Comparison of Revision and Redislocation Rates After First-Time Anterior Shoulder Instability Between Subluxators and Dislocators: A Midterm Outcome Study.

Background: Anterior shoulder instability is a common pathology seen especially in young men and highly active patient populations. Subluxation is a commonly encountered clinical issue, yet little is known about the effects of first-time subluxation compared with dislocation on shoulder stability and clinical outcomes after surgical stabilization.

Purpose: To compare revision and redislocation rates as well as patient-reported outcomes (PROs) between subluxators and dislocators after a first-time anterior shoulder instability event.

How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.

Background: The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR).

Bioaugmentation demonstrates similar outcomes and failure rates for arthroscopic revision rotator cuff repair compared to revision without bioaugmentation.

Background: Arthroscopic revision rotator cuff repairs (RCRs) exhibit lower healing rates and inferior outcomes compared to primary repairs. There is limited evidence regarding the use of bioaugmentation in the setting of revision RCRs. Autologous conditioned plasma (ACP) is a promising adjunct that has been shown to improve healing rates and patient-reported outcomes (PROs) in the primary setting.

Timing of Surgery & Rehabilitation After Multiligamentous Knee Reconstruction.

Purpose Of Review: To provide an overview of the current evidence of the timing of surgery and rehabilitation after multiligamentous knee injuries (MLKIs) and offer insights into the ongoing multi-center randomized controlled study, the 'STaR trial'.

Recent Findings: Due to the complexity of the MKLIs, they are usually treated surgically with the goal of either repairing or reconstructing the injured ligaments. Although the current literature on MLKIs is relatively extensive, the consensus on the timing of surgery or rehabilitation following surgery for MLKIs is still lacking.

Quadriceps tendon size does not affect postoperative strength recovery following quadriceps tendon anterior cruciate ligament reconstruction.

Objective: The influence of quadriceps tendon (QT) size on postoperative quadriceps strength following QT anterior cruciate ligament reconstruction (ACLR) is unclear. Therefore, this study aimed to determine the relationship between QT morphology and postoperative quadriceps strength recovery following primary ACLR using a QT autograft.

Methods: Patients who underwent primary ACLR using QT autograft from 2014 to 2022 followed by a postoperative isometric strength measurement between 5 and 8 months were retrospectively reviewed.

Outcomes After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon in Adolescent Athletes at Mean Follow-up of 4 Years.

Background: Despite increasing use of quadriceps tendon (QT) autograft in anterior cruciate ligament (ACL) reconstruction (ACLR), limited data exist regarding its outcomes in high-risk adolescent athletes.

Purpose: To (1) report the outcomes after QT ACLR in adolescent athletes and (2) identify patient-related and surgery-related factors that may influence failure rates after QT ACLR.

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

Nonanatomic femoral tunnel placement increases the risk of subsequent meniscal surgery after ACLR: Part II-Patients without recurrent ACL injury.

Purpose: The purpose of this study was to identify risk factors for subsequent meniscal surgery following anterior cruciate ligament (ACL) reconstruction (ACLR) in patients without recurrent ACL injury.

Methods: Patients aged ≥14 years who underwent primary ACLR with minimum 1-year follow-up and without recurrent ACL injury were retrospectively reviewed. Patient demographics and surgical data at the time of ACLR were collected.

Comparing MRI and arthroscopic appearances of common knee pathologies: A pictorial review.

Knee pathology, including anterior cruciate ligament (ACL) tears, meniscal tears, articular cartilage lesions, and intra-articular masses or cysts are common clinical entities treated by orthopedic surgeons with arthroscopic surgery. Preoperatively, magnetic resonance imaging (MRI) is now standard in confirming knee pathology, particularly detecting pathology less evident with history and physical examination alone. The radiologist's MRI interpretation becomes essential in evaluating intra-articular knee structures.

Complications in Anterior Cruciate Ligament Surgery and How to Avoid Them.

Complications following anterior cruciate ligament (ACL) reconstruction can be detrimental to a patient's recovery and limit their ability to successfully return to sport. Arthrofibrosis, graft failure, and infection are a few examples of complications that can arise. Therefore, it is important for surgeons to recognize that each step during perioperative surgical decision making can impact patients' risk for such complications.

Factors Associated With Knee Extension Strength Symmetry After Anterior Cruciate Ligament Reconstruction With Quadriceps Tendon Autograft.

Background: Diminished postoperative knee extension strength may occur after anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon (QT) autograft. Factors influencing the restoration of knee extensor strength after ACLR with QT autograft remain undefined.

Purpose: To identify factors that influence knee extensor strength after ACLR with QT autograft.

Magnetic Resonance Arthrogram Outperforms Standard Magnetic Resonance Imaging 2 Weeks After First Shoulder Dislocation for Labral Tear Diagnosis.

Purpose: To determine the comparative accuracy and precision of routine magnetic resonance imaging (MRI) versus magnetic resonance (MR) arthrogram in measuring labral tear size as a function of time from a shoulder dislocation.

Methods: We retrospectively evaluated consecutive patients who underwent primary arthroscopic stabilization between 2012 and 2021 in a single academic center. All patients completed a preoperative MRI or MR arthrogram of the shoulder within 60 days of injury and subsequently underwent arthroscopic repair within 6 months of imaging.

Margin convergence vs. superior capsular reconstruction for massive irreparable rotator cuff tears: outcomes are equivalent unless there is preoperative pseudoparesis.

Background: Margin convergence (MC) and superior capsular reconstruction (SCR) are common treatment options for irreparable rotator cuff tears in younger patients, although they differ in associated costs and operative times. The purpose of this study was to compare range of motion, patient-reported outcomes (PROs), and reoperation rates following MC and SCR. We hypothesized superior outcomes after SCR relative to MC regarding functional outcomes, subjective measures, and reoperation rates.

Defining Critical Humeral Bone Loss: Inferior Craniocaudal Hill-Sachs Extension as Predictor of Recurrent Instability After Primary Arthroscopic Bankart Repair.

Background: The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied.

Hypothesis: Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair.

Overhead athletes have comparable intraoperative injury patterns and clinical outcomes to non-overhead athletes following surgical stabilization for first-time anterior shoulder instability at average 6-year follow-up.

Background And Hypothesis: Anterior shoulder instability is a common problem affecting young, athletic populations that results in potential career-altering functional limitations. However, little is known regarding the differences in clinical outcomes after operative management of overhead vs. non-overhead athletes presenting with first-time anterior shoulder instability.

Myotendinous junction tears of the pectoralis major are occurring more frequently and discrepancies exist between intraoperative and radiographic assessments.

Background: Pectoralis major (PM) tears have been shown to occur most frequently at the tendinous humeral insertion. However, no substantial updates on tear location have been published in 20 years or are based on relatively small sample sizes. The primary purpose of this study was to evaluate PM tear location based on magnetic resonance imaging (MRI).

Near complete quadriceps tendon healing 2 years following harvest in anterior cruciate ligament reconstruction.

Purpose: Despite the recent increase in the use of quadriceps tendon (QT) autograft in anterior cruciate ligament reconstruction (ACLR); however, there remains a paucity of literature evaluating the postoperative morphology of the QT. The present study aimed to determine the postoperative morphologic change of the QT at a minimum of 2 years following harvesting during ACLR.

Methods: Patients who underwent ACLR with QT autograft and underwent magnetic resonance imaging (MRI) at a minimum of 2 years following harvesting were retrospectively included in the study.

Strength symmetry after autograft anterior cruciate ligament reconstruction.

Objective: To compare postoperative isometric quadriceps strength indices (QI%) and hamstring strength limb symmetry indices (HI%) between partial thickness quadriceps tendon (pQT), full thickness quadriceps tendon (fQT), and bone-patellar-tendon bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR).

Methods: Patients with primary ACLR with pQT, fQT, or BPTB autograft with the documentation of quantitative postoperative strength assessments between 2016 and 2021 were included. Isometric Biodex data, including QI% and HI% (calculated as the percentage of involved to uninvolved limb strength) were collected between 5 and 8 months and between 9 and 15 months postoperatively.

Revision Rates After Primary Allograft ACL Reconstruction by Allograft Tissue Type in Older Patients.

Background: While there is extensive literature on the use of allograft versus autograft in anterior cruciate ligament (ACL) reconstruction, there is limited clinical evidence to guide the surgeon in choice of allograft tissue type.

Purpose: To assess the revision rate after primary ACL reconstruction with allograft and to compare revision rates based on allograft tissue type and characteristics.

Study Design: Cohort study; Level of evidence, 3.

Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques.

Background: Multiple-revision anterior cruciate ligament reconstruction (ACLR) presents several technical challenges, often due to residual hardware, tunnel widening, malposition, or staged surgeries.

Purpose: To compare failure and complication rates between the over-the-top (OTT) and transportal drilling (TD) techniques in patients undergoing surgery for failed revision ACLR.

Study Design: Cohort study; Level of evidence, 3.

More anterior placement of femoral tunnel position in ACL-R is associated with postoperative meniscus tears.

Purpose: The purpose of this study was to investigate the relationship between tunnel position in ACL reconstruction (ACL-R) and postoperative meniscus tears.

Methods: This was a single institution, case-control study of 170 patients status-post ACL-R (2010-2019) separated into two matched groups (sex, age, BMI, graft type). Group 1-symptomatic, operative meniscus tears (both de novo and recurrent) after ACL-R.

Depressive and Anxiety Disorders Increase Risk for Recurrent Anterior Shoulder Pain Following Arthroscopic Suprapectoral Biceps Tenodesis.

Purpose: To evaluate factors associated with postoperative anterior shoulder pain following arthroscopic suprapectoral biceps tenodesis (ABT) and to determine the clinical impact of postoperative anterior shoulder pain.

Methods: A retrospective study of patients that underwent ABT between 2016 and 2020 was conducted. Groups were categorized by the presence (ASP+) or absence (ASP-) of postoperative anterior shoulder pain.

Surgeon anterior cruciate ligament reconstruction volume and rates of concomitant meniscus repair.

Purpose: The purpose of this study was to assess the effect of surgeon anterior cruciate ligament reconstruction (ACLR) volume on rates of ACLR with concomitant meniscus repair versus meniscectomy and subsequent meniscus surgeries.

Methods: A retrospective review was conducted from a database of all ACLR performed between 2015 and 2020 at a large integrated health care system. Surgeon volume was categorized as < 35 ACLR per year (low-volume), and ≥ 35 ACLR per year (high-volume).