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Table of Contents
doi : 10.1016/S0749-8063(21)00862-8
Volume 37, Issue 11, November 2021, Pages A9-A10, A13-A14
Instructions for Authors
doi : 10.1016/S0749-8063(21)00868-9
Volume 37, Issue 11, November 2021, Page A39
Medical Journal Content Continues Rapid Growth
James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.09.006
Volume 37, Issue 11, November 2021, Pages 3221-3222
Medical journal content continues to expand at a rapid rate. This is promising for the future of innovation and patient care but challenging for clinicians and scientists. We feature new journals, new social media platforms, educational advertisements, illuminating Letters to the Editor and enlightening Author Replies, Podcasts, Visual Abstracts, and Infographics. This is a developmental time for medical journal publication.
Evaluation of Journal Policies to Increase Promotion of Transparency and Openness in Sport Science Research
Harrison J.HansfordBExPhysAidan G.CashinPh.DMichael A.WewegeM.ScMichael C.FerraroB.Sci. (hons)James H.McAuleyPh.DMatthew D.JonesPh.DTransparency and Openness Promotion (TOP) Sport Science Collaborators
doi : 10.1016/j.arthro.2021.09.005
Volume 37, Issue 11, November 2021, Pages 3223-3225
Regarding “Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique”
Luis PérezCarroM.D., Ph.D.
doi : 10.1016/j.arthro.2021.09.008
Volume 37, Issue 11, November 2021, Page 3225
Author Reply to ”Regarding ‘Arthroscopic Fixation of Os Acetabuli and Labral Repair: Suture-on-Screw Technique’”
Steven F.DeFrodaM.D., M.Eng.DanielWichmanB.S.RobertBrowningM.D.Thomas D.AlterM.S.Shane J.NhoM.D., M.S.
doi : 10.1016/j.arthro.2021.09.009
Volume 37, Issue 11, November 2021, Pages 3225-3226
Proximal Hamstring Tears: Endoscopic Hamstring Repair
WilliamArroyoM.D.Carlos A.GuancheM.D.
doi : 10.1016/j.arthro.2021.09.010
Volume 37, Issue 11, November 2021, Pages 3227-3228
Proximal hamstring tears are common among athletes, especially in sports involving eccentric lengthening during forced hip flexion and knee extension, such as hurdles or water skiing. Tears are described by timing (acute [<1 month] or chronic) and severity (partial or complete). Complete tears are easily identified with magnetic resonance imaging; however, partial tears may be subtle and potentially missed. The spectrum of pathology associated with acute injuries ranges from minor strains to complete tears or avulsions. Acute tears commonly present as pain and bruising over the posterior thigh along with weakness with active knee flexion and often a sensation of instability of the lower extremity. Chronic injuries typically present with ischial pain associated with repetitive activities, and the spectrum includes chronic tendinopathies, ischial bursitis, partial tears, and nonoperatively treated complete tears. Nonoperative treatment is recommended in the setting of low-grade partial tears and insertional tendinosis. However, failure of nonoperative treatment of partial tears may benefit from surgical debridement and repair. Further, surgical repair of complete tears with retraction is usually recommended for active patients. Historically, surgical treatment has been limited to open surgical approaches, although endoscopic management of proximal hamstring tears and chronic ischial bursitis is an option. Our endoscopic technique employs the use of two anchors, double loaded with high-strength suture, and may support a faster recovery due to decreased surgical morbidity. It is important to note that some patients may not be candidates for this endoscopic repair as a result of several factors, including prior chronic and retracted tears, as well as those with altered regional tissue planes due to prior surgical repair.
Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: Arthroscopy-Guided Continuous Suprascapular Nerve Block Versus Ultrasound-Guided Continuous Interscalene Block
HyojuneKimM.D.abHa-JungKimM.D., Ph.D.cEui-SupLeeM.D.bSeonjeongLeeM.D.bJeong HeeParkM.S.N., A.P.N.bHyungtaeKimM.D.cIn-HoJeonM.D., Ph.D.bWon UkKohM.D., Ph.D.cKyoung HwanKohM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.04.067
Volume 37, Issue 11, November 2021, Pages 3229-3237
Editorial Commentary: The Evolution of Regional Anesthesia in Arthroscopic Rotator Cuff Repair: From Throbbing Shoulders to Paralyzed Diaphragms
Evan M.MillerM.D.aDanielleRiderB.S.aBrian R.WatermanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.06.011
Volume 37, Issue 11, November 2021, Pages 3238-3240
Rotator cuff repair may result in significant postoperative pain. Although opioids were once the gold standard, addiction and other side effects are of significant concern. Nonsteroidal anti-inflammatory drugs reduce pain, sleep disturbance, and need for opioids, but they may impair soft tissue healing. The use of gabapentinoids is equivocal. Intralesional analgesia carries a risk of glenohumeral chondrolysis. Cryotherapy is beneficial, but it is often not covered by insurance companies. Suprascapular nerve block addresses innervation of only 70% versus interscalene block, but the latter has a higher incidence of unintended, temporary motor and sensory deficits of the upper extremity and hemidiaphragmatic paresis, despite similar pain scores. Although neurodeficits and diaphragmatic hemiparesis resolve by 3 weeks, temporary complications affect length of hospital stay, initiation of physical therapy, and patient satisfaction. These variables contribute to the challenge of postoperative pain control amid a growing wave of modalities aimed at improving the extent and duration of patient-focused analgesia, especially the application of continuous block infusions.
Live Observational Objective Assessment of Operative Performance in a Cadaveric Model is Equivalent to Delayed Video-Based Assessment
Richard L.AngeloM.D., Ph.D.(Emeritus)aPatSt. PierreM.D.bJoeTauroM.D.cAnthony G.GallagherPh.D., D.Sc.d
doi : 10.1016/j.arthro.2021.04.060
Volume 37, Issue 11, November 2021, Pages 3241-3247
Latarjet After Failed Arthroscopic Bankart Repair Results in Twice the Rate of Recurrent Instability Compared With Primary Latarjet
Daniel L.RodkeyM.D.Donald F.ColantonioM.D.Lance E.LeClereM.D.Kelly G.KilcoyneM.D.Jonathan F.DickensM.D.
doi : 10.1016/j.arthro.2021.04.059
Volume 37, Issue 11, November 2021, Pages 3248-3252
Editorial Commentary: Better Stability Found With Primary Latarjet Compared With Those Performed After a Failed Arthroscopic Bankart Repair: Should We Be Doing More Primary Latarjet Procedures?
Daniel J.SolomonM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.07.035
Volume 37, Issue 11, November 2021, Pages 3253-3254
Traditionally, most orthopaedic surgeons use glenoid bone loss of >15% to 20% glenoid width as the cut off for arthroscopic Bankart repairs. More than that amount of bone loss suggests the need to augment the glenoid with bone—most often performed with a Latarjet coracoid transfer. Primary Latarjet procedures are more widely used in Europe compared with the United States for the treatment of shoulder instability—even with less bone loss than 15%. Better results regarding stability are found using primary Latarjet compared with those in revision Latarjet procedures performed after an arthroscopic Bankart procedure has failed. Perhaps this should lead us to doing primary Latarjet procedures, with a lower threshold of bone loss.
Advanced 3-Dimensional Characterization of Hill-Sachs Lesions in 100 Anterior Shoulder Instability Patients
PetarGolijaninM.D., M.B.A.cdLiamPeeblesB.S.biJustin W.ArnerM.D.aBrentonDouglassM.D.bAnnalisePeeblesB.S.bDanielleRiderB.A.hSrdjanNinkovicM.D. Ph.D.gKaareMidtgaardM.D.befCAPTMatthew T.ProvencherM.D., M.B.A., M.C., U.S.N.R.ab
doi : 10.1016/j.arthro.2021.05.015
Volume 37, Issue 11, November 2021, Pages 3255-3261
Editorial Commentary: It Is Not the Size, But the Location of Hill-Sachs Lesion That Matters
EijiItoiM.D., Ph.D.
doi : 10.1016/j.arthro.2021.07.011
Volume 37, Issue 11, November 2021, Pages 3262-3265
The risk of a Hill-Sachs lesion (HSL) to engage the anterior glenoid rim depends on the location of the medial margin of the HSL relative to the anterior rim of the glenoid. The same-sized HSL can be engaging or nonengaging depending upon the size of the glenoid. In order to assess these bony lesions (bipolar lesion) together, the glenoid track concept has been introduced: an on-track lesion (stable) and an off-track lesion (unstable). Three-dimensional computed tomography (3D-CT) confirms that more medialized HSLs have larger volume, greater width, more surface area loss, and higher lesion angles (HS angle), and are more inferior in the humeral head. We know that medialization of the HSL is a definitive risk factor to make it off track, whereas the volume, surface area, and width are all subordinate risk factors dependent on the medialization. On the other hand, while we know very little about the orientation of the HSL, recent research shows a significant association between the medialization and orientation of the HSL. However, we do not know whether the orientation is an independent risk factor or dependent on the medialization. There are two things I emphasize when I look at a HSL: 1) do not look at the HSL alone, but look at the glenoid as well, and 2) the risk of the HSL depends on the location of the medial margin of the HSL relative to the glenoid, not on the volume, depth, or length.
Postoperative Stiffness and Pain After Arthroscopic Labral Stabilization: Consider Anchor Arthropathy
CDRRobert A.WaltzM.D., M.C., U.S.N.aJeffreyWongM.D.bAnnalise M.PeeblesB.A.cPetarGolijaninB.S.dJoseph J.RuzbarskyM.D.aJustin W.ArnerM.D.aLiam A.PeeblesB.A.eJonathan A.GodinM.D., M.B.A.acPeter J.MillettM.D., M.Sc.acCAPTMatthew T.ProvencherM.D., M.B.A., M.C., U.S.N.R.ac
doi : 10.1016/j.arthro.2021.05.016
Volume 37, Issue 11, November 2021, Pages 3266-3274
Endoscopic Proximal Hamstring Repair Is Safe and Efficacious With High Patient Satisfaction at a Minimum of 2-Year Follow-Up
Amanda N.FletcherM.D., M.S.Gregory F.PereiraM.D.Brian C.LauM.D.Richard C.MatherIIIM.D., M.B.A.
doi : 10.1016/j.arthro.2021.03.067
Volume 37, Issue 11, November 2021, Pages 3275-3285
Editorial Commentary: Endoscopic Proximal Hamstring Repair Is Safe and Effective for Refractory Tendinosis and Partial Tears: “Pain in the Butt” Has an Endoscopic Solution!
BrettShoreM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.05.051
Volume 37, Issue 11, November 2021, Pages 3286-3287
While surgical treatment of acute proximal hamstring ruptures is well understood to be the best treatment option for many patients, treatment of chronic proximal hamstring pathology has lagged, with most management consisting of conservative options: rest, ice, physical therapy, nonsteroidal anti-inflammatory drugs, shock-wave therapy, and injections such as corticosteroids and platelet-rich plasma. However, recent research shows that endoscopic repair of chronic proximal hamstring pathology is safe and effective for treating this pathology at short-term follow-up, with high rates of return to activity and patient satisfaction. This presents an appealing treatment option for patients with refractory proximal hamstring pathology, as well as a technique for repairing acute, full-thickness tears. With attention to detail, complication rates are low for endoscopic treatment of both acute and chronic proximal hamstring pathology.
Isolated Acetabuloplasty for Femoroacetabular Impingement: Favorable Patient-Reported Outcomes and Sustained Survivorship at Minimum 5-Year Follow-Up
Matthew J.HartwellM.D.Allison M.MorganB.A.Patrick A.NelsonM.D.Claire E.FernandezB.B.A.Richard W.NicolayM.D.UjashShethM.D., M.Sc., F.R.C.S.C.Vehniah K.TjongM.D.Michael A.TerryM.D.
doi : 10.1016/j.arthro.2021.03.080
Volume 37, Issue 11, November 2021, Pages 3288-3294
Editorial Commentary: Femoroplasty May Not Be Necessary in All Patients With Hip Femoroacetabular Impingement, But Cam Lesions Should Not Be Ignored in Patients With Significant Femoral Head-Neck Offset
Justin W.ArnerM.D., Editorial Board
doi : 10.1016/j.arthro.2021.05.008
Volume 37, Issue 11, November 2021, Pages 3295-3296
Our knowledge of appropriate arthroscopic management of femoroacetabular impingement (FAI) continues to evolve. However, few studies exist evaluating mid- to long-term surgical outcomes to guide optimal treatment. The recent focus has been on the importance of cam femoroplasty in addition to labral treatment; however, studies have shown that correction of the alpha angle to normal does not correlate with patient outcomes. Furthermore, in cases of mixed impingement, an optimal degree of acetabuloplasty as measured by the lateral center-edge angle has not been determined. Few studies have evaluated isolated pincer decompression with omission of cam treatment. In select patients with small or negligible cam lesions who do not have acetabular dysplasia, a small, isolated acetabular rim resection of 1 to 3 mm may provide adequate FAI decompression as well as reduce surgical time and complications. Nonetheless, individualized FAI treatment is necessary that includes a comprehensive 180° femoroplasty in patients with sizable cam lesions to prevent future labral and chondral damage. An intraoperative dynamic examination is important to determine sufficient resolution of FAI. Predictive modeling may play an increasingly important role to ensure appropriate bony resection and to optimize long-term patient outcomes.
Unstable Lateral Hinge Fracture or Occult Complete Osteotomy Adversely Affects Correction Accuracy in Open-Wedge High Tibial Osteotomy
Ju-HoSongM.D.aSeong-IlBinM.D., Ph.D.bJong-MinKimM.D., Ph.D.bBum-SikLeeM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.04.032
Volume 37, Issue 11, November 2021, Pages 3297-3306
Degenerative Medial Meniscus Tear With a Displaced Flap Into the Meniscotibial Recess and Tibial Peripheral Reactive Bone Edema Presents Good Results With Arthroscopic Surgical Treatment
Camilo PartezaniHelitoM.D., Ph.D.acPaulo VictorPartezani HelitobcMarcel FaracoSobradoM.D.acPedro NogueiraGiglioM.D.aTales MollicaGuimaraesM.D.aJosé RicardoPécoraM.D., Ph.D.aRiccardo GomesGobbiM.D., Ph.D.aMarcelo BordaloRodriguesM.D., Ph.D.bcBrunoVande BergM.D., Ph.D.d
doi : 10.1016/j.arthro.2021.04.033
Volume 37, Issue 11, November 2021, Pages 3307-3315
Joint Space Width Increases Medially and Decreases Laterally at Different Time Points After Medial Open-Wedge High Tibial Osteotomy
Sang-MinLeeM.D.abcSeong-IlBinM.D., Ph.D.cJong-MinKimM.D., Ph.D.cBum-SikLeeM.D., Ph.D.cKuen TakSuhM.D., Ph.D.bdJu-HoSongM.D.d
doi : 10.1016/j.arthro.2021.04.007
Volume 37, Issue 11, November 2021, Pages 3316-3323
Editorial Commentary: Early Postoperative Knee Joint Space Width Change Is Attributable to Change in the Joint Line Convergence Angle After High Tibial Osteotomy and May Not Reflect Cartilage Regeneration
KenichiGoshimaM.D., Ph.D.
doi : 10.1016/j.arthro.2021.05.067
Volume 37, Issue 11, November 2021, Pages 3324-3325
Realignment of the weightbearing axis by high tibial osteotomy (HTO) can alter the forces acting on the articular cartilage within the knee, reducing the load on the medial compartment. This unloading effect is thought to allow the repair of the articular cartilage of the affected compartment. It is important to evaluate the serial changes of joint space width (JSW) after HTO for assessing the state of the cartilage and the unloading effect by HTO. However, early postoperative knee JSW change is attributable to change in the joint line convergence angle after HTO and may not reflect cartilage regeneration. In addition, the soft tissue laxity of the knee and changes in joint line convergence angle after HTO should be considered for assessing these early postoperative JSW changes.
Learning Curve For Lateral Meniscal Allograft Transplantation: Preventing Meniscal Extrusion
Jung-SuChoeM.D.aSeong-IlBinM.D.bBum-SikLeeM.D.bJong-MinKimM.D.bJu-HoSongM.D.bHyung-KwonChoM.D.b
doi : 10.1016/j.arthro.2021.04.042
Volume 37, Issue 11, November 2021, Pages 3326-3334
Suture Tape Augmentation Improves the Biomechanical Performance of Bone-Patellar Tendon-Bone Grafts Used for Anterior Cruciate Ligament Reconstruction
Matthew J.MatavaM.D.aJonathanKoscsoM.D.aLuciaMelaraM.S.bLjiljanaBogunovicM.D.a
doi : 10.1016/j.arthro.2021.04.053
Volume 37, Issue 11, November 2021, Pages 3335-3343
Editorial Commentary: The Anterior Cruciate Ligament May Be Safer Wearing a Suture Tape Augmentation Seat Belt: Click It or Ticket
Blake M.BodendorferM.D.
doi : 10.1016/j.arthro.2021.06.013
Volume 37, Issue 11, November 2021, Pages 3344-3346
Bone-patellar tendon-bone autograft for anterior cruciate ligament (ACL) reconstruction has the most data to support its use. However, there may still be room for improvement, and younger age, insufficient rehabilitation, altered neuromuscular patterns, and precocious return to play can increase risk of graft failure. High strength suture augmentation of soft-tissue repair or reconstruction has gained traction in a variety of applications for the knee, including medial collateral and posteromedial corner, lateral collateral ligament, posterior cruciate ligament, and ACL. For ACL reconstruction, the technique consists of using either suture or suture tape fixed at the femoral and tibial ACL footprints to allow for independent tensioning to back up the separately tensioned ACL reconstruction. The static augment serves as a load-sharing device, allowing the graft to see more strain during earlier levels of graft strain, until graft elongation occurs to a critical level whereby the augment will experience more strain than the graft. Hence, the “seat belt” analogy. This is distinct from static augmentation, where the high strength suture is fixed to the graft. Static augmentation (without tensioning separately from the graft) results in a load-sharing device and increased stiffness, but potential stress shielding compared with the “seat belt.” If suture tape augmentation improves patient outcome, it is a worthwhile to “click it.”
Mobilized Peripheral Blood Stem Cells are Pluripotent and Can Be Safely Harvested and Stored for Cartilage Repair
Adam W.AnzM.D.abJohnnyTorresB.S.bHillary A.PlummerPh.D., A.T.C.bCarolineSiew-Yoke JeePh.D.(Lond)eTravis J.DekkerM.D.cKevin B.JohnsonPh.D., M.B.A.dKhay-YongSawM.Ch.Orth., F.R.C.S.(Edin)f
doi : 10.1016/j.arthro.2021.04.036
Volume 37, Issue 11, November 2021, Pages 3347-3356
Editorial Commentary: Cell-Based Therapies for Articular Cartilage Repair Require Precise Progenitor Cell Characterization and Determination of Mechanism of Action
Claire D.EliasbergM.D.Scott A.RodeoM.D.
doi : 10.1016/j.arthro.2021.06.006
Volume 37, Issue 11, November 2021, Pages 3357-3359
Biologics and cell-based therapies, in particular, have come to the forefront of orthopaedic sports medicine as agents with therapeutic and regenerative potential. Autologous chondrocyte implantation has been used successfully for many years, but a recent focus on autologous progenitor cells derived from bone marrow aspirate, adipose tissue, and/or synovium has garnered significant interest. Mobilized peripheral blood mononuclear cells [PBMCs or connective tissue progenitors (CTPs)] represent a promising cell population for potential use in articular cartilage repair. The term “stem cell” has become widely popularized, but more specific language identifying the cell type by donor type, tissue of origin, cell surface marker profile, culture conditions, and other cell behavior/characteristics should be used. In 2019, Murray et al. proposed a five-item “DOSES” tool in an effort to encourage standardized reporting for cell-based therapies emphasizing donor, origin of tissue, separation from other cell types/preparation method, exhibited cell characteristics associated with behavior, and site of delivery. The advantages of the DOSES tool include both simplicity and ability to be applied to cell types not yet discovered. However, a universally accepted list of criteria for biologics does not yet exist. Additional research is necessary to better elucidate the precise mechanisms by which cell therapies have a clinical effect and define whether the therapies for the treatment of cartilage pathology merely help alleviate symptoms or actually provide structural improvements. There are few data to suggest exogenous cell therapies directly engraft, so identifying the paracrine mediators produced by these cells would be an area of further interest.
To Improve Pain and Function, Platelet-Rich Plasma Injections May Be an Alternative to Surgery for Treating Lateral Epicondylitis: A Systematic Review
RichardHardyEd.D., L.A.T.aAerikaToriB.S.bHannahFuchsB.S.bTaiyoLarsonbJeffersonBrandM.D.aEmilyMonroeM.D.a
doi : 10.1016/j.arthro.2021.04.043
Volume 37, Issue 11, November 2021, Pages 3360-3367
Editorial Commentary: Elbow Lateral Epicondylitis Treatment Using Platelet-Rich Plasma
Larry D.FieldM.D.
doi : 10.1016/j.arthro.2021.05.048
Volume 37, Issue 11, November 2021, Pages 3368-3370
The best treatment for elbow lateral epicondylitis is controversial. Multiple treatment interventions are used commonly, including physical therapy, corticosteroid injections, nonsteroidal anti-inflammatory drugs, bracing, acupuncture, ultrasound-guided percutaneous tenotomy, open or arthroscopic surgical debridement, and recently, platelet-rich plasma (PRP) or autologous blood injections. Patients in whom more traditional conservative measures have failed may benefit from PRP injections, although long-term outcomes after such injections are unclear. The complication rates of PRP injections are low. One PRP injection, if successful, could be a cost-effective alternative to surgery, but multiple injections are often recommended and third-party payers have historically rarely paid those medical claims, thus placing an increased financial burden on the patient.
Intraoperative Computer Vision Integrated Interactive Fluoroscopy Correlates With Successful Femoroplasty on Clinic-Based Radiographs
Austin M.LooneyM.D.aDaniel M.WichmanB.S.bKevin C.ParvareshM.D.bThomas D.AlterM.S.bShane J.NhoM.D.b
doi : 10.1016/j.arthro.2021.04.044
Volume 37, Issue 11, November 2021, Pages 3371-3382
Editorial Commentary: Assistive Technologies for Hip Arthroscopic Cam Resection Will Improve Diagnostic and Surgical Accuracy: Desperately Needed and Here to Stay
Emmanuel A.AudenaertM.D., Ph.D.,(Med.), Ph.D.,(Appl. Eng.)KateDuquesneI.R., M.Sc.
doi : 10.1016/j.arthro.2021.05.040
Volume 37, Issue 11, November 2021, Pages 3383-3384
Hip arthroscopy is technically demanding and presents a steep learning curve. Joint access and maneuverability of surgical tools are impeded by a large soft-tissue envelope. Furthermore, cam resection is challenging owing to the small size of the lesion and the difficulty in delineating what is normal and where the cam starts. Thus, the number of incomplete resections is high and represents the bulk of indications for revision hip arthroscopy. The search for assistive technologies to improve on diagnostics and surgical accuracy is consequently substantial and unquestionably needed. Intraoperative feedback will improve our resection accuracy while decreasing the learning efforts of both expert and novice surgeons.
