Do We Need to Reconsider How We Gauge Success After Anatomic Total Shoulder Arthroplasty? A Study of Thresholds Optimized for Patient Satisfaction Using the Simple Shoulder Test.

Background: Clinically important improvement after total shoulder arthroplasty is often assessed with shoulder-specific patient-reported outcome measures (PROMs) quantifying reduction in pain and restoration in function. It is unclear if commonly utilized threshold such as minimal clinically important difference (MCID), substantial clinical benefit (SCB), or patient acceptable symptom state (PASS), represent optimal improvement from the patients' perspective. The objectives of this study were to utilize the Simple Shoulder Test to: 1) compare commonly utilized thresholds for change in score and final score to thresholds optimized to patient satisfaction using receiver operative characteristic (ROC) curve analysis, and 2) determine the impact of using different thresholds on reporting of independent predictors of successful outcome in terms of patient satisfaction.

Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: 24-Month Results From a Randomized Controlled Trial.

Background: The indications for hip arthroscopy in patients aged ≥40 years remain controversial, as observational studies have suggested that advanced age portends poor functional outcomes, poor durability of improvement, and high rates of conversion to total hip arthroplasty.

Purpose: To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients aged ≥40 years with limited radiographic osteoarthritis.

Study Design: Randomized controlled trial; Level of evidence, 1.

Anatomic shoulder arthroplasty: the correlation between patient resilience, mental health, and outcome.

Background: Recovery from anatomic shoulder arthroplasty may be enhanced in patients with good mental health and the resilience to participate in the prescribed postoperative rehabilitation program. To test this concept, we utilized validated and reliable scales in determining whether resilience and mental health are associated with the outcome of anatomic arthroplasty.

Methods: Three hundred ninety-nine patients (195 ream and run [RnR] and 204 anatomic total shoulder arthroplasty [aTSA]) were surveyed at a mean follow-up of 6.

Infection in Shoulder Arthroplasty: Prevention, Diagnosis, and Treatment.

Prosthetic joint infection is a devastating complication following shoulder arthroplasty that can lead to pain, poor function, and poor quality of life. With the increasing number of shoulder arthroplasties performed annually, recognition of prosthetic infection and treatment is necessary. The skin surrounding the shoulder has a unique microbiome, and is the most commonly encountered bacteria causing prosthetic joint infection.

Medial Patellofemoral Ligament Reconstruction in the Pediatric Population: Skeletal Immaturity Does Not Affect Functional Outcomes but Demonstrates Increased Rate of Subsequent Knee Injury.

Purpose: To evaluate short- to mid-term-outcomes, including instability rates, following medial patellofemoral ligament (MPFL) reconstruction in skeletally immature versus mature pediatric patients.

Methods: Patients younger than age 18 with recurrent patellar instability who underwent primary allograft MPFL reconstruction by a single surgeon from 2013 to 2019 were identified. Skeletally immature patients underwent all-epiphyseal drilling and mature patients underwent metaphyseal drilling at the Schöttle's point.

Conservatively Treated Symptomatic Rotator Cuff Tendinopathy May Progress to a Tear.

Purpose: To determine the likelihood of, and risk factors for, progression of rotator cuff tendinopathy to tear on magnetic resonance imaging (MRI) in patients treated conservatively for minimum 1 year.

Methods: Patients in the Veterans Health Administration (VHA) Corporate Data Warehouse with a diagnosis of rotator cuff injury and sequential MRI of the same shoulder at least 1 year apart were identified. Presenting MRIs were reviewed to select patients with tendinopathy, while excluding those with a normal appearing cuff, tear, or prior repair.

Symptomatic Rotator Cuff Tear Progression: Conservatively Treated Full- and Partial-Thickness Tears Continue to Progress.

Purpose: To determine the likelihood of and risk factors for tear progression among patients with a symptomatic partial or full-thickness rotator cuff tears (RCTs) who return with continued shoulder pain and obtain subsequent magnetic resonance imaging (MRI) and to identify various patient factors and MRI findings associated with rotator cuff tear progression.

Methods: We performed a retrospective review of MRI studies from Veteran's Affair patients with conservatively treated partial- or full-thickness rotator cuff tears. Patient characteristics and demographics were obtained via chart review.

Tape Augmentation Does Not Affect Mid-Term Outcomes of Medial Patellofemoral Ligament Reconstruction in Skeletally Mature Adolescent Patients.

Purpose: To evaluate mid-term outcomes after medial patellofemoral ligament (MPFL) reconstruction with and without tape augmentation in the skeletally mature adolescent population.

Methods: All patients under age 18 with recurrent patellar instability treated with surgery at a single institution by a single surgeon from January 2013 through June 2017 were identified by current procedural terminology codes. Inclusion criteria were (1) primary MPFL reconstruction, (2) minimum 3 years' follow-up, (3) skeletal maturity.

Tibial Spine Repair in the Pediatric Population: Outcomes and Subsequent Injury Rates.

Purpose: To evaluate short- to mid-term outcomes after arthroscopic operative fixation of tibial spine fractures in pediatric patients, to determine the incidence of further ipsilateral and contralateral knee injuries, and to describe associated meniscal pathology and intraoperative findings at the time of tibial spine repair.

Methods: All patients under age 18 with a tibial spine fracture treated arthroscopically at 1 institution by 2 surgeons from 2008 through 2019 were identified by Current Procedural Terminology codes. Patients at least 1 year from their date of surgery were contacted to complete a questionnaire, which included the International Knee Documentation Committee (IKDC) form.

Footprint size matters: wider coronal greater tuberosity width is associated with increased rates of healing after rotator cuff repair.

Background: The purpose of this study was to determine whether greater tuberosity morphology (1) could be measured reliably on magnetic resonance imaging (MRI), (2) differed between patients with rotator cuff tears (RCTs) compared with those without tears or glenohumeral osteoarthritis, or (3) differed between patients with rotator cuff repairs (RCR) who healed and those that did not.

Methods: This is a retrospective comparative study. (1) We measured greater tuberosity width (coronal and sagittal), lateral offset, and angle on MRI corrected into the plane of the humerus.

Overgrowth After Pediatric Tibial Spine Repair with Symptomatic Leg Length Discrepancy: A Case Report.

Case: A 12-year-old girl sustained a right-sided tibial spine fracture while jumping on a trampoline. Postoperative course was complicated initially by arthrofibrosis requiring manipulation under anesthesia and subsequent leg length discrepancy attributed to posttraumatic overgrowth necessitating femoral epiphysiodesis. Ten years after initial injury, she reported her knee to be 63% of normal and an International Knee Documentation Committee score of 63.

Hip Arthroscopy Versus Physical Therapy for the Treatment of Symptomatic Acetabular Labral Tears in Patients Older Than 40 Years: A Randomized Controlled Trial.

Background: Previous observational studies have suggested poor results of arthroscopic surgery for the treatment of acetabular labral tears in patients older than 40 years.

Purpose: To compare hip arthroscopy versus nonoperative management for symptomatic labral tears in patients older than 40 years who have limited radiographic osteoarthritis.

Study Design: Randomized controlled trial; Level of evidence, 1.

Wrist Fractures in Skiers and Snowboarders: Incidence, Severity, and Risk Factors Over 40 Seasons.

Purpose: To determine and compare the incidence and severity of wrist fractures in skiers and snowboarders.

Methods: A university-run orthopedic clinic at the base of a major ski resort has maintained an injury database spanning the years 1972 to 2012. Demographic information, equipment type, ability level, trail type and conditions, number of falls, circumstances surrounding the injury, and radiographs were collected on participants sustaining wrist fractures and compared with uninjured control participants asked the same questions, but in reference to their last fall where no injury resulted.

The new dynamic isotonic manipulation examination (DIME) is a highly sensitive secondary screening tool for supraspinatus full-thickness tears.

Background: Traditional shoulder physical examination (PE) tests have suboptimal sensitivity for detection of supraspinatus full-thickness tears (FTTs). Therefore, clinicians may continue to suspect FTTs in some patients with negative rotator cuff PE tests and turn to magnetic resonance imaging (MRI) for definitive diagnosis. Consequently, there is a need for a secondary screening test that can accurately rule out FTTs in these patients to better inform clinicians which patients should undergo MRI.

Endoscopic Repair of Full-Thickness Gluteus Medius and Minimus Tears-Prospective Study With a Minimum 2-Year Follow-Up.

Purpose: To evaluate the short-term outcomes of endoscopic repair of full-thickness gluteus medius and minimus tendon tears with a minimum of 2-year follow-up and add to the paucity of literature on abductor tendon tears.

Methods: All patients who underwent endoscopic abductor tendon repair between December 2013 and August 2017 were prospectively evaluated. The inclusion criteria for this study were primary full-thickness gluteal tendon tears and at least 2-years of follow-up.

Knee Extension Does Not Reliably Reduce Acute Type II Tibial Spine Fractures: MRI Evaluation of Displacement During Extension Versus Resting Flexion.

Background: Type II tibial spine avulsion (TSA) fractures have traditionally been managed by first attempting to achieve closed reduction with extension and immobilization, with surgical indications reserved for those who fail to reduce within 3 mm. However, the frequency with which appropriate reduction can be achieved is largely unknown.

Purpose: To evaluate changes in displacement of type II TSA fractures by comparing magnetic resonance imaging (MRI) scans obtained with the knee in flexion and in extension.

A value-based care analysis of magnetic resonance imaging in patients with suspected rotator cuff tendinopathy and the implicated role of conservative management.

Background: Magnetic resonance imaging (MRI) is often used to evaluate the integrity of the rotator cuff in patients with suspected full-thickness rotator cuff tears or other cuff tendinopathies. The value of advanced imaging value comes into question when it is used as the initial musculoskeletal imaging test before a trial of conservative therapy in patients with atraumatic shoulder pain, minimal to no strength deficits on examination, and suspected cuff tendinopathy.

Methods: A prospective study of a group of patients suspected to have cuff tendinopathy based on clinical findings was performed.

Improvement in Functional Outcome Scores Despite Persistent Pain With 1 Year of Nonsurgical Management for Acetabular Labral Tears With or Without Femoroacetabular Impingement.

Background: Acetabular labral tears are increasingly recognized as a source of hip pain in a younger active population. Given the significant focus on surgical intervention, there has been limited investigation on the nonsurgical management and natural history of such injuries.

Hypothesis: Patients undergoing nonsurgical treatment for symptomatic acetabular labral tears experience functional improvement based on patient-reported outcome measures over the course of 1 year.

Scapholunate and perilunate injuries in the athlete.

Purpose Of The Review: Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries.

Recent Findings: Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season.

Peritrochanteric Endoscopy.

Over the last decade, there have been significant advances in endoscopic techniques for peritrochanteric disorders of the hip. Endoscopic repair of gluteus medius and minimus tears has demonstrated good to excellent results in most patients who meet surgical indications with extremely low complication rates. Treatment of coxa saltans and other peritrochanteric disorders are also described, though the literature lacks sufficient evidence to guide treatment.

Self-renewal and differentiation of reactive astrocyte-derived neural stem/progenitor cells isolated from the cortical peri-infarct area after stroke.

In response to stroke, subpopulations of cortical reactive astrocytes proliferate and express proteins commonly associated with neural stem/progenitor cells such as glial fibrillary acidic protein (GFAP) and Nestin. To examine the stem cell-related properties of cortical reactive astrocytes after injury, we generated GFAP-CreER(TM);tdRFP mice to permanently label reactive astrocytes. We isolated cells from the cortical peri-infarct area 3 d after stroke, and cultured them in neural stem cell medium containing epidermal growth factor and basic fibroblast growth factor.