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Instructions for Authors
doi : 10.1016/S0749-8063(21)00100-6
Volume 37, Issue 3, March 2021, Page A35
Proper Evaluation of Bone Loss Determines Shoulder Instability Indications and Outcomes
James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.01.004
Volume 37, Issue 3, March 2021, Pages 785-786
One of the most-read articles published in the history of Arthroscopy: The Journal of Arthroscopic and Related Surgery is “Evolving Concept of Bipolar Bone Loss and the Hill-Sachs Lesion: From ‘Engaging/Non-Engaging’ Lesion to ‘On-Track/Off-Track’ Lesion” by Di Giacomo, Itoi, and Burkhart. This 2014 article is a modern classic and has inspired a plethora of recent research as well as infographics published in Arthroscopy. We now understand, to the great benefit of patients, that proper evaluation of bone loss determines shoulder instability surgical indications and outcomes.
Regarding “The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis”
AdnanSaithnaM.D., F.R.C.S. (T&O)Camilo P.HelitoM.D.AlessandroCarrozzoM.D.Jin GooKimM.D.BertrandSonnery-CottetM.D.
doi : 10.1016/j.arthro.2020.12.200
Volume 37, Issue 3, March 2021, Pages 787-789
Author Reply to “Regarding ‘The Effect of Combined Anterolateral and Anterior Cruciate Ligament Reconstruction on Reducing Pivot Shift Rate and Clinical Outcomes: A Meta-analysis’”
CaiqiXuM.D.JieboChenM.D.EunshinaeChoB.M.JinzhongZhaoM.D.
doi : 10.1016/j.arthro.2020.12.199
Volume 37, Issue 3, March 2021, Pages 789-791
Meniscal Repair Techniques for Middle- and Posterior-Third Tears
Zachary S.AmanB.A.aJonathan F.DickensM.D.bTravis J.DekkerM.D.c
doi : 10.1016/j.arthro.2021.01.003
Volume 37, Issue 3, March 2021, Pages 792-794
Abstract: Technical advancements in meniscal repairs have greatly contributed to the ability to repair a variety of meniscal tears that were once thought untreatable. The gold-standard treatment for arthroscopic meniscal body repair remains an inside-out technique. The advantages of this technique are innate to the low-profile nature of the suture-passing construct, which allows for perpendicular access to tears with the benefit of multiple fixation points, in contrast to often bulkier all-inside repair devices. This technique requires a posteromedial or posterolateral incision for safe suture passing and needle retrieval and necessitates a surgical team experienced in this method of repair. However, the newest generation of all-inside devices has allowed for more facile placement of a variety of suture types. The all-inside repair technique includes both capsular-based and meniscal-based fixation, is not limited by a need for additional experienced surgical personnel to pass and retrieve needles, and does not require additional incisions. Regardless of fixation type, meniscal repair has been shown to improve long-term functional scores when compared with meniscectomy. Additionally, biological adjuncts have been introduced into the repair algorithm to improve healing rates when performing isolated meniscal repairs. Preparing the healing site with abrasion or trephination creates vascular channels that can facilitate repair. Intercondylar-notch marrow venting attempts to replicate the environment created by anterior cruciate ligament drilling for which healing rates are notably higher than those with isolated meniscal repairs. The use of fibrin clots in inside-out meniscal repairs with suturing of the clot to the area of the tear has also shown promising early healing rates on both magnetic resonance imaging and second-look arthroscopy. Finally, biological adjuncts such as platelet-rich plasma and concentrated bone marrow aspirate have shown both early clinical and radiographic improvements in Level IV case series, but further research is needed to more definitively measure their utility in the setting of meniscal repair.
Excellent Clinical and Radiological Midterm Outcomes for the Management of Recurrent Anterior Shoulder Instability by All-Arthroscopic Modified Eden-Hybinette Procedure Using Iliac Crest Autograft and Double-Pair Button Fixation System: 3-Year Clinical Case Series With No Loss to Follow-Up
GrigoriosAvramidisM.D., M.Sc.aStefaniaKokkineliM.D.aAngelosTrellopoulosM.D., M.Sc.aAnastasiaTsiogkaM.D., M.Sc.bMargaritaNatsikaM.D.cEmmanouilBrilakisM.D., M.Sc.aEmmanouilAntonogiannakisM.D.a
doi : 10.1016/j.arthro.2020.10.036
Volume 37, Issue 3, March 2021, Pages 795-803
To evaluate the clinical, functional, and radiological midterm outcomes of the all-arthroscopic modified Eden-Hybinette procedure in patients with recurrent anterior shoulder instability.
Editorial Commentary: Arthroscopic Shoulder Instability Surgery and Glenoid Bone Loss: A Paradigm Shift?
Peter S.VezeridisM.D., M.M.S., Social Media Board
doi : 10.1016/j.arthro.2020.12.205
Volume 37, Issue 3, March 2021, Pages 804-805
The successful treatment of shoulder instability, particularly in the setting of glenoid bone loss, is a challenging problem. There are several surgical options that are available for patients who have this clinical entity. Of these options, bone block procedures have become increasing common over the past several years, both for primary and revision surgery, with the aim to restore the native glenoid anatomy. The arthroscopic Eden–Hybinette procedure is a viable arthroscopic treatment option in patients who have anterior shoulder instability with anterior glenoid insufficiency. This technique has some distinct advantages over other bone block procedures, specifically the ability to avoid damage to the subscapularis and to preserve the coracoid process. In addition, the use of autograft has benefits over glenoid reconstruction procedures that use allograft, specifically pertaining to cost and availability.
Increased Risk of Short-Term Complications and Venous Thromboembolism in Latarjet-Bristow Procedures Compared With Bankart Repairs
J. BrettGoodloeM.D.Sophia A.TravenM.D.Charles A.JohnsonM.D.Shane K.WoolfM.D.John T.NuttingM.D.Harris S.SloneM.D.
doi : 10.1016/j.arthro.2020.10.039
Volume 37, Issue 3, March 2021, Pages 806-813
To (1) determine the rate of surgical complications and venous thromboembolism (VTE) in patients undergoing arthroscopic Bankart repair, open Bankart repair, or Latarjet-Bristow; and (2) assess potential risk factors for surgical complications and VTE in patients undergoing shoulder stabilization procedures.
Editorial Commentary: The Latarjet: Increased Shoulder Stability, and Increased Risk of Complications in Low Volume Practitioners
Benjamin G.GuevaraM.D., Editorial Board
doi : 10.1016/j.arthro.2020.12.202
Volume 37, Issue 3, March 2021, Pages 814-815
The Latarjet procedure is a well-established treatment for shoulder instability. It is traditionally used for recurrent instability with significant bone loss (i.e. >20%) or after failed soft tissue procedures. It can be done open or arthroscopically with either a subscapularis takedown or a split. It has good long-term results regarding recurrence and clinical outcomes. Unfortunately, it has higher complication rates in comparison to its alternative procedures such as arthroscopic Bankart repair or open Bankart repair. These complications may be due to the learning curve of performing the procedure and lack of proper training. The Latarjet procedure is a necessary tool to treat shoulder instability. We need better training and exposure to Latarjet procedures in residency, fellowship, and clinical practice so that more providers can do this procedure for our patients, but we need to do it more safely.
Acceptable Long-Term Outcomes of Arthroscopic Bone Grafting for Recurrent Posterior Shoulder Instability: Minimum Follow-Up of 5 Years
Roland StefanCamenzindM.D.abJavierMartin BecerraM.D.acLouisGossingM.D.adJulienSerane-FresnelM.D.aeEric R.WagnerM.D.afLaurentLafosseM.D.a
doi : 10.1016/j.arthro.2020.10.052
Volume 37, Issue 3, March 2021, Pages 816-823
To examine the long-term clinical outcome associated with arthroscopically placed autologous iliac crest bone graft (ICBG) for recurrent posterior shoulder instability.
Arthroscopic Iliac Crest Bone Allograft Combined With Subscapularis Upper-Third Tenodesis Shows a Low Recurrence Rate in the Treatment of Recurrent Anterior Shoulder Instability Associated With Critical Bone Loss
RaffaeleRussoM.D.aMarcoMaiottiM.D.bAndreaCozzolinoM.D.aGiuseppeDella RotondaM.D.aAntonioGuastafierroM.D.aCarloMassoniM.D.bStefanoViglioneM.D.a
doi : 10.1016/j.arthro.2020.11.037
Volume 37, Issue 3, March 2021, Pages 824-833
To evaluate the clinical and radiologic outcomes of patients undergoing arthroscopic glenoid bone allograft combined with subscapularis upper-third tenodesis for anterior shoulder instability associated with clinically relevant bone loss and hyperlaxity.
Editorial Commentary: Arthroscopic Glenoid Reconstruction With Subscapularis Tenodesis Results in Promising Clinical Outcomes, but Concerns Regarding Graft Resorption Rates Persist: A Long Way Toward a More Perfect Union
Daniel J.CognettiM.D.Andrew J.SheeanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.01.009
Volume 37, Issue 3, March 2021, Pages 834-836
The pros and cons of open and arthroscopic shoulder stabilization procedures have been studied exhaustively. Yet, in many situations, the rates of recurrent instability and overall complications associated with these techniques remain unacceptably high. Perhaps paradoxically, the refinement of arthroscopic shoulder stabilization techniques has only intensified the debate between proponents of either open or arthroscopic approaches, and although significant (however “significant” is defined), anteroinferior glenoid bone loss has historically been thought to constitute a relatively strong indication for an open bone augmentation procedure, surgeons, to their great credit, continue to push the limits of what can be accomplished arthroscopically. Arthroscopic glenoid reconstruction has emerged as a viable option that may represent “the best of both worlds.” Although modifications to the originally described arthroscopic glenoid reconstruction technique are promising, concerns persist regarding the fate of the graft and the durability of the procedure beyond short-term follow-up.
Arthroscopic Bankart Repair With and Without Curettage of the Glenoid Edge: A Prospective, Randomized, Controlled Study
Sanjay S.DesaiM.S., M.Ch.(UK), D.N.B., D.OrthVishwajeetSinghM.B.B.S., M.R.C.S.Ed., D.N.B.(Ortho)Hari KrishnaMataM.S.(Ortho.)
doi : 10.1016/j.arthro.2020.11.042
Volume 37, Issue 3, March 2021, Pages 837-842
To determine whether curettage of the cartilage on the glenoid edge in arthroscopic Bankart repair reduces the postoperative recurrence rate compared with noncuretted glenoid.
Editorial Commentary: Improving Arthroscopic Bankart Repair Outcomes in Patients With Subcritical Bone Loss: Does Giving Up a Little (Cartilage), Give Us a Lot (of Stability)?
Carl K.SchillhammerM.D.
doi : 10.1016/j.arthro.2020.12.215
Volume 37, Issue 3, March 2021, Pages 843-844
Over the past 3 decades, arthroscopic Bankart repair has become the gold standard for anterior shoulder instability in the absence of significant bone loss. Glenoid curettage may seem unusual in the setting of Bankart repair, but the advantage of a bleeding bony surface in reconstructive procedures is nearly universal in sports medicine, from cartilage restoration in the knee to rotator cuff repair. Intuitively, maximizing the surface of bleeding bone should improve healing, but is it really necessary to remove undamaged cartilage to create a healing response? Perhaps not in general, but in high-risk patients with subcritical bone loss curettage it could make sense. It has been well established that as the amount of bone loss drifts above 10%, recurrent instability after standard Bankart repair begins to rise. For many surgeons, the amount of glenoid and humeral bone loss in this patient population would encourage additional stabilizing measures in the form of Latarjet or Bankart repair with the addition of remplissage. Anterior glenoid cartilage curettage could be an additional tool when treating patients in subcritical bone loss. Removing 5 mm of glenoid cartilage may allow for anchor placement further posterior on the glenoid face, thus further closing off of the anterior glenohumeral joint space while providing potential added biologic benefit of increased bone to capsulolabral apposition. The addition of remplissage could further enhance stability and help hold the humeral head posteriorly and perhaps obviate the need for a bone block procedure.
Utility of Allograft Talus as a Source for Grafting of Concurrent Humeral and Glenoid Defects Associated With Anterior Glenohumeral Instability: An Anthropometric Analysis
B. GageGriswoldM.D.aDaniel W.ParéB.S.bZachary P.HerzwurmM.D.aCameron S.MurphyM.D.aBrice G.MorpethB.S.bMatthew T.ProvencherM.D.cStephen A.ParadaM.D.b
doi : 10.1016/j.arthro.2020.11.044
Volume 37, Issue 3, March 2021, Pages 845-851
To compare morphologic data of the talus using magnetic resonance images with previously reported values of the humeral head and the glenoid as a potential graft source for both the humeral head as well as glenoid reconstruction in the setting of concomitant glenoid and humeral head defects.
Elbow Torque Is Reduced in Asymptomatic College Pitchers With Elbow Laxity: A Dynamic Ultrasound Study
Lafi S.KhalilM.D.aFabien S.MetaM.D.aJoseph S.TramerM.D.aChad L.KlochkoM.D.bCourtneyScherD.O.bMarnixVan HolsbeeckM.D.bPatricia A.KolowichM.D.aEric C.MakhniM.D., M.B.A.aVasiliosMoutzourosM.D.aKelechi R.OkorohaM.D.a
doi : 10.1016/j.arthro.2020.12.208
Volume 37, Issue 3, March 2021, Pages 852-861
To determine the relation between medial elbow torque, as measured by wearable sensor technology, and adaptations of the medial elbow structures on dynamic ultrasound imaging in asymptomatic collegiate pitchers.
Volume of Gluteus Maximus and Minimus Increases After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
FanYangM.D.aMahmutMamtiminM.D.aYu-PengDuanM.D.aHaoSunaYanXuM.D.aXinZhangM.D.aXiao-YanZhengM.D.bJia-LinFanM.D.cHong-JieHuangM.D.aJian-QuanWangM.D.a
doi : 10.1016/j.arthro.2020.10.049
Volume 37, Issue 3, March 2021, Pages 862-870
To investigate the change in muscle volume around the hip in patients with femoroacetabular impingement (FAI) after arthroscopy and evaluate other factors related to muscle change.
Editorial Commentary: When Gluteal Strengthening Fails, Hip Femoroacetabular Impingement Correction Is the Ultimate Physical Therapy
DerekOchiaiM.D., Editorial Board
doi : 10.1016/j.arthro.2020.12.197
Volume 37, Issue 3, March 2021, Pages 871-872
Gluteal strength improvement is positively correlated with improved outcomes following hip arthroscopy femoroacetabular impingement correction. Arthroscopic femoroacetabular impingement surgery in itself also is correlated with postoperative improvement in gluteal strength. A trial of physical therapy or best conservative care can improve gluteal strength; however, oftentimes this is insufficient treatment. Hip arthroscopy can improve pain and function whilst also improving gluteal strength. When this is conveyed to patients, the additional knowledge can help them buy-in to their treatment regimen.
Improvements in Sleep Quality Are Maintained at a Minimum of 2 Years Following Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Kyle N.KunzeM.D.aJonathanRasioB.S.bIanClappM.S.bShane J.NhoM.D., M.S.b
doi : 10.1016/j.arthro.2020.10.048
Volume 37, Issue 3, March 2021, Pages 873-878
To present the results of a mid-term follow-up study on sleep quality at a minimum of 2 years after hip arthroscopy for femoroacetabular impingement syndrome.
Editorial Commentary: Arthrosomnology and the Solution to Coxalgia Somnia: Arthroscopic Hip Surgeons and Patients Increasingly Appreciate the Role of Sleep as Good Medicine
Joshua D.HarrisM.D.(Associate Editor)
doi : 10.1016/j.arthro.2020.12.234
Volume 37, Issue 3, March 2021, Pages 879-881
It is increasingly recognized that a variety of musculoskeletal disorders significantly influence sleep. In individuals with sleep dysfunction caused by hip pain (coxalgia somnia) from osteoarthritis, total hip arthroplasty has reliably improved pain and sleep quality in most patients. In nonarthritic, nondysplastic individuals with femoroacetabular impingement syndrome caused by cam and/or pincer morphology and labral tears, hip arthroscopy has similarly reliably improved pain and function in most patients. In addition, there is now early short-term evidence showing significant improvements in both sleep quantity and quality in most patients after arthroscopic hip preservation surgery. Integrating the realms of hip arthroscopy and sleep medicine, known as arthrosomnology, there are dozens of subjective patient-reported and objective clinician-measured outcomes available to analyze the impact of interventions. The Pittsburgh Sleep Quality Index is the most common subjective questionnaire used in orthopaedic surgery literature. Integrating the realms of wearable technology (fitness trackers, smart watches) and machine learning and artificial intelligence has incredible potential to collect immense volumes of accurate sleep “big data.”
A Reliable, Ultrasound-Based Method for the Diagnosis of Discoid Lateral Meniscus
Shun-JieYangM.M.Ming-ZhiZhangM.M.JianLiM.M.YangXueM.M.GangChenM.D.
doi : 10.1016/j.arthro.2020.09.034
Volume 37, Issue 3, March 2021, Pages 882-890
To explore the feasibility and validity of ultrasound in the diagnosis of discoid lateral meniscus (DLM) by comparing quantitatively the morphologic difference between DLM and normal lateral meniscus.
Editorial Commentary: The Pediatric Knee: Ultrasound Could Replace Magnetic Resonance Imaging for Evaluating a Discoid Lateral Meniscus
Joshua S.EverhartM.D., M.P.H.(Editorial Board)R. GunnarTysklindM.D.
doi : 10.1016/j.arthro.2021.01.011
Volume 37, Issue 3, March 2021, Pages 891-892
Magnetic resonance imaging has been referred to as the gold standard diagnostic modality for meniscal pathology in the adult knee. However, there are multiple issues with reliance on magnetic resonance imaging for evaluating the meniscus in children. Diagnostic accuracy for meniscus pathology in children is not as high as with adults. Additionally, young children often cannot tolerate lying still for the study and require sedation, with a small but non-zero risk of anesthetic complication and risk motion artifact even with sedation. Ultrasound can be used to reliably diagnose a discoid lateral meniscus in a testing environment that is well tolerated by young children.
Platelet-Rich Plasma Devices Can Be Used to Isolate Stem Cells From Synovial Fluid at the Point of Care
Eric A.BranchM.D.aAndrea M.MatuskaPh.D.bHillary A.PlummerPh.D.aRobert M.HarrisonbAdam W.AnzM.D.a
doi : 10.1016/j.arthro.2020.09.035
Volume 37, Issue 3, March 2021, Pages 893-900
To assess whether point-of-care devices designed for collecting cellular components from blood or bone marrow could be used to isolate viable stem cells from synovial fluid.
Editorial Commentary: Stem Cells. They Are in the Fat Tissue, Bone Marrow, and Even in the Synovial Fluid of the Knee Joint
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.2020.12.216
Volume 37, Issue 3, March 2021, Pages 901-902
Adult stem cells have been isolated in bone marrow and adipose tissue. These mesenchymal stromal cells (MSCs) have the ability to differentiate into osteogenic, chondrogenic, and adipogenic cell lines. The study by Branch et al. has identified MSCs in the synovial fluid of the knee in patients after anterior cruciate ligament injury and in patients with osteoarthritis of the knee. When mixing synovial fluid with whole blood and using a commercially available platelet-rich plasma–processing system, the total number of MSCs doubled in both groups when compared with the cell count in synovial fluid only. However, it is not clear whether the MSCs in the processed synovium–whole blood mix include synovial MSCs versus MSCs from only the blood. In addition, cell counts were substantially lower when compared with the typical concentrations of MSCs in bone marrow aspirate. The clinical application is yet to be defined.
Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function
ZheXuM.D.abcdZhixuHePh.D.bLipingShuPh.D.bcdXuanzeLiM.D.adMinxianMaM.D.bcdChuanYePh.D.abcde
doi : 10.1016/j.arthro.2020.10.013
Volume 37, Issue 3, March 2021, Pages 903-915
To evaluate the effectiveness and explore the therapeutic mechanisms of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) as a treatment for knee osteoarthritis (KOA).
Editorial Commentary: Platelet-Rich Martini or Vodka Hyaluronate? The Dilemma of Drink Selection for the Modern Orthopaedic Surgeon
BerardoDi MatteoM.D., Ph.D.abElizavetaKonM.D.(Prof.)bc
doi : 10.1016/j.arthro.2020.11.016
Volume 37, Issue 3, March 2021, Pages 916-918
The number of options for intra-articular treatment of osteoarthritis has been growing over the years, and currently a wide range of injectables is available, from “traditional” products such as corticosteroids and hyaluronic acid (HA) to biologic agents like platelet-rich plasma (PRP) and mesenchymal stem cells. Although the ultimate goal is to exert a modulation on the intra-articular environment, these substances act through different mechanisms of action. The combination of different products may have a rationale in taking advantage of complementary actions, but the “additive” effect and the safety should be demonstrated before any recommendation of use. Recently, the combination of HA and PRP has been tested in some clinical trials, with outcomes apparently superior to those of HA and PRP alone. This strategy may open a new scenario for the future, provided that we put scientific evidence before the pressure of the market, especially when dealing with cell-based approaches, which, although very attractive for patients, still need solid data to support their use as injectables.
Opioid Consumption After Knee Arthroscopy
Parth M.KamdarB.S.abNicoleLiddyB.S, M.S.bChristopherAntonacciM.S.T.cNikhil K.MandavaB.A.bDemetrisDelosM.D.bKatherine B.VadasdiM.D.bJames G.CunninghamM.D.bMarc S.KowalskyM.D.bR. TimothyGreeneM.D.bFrank G.AlbertaM.D.cPaul M.SethiM.D.b
doi : 10.1016/j.arthro.2020.10.019
Volume 37, Issue 3, March 2021, Pages 919-923.e10
To prospectively observe opioid consumption in patients undergoing knee arthroscopy and to create an evidence-based guideline for opioid prescription.
Combined Oral Contraceptive Use Increases the Risk of Venous Thromboembolism After Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction: An Analysis of 64,165 Patients in the Truven Database
Sophia A.TravenM.D.aKevin X.FarleyB.S.bMichael B.GottschalkM.D.bJ. BrettGoodloeM.D.aShane K.WoolfM.D.aJohn W.XerogeanesM.D.bHarris S.SloneM.D.a
doi : 10.1016/j.arthro.2020.10.025
Volume 37, Issue 3, March 2021, Pages 924-931
To use the Truven MarketScan database to (1) report the incidence of venous thromboembolism (VTE), including deep vein thromboses (DVTs) and pulmonary embolism (PE), in patients undergoing simple knee arthroscopy and anterior cruciate ligament (ACL) reconstruction, and (2) evaluate combined oral contraceptive (COCP) use as a potential risk factor for VTE in patients undergoing knee arthroscopy.
Tibiofemoral Contact Mechanics After Horizontal or Ripstop Suture in Inside-Out and Transtibial Repair for Meniscus Radial Tears in a Porcine Model
Hao-ZhiZhangM.D.a?Yun-FengZhouM.D.a?Wei-PingLiM.D.aHuanLuoM.D.aJing-TingWuB.N.bChuanJiangM.D.aZhongChenM.D.aJing-YiHouM.D.aRuiYangM.D.aBinSongPh.D., M.D.aZheng-ZhengZhangPh.D., M.D.a
doi : 10.1016/j.arthro.2020.10.031
Volume 37, Issue 3, March 2021, Pages 932-940.e2
To compare tibiofemoral contact mechanics after horizontal or ripstop (horizontal plus vertical) sutures in inside-out and transtibial repair for meniscal radial tears with 10 porcine knees in each group.
Editorial Commentary: Efforts to Heal Meniscal Radial Tears Are Ongoing
Jin GooKimM.D, Ph.D.aDhong WonLeeM.D.b
doi : 10.1016/j.arthro.2020.12.002
Volume 37, Issue 3, March 2021, Pages 941-943
Meniscal radial tears are equivalent to the meniscectomized state. However, successful healing rates by current repair methods for meniscal radial tears are still not satisfactory. Several suture configurations that could approximate the tear gap and stabilize meniscal tissue have been developed to overcome the shortcomings of simple horizontal stitches and cross stitches. The hybrid stitch method, composed of horizontal stitches and vertical stitches, has been introduced. This method can provide stable fixation because the vertical stitches suture the bundle of circumferential fibers, and the vertical stitches act as rip stops for the horizontal stitches. However, it is still challenging to heal meniscal radial tears in avascular areas or complex tears. In treating radial tears, it is important not only to improve suture mechanics but also to promote biologic healing potential.
Fibular Collateral Ligament Reconstruction Graft Options: Clinical and Radiographic Outcomes of Autograft Versus Allograft
Travis J.DekkerM.D.aWilliam W.SchairerM.D.aW. JeffreyGranthamM.D.aNicholas N.DePhillipoM.S., A.T.C., O.T.C.cZachary S.AmanB.A.bRobert F.LaPradeM.D., Ph.D.c
doi : 10.1016/j.arthro.2020.10.034
Volume 37, Issue 3, March 2021, Pages 944-950
To compare varus knee stability and clinical outcomes between patients who underwent fibular collateral ligament reconstruction (FCLR) or lateral collateral ligament (LCL) reconstruction with autografts versus allografts when undergoing concomitant anterior cruciate ligament reconstruction (ACLR).
Editorial Commentary: Autograft Beats Allograft for Most Knee Ligament Surgery
ErikTherrienM.D., F.R.C.S.C.Michael J.StuartM.D.Bruce A.LevyM.D.
doi : 10.1016/j.arthro.2020.12.181
Volume 37, Issue 3, March 2021, Pages 951-952
Knee ligament reconstruction can be performed with autograft or allograft. The use of an autograft has been shown to improve outcomes in primary anterior cruciate ligament reconstruction for young, active patients, and also in revision anterior cruciate ligament reconstruction surgery. A systematic review of posterior cruciate ligament reconstruction showed no difference in outcomes between autograft and allograft tissue. There is a paucity of data comparing autograft versus allograft for fibular collateral ligament and posterolateral corner reconstructions, alone or combined with other ligament surgery. Allograft advantages include no donor site morbidity and reduced operative time. Disadvantages include increased cost and higher failure rates in younger patients. Autograft tissue should be considered in younger, active patients whenever possible.
Effect of Vancomycin Soaking on Anterior Cruciate Ligament Graft Biomechanics
Joseph D.LamplotM.D.aJoseph N.LiuM.D.cIan D.HutchinsonM.D.bTonyChenPh.D.bHongshengWangPh.D.bAmandaWachM.S.bScott A.RodeoM.D.aRussell F.WarrenM.D.a
doi : 10.1016/j.arthro.2020.10.040
Volume 37, Issue 3, March 2021, Pages 953-960
To evaluate the effect of soaking of anterior cruciate ligament (ACL) grafts in vancomycin solution on graft biomechanical properties at the time of implantation.
Editorial Commentary: Vancomycin Soaking of the Graft in Anterior Cruciate Ligament Reconstruction: A Concept on the Way to Becoming the New Gold Standard
Thomas R.PfeifferM.D.
doi : 10.1016/j.arthro.2020.12.214
Volume 37, Issue 3, March 2021, Pages 961-963
An increasing number of surgeons adopt the concept of vancomycin soaking of the graft in anterior cruciate ligament reconstruction and report drastically reduced numbers of postoperative septic knee arthritis. This reduction of incidence is supported by in vitro data, showing no influence of vancomycin on tendon material properties. Although the applied antibiotic concentration has reported to be potent in eradicating graft contamination, no evidence of chondrotoxicity has been shown. Based on the increasing evidence, the call for randomized controlled trials stands in ethical contrast with the medical responsibility not to withhold patients an infection prophylaxis that has already been proven to be safe and effective.
Preoperative Patient-Centric Predictors of Postoperative Outcomes in Patients Undergoing Arthroscopic Meniscectomy
SretenFranovicM.S., B.S.Noah A.KuhlmannM.S., B.S.AlexPietroskiB.S.Collin T.SchlosserB.S.BrendanPageB.S.Kelechi R.OkorohaM.D.VasiliosMoutzourosM.D.Eric C.MakhniM.D., M.B.A.
doi : 10.1016/j.arthro.2020.10.042
Volume 37, Issue 3, March 2021, Pages 964-971
To determine the minimal clinically important difference (MCID) using Patient-Reported Outcome Measurement Information System (PROMIS) computer-adaptive testing assessments in patients undergoing arthroscopic partial meniscectomy. The secondary purpose was to identify which preoperative patient factors are associated with MCID achievement.
Editorial Commentary: Preoperative Patient-Reported Outcomes Measurement Information System Scores Predict Which Patients Will Benefit From Arthroscopic Meniscectomy: To Scope or Not to Scope?
Richard M.SilvermanM.D.Matthew J.MatavaM.D.
doi : 10.1016/j.arthro.2020.12.217
Volume 37, Issue 3, March 2021, Pages 972-975
Despite its widespread use and low complication rates, arthroscopic meniscectomy has not been uniformly successful in all patients, especially in those with concurrent osteoarthritis. The Patient-Reported Outcomes Measurement Information System (PROMIS) is an initiative funded by the National Institutes of Health to develop and validate patient-reported outcomes for clinical research and practice. PROMIS has shown the ability to enhance and standardize measurement of a variety of health domains affecting musculoskeletal function and in discriminating between various orthopaedic procedures through the use of computer adaptive testing. Preoperative PROMIS scores are valid predictors of postoperative minimal clinically important difference in patients undergoing arthroscopic meniscectomy based on preoperative decreased physical function and increased pain interference. PROMIS score cutoffs may be used by arthroscopic surgeons to counsel patients considering arthroscopic meniscectomy.
A Retrospective Comparison of Single-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis With Double-Bundle Anterior Cruciate Ligament Reconstruction
Ji HyunAhnM.D.JaehyunKimM.D.Ji WeonMunM.D.
doi : 10.1016/j.arthro.2020.11.011
Volume 37, Issue 3, March 2021, Pages 976-984
To compare postoperative objective knee stability and clinical outcomes between double-bundle (DB) anterior cruciate ligament reconstruction (ACLR) and single-bundle (SB) ACLR combined with lateral extra-articular tenodesis (LET).
Editorial Commentary: Lateral Extra-Articular Tenodesis Results in Better Stability After Anterior Cruciate Ligament Reconstruction for Patients With High-Grade Pivot Shifts
F. AlanBarberM.D., F.A.C.S.(Editorial Board)
doi : 10.1016/j.arthro.2020.12.180
Volume 37, Issue 3, March 2021, Pages 985-988
Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra- and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Relevant biomechanical data indicate that the deep iliotibial band fibers are more important than the ALL in controlling pivot shift. Lateral compartment overconstraint after ALL reconstruction does not appear to be a biomechanical or clinical issue. An ALL reconstruction creates a nonisometric construct (tight in extension and lax in flexion), allowing physiologic internal tibial rotation at 90° flexion, whereas lateral extra-articular tenodesis (LET) is more isometric, limiting physiologic internal tibial rotation at 90° flexion. The indications for a combined ACL/ALL reconstruction are evolving, but a Segond fracture and ligamentous hyperlaxity of ?5 using the modified Beighton system seem reasonable. An ACL/LET reconstruction results in better stability for patients with high-grade pivot shifts.
Primary Autologous Osteochondral Transfer Shows Superior Long-Term Outcome and Survival Rate Compared With Bone Marrow Stimulation for Large Cystic Osteochondral Lesion of Talus
Dong WooShimM.D.aKwang HwanParkM.D., Ph.D.bJin WooLeeM.D., Ph.D.bYun-jungYangPh.D.cJucheolShinM.D.bSeung HwanHanM.D., Ph.D.b
doi : 10.1016/j.arthro.2020.11.038
Volume 37, Issue 3, March 2021, Pages 989-997
To compare the results of bone marrow stimulation (BMS) versus autologous osteochondral transfer (AOT) as primary surgical option for large cystic osteochondral lesion of talus (OLT) and to further distinguish factors associated with clinical failures and overall survival.
Editorial Commentary: Osteochondral Lesions of the Talus: All, Nothing, or Something in Between
TobinEckelM.D.Jonathan F.DickensM.D.(Editorial Board)
doi : 10.1016/j.arthro.2020.12.224
Volume 37, Issue 3, March 2021, Pages 998-999
Osteochondral lesions of the talus occur with relatively frequency, often as the sequelae of benign ankle sprains, and are only surpassed by the knee and elbow as more common locations. While microfracture of the talus is the most common first-line surgical treatment performed at the time of ankle arthroscopy, marrow stimulation alone results in fibrocartilaginous repair tissue rather than true hyaline-like articular cartilage. In addition, the benefits of bone marrow stimulation for the treatment of large (>150 mm2), deep (>7 mm), or cystic lesions is limited. Autologous osteochondral transplant has emerged as one such treatment option for large lesions that may address underlying bone loss and reconstitute articular cartilage. The utility of autologous osteochondral transplant also must be interpreted with an understanding of the potential complications, including donor-site morbidity. In addition, it is important to decompress, curettage, and back fill associated cysts with bone graft. When cysts are not treated aggressively, patients may have ongoing bone marrow edema and pain.
The Efficacy of Arthroscopic Simulation Training on Clinical Ability: A Systematic Review
AndrewLuzziM.D.JustinHellwinkelM.D.MichaelaO’ConnorB.A.ConnorCrutchfieldB.A.T. SeanLynchM.D.
doi : 10.1016/j.arthro.2020.09.018
Volume 37, Issue 3, March 2021, Pages 1000-1007.e1
To examine the effect of arthroscopic simulator training on technical performance in a human model.
Editorial Commentary: Simulation-Based Training in Orthopaedic Surgery: Current Evidence and Limitations
Mohammed HusnainIqbalB.Sc.(Hons), M.B.B.S., M.R.C.S.aOmeairKhanB.Sc.(Hons), M.B.B.S., M.R.C.S.bAbdullatifAyd?nB.Sc.(Hons), M.B.B.S., Ph.D.c
doi : 10.1016/j.arthro.2020.12.003
Volume 37, Issue 3, March 2021, Pages 1008-1010
Simulation-based training has been widely adopted by surgical educators and is now an essential component of the modern resident’s skills acquisition pathway and career progression. The challenges faced by residents because of lack of exposure as a result of working-time directives—and now the COVID-19 (coronavirus disease 2019) pandemic limiting nonurgent and elective operating—reinforce the need for evidence-based simulation training. Although a wide range of training platforms have been developed, very few have shown transfer of skills. Simulation is thought to enhance the initial phase of the procedural learning curve; however, this hypothesis is yet to be tested in a high-quality study. Nevertheless, in light of the current evidence, simulation-based procedural curricula should be developed using the strengths of multiple different training platforms while incorporating the essential concept of nontechnical skills.
Mid- to Long-Term Outcomes of Hip Arthroscopy: A Systematic Review
CynthiaKyinB.A.aDavid R.MaldonadoM.D.aCammille C.GoB.S.bJacobShapiraM.D.aAjay C.LallM.D., M.S.acdBenjamin G.DombM.D.acd
doi : 10.1016/j.arthro.2020.10.001
Volume 37, Issue 3, March 2021, Pages 1011-1025
To assess mid- to long-term patient-reported outcomes (PROs) of hip arthroscopy as well as the rates of secondary surgery and to identify indications for surgery and noted predictors of failure.
Editorial Commentary: With Properly Indicated and Performed Surgery, We Can (Hopefully) Prevent Osteoarthritis in Patients With Hip Femoroacetabular Impingement
Robert W.WestermannM.D.AndrewSchaverB.S.
doi : 10.1016/j.arthro.2020.12.179
Volume 37, Issue 3, March 2021, Pages 1026-1027
Surgical treatment of femoroacetabular impingement (FAI) syndrome has been proven to be tremendously successful, outperforming the best conservative care and physical therapy in several prospective multicenter randomized controlled trials. The durability of this operation over time is less commonly reported on. We do know that FAI is associated with the development of hip osteoarthritis, and this is well established. We also know that surgical FAI treatment results in good short-term return to function/sport and improvements in patient-reported outcomes. We do not yet know if we are able to alter the natural history of FAI and prevent or delay conversion to total hip arthroplasty in this population.
Large Heterogeneity Among Minimal Clinically Important Differences for Hip Arthroscopy Outcomes: A Systematic Review of Reporting Trends and Quantification Methods
Kyle N.KunzeM.D.aJacob A.BartB.A.bMohsinAhmadB.A.bShane J.NhoM.D., M.S.bJorgeChahlaM.D., Ph.D.b
doi : 10.1016/j.arthro.2020.10.050
Volume 37, Issue 3, March 2021, Pages 1028-1037.e6
To perform a systematic review of reporting trends and quantification methods for the minimal clinically important difference (MCID) within the hip arthroscopy literature.
Editorial Commentary: Large Heterogeneity of Minimal Clinically Important Difference Utilization in Hip Arthroscopy Studies: Where Do We Go From Here?
Timothy J.JacksonM.D.(Associate Editor)
doi : 10.1016/j.arthro.2020.12.232
Volume 37, Issue 3, March 2021, Pages 1038-1039
The minimal clinically important difference is a relatively new method to evaluate outcomes after surgery, defined as the lowest value of change in the outcome score that results in a perceived clinical improvement. There is no clear delineation of use for this metric, resulting in a heterogeneous application in hip arthroscopy research, making comparisons with other studies difficult. Cohort-specific values calculated using an anchor-based method are best.
Bone Versus All Soft Tissue Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction: A Systematic Review
Raphael J.CrumB.S.aJeffreyKayM.D.bBryson P.LesniakM.D.cAlanGetgoodM.Phil., M.D., F.R.C.S(Tr&Orth), DipS.E.M.dVolkerMusahlM.D.cDarrende SAM.D., F.R.C.S.C., M.B.A(c)b
doi : 10.1016/j.arthro.2020.10.018
Volume 37, Issue 3, March 2021, Pages 1040-1052
To examine existing literature on objective and patient-reported outcomes and complications after anterior cruciate ligament reconstruction (ACLR) with bone-quadriceps-tendon (B-QT) or soft tissue-quadriceps tendon (S-QT) to further clarify the role of graft type in primary ACLR.
Editorial Commentary: Quadriceps Tendon All-Soft-Tissue Graft for Anterior Cruciate Ligament Reconstruction: More Information About A Newer Surgical Nail
Leslie J.BissonM.D., Editorial Board
doi : 10.1016/j.arthro.2020.11.026
Volume 37, Issue 3, March 2021, Pages 1053-1054
Many different autografts are available for anterior cruciate ligament reconstruction. Although patellar tendon graft and hamstrings are most commonly used, quadriceps tendon with or without a bone plug is gaining popularity. Preliminary evidence suggests that quad tendon without a bone plug performs at least as well as with a plug, although more comparative information is needed. In the meantime, surgeons should strive to gain experience with multiple anterior cruciate ligament grafts.
