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.

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.

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.

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.

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.

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.

One in 5 Athletes Sustain Reinjury Upon Return to High-Risk Sports After ACL Reconstruction: A Systematic Review in 1239 Athletes Younger Than 20 Years.

Context: Anterior cruciate ligament (ACL) reconstruction (ACLR) is frequently performed in patients younger than 20 years whose goal is to return to sport (RTS). Varying reinjury rates have been reported, and the factors responsible are unclear. Studies differ with regard to age, graft type, surgical techniques, postoperative rehabilitation, RTS guidelines, and methods used to determine ACL failures.

Single-Shot Versus Continuous Interscalene Block for Postoperative Pain Control After Shoulder Arthroplasty: A Prospective Randomized Clinical Trial.

Introduction: Continuous catheter infusion of local anesthetics extends the efficacy of regional anesthesia after prosthetic shoulder surgery. Our purpose was to compare continuous interscalene block (CIB) with single-shot interscalene block, and the hypothesis was these would offer similar safety and efficacy in patients with prosthetic shoulder arthroplasty.

Methods: Seventy-six patients were randomized to ropivacaine single-shot interscalene block or CIB after prosthetic shoulder arthroplasty.

Blood Flow-Restricted Training for Lower Extremity Muscle Weakness due to Knee Pathology: A Systematic Review.

Context:: Blood flow-restricted training (BFRT) has been suggested to treat lower extremity muscle weakness. The efficacy of BFRT for muscle problems related to knee pathology is unclear.

Objective:: To determine whether BFRT (1) improves muscle strength and cross-sectional area (CSA) for chronic knee-related lower extremity atrophy and (2) prevents muscle atrophy after knee surgery.

Low-impact sports activities are feasible after meniscus transplantation: a systematic review.

Purpose: To determine sports activities achieved after meniscus transplantation and if associations exist between sports activity levels and transplant failure or progression of tibiofemoral osteoarthritis (OA).

Methods: A systematic search was performed using PubMed and Cochrane online databases. Inclusionary criteria were English language, clinical trials published from 1996 through May 2017, minimum 2 years of follow-up, and sports activity data reported.

Effect of Fatigue Protocols on Lower Limb Neuromuscular Function and Implications for Anterior Cruciate Ligament Injury Prevention Training: A Systematic Review.

Background: Approximately two-thirds of anterior cruciate ligament (ACL) tears are sustained during noncontact situations when an athlete is cutting, pivoting, decelerating, or landing from a jump. Some investigators have postulated that fatigue may result in deleterious alterations in lower limb biomechanics during these activities that could increase the risk of noncontact ACL injuries. However, prior studies have noted a wide variation in fatigue protocols, athletic tasks studied, and effects of fatigue on lower limb kinetics and kinematics.

Long-term Survivorship and Function of Meniscus Transplantation.

Background: Clinical outcomes and survivorship of meniscus transplants remain unclear, especially when magnetic resonance imaging (MRI) and weightbearing radiographic findings are included as endpoints. Many studies calculate survivorship based only on subsequent operative procedures.

Purpose: We prospectively determined long-term survivorship and functional outcomes of 72 consecutive meniscus transplants.

A systematic review of the incidence and clinical significance of postoperative meniscus transplant extrusion.

Purpose: To determine the incidence and clinical significance of postoperative meniscus transplant extrusion.

Methods: A systematic search was performed using PubMed and Cochrane online databases. Inclusionary criteria were English language, clinical trials of meniscus transplantation published from 1984 to 2014, and meniscus extrusion measured on magnetic resonance imaging (MRI).