Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review.

Purpose: To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer.

Methods: A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence.

Editorial Commentary: Treating Patients With Recurrent Patellar Instability With an Individualized, Anatomic Approach Is Needed: Learn From the Anterior Cruciate Ligament.

Treatment algorithms for recurrent patellofemoral instability have evolved over time. Early treatment techniques focusing specifically on pain have been replaced by evidence-based and anatomically appropriate procedures such as ligament reconstruction, osteotomies, and trochleoplasty. Bony and soft-tissue factors contribute to recurrent patellofemoral instability, but the exact indications for soft-tissue, bony, and combined procedures remain controversial.

Patient-Reported and Quantitative Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction With Hamstring Tendon Autografts.

Background: The pivot-shift test has become more consistent and reliable and is a meaningful outcome measurement after anterior cruciate ligament reconstruction (ACLR).

Purpose/hypothesis: The purpose of this investigation was to assess patient-reported outcomes (PROs) and the quantitative pivot shift (QPS) preoperatively, at time zero immediately after anatomic ACLR, and after 24 months as well as the relationship between PROs and the QPS. It was hypothesized that anatomic ACLR would restore rotatory stability measured by the pivot-shift test and that QPS measurements would be positively correlated with PROs.

Comparison of Short-term Biodex Results After Anatomic Anterior Cruciate Ligament Reconstruction Among 3 Autografts.

Background: An individualized approach to anterior cruciate ligament reconstruction (ACLR) typically includes criteria-based postoperative rehabilitation. However, recent literature has suggested residual quadriceps weakness up to 12 months after ACLR, especially with a quadriceps tendon (QT) autograft.

Hypothesis: The QT would have poorer quadriceps strength symmetry at 5 to 8 months compared with the hamstring tendon (HS) and patellar tendon (BPTB), but there would be no significant difference at 9 to 15 months among all 3 groups.

Anatomic Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons Restores Quantitative Pivot Shift.

Background: It is still uncertain how surgical reconstruction of the anterior cruciate ligament (ACL) is able to restore rotatory laxity of the involved joint. The desired amount of restraint applied by the ACL graft, as compared with the healthy knee, has not been fully clarified.

Purpose: To quantify the ability of single-bundle anatomic ACL reconstruction using hamstring tendons in reducing the pivot-shift phenomenon immediately after surgery under anesthesia.

Distal femur morphology affects rotatory knee instability in patients with anterior cruciate ligament ruptures.

Purpose: Distal femur morphology has been shown to influence knee joint kinematics and may affect rotatory knee laxity. The purpose of this study was to determine the relationship between rotatory knee laxity and distal femoral morphology in patients with complete anterior cruciate ligament (ACL) rupture. It was hypothesized that increased posterior femoral condylar depth on standard lateral radiographs, quantified as the "lateral femoral condyle ratio" would correlate with increased rotatory knee laxity, measured by a quantitative pivot shift test.

Subcutaneous Ulnar Nerve Transposition Using Osborne's Ligament as a Ligamentodermal or Ligamentofascial Sling.

The ulnar nerve is most commonly compressed at the elbow in the cubital tunnel. Conservative and operative treatments have been applied for cubital tunnel syndrome. Surgical management options include decompression, medial epicondylectomy, and various anterior transposition techniques.

High-grade rotatory knee laxity may be predictable in ACL injuries.

Purpose: Lateral compartment acceleration and translation have been used to quantify rotatory knee laxity in the setting of anterior cruciate ligament (ACL) injury; however, their relationship remains elusive. The purpose of this study was to examine the correlation between lateral compartment acceleration and translation during pivot shift testing. It was hypothesized that a correlation would exist in ACL-injured and uninjured knees, irrespective of sex, but would be greatest in knees with combined ACL and lateral meniscus tear.

An Increased Lateral Femoral Condyle Ratio Is a Risk Factor for Anterior Cruciate Ligament Injury.

Background: The purpose of this study was to examine the relationship between distal femoral morphology and anterior cruciate ligament (ACL) injury, ACL reconstruction (ACLR) failure, and contralateral ACL injury. It was hypothesized that increased posterior femoral condylar depth, quantified as the lateral femoral condyle ratio, would correlate with increased risk of primary ACL injuries, ACLR failures, and contralateral ACL injuries.

Methods: The charts of consecutive patients who underwent arthroscopic knee surgery at an academic medical center from 2012 to 2016 with minimum follow-up of 24 months were retrospectively reviewed.

The Anterolateral Complex and Anterolateral Ligament of the Knee.

The anterolateral structures of the knee have recently garnered considerable interest regarding their role in rotatory knee instability related to anterior cruciate ligament tears. Isolated anterior cruciate ligament reconstruction may not always restore rotatory stability of the knee. In these patients, additional procedures, such as lateral reconstruction or tenodesis, may be indicated.

Refractory pain following hip arthroscopy: evaluation and management.

With increased knowledge and understanding of hip pathology, hip arthroscopy is rapidly becoming a popular treatment option for young patients with hip pain. Despite improved clinical and radiographic outcomes with arthroscopic treatment, some patients may have ongoing pain and less than satisfactory outcomes. While the reasons leading to failed hip arthroscopy are multifactorial, patient selection, surgical technique and rehabilitation all play a role.

Delayed Presentation of Compartment Syndrome of the Thigh in a Previously Undiagnosed Factor VII-Deficient High School Football Athlete: A Case Report.

Case: We describe a case of delayed presentation of compartment syndrome in the anterior aspect of the thigh in a high school athlete. The patient had sustained a blow to the thigh 8 days prior to presentation, and had continued to practice football in the setting of undiagnosed coagulopathy. He presented with severe thigh pain and the inability to contract the thigh muscles.

The Responsiveness of Patient- Reported Outcome Tools in Shoulder Surgery Is Dependent on the Underlying Pathological Condition.

Background: Given the high number of available patient-reported outcome (PRO) tools for patients undergoing shoulder surgery, comparative information is necessary to determine the most relevant forms to incorporate into clinical practice.

Purpose: To determine the utilization and responsiveness of common PRO tools in studies involving patients undergoing arthroscopic rotator cuff repair or operative management of glenohumeral instability.

Study Design: Systematic review.

Editorial Commentary: MRI Findings Are Only One Part of the Equation in National Football League Athletes: Shoulder Instability in Contact Athletes.

Shoulder instability is a common problem in contact sports such as the National Football League. Although many elite level football athletes will have shoulder magnetic resonance imaging (MRI) findings consistent with labral tearing on MRI, these imaging findings are not always correlated with symptomatic instability or functional limitations. It is crucial in all patients, not just National Football League athletes, to treat the patient, and not the MRI.

A Layered Anatomic Description of the Anterolateral Complex of the Knee.

Variability in anatomic terminology, dissection protocols, and use of embalmed as opposed to fresh frozen specimens has led to the controversy surrounding the "anterolateral ligament of the knee." Conceptually the complex anatomy of the anterolateral knee is made up of the superficial, middle, deep, and capsulo-osseous layers of the iliotibial band. The anterolateral capsule is deep to these tissues and is directly attached to the lateral meniscus.

Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis.

Purpose: A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears.

The Anterolateral Complex of the Knee.

Background: Significant controversy exists regarding the anterolateral structures of the knee.

Purpose: To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee.

Study Design: Descriptive laboratory study.

Technical Considerations in Revision Anterior Cruciate Ligament (ACL) Reconstruction Operative Techniques in Orthopaedics.

As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed in order to achieve successful results. The cause of the primary ACL reconstruction failure should be determined, and careful preoperative planning should be performed to address the cause(s) of failure.

Female sex is associated with greater rotatory knee laxity in collegiate athletes.

Purpose/hypothesis: The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension.

Methods: Ninety-eight collegiate athletes with a median age of 20 (range 18-25) years with no history of knee injuries were tested.

Preoperative Symptoms in Femoroacetabular Impingement Patients Are More Related to Mental Health Scores Than the Severity of Labral Tear or Magnitude of Bony Deformity.

Background: The purpose of this study was to determine the relationships between patient factors, mental health status, the condition of the local tissue, magnitude of bony deformity, and preoperative symptoms in a series of femoroacetabular impingement (FAI) patients.

Methods: From our prospective outcomes registry, we identified 64 patients with arthroscopically-treated labral tears and cam deformities. We assessed the correlations between patient factors (age, sex, body mass index, level of education), surgical findings (size of labral tear, presence of chondral lesions), mental health factors (VR-12 mental component score [MCS], depression, and preoperative use of psychotropic and/or opioid drugs), magnitude of FAI deformity (alpha and lateral center edge angles), and preoperative hip dysfunction and osteoarthritis outcome score (HOOS) subscales.

The Relationship Between Hip Strength and the Y Balance Test.

Context: The Y Balance Test was developed as a test of dynamic postural control and has been shown to be predictive of lower-extremity injury. However, the relationship between hip strength and performance on the Y Balance Test has not been fully elucidated.

Objective: The goal of this study was to identify the relationship between components of isometric hip strength and the Y Balance Test, to provide clinicians better guidance as to specific areas of muscle performance to address in the event of poor performance on the Y Balance Test.

Anatomic Femoral and Tibial Tunnel Placement During Anterior Cruciate Ligament Reconstruction: Anteromedial Portal All-Inside and Outside-In Techniques.

Tunnel malposition is one of the most common technical reasons for anterior cruciate ligament reconstruction failure. Small changes in tunnel placement can result in significant differences in outcome. More anatomic placement of the tunnels can lead to greater knee stability and a more accurate reproduction of native knee kinematics.

Technology assessment and cost-effectiveness in orthopedics: how to measure outcomes and deliver value in a constantly changing healthcare environment.

Purpose Of Review: The purpose of this study is to review the basic concepts of healthcare value, patient outcome measurement, and cost-effectiveness analyses as they relate to the introduction of new surgical techniques and technologies in the field of orthopedic surgery.

Recent Findings: An increased focus on financial stewardship in healthcare has resulted in a plethora of cost-effectiveness and patient outcome research. Recent research has made great progress in identifying orthopedic technologies that provide exceptional value and those that do not meet adequate standards for widespread adoption.