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Table of Contents
doi : 10.1016/S0749-8063(21)00544-2
Volume 37, Issue 7, July 2021, Pages A9-A12, A15-A16
Cover Image & Video Link
doi : 10.1016/S0749-8063(21)00545-4
Volume 37, Issue 7, July 2021, Page A16
Instructions for Authors
doi : 10.1016/S0749-8063(21)00550-8
Volume 37, Issue 7, July 2021, Page A35
Understanding Network Meta-analysis (NMA) Conclusions Requires Scrutiny of Methods and Results: Introduction to NMA and the Geometry of Evidence
Mark P.CoteP.T., D.P.T, M.S.C.T.R.James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.04.070
Volume 37, Issue 7, July 2021, Pages 2013-2016
Synthesis of medical literature to determine the best treatment for a given problem is challenging, particularly when multiple options exist. Network meta-analysis (NMA) allows the comparison of different treatment approaches in a single, systematic review including treatments that have never been compared head-to-head. A key to understanding NMA is to focus on the network geometry showing the number of included studies and their relationships: different treatment options are illustrated as nodes. Lines between nodes represent direct comparisons. For nodes not directly compared, indirect effects may be determined by use of the property of transitivity. Limitations of NMA include heterogeneity, where variability among included studies biases pairwise comparisons, and consistency, if direct and indirect comparisons between treatments do not agree. In the end, NMA allows numeric ranking of the estimated effects of each treatment from most to least effective. A disadvantage of NMA ranking methods is that readers may focus overly on what treatment ranks best and focus insufficiently on the methods and results that determine the rankings. The reliability of the rankings requires consideration of the geometry and strength of the network, including evaluation of heterogeneity, consistency, and transitivity. The conclusion of an NMA requires scrutiny of the methods and results.
In Memoriam: Howard J. Sweeney, M.D., June 21, 1926 – March 27, 2021
Richard L.AngeloM.D., Ph.D.
doi : 10.1016/j.arthro.2021.04.071
Volume 37, Issue 7, July 2021, Pages 2017-2018
Regarding “Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: A Double-Blind, Randomized, Controlled Trial”
ShaoyunZhangM.D.YixinDaiM.D.CongXiaoM.D.
doi : 10.1016/j.arthro.2021.02.039
Volume 37, Issue 7, July 2021, Pages 2019-2020
Author Reply to “Regarding ‘Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone–Patellar Tendon–Bone Autograft: A Double-Blind, Randomized, Controlled Trial’”
Michael J.AlaiaM.D.Jordan W.FriedB.M.David A.BloomB.A.Eoghan T.HurleyM.B., B.Ch., M.Ch.JovanPopovicM.D.Samuel L.BaronM.D.Kirk A.CampbellM.D.Eric J.StraussM.D.Laith M.JazrawiM.D.
doi : 10.1016/j.arthro.2021.02.040
Volume 37, Issue 7, July 2021, Pages 2020-2022
How Complex Is the Complex Innervation of the Hip Joint Capsular Complex?
JoannaTomlinsonB.Sc.BenjaminOndruschkaM.D.TorstenPrietzelM.D.JohannZwirnerM.D.NielsHammerM.D.
doi : 10.1016/j.arthro.2021.05.035
Volume 37, Issue 7, July 2021, Pages 2022-2024
Author Reply to “How Complex Is the Complex Innervation of the Coxal Capsular Complex?”
Carlos J.MeheuxM.D.TakashiHiraseM.D.DavidDongB.S.Terry A.ClyburnM.D.Joshua D.HarrisM.D.
doi : 10.1016/j.arthro.2021.05.034
Volume 37, Issue 7, July 2021, Pages 2024-2026
How the Biomechanical Complexity of Tendon Transfers in Shoulder Surgery is Still Robbing us of Sleep in 2021
Daniel P.BertholdM.D.Lukas N.MuenchM.D.Bassem T.ElhassanM.D.
doi : 10.1016/j.arthro.2021.04.026
Volume 37, Issue 7, July 2021, Pages 2026-2028
Posterior Tibial Slope: Understand Bony Morphology to Protect Knee Cruciate Ligament Grafts
Robert S.DeanM.D.abChristopher M.LarsonM.D.aBrian R.WatermanM.D.c
doi : 10.1016/j.arthro.2021.05.006
Volume 37, Issue 7, July 2021, Pages 2029-2030
Improved understanding of the biomechanical significance and clinical repercussions of tibial slope on cruciate ligament function has sparked a newfound clinical interest in this morphological feature. Using either magnetic resonance imaging or lateral tibia radiographs, the anterior-posterior angulation of the tibial plateau relative to the tibial shaft can be measured. Clinical and biomechanical studies have reported that increased posterior tibial slope (PTS) places significantly increased tension on the native and reconstructed anterior cruciate ligament (ACL), leading to an increased risk of failure. It has also been suggested that increased PTS of the lateral tibial plateau has a greater impact on ACL forces and anterior tibial translation than PTS of the medial tibial plateau. Conversely, a decreased PTS has been shown to be a risk factor for recurvatum deformity, posterior cruciate ligament (PCL) injury, and posterior tibial translation and has been linked to single bundle PCL reconstruction failure. In the setting of ACL insufficiency with a PTS greater than 12°, anterior closing wedge osteotomy has been shown to be protective for ACL reconstructions. Alternatively, some surgeons have advocated for the addition of lateral extraarticular stabilization procedures in the setting of increased PTS. Further, in the setting of PCL insufficiency with an anteriorly directed, or flat, PTS, anterior opening wedge osteotomy has shown encouraging results. In addition, double bundle PCL reconstructions should be strongly considered in the setting of anteriorly directed, or flat, tibial slope.
A Multisite Injection Is More Effective Than a Single Glenohumeral Injection of Corticosteroid in the Treatment of Primary Frozen Shoulder: A Randomized Controlled Trial
EmreKoramanM.D.IsmailTurkmenM.D.EsatUygurM.D.OguzPoyanl?M.D.
doi : 10.1016/j.arthro.2021.01.069
Volume 37, Issue 7, July 2021, Pages 2031-2040
Editorial Commentary: Corticosteroid Injections and Physical Therapy Are Effective First-Line Treatments for Frozen Shoulder
Jüri-ToomasKartusM.D., Ph.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.02.028
Volume 37, Issue 7, July 2021, Pages 2041-2042
Multisite corticosteroid injection therapy is more effective in terms of pain relief, restoration of motion, and functional status than single intra-articular injection for the treatment of primary frozen shoulder (adhesive capsulitis).
Nucleated Cell Count Has Negligible Predictive Value for the Number of Colony-Forming Units for Connective Tissue Progenitor Cells (Stem Cells) in Bone Marrow Aspirate Harvested From the Proximal Humerus During Arthroscopic Rotator Cuff Repair
Lukas N.MuenchM.D.abDaniel P.BertholdM.D.abCameronKiaM.D.aAlexanderOttoM.D.acMark P.CoteM.S., D.P.T.aMary BethMcCarthyB.S.aAugustus D.MazzoccaM.S., M.D.aJulianMehlM.D.ab
doi : 10.1016/j.arthro.2021.01.064
Volume 37, Issue 7, July 2021, Pages 2043-2052
To evaluate whether nucleated cell count (NCC) could serve as an approximation for the number of colony-forming units (CFUs) in concentrated bone marrow aspirate (cBMA) obtained from the proximal humerus.
Editorial Commentary: Shoulder Rotator Cuff Tendon Repair Using Bone Marrow Aspirate: Stem Cell Quantity Does Not Equal Quality
James B.CarrIIM.D.
doi : 10.1016/j.arthro.2021.03.017
Volume 37, Issue 7, July 2021, Pages 2053-2054
The use of biological agents in orthopaedic surgery is rapidly evolving. The potential to augment the healing environment at a surgical repair site is an especially exciting possibility. There are a few popular biological agents, including platelet-rich plasma, concentrated bone marrow aspirate (BMA), and adipose-derived connective tissue progenitor cells. BMA is an especially appealing biological agent because it can be harvested from a variety of sources, including the iliac crest, distal femur, and proximal humerus. As a result, BMA is readily accessible with minimal added surgical time and morbidity during surgical procedures on the hip, knee, and shoulder. In particular, the surgically repaired rotator cuff tendon is a prime candidate for biological augmentation, and the proximal humerus is an appealing source of concentrated BMA given its ease of access and low harvesting morbidity at the time of arthroscopic repair. The nucleated cell count may be considered a surrogate for the quality of BMA and can be readily calculated at the time of harvest. However, the quantity of nucleated cells does not necessarily equate to the quality of nucleated cells as colony-forming units after cell culture, nor do we know how ex vivo cell culture correlates with in vivo stem cell proliferation and healing. Most of all, future research must determine what factors (if any) do positively correlate with the number of colony-forming units.
Bankart Repair With Subscapularis Augmentation in Athletes With Shoulder Hyperlaxity
MarcoMaiottiM.D.aRaffaeleRussoM.D.cAntonioZaniniM.DdRobertoCastriciniM.D.fGianlucaCastellarinM.D.eSteffenSchr?terM.D.gCarloMassoniM.D.bFelix HenrySavoieIIIM.D.h
doi : 10.1016/j.arthro.2021.01.062
Volume 37, Issue 7, July 2021, Pages 2055-2062
Editorial Commentary: Personalized Medicine for Shoulder Instability May Result in Best Outcomes With the Lowest Complication Rates
Prof. Dr.Pietro S.RandelliM.D.
doi : 10.1016/j.arthro.2021.03.038
Volume 37, Issue 7, July 2021, Pages 2063-2064
Personalization is a type of medical care in which the treatment is customized for an individual patient. When treating shoulder instability, we need to consider not only soft-tissue damage but also the bony lesion and patient characteristics. Of particular importance is the consideration of whether there is anterior glenoid bone loss, together with the presence of a Hill–Sachs lesion, on or off-track, as well as whether the patient is hyperlax and/or is an athlete, in which case in what type of sport. In hyperlax, nonoverhead sport athletes with recurrent anterior instability and glenoid bone loss <15%, Bankart repair with subscapularis augmentation is an effective procedure with a lower risk of complications and arthritis than a bony procedure. This is a perfect example of personalized medicine indicating a particular treatment to the benefit of patients.
Arthroscopic Autologous Scapular Spine Bone Graft Combined With Bankart Repair for Anterior Shoulder Instability With Subcritical (10%-15%) Glenoid Bone Loss
MingXiangPh.D.aJinsongYangM.D.aHangChenM.D.aXiaochuanHuM.D.aQingZhangM.D.aYipingLiM.D.aChunyanJiangPh.D.b
doi : 10.1016/j.arthro.2021.01.061
Volume 37, Issue 7, July 2021, Pages 2065-2074
Editorial Commentary: Surgical Treatment of Shoulder Instability With Subcritical Glenoid Bone Loss Requires Innovation: Bankart May Risk Significant Recurrence and Latarjet May Risk Significant Complications
Sarah B.ShubertM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.03.055
Volume 37, Issue 7, July 2021, Pages 2075-2076
The patient with a history of shoulder dislocation and subcritical (10%-15%) glenoid bone loss presents a complicated scenario. The “safest” procedure (arthroscopic Bankart repair) may result in a high rate of failure and risk of further surgery. The most successful procedure for avoiding recurrence (Latarjet) comes with potentially high complication rates (of up to 20%), a steep learning curve, risk of permanent nerve injury (up to 15%), and substantial risk of subscapularis deficit. Innovation is most needed in surgery when current treatments lack success or risk significant complications. As surgeons, we are constantly striving to walk the line between using innovative techniques for our patients to better their lives and following the principle “first do no harm.” This recent article describes the outcomes of a 2-cm segment of scapular spine harvested through a small incision and stabilized with suture anchors along the anterior glenoid, combined with an arthroscopic labral repair. The technique appears to be safe, and practical, bearing in mind that excellent reported outcomes must be shown to be reproducible. Ideally, we should not have to choose between relatively high failure rates with arthroscopic Bankart repair or the greater reported complication rates with Latarjet. Innovation will pave the way to our greater success.
Greater Tuberosity Bone Mineral Density and Rotator Cuff Tear Size Are Independent Factors Associated With Cutting-Through in Arthroscopic Suture-Bridge Rotator Cuff Repair
SanghyeonLeeM.D.aJung-TaekHwangM.D., Ph.D.bSang-SooLeeM.D., Ph.D.bJun-HyuckLeeM.D.bTae-YeongKimM.D.b
doi : 10.1016/j.arthro.2021.01.059
Volume 37, Issue 7, July 2021, Pages 2077-2086
Editorial Commentary: Causes of Failure After Arthroscopic Rotator Cuff Repair
Mustafa S.RashidM.B. Ch.B., M.Sc., Ph.D.aIan K.Y.LoM.D., F.R.C.S.C.b
doi : 10.1016/j.arthro.2021.03.025
Volume 37, Issue 7, July 2021, Pages 2087-2089
Causes of failure after arthroscopic rotator cuff repair include patient factors, tear factors, and surgical factors. Failure may occur at the suture–tendon interface, the bone–tendon interface, or the bone–anchor interface. Low bone mineral density (BMD) in the greater tuberosity has been reported as a prognostic factor for recurrent tears following rotator cuff repair, and although most studies suggest the tendon-to-suture interface as the “weakest link,” patients with low BMD may have lower suture anchor pull-out strength. A potential alternative cause of failure is the suture cutting through the greater tuberosity bone in patients with low BMD. Knotless suture bridge constructs or single-row constructs may be more susceptible to a suture cutting through the bone. The knotted suture bridge technique, wherein the medial mattress sutures are tied, may to some extent “shield” against complete cut-through. When bone quality appears poor, a common response is to change the type of anchor, size of anchor, or the location of the anchor. Other factors, such as bone preparation, suture type, suture tensioning, and anchor type (e.g., internal vs external locking), may all potentially affect suture cutting through weak bone.
Needle Diagnostic Arthroscopy and Magnetic Resonance Imaging of the Shoulder Have Comparable Accuracy With Surgical Arthroscopy: A Prospective Clinical Trial
Eric R.WagnerM.D., M.S.aJarret M.WoodmassM.D., F.R.C.S.C.bZachary R.ZimmerM.D.cKathryn M.WelpM.S.cMichelle J.ChangB.S.cAlexander M.PreteB.S.cKevin X.FarleyB.S.aJon J.P.WarnerM.D.c
doi : 10.1016/j.arthro.2021.03.006
Volume 37, Issue 7, July 2021, Pages 2090-2098
Editorial Commentary: Indications for Needle Arthroscopy as an Alternative to Magnetic Resonance Imaging: More to the Picture Than Meets the Eye
ChadLavenderM.D.
doi : 10.1016/j.arthro.2021.04.014
Volume 37, Issue 7, July 2021, Pages 2099-2101
Needle arthroscopy (using a 1- to 1.9-mm diameter arthroscope) is not new, and new interest is a result of the expense and inconvenience of magnetic resonance imaging (MRI), including time out of work, prolonged diagnostic dilemmas, and finite advanced imaging resources. Improvements in the image quality with the modern needle arthroscope have made it a viable option for use as a diagnostic tool in the operative setting, and eventually, if surgeons are able to create strict criteria for proper diagnostic use of the needle arthroscope, it may become an excellent tool for in-office use despite financial or legal hurdles. Specific clinical scenarios for use of an diagnostic needle arthroscopy instead of an MRI (and typically immediately followed by therapeutic arthroscopy in the same setting) include (1) a patient with a clinically obvious meniscus tear with a locked knee, (2) a patient with an outdated but previously positive MRI with recurrent injury such as a recurrent shoulder or patella dislocations, (3) a patient who is ineligible for an MRI such as those with pacemakers or spinal implants who have clear and obvious clinical findings to suggest intra-articular pathology, and (4) a patient who is over the age of 50 years with positive rotator cuff testing after a shoulder dislocation in which I have a high degree of suspicion of a rotator cuff tear. In the future, we envision using multiple needle arthroscopes to provide simultaneous views from different angles during surgery and giving ourselves a 360° view. I envision an operating room in the future with multiple small needle scopes in joint and multiple viewing monitors providing a new 3-dimensional world of arthroscopy.
Concomitant Lumbar Spinal Stenosis Negatively Affects Outcomes After Hip Arthroscopy for Femoroacetabular Impingement
BerkcanAkpinarM.D.Lawrence J.LinB.A.David A.BloomB.S.ThomasYoumM.D.
doi : 10.1016/j.arthro.2021.01.068
Volume 37, Issue 7, July 2021, Pages 2102-2109
Editorial Commentary: Spine Pathology May Compromise the Results of Hip Arthroscopy: Will Hip Arthroscopy Improve Low Back Pain?
Andrew E.JimenezM.D.Benjamin G.DombM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.03.037
Volume 37, Issue 7, July 2021, Pages 2110-2111
Pathology of the lumbar spine and hip commonly occur concurrently. The hip–spine connection has been well documented in the hip arthroplasty literature but until recently has been largely ignored in the setting of hip arthroscopy. Physical examination and diagnostic workup of the lumbosacral junction are warranted to further our understanding of the effects of lumbosacral motion and pathology in patients with concomitant femoroacetabular impingement syndrome. An understanding of this relationship will better allow surgeons to counsel and preoperatively optimize patients undergoing evaluation and treatment of femoroacetabular impingement syndrome. Several studies have reported that patients with a previous lumbar arthrodesis undergoing hip arthroplasty have lower patient-reported outcomes and greater revision rates compared with patients without previous lumbar surgery, and similar to its effect on outcomes after hip arthroplasty, lumbar spine disease can compromise outcomes after hip arthroscopy. On the other side of the coin, hip arthroplasty has been shown to improve low back pain in patients with concomitant hip osteoarthritis. Can the arthroscopic treatment of nonarthritic hip pathology offer a similar result? We won't know unless we look.
Preoperative Rather Than Postoperative Intra-Articular Cartilage Degeneration Affects Long-Term Survivorship of Periacetabular Osteotomy
MasanoriFujiiM.D., Ph.D.aYasuharuNakashimaM.D., Ph.D.aKenjiKitamuraM.D.aGoroMotomuraM.D., Ph.D.aSatoshiHamaiM.D., Ph.D.aSatoshiIkemuraM.D., Ph.D.aYasuoNoguchiM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.01.060
Volume 37, Issue 7, July 2021, Pages 2112-2122
Intraoperative Classification System Yields Favorable Outcomes for Patients Treated Surgically for Greater Trochanteric Pain Syndrome
ShawnAnninM.D.aAjay C.LallM.D., M.S.abcMitchell B.MeghparaM.D.acDavid R.MaldonadoM.D.aJacobShapiraM.D.aPhilip J.RosinskyM.D.aHari K.AnkemM.D.aBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.01.058
Volume 37, Issue 7, July 2021, Pages 2123-2136
Editorial Commentary: An Optimal Classification System to Guide Prognosis and Treatment in Greater Trochanteric Pain Syndrome: Now We’re Speaking the Same Language
Joshua D.HarrisM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.03.083
Volume 37, Issue 7, July 2021, Pages 2137-2139
The optimal classification system in arthroscopic and related surgery research and clinical practice should be clinically relevant, descriptive, reproducible, simple, inexpensive, safe, and widely applicable. For the hip, classification systems that characterize intra-articular disorders like femoroacetabular impingement (FAI) syndrome, dysplasia, labral tears, and articular cartilage disease predominate the literature. Recently, awareness of peritrochanteric and other extra-articular disorders has increasingly led to greater recognition, diagnosis, and treatment of what has been historically known as “just bursitis”. These disorders are far more complex and include greater trochanteric pain syndrome, the spectrum of gluteal tendon pathology, greater trochanteric bursitis, snapping iliotibial band (external coxa saltans), and greater trochanteric-ischial impingement. The utility of an intraoperative greater trochanteric pain syndrome classification system has now been proven using prospectively collected data, assimilating a decade-long eligibility period following open or endoscopic treatment of peritrochanteric disorders with a minimum two-year follow-up using validated patient-reported outcome scores. This classification guides prognosis and treatment, exactly as an optimal orthopedic classification system should do.
Tenotomy for Iliopsoas Pathology is Infrequently Performed and Associated with Poorer Outcomes in Hips Undergoing Arthroscopy for Femoroacetabular Impingement
DeanMatsudaM.D.aBenjamin R.KivlanPh.D., P.T., S.C.S., O.C.S.bShane J.NhoM.D., M.S.cAndrew B.WolffM.D.dJohn P.SalvoJr.M.D.efJohn J.ChristoforettiM.D.ghRobRoy L.MartinPh.D.ijDominic S.CarreiraM.D.k
doi : 10.1016/j.arthro.2021.02.018
Volume 37, Issue 7, July 2021, Pages 2140-2148
Editorial Commentary: Indiscriminate Iliopsoas Tenotomy May Cause Complications–With Tight Indications and Transbursal Lengthening, We May Avoid Them
Benjamin G.DombM.D.(Editorial Board)David R.MaldonadoM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.04.065
Volume 37, Issue 7, July 2021, Pages 2149-2151
Surgical management of iliopsoas pathology that fails conservative treatment is controversial. Potential complications following iliopsoas tenotomy include recurrent painful internal snapping, postoperative pain, and hip flexor weakness. Concerns are even greater in dysplastic patients, in whom the iliopsoas may play a role as an anteromedial hip stabilizer. Although data demonstrate arthroscopic iliopsoas tenotomy for painful internal snapping as safe and effective, its use has declined for the reasons stated above. On the other hand, procedures such as capsular plication with inferior shift and anatomic labral repair, augmentation, and reconstruction have made it possible to restore the primary stabilizers in many cases of hip instability. In these cases, iliopsoas fractional lengthening (IFL) with avoidance of collateral damage to the musculature or capsule can successfully treat painful internal snapping hip. We recommend iliopsoas lengthening when (1) there is painful internal snapping, (2) IFL can be performed without collateral damage, (3) the primary soft tissue stabilizers can be restored or augmented, and (4) there is no bony morphology likely to cause continued instability.
Complications of Hip Endoscopy in the Treatment of Subgluteal Space Pathologies
BernardoAguilera-Boh?rquezM.D.aJulioPachecoM.D.abLizardoCastilloM.D.abDanielaCalvacheM.D.aErikaCantorM.Sc., Ph.D(c).c
doi : 10.1016/j.arthro.2021.02.016
Volume 37, Issue 7, July 2021, Pages 2152-2161
Editorial Commentary: Subgluteal Hip Arthroscopy for Sciatic Nerve Entrapment, Ischiofemoral Impingement, or Proximal Hamstring Tears: Beyond the Comfort Zone
David R.MaldonadoM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.03.054
Volume 37, Issue 7, July 2021, Pages 2162-2163
Advancements in hip arthroscopy are astounding. Circumferential labral reconstruction, labral augmentation, and capsular reconstruction are valuable tools. Beyond the “comfort zone” of the hip intra-articular realm, new frontiers include the peritrochanteric space, and a similarity to the subacromial space of the shoulder makes the transition attainable. In contrast, the subgluteal space is seen as outside the box. Sciatic nerve entrapment (SNE), ischiofemoral impingement (IFI), and tears of the proximal origin of the hamstring are among the subgluteal space pathologies. Clinical assessment of deep gluteal syndrome, defined as nondiscogenic sciatic nerve entrapment, can be particularly difficult but is critical and one of the skills that we as hip sports surgeons need to master. The respective treatments for SNE, IFI, and hamstring tears are nerve decompression, lesser trochanteric resection, and hamstring repair. Complications can occur, most commonly temporary injury of the sciatic nerve and permanent injury of the posterior femoral cutaneous nerve. While all located in the deep gluteal space, SNE, IFI, and proximal hamstring tears are unique entities. When thinking outside the box, it's important to consider the complicated contents of Pandora’s box.
Joint Venting Prior to Hip Distraction Minimizes Traction Forces During Hip Arthroscopy
Dillon C.O’NeillM.D.aAlexander J.MortensenB.S.bKelly M.TomasevichB.A.aSuzanna M.OhlsenB.S.bTemitope F.AdeyemiM.P.H.aTravis G.MaakM.D.aStephen K.AokiM.D.a
doi : 10.1016/j.arthro.2021.02.015
Volume 37, Issue 7, July 2021, Pages 2164-2170
Editorial Commentary: Hip Joint Venting Prior to Initiating Traction Reduces Postoperative Complications
Shane J.NhoM.D., M.S.Thomas D.AlterM.S.
doi : 10.1016/j.arthro.2021.04.012
Volume 37, Issue 7, July 2021, Pages 2171-2172
Hip arthroscopy for the treatment of femoroacetabular impingement syndrome requires access to the central compartment of the hip, which is more easily obtained with hip distraction. However, surgeons must balance improved surgical access with the risks of postoperative complications. Hip joint venting describes the disruption of the suction seal by introducing a large-gauge needle into the joint space and injecting air or fluid into the joint. Joint venting performed before initiating axial traction may reduce the force required to obtain central compartment access while mitigating postoperative complications.
Aging Decreases the Ultimate Tensile Strength of Bone–Patellar Tendon–Bone Allografts
Trevor J.SheltonM.D., M.S.aConnorDelmanM.D.bSeanMcNaryPh.D.bJ. RyanTaylorM.D., M.P.H.cRichard A.MarderM.D.b
doi : 10.1016/j.arthro.2021.02.042
Volume 37, Issue 7, July 2021, Pages 2173-2180
Tibial Slope Can Be Maintained During Medial Opening-Wedge Proximal Tibial Osteotomy With Sagittally Oriented Hinge, Posterior Plate Position, and Knee Hyperextension: A Cadaveric Study
Joseph J.RuzbarskyM.D.abJustin W.ArnerM.D.abGrant J.DornanM.S.bMatthew T.ProvencherM.D.abArmando F.VidalM.D.ab
doi : 10.1016/j.arthro.2021.01.065
Volume 37, Issue 7, July 2021, Pages 2181-2188
Editorial Commentary: Tibial Slope Should Be Naturally Maintained by Proper Posterior Cortical Osteotomy and Gap Distraction in Open-Wedge High Tibial Osteotomy
Yong SeukLeeM.D., Ph.D.
doi : 10.1016/j.arthro.2021.03.082
Volume 37, Issue 7, July 2021, Pages 2189-2190
The tibial slope usually increases after open-wedge high tibial osteotomy (OWHTO) because of several factors. The anteromedial cortex of the proximal tibia is angulated 45° relative to the posterior cortex, whereas the lateral cortex is nearly perpendicular. Therefore, an OWHTO with equal anterior and posterior gaps will increase the tibial slope. In addition, an anteromedial approach to the proximal tibia because of concern about neurovascular injury results in the failure to perform a proper osteotomy of the posterolateral cortex. Slope-optimization methods include a sagittally oriented hinge, posterior bone grafting, posterior plating, and forcefully extending the knee to compress the anterior gap sagittally oriented hinge, posterior positioning of the wedged plate, and knee extension during fixation. However, if the tibial slope is easily controlled using knee extension, this may indicate fracture of the lateral hinge, whereas a preserved lateral hinge is a prerequisite for a successful OWHTO. Most of all, a proper posterior cortical osteotomy is the key step to preventing increased tibial slope in OWHTO. Again, if an incomplete osteotomy is performed posterolaterally, the opening gap is increased anteriorly, leading to an unnecessary increase in posterior tibial slope; for biplanar osteotomy, retrotubercular osteotomy should be performed close to the patellar tendon and not be advanced to the posterolateral side of the hinge.
Axial But Not Sagittal Hinge Axis Affects Posterior Tibial Slope in Medial Open-Wedge High Tibial Osteotomy: A 3-Dimensional Surgical Simulation Study
YuanjunTengM.D.abHidekiMizu-uchiM.D., Ph.D.bYayiXiaM.D., Ph.D.aYukioAkasakiM.D., Ph.D.bTakenoriAkiyamaM.D.cShinyaKawaharaM.D., Ph.D.bYasuharuNakashimaM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.01.063
Volume 37, Issue 7, July 2021, Pages 2191-2201
Editorial Commentary: Posterolateral Malposition of the Cortical Hinge During Medial Open-Wedge High Tibial Osteotomy Increases Posterior Tibial Slope: Incomplete Posterior Osteotomy May Shift the Hinge From Lateral to Posterolateral
Dong JinRyuM.D., M.S.aJoon HoWangM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.03.003
Volume 37, Issue 7, July 2021, Pages 2202-2203
Medial open-wedge high tibial osteotomy is an established treatment option for relatively young patients with medial-compartment osteoarthritis and varus deformity. This procedure is mainly focused on correcting coronal malalignment; however, it inevitably affects the posterior tibial slope (PTS) in the sagittal plane. The alteration of the PTS significantly affects knee stability and kinematics. When medial open-wedge high tibial osteotomy is performed, incomplete osteotomy of the posterior cortex could lead to a cortical hinge shift from the lateral side to the posterolateral side, which indicates the alteration of the axial hinge axis. In this case, there is a risk of an increasing PTS. In addition, incomplete posterior cortex osteotomy can lead to a lateral hinge fracture.
H-Plasty Repair Technique Improved Tibiofemoral Contact Mechanics After Repair for Adjacent Radial Tears of Posterior Lateral Meniscus Root: A Biomechanical Study
Zheng-ZhengZhangPh.D., M.D.a?HuanLuoM.D.ab?Hao-ZhiZhangM.D.a?Yun-FengZhouM.D.aZhongChenM.D.aChuanJiangPh.D., M.D.aBinSongPh.D., M.D.aWei-PingLiM.D.a
doi : 10.1016/j.arthro.2021.02.017
Volume 37, Issue 7, July 2021, Pages 2204-2216.e2
Editorial Commentary: Medial and Lateral Meniscus Root Injuries Are Distinct, and Indications for Repair May Differ: Get Down to the Root of the Problem!
WolfPetersenM.D.(Associate Editor Emeritus)
doi : 10.1016/j.arthro.2021.03.068
Volume 37, Issue 7, July 2021, Pages 2217-2219
Medial and lateral root injuries are different clinical entities. Medial root injuries are of a degenerative nature and frequently are associated with obesity and varus deformity. Lateral root injuries, however, are more often of traumatic origin and usually associated with injuries to the anterior cruciate ligament. There is also a biomechanical difference between the 2 injuries. In the case of medial root injuries, the loss of circular hoop tension leads to an increase in peak contact pressure. In the case of lateral root lesions, the loss of hoop stress can be compensated for by an intact meniscofemoral ligament. Nevertheless, a repair also seems to make sense on the lateral meniscus, as the posterior root also has a stabilizing effect on the knee. The most suitable technique for lateral root repair depends on the type of lesion. A transtibial pull out repair is suitable for frequent avulsion injuries (type 1). In the case of type 2 injuries, which are also common, a side-to-side suture is an option.
Double-Bundle Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Tenodesis Is Effective in Restoring Knee Stability in a Chronic, Complex Anterior Cruciate Ligament-Injured Knee Model: A Cadaveric Biomechanical Study
Ji HyunAhnM.D.aIn JunKohM.D.bMichelle H.McGarryM.S.cNilay A.PatelM.D.dCharles C.LinM.D.eThay Q.LeePh.D.c
doi : 10.1016/j.arthro.2021.02.041
Volume 37, Issue 7, July 2021, Pages 2220-2234
Editorial Commentary: Chronic Anterior Cruciate Ligament Injury Requires Reconstruction Plus Lateral Tenodesis to Control Rotational Instability: Additional Technical Complexity May Result in Complications Without Improved Outcomes
StefanoZaffagniniM.D.aTommasoRoberti di SarsinaM.D.b
doi : 10.1016/j.arthro.2021.04.018
Volume 37, Issue 7, July 2021, Pages 2235-2236
How to restore native knee kinematics following complex knee injuries is still debated and under investigation. To better reproduce the native anterior cruciate ligament (ACL), surgeons have a host of different options, including graft choice, technique, fixation method, and single-, double-, and triple-bundle techniques, etc. Isolated ACL reconstruction alone is not effective in controlling complex instability patterns, especially regarding internal and external rotations. Several techniques have been described to address such instabilities, like single- or double- bundle ACL reconstruction plus lateral extra-articular tenodesis. In truth, chronic ACL injury requires reconstruction plus lateral tenodesis to control rotational instability. Additional technical complexity may result in complications without improved outcomes. Neither single-bundle nor double-bundle techniques are “truly” anatomic. Keep it simple; keep it safe.
Multimodal Nonopioid Pain Protocol Provides Equivalent Pain Versus Opioid Control Following Meniscus Surgery: A Prospective Randomized Controlled Trial
Toufic R.JildehaKelechi R.OkorohaM.D.bNoahKuhlmannB.S.aAustinCrossB.S.aMuhammad J.AbbasB.S.aVasiliosMoutzourosM.D.a
doi : 10.1016/j.arthro.2021.02.043
Volume 37, Issue 7, July 2021, Pages 2237-2245
Safety and Efficacy of an Amniotic Suspension Allograft Injection Over 12 Months in a Single-Blinded, Randomized Controlled Trial for Symptomatic Osteoarthritis of the Knee
Andreas H.GomollM.D.aJackFarrM.D.bBrian J.ColeM.D., M.B.A.cDavid C.FlaniganM.D.dChristianLattermannM.D.eBert R.MandelbaumM.D.fSabrina M.StricklandM.D.aKenneth R.ZaslavM.D.gKelly A.KimmerlingPh.D.hKatie C.MowryPh.D.h
doi : 10.1016/j.arthro.2021.02.044
Volume 37, Issue 7, July 2021, Pages 2246-2257
Editorial Commentary: Minimally Invasive Strategies for Osteoarthritis: From Platelets to Mesenchymal Stem Cells
ElizavetaKonM.D.BerardoDi MatteoM.D., Ph.D.
doi : 10.1016/j.arthro.2021.04.010
Volume 37, Issue 7, July 2021, Pages 2258-2261
The range of biological agents to treat osteoarthritis is in constant expansion, and recent trials suggest that amnion-derived products (such as umbilical cord stem cells or amniotic allograft suspension) may provide significant symptomatic relief and functional improvement compared with traditional injectables. Anyway, in many countries, stringent limitations exist on the manipulation and homologous use of placenta-derived products, and therefore, collecting more data is mandatory to endorse their use for musculoskeletal diseases in a safe and clearly regulated way. More in general, an increasing interest toward orthobiology has been observed in recent years, which led to the introduction in clinical practice of many minimally invasive strategies to treat osteoarthritis, from platelet-rich plasma to mesenchymal stem cells. On the basis of this trend, which involves physicians from different specialties, it would be fundamental to have clear guidelines establishing the correct use of these products in the setting of clinical routine not only to safely provide patients the most advanced therapeutic options but also to protect our practice from potential legal issues.
Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus
YoshiharuShimozonoM.D.aEmilie R.C.WilliamsonM.D.aNathaniel P.MercerM.S.aEoghan T.HurleyM.B., B.Ch., M.Ch.aHaoHuangB.S.bTimothy W.DeyerM.D.bJohn G.KennedyM.D., M.Ch., M.M.Sc., F.F.S.E.M., F.R.C.S.(Orth)a
doi : 10.1016/j.arthro.2021.03.032
Volume 37, Issue 7, July 2021, Pages 2262-2269
Editorial Commentary: Drill and Fill: Bone Marrow Stimulation Plus Allograft Matrix May Optimize the Treatment of Osteochondral Lesions of the Talus
Connor M.DelmanM.D.ChristopherKreulenM.D.EricGizaM.D.
doi : 10.1016/j.arthro.2021.04.046
Volume 37, Issue 7, July 2021, Pages 2270-2271
Osteochondral lesions of the talus remain a challenging pathologic entity facing orthopaedic foot and ankle surgeons. Although multiple treatment options exist, there is limited evidence supporting one technique over another. The ultimate goal of surgical intervention is to achieve lesion infill with tissue properties that best mimic those of hyaline articular cartilage. Restoring the anatomic surface of the talus may provide long-term clinical success and improve function. Augmentation of bone marrow stimulation with extracellular matrix cartilage allograft aims to achieve this goal.
Pain Is the Primary Factor Associated With Satisfaction With Symptoms for New Patients Presenting to the Orthopedic Clinic
David N.BernsteinM.D., M.B.A., M.A.aDylanKoolmeesB.S.bJoshHesterB.S.bNikhilYedullaB.S.bEric C.MakhniM.D., M.B.A.b
doi : 10.1016/j.arthro.2021.03.081
Volume 37, Issue 7, July 2021, Pages 2272-2278
Editorial Commentary: Patient-Reported Outcomes Measurement Information System (PROMIS) Needs an Anchor to Correlate Pain and Satisfactory Function in New Patient Orthopaedic Visits
Warren C.HammertM.D.
doi : 10.1016/j.arthro.2021.04.030
Volume 37, Issue 7, July 2021, Pages 2279-2280
In today’s health care climate, the patient perspective is becoming increasingly important. As the health care paradigm shifts toward value-based health care, patient-reported outcomes are becoming increasingly important for not only research but for routine clinical care. While there are many outcome instruments used for musculoskeletal care, the addition of the simple question of “how are you doing” or “are your symptoms manageable” can provide additional valuable insight to the provider and help improve care using a shared decision model. In other words, if you want to know how the patient is doing, you have to ask them. This biopsychosocial approach demonstrates caring for the entire patient. The Patient-Reported Outcomes Measurement Information System (PROMIS) is a patient-reported outcome instrument that was developed using the biopsychosocial model and has the advantage of being administered as a computer adaptive test. It can be used across health care and is comparable across medical specialties as the scores are standardized to US population-based norms. When used in isolation, PROMIS provides an idea of how the patient is doing compared with the population but does not give the insight as to how the patient is coping with their condition. The addition of an anchor question, such as their patient acceptable symptom state, adds further understanding to the individual patient.
Efficacy of Arthroscopic Surgery in the Management of Adhesive Capsulitis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials
BrianForsytheM.D.aOphelieLavoie-GagneB.S.aBhavik H.PatelM.D.cYiningLuM.D.aEthanRitzM.S.bJorgeChahlaM.D., Ph.D.aKelechi R.OkorohaM.D.dAnsworth A.AllenM.D.eBenedict U.NwachukwuM.D., M.B.A.e
doi : 10.1016/j.arthro.2020.09.041
Volume 37, Issue 7, July 2021, Pages 2281-2297
Intra-Articular Injections of Platelet-Rich Plasma, Adipose Mesenchymal Stem Cells, and Bone Marrow Mesenchymal Stem Cells Associated With Better Outcomes Than Hyaluronic Acid and Saline in Knee Osteoarthritis: A Systematic Review and Network Meta-analysis
DiZhaoM.D.aJian-kePanPh.D.bWei-yiYangPh.D.bYan-hongHanM.D.bLing-fengZengPh.D.bcGui-hongLiangM.D.bcJunLiuPh.D.bc
doi : 10.1016/j.arthro.2021.02.045
Volume 37, Issue 7, July 2021, Pages 2298-2314.e10
Editorial Commentary: Injection of Platelet-Rich Plasma Appears Superior to Hyaluronic Acid and Adipose- or Bone-Derived Marrow Stem Cells for Knee Osteoarthritis
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.2021.03.053
Volume 37, Issue 7, July 2021, Pages 2315-2317
Injection therapy for knee osteoarthritis continues to be a controversial topic. Commonly accepted treatment options are corticosteroid and hyaluronic acid injections, but recently platelet-rich plasma also has been a promising biologic treatment option. Adipose and bone marrow–derived mesenchymal stem cells have been applied clinically, but there is no strong supporting evidence for their use. It is also currently unknown whether stem cells can regenerate cartilage. As there is no cure for painful knee osteoarthritis, injection therapy can provide symptom relief. Recent network meta-analyses suggest that platelet-rich plasma provides the best functional improvement and safety for knee osteoarthritis, and adipose-derived mesenchymal stem cells provide excellent pain relief. We must bear in mind that other network meta-analyses report different results, and a challenge of network meta-analysis is inconsistency that can lead to biased treatment effect estimates.
Low-Intensity Pulsed Ultrasound Augments Tendon, Ligament, and Bone–Soft Tissue Healing in Preclinical Animal Models: A Systematic Review
Wilson C.LaiM.D.aBrenda C.IglesiasB.A.bBryan J.MarkM.D.aDeanWangM.D.a
doi : 10.1016/j.arthro.2021.02.019
Volume 37, Issue 7, July 2021, Pages 2318-2333.e3
Editorial Commentary: Treatment Efficacy Found in Animal Studies May Not Translate to Humans
Omer A.IlahiM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.03.036
Volume 37, Issue 7, July 2021, Pages 2334-2336
Efficacy of low-intensity pulsed ultrasonography (LIPUS) has been demonstrated in several mammalian models of injury/repair of tendons, ligaments, and soft tissue-bone junctions. But human studies have not demonstrated benefit from such intervention. In addition to innate healing differences between humans and research animals, another reason for this outcome variance may be that animal investigations of LIPUS have so far focused on healing after acute intervention, whereas randomized clinical trials have only looked at treating chronic tendinopathy in symptomatic patients. On the basis of current animal data, potential clinical benefit of LIPUS is most likely to be demonstrated for addressing acute injuries or postoperative scenarios. Yet, a particularly important anatomic difference between humans and experimental land animals regarding ultrasonography is the presence of subcutaneous adipose in the former versus the lack thereof in the latter, especially in the extremities, because overlying adipose attenuates ultrasound waves directed at underlying injured, repaired, or reconstructed tissues.
Generalized Joint Laxity Is Associated With Increased Failure Rates of Primary Anterior Cruciate Ligament Reconstructions: A Systematic Review
Nathan M.KrebsD.O.aSueBarber-WestinB.S.bFrank R.NoyesM.D.abc
doi : 10.1016/j.arthro.2021.02.021
Volume 37, Issue 7, July 2021, Pages 2337-2347
Editorial Commentary: Diagnosis and Treatment of Generalized Joint Hypermobility in Patients With Anterior Cruciate Ligament Injury
DavidSundemoM.D., Ph.D.aEric HamrinSenorskiR.P.T., Ph.D.aKristianSamuelssonM.D., Ph.D.ab
doi : 10.1016/j.arthro.2021.03.052
Volume 37, Issue 7, July 2021, Pages 2348-2350
Generalized joint hypermobility (GJH), or laxity, is defined as hyperextensibility of the synovial joints. Hypermobility is caused by alterations in the connective tissues, in turn caused by various factors including impaired function of collagen proteins. For measurement of knee GJH, we highly recommend using the Beighton score, the most frequently used method in both the sports medicine and other literature. Our recommendations on how to treat patients with anterior cruciate ligament (ACL) injury with generalized joint hypermobility include the following: (1) use patellar-tendon or quadriceps tendon autograft for ACL reconstruction; (2) always consider performing a lateral extra-articular tenodesis; and (3) make sure patients pass a return to sport test battery including strength, hop performance, subjective knee function, and movement quality. Delay to return to sport may be as long as 1 year after surgery.
Return-to-Sport Rate and Activity Level Are High Following Arthroscopic All-Inside Meniscal Repair With and Without Concomitant Anterior Cruciate Ligament Reconstruction: A Systematic Review
TrifonTotlisM.D., Ph.D.abEric D.HaunschildB.S.cNikolaosOtountzidisB.S.aKonstantinosStamouB.S.aNolan B.CondronB.S.cKonstantinosTsikopoulosM.D.dBrian J.ColeM.D., M.B.A.c
doi : 10.1016/j.arthro.2021.02.046
Volume 37, Issue 7, July 2021, Pages 2351-2360
Bone Grafting the Patellar Defect After Bone–Patellar Tendon–Bone Anterior Cruciate Ligament Reconstruction Decreases Anterior Knee Morbidity: A Systematic Review
Darius L.LameireB.Sc.aHassaanAbdel KhalikB.Sc., M.M.I.aAlexanderZakhariabJeffreyKayM.D.cMahmoudAlmasriM.D., F.R.C.S.C.cdDarrende SAM.D., F.R.C.S.C.c
doi : 10.1016/j.arthro.2021.03.031
Volume 37, Issue 7, July 2021, Pages 2361-2376.e1
A Systematic Review Shows High Variation in Terminology, Surgical Techniques, Preoperative Diagnostic Measures, and Geographic Differences in the Treatment of Athletic Pubalgia/Sports Hernia/Core Muscle Injury/Inguinal Disruption
Matthew J.KraeutlerM.D.aOmerMei-DanM.D.bJohn W.BelkB.A.bChristopher M.LarsonM.D.cToghrulTalishinskiyM.D.dAnthony J.ScilliaM.D.ae
doi : 10.1016/j.arthro.2021.03.049
Volume 37, Issue 7, July 2021, Pages 2377-2390.e2
Editorial Commentary: Managing Hip Pain, Athletic Pubalgia, Sports Hernia, Core Muscle Injury, and Inguinal Disruption Requires Diagnostic and Therapeutic Expertise
Dean K.MatsudaM.D., F.A.A.O.S.
doi : 10.1016/j.arthro.2021.04.027
Volume 37, Issue 7, July 2021, Pages 2391-2392
Pubalgia means pubic pain. This is different from core muscle injury (implying muscular pathology) or inguinal disruption (different anatomic region). Athletic pubalgia includes a myriad of pathologic conditions involving the pubic symphysis, adductors, rectus abdominis, posterior inguinal wall, and/or related nerves. Moreover, growing evidence supports a link between femoroacetabular impingement (FAI) and pubalgic conditions. Constrained hip range of motion in flexion causing obligatory transitory, even ballistic, posterior tilting of the hemipelvis may produce pathologic transfer stress to not only the pubic symphysis but the sacroiliac joint, lumbar spine, and proximal hamstrings, manifesting in diverse, often-painful, conditions. In select cases of pubalgia, patients may have clinical improvement with concurrent or even isolated treatment addressing FAI. Unlike atypical posterior hip pain from FAI, which may be referred pain that might respond favorably, albeit temporarily, to an intra-articular injection, secondary pubic pain from a transfer stress pathomechanism might not be expected to benefit from such. And, it’s not always FAI. Some patients who do not respond to nonoperative management may not require arthroscopic surgery and might benefit from open or laparoscopic mesh hernia repair, adductor tenotomy, primary tissue (hernia) repair, rectus abdominis repair, or even endoscopic surgery for osteitis pubis and/or pubalgia. And, finally, these may be combined with FAI surgical treatment. Refinement of definitions, pathologic conditions, technical advances, and collaboration with general surgeons will best help us treat our patients.
