Arthroscopic rotator cuff repair in active patients younger than 45 Years: a prospective analysis with a mean 5-year follow-up.

Background: To report clinical and activity-specific outcomes after arthroscopic rotator cuff repair (ARCR) for full-thickness supraspinatus tears in active individuals aged less than or equal to 45 years. The pre hoc hypothesis was that patients in this age group would demonstrate significant improvements in clinical outcomes following ARCR along with a significant improvement of athletic abilities.

Methods: Patients were included in this study if they were (1) active individuals aged between 18 and 45 years at the time of surgery, (2) had a full-thickness rotator cuff tear of the supraspinatus tendon with or without anterior or posterior extension, and (3) underwent ARCR.

Displaced Posterior Cruciate Avulsion Fracture Fixation With Medial Collateral Ligament and Lateral Meniscus Injury Using Combined Open and Arthroscopic Methods.

Tibial-sided posterior cruciate ligament avulsion fractures are challenging injuries that often occur concomitantly in the setting of multiligament knee and other soft-tissue injuries. There is no consensus on the optimal surgical approach or timing of treatment for these injuries. This Technical Note describes the fixation of a displaced posterior cruciate ligament avulsion fracture with concomitant grade 3 medial collateral ligament injuries and bucket-handle lateral meniscus tears using open and arthroscopic techniques.

Popliteal Cyst Compressive Tibial Neuropathy and Venous Insufficiency: A Case Report.

Popliteal cysts are a collection of synovial fluid found in the popliteal fossa that typically form in adults in association with traumatic injuries, degenerative conditions, or inflammatory arthritis of the knee. While often asymptomatic, popliteal cysts may become problematic as enlarging and ruptured cysts may compress surrounding neurovascular structures, resulting in lower extremity edema or peripheral neuropathy. We report a unique case of a symptomatic popliteal cyst in a patient with both compressive neuropathy and venous congestion in the setting of a non-ruptured popliteal cyst after a surgically repaired intraarticular injury.

A Systemic and Local Comparison of Senescence in an Acute Anterior Cruciate Ligament Injury-A Pilot Case Series.

Background: Senescence, a characteristic of cellular aging and inflammation, has been linked to the acceleration of osteoarthritis. The purpose of this study is to prospectively identify, measure, and compare senescent profiles in synovial fluid and peripheral blood in patients with an acute knee injury within 48 h.

Methods: Seven subjects, aged 18-60 years, with an acute ACL tear with effusion were prospectively enrolled.

Reanalysis of the Posterior Oblique Ligament: Quantitative Anatomy, Radiographic Markers, and Biomechanical Properties.

Background: The posterior oblique ligament (POL) is the largest structure of the posteromedial knee that is at risk of injury in conjunction with the medial collateral ligament (MCL). Its quantitative anatomy, biomechanical strength, and radiographic location have not been assessed in a single investigation.

Purpose: To evaluate the 3-dimensional and radiographic anatomy of the posteromedial knee and the biomechanical strength of the POL.

Treatment of the 'The Naked Humeral Head': Repair of Supraspinatus Avulsion, Subscapularis Tear, and Humeral Avulsion of the Glenohumeral Ligament.

A humeral avulsion of the glenohumeral ligament, or HAGL, lesion is a rare yet debilitating shoulder injury, which can lead to recurrent instability, pain, and overall shoulder dysfunction. The diagnosis is often difficult, requiring both high clinical suspicion, as well as identification on magnetic resonance imaging. In patients with an anterior HAGL, repair often requires an open approach.

Anterior to Posterior Bone Plug Suture Tunnels Provide Optimal Biomechanics for Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Graft.

Purpose: To evaluate different bone-patellar tendon-bone (BPTB) plug suture configurations for pull through strength, stiffness, and elongation at failure in a biomechanical model of suspensory fixation.

Methods: Forty nonpaired, fresh-frozen human cadaveric BPTB allografts with an average age of 65.6 years were tested.

The recovery curve of anatomic total shoulder arthroplasty for primary glenohumeral osteoarthritis: midterm results at a minimum of 5 years.

Background: Excellent results have been reported for anatomic total shoulder arthroplasty (TSA) for the treatment of primary glenohumeral osteoarthritis (GHOA). We aim to assess the recovery curve and longitudinal effects of time, age, sex, and glenoid morphology on patient-reported outcomes (PROs) after primary anatomic TSA for primary GHOA.

Methods: Patients who underwent primary anatomic TSA over 5 years ago were included: Short-Form 12 Physical Component Summary, American Shoulder and Elbow Surgeons scores, Quick Disabilities of the Arm Shoulder and Hand Score, Single Assessment Numeric Evaluation, and patient satisfaction were assessed.

Arthroscopic Segmental Medial Meniscus Allograft Transplant Using Three Fixation Techniques.

Partial meniscectomy or failed meniscus repair can lead to pain, dysfunction, and cartilage degradation due to increased contact forces. Meniscus transplantation can lead to favorable outcomes and cartilage preservation with careful patient selection. Limited data exist on segmental meniscus allograft transplantation, with promising results using synthetic grafts and early animal and biomechanical studies on segmental allograft transplantation, showing similar results to full meniscus allograft transplantation.

Editorial Commentary: Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Makes More Sense Than Triple-Bundle: Three's a Crowd.

Recent research reports impressive patient-reported and objective stability outcomes after triple-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. However, the results are similar to those reported in the orthopaedic literature for single-bundle ACL reconstruction. If the triple-bundle technique does not reduce graft failure rates, and bearing in mind that it is more complex, more expensive, and more difficult to revise, then an anatomically-positioned single-bundle ACL reconstruction makes more sense.

Anchor Arthropathy of the Shoulder Joint After Instability Repair: Outcomes Improve With Revision Surgery.

Purpose: To report clinical and patient-reported outcome measures (PROMs) in patients undergoing revision surgery after diagnosis of anchor-induced arthropathy.

Methods: Patients who underwent revision arthroscopic shoulder surgery and were diagnosed with post-instability glenohumeral arthropathy performed from January 2006 to May 2018 were included in the current study. Patients were excluded if they underwent prior open shoulder procedures, if glenoid bone loss was present, or if prerevision imaging and records were incomplete or not available.

Postoperative Stiffness and Pain After Arthroscopic Labral Stabilization: Consider Anchor Arthropathy.

Purpose: To describe the key clinical, imaging, and arthroscopic characteristics of anchor arthropathy after arthroscopic shoulder stabilization procedures and, secondarily, to define risk factors for the development of anchor-induced arthropathy.

Methods: A total of 23 patients who underwent revision arthroscopic shoulder surgery and were diagnosed with glenohumeral arthropathy were retrospectively identified from prospectively collected data registries between January 2000 and May 2018. Data included initial diagnosis and index procedure performed, presenting arthropathy symptoms including duration, and examination findings before revision surgery.

Open Popliteal Tendon Repair.

Popliteal tendon tears without concomitant damage to the cruciate ligaments or other posterolateral corner ligaments are rare entities with few studies reporting on their existence, with rare case reports discussing their treatment. Continued pain, instability, and effusions are typical symptoms, with magnetic resonance imaging being the main tool for diagnosis. Furthermore, monosodium urate crystals that induce gout have been shown to collect in the popliteal groove and thus may lead to degeneration and isolated tearing.

Clinical Outcomes of Arthroscopic Suprascapular Nerve Decompression for Suprascapular Neuropathy.

Purpose: To report clinical outcomes following arthroscopic suprascapular nerve (SSN) decompression for suprascapular neuropathy at the suprascapular and/or spinoglenoid notch in the absence of major concomitant pathology.

Methods: We retrospectively reviewed prospectively collected data of 19 patients who underwent SSN release at the suprascapular and/or spinoglenoid notch between April 2006 and August 2017 with ≥2 years of follow-up. Patients who underwent concomitant rotator cuff or labral repairs or had severe osteoarthritis were excluded.

Reliability of Magnetic Resonance Imaging Prediction of Anterior Cruciate Ligament Autograft Size and Comparison of Radiologist and Orthopaedic Surgeon Predictions.

Background: In anterior cruciate ligament (ACL) reconstruction, hamstring tendon autografts <8 mm have been associated with increased failure rates. There has been no established modality by which orthopaedic surgeons can preoperatively predict graft sizes.

Purpose/hypothesis: The purposes of this study were to (1) determine whether routine magnetic resonance imaging (MRI) measurement of hamstring tendon cross-sectional area (CSA) can reliably be used by sports medicine fellowship-trained orthopaedic surgeons to predict graft size and (2) determine whether radiologists and sports medicine surgeons are able to discriminate grafts below a predetermined cutoff value.

Minimum Five-year Outcomes and Clinical Survivorship for Arthroscopic Transosseous-equivalent Double-row Rotator Cuff Repair.

Introduction: Despite the widespread use of arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair (RCR) techniques, midterm outcome data are limited. The purpose of this article was to assess midterm clinical outcomes of patients following arthroscopic TOE RCR using either a knotless tape bridge (TB) repair or knotted suture bridge (SB) repair technique. We hypothesized that there would be significant improvements in patient-reported outcomes with TOE RCR that would be durable over time.

Impact of Age and Subscapularis Tendon Reparability on Return to Recreational Sports Activities and 2-Year Outcomes After Reverse Total Shoulder Arthroplasty.

Background: As the indications for reverse total shoulder arthroplasty (RTSA) have continued to expand, the average age of patients undergoing RTSA has decreased.

Purpose/hypothesis: The purpose of this study was to report the minimum 2-year outcomes after RTSA and to evaluate the impact of surgical variables on outcomes. We hypothesized that younger patients, patients with larger glenosphere, and patients with irreparable subscapularis tendons would experience worse subjective patient-reported outcome scores (PROS) and that younger patients and those with a reparable subscapularis would demonstrate a higher rate of return to recreational sports activities.

Primary Acromioclavicular-Coracoclavicular Reconstruction Using 2 Allografts, TightRope, and Stabilization to the Acromion.

Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, particularly among young athletes participating in contact sports. Injuries to the AC joint most commonly occur from direct impact at the acromion and are classified as types I to VI. Although most AC joint injuries can be treated nonoperatively, types IV to VI are best treated with surgery, with type III being controversial and most surgeons recommending an initial trial of nonoperative treatment.

Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions.

Background: The arthroscopic "bony Bankart bridge" (BBB) repair technique was recently shown to successfully restore shoulder stability at short-term follow-up, but longer-term outcomes have not yet been described.

Purpose: To report the outcomes at minimum 5-year follow-up after BBB repair for anterior shoulder instability with a bony Bankart lesion.

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