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Table of Contents
doi : 10.1016/S0749-8063(21)00782-9
Volume 37, Issue 10, October 2021, Pages A9-A10, A12, A14
Cover Image & Video Link
doi : 10.1016/S0749-8063(21)00783-0
Volume 37, Issue 10, October 2021, Page A14
Instructions for Authors
doi : 10.1016/S0749-8063(21)00788-X
Volume 37, Issue 10, October 2021, Page A35
AANA21: Reflections on the Combined AOSSM–AANA 2021 Annual Meeting
James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.08.004
Volume 37, Issue 10, October 2021, Pages 3001-3002
At the American Orthopaedic Society for Sports Medicine (AOSSM)–Arthroscopy Association of North America (AANA) 2021 Annual Meeting in Nashville, Tennessee, collaboration was the word of the day. AAOSM and AANA are a great pair, and many of us are long-time members of both associations. The attendance was unprecedented. Face-to-face meetings facilitate great spontaneity, profound exchange, nuanced communication, personal sharing, and efficient and passionate occurrence of new ideas. President Mark Getelman will host next year’s AANA Annual Meeting, AANA22, in another fantastic American city with which AANA is very familiar, San Francisco, California. The meeting will be held May 19-21, 2022, and we look forward to seeing many of you in the City by the Bay. It will be AANA’s 40th Annual Meeting, and naturally, your editors are planning to attend.
Proficiency-Based Progression Surgical Training: Preparation for Finishing School
Richard L.AngeloM.D., Ph.D.Anthony G.GallagherPh.D., D.Sc.
doi : 10.1016/j.arthro.2021.07.017
Volume 37, Issue 10, October 2021, Page 3003
Building Our Home: Lessons Learned Along the Way
Brian J.ColeM.D., M.B.A
doi : 10.1016/j.arthro.2021.08.006
Volume 37, Issue 10, October 2021, Pages 3004-3009
The Handshake or the Fist
Richard K.N.RyuM.D.
doi : 10.1016/j.arthro.2021.08.005
Volume 37, Issue 10, October 2021, Pages 3010-3012
Restoration of Labral Function in Primary Hip Arthroscopy From Labral Repair to Labral Reconstruction
David R.MaldonadoM.D.dPeter F.MonahanB.S.aBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.08.003
Volume 37, Issue 10, October 2021, Pages 3013-3015
The function and importance of the labrum in hip biomechanics has been established. A labral tear is the most common pathology in patients undergoing hip arthroscopy, and adequate management is critical for favorable outcomes. Although labral debridement was initially performed for arthroscopic labral tear management, there has been a shift toward labral restoration techniques. Currently, restoration with labral repair remains the gold standard for labral tear treatment, particularly in the primary setting. When compared to labral debridement, the literature has shown that labral repair has more favorable outcomes.
Increased Load to Failure in Biceps Tenodesis With All-Suture Suture Anchor Compared With Interference Screw: A Cadaveric Biomechanical Study
Dallas M.SmuinM.D.EmilyVannattaB.S.BrittanyAmmermanB.A., M.B.S.Christopher M.StauchB.S.Gregory S.LewisPh.D.AmanDhawanM.D.
doi : 10.1016/j.arthro.2021.03.085
Volume 37, Issue 10, October 2021, Pages 3016-3021
Editorial Commentary: What Is More Important: Strength or Displacement? Findings of All-Suture Anchor Versus Interference Screw for Biceps Tenodesis
CAPTMatthew T.ProvencherM.D., M.C., U.S.N.R. (Ret.), Editorial BoardAnnalise M.PeeblesB.A.a
doi : 10.1016/j.arthro.2021.06.009
Volume 37, Issue 10, October 2021, Pages 3022-3024
Tendinopathy of the long head of the biceps tendon (LHB) encompasses a range of pathology, including inflammatory tendinitis to degenerative tendinosis that can lead to pain, as well as instability of the LHB and its surrounding stabilizers. Accordingly, tenodesis of the LHB during shoulder surgery has been increasingly cited in the literature as a viable surgical option for the treatment of LHB pathology. While current treatment options include the use of multiple devices for tenodesis of the LHB, there remains a paucity of literature that investigates the biomechanical advantages of all-suture anchor devices compared to interference screws.
Mid-Term Outcomes of Arthroscopically-Assisted Anatomic Coracoclavicular Ligament Reconstruction Using Tendon Allograft for High-Grade Acromioclavicular Joint Dislocations
Philip C.NolteM.D., M.A.acJoseph J.RuzbarskyM.D.bBryant P.ElrickM.Sc.aThomasWoolsonB.S.aKaare S.MidtgaardM.D.adePeter J.MillettM.D., M.Sc.ab
doi : 10.1016/j.arthro.2021.04.035
Volume 37, Issue 10, October 2021, Pages 3025-3035
Editorial Commentary: Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction Leads to Improved Patient-Reported Outcomes, But Patient Satisfaction Is a Harder Threshold to PASS
Nicholas A.TrasoliniM.D.aBrian R.WatermanM.D.(Associate Editor)b
doi : 10.1016/j.arthro.2021.06.008
Volume 37, Issue 10, October 2021, Pages 3036-3038
There are numerous described techniques for surgical management of high-grade acromioclavicular (AC) joint injuries, and the associated clinical outcomes can be quite variable. Contemporary techniques are typically directed at anatomic reconstruction of the coracoclavicular (CC) ligaments through either an arthroscopy-assisted or an open approach. Most patients treated with acute surgery improve, whereas in chronic cases, the majority improve, but a significant number have persistent recurrent deformity due to loss of anatomic reduction. In addition, whether acute or chronic, over one quarter of patients do not have a PASS (patient acceptable symptomatic state). Of interest, PASS may not primarily be related to the final deformity in terms of coracoclavicular distance, and investigation is still required in terms of the effect of anteroposterior or rotational instability of the AC joint after injury and surgery. Finally, PASS values for AC separation are not well established, resulting in a current limitation of the strength of applying threshold values to this pathology.
Diagnostic Ultrasound Shows Reversal of Supraspinatus Muscle Atrophy Following Arthroscopic Rotator Cuff Repair
AlejandroPagán-ConesaM.D.aMaría TíscarGarcía-OrtizM.D.aEmilio JoséSalmerón-MartínezM.D., Ph.D.bAlejandroMoya-MartínezcFernandoLópez-PratsM.D., Ph.D.ad
doi : 10.1016/j.arthro.2021.04.039
Volume 37, Issue 10, October 2021, Pages 3039-3048
Editorial Commentary: Monitoring Tendon and Muscle Recovery After Rotator Cuff Repair Using Diagnostic Ultrasound Demonstrates that Early Repair is Beneficial for Many Patients With Reparable Tears
Samer S.HasanM.D., Ph.D., Editorial Board
doi : 10.1016/j.arthro.2021.07.006
Volume 37, Issue 10, October 2021, Pages 3049-3052
Rotator cuff repair is performed to effect healing of the enthesis; to restore shoulder comfort, strength, and function; to prevent tear propagation; and to prevent progression of atrophic muscle changes (fatty degeneration, fatty infiltration, and fatty atrophy) that eventually occur. Non-retracted and moderately retracted rotator cuff tears usually heal after repair, and muscle atrophy may recover over time. It follows that early rotator cuff repair is beneficial for many patients with chronic but reparable rotator cuff tears. Diagnostic ultrasound can provide quantitative information about the recovery of both muscle and tendon and represents a viable alternative to magnetic resonance imaging for evaluating healing after rotator cuff repair.
Triple-Row Technique Confers a Lower Retear Rate Than Standard Suture Bridge Technique in Arthroscopic Rotator Cuff Repairs
MakotoTanakaM.D., Ph.D.aHirotoHanaiM.D.cYukiKotaniM.D.cKosukeKurataniM.D.dKotaKoizumiM.D., Ph.D.eKenjiHayashidaM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.04.045
Volume 37, Issue 10, October 2021, Pages 3053-3061
Preoperative Magnetic Resonance Imaging Accurately Detects the Arthroscopic Comma Sign in Subscapularis Tears
AngelaAtingaM.D., F.R.C.RabTimDwyerM.B.B.S., F.R.A.C.S., F.R.C.S.C., Ph.D.cdJohn S.TheodoropoulosM.D. F.R.C.P.C.cdKatrinaDekirmendjianB.S. (P.A.)dAli M.NaraghiM.D., F.R.C.R.abLawrence M.WhiteM.D., F.R.C.P.C.ab
doi : 10.1016/j.arthro.2021.04.040
Volume 37, Issue 10, October 2021, Pages 3062-3069
Editorial Commentary: Magnetic Resonance Imaging Identifies the Comma Sign Seen During Arthroscopy for Subscapularis Tears
Daniel J.SolomonM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.07.009
Volume 37, Issue 10, October 2021, Pages 3070-3071
Subscapularis tears can sometimes be difficult to identify arthroscopically. Burkart recognized this and described the “comma sign,” an arc formed by a portion of the superior glenohumeral ligament/coracohumeral ligament complex, to help identify the subscapularis when it is torn and retracted. The comma sign marks the superolateral corner of the torn subscapularis tendon. In the majority of cases, the comma sign can be identified on preoperative magnetic resonance imaging. Magnetic resonance imaging findings of a comma sign include a predominantly low T1 and T2 signal intensity band of soft tissue, situated anterior and medial to the anterior glenoid labrum, extending vertically immediately lateral to the base of the coracoid, and bridging the subscapularis and supraspinatus fossa. Knowing that a comma sign is present before an arthroscopic subscapularis repair should help surgeons identify and secure the leading edge of the subscapularis for repair.
Randomized Trial of Arthroscopic Rotator Cuff With or Without Acromioplasty: No Difference in Patient-Reported Outcomes at Long-Term Follow-Up
Brian R.WatermanM.D.JonNewgrenM.A.Anirudh K.GowdM.D.BrandonCabarcasM.D.DrewLansdownM.D.Bernard R.BachM.D.Brian J.ColeM.D.Anthony A.RomeoM.D.Nikhil N.VermaM.D.
doi : 10.1016/j.arthro.2021.04.041
Volume 37, Issue 10, October 2021, Pages 3072-3078
Editorial Commentary: Acromioplasty Does Not Improve Clinical Outcome of Arthroscopic Rotator Cuff Repair: The Game Is Over!
GiuseppeMilanoM.D.(Editorial Board)Maristella F.SaccomannoM.D., Ph.D.
doi : 10.1016/j.arthro.2021.07.012
Volume 37, Issue 10, October 2021, Pages 3079-3080
Acromioplasty is a well-known, simple, and reproducible surgical technique that is used in isolation or in combination with other arthroscopic procedures. The clinical value of acromioplasty combined with arthroscopic rotator cuff repair has been largely investigated. Main theoretical benefits lie in the opportunity to improve the visualization, decrease abrasive wear with prominent acromial morphology, and release natural growth factors. On the other hand, acromioplasty and release of the coracoacromial ligament may weaken the insertion of the deltoid muscle, induce scar formation in the subacromial space, theoretically limiting shoulder mobility, and increase risk of anterior-superior humeral escape, especially in patients with large to massive rotator cuff tears. Clinical studies report conflicting results. My results show no differences in clinical outcomes in rotator cuff repairs with or without subacromial decompression, regardless of the acromial morphology. At the same time, I do believe that confirmatory studies are always necessary, especially if the aim is to disprove the usefulness of a common practice.
Six-Month Outcome Scores Predicts Short-Term Outcomes After Hip Arthroscopy
Charles C.LinM.D., M.S.Christopher A.ColasantiM.D.David A.BloomB.A.ThomasYoumM.D.
doi : 10.1016/j.arthro.2021.03.046
Volume 37, Issue 10, October 2021, Pages 3081-3087
Editorial Commentary: Patients Who Achieve a Minimal Clinically Important Difference (Feel Better) Early After Hip Arthroscopy Have the Highest Rates of Long-Term Satisfaction
JaskarndipChahalM.D., M.Sc., M.B.A.TimDwyerM.B.B.S., Ph.D.
doi : 10.1016/j.arthro.2021.04.077
Volume 37, Issue 10, October 2021, Pages 3088-3089
Analyzing patient-reported outcomes using the lens of the minimal clinical important difference (MCID) and patient acceptable symptomatic state allows surgeons to assess patient recovery at the individual level and make necessary changes to management if necessary. When patients with femoroacetabular impingement achieve MCID 6 months after arthroscopic treatment, they achieve patient acceptable symptomatic state 2 years postoperatively 88% of the time. The findings highlight the importance of the postoperative recovery trajectory and illustrate a quantitative way to study the progress of individual patients along their care journey.
Intraoperative Findings and Clinical Outcomes Associated With Arthroscopic Management of Subspine Impingement: A Propensity-Matched, Controlled Study
JacobShapiraM.D.aMitchell J.YeltonB.S.aRachel M.GleinB.S.aPhilip J.RosinskyM.D.aDavid R.MaldonadoM.D.aMitchell B.MeghparaM.D.abHari K.AnkemM.D.aAjay C.LallM.D., M.S.abcBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.03.057
Volume 37, Issue 10, October 2021, Pages 3090-3101
Editorial Commentary: Hip Subspine Impact: Is There a Synergistic Effect Between Subspine Impact and Femoroacetabular Impingement?
BernardoAguilera-BohórquezM.D.
doi : 10.1016/j.arthro.2021.05.003
Volume 37, Issue 10, October 2021, Pages 3102-3103
Hip subspine impingement (SSI) is a condition located in the extra-articular area of the hip and is characterized by irregular contact between the anterior inferior iliac spine (AIIS) and the distal femoral neck. Recently, it also has been described that SSI can occur in a normal AIIS, without or in combination with femoroacetabular impingement (FAI), which has redirected the focus of the research. In clinical practice, SSI has no characteristic symptoms/signs and shares similar clinical findings with FAI, making it an important cause of revision hip arthroscopy due to the increased risk of being underdiagnosed and untreated. Consequently, interest in studying SSI and FAI simultaneously has grown to determine whether injuries to the labrum, chondrolabral junction, and acetabular cartilage can be aggravated by dynamic dysfunction or abnormal morphology of the AIIS.
Arthroscopic Excision of Intra-Articular Osteoid Osteoma of the Hip: A Case Series
LinghuiDaiM.D.XinZhangM.D.YuMeiM.D.GuanyingGaoM.D.HongjieHuangM.D.ChengWangM.D.XiaodongJuM.D.YanXuM.D.JianquanWang
doi : 10.1016/j.arthro.2021.03.060
Volume 37, Issue 10, October 2021, Pages 3104-3112
Determining Clinically Meaningful Thresholds for the Nonarthritic Hip Score in Patients Undergoing Arthroscopy for Femoroacetabular Impingement Syndrome
Philip J.RosinskyM.D.aCynthiaKyinB.A.aDavid R.MaldonadoM.D.bJacobShapiraM.D.aMitchell B.MeghparaM.D.acHari K.AnkemM.D.aAjay C.LallM.D.acdBenjamin G.DombM.D.acd
doi : 10.1016/j.arthro.2021.03.059
Volume 37, Issue 10, October 2021, Pages 3113-3121
Editorial Commentary: Patient-Reported Outcome Measures With Established Clinically Important Outcome Values Should Be Used for Hip Arthroscopy Patients: Sifting Through the White Noise
RobRoyMartinP.T., Pd.D., C.S.C.S.AshleyDisantisP.T., O.C.S.
doi : 10.1016/j.arthro.2021.05.036
Volume 37, Issue 10, October 2021, Pages 3122-3124
Patient-reported outcome measures (PROM) are widely used after hip arthroscopy to track postoperative outcomes. With the number of hip arthroscopies performed each year continuing to rise in the United States, it is important to understand which specific PROM is appropriate for use in clinical practice. Clinically important outcome values (CIOVs), including minimal clinically important difference (MCID), patient-acceptable symptom state (PASS), and substantial clinical benefit values, must be determined to allow for score interpretation. Many of the commonly used PROM in hip arthroscopy have CIOVs supporting their use for hip arthroscopy. The selection of an appropriate PROM allows for useful score interpretation at a single time point, as well as changes in score over time, while avoiding response burden to the patient. While the question of “Which PROM should I use?” remains unclear, CIOVs values have been established for the Nonarthritic Hip Score, modified Harris hip score, Hip Outcome Score, and International Hip Outcome Tool. We believe the advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS) may outweigh those of the legacy instruments, but future research will be needed to psychometrically prove this!
Intra-Articular Injection of Autologous Microfat and Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Comparative Study
Marie LaureLouisM.D.abcRobinson GravierDumonceauM.Sc.dElisabethJouveM.Sc.dMichelCohenM.D.eRymDjourifNathalieRichardetM.Sc.abEmmanuelleJourdanPharm.D.gLaurentGiraudoM.Sc.hChloeDumoulinM.Sc.hFannyGrimaudPharm.D.hFrancoise DignatGeorgePharm.D., Ph.D.ijJulieVeranPh.D.hFlorenceSabatierPharm.D., Ph.D.hjJérémyMagalonPharm.D., Ph.D.hj
doi : 10.1016/j.arthro.2021.03.074
Volume 37, Issue 10, October 2021, Pages 3125-3137.e3
Editorial Commentary: If Individual Treatments Are Potentiated, Multimodal Therapy Including Cells and Platelet-Rich Plasma May Beneficially Treat Cartilage Degeneration and Arthritis
Mark G.SiegelM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.04.072
Volume 37, Issue 10, October 2021, Pages 3138-3139
Multimodal therapies may optimize treatments if individual treatments are potentiated. In an attempt to obtain the elusive cure for cartilage degeneration, combined biologic injectable therapy might improve results. Due to the multipotent mesenchymal stem cells in adipose tissue, microfat containing adipose-derived stem cells may assist in cartilage repair. Platelet-rich plasma (PRP) has been similarly shown to be an effective biologic therapy through the release of growth factors affecting chondrocyte metabolism and decreasing inflammation. These 2 different products might be synergistic. Recent study, however, shows no significant differences when evaluating microfat with or without PRP, and importantly also shows that PRP with microfat does provide improvement in knee arthritic pain. This improvement may not correlate with the development of new cartilage, but it does improve function. Each biologic has beneficial effects on knee joint function through different mechanisms.
All-Inside Anterior Cruciate Ligament Reconstruction Using Quadrupled Semitendinosus: Comparable 2-Year Outcomes in Male and Female Patients
Natalie A.LowensteinB.S.Daniel B.HaberM.D.Peter J.OstergaardM.D.Jamie E.CollinsPh.D.Elizabeth G.MatzkinM.D.
doi : 10.1016/j.arthro.2021.03.077
Volume 37, Issue 10, October 2021, Pages 3140-3148
Editorial Commentary: With Appropriate Anterior Cruciate Ligament Graft Selection, All-Inside Reconstruction Results in Excellent Outcomes: Stay “Inside” and Be Cognizant of Hamstring Graft Diameter Expectations in Shorter Patients
Randy S.SchwartzbergM.D.
doi : 10.1016/j.arthro.2021.05.004
Volume 37, Issue 10, October 2021, Pages 3149-3151
All-inside anterior cruciate ligament (ACL) reconstruction is a minimally invasive and anatomic technique with predictably excellent results. The array of graft choices that exists for skilled arthroscopists include semitendinosis autograft with or without gracilis, quadriceps tendon autograft, and patellar tendon autograft and allograft. The advantages of all-inside ACL reconstruction include independent femoral socket creation and less pain compared with a full tibial tunnel in the early postoperative period. This is a technique that should not trump appropriate graft selection. It is expected that autografts will fare better in younger patients who participate in activities at greater risk for ACL injuries. Selection of a semitendinosis autograft results in predictably excellent results when graft diameters are 8 mm or greater. Quadrupling the semitendinosis and adding the gracilis when needed can provide sufficient graft diameter in many patients. However, caution should be taken when harvesting hamstring grafts from shorter patients. Semitendinosis tendons in such patients are sometimes not long enough to quadruple and can result in a diameters less than 8 mm even when the gracilis is added. With appropriate graft selection, staying “inside” for ACL reconstruction is expected to result in great objective and subjective outcomes for our patients.
Vancomycin Presoaking of Anterior Cruciate Ligament Tendon Grafts Is Highly Cost-Effective for Preventing Infection
Verdinand C.B.RuelosB.S.aRichard N.PuzzitielloM.D.aMariano E.MenendezM.D.aNicholas R.PaganiM.D.aMichael A.MovermanM.D.aBrianForsytheM.D.bMatthew J.SalzlerM.D.a
doi : 10.1016/j.arthro.2021.04.005
Volume 37, Issue 10, October 2021, Pages 3152-3156
Editorial Commentary: Vancomycin Solution Pretreatment of Anterior Cruciate Ligament Tendon Graft Reduces Infection Rates, Is Clinically and Biomechanically Sound, and Is Cost-Effective
Lucas S.McDonaldM.D., M.P.H.T.M., C.D.R., M.S., U.S.N., Editorial Board
doi : 10.1016/j.arthro.2021.05.044
Volume 37, Issue 10, October 2021, Pages 3157-3158
Prevention of postoperative infection following anterior cruciate ligament (ACL) reconstruction remains a high priority for orthopaedic surgeons. Vancomycin presoaking of ACL grafts is a biomechanically sound, clinically effective, and cost-efficient method of improving ACL reconstruction infection rates.
An Increased Lateral Femoral Condyle Ratio Is an Important Risk Factor for a Medial Meniscus Ramp Lesion Including Red-Red Zone Tear
Seong HwanKimM.D., Ph.D.Yong-BeomParkM.D., Ph.DYoo-SunWonM.D.
doi : 10.1016/j.arthro.2021.03.078
Volume 37, Issue 10, October 2021, Pages 3159-3165
Editorial Commentary: The Importance of Bony Morphology in the Anterior Cruciate Ligament-Injured Patient
Gian AndreaLucidiM.D.abRobinDunnM.D.bNyaluma N.WagalaM.D.bVolkerMusahlM.D.b
doi : 10.1016/j.arthro.2021.05.043
Volume 37, Issue 10, October 2021, Pages 3166-3169
The outcome of anterior cruciate ligament (ACL) surgery depends on many factors. Successful ACL surgery includes evaluating patients' characteristics and addressing all the underlying knee pathologies, including the meniscus tears and ramp lesions. In recent years, there has been a growing interest in ramp lesions as well as the role that bony morphology plays in predisposing patients to ACL injury and failed ACL surgery. Not only pathologic but also physiologic variations in bony morphology like tibial slope and lateral femoral condyle ratio have been correlated with clinical outcomes, failure rates, rotatory instability, and even lesions to the contralateral knee. Evaluating each patient’s specific anatomy is recommended when customizing ACL surgery. With further research and increased awareness of relevant bony parameters, we will be able to improve our ability to prevent injury, increase the diagnostic accuracy of associated lesions, and tailor surgery to improve the outcomes and reduce failure rates.
Nicotine Exposure Via Electronic Cigarettes Significantly Impedes Biomechanical Healing Properties of Tendon Healing in a Rat Model
PatrickKennedyM.D., D.P.T.aKaitlinSalokyB.S.bAdityaYadavalliM.D.cErinBarlowM.D.cMichaelAynardiM.D.aMatthewGarnerM.D.aJesseBibleM.D.aGregory S.LewisPh.D.aAmanDhawanM.D.a
doi : 10.1016/j.arthro.2021.03.071
Volume 37, Issue 10, October 2021, Pages 3170-3176
Patellofemoral Osteoarthritis Progresses After Medial Open-Wedge High Tibial Osteotomy: A Systematic Review
KiminariKataokaM.D.aShuWatanabeM.D.aKantoNagaiM.D., Ph.D.aJeffreyKayM.D.bTakehikoMatsushitaM.D., Ph.D.aRyosukeKurodaM.D., Ph.D.aDarrende SAM.B.A.(c), M.D., F.R.C.S.C.b
doi : 10.1016/j.arthro.2021.04.015
Volume 37, Issue 10, October 2021, Pages 3177-3186
The Superficial “Swing-Down” Quadriceps Tendon Autograft Is a Viable Option for Medial Patellofemoral Ligament Reconstruction: A Systematic Review
OlumideOlotuB.Sc.abAliSiddiquiaDevinPetersonM.D., F.R.C.S.C.cDarrende SAM.B.A.(c), M.D., F.R.C.S.C.c
doi : 10.1016/j.arthro.2021.04.048
Volume 37, Issue 10, October 2021, Pages 3187-3197
Editorial Commentary: Is the Pendulum “Swinging” Away From Patellar Fixation in Medial Patellofemoral Ligament Reconstruction?
Seth L.ShermanM.D., Editorial BoardDaniel M.CurtisM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.06.001
Volume 37, Issue 10, October 2021, Pages 3198-3199
Medial patellofemoral ligament (MPFL) reconstruction is the “workhorse” for surgical stabilization of recurrent patella instability. Complications of patella fixation (i.e., patella fracture) are rare but potentially catastrophic. Modifications to traditional MPFL reconstruction that avoid patella fixation are promising. These alternatives may be favored in high-risk scenarios such as revision, smaller pediatric cases, and patellofemoral arthroplasty with concomitant instability. Large-scale prospective and/or randomized studies are needed to differentiate between MPFL reconstruction techniques.
Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Shoulder: An Orthoregeneration Network (ON) Foundation Review
Nolan B.CondronB.S.aBenjamin S.KesterM.D.aJohn M.TokishM.D.bMatthias A.ZumsteinM.D.cReubenGobezieM.D.dMarkusScheibelM.D.efBrian J.ColeM.D., M.B.A.a
doi : 10.1016/j.arthro.2021.06.033
Volume 37, Issue 10, October 2021, Pages 3200-3218
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the shoulder including the rotator cuff tendons, glenohumeral articular cartilage, glenoid labrum, the joint capsule, and bone. Promising and established treatment modalities include hyaluronic acid (HA); platelet-rich plasma (PRP) and platelet rich concentrates (PRC); bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs alternatively termed medicinal signaling cells and frequently, misleadingly labelled “mesenchymal stem cells”); MSC harvested from adipose, umbilical, or placental sources; factors including vascular endothelial growth factors (VEGF), basic fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF?), bone morphogenic protein (BMP), and matrix metalloproteinases (MMPs); prolotherapy; pulsed electromagnetic field therapy; microfracture and other marrow-stimulation techniques; biologic resurfacing using acellular dermal allografts, allograft Achilles tendons, allograft lateral menisci, fascia lata autografts, and porcine xenografts; osteochondral autograft or allograft); and autologous chondrocyte implantation (ACI). Studies involving hyaluronic acid, platelet rich plasma, and medicinal signaling cells of various origin tissues have shown mixed results to-date as isolated treatments and as surgical adjuncts. Despite varied results thus far, there is great potential for improved efficacy with refinement of current techniques and translation of burgeoning preclinical work.
