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Table of Contents
doi : 10.1016/S0749-8063(21)00706-4
Volume 37, Issue 9, September 2021, Pages A9-A10, A12, A14-A15
Instructions for Authors
doi : 10.1016/S0749-8063(21)00712-X
Volume 37, Issue 9, September 2021, Page A35
Medical Journals Should Be a Forum for Disruptive Research
ErikHohmannM.D., Ph.D., F.R.C.S.(Associate Editor)James H.LubowitzM.D.(Editor-in-Chief)Jefferson C.BrandM.D.(Assistant Editor-in-Chief)Michael J.RossiM.D., M.S.(Assistant Editor-in-Chief)
doi : 10.1016/j.arthro.2021.07.001
Volume 37, Issue 9, September 2021, Pages 2723-2725
Disruptive innovation completely changes the traditional way that we operate and may only be realized in retrospect. For example, shoulder superior capsule reconstruction (SCR) is a complete change from the traditional methods of treating massive, irreparable rotator cuff tears and pseudoparalysis. Classic examples of disruptions in orthopaedic surgery include distraction osteogenesis, total hip joint replacement arthroplasty, and modern orthopaedic trauma care. Orthopaedic technologies that promise future disruption include artificial intelligence, surgical simulation, and orthopaedic biologics, including mesenchymal stromal cell (MSC) and gene therapy. Most of all, arthroscopic surgery completely changed the way we operate by using new methods and technology. Many never saw it coming. The challenge going forward is to motivate and foster new ideas and research that result in innovation and progress. Skepticism has a place, but not at the expense of transformative ideas, particularly as medical journals offer the alternative of prospective hypothesis testing using the scientific method, followed by unbiased peer review, and publication. Medical journals should be a forum for disruptive research.
The Appropriate Methodologies in Biomechanical Studies Regarding Lateral Extra-Articular Procedures: What We Really Need in the Controlled Laboratory Studies
JunjieXuM.D.JinzhongZhaoM.D.
doi : 10.1016/j.arthro.2021.06.020
Volume 37, Issue 9, September 2021, Pages 2726-2728
Regarding “The Top 50 Most-Cited Shoulder Arthroscopy Studies”
ChristopheTrojaniM.D., Ph.D., H.D.R.
doi : 10.1016/j.arthro.2021.07.004
Volume 37, Issue 9, September 2021, Pages 2728-2729
Author Reply to “Regarding ‘The Top 50 Most-Cited Shoulder Arthroscopy Studies’”
M. LaneMooreB.S.Jordan R.PollockB.S.Kade S.McQuiveyM.D.Joshua S.BinghamM.D.
doi : 10.1016/j.arthro.2021.07.002
Volume 37, Issue 9, September 2021, Pages 2730-2731
Platelet-Rich Plasma: Fundamentals and Clinical Applications
Andrew J.SheeanM.D.aAdam W.AnzM.D.bJames P.BradleyM.D.c
doi : 10.1016/j.arthro.2021.07.003
Volume 37, Issue 9, September 2021, Pages 2732-2734
Platelet-rich plasma (PRP) is perhaps the most widely studied of the biologic therapies, with an ever-growing body of evidence supporting its safety and efficacy in decreasing inflammation and pain and promoting healing in the setting of both nonoperative and operative treatments. PRP is produced by the centrifugation of whole blood, isolating its constituent parts based on their unique densities. These density gradients can be selectively harvested so as to obtain different concentrations of various blood product components, such as platelets and leukocytes. A precise and consistent method for describing the essential characteristics of different PRP formulations is critical for both practical and research purposes. The concentration of platelets, method of activation, and the total number of red blood cells (RBCs), white blood cells (WBCs), and neutrophils relative to baseline values are all of particular importance in accurately describing a PRP formulation. The biologic activity of PRP is manifold: platelet ?
Repair Tension During Arthroscopic Rotator Cuff Repair is Correlated With Preoperative Tendon Retraction and Postoperative Rotator Cuff Integrity
YoshitsuguTakedaM.D., Ph.D.aKojiFujiiM.D., Ph.D.aNaotoSuzueM.D., Ph.D.aKatsutoshiMiyatakeM.D., Ph.D.bYoshiteruKawasakiM.D., Ph.D.aKenjiYokoyamaM.D.ac
doi : 10.1016/j.arthro.2021.03.069
Volume 37, Issue 9, September 2021, Pages 2735-2742
Editorial Commentary: Overtensioning of Rotator Cuff Tear Repair Predisposes to Failure of Complete Healing
Bum JinShimM.D., Ph.D.
doi : 10.1016/j.arthro.2021.04.074
Volume 37, Issue 9, September 2021, Pages 2743-2744
Overtension repair of rotator cuff tear may predispose to the failure of postoperative integrity of the rotator cuff tendon. Surgeons should consider the size of the rotator cuff tear and maintain adequate tension for successful rotator cuff repair. Feel the tension on the tendon: too much can poison the outcome.
Subacromial Platelet-Rich Plasma Injections Decrease Pain and Improve Functional Outcomes in Patients With Refractory Rotator Cuff Tendinopathy
Luciano A.RossiM.D., Ph.D.Nicol?sPiuzziM.D.DiegoGiuntaPh.D.IgnacioTanoiraM.D.RodrigoBrandarizM.D.IgnacioPasqualiniM.D.MaximilianoRanallettaM.D.
doi : 10.1016/j.arthro.2021.03.079
Volume 37, Issue 9, September 2021, Pages 2745-2753
Editorial Commentary: Platelet-Rich Plasma Shows Promise for Improving Shoulder Tendinopathy
James B.CarrM.D.
doi : 10.1016/j.arthro.2021.05.045
Volume 37, Issue 9, September 2021, Pages 2754-2755
Platelet-rich plasma (PRP) injections continue to be used at increasing rates to treat common musculoskeletal conditions. PRP has a low-risk profile and emerging in vitro evidence to support its positive effects on soft-tissue healing. PRP has been shown to be of benefit for knee osteoarthritis, but less has been published regarding the shoulder. PRP delivers a high concentration of growth factors, cytokines, and other important inflammatory modulators. Its use is appealing for treating partial-thickness rotator cuff tears, subacromial bursitis, and rotator cuff tendinopathy since rotator cuff tendons often have poor healing capacity due to intrinsic degeneration. PRP has been shown to increase cell proliferation and matrix synthesis in tenocytes, which may aid tendon regeneration and healing. Adult tendons also contain a small amount of tendon progenitor cells, which can be induced to an active state by PRP. In addition, PRP is an autologous biologic agent and easy to acquire and administer in an outpatient clinical setting. Clinical studies continue to lag and are often heterogenous in quality and in results. PRP can vary widely based on multiple intrinsic and extrinsic factors, including patient age, sex, activity level, centrifugation speed, and number of centrifugation cycles. Thus, quality research methods should include reporting using the PAW (platelets/activation/white blood cells) system. Clinicians should remain cautiously optimistic about the future role of PRP injections in the shoulder.
Improved Clinical and Radiologic Outcomes Seen after Superior Capsule Reconstruction using Long Head Biceps Tendon Autograft
DoosupKimM.D., Ph.D.abJaewoongUmM.D.aJunhyeokLeeM.S.cJaehyeonKimM.D.b
doi : 10.1016/j.arthro.2021.04.006
Volume 37, Issue 9, September 2021, Pages 2756-2767
Editorial Commentary: Long Head Biceps Tendon Autograft Is an Ideal and Cost-effective Graft Choice in Superior Capsular Reconstruction of the Glenohumeral Joint
IlyaVoloshinM.D.
doi : 10.1016/j.arthro.2021.05.041
Volume 37, Issue 9, September 2021, Page 2768
Recent literature supports the concept of superior capsular reconstruction (SCR) in patients with irreparable massive rotator cuff tears. Tensor fascia lata autograft and dermal allograft have been used with reported improvement of clinical outcomes. Long head biceps (LHB) tendon autograft has been proposed as an alternative autograft source for SCR. The advantage of LHB autograft is its anatomic proximity, robust graft strength, and cost-effectiveness. The biomechanical data, as well as short-term clinical outcomes, support the use of LHB autograft for SCR.
Biceps Rerouting for Semirigid Large-to-Massive Rotator Cuff Tears
Sung-MinRheeM.D.aSeung-MinYounF.R.A.C.S.bJoon HongParkM.D.aYong GirlRheeM.D.b
doi : 10.1016/j.arthro.2021.04.008
Volume 37, Issue 9, September 2021, Pages 2769-2779
Editorial Commentary: Anterior Cable Reconstruction for the Shoulder Superior Capsule: Time for “Indication Rounds”
Maxwell C.ParkM.D.
doi : 10.1016/j.arthro.2021.05.039
Volume 37, Issue 9, September 2021, Pages 2780-2782
Anterior cable reconstruction (ACR) techniques for the superior capsule are multiple and varied. To optimize patient outcomes, technical considerations must be supported by basic science, both anatomically and biomechanically. ACR was designed to treat only partially repairable rotator cuff tendon tears, to provide a static support to a dynamic partial (and therefore “nonanatomic”) repair, and to treat tears that could not be treated by transosseous-equivalent footprint-restoring “anatomic” repairs (both capsule and tendon repaired), but were also not so large as to necessitate superior capsule reconstruction. ACR allows restoration of posterosuperior capsular function with side-to-side repair sutures, and much of the biomechanical functionality comes from using whatever inherent native superior capsule is available. Cable reconstructions should be secured to normal attachment sites on the glenoid and greater tuberosity sulcus. Also, graft tension must be accounted for when considering humeral motion such as rotation and adduction. The indications for ACR need to be carefully considered and account for both anatomic and biomechanical rationales. In the face of new ACR techniques, the need to discern what is possible versus what procedure is indicated cannot be overlooked.
Superior Capsular Reconstruction With Autologous Fascia Lata Using a Single Lateral-Row Technique Is an Effective Option in Massive Irreparable Rotator Cuff Tears: Minimum 2-Year Follow-Up
Jose FranciscoAlarconM.D.aBastianUribe-EchevarriaM.D.bhCarlosClaresM.D.cDanielApablazaM.D.dJuan CarlosVargasM.D.eSergioBenaventeM.D.fVivianaRiveraM.D.g
doi : 10.1016/j.arthro.2021.04.009
Volume 37, Issue 9, September 2021, Pages 2783-2796
Editorial Commentary: Human Dermal Allograft Is Preferable to Fascia Lata Autograft Based on Similar Outcomes Without Donor-Site Morbidity
AdnanSaithnaM.D., F.R.C.S. (T&O), Editorial Board
doi : 10.1016/j.arthro.2021.05.037
Volume 37, Issue 9, September 2021, Pages 2797-2799
Superior capsular reconstruction (SCR) is increasingly considered a “game-changer” for young patients with irreparable rotator cuff tears. Popular graft choices include fascia lata autograft (FLA) and human dermal allograft (HDA), with the latter strongly preferred in North America and Europe. Despite that, there seems to be a general perception that FLAs are associated with better healing rates due to better biology. However, critical analysis of the literature demonstrates abundant limitations that preclude strong conclusions about whether one graft type is optimal. Furthermore, recent studies have demonstrated that HDAs used for SCR have good healing potential and are also associated with generally good short-term clinical outcomes. A clinical pearl is that humeral sided repair failures are not uncommon, and double-row repair techniques should be thoughtfully considered. The main downside of FLAs is the associated donor site morbidity. Given the lack of proven advantage of FLAs, the impetus to move away from the current trend to use HDAs is low.
Pullout Strength of All-Suture and Metallic Anchors in Repair of Lateral Collateral Ligament Injuries of the Elbow
Kaare S.MidtgaardM.D.abcPhilip-C.NolteM.A., M.D.adJon W.MilesM.Sc.aKira K.TangheB.S.aBrenton W.DouglassM.D.aLiam A.PeeblesB.A.aMatthew T.ProvencherM.D., M.B.A., CAPT, M.C., U.S.N.R. (Ret).ae
doi : 10.1016/j.arthro.2021.05.060
Volume 37, Issue 9, September 2021, Pages 2800-2806
Editorial Commentary: All-Suture Anchors Are Small, Easier to Revise, and Biomechanically Equivalent to Conventional Implants: They Are the Way of the Future
Ronald S.PaikM.D., Editorial Board
doi : 10.1016/j.arthro.2021.07.007
Volume 37, Issue 9, September 2021, Pages 2807-2808
All-suture anchors (ASAs) show biomechanical equivalence to conventional implants. The smaller size and easier ability to revise are important advantages of ASAs. A more vertical insertion angle increases ASA pullout strength. Proper depth of insertion is required to optimally seat ASAs on cortical bone. ASA pullout strength also results from compression of cancellous bone between the anchor and the cortex, and appropriately pretensioning the suture before loading is critical. A larger anchor (and a higher the number of sutures loaded per anchor) leads to a higher pullout strength of the anchor. Understanding the correct implantation technique is important to optimize the strength of ASAs.
Salvage Revision Hip Arthroscopy Including Remplissage Improves Patient-Reported Outcomes After Cam Over-Resection
Justin W.ArnerM.D.Joseph J.RuzbarskyM.D.RuiSoaresB.S.KarenBriggsM.P.H.Marc J.PhilipponM.D.
doi : 10.1016/j.arthro.2021.03.061
Volume 37, Issue 9, September 2021, Pages 2809-2816
Editorial Commentary: Hip Cam Overresection May Result in Inferior Outcomes: The Goldilocks Paradox of Too Little, Too Much, or Just Right?
Stephen A.HuntM.D., F.A.A.O.S., Editorial Board
doi : 10.1016/j.arthro.2021.06.010
Volume 37, Issue 9, September 2021, Pages 2817-2819
Femoroacetabular impingement is a recognized source of hip pain and cause of labral and articular cartilage injury. Persistent femoroacetabular impingement has been recognized as a source of inferior patient-reported outcomes, and attempts to define a “normal” ?-angle has resulted in more aggressive resection of cam lesions. An overzealous femoroplasty may result in iatrogenic hip instability. A dynamic intraoperative examination may be the best way to truly recognize this problem, in particular, by visualizing the loss of the suction seal, as the cam resection engages the acetabulum, resulting in subluxation. A soft tissue “remplissage” salvage procedure may offer an option to correct cam overresection and improve patient outcomes during revision arthroscopy, as we continue to search for the “right” amount of cam correction to perform.
Endoscopic Tenotomy for Iliopsoas Tendinopathy Following Total Hip Arthroplasty Can Relieve Pain Regardless of Acetabular Cup Overhang or Anteversion
Maria-RoxanaViamont-GuerraM.D.abSoniaRamos-PascualM.Eng., Ph.D.cMoSaffariniM.Eng., M.B.A., F.R.S.M.cNicolasBoninM.D.ab
doi : 10.1016/j.arthro.2021.03.043
Volume 37, Issue 9, September 2021, Pages 2820-2829
Editorial Commentary: Iliopsoas Tenotomy for Pain After Total Hip: A Great Operation IF the Diagnosis Is Right
AndrewBlackmanM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.05.001
Volume 37, Issue 9, September 2021, Pages 2830-2831
Iliopsoas tendon pain can be a frustrating condition for both patients and surgeons after total hip arthroplasty. It is difficult to diagnose definitively, as there is no imaging modality that offers reliable information and there are numerous causes of persistent groin pain in this patient population. The pain can ruin the results of an otherwise well-functioning total hip arthroplasty. Patients who respond best to arthroscopic iliopsoas tenotomy are those with isolated pain with hip flexion activities and reproducible pain with resisted hip flexion on examination or other provocative iliopsoas maneuvers. Patients with these symptoms in addition to more generalized pain findings (pain with weight-bearing, pain at night, pain with passive range of motion) tend not to respond as favorably to isolated iliopsoas tenotomy. In addition, optimal treatment for refractory cases has been controversial historically, as both acetabular component revision and iliopsoas tendon lengthening have been advocated. With the ever-increasing popularity of hip arthroscopy and recent clinical outcome reports, arthroscopic (or endoscopic) iliopsoas tenotomy has proven to be a very safe and effective treatment option for these patients, with one caveat: the diagnosis must be correct.
Pie-Crusting Capsulotomy Provides Similar Visualization With Increased Repair Stiffness Compared With a T-Capsulotomy: A Biomechanical Study
Frank B.WydraM.D.adIanAl’KhafajiM.D.adLeeHarunoM.D.bJorgeChahlaM.D., Ph.D.eTrevor J.NelsonB.S., M.S.cMichael B.GerhardtM.D.adMelodie F.MetzgerPh.D.bc
doi : 10.1016/j.arthro.2021.03.044
Volume 37, Issue 9, September 2021, Pages 2832-2837
Editorial Commentary: Thermal Pie-Crusting the Hip Capsule Improves Exposure: But Is it Safe?
DerekOchiaiM.D., Editorial Board
doi : 10.1016/j.arthro.2021.04.064
Volume 37, Issue 9, September 2021, Pages 2838-2839
Thermal pie-crusting of the capsule can increase hip arthroscopy surgical exposure in the peripheral compartment. Recent time-zero biomechanical research suggests that repairing the capsule after pie-crusting yields similar strength and increased stiffness when compared to a T-capsulotomy. However, the risks of thermal damage to the capsule should be weighed against the biomechanical advantages of repairing a pie-crusted capsule versus a T-capsulotomized capsule. In addition, if a surgeon wants to inject an intra-articular orthobiologic such as platelet-rich plasma (PRP), I would not recommend pie-crusting because the full-thickness slits in the capsule could allow the PRP to escape, even after capsular repair. I will still use traction sutures for 100% of my hip arthroscopy procedures. However, in the very rare setting when traction sutures alone yield inadequate exposure, I will perform pie-crusting instead of a T-capsulotomy.
Hip Arthroscopy With and Without A Perineal Post: A Comparison of Early Postoperative Pain
Andrew L.SchaverB.S.NolanMattinglyB.S.Natalie A.GlassPh.D.Michael C.WilleyM.D.Robert W.WestermannM.D.
doi : 10.1016/j.arthro.2021.03.045
Volume 37, Issue 9, September 2021, Pages 2840-2845
Editorial Commentary: Post-Free Arthroscopy Reduces Complications and Pain: To Post or Not to Post? Is That Still a Question?
RobertKollmorgenD.O., FAAOS, FAOBOS(Editorial Board)
doi : 10.1016/j.arthro.2021.05.007
Volume 37, Issue 9, September 2021, Pages 2846-2847
Post-free hip arthroscopy has garnered much attention over the past several years. The attraction of eliminating groin complications is at the forefront of this technique. Recent studies have shown improved blood flow, safe techniques, but other benefits, if any, are yet to be discovered. For now, those adopting post-free distraction do so to eliminate a source of groin complication, improved access to the cam, and a perceived decrease in pain. Several options exist to achieve post-free distraction, and, as we continue to perfect this technique, continued studies may reveal other advantages or disadvantages to post removal.
Revision Anterior Cruciate Ligament Reconstruction with the All-Soft Tissue Quadriceps Tendon Autograft Has Acceptable Early and Intermediate-Term Outcomes
Jennifer L.HunnicuttPh.D., A.T.C.aWilliam B.HaynesM.D.bHarris S.SloneM.D.cJanelle A.PrinceA.T.C.aStephanie A.BodenM.D.dJohn W.XerogeanesM.D.a
doi : 10.1016/j.arthro.2021.03.035
Volume 37, Issue 9, September 2021, Pages 2848-2857
Editorial Commentary: Revision Anterior Cruciate Ligament Using Soft Tissue Autograft Quadriceps Is Effective but Not Recommended for All Comers
Sarav S.ShahM.D., Editorial Board
doi : 10.1016/j.arthro.2021.05.011
Volume 37, Issue 9, September 2021, Pages 2858-2859
The average revision rate is between 3.2% and 11.1%following primary anterior cruciate ligament (ACL) reconstructions,1 and an objective failure rate of 13.7% has been reported for revision ACLR.2 Prior implants, positioning of tunnels, and muscle weakness from the prior reconstruction present challenges. Additionally, graft choice for the revision reconstruction is restricted, depending on the primary reconstruction. Revision ACL reconstruction with the all-soft tissue quadriceps tendon autograft is a viable option with 83.3% of the patients surpassing the minimally clinically significant difference for International Knee Documentation Committee (IKDC) scores, which is similar to outcomes for revision ACL reconstruction (ACLR) using bone-patella-bone and hamstring tendon autografts. Furthermore, objective strength data suggest that it is possible to achieve equal limb symmetry index strength ratios even in the setting of prior bone-patella tendon-bone autograft. However, although I am cautiously optimistic regarding soft tissue quadriceps autograft in revision ACLR, I would be hesitant to recommend it for all comers. In my experience, young high school/collegiate female athletes with primary reconstruction using BPTB autograft may not be able to tolerate a secondary insult to the extensor mechanism via quadriceps tendon (QT) autograft harvest, where hematoma and arthrofibrosis could be concerns. Furthermore, increased posterior tibial slope may require evaluation and treatment, and the addition of a lateral extra-articular tenodesis may reduce residual rotatory laxity in ACL revision patients.
Blood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstrings Muscles
Frank R.NoyesM.D.abcdSue D.Barber-WestinB.S.dLindseySipesA.T.C.d
doi : 10.1016/j.arthro.2021.03.040
Volume 37, Issue 9, September 2021, Pages 2860-2869
Editorial Commentary: Blood Flow Restriction Therapy Continues to Prove Effective
Robert F.LaPradeM.D., Ph.D.aJill K.MonsonP.T., O.C.SbJonSchoeneckerP.T., O.C.S., C.S.C.S.b
doi : 10.1016/j.arthro.2021.04.073
Volume 37, Issue 9, September 2021, Pages 2870-2872
Blood flow restriction (BFR) training continues to look promising to try and maintain muscle mass or to rebuild muscle mass and strength after injury or surgery. Because additional potential benefits include pain control, increased gene expression (leading to atrophy reduction), and muscle excitation, our use of the modality favors earlier over middle- or late-phase postoperative use. We initiate BFR therapy 2-14 days postoperatively, often with reduced cuff pressure in the first several sessions before increasing to the recommended therapeutic occlusion level. We have observed the greatest benefit for individuals who are non–weight-bearing for 6 to 8 weeks and who may have more postoperative restrictions due to the nature of the surgery. Compared with the opposite thigh, we have seen instances in which quadriceps girth has been preserved, although not increased, following the non–weight-bearing period. Ideally, we use 1 to 3 low-load resistance training exercises per session at least 2 times per week for 6 weeks. We also employ BFR following osteotomy or any procedure where bone drilling is used, as researchers have observed improved bone health. Additional benefits relevant to the early postoperative phase, such as effusion and pain reduction, have not been clearly established. Anecdotally, we have seen effusion levels temporarily increase during treatment but then resolve to baseline within 30 to 60 minutes of tourniquet deflation. Further high-level research is necessary to objectively validate BFR use and which patients may best benefit from it.
Motorized Shaver Harvest Results in Similar Cell Yield and Characteristics Compared With Rongeur Biopsy During Arthroscopic Synovium-Derived Mesenchymal Stem Cell Harvest
Dong IlShinM.S.abMijinKimPh.D.abDo YoungParkPh.D., M.D.acdByoung-HyunMinPh.D., M.D.abcHee-WoongYunPh.D.abJun YoungChungM.D.cKyung JunMinM.D.c
doi : 10.1016/j.arthro.2021.03.042
Volume 37, Issue 9, September 2021, Pages 2873-2882
Editorial Commentary: Point-of-Care Harvest and Application of Resident Stem Are Practical and Cost-Effective
AdamAnzM.D.
doi : 10.1016/j.arthro.2021.05.068
Volume 37, Issue 9, September 2021, Pages 2883-2884
Point-of-care harvest and application of residence stem cells are practical and cost-effective. Tissue formerly considered waste contains these biologically potent cells, and use of such tissue may represent a big part of biologics going forward. The practical application of orthobiologics has slowed because of 3 hurdles: the regulatory requirements of stem cell technologies; the energy, time, and money required to develop a clinical evidence base; and the expense that they present to patients and institutions. Orthobiologic technologies that are simple and cheap and that leverage tissues that are already readily available at the point of care (i.e., the surgical procedure) solve many of these challenges. Cell sources could include knee synovium, shoulder subacromial bursa, bone marrow aspirate, and anterior cruciate ligament injury effusion fluid and stump tissue. A current concern is that collagenase processing and culture expansion are steps resulting in regulatory hurdles in the United States.
Corticosteroid Injections 1 Month Before Arthroscopic Meniscectomy Increase the Risk of Surgical-Site Infection
BrianForsytheM.D.aEnrico M.ForlenzaM.D.aAvineshAgarwallaM.D.bMatthew R.CohnM.D.aOphelieLavoie-GagneM.D.aYiningLuM.D.aRandyMascarenhasM.D.c
doi : 10.1016/j.arthro.2021.02.047
Volume 37, Issue 9, September 2021, Pages 2885-2890.e2
Anatomical Triple Bundle Anterior Cruciate Ligament Reconstructions With Hamstring Tendon Autografts: Tunnel Locations and 2-Year Clinical Outcomes
RyoheiUchidaM.D., Ph.D.abKonseiShinoM.D., Ph.D.aRyoIuchiM.D., Ph.D.aYutaTachibanaM.D., Ph.D.aHiroyukiYokoiM.D., Ph.D.aShigetoNakagawaM.D., Ph.D.aTatsuoMaeM.D., Ph.D.c
doi : 10.1016/j.arthro.2021.03.070
Volume 37, Issue 9, September 2021, Pages 2891-2900
Editorial Commentary: Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Makes More Sense Than Triple-Bundle: Three’s a Crowd
Jonathan A.GodinM.D., M.B.A., Editorial Board
doi : 10.1016/j.arthro.2021.05.053
Volume 37, Issue 9, September 2021, Pages 2901-2902
Recent research reports impressive patient-reported and objective stability outcomes after triple-bundle anterior cruciate ligament (ACL) reconstruction with hamstring autograft. However, the results are similar to those reported in the orthopaedic literature for single-bundle ACL reconstruction. If the triple-bundle technique does not reduce graft failure rates, and bearing in mind that it is more complex, more expensive, and more difficult to revise, then an anatomically-positioned single-bundle ACL reconstruction makes more sense. If the data supporting double-bundle ACL reconstruction is inconclusive, then why add a third bundle?
The Graft Insertion Length in the Femoral Tunnel During Anterior Cruciate Ligament Reconstruction With Suspensory Fixation and Tibialis Anterior Allograft Does Not Affect Surgical Outcomes but Is Negatively Correlated With Tunnel Widening
Hyun-SooMoonM.D.abChong-HyukChoiM.D., Ph.D.acJe-HyunYooM.D., Ph.D.abMinJungM.D., Ph.D.acTae-HoLeeM.D.adKi-HongChoiM.D.cSung-HwanKimM.D., Ph.D.ad
doi : 10.1016/j.arthro.2021.03.072
Volume 37, Issue 9, September 2021, Pages 2903-2914.e1
Cartilage Status, Rather Than Chronologic Age, Determines the Outcomes of Open Wedge High Tibial Osteotomy: A Cartilage Status–Matched Cohort Study
Ju-HoSongM.D.aSeong-IlBinM.D., Ph.D.bJong-MinKimM.D., Ph.D.bBum-SikLeeM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.03.075
Volume 37, Issue 9, September 2021, Pages 2915-2922
Editorial Commentary: Chronological Age Is Not Associated With Adverse Postoperative Outcomes After High Tibial Osteotomy: Contradiction of Another Dogma From the Past
Hong-YeolYangM.D.Jong-KeunSeonM.D., Ph.D.
doi : 10.1016/j.arthro.2021.05.042
Volume 37, Issue 9, September 2021, Pages 2923-2924
Open wedge high tibial osteotomy (OWHTO) is an established treatment option for treating medial compartmental knee osteoarthritis with varus deformity. Among several factors associated with postoperative outcomes, patient age is immensely decisive in reconstructive knee joint surgeries, including OWHTO and total knee arthroplasty. Surprisingly, the direct effect of age on OWHTO outcomes is poorly defined in current clinical practice. Recent research comparing clinical and radiologic outcomes according to age was introduced, and the influential predictor determining OWHTO outcomes was cartilage status rather than age. In the future, when deciding its suitability, OWHTO should absolutely be considered as an attractive treatment even in elderly patients without highly advanced cartilage degeneration; advanced age should not be identified as a risk factor but rather a potential indication for OWHTO. However, a large-scale long-term follow-up study is necessary to elucidate these findings.
A Biomechanical Comparison of High-Tensile Strength Tape Versus High-Tensile Strength Suture for Tendon Fixation Under Cyclic Loading
Anthony H.LeM.S.aWilliam B.RoachM.D., C.P.T., U.S.A.bTimothy C.MauntelPh.D., A.T.C.acBrad D.HendershotPh.D.adMelvin D.HelgesonM.D., C.O.L., U.S.A.bcDonald F.ColantonioM.D., M.A.J., U.S.A.bDonald R.FredericksM.D., C.P.T., U.S.A.bSean E.SlavenM.D., C.P.T., U.S.A.bAlfred J.PisanoM.D., M.A.J., U.S.A.bLance E.LeClereM.D., C.D.R., U.S.N.e
doi : 10.1016/j.arthro.2021.04.016
Volume 37, Issue 9, September 2021, Pages 2925-2933
Editorial Commentary: Suture Type or Technique Has Little Influence on Outcome After Acute Lower-Extremity Tendon Rupture
F. AlanBarberM.D., F.A.C.S.(Editorial Board)
doi : 10.1016/j.arthro.2021.05.046
Volume 37, Issue 9, September 2021, Pages 2934-2936
Operative repair of Achilles tendon rupture significantly decreases the rerupture rate, regardless of type of surgical suture technique. Likewise, regarding repair of either the quadriceps or patellar tendon, surgical repair technique does not significantly influence the generally excellent outcomes achieved, whereas too-early mobilization should be avoided. In terms of the use of suture versus suture tape, load to failure is similar. Many factors impact tendon rupture repair success, including postoperative care, the quality of the tendon, underlying medical issues, and patient compliance, but suture type or technique has little influence on outcome after acute lower-extremity tendon rupture.
The Efficacy of Platelet-Rich Plasma for Improving Pain and Function in Lateral Epicondylitis: A Systematic Review and Meta-analysis with Risk-of-Bias Assessment
Xiao T.ChenB.A.aWilliamFangM.S.aIan A.JonesB.A.bNathanael D.HeckmannM.D.aCaronParkM.S.cC. ThomasVangsnessJr.M.D.a
doi : 10.1016/j.arthro.2021.04.061
Volume 37, Issue 9, September 2021, Pages 2937-2952
Over 30% of Systematic Reviews and Meta-analyses Focused on Rotator Cuff Tear Treatments Contained Spin in the Abstract
Arjun K.ReddyB.A.aSamuelShepardB.S.aRyanOttwellB.S.aJayThompsonD.O.bChristopher M.PriceD.O.aWadeArthurB.S.aChadHansonD.O.bAndrewEbertM.D.bDrew N.WrightM.L.S.cMicahHartwellPh.D.adMattVassarPh.D.ad
doi : 10.1016/j.arthro.2021.03.066
Volume 37, Issue 9, September 2021, Pages 2953-2959
Complications of Superior Capsule Reconstruction for the Treatment of Functionally Irreparable Rotator Cuff Tears: A Systematic Review
Micah C.SommerB.Sc.abEricWagnerM.D., M.Sc.cSophieZhuM.D.abSheilaMcRaeM.Sc., Ph.D.abPeter B.MacDonaldM.D., F.R.C.S.C.abDanOgbornP.T., Ph.D.aJarret M.WoodmassM.D., F.R.C.S.C.ab
doi : 10.1016/j.arthro.2021.03.076
Volume 37, Issue 9, September 2021, Pages 2960-2972
The purpose of this systematic review is to characterize the complications associated with superior capsule reconstruction (SCR) for the treatment of functionally irreparable rotator cuff tears (FIRCTs).
Editorial Commentary: Superior Capsular Reconstruction: Indications and Proper Technique Results in Good Outcomes but Reports of Complications
MoinKhanM.D., M.Sc., F.R.C.S.C.
doi : 10.1016/j.arthro.2021.05.047
Volume 37, Issue 9, September 2021, Pages 2973-2974
Superior capsular reconstruction is a minimally invasive option to treat massive irreparable rotator cuff tears. In the appropriately selected patient, available data suggest that while the procedure generally results in improved function, there is a not insignificant risk of complications. Moreover, the rate of complications is likely underestimated given that outcomes are typically published by those with significant technical expertise. The literature supports improved outcomes in patients without significant degenerative change (less than Hamada 3) along with an intact or repairable subscapularis. Graft failure is the most common complication, and appropriate graft selection (ideally at least 4 mm thick) and careful preparation are essential. Additionally, surgeons could consider 3 anchors on the glenoid to provide secure fixation and a double-row transosseous equivalent construct on the humerus. To prevent suture pullout or excessive tension on the graft, it is important to maintain a sufficient border of graft and measure the graft in 30° of forward elevation and 30° of abduction. Additional fixation with posterior side-to-side repair of the graft to the infraspinatus has been reported to improve biomechanical properties of the construct. Existing research is skewed toward low-level evidence at high risk of bias and the reported results of high-volume surgeons. High-quality pragmatic trials are required to truly understand the optimal indications and real-world outcomes of the superior capsular reconstruction.
Capsular Repair May Improve Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement: A Systematic Review of Comparative Outcome Studies
Jade S.OwensB.S.aAndrew E.JimenezM.D.aJacobShapiraM.D.aBenjamin R.SaksM.D.aRachel M.GleinB.S.aDavid R.MaldonadoM.D.aHari K.AnkemM.D.aPayam W.SabetianM.D.aAjay C.LallM.D., M.S.abcBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.03.063
Volume 37, Issue 9, September 2021, Pages 2975-2990
Nearly One-Third of Published Systematic Reviews and Meta-analyses Yield Inconclusive Conclusions: A Systematic Review
Joshua D.HarrisM.D.aMark P.CoteP.T., D.P.T., M.S.C.T.R.bAmanDhawanM.D.cErikHohmannM.D., M.B.B.S., F.R.C.S., Ph.D.dJefferson C.BrandM.D.e
doi : 10.1016/j.arthro.2021.03.073
Volume 37, Issue 9, September 2021, Pages 2991-2998
To perform a systematic review that determines the percentage of published orthopedic surgery and sports medicine systematic reviews and meta-analyses that have a conclusive conclusion.
