techniques utilized, the number of surgeons included, and attrition bias., Purpose: To analyze a single surgeon's 35-year experience with ACLR using the transtibial technique, with an emphasis on temporal trends in graft selection and subanalyses on rates of revision surgery, contralateral ACLR, and nonrevision reoperation among different demographic cohorts of patients., Study Design: Case series; Level of evidence, 4., Methods: All patients who underwent arthroscopically assisted single-bundle ACLR between 1986 and 2021 were identified from a prospectively maintained single-surgeon registry. Outcomes of interest included revision, reoperation, and contralateral rupture rates., Results: A total of 2915 ACLRs were performed during the senior surgeon's career. The mean age for primary ACLR was 29.4 ± 14.8 years. During primary ACLR, 98.4% of patients received a central-third bone-patellar tendon-bone (BPTB) graft. Increasing patient age was associated with increasing allograft usage ( P < .01), with a significant temporal increase in allograft usage over the senior surgeon's career ( P < .01). There was a higher revision rate among younger patients ( P < .01), female patients aged 21 to 25 years ( P = .01), and patients who received an allograft during the primary procedure ( P = .04). The contralateral rupture rate showed no difference between sexes ( P = .34); however, patients who underwent ACLR with autograft had a greater rate of contralateral injury compared with those with allograft ( P < .01). The contralateral rupture rate was greater than the revision rate ( P < .01). The most common causes of nonrevision reoperation were failed meniscal repair, new meniscal tears, arthrofibrosis, and painful hardware removal., Conclusion: The findings of this single-surgeon registry reveal temporal trends in ACLR over a 35-year career. There was a trend toward increasing BPTB allograft use in ACLR, especially in older patients and revision cases. A greater revision rate was observed among younger patients, female patients, and those receiving allografts during primary surgery. Contralateral ACLR was more common than revision surgery., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.J.R. has received education payments from Medwest Associates, Arthrex, and Crossroads Orthopedics LLC; consulting fees from Vericel; and hospitality payments from Wright Medical Tech and Stryker. J.C. has received education payments from Medwest Associates, Arthrex, and Smith+Nephew; consulting fees from RTI Surgical, Smith+Nephew, Vericel, Arthrex, and DePuy Synthes Products; nonconsulting fees from Smith+Nephew and Arthrex; compensation for serving as faculty or as a speaker for a nonaccredited and noncertified continuing education program from Linvatec; a grant from Arthrex; and hospitality payments from Medical Device Business Services, Medwest Associates, and Stryker. B.R.B. has received consulting fees from OsteoCentric Tech; hospitality payments from OsteoCentric Tech; and honoraria from NovoPedics. 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.)

Suprascapular nerve (SSN) entrapment is a rare but significant cause of posterior shoulder pain and weakness. Compression of the nerve at the level of the spinoglenoid notch leads to weakness and atrophy of the infraspinatus. A detailed history and physical examination along with appropriate workup are paramount to arrive at this diagnosis. Surgical decompression is indicated in cases refractory to conservative management. In this Technical Note, we describe our technique for open decompression of the SSN at the spinoglenoid notch. This approach permits direct visualization of the SSN and allows for a safe, reliable, and thorough decompression., (© 2024 The Authors.)

Purpose: To perform a multinational survey and identify patterns in capsular management at the time of hip arthroscopy., Methods: An anonymous, nonvalidated survey was distributed by the American Orthopaedic Society for Sports Medicine; Arthroscopy Association of North America; European Society of Sports Traumatology, Knee Surgery & Arthroscopy; International Society for Hip Arthroscopy; and Turkish Society of Sports Traumatology, Arthroscopy, and Knee Surgery. The questions were broken down into 6 categories: demographic characteristics, capsulotomy preference, traction stitches, capsular closure, postoperative rehabilitation, and postoperative complications., Results: The survey was completed by 157 surgeons. Surgeons who performed half or full T-type capsulotomies had 2.4 higher odds of using traction sutures for managing both the peripheral and central compartments during hip arthroscopy for femoroacetabular impingement (P = .024). Surgeons who believed that there was sufficient literature regarding the importance of hip capsular closure had 1.9 higher odds of routinely performing complete closure of the capsule (P = .044). Additionally, surgeons who practiced in the United States had 8.1 higher odds of routinely closing the capsule relative to international surgeons (P < .001). Moreover, surgeons who received hip arthroscopy training in residency or fellowship had 2.4 higher odds of closing the capsule completely compared with surgeons who did not have exposure to hip arthroscopy during their training (P = .009)., Conclusions: Geographic and surgeon-related variables correlate with capsular management preferences during hip arthroscopy. Surgeons who perform half or full T-capsulotomies more often use traction stitches for managing both the peripheral and central compartments. Surgeons performing routine capsular closure are more likely to believe that sufficient evidence is available to support the practice, with surgeons in the United States being more likely to perform routine capsular closure in comparison to their international colleagues., Clinical Relevance: As the field of hip preservation continues to evolve, capsular management will likely continue to play an important role in access, instrumentation, and postoperative outcomes., Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: M.H. reports a relationship with Moximed. S.J.N. receives research support from AlloSource, Arthrex, Athletico, DJ Orthopaedics, Linvatec, Miomed, Smith & Nephew, and Stryker; is a board or committee member of American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America; receives intellectual property royalties from Ossur and Stryker; receives publishing royalties and financial or material support from Springer; and is a paid consultant for Stryker. J.C. is a paid consultant for Arthrex, ConMed Linvatec, Ossur, and Smith & Nephew and is a board or committee member of American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, and International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Social media has the potential to play a substantial role in the decision-making of patients when choosing a physician for care., Purpose: The purpose of this study was to determine whether an association exists between physician social media activity and patient satisfaction ratings on physician review websites (PRWs) as well as number of reviews. It was hypothesized that there would be a significant association between physician social media utilization and patient satisfaction ratings., Study Design: Cross-sectional study., Methods: The American Orthopaedic Society for Sports Medicine database was queried for the complete membership list. The online media profile and level of activity of the members were evaluated, and an online media presence score was calculated. The surgeons with the approximately top 10% of online media presence scores were compiled to assess the relationship between social media usage (Twitter, Instagram, YouTube, and Facebook) and patient satisfaction ratings on the Google Reviews, Healthgrades, and Vitals PRWs. Bivariate analysis was performed to compare demographic variables and level of online presence., Results: A total of 325 surgeons were included in the analysis. The most common platform used was Facebook (88.3%). There was no significant relationship between active social media use and overall ratings on any of the PRWs. Active Twitter use was associated with a greater number of ratings on all review websites, a greater number of comments on Google Reviews and Healthgrades, and shorter patient-reported clinic wait times on Healthgrades. Active Instagram use was associated with a greater number of comments on Vitals. No relationships were observed for YouTube or Facebook., Conclusion: For the included sports medicine surgeons who were most active on social media, no significant relationships were found between social media use and overall ratings on PRWs. Of all the platforms assessed, active use of Twitter was the only significant predictor of more reviews on PRWs. Thus, when deciding which form of social media engagement to prioritize in building one's practice, Twitter may serve as a relatively low-demand, high-reward option., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.W.S. has received education payments from Medwest Associates and Smith & Nephew. O.A.O. has received education payments from Medwest Associates. J.C. has received education payments from Medwest Associates, Arthrex, and Smith & Nephew; consulting fees from Smith & Nephew, Vericel, Arthrex, DePuy Synthes Products, Conmed, Ossur, and Linvatec; nonconsulting fees from Smith & Nephew and Linvatec; hospitality payments from Stryker and Medical Device Business Services; and a grant from Arthrex. 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 was not sought for the present study., (© The Author(s) 2024.)

Purpose: There remains controversy regarding the optimal surgical treatment for acute complete (grade III) posterolateral corner (PLC) injuries. The purpose of this article is to systematically review the contemporary literature regarding surgical options and subsequent outcomes of acute grade III PLC injuries., Methods: A systematic review was performed using the following search terms: posterolateral corner knee, posterolateral knee, posterolateral instability, multi-ligament knee, and knee dislocation. Inclusion criteria consisted of studies with level I-IV evidence, reporting on human patients with acute grade III PLC injuries undergoing operative management within 4 weeks from injury, with subjective and/or objective outcomes (including varus stress examinations or varus stress radiographs) reported at a minimum 2-year follow-up. Two investigators independently performed the search by sequentially screening articles. Accepted definitions of varus stability on examination or stress radiographs and revision surgery were used to determine success and failure of treatment., Results: A total of 12 studies, consisting of 288 patients were included. Ten studies reported primary repair, while reconstruction techniques were reported in seven studies. Overall, 43% (n = 125/288) of injuries involved the PLC, ACL and PCL. Staged reconstruction was reported in 25% (n = 3/12) of studies. The Lysholm score was the most commonly reported outcome measure. An overall failure rate of 12.4% (n = 35/282) was observed. Surgical failure was significantly higher in patients undergoing repair (21.9%; n = 21/96) compared to reconstruction (7.1%; n = 6/84) (p = 0.0058). Return to sport was greater in patients undergoing reconstruction (100%; n = 22/22) compared to repair (94%; n = 48/51) (n.s). The most common post-operative complication was arthrofibrosis requiring manipulation under anesthesia (8.7%; n = 25/288). A total of 3.8% (n = 11/288) of patients underwent revision PLC reconstruction., Conclusion: There remains substantial heterogeneity in the surgical techniques of acute, grade III PLC injuries with an overall failure rate of 12.4%. Failure rates were significantly lower, and return to sport rates higher in patients undergoing PLC reconstruction compared to repair. The most common postoperative complication was arthrofibrosis requiring manipulation under anesthesia., Level of Evidence: Level IV., (© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).)

Background: Posterior cruciate ligament (PCL) reconstruction techniques have historically focused on single-bundle (SB) reconstruction of the larger anterolateral bundle without addressing the codominant posteromedial bundle. The SB technique has been associated with residual laxity and instability, leading to the development of double-bundle (DB) reconstruction techniques., Purpose: To perform a meta-analysis of comparative clinical and biomechanical studies to differentiate the pooled outcomes of SB and DB PCL reconstruction cohorts., Study Design: Meta-analysis and systematic review: Level of evidence, 3., Methods: Six databases were queried in February 2022 for literature directly comparing clinical and biomechanical outcomes for patients or cadaveric specimens undergoing DB PCL reconstruction against SB PCL reconstruction. Biomechanical outcomes included posterior tibial translational laxity, external rotational laxity, and varus laxity at 30° and 90° of knee flexion. Clinical outcomes included the side-to-side difference in posterior tibial translation during postoperative stress radiographs, risk of a major complication, and the following postoperative patient-reported outcome measures: Lysholm, Tegner, and International Knee Documentation Committee (IKDC) subjective and objective scores. A random-effects model was used to compare pooled clinical and biomechanical outcomes between the cohorts., Results: Fifteen biomechanical studies and 13 clinical studies were included in this meta-analysis. The DB group demonstrated significantly less posterior tibial translation at 30° and 90° of knee flexion ( P < .00001). Additionally, the DB group demonstrated significantly less external rotation laxity at 90° of knee flexion ( P = .0002) but not at 30° of knee flexion ( P = .33). There was no difference in varus laxity between the groups at 30° ( P = .56) or 90° ( P = .24) of knee flexion. There was significantly less translation on stress radiographs in the DB group ( P = .02). Clinically, there was no significant difference between the groups for the Lysholm score ( P = .95), Tegner score ( P = .14), or risk of a major complication ( P = .93). DB PCL reconstruction led to significantly higher odds of achieving "normal" or "near normal" objective IKDC outcomes for the included prospective studies ( P = .04) and higher subjective IKDC scores ( P = .01)., Conclusion: DB PCL reconstruction leads to superior biomechanical outcomes and clinical outcomes relative to SB PCL reconstruction. Re-creating native anatomy during PCL reconstruction maximizes biomechanical stability and clinical outcomes., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.W.S. has received support for education from Smith & Nephew and Medwest Associates. M.H. has received consulting fees from Moximed, support for education from Smith & Nephew and Medwest Associates, and hospitality payments from Medical Device Business Services and DePuy Synthes Sales. J.C. has received consulting fees from Arthrex, CONMED Linvatec, Ossur, DePuy Synthes Products, and Smith & Nephew; support for education from Arthrex, Smith & Nephew, and Medwest Associates; and hospitality payments from Medical Device Business Services 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.

Acute, traumatic distal biceps tendon injuries are common among the middle-aged athletic male population. Surgical repair of distal biceps tendon remains the most effective means to restore maximal strength of forearm supination and elbow flexion with relief of antecubital pain. To date, no consensus exists on the optimal fixation method during distal biceps tendon repair and multiple techniques are accepted, including 1- and 2-incision approaches and tendon fixation with suture anchors, transosseous sutures, interference screws, and cortical buttons. In this Technical Note, we demonstrate a distal biceps tendon repair technique using a single-incision approach with bicortical, tensionable suspensory button fixation., (© 2023 The Authors.)

Background: While the biomechanical importance of the hip capsule is well described, there remains controversy over the necessity of routine capsular closure after hip arthroscopy., Purpose: To perform a meta-analysis of clinical studies to compare pooled outcomes of complete hip capsular closure cohorts against unrepaired hip capsule cohorts., Study Design: Systematic review; Level of evidence, 3., Methods: The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, CINAHL/EBSCO, and Scopus were queried in February 2022 for studies that directly compared clinical outcomes for hip arthroscopy patients treated with either complete capsular closure or an unrepaired capsule. Outcomes assessed were incidence of revision hip arthroscopy, incidence of subsequent conversion to total hip arthroplasty (THA), and improvement from baseline in modified Harris Hip Score (mHHS), Hip Outcome Score (HOS) activities of daily living (ADL), HOS sports specific (SS) subscale, Copenhagen Hip and Groin Outcome Score (HAGOS) ADL, and HAGOS SS subscale. A pooled weighted mean difference (WMD) was used to compare changes in mHHS. A pooled standardized mean difference (SMD) was used to compare changes in the ADL and SS outcomes. A pooled risk ratio (RR) was used to compare the probability of revision hip arthroscopy and conversion to THA based on capsular management. For pooled outcomes where heterogeneity was regarded as potentially unimportant, a fixed-effects model was implemented. For pooled outcomes with considerable heterogeneity, a random-effects model was implemented., Results: Of the 1896 records identified in our search, 11 studies (1897 patients) were included. A significantly higher improvement in mHHS (WMD, -3.72; 95% CI, -4.95 to -2.50; P < .00001) and ADL outcomes (SMD, -0.30; 95% CI, -0.54 to -0.07; P = .01) were seen after complete capsular closure. There was a significantly lower probability of subsequent revision hip arthroscopy (RR, 1.67; 95% CI, 1.14 to 2.45; P = .008) and conversion to THA (RR, 2.01; 95% CI, 1.06 to 3.79; P = .03) after complete capsular repair. There was no difference in SS outcomes (SMD, -0.02; 95% CI, -0.16 to 0.13; P = .81) between the 2 groups., Conclusion: This meta-analysis demonstrated that routine complete capsular closure after hip arthroscopy led to superior clinical outcomes relative to unrepaired hip capsules., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: L.S. has received education payments from Medwest, Rock Medical, and Smith & Nephew. M.H. has received education payments from Medwest and Smith & Nephew, consulting fees from Moximed, and hospitality payments from Medical Device Business Services. J.C. has received grant support from Arthrex; education payments from Arthrex and Smith & Nephew; consulting fees from Arthrex, DePuy, Linvatec, Ossur, Smith & Nephew, and Vericel; nonconsulting fees from Linvatec and Smith & Nephew; and hospitality payments from Styker. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

During anatomic total shoulder arthroplasty, careful dissection and meticulous soft tissue management ensure adequate visualization of the articular and bony surfaces, allowing the proper use of surgical instrumentation and ensuring accurate placement of prosthetic components. Exposure must be balanced with protection of the surrounding soft tissues, as well as neurovascular structures, which can have long-term postoperative implications. In Part 2 of this technique series for the management of glenohumeral osteoarthritis, we describe our technical approach for dissection, exposure, and management of soft tissues in anatomic total shoulder arthroplasty, including pearls and pitfalls, as well as a discussion of the benefits and risks of the most common approaches., (© 2023 The Authors.)

The proposed benefits of stemless humeral implants include greater bone preservation, decreased cortical stress shielding, less risk of diaphyseal stress risers, decreased surgical time, and greater ease of implant removal during revision surgery. In part 3 of this comprehensive technique series on the management of glenohumeral arthritis, we present our step-by-step surgical technique for use of a patient-specific 3-dimensionally printed glenoid drill guide, placement of a stemless anatomic total shoulder prosthesis, and subscapularis repair, and we highlight our protocol for postoperative rehabilitation., (© 2023 The Authors.)

Patients with pathologic genu recurvatum may present with complaints regarding anterior knee pain, instability, loss of range of motion, or locking episodes of the knee. Symptomatic genu recurvatum refractory to conservative measures may require surgical treatment. In this Technical Note, the authors describe a surgical technique involving an anterior opening-wedge high tibial osteotomy for a patient with symptomatic genu recurvatum from a knee hyperextension injury resulting in posterior soft-tissue laxity. The surgical technique aims to correct the limb sagittal alignment and provide stability to the knee joint, with the ultimate goal of improving patient outcomes., (© 2023 The Authors.)

Successful total shoulder arthroplasty relies on a multitude of factors specific to patients, implant selection, and surgical technique. Among technical factors, correct intraoperative placement of prosthetic components is paramount. Three-dimensional computed tomography has emerged as a vital tool, allowing surgeons to measure glenoid inclination, glenoid version, and humeral head subluxation more accurately and reproducibly. Several commercial preoperative planning software resources are available to determine the optimal size and positioning of prosthetic components yet do so at significant cost and with meaningful time constraints. At our institution, we have applied the principles of these technologies to develop a custom, 3-dimensionally printed glenoid guide for accurate placement of the central pin. In this technical note, we describe our evaluation of patients with glenohumeral arthritis, as well as our step-by-step procedure for designing and printing a custom patient-specific instrumentation glenoid guide for anatomic total shoulder arthroplasty., (© 2023 The Authors.)

Aim: This article aims to perform a systematic review of the clinical literature regarding the efficacy of single-stage autologous cartilage repair., Methods: A systematic review of the literature was performed using PubMed, Scopus, Web of Science, and the Cochrane Library. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed., Results: Twelve studies were identified; however, due to overlapping patient cohorts, nine studies were included for data extraction and analysis. Six studies applied minced cartilage, while three studies utilized enzymatically processed cartilage. Two authorship groups described single-stage techniques that exclusively utilized cartilage from the debrided lesion rim, while the remaining groups either utilized healthy cartilage or combined healthy cartilage with cartilage debrided from lesion rim. Among the included techniques, scaffold augments were used in four studies, and three studies implemented bone autograft augmentation. When summarizing patient reported outcome measures for the included studies, single-stage autologous cartilage repair demonstrated an average improvement ranging from 18.7 ​± ​5.3 to 30.0 ​± ​8.0 amongst the Knee Injury and Osteoarthritis Outcome Scores subsections, 24.3 ​± ​10.5 for the International Knee Documentation Committee subjective score, and 41.0 ​± ​10.0 for Visual Analogue Scale-Pain., Conclusion: Single-stage autologous cartilage repair is a promising technique with positive clinical data to date. The current study highlights the overall improvement in patient reported outcomes after repair for chondral defects to the knee with average follow-up ranging from 12 to 201 months and also the heterogeneity and variability of the single-stage surgical technique. Further discussion on the standardization of practices for a cost-effective single-stage augmented autologous cartilage technique is needed. In the future, a well-designed randomized controlled trial is needed to explore the efficacy of this therapeutic modality relative to established intervention., Level of Evidence: Systematic review; Level IV., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objectives: Patients with Trisomy 21 (T21) commonly have gastrointestinal symptoms and diseases that prompt evaluation with esophagogastroduodenoscopy (EGD). Our objective is to characterize duodenal histological abnormalities in these patients when undergoing EGD. A secondary aim is to explore associations of histologic findings with different therapies., Methods: Patients 30 years old or younger with T21 who underwent EGD from 2000 to 2020 at 6 hospitals were included in this retrospective cohort study. Duodenal biopsies were categorized based on reported histopathology findings as normal or abnormal. Abnormal pathology reports were reviewed and categorized into villous atrophy (VA) and duodenitis without VA. The VA group was further categorized based on the presence or absence of celiac disease (CD)., Results: We identified 836 patients with T21 who underwent EGD, 419 (50.1%) of whom had duodenal histologic abnormalities. At the time of the first (index) abnormal duodenal biopsy, 290 of 419 had VA and of those, 172 of 290 met CD diagnostic criteria, while 118 of 290 did not meet CD criteria (nonspecific VA). Among the patients with an abnormal biopsy, acid suppression at the time of the index biopsy was less common in patients with VA-CD compared to patients without VA or patients with nonspecific VA (12.2% vs 45.7% vs 44.9%)., Conclusions: Half of the T21 patients in this cohort had abnormal duodenal biopsies including a subgroup with nonspecific VA. In this cohort, acid suppression use was more prevalent in patients with abnormalities other than CD., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

The use of ulnar collateral ligament (UCL) repair with concomitant internal bracing for throwing athletes is a viable treatment option, but must take into account tear location, ligament quality, the expected length of the athlete's career, desire to advance to the next level of competition, and age. There has been increased interest in repair of UCL injuries in overhead athletes due to advancements in surgical technique, as well as improved technologies of anchor and suture material. In addition, return to sport can be accelerated compared to reconstruction. In this Technical Note, we demonstrate an ulnar collateral ligament repair technique, with internal bracing augmentation for high-grade partial proximal tears in the throwing athlete that is reliable, strong, and easily reproducible., (© 2023 The Authors.)

Although historically overlooked, medial meniscus posterior root (MMPR) tears are now increasingly recognized as a substantial cause of biomechanical impairment and morbidity. MMPR tears, when left untreated, are strongly correlated to meniscal extrusion and ultimately lead to altered kinematics and loading functionally equivalent to a total meniscectomy. To prevent progressive joint degeneration and alleviate pain while re-establishing native joint kinematics, MMPR repair is generally recommended in appropriately selected patients. In this Technical Note, the authors describe a detailed checklist with 10 crucial points of emphasis when performing the gold-standard transtibial pull-out repair of the MMPR, with an additional centralization stitch, providing technical pearls backed up by previous literature and ample experience treating this condition., (© 2023 The Authors.)

Importance: There has been growing interest in the use of patient-specific instrumentation (PSI) to maximise accuracy and minimise the risk of major complications for medial opening-wedge high tibial osteotomies (MOW-HTOs). Numerous studies have reported the efficacy and safety of implementing this technology into clinical practice, yet no systematic review summarising the clinical literature on PSI for MOW-HTOs has been performed to date., Aim: The aim of this investigation was to perform a systematic review summarising the evidence surrounding the use of PSI for MOW-HTOs in the management of medial compartment osteoarthritis., Evidence Review: PubMed, Scopus, and the Cochrane Library were queried in October 2021 for studies that used PSI for MOW-HTOs when managing medial compartment knee osteoarthritis. Primary outcomes included accuracy in coronal plane correction (mechanical medial proximal tibial angle), sagittal plane correction (posterior tibial slope), and mechanical axis correction (hip-knee-ankle angle [HKA], mechanical femorotibial angle, and weight-bearing line). Accuracy was defined as error between post-operative measurements relative to the planned pre-operative correction. A secondary outcome was the incidence of major complications., Findings: This review included eight different techniques among the 14 included studies. There was a weighted mean error of 0.5° (range: 0.1°-1.3°) for the mechanical medial proximal tibial angle, 0.6° (range: 0.3°-2.7°) for the posterior tibial slope, and 0.8° (range: 0.1°-1.0°) for the hip-knee-ankle angle. Four studies compared the correctional error of the mechanical axis between conventional techniques and PSI techniques. The comparative difference between the two techniques favoured the use of PSI for MOW-HTOs (standardised mean difference ​= ​0.52; 95% confidence interval, 0.16 to 0.87; p ​= ​0.004). Among the 14 studies evaluated, four studies explicitly reported no major complications, while five studies reported a non-zero incidence of major complications. Among these nine studies, the weighted mean major complication rate was 7.1% (range: 0.0-13.0%)., Conclusions and Relevance: The findings of this present systematic review suggest that the use of PSI for MOW-HTOs leads to high accuracy relative to the planned corrections in the coronal plane, sagittal plane, and mechanical axis. Furthermore, these findings would suggest there is a low risk of major complications when implementing PSI for MOW-HTOs., Level of Evidence: Systematic review; IV., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Social media has the potential to act as an avenue for patient recruitment, patient and surgeon education, and expansion of the physician-patient relationship., Purpose: To evaluate the existing social media presence among members of the American Orthopaedic Society for Sports Medicine (AOSSM) to describe trends in different subgroups within the membership., Study Design: Cross-sectional study., Methods: The AOSSM database was queried for a complete membership list. Members were excluded from analysis if they were not orthopaedic sports medicine surgeons practicing in the United States. Demographic characteristics, online media profiles, and levels of online presence were evaluated, and an online media presence score was calculated. Bivariate analysis was performed to compare demographic variables and levels of online presence., Results: A total of 2870 surgeons were included in the analysis. LinkedIn was the most used platform (56%), while YouTube was the least used (10%). Surgeons in academic practice had a significantly greater overall social media presence than their private practice counterparts. Female surgeons had a more significant active online presence on Twitter, Instagram, and Facebook than male surgeons. Surgeons practicing in the Northeast had a greater social media presence than those in any other United States region, and surgeons in the earlier stages of practice (0-14 years) were more likely to utilize social media than their more senior colleagues (≥15 years of practice). On multivariate analysis, surgeons in the earlier stages of practice were more likely to have active Twitter, Instagram, and Facebook accounts, and female surgeons were more likely to have an active Facebook account. Additionally, multivariate analysis revealed that a greater number of ResearchGate publications were associated with male sex and having an academic practice. Comparatively, active Twitter and Instagram use was associated with having an academic practice., Conclusion: The most used platform in this surgeon population was LinkedIn. Orthopaedic surgeons in academic practice, female surgeons, those early in their career, and those practicing in the Northeast highlighted a subset of the sports medicine community who were more likely to have an active online presence compared to the rest of the AOSSM., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: H.W.S. has received education payments from Medwest and Smith & Nephew. N.N.V. has received education payments from Medwest; consulting fees from Arthrex, Medacta, Smith & Nephew, and Stryker; speaking fees from Arthrex; and royalties from Graymont Professional Products and Smith & Nephew. J.C. has received education payments from Arthrex and Smith & Nephew; consulting fees from Arthrex, DePuy, Linvatec, and Smith & Nephew; and speaking fees from Linvatec. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

Hip capsulotomy is performed during arthroscopic hip procedures to achieve adequate visualization of the joint and instrument access. The hip capsule, and in particular the iliofemoral ligament, is an important stabilizer of the hip joint, and patients who undergo capsulotomy without subsequent repair may experience hip pain and instability, with increased risk of requiring revision hip arthroscopy. Therefore, restoring watertight closure of the capsule is necessary to restore native biomechanics and achieve desired postoperative outcomes. Although primary repair or plication suffice in most cases, capsule reconstruction may instead be necessary when there is insufficient tissue, often due to capsular insufficiency following index surgery. The purpose of this Technical Note is to describe the authors' current technique for arthroscopic hip capsular reconstruction using the indirect head of the rectus femoris tendon in the setting of capsular iatrogenic hip instability, as well as its advantages and disadvantages and technical pearls and pitfalls., (© 2022 The Authors.)

Osteochondral allograft transplantation provides components of both cartilage and subchondral bone and can be used in large and multifocal defects where autologous procedures are limited by donor-site morbidity. Osteochondral allograft transplantation is particularly appealing in the management of failed cartilage repair, as larger defects and subchondral bone involvement are often present, and the use of multiple overlapping plugs might be considered. The described technique provides our preoperative workup and reproducible surgical approach for patients who have undergone previous osteochondral transplantation with graft failure and are young, active patients who would not be otherwise suited for a knee arthroplasty procedure., (© 2022 The Authors.)

Whereas acute proximal tibiofibular joint (PTFJ) dislocation may require urgent reduction, chronic or recurrent instability may initially be approached with conservative treatment. Indications for PTFJ reconstruction include persistent lateral knee pain and/or tibiofibular instability for which conservative treatment has failed. Owing to the low incidence of diagnosed isolated PTFJ instability, there is still no consensus regarding the optimal surgical treatment, with an array of options having been previously described. We describe the treatment of isolated PTFJ instability using an anatomic reconstruction with semitendinosus allograft for chronic instability., (© 2022 The Authors.)

Purpose: To investigate the type of questions patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) are searching online and determine the type and quality of the online sources from the top results to each query by the "people also ask" Google algorithm., Methods: Three search strings pertaining to FAI were carried out through Google. The webpage information was manually collected from the "People also ask" Google algorithm. Questions were categorized using Rothwell's classification method. Each website was assessed using Journal of the American Medical Association Benchmark Criteria for source quality., Results: A total of 286 unique questions were collected with their associated webpages. The most common questions included: "How do you treat femoroacetabular impingement and labral tears without surgery?" "What is the recovery process after hip arthroscopy and are there limitations after surgery?" and "How do you diagnose hip impingement and differentiate from other causes of hip pain?" The Rothwell Classification of questions were fact (43.4%), policy (34.3%), and value (20.6%). The most common webpage categories were Medical Practice (30.4%), Academic (25.8%), and Commercial (20.6%). The most common subcategories were Indications/Management (29.7%) and Pain (13.6%). Government websites had the highest average Journal of the American Medical Association score (3.42), whereas Single Surgeon Practice websites had the lowest (1.35). Conclusions : Commonly asked questions on Google regarding FAI and labral tears pertain to the indications and management of pathology as well as pain control and restrictions in activity. The majority of information is provided by medical practice, academic, and commercial sources, which have highly variable academic transparency., Clinical Relevance: By better understanding which questions patients ask online, surgeons can personalize patient education and enhance patient satisfaction and treatment outcomes after hip arthroscopy., (© 2022 The Authors.)

SLAP lesions can be significant pain generators in the shoulder. These injuries are the most common shoulder injury in overhead athletes, as repetitive overhead motion is the most common etiology of SLAP lesions. These lesions present a diagnostic and treatment challenge to patients and physicians. Factors to consider when discussing treatment options for SLAP lesions include age, type of sports activity, level of sports participation, and degree of symptoms. Nonoperative management is the first-line treatment for most young, active patients without history of trauma, mechanical symptoms, and/or demand for overhead activities. These conservative measures include rest, avoidance of aggravating factors, injections, and physical therapy focusing on correcting scapular dyskinesis, restoring range of motion and strength, and evaluating the biomechanical throwing motion. It has been reported that 40% of professional baseball players can successfully return to play after rehabilitation alone. Alternatively, operative treatment is reserved for failure of nonoperative treatment and those with persistent symptoms that prevent individuals from participating in sports activities or activities of daily living. The two most common operative treatment options include arthroscopic repair versus biceps tenodesis. Arthroscopic repair can be considered in younger athletes (<30 years old) and elite athletes who are involved in overhead sports (baseball, tennis, volleyball) and consists of repairing the labral anchor back to the superior glenoid rim with knotless anchor repair techniques. Alternatively, biceps tenodesis is the first-line treatment option for failed SLAP repairs, and as an index procedure, traditionally has been reserved for middle-aged individuals (>30 years old), patients receiving workers' compensation, nonoverhead athletes, or in those with concomitant rotator cuff tears. However, due to a relatively high failure rate of SLAP repairs, biceps tenodesis as an index procedure is gaining more popularity, as emerging evidence suggests encouraging functional outcomes and return-to-sport rates even in younger athletes., (Copyright © 2022. Published by Elsevier Inc.)

In recent years, repair of the injured anterior cruciate ligament (ACL) has been subject to a renewed interest as novel arthroscopic techniques have been developed. Specifically, the bridge-enhanced ACL repair is a technique composed of a resorbable protein-based implant combined with autologous blood that is used to bridge the gap between 2 torn edges of a mid-substance ACL tear. This implant is believed to help facilitate healing of a primary suture repair and suture cinch and has since demonstrated noninferiority to ACL reconstruction with autograft at 2-year follow-up. The purpose of this Technical Note is to describe a step-by-step surgical technique of a mid-substance ACL repair using the bridge-enhanced ACL repair system in a case with a concomitant lateral meniscus radial repair., (© 2022 The Authors.)

Labral tears resulting in 270° near-circumferential pathology predispose patients to recurrent instability and are technically challenging to repair. Furthermore, when such lesions are associated with Hill-Sachs lesions, recurrent instability risk is significantly increased and can result in substantially lower clinical outcomes. When determining a surgical treatment algorithm for shoulder stabilization, it is important to consider both humeral- and glenoid-sided pathology because subtle defects can have significant influence on recurrence and patient reported outcomes. In this Technical Note and accompanying video, we discuss our surgical technique for knotless arthroscopic stabilization for a 270° labral tear with concurrent remplissage in the setting of recurrent shoulder instability., (© 2022 The Authors.)