Early clinical and patient-reported outcomes for arthroscopic and mini-open superior capsular reconstruction are similar for irreparable rotator cuff tears.

Objectives: The purpose of this study was to report and compare postoperative range of motion (ROM), patient-reported outcomes, and failure rates following superior capsular reconstruction (SCR) and to compare outcomes between arthroscopic and mini-open techniques.

Methods: All SCR procedures utilising dermal allograft with a minimum of 6 months of follow-up at multiple institutions between November 2015 and October 2019 were retrospectively reviewed. Preoperative patient demographics, imaging measurements, surgical technique (arthroscopic versus mini-open), and outcomes including pain scores, conversion to reverse shoulder arthroplasty, subsequent surgery, and postoperative ROM were recorded.

Editorial Commentary: Postoperative Pain Management After Anterior Cruciate Ligament Reconstruction Can Minimize Opioid Use and Allow Early Rehabilitation.

Effective analgesia is essential after anterior cruciate ligament (ACL) reconstruction to control pain while minimizing opioid consumption and allowing early rehabilitation. Orthopaedic surgeons write the third-largest number of opioid prescriptions, which are responsible for 1/10th of all opioid prescriptions, and one-third of patients with ACL injury use opioids preoperatively, a risk factor for postoperative abuse. Pain management after ACL reconstruction using variety of analgesic regimens including various permutations of nerve blocks, nerve block adjuncts, intra-articular injections, intravenous and oral medications, cryotherapy, compression stockings, and transcutaneous electrical nerve stimulation units, based on multidisciplinary collaboration between surgeons and anesthesiologists, can minimize opioid consumption.

Isometric Knee Strength is Greater in Individuals Who Score Higher on Psychological Readiness to Return to Sport After Primary Anterior Cruciate Ligament Reconstruction.

Background: Anterior cruciate ligament (ACL) injury is extremely common among athletes. Rate of second ACL injury due to surgical graft rupture or contralateral limb ACL injury is approximately 15-32%. Psychological readiness to return to sport (RTS) may be an important predictor of successful RTS outcomes.

Operative Versus Nonoperative Management of Displaced Midshaft Clavicle Fractures: A Cost-effectiveness Analysis.

To date, the optimal management of displaced midshaft clavicle fractures remains unknown. Operatively, plate or nail fixation may be used. Nonoperatively, the options are sling or harness.

Females have Lower Knee Strength and Vertical Ground Reaction Forces During Landing than Males Following Anterior Cruciate Ligament Reconstruction at the Time of Return to Sport.

Purpose: There is a high rate of second anterior cruciate ligament (ACL) injury (ipsilateral graft or contralateral ACL) upon return-to-sport (RTS) following ACL reconstruction (ACLR). While a significant amount of epidemiological data exists demonstrating sex differences as risk factors for primary ACL injury, less is known about sex differences as potential risk factors for second ACL injury. The purpose of this study is to determine if there are sex-specific differences in potential risk factors for second ACL injury at the time of clearance for RTS.

Altered lower extremity biomechanics following anterior cruciate ligament reconstruction during single-leg and double-leg stop-jump tasks: A bilateral total support moment analysis.

Background: Injury to the anterior cruciate ligament (ACL) can lead to long-lasting biomechanical alterations that put individuals at risk of a second ACL injury. Examining the total support moment may reveal between- and within-limb compensatory strategies.

Methods: Twenty-six participants who were cleared to return to sport following ACL reconstruction were recruited.

Immune cell profiles in synovial fluid after anterior cruciate ligament and meniscus injuries.

Background: Anterior cruciate ligament (ACL) and meniscus tears are common knee injuries. Despite the high rate of post-traumatic osteoarthritis (PTOA) following these injuries, the contributing factors remain unclear. In this study, we characterized the immune cell profiles of normal and injured joints at the time of ACL and meniscal surgeries.

Histologic Analysis of Porcine Dermal Graft Augmentation in Treatment of Rotator Cuff Tears.

Background: Biologic augmentation via extracellular matrix (ECM) scaffolds has been utilized to address rotator cuff tears with poor-quality tissue.

Purpose: To evaluate the cellular changes in graft explants taken from patients treated with porcine dermal grafts for rotator cuff tears.

Study Design: Case series; Level of evidence, 4.

Contracture and transient receptor potential channel upregulation in the anterior glenohumeral joint capsule of patients with end-stage osteoarthritis.

Background: During anatomic total shoulder arthroplasty (TSA) for primary glenohumeral osteoarthritis (GHOA), the anterior shoulder joint capsule (ASJC) is characterized grossly by contracture, synovitis, and fibrosis. In tissues that develop fibrosis, there is substantial cross-talk between macrophages, fibroblasts, and myofibroblasts, modulated by calcium signaling and transient receptor potential (TRP) channel signaling. The purpose of this study was to compare and characterize the degree of synovitis, inflammatory infiltrate, and TRP channel expression in ASJC harvested from shoulders with and without primary GHOA.

Advanced Patellar Tendinopathy Is Associated With Increased Rates of Bone-Patellar Tendon-Bone Autograft Failure at Early Follow-up After Anterior Cruciate Ligament Reconstruction.

Background: Revision anterior cruciate ligament (ACL) reconstruction can be potentially devastating for a patient. As such, it is important to identify prognostic factors that place patients at an increased risk for graft failure. There are no data on the effects of patellar tendinopathy on failure of ACL reconstruction when using a bone-patellar tendon-bone (BPTB) autograft.

Graft use in the treatment of large and massive rotator cuff tears: an overview of techniques and modes of failure with MRI correlation.

Despite technical advances, repair of large or massive rotator cuff tears continues to demonstrate a relatively high rate of failure. Rotator cuff repair or superior capsular reconstruction (SCR) using a variety of commercially available grafts provides a promising option in patients with tears that may be at high risk for failure or otherwise considered irreparable. There are three major graft constructs that exist when utilizing graft in rotator cuff repair or reconstruction: augmentation at the rotator cuff footprint, bridging, and SCR.

Rotator Cuff Matrix Augmentation and Interposition: A Systematic Review and Meta-analysis.

Background: Surgical management of rotator cuff tears is controversial and complex, ranging from nonoperative management to reverse shoulder arthroplasty.

Purpose: To systematically review and evaluate the outcomes of graft augmentation or interposition versus rotator cuff repair (RCR) alone and evaluate via meta-analysis whether the use of a graft leads to superior outcomes versus RCR alone.

Study Design: Systematic review and meta-analysis.

Interposition Dermal Matrix Xenografts: A Successful Alternative to Traditional Treatment of Massive Rotator Cuff Tears.

Background: Management of massive rotator cuff tears in shoulders without glenohumeral arthritis remains problematic for surgeons. Repairs of massive rotator cuff tears have failure rates of 20% to 94% at 1 to 2 years postoperatively as demonstrated with arthrography, ultrasound, and magnetic resonance imaging. Additionally, inconsistent outcomes have been reported with debridement alone of massive rotator cuff tears, and limitations have been seen with other current methods of operative intervention, including arthroplasty and tendon transfers.

A prospective, multicenter study to evaluate clinical and radiographic outcomes in primary rotator cuff repair reinforced with a xenograft dermal matrix.

Background: Minimal information is currently available on the outcome of rotator cuff repair reinforced with an extracellular matrix (ECM) graft. Therefore, the purpose of this study was to determine the clinical and radiographic outcome of repair of large rotator cuff tears with ECM graft reinforcement.

Methods: This was a prospective study of 61 shoulders with large repairable rotator cuff tears (3 to 5 cm).

Inside-Out Antegrade Tibial Tunnel Drilling Through the Posterolateral Portal Using a Flexible Reamer in Posterior Cruciate Ligament Reconstruction.

Posterior cruciate ligament (PCL) reconstruction using the transtibial drilling or arthroscopic tibial-inlay technique has a risk of injury to the popliteal neurovascular bundle because a pin is drilled anterior to posterior. Intraoperative fluoroscopy is used to decrease the risk of neurovascular injury. In addition, graft passage in the transtibial technique may be problematic because of a sharp turn when placing the graft into the tibial tunnel, which may damage graft fibers.

Posterolateral portal tibial tunnel drilling for posterior cruciate ligament reconstruction: technique and evaluation of safety and tunnel position.

Purpose: To evaluate the safety for neurovascular structures and accuracy for tunnel placement of the posterolateral portal tibial tunnel drilling technique in posterior cruciate ligament (PCL) reconstruction.

Methods: Fifteen fresh-frozen human cadaveric knees were used. The tibial tunnel for the PCL was created using a flexible reamer from the posterolateral portal.

Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies.

The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included.

Knee Kinematics During Noncontact Anterior Cruciate Ligament Injury as Determined From Bone Bruise Location.

Background: The motions causing noncontact anterior cruciate ligament (ACL) injury remain unclear. Tibiofemoral bone bruises are believed to be the result of joint impact near the time of ACL rupture. The locations and frequencies of these bone bruises have been reported, but there are limited data quantifying knee position and orientation near the time of injury based on these contusions.

Stem cell therapies for knee cartilage repair: the current status of preclinical and clinical studies.

Background: Articular cartilage damage of the knee is common, causing significant morbidity worldwide. Many adult tissues contain cells that are able to differentiate into multiple cell types, including chondrocytes. These stem cells have gained significant attention over the past decade and may become frontline management for cartilage defects in the very near future.

Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft.

Background: The management of irreparable massive or full-thickness 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis remains a difficult challenge for the treating surgeon. Many different treatment options, with varied success, have been proposed.

Hypotheses: (1) Patients undergoing reconstruction of irreparable massive or full-thickness 2-tendon rotator cuff tears by dermal tissue matrix xenograft would demonstrate improvements in pain, range of motion, strength, and subjective functional outcomes.

Thermal shrinkage for shoulder instability.

Unlabelled: Thermal capsular shrinkage was popular for the treatment of shoulder instability, despite a paucity of outcomes data in the literature defining the indications for this procedure or supporting its long-term efficacy. The purpose of this study was to perform a clinical evaluation of radiofrequency thermal capsular shrinkage for the treatment of shoulder instability, with a minimum 2-year follow-up. From 1999 to 2001, 101 consecutive patients with mild to moderate shoulder instability underwent shoulder stabilization surgery with thermal capsular shrinkage using a monopolar radiofrequency device.

ACL graft failure location differs between allografts and autografts.

Background: Between 5 and 20% of patients undergoing ACL reconstruction fail and require revision. Animal studies have demonstrated slower incorporation of allograft tissue, which may affect the mechanism of graft failure. The purpose of this study is to determine the location of traumatic graft failure following ACL reconstruction and investigate differences in failure patterns between autografts and allografts.