Latissimus Dorsi Tendon Transfer and Reverse Shoulder Arthroplasty: Restoring Mechanical Advantage by Transfer Posterior to the Long Head of the Triceps Tendon.

Background: Patients undergoing reverse shoulder arthroplasty (RSA) for rotator cuff arthropathy may present with an external rotation (ER) lag due to posterior rotator cuff insufficiency. As a result, the addition of a latissimus dorsi (LD) tendon transfer in combination with RSA has become increasingly utilized. Initial descriptions of LD tendon transfer involved rerouting of the LD tendon posterior to the long head of the triceps tendon.

A Preliminary Study of Post-Market Bridge-Enhanced ACL Restoration (BEAR) Suggests Non-Inferior Short-Term Outcomes and Low Complications.

Background: To improve outcomes following anterior cruciate ligament (ACL) reconstruction, bridge-enhanced ACL restoration (BEAR) was introduced. Bridge-enhanced ACL restoration uses a collagen-based implant saturated with infused autologous blood to bridge the torn proximal and distal ACL fibers.

Purpose: We sought to analyze the short-term complications, clinical outcomes, and patient-reported outcome measures (PROMs) in patients undergoing BEAR outside of the initial clinical trials.

Magnetic Resonance Imaging Patterns of Common Injuries in Pediatric and Adolescent Athletes.

Injuries in pediatric and adolescent athletes continue to rise in the United States, with increases in year-round sports participation, earlier sport specialization, and inadequate access to neuromuscular training programs. In this setting, the use of magnetic resonance imaging (MRI) provides a critical diagnostic tool. This review article describes the utility of MRI in diagnosing common pediatric and adolescent sports injuries and presents imaging findings associated with these pathologies.

Risk Factors for Atraumatic Medial Patellar Facet Lesions.

Background: Medial patellar facet lesions have been well-described in the setting of patellar instability. However, relatively little is known about risk factors for atraumatic medial patellar facet lesions.

Purpose/hypothesis: To identify clinical and radiographic risk factors for medial patellar facet lesions in patients without a history of trauma or patellar instability.

Decreased Effective Patellar Tendon Length following Distalization Tibial Tubercle Osteotomy without Patellar Tendon Tenodesis.

Background: Distalization tibial tubercle osteotomy (TTO) is an effective treatment for improving patellar height in patients with patella alta associated with patellofemoral instability and cartilage lesions. The addition of a patellar tendon tenodesis has been suggested; nonetheless, concerns exist regarding possible increased patellofemoral cartilage stresses.

Purpose: To evaluate pre- and postoperative patellar tendon length and alignment parameters on magnetic resonance imaging (MRI), as well as patient-reported outcome measures (PROMs) after distalization TTO without patellar tendon tenodesis.

Medial Meniscus Posterior Root Tears Lead to Changes in Joint Contact Mechanics at Low Flexion Angles During Simulated Gait.

Background: Previous biomechanical studies evaluating medial meniscus posterior root tears (MMPRTs) are limited to low loads applied at specified loading angles, which cannot capture the effects of MMPRTs during the multidirectional forces and moments placed across the knee during physiological activities.

Purpose: To quantify the effects of MMPRTs on knee joint contact mechanics during simulated gait.

Study Design: Controlled laboratory study.

Systematic Review of Clinical Outcomes After Proximal Tibia Anterior Closing-Wedge Osteotomy With ACL Reconstruction.

Background: While increased posterior tibial slope (PTS) is an important risk factor for failure after anterior cruciate ligament (ACL) reconstruction, controversy exists regarding indications and outcomes of proximal tibia anterior closing-wedge osteotomy (ACWO) with concomitant ACL reconstruction in patients with ACL tears.

Purpose: To assess clinical outcomes after combined ACL reconstruction and proximal tibia ACWO.

Study Design: Systematic review; Level of evidence, 4.

Male sex is an independent risk factor for patellar osteochondral fractures following acute patellar dislocation in pediatric patients.

Purpose: Although most patellar dislocations are associated with medial patellofemoral ligament (MPFL) injury, many patients also sustain concomitant patellar osteochondral fractures following a patellar dislocation. Few prior studies have described or evaluated risk factors for patellar osteochondral fractures in pediatric patients. The purpose of the present study was to describe the incidenceand location of patellar osteochondral fractures following acute patellar dislocation in pediatric patients.

Proximal bone block with distal screw trajectory improves mechanical stability during distalization tibial tubercle osteotomy.

Purpose: The purpose of this study was to quantify differences in mechanical stability of a wedge-shaped distalization tibial tubercle osteotomy (TTO) with a standard technique, versus a modified technique with use of a proximal bone block and distally angled screw trajectory.

Methods: Ten fresh-frozen cadaver lower extremity specimens (five matched pairs) were utilized. Within each specimen pair, one specimen was randomly assigned to undergo a standard distalization osteotomy fixed with two bicortical 4.

Patellofemoral arthroplasty conversion to total knee arthroplasty: An updated retrieval analysis and clinical outcomes.

Background: A prior retrieval analysis found high rates of infection after conversion of PFA to TKA, but was limited by a small sample size. The purpose of this study is to perform a retrieval analysis with clinical correlation on an expanded group of patients to better understand conversion of PFA to TKA.

Method: A retrospective review of an implant retrieval registry identified 62 conversions of PFA to TKA between 2004-2021.

Comprehensive Review of Multidirectional Instability of the Shoulder.

Multidirectional instability of the shoulder can result from underlying atraumatic laxity, from repetitive microtrauma, or from a traumatic injury and often occurs in association with generalized ligamentous laxity or underlying connective tissue disorders. It is critical to differentiate multidirectional instability from unidirectional instability with or without generalized laxity to maximize treatment success. Although rehabilitation is still considered the primary treatment method for this condition, surgical treatment in the form of open inferior capsular shift or arthroscopic pancapsulolabral plication is indicated if conservative treatment fails.

No difference in patient reported outcomes between cohorts undergoing lesion-specific surgery for osteochondritis dissecans of the knee.

Introduction: There is a paucity of data on patient reported outcome measures (PROMs) associated with surgical treatment of osteochondritis dissecans (OCD). As a result, preoperative patient and family counseling regarding expected outcomes is difficult. The purpose of this study was to compare pre-to post-operative changes in PROMs amongst cohorts of patients with OCD that underwent one of three lesion-specific surgical treatments: 1) transarticular drilling for stable lesions, 2) drilling and fixation for unstable lesions 3) grafting for unsalvageable lesions.

Assessment of Patellar Vascularity after Patellar Cartilage Restoration via Lateral Parapatellar Approach: Analysis Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging.

Objective: Patellofemoral cartilage restoration procedures, including osteochondral allograft, particulated juvenile cartilage, and matrix-induced autologous chondrocyte implantation, have been shown to be effective treatments for patellofemoral cartilage lesions. However, concerns exist regarding disruption of the patellar vascular supply and secondary stabilizers of the patellofemoral joint during medial parapatellar approaches, especially when combined with a lateral release. A lateral parapatellar approach affords the possibility of avoiding disruption of the medial blood supply to the patella, while also allowing laterally-based soft tissue stabilization procedures.

Establishing minimal detectable change thresholds for the international knee documentation committee and Kujala scores at one and two years after patellofemoral joint arthroplasty.

Purpose: To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA).

Methods: A distribution-based method (one-half the standard deviation of the mean difference between postoperative and preoperative outcome scores) was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints.

Rare Fracture Knee Dislocation Treated with Ligament Repair and Novel Arcuate Fracture Repair Technique: A Case Report.

Case: A 57-year-old man presented with a left knee dislocation after a motor vehicle collision. Clinical and imaging evaluation demonstrated disruption of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), anterolateral ligament (ALL), and posterolateral corner (PLC). The patient underwent acute, single-stage arthroscopic primary ACL and PCL repair, with arcuate fracture fixation using a novel technique.

Patient Experience and Satisfaction with Telemedicine During Coronavirus Disease 2019: A Multi-Institution Experience.

The coronavirus disease 2019 (COVID-19) heralded an unprecedented increase in telemedicine utilization. Our objective was to assess patient satisfaction with telemedicine during the COVID-19 era. Telemedicine visit data were gathered from Stanford Health Care (Stanford) and the Hospital for Special Surgery (HSS).

Defining Minimal Clinically Important Difference After Open Hip Abductor Repair.

Background: Open repair for gluteus medius and minimus tears is a common surgical treatment for patients with lateral hip pain associated with abductor tears; however, clinically meaningful outcomes have not been described after open surgical treatment.

Purpose: To define the minimal clinically important difference (MCID) in patient-reported outcome measures (PROMs) in patients undergoing open gluteus medius or minimus repair, and to identify preoperative patient characteristics predictive of achieving MCID postoperatively.

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

Magnetic Resonance Imaging Findings of Core Muscle Injuries in High Level Athletes.

Core muscle injuries are common injuries in athletes involved in high speed side-to-side acceleration movements. The term core muscle injury encapsulates several different injuries that occur in the pelvic region that have similar presentations. Along with a good history and physical examination, magnetic resonance imaging (MRI) can be a helpful tool in the diagnostic process.