Earlier Initiation of Supervised Physical Rehabilitation Is Not Associated With Decreased Arthrofibrosis After Isolated Arthroscopic Anterior Cruciate Ligament Reconstruction.

Purpose: To identify whether the timing of supervised physical rehabilitation initiation after isolated arthroscopic anterior cruciate ligament reconstruction (ACLR) is associated with (1) diagnosis of arthrofibrosis and (2) surgical intervention for arthrofibrosis within 12 months after surgery.

Methods: Outpatient isolated arthroscopic ACLR procedures in 2017-2020 were identified from the Merative MarketScan database. The cohort was limited to patients aged 18 to 64 years who initiated supervised physical rehabilitation at 0 to 30 days postoperatively and had continuous enrollment in the database for 12 months before and after surgery.

Limited Use of Supervised Physical Rehabilitation Beyond 3 Months After Arthroscopic Anterior Cruciate Ligament Reconstruction With Greater Use in Female and Younger Patients.

Purpose: To characterize the initiation and use of supervised physical rehabilitation after arthroscopic anterior cruciate ligament reconstruction (ACLR), including overall duration of rehabilitation and number of rehabilitation visits, and to describe demographic and clinical predictors of rehabilitation initiation and use characteristics.

Methods: Patients aged 14 to 64 years in the United States who underwent ACLR from 2017 to 2020 were identified using the Merative MarketScan Database. For patients initiating rehabilitation within 45 days postoperatively, the overall duration and number of visits within 1 year after surgery were determined.

Modified Bridge-Enhanced Anterior Cruciate Ligament Repair.

Historically, the treatment of anterior cruciate ligament (ACL) injuries shifted from primary repair to reconstruction because the native, intrasynovial location of the ACL precluded the formation of a fibrin-rich clot needed for ligament healing. However, increasing attention has been paid to augmenting the biological environment surrounding the ACL to facilitate its healing after arthroscopic repair. The bridge-enhanced ACL restoration implant uses resorbable collagen mixed with autologous blood to provide a biological scaffold for tissue healing.

Ambulatory Surgery Centers Reduce Patient Out-of-Pocket Expenditures for Isolated Arthroscopic Rotator Cuff Repair, but Patient Out-of-Pocket Expenditures Are Increasing at a Faster Rate Than Total Healthcare Utilization Reimbursement From Payers.

Purpose: To categorize and trend annual out-of-pocket expenditures for arthroscopic rotator cuff repair (RCR) patients relative to total healthcare utilization (THU) reimbursement and compare drivers of patient out-of-pocket expenditures (POPE) in a granular fashion via analyses by insurance type and surgical setting.

Methods: Patients who underwent outpatient arthroscopic RCR in the United States from 2013 to 2018 were identified from the IBM MarketScan Database. Primary outcome variables were total POPE and THU reimbursement, which were calculated for all claims in the 9-month perioperative period.

Association between timing of initiating supervised physical rehabilitation after rotator cuff repair and incidence of repeat repair and capsulitis: a population-based analysis.

Background: There is limited consensus on the optimal time to initiate supervised physical rehabilitation after a rotator cuff repair (RCR). We examined whether timing of initiating supervised physical rehabilitation was associated with repeat RCR or development of adhesive capsulitis within 12 months postoperatively in an observational cohort of commercially insured adults.

Methods: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters Database.

Assessment of Risk Factors and Rate of Conversion to Total Hip Arthroplasty Within 2 Years After Hip Arthroscopy Utilizing a Large Database of Commercially Insured Patients in the United States.

Background: The conversion rate of hip arthroscopy (HA) to total hip arthroplasty (THA) has been reported to be as high as 10%. Despite identifying factors that increase the risk of conversion, current studies do not stratify patients by type of arthroscopic procedure.

Purpose/hypothesis: To analyze the rate and predictors of conversion to THA within 2 years after HA.

Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study.

Objective: The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession.

Methods: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020.

Increased rate of out-of-network surgeon selection for hip arthroscopy compared to more common orthopedic sports procedures.

Background: Demand for hip arthroscopy (HA) has increased, but shortfalls in HA training may create disparities in care access. This analysis aimed to (1) compare out-of-network (OON) surgeon utilization for HA with that of more common orthopedics sports procedures, including rotator cuff repair (RCR), partial meniscectomy (PM), and anterior cruciate ligament reconstruction (ACLR), (2) compare the HA OON surgeon rate with another less commonly performed procedure, meniscus allograft transplant (MAT), and (3) analyze trends and predictors of OON surgeon utilization.

Methods: The 2013-2017 IBM MarketScan database identified patients under 65 who underwent HA, RCR, PM, ACLR, or MAT.

Hip Arthroscopy Trends: Increasing Patient Out-of-Pocket Costs, Lower Surgeon Reimbursement, and Cost Reduction With Utilization of Ambulatory Surgery Centers.

Purpose: To (1) report on trends in immediate procedure reimbursement, patient out-of-pocket expenditures, and surgeon reimbursement in hip arthroscopy (2) compare trends in ambulatory surgery centers (ASC) versus outpatient hospitals (OH) utilization; (3) quantify the cost differences (if any) associated with ASC versus OH settings; and 4) determine the factors that predict ASC utilization for hip arthroscopy.

Methods: The cohort for this descriptive epidemiology study was any patient over 18 years identified in the IBM MarketScan Commercial Claims Encounter database who underwent an outpatient hip arthroscopy, identified by Current Procedural Terminology codes, in the United States from 2013 to 2017. Immediate procedure reimbursement, patient out-of-pocket expenditure, and surgeon reimbursement were calculated, and a multivariable model was used to determine the influence of specific factors on these outcome variables.

Ambulatory Surgery Centers Significantly Decrease Total Health Care Expenditures in Primary Anterior Cruciate Ligament Reconstruction.

Background: Anterior cruciate ligament reconstruction (ACLR) is a commonly performed orthopaedic procedure. The volume and cost of ACLR procedures are increasing annually, but the drivers of these cost increases are not well described.

Purpose: To analyze the modifiable drivers of total health care utilization (THU), immediate procedure reimbursement, and surgeon reimbursement for patients undergoing ACLR using a large national commercial insurance database from 2013 to 2017.

Trends in Health Care Expenditures and Patient Out-of-Pocket Expenses in Primary Anterior Cruciate Ligament Reconstruction.

Background: Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopaedic procedures in the United States, and the number of procedures is increasing annually, as is the cost. Patients are expected to shoulder a larger out-of-pocket expenditure.

Purpose: To answer the following questions: (1) How is reimbursement changing for ACLR, and how is this affecting patients' out-of-pocket expenditures? (2) How are reimbursements from payers and patients' out-of-pocket expenses for ACLR distributed, and how is this changing? (3) Does performing ACLR in an ambulatory surgery center (ASC) result in lower costs for payers and patients?

Study Design: Economic and decision analysis study; Level of evidence, 4.

Trends in Private Equity Acquisition of Orthopaedic Surgery Practices in the United States.

Background: Independent orthopaedic practices in the United States have become attractive targets for acquisition by hospital systems and private equity (PE) firms because of the increasing demand for outpatient surgery. Consolidation in this market will have notable effects on the delivery and cost of orthopaedic services. In this study, we identified major trends in orthopaedic practice acquisitions over the past decade.

Impact of Increasing Comorbidity Burden on Resource Utilization in Patients With Proximal Humerus Fractures.

Introduction: Proximal humerus fractures (PHF) are a common upper extremity fracture in the elderly cohort. An aging and more comorbid cohort, along with recent trends of increased operative intervention, suggests that there could be an increase in resource utilization caring for these patients. We sought to quantify these trends and quantify the impact that comorbidity burden has on resource utilization.

Utilization, effectiveness, and safety of tranexamic acid use in hip fracture surgery: A population-based study.

Objective: To assess the effect of tranexamic acid (TXA) use in hip fracture surgery.

Methods: A retrospective cohort study was performed using the Premier Healthcare database. A propensity score matching approach was applied to assess associations between TXA use and blood transfusion, perioperative complications, length of stay (LOS), and hospitalization cost.

Soft tissue resurfacing for glenohumeral arthritis: a systematic review.

Background: Severe glenohumeral arthritis in the young/active patient remains challenging. Historically, glenohumeral arthrodesis was recommended with limited return of function. Total shoulder arthroplasty has shown increasing survivorship at 15 years; however it is still not ideal for young patients.

Outcomes of Primary Biceps Subpectoral Tenodesis in an Active Population: A Prospective Evaluation of 101 Patients.

Purpose: To evaluate the surgical outcomes of a primary subpectoral biceps tenodesis for long head of the biceps tendon (LHBT) pathology in a large cohort of prospectively, serially collected, patients in a young active population that has known high physical demands and requirements of their shoulder to perform their vocation.

Methods: A retrospective review of prospectively collected data from an active military personnel with a diagnosis of a Type II SLAP tear or biceps tenosynovitis was performed. Outcomes were evaluated at a minimum follow-up time of 18 months based on preoperative and postoperative assessments of the Single Assessment Numeric Evaluation, Western Ontario Rotator Cuff index, biceps position, and return to active duty.

Effectiveness of intravenous acetaminophen for postoperative pain management in shoulder arthroplasties: A population-based study.

Background: Intravenous acetaminophen (IV APAP) is an option in multimodal postoperative analgesia. Prior trials focus on hip and knee arthroplasties, whereas large-scale data on utilization and effectiveness in shoulder arthroplasties are lacking.

Methods: Data on 67,494 (452 hospitals) partial/total shoulder arthroplasties were extracted from the Premier claims database (2011-2016).

Drain Use is Associated with Increased Odds of Blood Transfusion in Total Shoulder Arthroplasty: A Population-Based Study.

Background: In the absence of evidence supporting its benefit, the American Academy of Orthopaedic Surgeons (AAOS) strongly recommends against closed wound drainage in TKA; however, drain usage remains common in other joints, including the shoulder. While an extensive body of research exists for drain use in lower extremity joint arthroplasty, large-scale data on drain use and its association with benefits and complications in shoulder arthroplasties is lacking. Such data may be particularly valuable given the rapidly increasing demand for shoulder arthroplasties.

Utilization and Real-world Effectiveness of Tranexamic Use in Shoulder Arthroplasty: A Population-based Study.

Introduction: Tranexamic acid (TXA) is increasingly used to reduce blood loss in lower extremity arthroplasty, but limited data exist for its effectiveness in patients undergoing shoulder arthroplasty. We aimed to use national data to assess the frequency of use and effectiveness of TXA in patients undergoing shoulder arthroplasty.

Methods: Using national claims data from patients undergoing shoulder arthroplasty (Premier Healthcare; 2010 to 2016; n = 82,512; 429 hospitals), we categorized patients according to whether they received perioperative TXA.

Outcomes of Patellofemoral Osteochondral Lesions Treated With Structural Grafts in Patients Older Than 40 Years.

Background Chondral lesions in the patellofemoral compartment represent a difficult entity to treat among active patients, with no clear consensus on the optimal treatment strategy. The purpose of this study was to review the functional outcomes of patients >40 years old with primary patellofemoral osteochondral lesions who underwent a cartilage restoration procedure with a structural graft. Methods Following institutional review board approval, 35 patients >40 years treated for patellofemoral chondral or osteochondral injuries were retrospectively identified.

Return to play and performance after anterior cruciate ligament reconstruction in the National Basketball Association: surgeon case series and literature review.

Objectives: To investigate return to play (RTP) and functional performance after anterior cruciate ligament reconstruction (ACLR) in National Basketball Association (NBA) players and to perform a systematic review of the literature to understand RTP after ACLR in professional basketball.

Methods: NBA players undergoing ACLR between 2008 and 2014 by two surgeons were identified. RTP and performance were assessed based on a review of publically available statistics.

Prospective Evaluation of Surgical Treatment of Humeral Avulsions of the Glenohumeral Ligament.

Background: Humeral avulsion of the glenohumeral ligament (HAGL) is an infrequent but significant contributor to shoulder dysfunction, instability, and functional loss.

Purpose: To prospectively identify patients with HAGL lesions and then conduct retrospective evaluation of the clinical history, examination findings, and surgical outcomes of these patients.

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

Capsular Preservation Using Suture Suspension Technique in Hip Arthroscopy for Femoroacetabular Impingement.

This article describes the use of sutures to enhance visualization while protecting the capsule in both the central and peripheral compartments during hip arthroscopy. We describe first a technique to preserve the proximal capsule cuff while working in the central compartment and then an alternative to the T-capsulotomy while maintaining excellent visualization of the peripheral compartment during femoroplasty of cam-type femoroacetabular impingement. By use of suture suspension of the capsule, multiple goals are achieved: The integrity of the proximal capsule cuff is maintained while aiding in visualization of the central compartment; the iliofemoral ligament is spared, which plays a critical role in preventing microinstability; the necessary space is created to obtain adequate visualization of the peripheral compartment for complete femoroplasty; and operative time is reduced because creation and subsequent repair of the T-capsulotomy can be avoided.

Surgical Release of the Pectoralis Minor Tendon for Scapular Dyskinesia and Shoulder Pain.

Background: Pectoralis minor (PM) tightness has been linked to pain and dysfunction of the shoulder joint secondary to anterior tilt and internal rotation of the scapula, thus causing secondary impingement of the subacromial space.

Purpose: To describe outcomes pertaining to nonoperative and operative treatment via surgical release of the PM tendon for pathologic PM tightness in an active population.

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

Biceps tenodesis for long head of the biceps after auto-rupture or failed surgical tenotomy: results in an active population.

Background: Long head of the biceps (LHB) deformity after surgical tenotomy or auto-rupture may result from attrition or injury. The purpose of this study was to describe the surgical outcomes of biceps tenodesis after failed surgical tenotomy or auto-rupture of the LHB tendon in a population of active patients.

Methods: During a 5-year period, 11 patients with a mean age of 43.