Trends and Complications of Medial Patellofemoral Ligament Reconstruction Among Applicants for the American Board of Orthopaedic Surgery Part II and Maintenance of Certification Examinations: Analysis of Data Over a 15-Year Period.

Background: Medial patellofemoral ligament reconstruction (MPFLR) and tibial tubercle osteotomy (TTO) are commonly performed surgical procedures that often have a high learning curve.

Purpose: To review the American Board of Orthopaedic Surgery (ABOS) Part II oral examination case list and the Maintenance of Certification (MOC) examination case list databases for trends in MPFLR (isolated and with concurrent TTO) and complication rates.

Study Design: Cross-sectional study; Level of evidence, 3.

Single-Stage Combined Autologous-Allogenic Cartilage Restoration: Surgical Technique.

Articular cartilage injuries in young patients pose a notable treatment dilemma. Multiple reported techniques exist, although some of the most prominent methods currently rely on multiple procedures for chondrocyte harvest and colony expansion prior to implantation. The associated cost and effort this requires limits availability on a global basis, which creates a need for a more widely available cartilage procedure.

Arthroscopic Removal of Loose Glenoid Component in Anatomic Total Shoulder Arthroplasty.

Aseptic glenoid component loosening after anatomic total shoulder arthroplasty remains an important cause of late clinical failure and revision surgery. We present here the surgical technique of all-arthroscopic removal and glenoid bone grafting. Arthroscopic removal of a loose glenoid component and bone grafting of the glenoid defect without dermal allograft preserves glenoid bone stock and obviates the need for multiple suture anchors to hold the graft in place.

Open-wedge high tibial osteotomy with and without bone void filler: Allograft leads to faster bone union and weight bearing with comparable return to work and sports rates.

Purpose: To compare the clinical and radiological outcome of open-wedge high tibial osteotomy (OWHTO) with allogenous bone chips to a control group without bone void filler. The focus was on the rates and timelines of return to work (RTW) and return to sports (RTS), given the significance of these factors for the satisfaction of young and active patients.

Methods: One hundred and ninety-five cases of OWHTO (112 cases with allograft vs.

Return to Sports in Patients Aged 50 Years or Younger After Robotic-Assisted Patellofemoral Arthroplasty: A 10-Year Experience Reporting High Clinical Benefits and High Patient Satisfaction With Return to an Active Lifestyle.

Background: Limited data are available on return to sports and patient psychometric ratings of success after patellofemoral arthroplasty (PFA) in younger patients with high expectations to return to an active lifestyle.

Purpose/hypothesis: The purpose of this article was to determine the role of PFA and its success in meeting patient expectations regarding the return to low-impact recreational sports and an active lifestyle in younger, active patients. It was hypothesized that PFA would allow younger patients to return to low-impact sports and an active lifestyle and achieve high patient psychometric ratings.

All-Arthroscopic Matrix-Associated Autologous Chondrocyte Implantation for a Trochlear Defect.

Matrix-associated autologous chondrocyte implantation (MACI) is a 2-step technique designed to treat symptomatic full-thickness articular cartilage defects of the knee. In this technique article, MACI (autologous cultured chondrocytes on porcine collagen membrane) is used to treat a femoral trochlear defect of the knee. Treating a defect with this technique leads to improved clinical outcomes by restoring the native chondral surface architecture and biomechanics of the knee.

Arthroscopic Repair of Retracted Large and Massive Rotator Cuff Tears With and Without Augmentation With a Bio-Inductive Collagen Implant Reveals Substantial and Comparable Clinical Improvement.

Purpose: To compare clinical and imaging results after repair of retracted large and massive full-thickness rotator cuff tears, including revision repairs, with and without augmentation with a bio-inductive collagen implant.

Methods: The study group comprised 24 patients (17 male subjects) with retracted 2 or 3 tendon rotator cuff tears undergoing arthroscopic repair followed by onlay augmentation with a bio-inductive collagen implant. The control group comprised 24 patients (19 male subjects) matched by tear size undergoing repair without augmentation.

Clinical Commentary: A Criteria-Based Testing Protocol for Return to Sport Post Hip Arthroscopy for Impingement.

Unlabelled: Overall, 84%-87% of athletes will return to sport following hip arthroscopy; however, some literature suggests that only 57% of athletes return to their preinjury level, and only 16.9% report optimal performance. This discrepancy may be due to a lack of consistency within the definition of return to sport as well as a lack of consistency within rehabilitation programs when determining return to sport readiness.

Total shoulder arthroplasty in patients aged 80 years and older: a systematic review.

Background: Elderly patients and their surgeons may eschew shoulder arthroplasty due to concerns over patient safety and longevity. The purpose of this study was to review the current literature evaluating the clinical and radiographic outcomes of shoulder arthroplasty performed in patients 80 years and older.

Methods: A literature search of the Embase, PubMed, Medline, and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Editorial Commentary: Hip Arthroscopy Outcomes in Older Patients Can Equal Outcomes in Younger Patients With Proper Surgical Indications.

Hip arthroscopy patients often present with clinical features that help broadly categorize them as the younger patient with femoroacetabular impingement, the microinstability- or instability-related patient, those patients with predominant peripheral compartment disease, and the older patient with femoroacetabular impingement plus peripheral compartment disease. Outcomes in older patients can equal outcomes in younger patients with proper surgical indications. Specifically, older hip arthroscopy patients do well in the absence of degenerative articular cartilage changes.

Functional Interaction of the Cruciate Ligaments, Posteromedial and Posterolateral Capsule, Oblique Popliteal Ligament, and Other Structures in Preventing Abnormal Knee Hyperextension.

Background: The ligaments and soft tissue capsular structures of the knee joint that provide a resisting force to prevent abnormal knee hyperextension have not been determined. This knowledge is required for the diagnosis and treatment of knee hyperextension abnormalities.

Purpose: To determine the resisting moment of knee ligament and capsular structures that resist knee hyperextension.

Prosthetic shoulder arthroplasty in patients 40 years or younger: outcomes stratified by diagnosis and surgery.

Background: The outcomes of patients 50-55 years old or younger undergoing prosthetic shoulder arthroplasty (PSA) may not generalize to younger patients. We report outcomes following PSA in a consecutive series of patients 40 years or younger. We hypothesize that total shoulder arthroplasty (TSA) provides better outcome and durability than resurfacing hemiarthroplasty (RHA).

ASIS Avulsion Fracture Repair with Lag Screw and Tape Bridge Construct.

An anterior superior iliac spine avulsion (ASIS) is an injury that is induced by a rapid contraction of the sartorius and tensor fascia lata (TFL) muscles in the thigh. In this technique article, the ASIS is repaired by restoring normal length and tension to the sartorius muscle-tendon unit, which optimizes anatomic healing and function of the hip. We recommend a hybrid fixation strategy.

Addressing Arthroscopic-Assisted Acromioclavicular Joint Reconstruction in the Beach Chair Position With Concomitant Labral Pathology in the Lateral Decubitus Position.

High-grade Acromioclavicular (AC) injuries are complete dislocations, involving ruptures of the AC and coracoclavicular ligaments. They occur following trauma after a fall, direct-blow to an adducted arm, or indirectly by falling onto an abducted, outstretched extremity. Given this traumatic etiology, additional intra-articular pathologies can arise and may go unnoticed because of the painful and prominent AC joint (ACJ).

Reverse shoulder arthroplasty in patients 85 years and older is safe, effective, and durable.

Background: Reverse shoulder arthroplasty (RSA) was originally indicated for older adults, but outcomes in the oldest patients have not been studied. The purpose of this study was to report on patients aged ≥85 years undergoing RSA. We hypothesized that RSA would be safe, effective, and durable.

Shoulder Hemiarthroplasty with Nonprosthetic Glenoid Arthroplasty: The Ream-and-Run Procedure.

»: Glenoid component wear and loosening are the principal failure modes of anatomic total shoulder arthroplasty (aTSA).

»: The ream-and-run (RnR) procedure is an alternative glenohumeral arthroplasty for patients who wish to avoid the risks and limitations of a prosthetic glenoid component.

»: During the RnR procedure, the arthritic glenoid is conservatively reamed to a single concavity, while the prosthetic humeral component and soft tissues are balanced to provide both mobility and stability of the joint.

Epidemiology of youth and high school American football-related injuries presenting to United States emergency departments: 2010-2019.

Objectives: American football is one of the most popular sports in the United States (US) among youth and high school athletes; however, participation is decreasing due to concerns about safety. This has led to many new safety initiatives over the last decade, but few studies have sought to evaluate if these interventions have made football safer. The purpose of this study is to investigate national-level data on football-related injuries to compare the injury characteristics and specific injury risks of high school and youth athletes over the last decade.

Femoral tunnel malposition is the most common indication for revision medial patellofemoral ligament reconstruction with promising early outcomes following revision reconstruction: a systematic review.

Purpose: The purpose of this study was to identify the causes of failure of previous medial patellofemoral ligament reconstruction (MPFL-R), and to furthermore report the surgical techniques available for MPFL revision surgery.

Methods: Four databases [PubMed, Ovid (MEDLINE), Cochrane Database, and EMBASE] were searched until September 29, 2020 for human studies pertaining to revision MPFL. Two reviewers screened the literature independently and in duplicate.

Blood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstrings Muscles.

Purpose: To report a prospective study of patients who underwent blood flow restriction training (BFRT) for marked quadriceps or hamstring muscle deficits after failure to respond to traditional rehabilitation after knee surgery.

Methods: The BFRT protocol consisted of 4 low resistance exercises (30% of 1 repetition maximum): leg press, knee extension, mini-squats, and hamstring curls with 60% to 80% limb arterial occlusion pressure. Knee peak isometric muscle torque (60° flexion) was measured on an isokinetic dynamometer.

Generalized Joint Laxity Is Associated With Increased Failure Rates of Primary Anterior Cruciate Ligament Reconstructions: A Systematic Review.

Purpose: To investigate patients with generalized joint laxity (GJL) after primary anterior cruciate ligament reconstruction (ACLR) as to the risk of ACLR failure, graft selection success rates, and overall clinical outcomes.

Methods: A systematic review of the PubMed and EMBASE databases was performed to identify studies published from the inception of the databases through February 4, 2020. The inclusion criteria were original studies written in English involving outcomes of patients with GJL who had undergone primary ACLR.

Comparison of in-season and off-season wrestling injuries presenting to United States emergency departments: 2000-2018.

Objectives: Wrestling is a physically demanding sport with an inherently high risk of injury relative to other sports. Injury risk factors may change dramatically for athletes participating in off-season wrestling, given exposure to new opponents, training methods, and wrestling styles compared with in-season months; however, this has never been elucidated in the literature. This study seeks to characterize the injuries sustained while participating in off-season wrestling and compare them to injuries sustained during the in-season months for middle and high school age athletes.

A Biomechanical Study of Pivot-Shift and Lachman Translations in Anterior Cruciate Ligament-Sectioned Knees, Anterior Cruciate Ligament-Reconstructed Knees, and Knees With Partial Anterior Cruciate Ligament Graft Slackening: Instrumented Lachman Tests Statistically Correlate and Supplement Subjective Pivot-Shift Tests.

Purpose: To determine the statistical and predictive correlation between instrumented Lachman and pivot-shift tests with progressive loss of anterior cruciate ligament (ACL) function.

Methods: The kinematic correlations between pivot-shift and Lachman anterior tibial translations (ATTs) in ACL-deficient and ACL-reconstructed states and in partially lax ACL grafts were determined with precise robotic testing in cadaveric knees. The Lachman test (100-N anteroposterior) and 2 pivot-shift loadings were conducted: anterior tibial loading (100 N), valgus rotation (7 Nm), and internal rotation (5 Nm and 1 Nm).

Arthroscopic Evaluation and Treatment of Complications That Arise Following Prosthetic Shoulder Arthroplasty.

Arthroscopy may be used to diagnose symptomatic glenoid loosening following anatomic total shoulder arthroplasty (aTSA), and arthroscopic glenoid component removal may suffice as treatment for some patients. Arthroscopy may be used to diagnose shoulder prosthetic joint infection (PJI) following aTSA and reverse shoulder arthroplasty (RSA). Tissues are biopsied from multiple sites within the joint and the subdeltoid or subacromial space, and they are cultured for a minimum of 14 days.