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Arthroscopy Annual Awards: The “Old Normal”
Jefferson C. Brand, Michael J. Rossi, James H. Lubowitz
doi : 10.1016/j.arthro.2020.11.020
Volume 37, ISSUE 1, P1-6, January 01, 2021
With sincere thanks to the Arthroscopy Association of North America Education Foundation for their support, we are pleased to announce the Annual Awards for our best Clinical Research, Basic Science Research, Resident/Fellow Research, and Systematic Reviews published in 2020, as well as the Most Downloaded and Most Cited papers published 5 years ago. We proudly introduce new members of our editorial team, and your editors update their disclosures of potential conflicts of interest.
Christopher T. J. Servant, B.Sc.(Hons), M.B.B.S., F.R.C.S.(Tr&Orth), Associate Editor
James H. Lubowitz
doi : 10.1016/j.arthro.2020.10.015
Volume 37, ISSUE 1, P6, January 01, 2021
Andrew G. Geeslin, M.D., Infographics Editor
James H. Lubowitz
doi : 10.1016/j.arthro.2020.10.006
Volume 37, ISSUE 1, P7, January 01, 2021
Niraj V. Kalore, M.D., Visual Abstracts Editor
James H. Lubowitz
doi : 10.1016/j.arthro.2020.11.014
Volume 37, ISSUE 1, P7, January 01, 2021
Letter to the Editor: Is Criticism About Inherent Biases in Rigorous Orthopaedic Trials Prone to Biases?
Aleksi Reito, Teemu Karjalainen
doi : 10.1016/j.arthro.2020.11.005
Volume 37, ISSUE 1, P8-9, January 01, 2021
Author Reply to “Is Criticism About Inherent Biases in Rigorous Orthopaedic Trials Prone to Biases?”
Erik Hohmann, Kevin Shea, Bastian Scheiderer, Peter Millett, Andreas Imhoff
doi : 10.1016/j.arthro.2020.11.002
Volume 37, ISSUE 1, P9-11, January 01, 2021
Regarding “A Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears”
Rameshwar Datt, Gunjar Jain, Rahul Morankar, Vijaykumar Digge
doi : 10.1016/j.arthro.2020.11.004
Volume 37, ISSUE 1, P11-12, January 01, 2021
Author Reply to “Regarding ‘A Prospective Randomized Trial Comparing Suture Bridge and Medially Based Single-Row Rotator Cuff Repair in Medium-Sized Supraspinatus Tears’”
Kotaro Yamakado
doi : 10.1016/j.arthro.2020.11.003
Volume 37, ISSUE 1, P12-13, January 01, 2021
Regarding “Analyzing Spin in Abstracts of Orthopaedic Randomized Controlled Trials With Statistically Insignificant Primary Endpoints”
Girinivasan Chellamuthu, Sathish Muthu
doi : 10.1016/j.arthro.2020.11.006
Volume 37, ISSUE 1, P13-14, January 01, 2021
Stress Radiographs for Ligamentous Knee Injuries
Nicholas N. DePhillipo,Patrick W. Kane,Lars Engebretsen
doi : 10.1016/j.arthro.2020.11.001
Volume 37, ISSUE 1, P15-16, January 01, 2021
Stress radiographs can provide an objective, quantifiable assessment of ligamentous knee injury. Commonly utilized techniques include varus, valgus, and posterior stress radiographs and can be used to augment findings on physical examination and magnetic resonance imaging. Both in vitro and in vivo studies have demonstrated reliability and validity of stress radiographs for diagnosing isolated and multiple ligament knee injuries.
Shoulder Position During Magnetic Resonance Arthrogram Significantly Affects Capsular Measurements
Charles Cody White,Venkatraman Kothandaraman,Jackie Lin,...Harris S. Slone,Richard J. Friedman,Josef K. Eichinger
doi : 10.1016/j.arthro.2020.09.014
Volume 37, ISSUE 1, P17-25, January 01, 2021
To determine whether change in shoulder position between internal rotation (IR) and external rotation (ER) during magnetic resonance arthrography (MRA) affects previously defined capsular measurements and to determine the utility of rotation in the diagnosis of instability.
Editorial Commentary: There Is Value in Standardizing the Position of the Arm During Magnetic Resonance Imaging Arthrogram of the Shoulder When Evaluating for Suspected Instability (and It Doesn’t Have to Be Painful to the Patient!)
Gregory F. Carolan
doi : 10.1016/j.arthro.2020.10.044
Volume 37, ISSUE 1, P26-27, January 01, 2021
Evaluating and treating a shoulder with suspected instability remains a challenge for all. Most authors and surgeons would agree that clinical history and physical examination of the patient are the most important aspects of this evaluation. Over the past 15 years, however, radiographic imaging has become a much more prevalent (and essential) component. Magnetic resonance imaging arthrogram has become the gold standard to evaluate a patient for suspected instability and is currently considered the most appropriate advanced study by the American College of Radiologists to do so in both traumatic and atraumatic presentations.
Arthroscopic Repair of Medium to Large Rotator Cuff Tears With a Triple-Loaded Medially Based Single-Row Technique Augmented With Marrow Vents
Brian D. Dierckman,Petros Frousiakis,Joseph P. Burns,...Mark H. Getelman,Ronald P. Karzel,Stephen J. Snyder
doi : 10.1016/j.arthro.2020.08.003
Volume 37, ISSUE 1, P28-37, January 01, 2021
Editorial Commentary: Biology and Biomechanics Must Be Carefully Balanced for a Durable Rotator Cuff Repair
Samer S. Hasan
doi : 10.1016/j.arthro.2020.09.049
Volume 37, ISSUE 1, P38-41, January 01, 2021
Arthroscopic rotator cuff repair strategies have evolved over 3 decades, but suture anchor design, anchor configuration, and stitches have been largely driven by repair biomechanics. In recent years there has been a shift toward repair strategies that enhance the biology of tendon repair. Double-row and transosseous equivalent suture anchor repair constructs demonstrate excellent time zero mechanical properties, but the resulting increased repair tension and tendon compression may compromise tendon healing. Modern single-row repairs employing medialized triple-loaded suture anchors, simple stitches, and lateral marrow venting avoid some of the problems associated with double-row repairs and demonstrate excellent short-term healing and clinical results. The most robust repair fails if the tendon does not heal. Biology and biomechanics must be carefully balanced.
Inpatient Arthroscopic Rotator Cuff Repair Is Associated With Higher Postoperative Complications Compared With Same-Day Discharge: A Matched Cohort Analysis
Zain M. Khazi,Yining Lu,William Cregar,...Trevor R. Gulbrandsen,Randy Mascarenhas,Brian Forsythe
doi : 10.1016/j.arthro.2020.07.021
Volume 37, ISSUE 1, P42-49, January 01, 2021
Complications Within 6 Months After Arthroscopic Rotator Cuff Repair: Registry-Based Evaluation According to a Core Event Set and Severity Grading
Quinten Felsch,Victoria Mai,Holger Durchholz,...Maximilian Lenz,Carl Capellen,Laurent Audigé
doi : 10.1016/j.arthro.2020.08.010
Volume 37, ISSUE 1, P50-58, January 01, 2021
Editorial Commentary: Adverse Events After Rotator Cuff Repair Are Not Rare: Houston, We (May) Have a Problem
Adam Kwapisz
doi : 10.1016/j.arthro.2020.10.045
Volume 37, ISSUE 1, P59-60, January 01, 2021
The first national medical database registry was started in Sweden in 1975, and clinical registries have gained enormous popularity. Analysis of a large database of rotator cuff repair surgeries shows that adverse events may occur in almost 1 of 5 cases, showing the use of a register as a highly beneficial source of information. However, retrospective review of prospectively collected registry data has limitations and biases as well as benefits, including inconsistent reporting and recording of data, lack of control of confounding patient variables, and loss to follow-up.
The 50 Highest Cited Papers on Rotator Cuff Tear
Filippo Familiari,Roberto Castricini,Olimpio Galasso,Giorgio Gasparini,Bruno Iann?,Francesco Ranuccio
doi : 10.1016/j.arthro.2020.07.044
Volume 37, ISSUE 1, P61-68, January 01, 2021
Editorial Commentary: The Top Cited Rotator Cuff Repair Articles: It’s All About Popular
Stephen C. Weber
doi : 10.1016/j.arthro.2020.09.027
Volume 37, ISSUE 1, P69-70, January 01, 2021
Hematologic Expression After Shoulder Surgery: Normalization Curve of Serum Inflammatory Markers
Sung-Min Rhee,Myung Seo Kim,Jong Dae Kim,Kyunghan Ro,Young Wan Ko,Yong Girl Rhee
doi : 10.1016/j.arthro.2020.09.017
Volume 37, ISSUE 1, P71-82, January 01, 2021
Editorial Commentary: Are Serum Inflammatory Markers Useful Diagnostic Tools in the Shoulder?
Eric T. Ricchetti
doi : 10.1016/j.arthro.2020.10.046
Volume 37, ISSUE 1, P83-85, January 01, 2021
Serum inflammatory markers are commonly used to evaluate for the presence of surgical-site infection or periprosthetic joint infections following orthopaedic surgery. However, data on the utility of these tests following shoulder surgery are more limited. Worse diagnostic performance is seen in the shoulder when compared with use of these tests in the evaluation of hip and knee infections, likely due to the low virulence of the commonly cultured shoulder organisms, and the normalization of these serum markers following shoulder surgery is less well defined when compared with the hip and knee literature. A better understanding of the behavior of these serum inflammatory markers in the shoulder may enhance the utility of these tests in the diagnosis and management of infection following elective shoulder surgery.
Arthroscopic Capsular Management of the Hip: A Comparison of Indications for and Clinical Outcomes of Periportal Versus Interportal Capsulotomy
Ryan P. McGovern,Gabriella Bucci,Beth A. Nickel,Henry B. Ellis,Joel E. Wells,John J. Christoforetti
doi : 10.1016/j.arthro.2020.08.004
Volume 37, ISSUE 1, P86-94, January 01, 2021
Editorial Commentary: Evidence-Based Guidelines for Management of the Hip Capsule During Arthroscopy: Has It Become Personal?
Ioanna K. Bolia
doi : 10.1016/j.arthro.2020.09.045
Volume 37, ISSUE 1, P95-97, January 01, 2021
The management of the capsule during hip arthroscopy for femoroacetabular impingement syndrome has been in the spotlight during the last decade. Although there is robust biomechanical evidence that preserving the anatomic integrity of the iliofemoral ligament is important for the stability of the hip joint, the effect of capsular management on patient outcomes is often debated in clinical studies. Mid-term and long-term follow-up studies have shown that capsular closure is associated with decreased risk of hip arthroscopy failure, but no difference in patient outcomes based on capsular management has been found by some case series studies. What is driving the controversy in the literature? It seems to stem from the variation in surgical techniques used to perform hip capsulotomy or capsular repair, worldwide. Given that improvement in patient outcomes must be prioritized, it is time to use the existing knowledge appropriately to establish evidence-based guidelines for the management of hip capsule during hip arthroscopy.
Decreased Hip Labral Width Measured via Preoperative Magnetic Resonance Imaging Is Associated With Inferior Outcomes for Arthroscopic Labral Repair for Femoroacetabular Impingement
Daniel J. Kaplan,Mohammad Samim,Christopher J. Burke,Samuel L. Baron,Robert J. Meislin,Thomas Youm
doi : 10.1016/j.arthro.2020.08.006
Volume 37, ISSUE 1, P98-107, January 01, 2021
Editorial Commentary: Arthroscopic Treatment for Diminutive Hip Labral Size: Go Big or Go Home?
Alan L. Zhang
doi : 10.1016/j.arthro.2020.09.040
Volume 37, ISSUE 1, P108-110, January 01, 2021
The diminutive (or hypoplastic or hypotrophic) hip labrum presents a unique surgical challenge in the setting of femoroacetabular impingement syndrome for many hip arthroscopists. Insufficient labral tissue leads to increased risk for suture cutout or overeversion, with resulting loss of suction seal when attempting arthroscopic repair. Although some surgeons have demonstrated clinical improvement after performing primary refixation of the diminutive labrum, others have reported inferior outcomes for patients with labral width <4 mm compared with patients having normal or larger labral width. Alternative treatment methods, including labral reconstruction or labral augmentation with autograft or allograft, may be effective, based on select single-surgeon studies. As further research is needed to fully evaluate outcomes of these techniques, hip arthroscopists should recognize the difficult task at hand and be prepared to use assorted treatment options to augment a diminutive labrum. Larger labra can maintain contact with the femoral head after repair, and techniques such as labral base fixation can help to preserve this interaction and recreate the suction seal.
Femoral Derotation Osteotomy Improves Hip and Spine Function in Patients With Increased or Decreased Femoral Torsion
Munif Hatem,Anthony Nicholas Khoury,Lane Richard Erickson,Alan Leslie Jones,Hal David Martin
doi : 10.1016/j.arthro.2020.08.008
Volume 37, ISSUE 1, P111-123, January 01, 2021
Editorial Commentary: A Simple Twist of Fate: The Ramifications of Abnormal Femoral Version
Robert L. Buly
doi : 10.1016/j.arthro.2020.10.005
Volume 37, ISSUE 1, P124-127, January 01, 2021
The abnormalities of femoral twist or version, whether increased anteversion or retroversion, are frequently overlooked. These skeletal aberrations are responsible for a host of hip problems such as impingement, instability and damage to the labrum and articular cartilage, often resulting in osteoarthritis if left untreated. In addition to the intrinsic hip damage, extra articular problems such as posterior hip impingement, pelvic tendonopathies, problems with gait and sitting as well as spinal decompensation are also very common. It is incumbent upon those who manage hip problems to be aware of the damage caused by femoral version abnormalities and the treatment options available.
Ultrasound and Ultrasound-Guided Hip Injection Have High Accuracy in the Diagnosis of Femoroacetabular Impingement With Atypical Symptoms
Guanying Gao,Qiang Fu,Ruiqi Wu,Rongge Liu,Ligang Cui,Yan Xu
doi : 10.1016/j.arthro.2020.08.013
Volume 37, ISSUE 1, P128-135, January 01, 2021
Editorial Commentary: Ultrasound-Guided Injection With Dynamic Assessment Could Improve Outcomes in Atypical and Revision Hip Arthroscopy Patients: But Today, Few Are Trained to Hear at Such High Frequencies
Christopher M. Larson
doi : 10.1016/j.arthro.2020.09.051
Volume 37, ISSUE 1, P136-138, January 01, 2021
Imaging modalities for hip disorders all have their strengths and weaknesses. Magnetic resonance imaging is superior for evaluating soft tissue pathology, computerized tomography best characterizes osseous morphology, and plain radiographs can accurately depict 2-dimensional anatomy and are familiar to most clinicians. Ultrasound-guided injections have become commonplace in the musculoskeletal arena. Ultrasound evaluation of musculoskeletal anatomy has received increased attention, has the ability to image soft tissue and osseous structures, and more importantly, has the ability to dynamically evaluate these structures in real time. A noninvasive dynamic assessment of the hip region could be an absolute game changer for the hip preservation/sports medicine community in the diagnosis of atypical hip pain, femoroacetabular impingement, and labral tears. Widespread ability and expertise to perform these dynamic ultrasound assessments, however, is not in place at this time. We need more training and studies to best harness the potential benefits of these sound waves.
Neuraxial Anesthesia Is Associated With Decreased Pain Scores and Post-Anesthesia Care Unit Opioid Requirement Compared With General Anesthesia in Hip Arthroscopy
Elizabeth H.G. Turner,Christopher J. Whalen,Matthew A. Beilfuss,Scott J. Hetzel,Kristopher M. Schroeder,Andrea M. Spiker
doi : 10.1016/j.arthro.2020.08.032
Volume 37, ISSUE 1, P139-146, January 01, 2021
Editorial Commentary: Neuraxial Anesthesia Improves Pain After Hip Arthroscopy but Risks Ambulatory Discharge Delay
Edward N. Yap,Matthias Behrends
doi : 10.1016/j.arthro.2020.10.028
Volume 37, ISSUE 1, P147-148, January 01, 2021
Hip arthroscopy continues to be one of the fastest-growing orthopaedic procedures nationally, and pain control following these procedures can be challenging. As regional anesthesia techniques for this population have shown to have limited benefits, pain management for hip arthroscopy focused on multimodal analgesia and preventive analgesia, interventions that reduce postoperative hyperalgesia. The use of neuraxial anesthesia such as spinal and epidural anesthesia, established preventive analgesic anesthetic techniques, has demonstrated to improve postoperative pain in orthopaedic surgery when compared with general anesthesia. This promising finding highlights that despite potential disadvantages of neuraxial anesthesia, such as a small risk for complications or delayed resolution of the neuraxial block that could delay discharge, neuraxial anesthesia could be a suitable anesthetic technique for ambulatory orthopaedic surgery.
Prevalence of Lumbosacral Transitional Vertebrae in Patients With Symptomatic Femoroacetabular Impingement Requiring Hip Arthroscopy
Roger Luo,Dena Barsoum,Humaira Ashraf,...Nicole R. Hurwitz,Campbell Y. Goldsmith,Peter J. Moley
doi : 10.1016/j.arthro.2020.08.034
Volume 37, ISSUE 1, P149-155, January 01, 2021
Editorial Commentary: Lumbosacral Anatomy and Mechanics Influence Femoroacetabular Impingement Syndrome and Surgical Outcomes: The Hip Bone Is Connected to the Back Bone
Christopher L. McCrum
doi : 10.1016/j.arthro.2020.10.030
Volume 37, ISSUE 1, P156-158, January 01, 2021
The hip joint in general and femoroacetabular impingement (FAI) in particular do not exist in a vacuum. Impingement kinematics are very closely tied to the relationship between spinopelvic motion and posture, and that of the hip joint itself. While the relationship of lumbar degenerative disease, fusion, and sagittal balance to hip arthroplasty has been well studied, there is a paucity of data on the analogous relationship of the stiff spine with hip arthroscopy and FAI. While further studies are critical in advancing our understanding of this relationship in this unique population, surgeons still must consider the relationship of lumbosacral motion and posture, including the anatomic variant of lumbosacral transitional vertebrae, when evaluating and treating patients with FAI.
Cam Osteochondroplasty for Femoroacetabular Impingement Increases Microinstability in Deep Flexion: A Cadaveric Study
K. C. Geoffrey Ng,Hadi El Daou,Marcus J.K. Bankes,Ferdinando Rodriguez y Baena,Jonathan R.T. Jeffers
doi : 10.1016/j.arthro.2020.08.037
Volume 37, ISSUE 1, P159-170, January 01, 2021
Editorial Commentary: Microinstability After Cam Osteochondroplasty Results From Over-Resection—Everything in Moderation
Timothy J. Jackson
doi : 10.1016/j.arthro.2020.10.023
Volume 37, ISSUE 1, P171-172, January 01, 2021
Cam impingement is one of the most common pathologies treated with hip arthroscopy. While it is a common treatment, it can be difficult to achieve the perfect osteochondroplasty, one that neither over- nor under-resects the head–neck junction. Clinical studies and now biomechanical analysis show over-resection of cam lesions can result in inferior clinical outcomes from microinstability.
Allograft Augmentation of Hamstring Autograft in Anterior Cruciate Ligament Reconstruction Results in Equivalent Outcomes to Autograft Alone
Allison J. Rao,David M. Macknet,Casey R. Stuhlman,...Susan M. Odum,Bryan M. Saltzman,James E. Fleischli
doi : 10.1016/j.arthro.2020.07.010
Volume 37, ISSUE 1, P173-182.e2, January 01, 2021
Editorial Commentary: Anterior Cruciate Ligament Hamstring Autografts Should Be Avoided in Patients Younger Than 25 Years Old: Autograft–Allograft Hybrids Remain Controversial
Michael D. Feldman
doi : 10.1016/j.arthro.2020.10.002
Volume 37, ISSUE 1, P183-184, January 01, 2021
Some studies have reported no difference between autograft and hybrid anterior cruciate ligament reconstructions. However, other studies have shown a significantly greater revision rate. Consequently, surgeons are reluctant to perform hybrid reconstructions in younger patients with diminutive hamstring autografts and have turned to other autograft graft sources (e.g., quadriceps tendon, patellar tendon). Until we can perform high-quality prospective studies that can definitively answer this question, we should consider avoiding autograft hamstring reconstructions in patients younger than 25 years old so that we are not faced with the dilemma of implanting an undersized autograft or a hybrid graft, as both may be at increased risk for failure.
A Longitudinal Comparison of Patient-Reported Outcomes Measurement Information System to Legacy Scales in Knee and Shoulder Arthroscopy Patients
Nicholas A. Giordano,Michael Kent,Chester C. Buckenmaier III,...Jonathan F. Dickens,Matt Millington,Krista Beth Highland
doi : 10.1016/j.arthro.2020.07.026
Volume 37, ISSUE 1, P185-194.e2, January 01, 2021
Beighton Score, Tibial Slope, Tibial Subluxation, Quadriceps Circumference Difference, and Family History Are Risk Factors for Anterior Cruciate Ligament Graft Failure: A Retrospective Comparison of Primary and Revision Anterior Cruciate Ligament Reconstructions
Connor G. Ziegler,Nicholas N. DePhillipo,Mitchell I. Kennedy,Travis J. Dekker,Grant J. Dornan,Robert F. LaPrade
doi : 10.1016/j.arthro.2020.08.031
Volume 37, ISSUE 1, P195-205, January 01, 2021
Editorial Commentary: Remember the Risk Factors During Individualized, Anatomic, Value-Based Anterior Cruciate Ligament Reconstruction
Freddie H. Fu,Kevin J. Byrne,Brian M. Godshaw
doi : 10.1016/j.arthro.2020.11.008
Volume 37, ISSUE 1, P206-208, January 01, 2021
Understanding the etiology behind anterior cruciate ligament (ACL) reconstruction failure is a complex topic still being investigated heavily. The 3 classes of failure are technical, traumatic, and biologic. Technical errors are most common and most frequently reflect tunnel malposition. In addition, tibial slope has long been understood to be a risk factor for failed ACL reconstruction. Although not routinely performed at time of primary ACL reconstruction, osteotomy may be considered in the setting of failed ACL reconstruction. Relative quadriceps weakness is a risk factor, and we recommend sport-specific return-to-play testing as well as benchmarks for relative quadriceps strength before full return to activity. Revision ACL reconstruction is associated with both increased costs and worse patient outcomes, so every effort should be made to give patients the best chance of success after the index surgery. Whereas this begins with understanding the patient’s history and risk factors for failure, it crescendos with careful attention to the individually variable factors that make each case unique, tailoring one’s management to ensure that each patient receives an anatomic, individualized, and value-based ACL reconstruction.
Remnant-Tensioning Single-Bundle Anterior Cruciate Ligament Reconstruction Provides Comparable Stability to and Better Graft Vascularity Than Double-Bundle Anterior Cruciate Ligament Reconstruction in Acute or Subacute Injury: A Prospective Randomized Controlled Study Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging
Jun Ho Kim,Eunsun Oh,Young Cheol Yoon,Do Kyung Lee,Sung-Sahn Lee,Joon Ho Wang
doi : 10.1016/j.arthro.2020.08.035
Volume 37, ISSUE 1, P209-221, January 01, 2021
Degree of Anterolateral Ligament Injury Impacts Outcomes After Double-Bundle Anterior Cruciate Ligament Reconstruction
Ji Hyun Ahn,Seul Ki Lee,Ji Weon Mun,Sang Woo Kim
doi : 10.1016/j.arthro.2020.09.003
Volume 37, ISSUE 1, P222-230, January 01, 2021
Editorial Commentary: Another Take on the Anterolateral Ligament: High-Grade Are Worse Than Low-Grade Injuries, But the Categorization Is Problematic
Erik Hohmann
doi : 10.1016/j.arthro.2020.10.022
Volume 37, ISSUE 1, P231-233, January 01, 2021
The anatomy, function, and existence of the anterolateral ligament (ALL) is still hotly debated and a controversial topic. Currently both basic biomechanical and clinical studies are not providing sufficient and strong evidence to either support or refute that the ALL plays an important role for knee stability. One could argue that stability is provided by the anterolateral complex, including the iliotibial band, Kaplan fibers, and the anterolateral capsule, which may contain a structure called the ALL. Magnetic resonance imaging (MRI) is routinely performed in patients with anterior cruciate ligament (ACL) injury, but unfortunately ALL injuries cannot be reliably diagnosed in patients with concomitant ACL tears. When dividing ALL injuries into high and low grade using preoperative MRI and investigating clinical outcomes after double-bundle ACL reconstruction, patients with high-grade injuries have inferior outcomes and a significantly greater revision rates. However, the limitations of this research reduce the validity of these conclusions: high rate of loss to follow-up above accepted standard, unequal size of their study groups, fragility index of zero, the inaccuracy of diagnosing ALL injuries in the presence of ACL tears on MRI, and the dilemma with randomly classifying high- and low-grade ALL injury based on MRI.
Validating the Role of Tibial Tubercle–Posterior Cruciate Ligament Distance and Tibial Tubercle–Trochlear Groove Distance Measured by Magnetic Resonance Imaging in Patients With Patellar Dislocation: A Diagnostic Study
Zijie Xu,Hua Zhang,Wenlong Yan,Man Qiu,Jian Zhang,Aiguo Zhou
doi : 10.1016/j.arthro.2020.09.004
Volume 37, ISSUE 1, P234-242, January 01, 2021
Posterior Tibial Slope Measurements Using the Anatomic Axis Are Significantly Increased Compared With Those That Use the Mechanical Axis
Robert S. Dean,Nicholas N. DePhillipo,Jorge Chahla,Christopher M. Larson,Robert F. LaPrade
doi : 10.1016/j.arthro.2020.09.006
Volume 37, ISSUE 1, P243-249, January 01, 2021
Editorial Commentary: Posterior Tibial Slope: The “Unknown Size” of the Knee Joint
Martin Faschingbauer
doi : 10.1016/j.arthro.2020.10.024
Volume 37, ISSUE 1, P250-251, January 01, 2021
The posterior tibial slope (PTS) plays an immensely important role in almost every orthopaedic operation on the knee joint. The PTS is a decisive factor in the reconstruction of a torn anterior or posterior cruciate ligament, in high tibial osteotomy and, of course, in total knee arthroplasty. It is therefore all the more surprising that in current clinical practice relatively little emphasis is placed on the exact measurement of PTS. If the true value is not known, the influence of the same is pure coincidence. In the coronal plane, it is clinically valid practice to determine the hip–knee–ankle angle and thus to be able to determine the mechanical and anatomical axes at the tibia and femur. In the sagittal plane, however, an in-depth analysis is often dispensed with and only a short lateral knee radiograph is used. Different axes are described to determine the PTS. In addition, it is often overlooked that a determination of the PTS on lateral radiographs can only represent an average, since the medial and lateral tibial plateau shows considerable differences purely anatomically. In the future, we should place more emphasis on an analysis of the sagittal plane in the knee joint including PTS at least as profound as the analysis of the frontal plane. Here, radiographs of the entire lateral tibia must be requested to determine the true axis and thus the true PTS.
Assessing the Resident Progenitor Cell Population and the Vascularity of the Adult Human Meniscus
Jorge Chahla,Angela Papalamprou,Virginia Chan,...Wafa Tawackoli,Melodie F. Metzger,Dmitriy Sheyn
doi : 10.1016/j.arthro.2020.09.021
Volume 37, ISSUE 1, P252-265, January 01, 2021
Editorial Commentary: Discovery: Progenitor Cells and Endothelial Cells Are Found in the White-White Zone of the Meniscus, But This Does Not Mean That These Tears Heal or Should Be Repaired
Erik Hohmann
doi : 10.1016/j.arthro.2020.11.007
Volume 37, ISSUE 1, P266-267, January 01, 2021
More than 35 years ago, the concept of vascular zones of the meniscus was introduced. It has been shown that blood supply is limited to the peripheral 25% of the lateral and 30% of the medial meniscus. This obviously has repercussions with regard to the healing potential of meniscus tears, whether repaired or not. In general, tears that extend into the white-white zone, such as flaps, cleavage tears, and radial tears, are deemed irreparable. However, several recent reports have suggested that radial tears in the white-white zone, when repaired, heal and have good clinical outcomes. Now progenitor mesenchymal cells have been identified in the white-white zones, confirming the potential of the meniscus to heal. However, blood supply was demonstrated only by indirect signs such as the presence of endothelial cells and the presence of endothelial surface markers.
All-Inside Arthroscopic Modified Brostr?m Technique to Repair Anterior Talofibular Ligament Provides a Similar Outcome Compared With Open Brostr?m-Gould Procedure
Yun-Feng Zhou,Zheng-Zheng Zhang,Hao-Zhi Zhang,Wei-Ping Li,Hui-Yong Shen,Bin Song
doi : 10.1016/j.arthro.2020.08.030
Volume 37, ISSUE 1, P268-279, January 01, 2021
To introduce an all-inside modified Brostr?m technique to suture the anterior talofibular ligament (ATFL) and inferior extensor retinaculum (IER) under arthroscopy and to compare its outcomes with those of the conventional open procedure.
Editorial Commentary: Arthroscopic Treatment of Ankle Instability Is the Emerging Gold Standard
Jordi Vega,Miki Dalmau-Pastor
doi : 10.1016/j.arthro.2020.10.043
Volume 37, ISSUE 1, P280-281, January 01, 2021
Arthroscopic techniques for the treatment of ankle instability are increasing. The possibility of treating concomitant ankle pathology and ankle instability in the same procedure with similar outcomes and minor complications is making foot and ankle surgeons rethink the role of the current gold standard technique, the open Brostr?m-Gould procedure. The improvement of arthroscopic procedures in the ankle joint, as has happened before in other joints, is forcing the evolution of the classic open gold standard techniques toward an arthroscopic approach. A nondistraction and ankle dorsiflexion procedure is the key arthroscopic technique. The anterior talofibular ligament’s superior fascicle, an intra-articular structure, is located on the floor of the lateral gutter, and distraction detrimentally narrows the view and access to this space.
Administrative Databases Used for Sports Medicine Research Demonstrate Significant Differences in Underlying Patient Demographics and Resulting Surgical Trends
Michelle Xiao,Joseph Donahue,Marc R. Safran,Seth L. Sherman,Geoffrey D. Abrams
doi : 10.1016/j.arthro.2020.09.013
Volume 37, ISSUE 1, P282-289.e1, January 01, 2021
Editorial Commentary: Big Databases Are Not All Created Equal: Interpret Their Studies With Caution
Michael D. Feldman
doi : 10.1016/j.arthro.2020.11.009
Volume 37, ISSUE 1, P290-291, January 01, 2021
“Big Data” studies are extremely important in orthopedic research, as randomized controlled trials with extremely large sample sizes are nearly impossible to perform. But, as always, the devil is in the details. Databases are only as good as the information that is put into them. And when evaluating these studies, let’s not forget how to interpret them. Many factors—patient insurance status, age, socioeconomic status, ethnicity, and comorbidities; regional variations; hospital status (inpatient/outpatient); clerical errors, recording biases, and omission of relevant orthopedic outcome measures; temporal changes in billing codes; payer mix; population demographics and catchment area; and data collection methodology—mean that the results of a specific big data study may or may not be generalizable to other populations.
Intra-Articular Injections of Hyaluronic Acid or Steroids Associated With Better Outcomes Than Platelet-Rich Plasma, Adipose Mesenchymal Stromal Cells, or Placebo in Knee Osteoarthritis: A Network Meta-analysis
Seung-Beom Han,In-Wook Seo,Young-Soo Shin
doi : 10.1016/j.arthro.2020.03.041
Volume 37, ISSUE 1, P292-306, January 01, 2021
Editorial Commentary: Intra-Articular Injections for Painful Knee Osteoarthritis: What Is the Current Treatment Paradigm?
Raveendhara R. Bannuru
doi : 10.1016/j.arthro.2020.09.031
Volume 37, ISSUE 1, P307-308, January 01, 2021
Intra-articular corticosteroids are useful for acute and short-term pain relief, whereas hyaluronic acid is useful for a longer-term treatment effect for patients with knee osteoarthritis. More rigorous research using homogeneous preparations and techniques and randomizing larger numbers of knee osteoarthritis patients are warranted before recommending any wider acceptance of platelet-rich plasma and stem cell therapies. This is of utmost importance, especially with several new injectables such as anti–nerve growth factor antibodies, Wnt pathway inhibitors, and capsaicin showing promise to enter the market soon.
Platelet-Rich Plasma Versus Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Meta-analysis of 26 Randomized Controlled Trials
Jixiang Tan,Hong Chen,Lin Zhao,Wei Huang
doi : 10.1016/j.arthro.2020.07.011
Volume 37, ISSUE 1, P309-325, January 01, 2021
Editorial Commentary: Meta-analysis Shows That Platelet-Rich Plasma Is Safe and Effective for Knee Osteoarthritis: Future Randomized Controlled Trials Must Be of High Quality—Not High Quantity
Nikolaos K. Paschos
doi : 10.1016/j.arthro.2020.10.004
Volume 37, ISSUE 1, P326-327, January 01, 2021
The use of platelet-rich plasma in knee osteoarthritis is still controversial, and meta-analysis shows that platelet-rich plasma can be effective and safe for nonoperative management of knee osteoarthritis. Randomized controlled trials (RCTs) are essential tools for evaluating the effectiveness and safety of new therapeutic interventions. Meta-analysis of these RCTs is critical to try to approximate the truth but also reminds us that sometimes, “value does not necessarily derive from quantity but rather from quality.” Given the fact that approximately 92.8% of published abstracts of RCTs report at least 1 significant outcome (indicated as at least P < .05), there is a notion that significant outcomes are most likely to become published, suggesting a potential publication bias. Therefore, additional studies repeating the significant outcomes are sometimes necessary.
Superior Postoperative Stability and Functional Outcomes With Anteromedial Versus Transtibial Technique of Single-Bundle Autologous Hamstring Anterior Cruciate Ligament Reconstruction: A Meta-analysis of Prospective Randomized Controlled Trials
Vikaesh Moorthy,Andrew Arjun Sayampanathan,Andrew Hwee Chye Tan
doi : 10.1016/j.arthro.2020.07.018
Volume 37, ISSUE 1, P328-337, January 01, 2021
Editorial Commentary: Independent Femoral Tunnel Drilling Avoids Anterior Cruciate Ligament Graft Malpositioning: Advice From a Transtibial Convert
Patrick A. Smith
doi : 10.1016/j.arthro.2020.10.026
Volume 37, ISSUE 1, P338-339, January 01, 2021
Optimal femoral anterior cruciate ligament graft placement has been extensively studied. The champions of transtibial reconstruction debate the backers of anteromedial portal and outside-in drilling. The holy grail is footprint restoration and how we best to get there. To me, creating the femur independently provides the best chance of finding that footprint by being unconstrained by the tibia. Anterior cruciate ligament surgery is challenging enough; decrease intraoperative stress and increase your likelihood of femoral footprint restoration by drilling it though the anteromedial portal.
Intra-Articular Mesenchymal Stromal Cell Injections Are No Different From Placebo in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Wenli Dai,Xi Leng,Jian Wang,...Jin Cheng,Xiaoqing Hu,Yingfang Ao
doi : 10.1016/j.arthro.2020.10.016
Volume 37, ISSUE 1, P340-358, January 01, 2021
Editorial Commentary: Stem Cell Treatment in Knee Osteoarthritis: What for? Pain Management or Cartilage Regeneration?
Seong Hwan Kim,Yong-Beom Park
doi : 10.1016/j.arthro.2020.11.017
Volume 37, ISSUE 1, P359-361, January 01, 2021
The efficacy of mesenchymal stem cells regarding clinical outcomes and cartilage regeneration in knee osteoarthritis remains unclear; however, their theoretical role in multilineage cellular differentiation and immunomodulation of the arthritic cascade has been investigated. Several studies have reported that the use of stem cell therapy for knee osteoarthritis helps in pain improvement, but its effect on cartilage regeneration has not yet been explored. Moreover, numerous studies have reported high heterogeneity in the cell sources, as well as methods of culture expansion or cell concentration, and differences in delivery methods, assessment tools, and concomitant surgical procedures, which could affect the clinical outcomes or evaluation of cartilage regeneration potency. Furthermore, future studies are warranted to examine these factors in detail to interpret the results of mesenchymal stem cell treatment for knee osteoarthritis.
Regenerative Potential of Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis and Chondral Defects: A Systematic Review and Meta-analysis
Bhargavi Maheshwer,Evan M. Polce,Katlynn Paul,...Nikhil N. Verma,Brian J. Cole,Jorge Chahla
doi : 10.1016/j.arthro.2020.05.037
Volume 37, ISSUE 1, P362-378, January 01, 2021
Editorial Commentary: Stem Cell Therapy for the Knee: Heterogeneity in Cell Sources, Delivery Methods, and Concomitant Surgery Needs to Be Considered
Yong-Beom Park
doi : 10.1016/j.arthro.2020.07.035
Volume 37, ISSUE 1, P379-380, January 01, 2021
Mesenchymal stem cells (MSCs) have been investigated for the treatment of knee osteoarthritis because of their unique properties, including self-renewal, multi-linear cellular differentiation, and immunomodulatory capacity. However, the efficacy of MSCs for positive clinical outcomes in the treatment of knee osteoarthritis remains controversial. Because clinical studies in general have high variability, the heterogeneity in the sources of the stem cells used, efficacy of delivery methods, and concomitant surgery should be carefully considered to interpret the benefits of MSC therapy for knee osteoarthritis.
Return to Play After Anterior Cruciate Ligament Reconstruction with Extra-Articular Augmentation: A Systematic Review
Eoghan T. Hurley,Amit K. Manjunath,Eric J. Strauss,Laith M. Jazrawi,Michael J. Alaia
doi : 10.1016/j.arthro.2020.06.007
Volume 37, ISSUE 1, P381-387, January 01, 2021
Editorial Commentary: Return to Sport Following Extra-Articular Augmentation of Anterior Cruciate Ligament Reconstruction—Let the LET (Lateral Extra-Articular Tenodesis) Games Commence!
Alan Getgood
doi : 10.1016/j.arthro.2020.07.041
Volume 37, ISSUE 1, P388-390, January 01, 2021
The debate around extra-articular augmentation (EA) of anterior cruciate ligament (ACL) reconstruction continues to provide a rich source of research articles that we ultimately hope will improve patient outcomes. When combined with ACL reconstruction, anterolateral ligament reconstruction or lateral extra-articular tenodesis procedures reduce graft failure and persistent rotatory laxity. An important metric of ACL reconstruction outcome is return to play (RTP). RTP rates are also excellent when EA procedures are used in both primary and revision ACL reconstruction. However, when it comes to RTP, EA augmentation has yet to show significant improvement over isolated ACL reconstruction.
Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill-Sachs Lesions: A Systematic Review
Matthew L. Vopat,Liam A. Peebles,Trevor McBride,Isaak Cirone,Danielle Rider,CAPT. Matthew T. Provencher
doi : 10.1016/j.arthro.2020.08.005
Volume 37, ISSUE 1, P391-401, January 01, 2021
Superior Capsular Reconstruction Provides Sufficient Biomechanical Outcomes for Massive, Irreparable Rotator Cuff Tears: A Systematic Review
Tyler J. Smith,Anirudh K. Gowd,John Kunkel,Lisa Kaplin,Brian R. Waterman
doi : 10.1016/j.arthro.2020.09.007
Volume 37, ISSUE 1, P402-410, January 01, 2021
Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears
Samer S. Hasan
doi : 10.1016/j.arthro.2020.11.015
Volume 37, ISSUE 1, P411-414, January 01, 2021
Superior capsular reconstruction (SCR) has undergone extensive biomechanical and clinical study. Systematic review of biomechanical studies has shown that SCR functions to depress the humeral head and improve the glenohumeral register, which provides proof of concept. Clinical studies have shown the short-term effectiveness of SCR, but this is influenced by graft type and thickness, as well as surgical technique. These studies are mostly flawed because follow-up is brief, postoperative imaging is often lacking, and the results may not be generalizable.
Acknowledgment of Reviewers
doi : 10.1016/S0749-8063(20)31027-6
Volume 37, ISSUE 1, P415-419, January 01, 2021
Table of Contents
doi : 10.1016/S0749-8063(20)30997-X
Volume 37, ISSUE 1, PA14-A16, January 01, 2021
Cover Image & Video Link
doi : 10.1016/S0749-8063(20)30998-1
Volume 37, ISSUE 1, PA16, January 01, 2021
Instructions for Authors
doi : 10.1016/S0749-8063(20)31003-3
Volume 37, ISSUE 1, PA42-A48, January 01, 2021
Suggested Guidelines for the Practice of Arthroscopic Surgery
doi : 10.1016/S0749-8063(20)31004-5
Volume 37, ISSUE 1, PA51, January 01, 2021
