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The Critical Reader—Numerators and Denominators
James L. Carey, MD, MPH
doi : 10.1177/03635465211047196
Volume: 49 issue: 12, page(s): 3170-3172
Bridging Allograft Reconstruction Is Superior to Maximal Repair for the Treatment of Chronic, Massive Rotator Cuff Tears: Results of a Prospective, Randomized Controlled Trial
Ivan Wong, MD, MACM, Dip Sports Med*, †, Sara Sparavalo, MASc†, John-Paul King, MD†, Catherine M. Coady, MD†
doi : 10.1177/03635465211039846
Volume: 49 issue: 12, page(s): 3173-3183
Despite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction.
Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis
Joy C. MacDermid, PhD*, Dianne Bryant, PhD, Richard Holtby, MB, BS, FRCSC, Helen Razmjou, PhD, Kenneth Faber, MD, MHPE, FRCSC, JOINTS Canada, Robert Balyk, MD, FRCSC, Richard Boorman, MD, FRCSC, David Sheps, MD, MSc, MBA, FRCSC, Robert McCormack, MD, FRCSC, George Athwal, MD, FRCSC, Robert Hollinshead, MD, FRCSC, Ian Lo, MD, FRCSC, Ryan Bicknell, MD, MSc, FRCSC, Nicholas Mohtadi, MD, MSc, FRCSC, Martin Bouliane, MD, FRCSC, Donald Glasgow, MD, FRCSC, Marie-Eve Lebel, MD, FRCSC, Aleem Lalani, MD, FRCSC, Farhad O. Moola, MD, FRCSC, Robert Litchfield, MD, FRCSC, Jaydeep Moro, MD, FRCSC, Peter MacDonald, MD, FRCSC, J.W. Bergman, MD, FRCSC, Jeff Bury, MD, FRCSC, Darren Drosdowech, MD, FRCSC
doi : 10.1177/03635465211038233
Volume: 49 issue: 12, page(s): 3184-3195
Patients with complete rotator cuff tears who fail a course of nonoperative therapy can benefit from surgical repair.
Clinical and Structural Results of Rotator Cuff Repair Compared With Rotator Cuff Debridement in Arthroscopic Treatment of Calcifying Tendinitis of the Shoulder
Olaf Lorbach, MD, PhD*, †, ‡, Alexander Haupert, MD‡, Catharina Berger, MD‡, Matthias Brockmeyer, MD‡
doi : 10.1177/03635465211037690
Volume: 49 issue: 12, page(s): 3196-3201
Arthroscopic treatment of calcifying tendinitis of the shoulder reveals good to excellent results. However, whether the tendon needs to be repaired after removal of the calcific deposit or simply debrided remains unclear.
Transtendon Suture Bridge Repair of Both-Sided Partial-Thickness Rotator Cuff Tears: Midterm Outcomes
Dongwhan Suh, MD*, Sang-Eun Park, MD, PhD*, Young-Hun Han, MD*, Eung-Sic Kim, MD*, Jong-Hun Ji, MD, PhD*†
doi : 10.1177/03635465211034503
Volume: 49 issue: 12, page(s): 3202-3211
Among symptomatic partial-thickness rotator cuff tears (PTRCT) indicated for surgery, both-sided (concurrent articular and bursal side) PTRCT are rarely reported and discussed in the literature. Without clinical data on and definite guidelines for treating these rare partial tears, appropriate management cannot be expected.
A “Comma Sign”–Directed Subscapularis Repair in Anterosuperior Rotator Cuff Tears Yields Biomechanical Advantages in a Cadaveric Model
Michael Hackl, MD*, †, ‡, Eduard Buess, MD§, Sandra Kammerlohr†, ‡, Julia Nacov†, ‡, Manfred Staat, PhD?, Tim Leschinger, MD†, ‡, Lars P. Müller, MD†, ‡, Kilian Wegmann, MD†, ‡
doi : 10.1177/03635465211031506
Volume: 49 issue: 12, page(s): 3212-3217
Additional stabilization of the “comma sign” in anterosuperior rotator cuff repair has been proposed to provide biomechanical benefits regarding stability of the repair.
Coracoid or Clavicle Fractures Associated With Coracoclavicular Ligament Reconstruction
Nicholas M. Panarello, MD*, Donald F. Colantonio, MD*, Colin J. Harrington, MD*, Scott M. Feeley, MD*, Tahler D. Bandarra, MD*, Jonathan F. Dickens, MD*, Kelly G. Kilcoyne, MD*†
doi : 10.1177/03635465211036713
Volume: 49 issue: 12, page(s): 3218-3225
Coracoclavicular (CC) ligament reconstruction is a commonly performed procedure for high-grade acromioclavicular (AC) joint separations. Although distal clavicle and coracoid process fractures represent potential complications, they have been described in only case reports and small case series.
Radial Head Lag: A Possible Biomechanical Mechanism for Osteochondritis Dissecans of the Capitellum in Baseball Pitchers
Dani Rotman, MD*, †, Jae-Man Kwak, MD*, Jorge Rojas Lievano, MD*, Alexander Hooke, MA‡, Christopher L. Camp, MD*, James S. Fitzsimmons, BSc*, Shawn W. O’Driscoll, PhD, MD*§
doi : 10.1177/03635465211033971
Volume: 49 issue: 12, page(s): 3226-3233
Osteochondritis dissecans (OCD) of the capitellum is common in throwing athletes and is believed to result from repetitive overloading on the radiocapitellar (RC) joint, although the cause and mechanism remain unclear. The torsional forces (moments) generated by the triceps during elbow extension pull only on the ulna; therefore, the radial head moves passively across the capitellum and is effectively “dragged along” by the ulna. Any laxity in the proximal radioulnar joint could lead to asynchronous motion between the radius and ulna, resulting in the radial head lagging behind the coronoid and possibly malarticulating with the capitellum during such motion.
Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature
Stylianos Kapetanakis, MD, PhD*, †, ‡, Nikolaos Gkantsinikoudis, MD†, Georgios Charitoudis, PhD†
doi : 10.1177/03635465211032612
Volume: 49 issue: 12, page(s): 3234-3241
Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients.
Patient-Reported Outcome Scores and Rate of Return to Sport After Hip Arthroscopic Surgery: A Sex-Based Comparison in Professional and Collegiate Athletes
Rachel M. Glein, BS*, Andrew E. Jimenez, MD*, Kara B. Miecznikowski, BS*, Benjamin R. Saks, MD*, †, Hari K. Ankem, MD*, Payam W. Sabetian, MD*, David R. Maldonado, MD*, Ajay C. Lall, MD, MS*, †, ‡, Benjamin G. Domb, MD*, †, ‡§
doi : 10.1177/03635465211039834
Volume: 49 issue: 12, page(s): 3242-3249
No studies have compared outcomes and return to sport (RTS) after hip arthroscopic surgery between matched groups of male and female athletes with a minimum 2-year follow-up.
The Natural Course of Recovery After Hip Arthroscopy for Femoroacetabular Impingement According to the International Hip Outcome Tool–12 and Hip Outcome Score Sports Subscale
Blake M. Bodendorfer, MD*, Ian M. Clapp, MD, MS*†, Steven F. DeFroda, MD, MEng*, Philip Malloy, PT, PhD‡, Thomas D. Alter, MS*, Kevin C. Parvaresh, MD*, Jorge Chahla, MD, PhD*, Shane J. Nho, MD, MS*
doi : 10.1177/03635465211034511
Volume: 49 issue: 12, page(s): 3250-3260
A paucity of literature exists regarding trajectories of functional and sports-specific recovery after hip arthroscopy for femoroacetabular impingement syndrome (FAIS).
Return to Sports and Minimum 2-Year Outcomes of Primary Arthroscopic Hip Labral Reconstruction for Irreparable Tears in High-Level Athletes With a Propensity-Matched Benchmarking Against a Labral Repair Control Group
Andrew E. Jimenez, MD*, Peter F. Monahan, BS*, Jade S. Owens, BS*, David R. Maldonado, MD†, Benjamin R. Saks, MD*, ‡, Hari K. Ankem, MD*, Payam W. Sabetian, MD*, Ajay C. Lall, MD, MS*, †, ‡, Benjamin G. Domb, MD*, ‡, §?
doi : 10.1177/03635465211032593
Volume: 49 issue: 12, page(s): 3261-3269
Labral reconstruction has shown promise for the treatment of irreparable labral tears in high-level athletes. The literature is scarce regarding outcomes and timing of return to sports (RTS) in these patients.
Morphological Changes in the Residual Meniscus After Reshaping Surgery for a Discoid Lateral Meniscus
Kazuya Nishino, MD*, Yusuke Hashimoto, MD, PhD*†, Syuko Tsumoto, MD*, Shinya Yamasaki, MD, PhD‡, Hiroaki Nakamura, MD, PhD*
doi : 10.1177/03635465211033586
Volume: 49 issue: 12, page(s): 3270-3278
Arthroscopic reshaping surgery is the first treatment option for a symptomatic discoid lateral meniscus (DLM) to preserve the peripheral rim. However, the degree of postoperative morphological change in the residual meniscus is unclear.
Biomechanical Analysis of Segmental Medial Meniscal Transplantation in a Human Cadaveric Model
Daniel B. Haber, MD*, †, Brenton W. Douglass, BA†, Justin W. Arner, MD*, †, Jon W. Miles, MS†, Liam A. Peebles, BA†, Grant J. Dornan, MSc†, Armando F. Vidal, MD*, †, CAPT Matthew T. Provencher, MD, MBA, MC, USNR (Ret)*, †‡
doi : 10.1177/03635465211036441
Volume: 49 issue: 12, page(s): 3279-3286
Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation.
Platelet-Rich Plasma Augmentation of Meniscal Repair in the Setting of Anterior Cruciate Ligament Reconstruction
Lane Bailey, PhD, PT*, †, Matthew Weldon, MD‡, Jacquelyn Kleihege, PT, MPT†, Kyle Lauck, BS‡, Mohammad Syed, BS‡, Randy Mascarenhas, MD§, Walter R. Lowe, MD†, ‡
doi : 10.1177/03635465211036471
Volume: 49 issue: 12, page(s): 3287-3292
The increasing incidence of anterior cruciate ligament (ACL) and meniscal injuries has led to strong interest in discovering new methods to enhance the biological healing response of these tissues. Platelet-rich plasma (PRP) contains various growth factors associated with a positive healing response, but few existing clinical studies are available to determine the risks and benefits of these therapies.
Kinematic Alterations After Anterior Cruciate Ligament Reconstruction via Transtibial Techniques With Medial Meniscal Repair Versus Partial Medial Meniscectomy
Ming Wang, PhD*, †, Zefeng Lin, PhD‡, §, Wanshun Wang, MD‡, §, Lingling Chen, MD‡, §, Hong Xia, PhD‡, §, Yu Zhang, PhD*?, Wenhan Huang, PhD*?
doi : 10.1177/03635465211033982
Volume: 49 issue: 12, page(s): 3293-3301
The treatment strategies for meniscal injuries during anterior cruciate ligament (ACL) reconstruction remain a topic of debate.
Association Between Meniscal Allograft Tears and Early Surgical Meniscal Allograft Failure
Philipp W. Winkler, MD*, †, Nyaluma N. Wagala, MD*, Jonathan D. Hughes, MD*, James J. Irrgang, PT, PhD*, ‡, Freddie H. Fu, MD*, Volker Musahl, MD*§
doi : 10.1177/03635465211032970
Volume: 49 issue: 12, page(s): 3302-3311
Meniscal allograft transplantation (MAT) has become a viable treatment option for patients with symptomatic meniscal deficiency. Some patients experience early surgical meniscal allograft failure attributed to causes that have not yet been sufficiently clarified.
Familial Risk and Its Interaction With Body Mass Index and Physical Activity in Anterior Cruciate Ligament Injury Among First-Degree Relatives: A Population-Based Cohort Study
Hyeong Sik Ahn, MD, PhD*, Dae-Hee Lee, MD, PhD†, Sayada Zartasha Kazmi, MD*, Taeuk Kang, MPH, PhD‡, Young Sung Lee, MD, PhD§, Ryunsu Sung, BA*, Jaewoo Cha, MPH?, Yoon Jung Choi, BA*, Gahwi Hong, BS*, Hoo Jae Hann, MD, PhD¶#, Hyun Jung Kim, MPH, PhD*#
doi : 10.1177/03635465211032643
Volume: 49 issue: 12, page(s): 3312-3321
Genetic and behavioral risk factors have been suggested to play a role in anterior cruciate ligament (ACL) injury. However, population-based familial risk estimates are unavailable.
Effects of Pubertal Maturation on ACL Forces During a Landing Task in Females
Azadeh Nasseri, PhD*, †, ‡, David G. Lloyd, PhD†, ‡, Clare Minahan, PhD†, Timothy A. Sayer, PhD§, Kade Paterson, PhD§, Christopher J. Vertullo, MBBS, PhD?, Adam L. Bryant, PhD§, David J. Saxby, PhD†, ‡
doi : 10.1177/03635465211038332
Volume: 49 issue: 12, page(s): 3322-3334
Rates of anterior cruciate ligament (ACL) rupture in young people have increased by >70% over the past two decades. Adolescent and young adult females are at higher risk of ACL injury as compared with their prepubertal counterparts.
Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability
Jong-Min Kim, MD, PhD*, Jae-Ang Sim, MD, PhD†, HongYeol Yang, MD‡, Young-Mo Kim, MD, PhD§, Joon-Ho Wang, MD, PhD?, Jong-Keun Seon, MD, PhD‡¶
doi : 10.1177/03635465211037716
Volume: 49 issue: 12, page(s): 3335-3343
No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability.
Dysplastic Patellofemoral Joints Lead to a Shift in Contact Forces: A 3D-Printed Cadaveric Model
Robert C. Spang, MD*, Amirhossein Jahandar, MSc*, Kathleen N. Meyers, MSc*, Joseph T. Nguyen, MPH*, Suzanne A. Maher, PhD*, Sabrina M. Strickland, MD*†
doi : 10.1177/03635465211031427
Volume: 49 issue: 12, page(s): 3344-3349
The distribution of contact forces across the dysplastic patellofemoral joint has not been adequately quantified because models cannot easily mimic the dysplasia of both the trochlea and the patella. Thus, the mechanical consequences of surgical treatments to correct dysplasia cannot be established.
Detection of Lateral Hinge Fractures After Medial Closing Wedge Distal Femoral Osteotomy: Computed Tomography Versus Plain Radiography
Kyung Wook Nha, MD, PhD*, Kun Woo Kim, MD*, Ji Hoon Bae, MD, PhD†, Ki-Mo Jang, MD, PhD‡, Sang-Gyun Kim, MD§?
doi : 10.1177/03635465211031434
Volume: 49 issue: 12, page(s): 3350-3356
Limited evidence exists in the literature regarding the detection rates of lateral hinge fracture (LHF) on computed tomography (CT) after medial closing wedge distal femoral osteotomy (MCDFO). Moreover, the effect of LHF on bone healing after MCDFO remains unclear.
Early-Stage Primary Anti-inflammatory Therapy Enhances the Regenerative Efficacy of Platelet-Rich Plasma in a Rabbit Achilles Tendinopathy Model
Dengfeng Ruan, MD, Yang Fei, MD, Shengjun Qian, MD, Zizhan Huang, MD, Weishan Chen, MD, Chenqi Tang, MD, Xinyu Xiang, BS, Jialu Xu, Zi Yin, PhD, Xiao Chen, PhD, Boon Chin Heng, Wanlu Liu, PhD, Weiliang Shen, MD*, Hongwei Ouyang, MD, PhD*
doi : 10.1177/03635465211037354
Volume: 49 issue: 12, page(s): 3357-3371
Tendinopathy is a pervasive clinical problem that afflicts both athletes and the general public. Although the inflammatory changes in tendinopathy are well characterized, how the therapeutic effects of platelet-rich plasma (PRP) on tendinopathy are being modulated by the inflammatory environment is not well defined.
State-Level Implementation of Health and Safety Policies to Prevent Sudden Death and Catastrophic Injuries Within High Schools: An Update
Samantha E. Scarneo-Miller, PhD, ATC*, †, Christianne M. Eason, PhD, ATC‡, William M. Adams, PhD, ATC§, ?, Rebecca L. Stearns, PhD, ATC‡, Douglas J. Casa, PhD, ATC‡
doi : 10.1177/03635465211031849
Volume: 49 issue: 12, page(s): 3372-3378
Mandated sports safety policies that incorporate evidence-based best practices have been shown to mitigate the risk of mortality and morbidity in sports. In 2017, a review of the state-level implementation of health and safety policies within high schools was released.
Prevalence and Burden of Self-Reported Health Problems in Junior Male Elite Ice Hockey Players: A 44-Week Prospective Cohort Study
Anine Nordstrøm, MD*, †, ‡, Roald Bahr, MD, PhD†, Ben Clarsen, PT, PhD‡, §, Ove Talsnes, MD, PhD‡, ?
doi : 10.1177/03635465211032979
Volume: 49 issue: 12, page(s): 3379-3385
Little is known about the burden of overuse injuries and illnesses in junior elite ice hockey.
Association of Pitch Timing and Throwing Arm Kinetics in High School and Professional Pitchers
Joseph E. Manzi, BS*, Brittany Dowling, MS†, Zhaorui Wang, BS*, Kyle N. Kunze, MD‡, Jennifer Estrada, BS‡, Michael C. Fu, MD‡, Kathryn L. McElheny, MD‡, James B. Carr, II, MD§, Joshua S. Dines, MD‡?
doi : 10.1177/03635465211031853
Volume: 49 issue: 12, page(s): 3386-3394
Understanding the relationship between the temporal phases of the baseball pitch and subsequent joint loading may improve our understanding of optimal pitching mechanics and contribute to injury prevention in baseball pitchers.
Early Failure of a Polyvinyl Alcohol Hydrogel Implant With Osteolysis and Foreign Body Reactions in an Ovine Model of Cartilage Repair
Marta Cercone, DVM, PhD*, Jacqueline Chevalier, MSc*, John G. Kennedy, MD†, Andrew D. Miller, DVM‡, Lisa A. Fortier, DVM, PhD*§
doi : 10.1177/03635465211033601
Volume: 49 issue: 12, page(s): 3395-3403
Hemiarthroplasty using a polyvinyl alcohol (PVA) hydrogel synthetic implant has been suggested as a good alternative to arthrodesis for the treatment of hallux rigidus. However, failure rates as high as 20% have been recorded.
Colony Forming Potential and Protein Composition of Commercial Umbilical Cord Allograft Products in Comparison With Autologous Orthobiologics
Dustin R. Berger, MSc*, Christopher J. Centeno, MD*, †, John D. Kisiday, PhD‡, C. Wayne McIlwraith, BVSc, PhD, DSc‡, §, Neven J. Steinmetz, PhD*?
doi : 10.1177/03635465211031275
Volume: 49 issue: 12, page(s): 3404-3413
Umbilical cord (UC) connective tissues contain plastic-adherent, colony forming unit–fibroblasts (CFU-Fs) amenable to culture expansion for potential therapeutic use. Recently, UC-derived allograft products have been made available to practitioners in orthopaedics and other specialties, by companies purporting “stem cell”–based healing. However, such marketing claims conflict with existing regulations for these human tissues, generating questions over the cellular and protein composition of current commercially available UC allograft products.
Food and Drug Administration’s Position on Commonly Injected Biologic Materials in Orthopaedic Surgery
William H. Fang, MS, C. Thomas Vangsness, Jr, MD‡
doi : 10.1177/0363546521990900
Volume: 49 issue: 12, page(s): 3414-3421
The use of biologically based therapies is becoming a popular less-invasive therapy for relieving pain and promoting tissue regeneration. The most commonly used biologics are autologous adipose-derived products, bone marrow aspirations, and platelet-rich plasma (PRP). Birth tissue is a common allogenic source of biologics, including umbilical cord, placental membranes, and amniotic fluid. Injected biologics, depending on the indication and how they are processed, formulated, delivered, and promoted, can be subject to different regulatory pathways. The aim of this review is to provide an overview of these products and procedures and educate the musculoskeletal community about the relevant current Food and Drug Administration (FDA) regulations.
Return to Play and Fracture Union After the Surgical Management of Jones Fractures in Athletes: A Systematic Review and Meta-analysis
Ahmed Khalil Attia, MD*, †, Tarek Taha, MD‡, Geraldine Kong, MD†, Abduljabbar Alhammoud, MD†, Karim Mahmoud, MD§, Mark Myerson, MD?
doi : 10.1177/0363546521990020
Volume: 49 issue: 12, page(s): 3422-3436
Proximal fifth metatarsal fractures are among the most common forefoot injuries in athletes. The management of this injury can be challenging because of delayed union and refractures. Intramedullary (IM) screw fixation rather than nonoperative management has been recommended in the athletic population.
The Statistical Fragility of Platelet-Rich Plasma in Rotator Cuff Surgery: A Systematic Review and Meta-analysis
Robert L. Parisien, MD*, †, Cooper Ehlers, BA‡, Antonio Cusano, MD§, Paul Tornetta, III, MD?, Xinning Li, MD?, Dean Wang, MD¶
doi : 10.1177/0363546521989976
Volume: 49 issue: 12, page(s): 3437-3442
The practice of evidence-based medicine relies on objective data to guide clinical decision-making with specific statistical thresholds conveying study significance.
Incidence of Intraoperative and Postoperative Complications After Posterolateral Corner Reconstruction or Repair: A Systematic Review of the Current Literature
Bhargavi Maheshwer, BS*, Justin Drager, MD†, Nalin S. John, BS‡, Brady T. Williams, MD§, Robert F. LaPrade, MD, PhD?, Jorge Chahla, MD, PhD¶#
doi : 10.1177/0363546520981697
Volume: 49 issue: 12, page(s): 3443-3452
Posterolateral corner (PLC) injuries of the knee are being increasingly recognized and treated in current orthopaedic practice. While there are numerous systematic reviews evaluating the management and outcomes after PLC injuries, there are limited data investigating complications after PLC reconstruction or repair.
Kenneth E. DeHaven, MD (1939-2021)
Michael D. Maloney, MD
doi : 10.1177/03635465211049177
Volume: 49 issue: 12, page(s): 3454-3455
Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation: Letter to the Editor
Kaywan Izadpanah, MD, Prof., Matthias Feucht, MD, Prof., Moritz Mayr, MD, Sebastian Ferdinand Bendak
doi : 10.1177/03635465211040067
Volume: 49 issue: 12, page(s): NP59-NP60
Radiographic Methods Are as Accurate as Magnetic Resonance Imaging for Graft Sizing Before Lateral Meniscal Transplantation: Response
Luiz Felipe Ambra, MD, PhD, Camila Cohen Kaleka, MD, Pedro Debieux, MD, PhD, Julio Cesar Almeida, MD, Nehal Shah, MD, Moises Cohen, MD, PhD, Andreas H. Gomoll, MD
doi : 10.1177/03635465211037939
Volume: 49 issue: 12, page(s): NP60-NP61
Erratum to “Age Is More Predictive of Safe Movement Patterns Than Are Physical Activity or Sports Specialization: A Prospective Motion Analysis Study of Young Athletes”
doi : 10.1177/03635465211047896
Volume: 49 issue: 12, page(s): NP62-NP62
