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Table of Contents
doi : 10.1016/S0749-8063(21)00620-4
Volume 37, Issue 8, August 2021, Pages A9-A12, A14
Instructions for Authors
doi : 10.1016/S0749-8063(21)00626-5
Volume 37, Issue 8, August 2021, Page A35
Introducing the Orthoregeneration Network Foundation Review Articles: Guiding Tissue Regeneration and Biologic Therapies Into Practice
James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.06.005
Volume 37, Issue 8, August 2021, Pages 2395-2396
In this issue of Arthroscopy, readers will find the first of what are designed to be a series of peer-reviewed Orthoregeneration Network (ON) Foundation review articles. The ON Foundation is an independent, nonprofit, international foundation dedicated to promoting research and education in the field of orthopaedic tissue regeneration. ON defines “Orthoregeneration … as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration” making use of treatments, including “drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli.” The article is accessible and could be of interest to all readers, including clinicians, as well as basic scientists and researchers. It brings us great pleasure to collaborate with the ON Foundation and introduce the ON Foundation Reviews to the readers of Arthroscopy.
Single Row Rotator Cuff Repair with Triple Loaded Suture Anchors: The SCOI Row Technique
WilliamArroyoM.D.Mark H.GetelmanM.D.Stephen J.SnyderM.D.
doi : 10.1016/j.arthro.2021.06.004
Volume 37, Issue 8, August 2021, Pages 2397-2398
Since the introduction of rotator cuff repair in the beginning of the 20th century, there have been significant advances in the surgical techniques and improvement in patient outcomes. However, controversy remains regarding the best method for tendon repair, including implant choice, ideal suture construct, and the potential benefits of supplemental biologic additives in order to achieve repair with the best opportunity for healing. The “SCOI Row” technique has been refined over three decades with extensive application and consistently good outcomes. Our technique uses a single row of anchors, triple loaded with a high-strength suture maximizing the number of sutures passed through the tendon to repair the rotator cuff arthroscopically. These anchors are placed 3-4 millimeters from the articular cartilage, providing strong anchorage and a low-tension repair. Debridement of devitalized tendon and only incorporating healthy tendon into the repair is imperative. The biology of the repair is enhanced with bone marrow vents created via microfracture of the greater tuberosity, forming the “Crimson Duvet” or bone marrow super-clot that will envelope the repair site. The bone marrow vents deliver marrow elements, including growth factors and mesenchymal cells that will help to regenerate the footprint of the rotator cuff. This repair construct has been evaluated biomechanically by other investigators and is favorable, as compared to dual row repairs. Our outcomes show greater than 90 % healing rate on postoperative magnetic resonance imaging and excellent patient-reported outcomes.
Arthroscopic Iliac Bone Grafting for Traumatic Anterior Shoulder Instability With Significant Glenoid Bone Loss Yields Low Recurrence and Good Outcome at a Minimum of Five-Year Follow-Up
YusukeUedaM.D.aHiroyukiSugayaM.D.bNorimasaTakahashiM.D.aKeisukeMatsukiM.D.aMorihitoTokaiM.D.bTakeshiMoriokaM.D.aShotaHoshikaM.D.a
doi : 10.1016/j.arthro.2021.03.028
Volume 37, Issue 8, August 2021, Pages 2399-2408
Editorial Commentary: A Functional Capsule, Not the Type of Bone Graft, Determines Outcome After Shoulder Stabilization in Cases of Anterior Glenoid Bone Deficiency
GeoffroyNourissatM.D., Ph.D.VictorHoussetM.D.MaloLehanneurM.D.ClaireBastardM.D.
doi : 10.1016/j.arthro.2021.05.054
Volume 37, Issue 8, August 2021, Pages 2409-2411
Many clinical results of surgical treatment of recurrent anterior shoulder instability confirm the importance of anterior bone grafting of the glenoid defect. Some studies even propose to perform a graft, even when there is no bony defect. Short- and middle-term studies report comparable results between bone grafting and Latarjet procedure. But one of the main questions that still remains is the quality and efficiency of the capsule. If Latarjet is the gold standard in anterior shoulder stabilization with very good results at very long follow-up, it is probably because the capsule is replaced by the conjoint tendon. Because Latarjet is a difficult surgery and has some complexes and/or challenging complications and because it is a nonanatomic procedure, there is a true place for anterior bone grafting. This anterior grafting under arthroscopy provides excellent results, but it is mandatory to be sure that the shoulder capsule is working. Clinical, functional, and imaging studies of this capsule need to be performed for a better understanding of the unstable shoulder function and treatment.
Open Latarjet Procedure in Athletes Following Failed Prior Instability Surgery Results in Lower Rates of Return to Play
Martin S.DaveyM.B., B.Ch., M.Ch., M.R.C.S.abEoghan T.HurleyM.B., B.Ch., M.Ch.abcRossO’DohertyabPadraicStaffordabEthanDelahuntabMohamedGaafarFRCS (Tr & Orth)aLeoPauzenbergerM.D.aHannanMullettM.Ch. FRCS (Tr & Orth)a
doi : 10.1016/j.arthro.2021.03.062
Volume 37, Issue 8, August 2021, Pages 2412-2417
Editorial Commentary: Lower Return to Play After Failed Prior Instability Surgery: Should the Open Latarjet Be the Gold Standard for Anterior Shoulder Instability?
Matthew A.DorweilerM.D.Julie Y.BishopM.D.
doi : 10.1016/j.arthro.2021.04.069
Volume 37, Issue 8, August 2021, Pages 2418-2419
Anterior shoulder instability is common in contact athletes. Arthroscopic Bankart repair can result in good clinical outcomes, but high recurrence rates have been reported. The open Latarjet procedure can result in excellent functional outcomes with low rates of recurrent instability. Despite these encouraging results, there may be a lower return to play rate in athletes undergoing this procedure for a prior failed instability surgery. Due to the complexity of the procedure and high complication rate, the open Latarjet should continue to be reserved for cases of significant glenoid bone loss or revision settings.
Modified Superior Capsule Reconstruction Using the Long Head of the Biceps Tendon as Reinforcement to Rotator Cuff Repair Lowers Retear Rate in Large to Massive Reparable Rotator Cuff Tears
Chen-HaoChiangM.D.abLeoShawM.D.cWei-HsingChihM.D.bMing-LongYehPh.D.aHsiao-HsienTingM.D.dChang-HaoLinM.S.bChao-PingChenM.D.cefWei-RenSuM.S.g
doi : 10.1016/j.arthro.2021.04.003
Volume 37, Issue 8, August 2021, Pages 2420-2431
Multiple Instability Events at Initial Presentation Are the Major Predictor of Failure of Nonoperative Treatment for Anterior Shoulder Instability
Nicholas C.DuethmanM.D.Christopher D.BernardM.D.DevinLelandM.D.Ryan R.WilburB.A.Aaron J.KrychM.D.Diane L.DahmM.D.Jonathan D.BarlowM.D.Christopher L.CampM.D.
doi : 10.1016/j.arthro.2021.03.047
Volume 37, Issue 8, August 2021, Pages 2432-2439
Editorial Commentary: Management of First-Time Anterior Shoulder Instability Requires Risk Stratification and Surgery for Many, But Not All
UjashShethM.D., M.Sc., F.R.C.S.C.
doi : 10.1016/j.arthro.2021.05.052
Volume 37, Issue 8, August 2021, Pages 2440-2443
The management of a patient with a first-time anterior shoulder dislocation has been the subject of longstanding debate among shoulder surgeons. A number of prognostic factors for recurrent instability have been proposed, including younger age, male sex, contact sports, and glenoid bone loss. Predictive tools and scores have been developed to assist in risk stratifying this patient population; however, no universally agreed upon, clinically validated algorithm exists. More recently, there has been emerging evidence favoring early surgical stabilization, as it has been shown to result in better overall outcomes compared with patients undergoing surgery following episodes of recurrent instability. With each subsequent dislocation or subluxation event, there is increased glenoid bone loss (and development of inverted-pear glenoid), a greater prevalence of engaging (i.e., off-track) Hill-Sachs lesions, more extensive labral tears, a greater risk of rotator cuff involvement (in the older patient), and increased plastic and/or permanent deformation, elongation, and compromise of the antero-inferior glenohumeral joint capsule and associated inferior glenohumeral ligament complex. Moreover, there is now sufficient evidence to suggest that recurrence comes at a cost, as it is a major risk factor for poor outcomes following arthroscopic stabilization. However, one risk is overtreatment, potentially exposing those individuals who would not have had another instability event due to an unnecessary procedure. We should continue to use the available evidence within the literature to help risk-stratify patients and develop an individualized treatment plan through a shared decision-making process with the patient.
Incomplete Rotator Cable Did Not Cause Rotator Cuff Dysfunction in Case of Rotator Cuff Tear: A Biomechanical Study of the Relationship Between Rotator Cable Integrity and Rotator Cuff Function
LirenWangPh.D.YuhaoKangPh.D.GuomingXiePh.D.JiangyuCaiPh.D.Chang’anChenPh.D.XiaoyuYanPh.D.JiaJiangPh.D.JinzhongZhaoM.D.
doi : 10.1016/j.arthro.2021.03.051
Volume 37, Issue 8, August 2021, Pages 2444-2451
Editorial Commentary: Rotator Cable Compromise May Not Always Result in Poor Shoulder Function
Maj. Travis J.DekkerM.D., M.C., U.S.A.F.Editorial BoardaZachary S.AmanB.A.bNicholas N.DePhillipoPh.D., A.T.C., O.T.C.c
doi : 10.1016/j.arthro.2021.04.029
Volume 37, Issue 8, August 2021, Pages 2452-2454
Compromise of the rotator cable has been linked with poor shoulder function in patients with rotator cuff tears. Yet, some patients remain asymptomatic with relatively good function despite rotator cuff tear pathology. Dynamic changes in co-contraction of opposing muscle groups throughout full range of motion have a significant effect on the stability of the shoulder joint. Advancements in biomechanical shoulder models have allowed investigators to diverge from historically static methods to more physiologic dynamic tests, which may provide stronger and more meaningful evidence when applied clinically. Nevertheless, with limitations seen in cadaveric models, the findings observed in live patients under fluoroscopic evaluation with known rotator cuff tear patterns remain a gold standard and practical way to approach the pathologic biomechanical environment of the rotator cuff tear compromised shoulder. The functional status of the glenohumeral joint and the integrity of various aspects of the rotator cuff remain a key part of clinical decision-making in approaches of rotator cuff repair (decompression and debridement, partial repair, margin convergence, augmentations, releases, double-row repairs), tendon transfers, superior capsular reconstructions, resurfacing options, and even considerations of arthroplasty.
The Latarjet Procedure Without Remplissage Is Effective to Restore Stability in Athletes With Glenoid Bone Defects Greater Than 25% and Off-Track Hill-Sachs Lesions
Rodrigo Nicol?sBrandarizM.D.Tomas DavidGorodischerM.D.IgnacioPasqualiniM.D.Luciano AndresRossiM.D.IgnacioTanoiraM.D.MaximilianoRanallettaM.D.
doi : 10.1016/j.arthro.2021.03.048
Volume 37, Issue 8, August 2021, Pages 2455-2461
Editorial Commentary: Remplissage Is Not Needed When Performing the Latarjet Procedure in the Setting of Off-Track Hill-Sachs Lesions: One of the Classics Continues to Get Better With Age (and Some Help From New Data)
Andrew J.SheeanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.05.049
Volume 37, Issue 8, August 2021, Pages 2462-2464
The glenoid track paradigm has played a pivotal role in the development of a contemporary approach to shoulder stabilization surgery. A number of studies have validated the importance of bipolar bone loss in the pathogenesis of recurrent anterior shoulder instability and defined the limitations of soft tissue–based, arthroscopic surgical approaches. The glenoid track paradigm has also helped to clarify the indications for coracoid transfer procedures, although some question persists as to the necessity of addressing an “off-track” Hill-Sachs lesion with remplissage concurrently with the Latarjet procedure for large glenoid bone defects. The best available evidence would suggest that the Latarjet procedure can be expected to yield favorable clinical outcomes even in the setting of an off-track Hill-Sachs lesion, thereby obviating the necessity of concomitant remplissage for cases involving advanced degrees of bipolar bone loss.
A Comparison of Outcomes After Endoscopic Repair of Partial- Versus Full-Thickness Tears of the Gluteus Medius Tendon
MathieuThaunatM.D.Benoitde Saint VincentM.D.EtienneCaronM.D.Pramod S.IngaleM.S.
doi : 10.1016/j.arthro.2021.02.020
Volume 37, Issue 8, August 2021, Pages 2465-2472
Borderline Dysplastic Female Patients With Painful Internal Snapping Improve Clinical Outcomes At Minimum 2-Year Follow-Up Following Hip Arthroscopy With Femoroplasty, Labral Repair, Iliopsoas Fractional Lengthening, and Capsular Plication: A Propensity-Matched Controlled Comparison
David R.MaldonadoM.D.aSamantha C.DiulusB.S.aShawnAnninM.D.aJacobShapiraM.D.aPhilip J.RosinskyM.D.aCynthiaKyinB.A.aAjay C.LallM.D., M.S.abcBenjamin G.DombM.D.bc
doi : 10.1016/j.arthro.2021.03.034
Volume 37, Issue 8, August 2021, Pages 2473-2484
Editorial Commentary: Psoas Tenotomy in the Setting of a Borderline Dysplastic Hip Risks Iatrogenic Instability: Be Extremely Cautious and Particularly in Athletes
Christopher M.LarsonM.D.
doi : 10.1016/j.arthro.2021.04.025
Volume 37, Issue 8, August 2021, Pages 2485-2487
Successful outcomes after psoas tenotomies have been reported and proposed in the setting of recalcitrant internal snapping and psoas impingement. However, case reports citing hip flexion weakness and iatrogenic instability created concern regarding the role for psoas tenotomies. Despite these concerns, some recent studies reporting improved outcomes after endoscopic psoas tenotomies breathe further life into this controversial topic. Psoas tenotomy in the setting of a borderline dysplastic hip likely carries an even greater risk for iatrogenic instability. It might be critical to evaluate for clinical signs and symptoms of instability in addition to radiographic parameters to avoid this potentially devastating complication. In addition, the traditional definition of borderline dysplasia is based on lateral acetabular coverage that might be less important than anterior acetabular coverage and femoral version when contemplating psoas tenotomies on the basis of the dynamic anterior stabilizing effect of the iliopsoas myotendinous unit. Surgeons should also be extremely cautious when considering psoas tenotomy in an athletic population with the potential for persistent weakness and limited data hinting at inferior sports specific outcomes. In the end, it is not clear whether the psoas tenotomy “drives” the improvements seen in some studies, or whether many of these patients ultimately battle their way into a minimally clinically important difference “despite” the psoas tenotomy.
Gender and Age-Specific Differences Observed in Rates of Achieving Meaningful Clinical Outcomes 5-Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome
Edward C.BeckM.D., M.P.H.aJustinDragerM.D.bBenedict U.NwachukwuM.D., M.B.A.cKyleenJanB.S.bJonathanRasioB.S.bShane J.NhoM.D., M.S.b
doi : 10.1016/j.arthro.2021.02.033
Volume 37, Issue 8, August 2021, Pages 2488-2496.e1
Magnetic Resonance Imaging Predictors of Chondral Lesions in Patients With Femoroacetabular Impingement: An Analysis of 545 Cases
Mia S.HagenM.D.aWilliam M.HannayM.D.aQuinnSaluanbT. SeanLynchM.D.cRobert W.WestermannM.D.dJamesRosneckM.D.b
doi : 10.1016/j.arthro.2021.03.041
Volume 37, Issue 8, August 2021, Pages 2497-2501
Arthroscopic Subchondral Drilling Followed by Injection of Peripheral Blood Stem Cells and Hyaluronic Acid Showed Improved Outcome Compared to Hyaluronic Acid and Physiotherapy for Massive Knee Chondral Defects: A Randomized Controlled Trial
Khay-YongSawM.Ch.Orth., F.R.C.S.(Edin)aAdam W.AnzM.D.bReza Ching-SoongNgM.D.aCaroline Siew-YokeJeePh.D.(UK)aSoo FinLowM.D.(USM), M.Med Rad(UKM)aChristopherDorvaultM.D.cKevin B.JohnsonPh.D., M.B.A.d
doi : 10.1016/j.arthro.2021.01.067
Volume 37, Issue 8, August 2021, Pages 2502-2517
Editorial Commentary: Peripheral Blood Stem Cells Mobilization Using Granulocyte Colony-Stimulating Factor for Articular Cartilage Injuries: Wake Them Up and Make Them Come to You!
JorgeChahlaM.D., Ph.D.(Editorial Board)SafaGursoyM.D., Ph.D.
doi : 10.1016/j.arthro.2021.03.026
Volume 37, Issue 8, August 2021, Pages 2518-2520
Articular cartilage injuries constitute a prevalent musculoskeletal problem in the general population. Restorative cartilage procedures are specifically challenging, as recapitulating hyaline cartilage can be difficult, thus compromising clinical outcomes. Progenitor cells for the treatment of articular cartilage injuries constitute a promising therapeutic method that has been increasing exponentially. Progenitor cells can be obtained from many different human tissues, such as bone marrow, adipose tissue, and muscle, as well as from peripheral blood after mobilizing stem cells from bone marrow with granulocyte colony-stimulating factor simulation. The minimally invasiveness, low complication rate, and efficacy of peripheral blood stem cells has gained significant attention and rapidly has become a promising source of progenitor cell delivery in the past decade.
Allogenic Human Umbilical Cord Blood-Derived Mesenchymal Stem Cells Are More Effective Than Bone Marrow Aspiration Concentrate for Cartilage Regeneration After High Tibial Osteotomy in Medial Unicompartmental Osteoarthritis of Knee
Nam-HunLeeM.D.Seung-MinNaM.D.Hyeon-WookAhnM.D.Joon-KyooKangM.D.Jong-KeunSeonM.D., Ph.D.Eun-KyooSongM.D., Ph.D.
doi : 10.1016/j.arthro.2021.02.022
Volume 37, Issue 8, August 2021, Pages 2521-2530
Editorial Commentary: When Treating Cartilage Lesions With Osseous Involvement, Biologic “Chondrofacilitation” Using Either Bone Marrow Aspirate Concentrate or Mesenchymal Stem Cells Augments Microfracture
Mathew J.HamulaM.D.aBert R.MandelbaumM.D.b
doi : 10.1016/j.arthro.2021.05.056
Volume 37, Issue 8, August 2021, Pages 2531-2532
The use of biologic augmentation following microfracture for symptomatic cartilage defects of the knee with osseous involvement shows encouraging results. Bone marrow aspirate concentrate provides growth factors to the injury site, such as vascular endothelial growth factor, platelet-derived growth factor, transforming growth factor-?a, and bone morphogenetic proteins in addition to the mesenchymal stem cells present in the concentrate. Cellular-based therapies like mesenchymal stem cells are becoming more widely used in conjunction with surgical treatment of focal cartilage lesions with early promising results. Both treatment options improve clinical and radiographic outcomes. As for the efficacy of mesenchymal stem cells versus bone marrow aspirate concentrate, we believe that both have promising results.
Sagittal Inclination Angle of Graft Is Associated With Knee Stability After Anatomic Anterior Cruciate Ligament Reconstruction
KeiichiHagiwaraM.D., Ph.D.aMasanoriTerauchiM.D., Ph.D.bKazuhisaHatayamaM.D., Ph.D.bShinyaYanagisawaM.D., Ph.D.aTakashiOhsawaM.D., Ph.D.aMasashiKimuraM.D., Ph.D.a
doi : 10.1016/j.arthro.2021.03.007
Volume 37, Issue 8, August 2021, Pages 2533-2541
Editorial Commentary: Outcomes After Anterior Cruciate Ligament Reconstruction Are Defined by Individual Anatomy, Including Both Soft Tissue and Bone Morphology: It’s All Important
FreddieFuM.D., D.Sc. (Hon.), D.Ps. (Hon.)Kevin J.ByrneM.D.Gian AndreaLucidiM.D.
doi : 10.1016/j.arthro.2021.04.019
Volume 37, Issue 8, August 2021, Pages 2542-2544
Well-designed studies add to our understanding of the anatomy, biology, biomechanics, and outcomes of the anterior cruciate ligament (ACL) following injury. Despite improvements in ACL treatment, we are still unable to exactly restore the individually unique function of the native ACL due to the complexity of knee physiology. The ACL is a dynamic structure with a rich neurovascular supply, distinct bundles, and 3-dimensional architecture that function in synergy with the bony morphology to facilitate healthy knee kinematics. Furthermore, the ACL exhibits a wide range of natural, anatomic variation. Since anatomic ACL reconstruction has been defined as functional restoration of the ACL to its native dimensions and collagen orientation, in addition to restoring the native footprint, it is important to restore the native size of the ACL, as the size of the tibial insertion site can vary by a factor of 3 from patient to patient. Moreover, variations in ACL soft tissue reflect differences in bony morphology. Bony morphology influences the static and dynamic biomechanics of the knee. Several bony morphologic factors influence the outcomes following ACL reconstruction, including posterior tibial slope, femoral condylar offset ratio, and notch shape. Morphologic differences that reflect pathologic states, such as the lateral notch sign and posterolateral plateau fracture, have been shown to be associated with greater grade instability. To respect the unique nature of each patient during surgical treatment, it is necessary to perform an individualized, anatomic, and value-based ACL reconstruction.
Post-arthroscopic Subchondral Insufficiency Fractures of the Knee Yield High Rate of Conversion to Arthroplasty
Laurel A.BarrasM.D.AyooshPareekM.D.Chad W.ParkesM.D.Bryant M.SongM.S.Christopher L.CampM.D.Daniel B.F.SarisM.D., Ph.D.Michael J.StuartM.D.Aaron J.KrychM.D.
doi : 10.1016/j.arthro.2021.03.029
Volume 37, Issue 8, August 2021, Pages 2545-2553
Femoral Tunnel Widening After Double-Bundle Anterior Cruciate Ligament Reconstruction With Hamstring Autograft Produces a Small Shift of the Tunnel Position in the Anterior and Distal Direction: Computed Tomography–Based Retrospective Cohort Analysis
Do kyungLeeM.D.aJun HoKimM.D.bSung-SahnLeeM.D.cByung HoonLeeM.D.dHyeonsooKimM.D.aJinwooKimM.D.aJoon HoWangM.D., Ph.D.efg
doi : 10.1016/j.arthro.2021.03.008
Volume 37, Issue 8, August 2021, Pages 2554-2563.e1
Editorial Commentary: Tunnel Widening After Anterior Cruciate Ligament Reconstruction May Increase Laxity and Complicate Revision
ShujiTaketomiM.D., Ph.D.
doi : 10.1016/j.arthro.2021.04.013
Volume 37, Issue 8, August 2021, Pages 2564-2566
Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction has been a research area of interest in ACL reconstruction. It has been demonstrated that femoral tunnels enlarge anteriorly and distally (ie, the direction where the mechanical traction force of the graft works) rather than concentrically after anatomic double-bundle ACL reconstruction using hamstring autografts. This finding suggests that the wall supporting the graft moves closer to the direction of the pull, leading to increased laxity of the knee joint due to TW. The causes of TW are presumed to be multifactorial, with both biological and mechanical features. Biological factors include osteolytic cytokines that enter the space between the graft and the bone through the synovial fluid. Mechanical factors include longitudinal graft motion by extracortical femoral fixation (known as the bungee effect), transverse graft motion (also called the windshield-wiper effect), improper graft placement, higher initial graft tension, accelerated rehabilitation, and so on. Although TW does not seem to affect short-term clinical outcomes from studies published to date, it is plausible to speculate that the expansion of the bone tunnel (ie, the edge where the graft tendon is fixed) would theoretically increase joint laxity to some extent, and it would be premature to conclude that TW has no effect on clinical outcomes relative to graft–tunnel micromotion. In addition, there is a general consensus that the presence of expanded tunnels often severely complicates revision ACL reconstruction. In ACL reconstruction using the hamstring tendon, it is necessary to take into account the possibility of a shift in the tunnel position when determining the location of the femoral tunnel.
Retro-Tubercle Biplanar Opening Wedge High Tibial Osteotomy Is Favorable for the Patellofemoral Joint But Not for the Osteotomized Tubercle Itself Compared With Supra-Tubercle Osteotomy
Joo SungKimM.D.Jae IkLeeM.D.Han GyeolChoiM.D.Hyun JinYooM.D.You SunJungM.D.Yong SeukLeeM.D., Ph.D.
doi : 10.1016/j.arthro.2021.03.009
Volume 37, Issue 8, August 2021, Pages 2567-2578
Editorial Commentary: Uniplane High Tibial Osteotomy Just Below the Metaphyseal Flare Is Preferable to Biplane Opening Wedge High Tibial Osteotomy Distal to the Tuberosity: A Cut Below Our Expectations
Drew W.NuteM.D.(Editorial Board)Craig R.BottoniM.D.
doi : 10.1016/j.arthro.2021.04.024
Volume 37, Issue 8, August 2021, Pages 2579-2581
Higher Meniscal Slope Is a Risk Factor for Anterior Cruciate Ligament Injury in Skeletally Immature Patients
Eduardo VasconcelosFreitasM.D.aMayara KatoPerezM.D.bAndrew E.JimenezM.D.cJailson RodriguesLopesM.D.dAndré FukunishiYamadaM.D., Ph.D.eMoisesCohenM.D., Ph.D.fDiego CostaAsturM.D., Ph.D.gh
doi : 10.1016/j.arthro.2021.03.030
Volume 37, Issue 8, August 2021, Pages 2582-2588
Editorial Commentary: Increased Tibial Slope Is Associated With Anterior Cruciate Ligament Injury Risk, and Tibial Slope Increases in the Skeletally Immature, Anterior Cruciate Ligament-Deficient Knee: A Chicken or Egg Causality Dilemma?
SteffenSauerM.D.aMarkClatworthyM.D., F.R.A.C.S.b
doi : 10.1016/j.arthro.2021.04.047
Volume 37, Issue 8, August 2021, Pages 2589-2590
Increased tibial slope is associated with increased risk of anterior cruciate ligament (ACL) injury in the skeletally immature. Recent studies, however, emphasize a mutual influence, as tibial slope has been shown to increase over time in the ACL-deficient skeletally immature knee. It is hypothesized that altered biomechanics with enhanced posterior force transmission in the ACL-deficient knee may influence the developing physis, leading to altered longitudinal growth and increased tibial slope. In addition to tibial slope, the meniscal geometry, including meniscal bone angle and meniscal slope, have been shown to influence the risk of ACL injury. In the skeletally immature knee, especially, the soft tissue geometry is thought to have significant impact on ACL injury risk. However, it remains unknown whether alteration of the meniscal slope may represent a causality of ACL deficiency.
Infographics Are More Effective at Increasing Social Media Attention in Comparison With Original Research Articles: An Altmetrics-Based Analysis
Kyle N.KunzeM.D.aAmarVadheraB.S.bRitikaPurbeycHarshSinghB.S.bGregory S.KazarianM.D.aJorgeChahlaM.D., Ph.D.b
doi : 10.1016/j.arthro.2021.03.056
Volume 37, Issue 8, August 2021, Pages 2591-2597
Editorial Commentary: Infographics Engage a Broader Audience Than Traditional Scientific Articles in the Medical Literature: The Latest Social Media Influencer?
Andrew G.GeeslinM.D., Infographics Editor, Editorial Board
doi : 10.1016/j.arthro.2021.05.038
Volume 37, Issue 8, August 2021, Pages 2598-2599
Infographics are an evolving medium within the orthopaedic literature and support engagement of a broad audience than traditional scientific articles. Arthroscopy infographics have been published monthly since January 2019 on a range of topics relevant to the readership. Citation numbers have long been used as a metric for quality and relevance of a scientific article, although alternative metrics (altmetrics) are now available to quantify the online activity related to scholarly content. Altmetrics are defined as “metrics and qualitative data that are complementary to traditional, citation-based metrics,” and the altmetric attention score depends on 3 main factors: volume (number of “mentions”), sources (e.g. newspaper, blog, tweet), and author (source of the “mention”, e.g. physician vs journal). Recent research links altmetric scores to citation gains. Infographics are a tool for expanding, educating, and increasing the breadth of medical journal readership.
Complications Following Biologic Therapeutic Injections: A Multicenter Case Series
Claire D.EliasbergM.D.aDaniel A.NemirovB.A.bBert R.MandelbaumM.D.cAndrew D.PearleM.D.aJohn M.TokishM.D.dMichael R.BariaM.D., M.B.A.ePeter J.MillettM.D.fShane A.ShapiroM.D.gScott A.RodeoM.D.a
doi : 10.1016/j.arthro.2021.03.065
Volume 37, Issue 8, August 2021, Pages 2600-2605
Editorial Commentary: Risks of Biologic Therapies in Sports Medicine: Landmines on the Road to the Holy Grail
Kevin B.FreedmanM.D., M.S.C.E.
doi : 10.1016/j.arthro.2021.06.003
Volume 37, Issue 8, August 2021, Pages 2606-2607
Biologic therapies hold great promise in the treatment of a variety of sports medicine conditions, including cartilage injuries, osteoarthritis, and tendon or ligament tears. Cell-based therapies currently under investigation include autologous products such as platelet-rich plasma, bone marrow aspirate concentrate, other adipose and mesenchymal stem cell products, and allogeneic products such as umbilical cord and placenta-derived products. However, their use does not come without risk, and the complications of these treatments can be underreported. Risks include infection, sterile inflammatory response, or a combination. Many times, when offering injection therapy, we consider the greatest risk a lack of efficacy. A “no harm, no foul” attitude is taken. Many of us think that the biggest risk of such injections, due to out-of-pocket expense, would be damage to someone’s checkbook more than damage to their health. However, there are real medical risks to our treatments. Regulatory efforts around the use of biologics are needed to track both efficacy and side effects, as we advance this technology and expand its use in the future.
Platelet-Rich Product Supplementation in Rotator Cuff Repair Reduces Retear Rates and Improves Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials
JamesRyanM.D.aCaseyImbergamoB.S.aSuleimanSudahM.D.bGregKirchnerM.D.cPatriciaGreenbergM.S.aJamesMonicaM.D.aCharlesGattM.D.a
doi : 10.1016/j.arthro.2021.03.010
Volume 37, Issue 8, August 2021, Pages 2608-2624
Editorial Commentary: Leukocyte-Poor Platelet-Rich Plasma Decreases Retear Rate in Arthroscopic Rotator Cuff Repair: Platelet-Rich Plasma Type Matters
Daniel J.SolomonM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.04.028
Volume 37, Issue 8, August 2021, Pages 2625-2626
Numerous studies, including several meta-analysis reviews of platelet-rich plasma (PRP) in the setting of arthroscopic rotator cuff repair, show mixed results. Focusing on specific types of PRP configuration may elucidate which provide value and which do not. Recent meta-analysis demonstrates that leukocyte-poor PRP or “pure PRP” treatment is shown to decrease retear rate and patient-reported outcome measures after arthroscopic rotator cuff repair of the shoulder. Meta-analyses resulting in conflicting results may be attributed to different study inclusion and exclusion criteria and date of search.
Preventative and Disease-Modifying Investigations for Osteoarthritis Management Are Significantly Under-represented in the Clinical Trial Pipeline: A 2020 Review
Nicholas N.DePhillipoPh.D., A.T.C., O.T.C.aZachary S.AmanB.A.bTravis J.DekkerM.D.cGilbertMoatsheM.D., Ph.D.adJorgeChahlaM.D., Ph.D.eRobert F.LaPradeM.D., Ph.D.f
doi : 10.1016/j.arthro.2021.03.050
Volume 37, Issue 8, August 2021, Pages 2627-2639
Editorial Commentary: More Clinical Trials Should Focus on Primary Prevention of Osteoarthritis: Disruptive Thinkers Are Required
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.2021.05.009
Volume 37, Issue 8, August 2021, Pages 2640-2641
With increasing life expectancy and an increased prevalence of osteoarthritis, the total number of individuals with symptomatic degenerative arthritis will most likely increase considerably. The current focus of nonoperative treatment is on weight loss, exercise, muscle strengthening, physical therapy, nonsteroidal anti-inflammatory drugs, intra-articular injection therapies with corticosteroids, hyaluronic acid, or platelet-rich plasma, and lately, disease-modifying drugs. Obviously, prevention is better than cure, but only 5% of all studies registered on ClinicalTrials.gov in the United States are intending to develop strategies for prevention. The overall majority of included studies (89%) will target symptom resolution, and 6% will investigate disease-modifying drugs.
Hip Capsular Management in Patients With Femoroacetabular Impingement or Microinstability: A Systematic Review of Biomechanical Studies
Andrew E.JimenezM.D.aJade S.OwensB.S.aJacobShapiraM.D.aBenjamin R.SaksM.D.acHari K.AnkemM.D.aPayam W.SabetianM.D.aAjay C.LallM.D., M.S.abcBenjamin G.DombM.D.ac
doi : 10.1016/j.arthro.2021.04.004
Volume 37, Issue 8, August 2021, Pages 2642-2654
Editorial Commentary: Biomechanical Analyses of the Hip Capture Are Way Too Simple! The Capsule Is Just One Piece of the Puzzle
Carlos A.GuancheM.D.
doi : 10.1016/j.arthro.2021.05.002
Volume 37, Issue 8, August 2021, Pages 2655-2656
The hip capsule is clearly a significant part of the hip and the considerations that we need to take into account when performing hip arthroscopy. Any study that adds some further clarity to this important structure is welcome and appreciated. The inherent problem with all of these articles is the lack of application to the reality of a living, breathing patient whose capsule changes following time zero of the capsular intervention and also whose negative intra-articular pressure is immediately violated and not recreated following any intervention that is undertaken. Hip capsular closure and perhaps even imbrication is indicated in some cases, but in many cases, it is a nonissue.
Patient-Reported Outcomes in Athletes Following Hip Arthroscopy for Femoroacetabular Impingement With Subanalysis on Return to Sport and Performance Level: A Systematic Review
ShawnAnninM.D.aAjay C.LallM.D., M.S.abcMitchell J.YeltonB.S.aJacobShapiraM.D.aPhilip J.RosinskyM.D.aMitchell B.MeghparaM.D.abDavid R.MaldonadoM.D.aHariAnkemM.D.aBenjamin G.DombM.D.abc
doi : 10.1016/j.arthro.2021.03.064
Volume 37, Issue 8, August 2021, Pages 2657-2676
Combined Anterolateral and Anterior Cruciate Ligament Reconstruction Improves Pivot Shift Compared With Isolated Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Kyle N.KunzeM.D.aJosephManziB.S.bMichelleRichardsonB.S.cAlexander E.WhiteM.D.aCarloColadonatoB.S.dNicholas N.DePhillipoPh.D., A.T.C.eRobert F.LaPradeM.D., Ph.D.eJorgeChahlaM.D., Ph.D.f
doi : 10.1016/j.arthro.2021.03.058
Volume 37, Issue 8, August 2021, Pages 2677-2703
Nonoperative and Operative Soft-Tissue and Cartilage Regeneration and Orthopaedic Biologics of the Knee: An Orthoregeneration Network (ON) Foundation Review
Derrick M.KnapikM.D.aAghoghoEvuarherheJr.B.S.aRachel M.FrankM.D.bMatthiasSteinwachsM.D.cScottRodeoM.D.dMarcusMummeM.D.eBrian J.ColeM.D., M.B.A.a
doi : 10.1016/j.arthro.2021.04.002
Volume 37, Issue 8, August 2021, Pages 2704-2721
Orthoregeneration is defined as a solution for orthopedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration. Options include: drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electro-magnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the knee, including symptomatic osteoarthritis and chondral injuries, as well as injuries to tendon, meniscus, and ligament, including the anterior cruciate ligament. Promising and established treatment modalities include hyaluronic acid (HA) in liquid or scaffold form; platelet-rich plasma (PRP); bone marrow aspirate (BMA) comprising mesenchymal stromal cells (MSCs), hematopoietic stem cells, endothelial progenitor cells, and growth factors; connective tissue progenitor cells (CTPs) including adipose-derived mesenchymal stem cells (AD-MSCs) and tendon-derived stem cells (TDSCs); matrix cell–based therapy including autologous chondrocytes or allograft; vitamin D; and fibrin clot. Future investigations should standardize solution preparations, because inconsistent results reported may be due to heterogeneity of HA, PRP, BMAC, or MSC preparations and regimens, which may inhibit meaningful comparison between studies to determine the true efficacy and safety for each treatment.
