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Table of Contents
doi : 10.1016/S0749-8063(21)01132-4
Volume 38, Issue 2, February 2022, Pages A9-A12, A14-A16
Instructions for Authors
doi : 10.1016/S0749-8063(21)01138-5
Volume 38, Issue 2, February 2022, Page A41
Comprehensive Review of Shoulder Instability Includes Diagnosis, Nonoperative Management, Bankart, Latarjet, Remplissage, Glenoid Bone-Grafting, Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up
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.2021.11.052
Volume 38, Issue 2, February 2022, Pages 209-210
The Delphi method is a structured communication technique used to allow a panel of experts to achieve a consensus in a systematic manner. Expert consensus on shoulder instability includes review of diagnosis, nonoperative management, Bankart, Latarjet, remplissage, glenoid bone-grafting, revision surgery, rehabilitation and return to play, and clinical follow-up. Amplified by Editorial Commentary, this is much to study, clinically relevant, and to the ultimate benefit of our patients.
Hip Microinstability: Understanding a Newly Defined Hip Pathology in Young Athletes
Daniel M.CurtisM.D.Iain R.MurrayF.R.C.S., Ph.D.Adam J.MoneyM.D.W. MichaelPullenM.D.Marc R.SafranM.D.
doi : 10.1016/j.arthro.2021.12.001
Volume 38, Issue 2, February 2022, Pages 211-213
Microinstability is an increasingly recognized diagnosis in young athletes presenting with hip pain. Causes of microinstability may include abnormality of the hip bony anatomy, acetabular labral tears, joint capsule laxity or injury, and muscle dysfunction. Borderline hip dysplasia is an increasingly recognized factor predisposing to microinstability. The capsuloligamentous structures of the hip, particularly the iliofemoral ligament, provide important restraints to femoral head motion, and iatrogenic defects can predispose patients to instability after surgery. Injury to the acetabular labrum may disrupt its important hip-stabilizing properties including the suction seal and improved acetabular depth. Hip muscle weakness or imbalance may result in increased femoral head motion within the acetabulum. The diagnosis of hip microinstability can be challenging, and the history is often nonspecific. Physical examination maneuvers include the anterior apprehension, prone instability, axial distraction, and abduction-hyperextension-external rotation tests. Radiographic features may include borderline hip dysplasia, femoral head-neck junction cliff sign, and an elevated femoral-epiphyseal acetabular roof index. Magnetic resonance arthrography may demonstrate a capsular defect, capsular thinning, or labral pathology. Diagnostic intra-articular injection of anesthetic can confirm the intra-articular nature of the pathology. Management of hip microinstability focuses on strengthening the dynamic stabilizers of the hip through focused physical therapy. Surgery may be considered in recalcitrant cases where symptoms persist despite optimization of hip stabilizer strength. In such cases, addressing the primary source of instability through labral repair or reconstruction and capsular repair or plication can be considered. In highly selected cases, surgery can result in excellent outcomes.
Anterior Shoulder Instability Part I—Diagnosis, Nonoperative Management, and Bankart Repair—An International Consensus Statement
Eoghan T.HurleyM.B., B.Ch., M.Ch., Ph.D.abBogdan A.MatacheM.D., C.M., F.R.C.S.C.cIvanWongM.D., F.R.C.S.C.dEijiItoiM.D., Ph.D.eEric J.StraussM.D.aRuth A.DelaneyF.R.C.S.bLionelNeytonM.D.fGeorge S.AthwalM.D., F.R.C.S.C.gLeoPauzenbergerM.D.bHannanMullettM.Ch., F.R.C.S.I. (Tr & Orth)bLaith M.JazrawiM.D.a
doi : 10.1016/j.arthro.2021.07.022
Volume 38, Issue 2, February 2022, Pages 214-223.e7
Anterior Shoulder Instability Part II—Latarjet, Remplissage, and Glenoid Bone-Grafting—An International Consensus Statement
Eoghan T.HurleyM.B., B.Ch., M.Ch., Ph.D.abBogdan A.MatacheM.D., C.M., F.R.C.S.C.cIvanWongM.D., F.R.C.S.C.dEijiItoiM.D., Ph.D.eEric J.StraussM.D.aRuth A.DelaneyF.R.C.S.bLionelNeytonM.D.fGeorge S.AthwalM.D., F.R.C.S.C.gLeoPauzenbergerM.D.bHannanMullettM.Ch., F.R.C.S.I. (Tr & Orth)bLaith M.JazrawiM.D.a
doi : 10.1016/j.arthro.2021.07.023
Volume 38, Issue 2, February 2022, Pages 224-233.e6
Anterior Shoulder Instability Part III—Revision Surgery, Rehabilitation and Return to Play, and Clinical Follow-Up—An International Consensus Statement
Bogdan A.MatacheM.D., C.M., F.R.C.S.C.cEoghan T.HurleyM.B., B.Ch., M.Ch., Ph.D.abIvanWongM.D., F.R.C.S.C.dEijiItoiM.D., Ph.D.eEric J.StraussM.D.aRuth A.DelaneyF.R.C.S.bLionelNeytonM.D.fGeorge S.AthwalM.D., F.R.C.S.C.gLeoPauzenbergerM.D.bHannanMullettM.Ch., F.R.C.S.I. (Tr & Orth)bLaith M.JazrawiM.D.a
doi : 10.1016/j.arthro.2021.07.019
Volume 38, Issue 2, February 2022, Pages 234-242.e6
Editorial Commentary: A Consensus of Experts Complements the Clinical Evidence on Diagnosis and Treatment of Anterior Glenohumeral Instability
Samer S.HasanM.D., Ph.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.08.034
Volume 38, Issue 2, February 2022, Pages 243-246
The current diagnostic and treatment strategies for anterior glenohumeral instability have been refined by high-quality clinical and basic science studies, but many controversies remain. These include the bone loss threshold for arthroscopic Bankart repair and the influence of other clinical factors on this decision, the optimal bracing position following anterior glenohumeral dislocation, and the optimal coracoid graft orientation during the Latarjet procedure. Randomized clinical trials often present conflicting results, and many of these are small-sample and fragile studies. Obtaining an expert consensus on the topic, by means of the Delphi method, is an attractive alternative to such clinical trials. Several studies employing variations of the Delphi method have addressed the diagnosis and treatment of anterior glenohumeral instability. These have stressed the importance of a meticulous technique during arthroscopic Bankart repair and of recognition of glenoid and humeral bone loss and treating this appropriately. These studies have also helped identify areas where consensus is modest or lacking to motivate additional clinical research study.
Editorial Commentary: To Properly Apply Delphi Consensus Conclusions, Strengths and Weaknesses of the Process Require Consideration: Unified Expert Opinion or Toxic Fumes Resulting in a Strange Trance?
Stephen C.WeberM.D.
doi : 10.1016/j.arthro.2021.08.027
Volume 38, Issue 2, February 2022, Pages 247-249
The Delphi Consensus Process is a tool to allow diverse expert opinion to be consolidated to better understand complex problems. The process has recently been applied to orthopaedic treatment options. While a piece of the puzzle, the strengths and weaknesses of this process must be understood to allow the orthopaedist to apply the conclusions of the Delphi Consensus process effectively. It is important to recognize that expert opinion has been upended time and time again by carefully collected clinical-outcome data. It is unclear whether the visions of the Oracle are due to wisdom or toxic fumes resulting in a strange trance.
Editorial Commentary: Wider Acceptance of Medical Expert Consensus Research Requires Strict Adherence to Delphi Panel Methodology
ErikHohmannM.B.B.S., F.R.C.S., F.R.C.S. (Tr.&Orth.), Ph.D., M.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.08.014
Volume 38, Issue 2, February 2022, Pages 250-252
The diagnosis and treatment of an anterior glenohumeral instability remains controversial. Currently, there is no universally globally accepted approach. In addition to individual surgeon’s experiences and preferences, surgical training, regional differences in patient’s expectations, and demands confound decision-making. Evidence-based medicine and large randomized trials are not helpful, as they cannot possibly account for all potential confounders. The Delphi technique is an expert consensus-based evidence approach and a reasonable alternative to randomized trials. It pools the experience of experts in the field in a scientific fashion but has been criticized for only producing the lowest common denominator, resulting in oversimplification of a complex problem. However, this criticism is commonly a result of inadequate execution of the methods rather than the methodology itself. It could be that strict adherence to Delphi methodology could result in greater acceptance of Delphi (rather than "modified" Delphi) findings; a stricter approach also may lead to lower agreement between participating experts.
Superior Capsular Reconstruction: A Salvage Option for Massive Irreparable Rotator Cuff Tears with Pseudoparalysis or Subscapularis Insufficiency
Marisa N.UlrichB.S.aTravis L.FrantzM.D.bJoshua S.EverhartM.D., M.P.H.cJonathan D.BarlowM.D.dGrant L.JonesM.D.bJulie Y.BishopM.D.bGregory L.CvetanovichM.D.a
doi : 10.1016/j.arthro.2021.05.018
Volume 38, Issue 2, February 2022, Pages 253-261
Two-Year Retrospective Patient-Reported Outcomes Following Superior Capsular Reconstruction
Ahmad M.HammadM.D.aCameronPhillipsM.D.bCoen A.WijdicksPh.D.cChristopher R.AdamsM.D.cdPatrick J.DenardM.D.b
doi : 10.1016/j.arthro.2021.05.025
Volume 38, Issue 2, February 2022, Pages 262-266
Improved Outcomes Following Arthroscopic Superior Capsular Reconstruction May Not Be Associated With Changes in Shoulder Kinematics: An In Vivo Study
Gillian E.KaneB.S.Clarissa M.LeVasseurM.S.Jonathan D.HughesM.D.Alexandra S.GabrielliM.D.AdamPopchakD.P.T., Ph.D.WilliamAnderstPh.D.AlbertLinM.D.
doi : 10.1016/j.arthro.2021.06.018
Volume 38, Issue 2, February 2022, Pages 267-275
Editorial Commentary: Clinical Improvements of Superior Capsular Reconstruction Are Not Due to Maintained Dynamic Acromiohumeral Distance
AmanDhawanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.09.007
Volume 38, Issue 2, February 2022, Pages 276-277
Biomechanical data often help inform clinical decision-making in orthopaedic surgery. However, there are times when the biomechanical data and clinical data do not align. This is seen in cases of statistical but clinically irrelevant differences. This is also seen at times in cases of demonstrated clinical improvements with a poorly understood mechanism. Superior capsular reconstruction has gained significant traction since the original description in 2012. It has taken a central role in the armamentarium of treatment options of irreparable rotator cuff tears. There is robust published literature on the time zero biomechanics of superior capsular reconstruction and its stabilizing effects on the glenohumeral joint, especially with regards to superior migration of the humeral head. There also is demonstrated good early patient-reported outcomes with superior capsular reconstruction. However, the cause and effect may not be as simple as the biomechanical studies may suggest, and the underlying mechanism of why the superior capsular reconstruction appears to improve early outcomes remains poorly understood. These mechanisms are important to understand in order to inform technique changes and improvements and help us optimize treatment of the patient with an irreparable rotator cuff tear.
Ultrasonography Outperforms Magnetic Resonance Imaging in Diagnosing Partial-Thickness Subscapularis Tear
SizhengZhuM.D.aDarongPuM.D.bJiaLiM.D.cDandongWuM.D.dWeiHuangM.D.aNingHuM.D.aHongChenM.D.a
doi : 10.1016/j.arthro.2021.07.015
Volume 38, Issue 2, February 2022, Pages 278-284
Editorial Commentary: Magnetic Resonance Imaging Is Generally Superior to Ultrasound for Evaluation of Rotator Cuff Pathology: If Unrecognized Subscapularis Pathology Is Suspected After Magnetic Resonance Imaging, Ultrasound Can Then Be Performed
Michael D.FeldmanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.08.029
Volume 38, Issue 2, February 2022, Pages 285-286
The advantages of using ultrasound over magnetic resonance imaging (MRI) in the diagnosis of rotator cuff pathology include patient and technical factors. Patient factors include the lack of claustrophobia or positioning constraints. Technical considerations include dynamic and real-time assessment, absence of contraindications due to implants, decreased cost, and portability. However, the limitations of ultrasound include operator dependency and skill, limited availability of experienced ultrasonographers, decreased sensitivity for other shoulder pathology, and possible less sensitivity for some types of rotator cuff pathology. In my practice, MRI, when indicated, is still the test of choice, as it is readily available, more versatile in diagnosing a wide range of shoulder pathologies, and not dependent on the availability of a skilled ultrasound operator. Should there still be concern for an unrecognized partial subscapularis tendon injury after MRI, ultrasound can then be performed.
Intramedullary Unicortical Button and All-Suture Anchors Provide Similar Maximum Strength for Onlay Distal Biceps Tendon Repair
Donald F.ColantonioM.D.acAnthony H.LeM.S.bLaura E.KeelingM.D.dSean E.SlavenM.D.acTarun K.VippaB.S.eMelvin D.HelgesonM.D.acEdward S.ChangM.D.ce
doi : 10.1016/j.arthro.2021.06.036
Volume 38, Issue 2, February 2022, Pages 287-294
Editorial Commentary: All-Suture Anchors Are Evidence-Based and Biomechanically Sound but Require Additional Clinical Outcomes Evaluation
AlexanderOttoM.D.
doi : 10.1016/j.arthro.2021.09.022
Volume 38, Issue 2, February 2022, Pages 295-296
Bursal Acromial Reconstruction (BAR) Using an Acellular Dermal Allograft for Massive, Irreparable Posterosuperior Rotator Cuff Tears: A Dynamic Biomechanical Investigation
Daniel P.BertholdM.D.abMattRavenscroftF.R.C.S. (T&O)cRyanBellB.S.cElifhoObopilweM.S.bMark P.CoteD.P.T., P.T.bZenonKaneB.S.bBarnes W.MorganF.R.C.S. (T&O)cNilsMühlenfeldM.D.dAugustus D.MazzoccaM.S., M.D.bLukas N.MuenchM.D.ac
doi : 10.1016/j.arthro.2021.07.021
Volume 38, Issue 2, February 2022, Pages 297-306.e2
Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30
Eoghan T.HurleyM.B., B.Ch., M.Ch.Christopher A.ColasantiM.D.Nathan A.LorentzB.S.Kirk A.CampbellM.D.Michael J.AlaiaM.D.Eric J.StraussM.D.Bogdan A.MatacheM.D., C.M., F.R.C.S.C.Laith M.JazrawiM.D.
doi : 10.1016/j.arthro.2021.07.028
Volume 38, Issue 2, February 2022, Pages 307-312
Editorial Commentary: Subpectoral Biceps Tenodesis Is a Safe Alternative to Arthroscopic Repair for Unstable SLAP Tear in the Young Athlete: Should We Do the Last Operation First?
Brian R.WatermanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.10.019
Volume 38, Issue 2, February 2022, Pages 313-314
The clinical significance of structural pathology affecting the biceps-superior labrum complex may be highly variable. Among younger, physically active patients with symptomatic superior labrum anterior-posterior (SLAP) tears that have failed to respond to nonoperative treatment, we continue to lack clear high-level evidence to guide surgical decision making, including a decision between arthroscopic SLAP repair or primary biceps tenodesis for more unstable, type II lesions. Rates of patient satisfaction, return to play, return to prior level of activity, and secondary revision rate are widely reported, and we lack consensus for surgical best practice treatment. With the high rate of postoperative stiffness and revision reoperation and inconsistent functional outcomes after modern arthroscopic shoulder SLAP repair with knotless anchor technology, subpectoral biceps tenodesis may emerge as a primary alternative for treating the young athlete with unstable SLAP tears.
Outcomes of Arthroscopic Elbow Contracture Release: Improvement for Severe Prosupination and Flexion Contracture
Christina M.BeckM.D., Ph.D.Matthew J.GluckM.S.YiyangZhangM.D., F.R.C.S.C.Joshua D.McGoughM.S.WayneReiznerM.D.Todd A.RubinM.D.Michael R.HausmanM.D.
doi : 10.1016/j.arthro.2021.07.020
Volume 38, Issue 2, February 2022, Pages 315-322
Editorial Commentary: Arthroscopic Release of Severe Elbow Contracture Is Safe and Effective: It Can Be Done, and It Should Be Done
Andrew J.SheeanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.12.015
Volume 38, Issue 2, February 2022, Pages 323-324
The surgical management of elbow contracture remains a challenging proposition, and both open and arthroscopic approaches have been described with varying degrees of success. In particular, previous series involving severe cases have left much to be desired in terms of clinical outcomes and complication rates. Herein lies an opportunity for innovation via alternative, arthroscopic approaches. In the hands of a single senior surgeon, arthroscopic elbow contracture release can be accomplished, even in the setting of severe, post-traumatic cases, with an expectation for substantial improvements in the arc of motion and comparable, if not better, complication rates than reported previously in other series. However, concerns regarding the reproducibility of these results persist and should compel future efforts to prove that these techniques can yield similar results among a group of surgeons.
A Single Injection of Amniotic Suspension Allograft Is Safe and Effective for Treatment of Mild to Moderate Hip Osteoarthritis: A Prospective Study
Molly C.MeadowsM.D.aKatiaElismanM.S.aShane J.NhoM.D.bKatieMowryPh.D.cMarc R.SafranM.D.a
doi : 10.1016/j.arthro.2021.04.034
Volume 38, Issue 2, February 2022, Pages 325-331
Editorial Commentary: Amniotic Orthopaedic Biologics: There’s Hope If We Avoid Hype
Kenneth R.ZaslavM.D.
doi : 10.1016/j.arthro.2021.06.012
Volume 38, Issue 2, February 2022, Pages 332-334
Amniotic products donated from mothers having live births have been in use for wound care and other medical uses for many years. Recent developments in regenerative sciences have suggested these products in solution or lyophilized forms may be useful for the treatment of inflammatory diseases such as chronic tendinopathies and osteoarthritis of joints. These products for these indications, however, are deemed human cells, tissues, or cellular or tissue-based products (otherwise known as HCTPs) in the “351” category, meaning that they need to have a biologic license to be marketed and sold in the United States, and to gain this license, one needs to go through the usual rigor of investigational new drug filing and phase 1, 2, and 3 trials to prove safety and efficacy. Although current clinical use of amniotic solution and lyophilized products is on hold through this study period, both basic science and clinical trial studies are building a convincing set of data that suggest broad possibilities for their uses in the future. To date, both animal and human studies have shown that a single injection of amniotic suspension allograft is safe, has not elicited any significant immune response, and has been shown to be effective in several prospective studies and at least one well-controlled randomized controlled human study for knee osteoarthritis when compared with both hyaluronic acid and placebo saline. Proteins in these harvested and processed tissue allografts are anti-inflammatory, anticatabolic, and proanabolic. Appropriate caution by the Food and Drug Administration in granting licenses for these indications should not dissuade basic scientists and physicians from pursuing further research into these interesting products.
Comparable Minimum 2-Year Patient-Reported Outcome Scores Between Circumferential and Segmental Labral Reconstruction for the Management of Irreparable Labral Tear and Femoroacetabular Impingement Syndrome in the Primary Setting: A Propensity-Matched Study
David R.MaldonadoM.D.aCynthiaKyinB.A.aJacobShapiraM.D.aMitchell B.MeghparaM.D.acPhilip J.RosinskyM.D.aAjay C.LallM.D.abcBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.04.037
Volume 38, Issue 2, February 2022, Pages 335-348
Editorial Commentary: Segmental Hip Labral Reconstruction May Be Superior to Circumferential Reconstruction: Bigger Isn’t Better
Elizabeth J.ScottM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.05.069
Volume 38, Issue 2, February 2022, Pages 349-351
Hip arthroscopic segmental and circumferential labral reconstruction show similar outcomes in short-term follow-up. Will bigger (circumferential reconstruction) eventually be largely a historical method? Bigger does not appear to be better, although some argue that segmental techniques inadequately restore the labrum’s function, incompletely treat the defect, and result in mismatch at the labral-graft junction, which is also a “weak spot” for future tears. Yet, others show that circumferential reconstruction is without clear benefit and adds additional anchors, complexity and operating room time and costs. The next phase of research on hip labral reconstruction requires evaluation of the numerous variables within the category of “reconstruction.” Today, a great number of different reconstruction techniques exist. Measuring a segmental defect can be challenging but is facilitated with methods such as the kite technique, use of a shoulder superior capsular reconstruction guide, or a pull-through method to simply avoid measuring. Graft options include ligamentum teres and iliotibial band, anterior and posterior tibialis, hamstring, fascia lata, autograft and allograft. Graft preparation, passage, and fixation techniques also vary widely. Finally, determining how much overlap with native labrum, ideal graft tension, or integrating the transverse acetabular ligament is more art than science. It’s time we begin to critically evaluate the differences in reconstructive techniques.
Multicenter Outcomes After Primary Hip Arthroscopy: A Comparative Analysis of Two-Year Outcomes After Labral Repair, Segmental Labral Reconstruction, or Circumferential Labral Reconstruction
Blake M.BodendorferM.D.aThomas D.AlterM.S.aDominic S.CarreiraM.D.bAndrew B.WolffM.D.cBenjamin R.KivlanPh.D., P.T.dJohn J.ChristoforettiM.D.efgJohn P.SalvoM.D.hiDean K.MatsudaM.D.jShane J.NhoM.D., M.S.a
doi : 10.1016/j.arthro.2021.05.013
Volume 38, Issue 2, February 2022, Pages 352-361
Editorial Commentary: Hip Primary Labral Repair Versus Reconstruction: Equally Successful Outcomes Can Be Achieved Based on Proper Indications
Joshua D.HarrisM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.08.013
Volume 38, Issue 2, February 2022, Pages 362-364
One of the core principles of hip arthroscopy is preservation of the acetabular labrum. Compromise of the biomechanical function of the labrum underlies a significant symptom source in patients undergoing hip preservation surgery. As surgical techniques continue to improve and evolve beyond labral repair, increased use of advanced arthroscopic procedures like segmental and circumferential reconstruction shed further light on the optimal labral intervention. In the revision setting, labral deficiency warrants labral reconstruction or augmentation. Both segmental and circumferential techniques may significantly improve patient-reported outcomes. However, in the primary setting, controversy exists not necessarily in the surgical technique, but more in the indications to perform which specific labral intervention. Reasonable indications for primary labral reconstruction include a calcified or ossified labrum, irreparable labral tissue, and hypotrophy of the labrum (less than 2-3 mm) with a proven deficient suction seal without resistance to axial distraction. Short-term multicenter studies demonstrate similar success rates between primary labral reconstruction and repair using validated patient-report outcome scores. Mid- and long-term clinical and economic investigations comparing labral reconstruction and repair are needed to determine the role of primary reconstruction in modern arthroscopic hip preservation surgery.
The Effect of Rim Preparation, Labral Augmentation, and Labral Reconstruction on the Suction Seal of the Hip
SunikomSuppauksornM.D.Kevin C.ParvareshM.D.JonathanRasioB.S.Elizabeth F.ShewmanM.S.Shane J.NhoM.D., M.S.
doi : 10.1016/j.arthro.2021.04.050
Volume 38, Issue 2, February 2022, Pages 365-373
Femoro-Epiphyseal Acetabular Roof (FEAR) Index and Anterior Acetabular Coverage Correlate With Labral Length in Developmental Dysplasia of the Hip
YuichiKurodaM.D., Ph.D.aShingoHashimotoM.D., Ph.D.aMasayoshiSaitoM.D.bTomoyukiMatsumotoM.D., Ph.D.aNaokiNakanoM.D., Ph.D.aRyosukeKurodaM.D., Ph.D.aShinyaHayashiM.D., Ph.D.a
doi : 10.1016/j.arthro.2021.04.051
Volume 38, Issue 2, February 2022, Pages 374-381
Editorial Commentary: Hip Dysplasia—Arthroscopic Femoroacetabular Impingement Versus Periacetabular Osteotomy: Do Not FEAR the Size of the Next Step
AlexanderZimmererM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.06.032
Volume 38, Issue 2, February 2022, Pages 382-384
Hip dysplasia is characterized by inadequate acetabular coverage of the femoral head. There is a consensus that hip dysplasia with a lateral center edge angle (LCEA) less than18° should be treated with realignment of acetabular coverage by acetabular osteotomy, but there is controversy whether milder, borderline dysplasia with an LCEA between 18° and 25° should be treated with arthroscopy or acetabular reorientation. Identifying whether the problem is related to dysplasia or femoroacetabular impingement syndrome is essential, and a crucial factor is whether the hip is unstable. A femoroepiphyseal acetabular roof (FEAR) index with a cutoff value of 2 predicts hip stability with 90% probability, even with a normative LCEA. In addition, according to the anterior-wall index (AWI), the anterior acetabular border should cross onto the middle third of the medial femoral head radius on a line that runs parallel to the femoral neck axis through the center of the femoral head. A reduced AWI suggests a deficient anterior rim. Next, lateral labrum length correlates with the FEAR index and anterior labrum length with AWI, i.e., anterior dysplasia. Consequently, the lateral labrum increases in size with progressive instability, and the anterior labrum increases in size with decreased anterior coverage. Threshold values for labrum size should be defined to guide clinical decision making. Ultimately, we require an algorithm to guide arthroscopy versus bony correction.
The Inverse Relationship Between Labral Size and Acetabular Coverage: Does It Protect the Cartilage in the Dysplastic Hip?
JacobShapiraM.D.aJeffrey W.ChenB.A.cMitchell J.YeltonB.S.aPhilip J.RosinskyM.D.aDavid R.MaldonadoM.D.aMitchell B.MeghparaM.D.adAjay C.LallM.D., M.S.abdBenjamin G.DombM.D.abd
doi : 10.1016/j.arthro.2021.04.052
Volume 38, Issue 2, February 2022, Pages 385-393
Changes in Hip Capsule Morphology after Arthroscopic Treatment for Femoroacetabular Impingement Syndrome with Periportal Capsulotomy are Correlated With Improvements in Patient-Reported Outcomes
Kevin H.NguyenB.S.aChaceShawB.A.aThomas M.LinkM.D., Ph.D.bSharmilaMajumdarPh.D.bRichard B.SouzaP.T., Ph.D.bThomas P.VailM.D.aAlan L.ZhangM.D.a
doi : 10.1016/j.arthro.2021.05.012
Volume 38, Issue 2, February 2022, Pages 394-403
Dynamic Assessment of Femoroacetabular Impingement Syndrome Hips
Andrea M.SpikerM.D.aAndrew P.KraszewskiPh.D.cTravis G.MaakM.D.dBenedict U.NwachukwuM.D.bSherry I.BackusP.T., D.P.T., M.A.cHoward J.HillstromPh.D.cBryan T.KellyM.D.bAnil S.RanawatM.D.b
doi : 10.1016/j.arthro.2021.05.062
Volume 38, Issue 2, February 2022, Pages 404-416.e3
Autologous Platelet-Rich Fibrin Membrane to Augment Healing of Microfracture Has Better Macroscopic and Histologic Grades Compared With Microfracture Alone on Chondral Defects in a Rabbit Model
TakuyaKinoshitaM.D.YusukeHashimotoM.D., Ph.D.KumiOritaPh.D.YoheiNishidaM.D.KazuyaNishinoM.D.HiroakiNakamuraM.D., Ph.D.
doi : 10.1016/j.arthro.2021.04.055
Volume 38, Issue 2, February 2022, Pages 417-426
Intraoperative and Early (90-Day) Postoperative Complications and Associated Variables with Multiligamentous Knee Reconstruction: 15-year Experience from a Single Academic Institution
Derek P.AxibalM.D.aNicholas C.YeattsB.S.abAlexander A.HysongM.D.bIan S.HongB.M.Sc.abDavid P.TrofaM.D.cClaude T.MoormanIIIM.D.abDana P.PiaseckiM.D.aJames E.FleischliM.D.aBryan M.SaltzmanM.D.ab
doi : 10.1016/j.arthro.2021.05.027
Volume 38, Issue 2, February 2022, Pages 427-438
Editorial Commentary: Prevention of Complications During Multiple Ligament Knee Injury Reconstruction: It’s Complicated!
Mark D.MillerM.D.
doi : 10.1016/j.arthro.2021.08.025
Volume 38, Issue 2, February 2022, Pages 439-440
Treatment of multiple-ligament knee injuries is complex and complicated. Surgeons should strive to keep their operative times under 5 hours, limit inside-out meniscal repair, consider fibular-based only posterolateral corner reconstructions (except in cases with associated proximal tibia-fibular joint injuries or massive posterolateral corner injuries), avoid acute surgery when possible, and proceed cautiously with ultra-low-velocity dislocations. Multiple-ligament knee injury reconstruction is challenging and complicated but a sincere thank you is extended to those surgeons who take on complex knee surgery.
Biochemical Characteristics and Clinical Result of Bone Marrow–Derived Fibrin Clot for Repair of Isolated Meniscal Injury in the Avascular Zone
YusukeHashimotoM.D., Ph.D.aKazuyaNishinoM.D.aKumiOritaPh.D.aShinyaYamasakiM.D., Ph.D.bYoheiNishidaM.D.aTakuyaKinoshitaM.D.aHiroakiNakamuraM.D., Ph.D.a
doi : 10.1016/j.arthro.2021.05.026
Volume 38, Issue 2, February 2022, Pages 441-449
Editorial Commentary: Biologic Augmentation of Meniscus Repair Is Complex
Nikolaos K.PaschosM.D., Ph.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.08.017
Volume 38, Issue 2, February 2022, Pages 450-451
In the setting of biological augmentation for meniscus repair, it is extremely important to evaluate all aspects, including effectiveness, costs, potential risks, benefits, and limitations. It seems that everything matters in healing: the aspirate source of the bioactive agents, cell content, presence of stem cells and their type, growth factors, cytokines, biomechanical scaffold, and the quality of the tissue. There are several differences among mesenchymal, adipose, and peripheral blood stem cells, with the cell origin affecting the differentiation potential towards bone, cartilage and ligament. Moreover, different aspirate sources and fibrin clots have different content in cells, growth factors, and cytokines. In this equation, it is not as simple as the more the better. Different doses of growth factors may have different effects in the different cell types. And as this was not complicated enough, synergistic phenomena between cells and between growth factors can play a huge role. Add to that the role of the biomechanical environment, the proper timing of the healing phases and the inherent patient characteristics. There is very, very much to learn, and finally, we acknowledge that not all menisci repairs can always heal.
Do Outcomes of Meniscal Allograft Transplantation Differ Based on Age and Sex? A Comparative Group Analysis
RachelFrankM.D.RonGilatM.D.Eric D.HaunschildB.S.HaileyHuddlestonM.D.SumitPatelM.S.AghoghoEvuarherheJr.B.S.Derrick M.KnapikM.D.JustinDragerM.D.Adam B.YankeM.D., Ph.D.Brian J.ColeM.D., M.B.A.
doi : 10.1016/j.arthro.2021.05.029
Volume 38, Issue 2, February 2022, Pages 452-465.e3
A National Perspective of Patellar Instability in Children and Adolescents in the United States: MPFL Reconstruction Is Three Times Higher Than the Incidence of Isolated Lateral Release
PramodKamalapathyB.A.aJeremyK. RushM.D.aSamuel R.MontgomeryJr.B.S.bDavid R.DiduchM.D.aBrian C.WernerM.D.a
doi : 10.1016/j.arthro.2021.05.061
Volume 38, Issue 2, February 2022, Pages 466-473.e1
Editorial Commentary: Despite Decades of Research on Patellar Instability, the Isolated Lateral Release Endures
Elizabeth J.ScottM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.07.026
Volume 38, Issue 2, February 2022, Pages 474-475
Surgical management of patellar instability has transformed over the last 40 years as our understanding of contributing anatomical factors, particularly medial patellofemoral ligament insufficiency, has matured. The International Patellofemoral Study Group recently concluded with 89% agreement that lateral release should not be done in isolation for patellofemoral instability. And yet, with 11% dissent, controversy remains, and the isolated lateral retinacular release for patellar instability continues to be favored by a subset of surgeons. In my opinion, lateral retinacular release may have a role in the rare situation in which laterally based capsuloligamentous tightness has led to focal patellar compression, but in the setting of patellar instability, lateral release should not be used alone as a solution for patellofemoral instability.
Intra-articular Pure Platelet-Rich Plasma Combined With Open-Wedge High Tibial Osteotomy Improves Clinical Outcomes and Minimal Joint Space Width Compared With High Tibial Osteotomy Alone in Knee Osteoarthritis: A Prospective Study
QianZhangM.D.aWuXuM.D.aKailunWuM.D.bWeiliFuM.D., Ph.D.cHuilinYangM.D., Ph.D.aJiong JiongGuoM.D., Ph.D.a
doi : 10.1016/j.arthro.2021.09.013
Volume 38, Issue 2, February 2022, Pages 476-485
Editorial Commentary: Intraoperative Platelet-Rich Plasma Injections for Open-Wedge High Tibial Osteotomies Effectively Improve Clinical Outcomes and Minimal Medial Joint Space Width: An Orthobiologic Application
KevinCredilleB.S.E., M.S.DhanurDamodarM.D.AdamYankeM.D., Ph.D.
doi : 10.1016/j.arthro.2021.11.010
Volume 38, Issue 2, February 2022, Pages 486-488
Osteoarthritis is a significant cause of morbidity and mortality involving the knee joint, and high tibial osteotomy is becoming more commonly used to treat severe knee osteoarthritis. In addition, the best management and therapies to mitigate osteoarthritis symptoms and progression may include biologic injections, as we focus on more than just structural abnormalities but also on the inflammatory environment in the joint. These therapies include platelet-rich plasma, bone marrow aspirate concentrate, cell-based therapies, adipose-derived stromal cells, and amniotic suspension allografts. Recent research supports a promising therapy: combined high tibial osteotomy and intraoperative, intraarticular platelet-rich plasma injection.
Isolated Arthroscopic Partial Meniscectomy Is More Effective at Improving Meniscal Symptoms in Comparison With Mechanical Symptoms in Patients With Concomitant Untreated Chondral Lesions
Leslie J.BissonM.D.aMelissa A.KluczynskiM.S.aWilliam M.WindM.D.aMarc S.FinebergM.D.aGeoffrey A.BernasM.D.aMichael A.RauhM.D.aJohn M.MarzoM.D.aZehuaZhouPh.D.bJiweiZhaoPh.D.c
doi : 10.1016/j.arthro.2021.09.029
Volume 38, Issue 2, February 2022, Pages 489-497.e17
Biologically Augmented Suture for Ligament Bracing Procedures Positively Affects Human Ligamentocytes and Osteoblasts In Vitro
AlexanderOttoM.D.bcMary Beth R.McCarthyB.S.aJoshua B.BaldinoPharm.D., M.D.aJulianMehlM.D.bLukas N.MuenchM.D.bLisa M.TamburiniM.S.aColin L.UyekiB.A.aRobert A.ArcieroM.D.aAugustus D.MazzoccaM.S., M.D.a
doi : 10.1016/j.arthro.2021.11.006
Volume 38, Issue 2, February 2022, Pages 498-505
Tranexamic Acid Use in Anterior Cruciate Ligament Reconstruction Decreases Bleeding Complications: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
NedalAlkhatibM.D.aMasonAlNouriM.D.bAbdullah Saad A.AbdullahM.D.cOsama ZiedAhmad AlzobiM.D.dEslamAlkaramanyM.D.dEijiSasakiM.D., Ph.D.bYasuyukiIshibashiM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.07.030
Volume 38, Issue 2, February 2022, Pages 506-518.e6
Editorial Commentary: The Current Evidence in Support of Tranexamic Acid in Arthroscopic Surgery Is Poor
ErikHohmannM.B.B.S., F.R.C.S., F.R.C.S. (Tr.&Orth.), Ph.D., M.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.11.014
Volume 38, Issue 2, February 2022, Pages 519-521
Tranexamic acid (TXA) has been used to treat severe bleeding events for nearly 60 years and is on the list of World Health Organization essential medicines. Initially, it was described to treat heavy menstrual bleeding, but it is now used for a variety of applications. In orthopedic surgery, TXA is commonly used to reduce bleeding after total joint arthroplasty and spine surgery. The use of TXA for joint arthroplasty has been principally endorsed by various orthopedic societies, but they have also criticized a lack of evidence for high-risk patients with a history of pulmonary embolus, vascular stents, stroke, transient ischemic attack, and other cardiac, respiratory, or vascular conditions. TXA may also reduce bleeding complications in arthroscopic surgery, and the findings of recent meta-analyses suggest that intravenous application reduced drainage output and the need for knee joint aspiration and reduced knee swelling. It also had a positive short-term effect on clinical and functional outcomes. However, high risk of bias, low-study quality, and heterogeneity substantially reduced the quality of evidence and the validity of the study conclusions. In my opinion, on the basis of the current evidence, the routine use of TXA in arthroscopic surgery is not recommended.
Shoulder Latarjet Surgery Shows Wide Variation in Reported Indications, Techniques, Perioperative Treatment, and Definition of Outcomes, Complications, and Failure: A Systematic Review
Justin W.ArnerM.D.aKiraTangheB.S.aTannerShieldsB.S.aAbedAbdelazizM.D.bSimonLeeM.D.aLiamPeeblesB.A.aCAPTMatthew T.ProvencherM.D., M.B.A., M.C., U.S.N.R. (Ret.)a
doi : 10.1016/j.arthro.2021.09.020
Volume 38, Issue 2, February 2022, Pages 522-538
Platelet-Rich Plasma Has Better Results for Retear Rate, Pain, and Outcome Than Platelet-Rich Fibrin After Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials
YinghaoLiM.D.TaoLiM.D.JianLiM.M.XinTangM.D.RanLiB.S.YanXiongM.D.
doi : 10.1016/j.arthro.2021.05.023
Volume 38, Issue 2, February 2022, Pages 539-550
Bone Block Augmentation of the Posterior Glenoid for Recurrent Posterior Shoulder Instability Is Associated With High Rates of Clinical Failure: A Systematic Review
Daniel J.CognettiM.D.aJonathan D.HughesM.D.bJeffreyKayM.D.cJesseChasteenM.D.dMichael A.FoxM.D.bRobert U.HartzlerM.D.eAlbertLinM.D.bAndrew J.SheeanM.D.a
doi : 10.1016/j.arthro.2021.07.018
Volume 38, Issue 2, February 2022, Pages 551-563.e5
Editorial Commentary: Posterior Shoulder Instability Surgical Treatment Outcomes Are Inferior to Outcomes of Anterior Instability: Standardization of Patient Evaluation and Indications Could Improve Results
Annalise M.PeeblesB.A.CAPTMatthew T.ProvencherM.D., M.B.A., M.C., U.S.N.R. (Ret.)(Editorial Board)
doi : 10.1016/j.arthro.2021.08.028
Volume 38, Issue 2, February 2022, Pages 564-566
Arthroscopic capsulolabral repair remains the mainstay of treatment in patients with refractory shoulder posterior instability. In addition, glenoid bone block augmentation procedures for posterior shoulder instability are gaining momentum. Unfortunately, results from anterior glenoid bone block augmentation procedures have enjoyed much better success than posterior, and it is unclear why surgical treatment of posterior instability with either congenital or acquired retroversion, with or without posterior bone loss, can result in complications or poor outcomes. It is essential to standardize evaluation and reporting of clinical presentation, radiographic assessment, indications, and mid- to long-term follow-up in patients who undergo posterior shoulder bony augmentation procedures. Current literature suggests that greater than 11% posterior glenoid bone loss increases risk of surgical failure 10 times, and 15% posterior bone loss increases risk of surgical failure 25 times, suggesting a possible threshold for posterior bony augmentation. However, in the end, the problem is complex, and work remains to better define optimal patient indications in consideration of congenital or acquired pathology, retroversion, amount of bone loss, and patient demographics and risk factors.
Arthroscopically Assisted Coraco-Clavicular Ligament Reconstruction in Treatment of Acute Displaced Distal Clavicle Fractures Provides Good to Excellent Shoulder Function Despite Low Union Rates and High Complication Rates: A Systematic Review
Shahbaz S.MalikM.Sc. (Orth Engin), L.L.M., F.R.C.S. (Tr&Orth)aMuaazTahirM.B.B.S., M.R.C.S.bSherazMalikM.Sc. (Orth Engin), L.L.M., F.R.C.S. (Tr&Orth)cAdamKwapiszM.D., Ph.D.dRobert W.JordanM.Sc., F.R.C.S. (Tr&Orth)e
doi : 10.1016/j.arthro.2021.06.034
Volume 38, Issue 2, February 2022, Pages 567-582
Social Determinants of Health Influence Access to Care and Outcomes in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Systematic Review
AlexanderZiedasB.S.VaragAbedB.S.AlexanderSwantekB.S.E.AustinCrossB.S.SarahChaidesB.S.TahsinRahmanM.D.Eric C.MakhniM.D., M.B.A.
doi : 10.1016/j.arthro.2021.06.031
Volume 38, Issue 2, February 2022, Pages 583-594.e4
Editorial Commentary: Identifying the Problem Is Only the First Step in Fixing Disparities in Anterior Cruciate Ligament Injury Care
Daniel M.CurtisM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.08.010
Volume 38, Issue 2, February 2022, Pages 595-596
Anterior cruciate ligament reconstruction (ACL-R) is one of the most commonly performed orthopaedic surgeries. Social determinants of health, including race, ethnicity, income, education, insurance, and employment status, are major nonmodifiable risk factors for worse outcomes and higher complication rates after ACL-R. Improved understanding of these variables can help surgeons assess risk and counsel their patients, but evidence-based solutions to improving access to care and outcomes after ACL-R in at-risk patients are needed.
Improved Outcome and Earlier Return to Activity After Suture Tape Augmentation Versus Broström Repair for Chronic Lateral Ankle Instability? A Systematic Review
UlrikeWittigM.D.aGloriaHohenbergerM.D., Ph.D.aMartinOrnigM.D.aReinhardSchuhM.D., Ph.D.bPatrickReinbacherM.D.aAndreasLeithnerM.D.aPatrickHolwegM.D.a
doi : 10.1016/j.arthro.2021.06.028
Volume 38, Issue 2, February 2022, Pages 597-608
Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Instruments Compare Favorably With Legacy Patient-Reported Outcome Measures in Upper- and Lower-Extremity Orthopaedic Patients: A Systematic Review of the Literature
Alexander C.ZiedasB.S.VaragAbedB.S.Alexander J.SwantekB.S.E.Tahsin M.RahmanM.D.AustinCrossB.S.KatherineThomashowM.S.Eric C.MakhniM.D., M.B.A.
doi : 10.1016/j.arthro.2021.05.031
Volume 38, Issue 2, February 2022, Pages 609-631
Best Practice Guidelines for Propensity Score Methods in Medical Research: Consideration on Theory, Implementation, and Reporting. A Review
Jeffrey W.ChenB.A.aDavid R.MaldonadoM.D.bBrooke L.KowalskiB.S.aKara B.MiecznikowskiB.S.bCynthiaKyinB.S.bJeffrey A.GornbeinPh.D.eBenjamin G.DombM.D.bcd
doi : 10.1016/j.arthro.2021.06.037
Volume 38, Issue 2, February 2022, Pages 632-642
Rigorous and reproducible methodology of controlling for bias is essential for high-quality, evidence-based studies. Propensity score matching (PSM) is a valuable way to control for bias and achieve pseudo-randomization in retrospective observation studies. The purpose of this review is to 1) provide a clear conceptual framework for PSM, 2) recommend how to best report its use in studies, and 3) offer some practical examples of implementation. First, this article covers the concepts behind PSM, discusses its pros and cons, and compares it with other methods of controlling for bias, namely, hard/exact matching and regression analysis. Second, recommendations are given for what to report in a manuscript when PSM is used. Finally, a worked example is provided, which can also serve as a template for the reader’s own studies. A study’s conclusions are only as strong as its methods. PSM is an invaluable tool for producing rigorous and reproducible results in observational studies. The goal of this article is to give practicing clinical physicians not only a better understanding of PSM and its implications but the ability to implement it for their own studies.
Nonoperative and Operative Bone and Cartilage Regeneration and Orthopaedic Biologics of the Hip: An Orthoregeneration Network (ON) Foundation Hip Review
JacquesHernigouM.D.aPeterVerdonkM.D., Ph.D.bYasuhiroHommaM.D., Ph.D.dRenéVerdonkM.D.cStuart B.GoodmanM.D., Ph.D.ePhilippeHernigouM.D.f
doi : 10.1016/j.arthro.2021.08.032
Volume 38, Issue 2, February 2022, Pages 643-656
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 electromagnetic 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 hip, including osteonecrosis (aseptic necrosis) involving bone marrow, bone, and cartilage, and chondral injuries involving articular cartilage, synovium, and bone marrow. Promising and established treatment modalities for osteonecrosis include nonweightbearing; pharmacological treatments including low molecular-weight heparin, prostacyclin, statins, bisphosphonates, and denosumab, a receptor activator of nuclear factor-kB ligand inhibitor; extracorporeal shock wave therapy; pulsed electromagnetic fields; core decompression surgery; cellular therapies including bone marrow aspirate comprising mesenchymal stromal cells (MSCs aka mesenchymal stem cells) and bone marrow autologous concentrate, with or without expanded or cultured cells, and possible addition of bone morphogenetic protein-2, vascular endothelial growth factor, and basic fibroblast growth factor; and arterial perfusion of MSCs that may be combined with addition of carriers or scaffolds including autologous MSCs cultured with beta-tricalcium phosphate ceramics associated with a free vascularized fibula. Promising and established treatment modalities for chondral lesions include autologous platelet-rich plasma; hyaluronic acid; MSCs (in expanded or nonexpanded form) derived from bone marrow or other sources such as fat, placenta, umbilical cord blood, synovial membrane, and cartilage; microfracture or microfracture augmented with membrane containing MSCs, collagen, HA, or synthetic polymer; mosaicplasty; 1-stage autologous cartilage translation (ACT) or 2-stage ACT using 3-dimensional spheroids; and autologous cartilage grafting; chondral flap repair, or flap fixation with fibrin glue. Hip pain is catastrophic in young patients, and promising therapies offer an alternative to premature arthroplasty. This may address both physical and psychological components of pain; the goal is to avoid or postpone an artificial joint.
