Arthroscopy

PURPOSE: To provide an update on the incidence and extent of graft extrusion following meniscus allograft transplantation (MAT) and to systematically review the literature to identify if the type of root fixation or additional surgical techniques may reduce the risk of developing graft extrusion. METHODS: A systematic search, in accordance with the PRISMA guidelines, was conducted using the MEDLINE, EMBASE, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials (CENTRAL) databases...

Massive rotator cuff tears (MRCTs) are a challenge to treat with options from arthroscopic rotator cuff repair to reverse shoulder arthroplasty. Arthroscopic repair may still be an option even in the setting of advanced Goutallier changes and Hamada grades and regardless of healing. As the lifetime risk of revision for a 55 year old patient having an RSA was approximately 1 in 3, arthroscopic surgical management of MRCTs should not be discounted. An individualized approach that should consider the patient's radiographs (severity of arthritis), function (i...

Recent research shows that magnetic resonance arthrogram (MRA) offers better definition of certain shoulder pathology, especially labral tears, compared to magnetic resonance imaging (MRI). Conventional MRI accuracy and precision deteriorates after two weeks, and few health delivery environments achieve MRI within 14 days of a shoulder dislocation. Moreover, further loss of MRI accuracy is time dependent. While MRA should be considered as a first-line imaging study when evaluating shoulder instability more than two weeks after the patient's injury, one must also consider clinical value and cost-effectiveness...

PURPOSE: To compare pre- and post-operative findings between patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with lateral impingement versus those without lateral impingement METHODS: Patients who underwent primary hip arthroscopy for FAIS between 2012-2017 with minimum 5-year follow-up were included. Alpha angle (AA) was measured on preoperative AP and 90° Dunn radiographs. Patients with AA > 60° on Dunn view but not AP view (no lateral impingement) were propensity matched by sex, age, and BMI in a 1:3 ratio to patients with AA > 60° on both views (lateral impingement)...

PURPOSE: To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes. METHODS: All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively...

In recent years, there has been a shift in healthcare away from the fee-for-service model to a value-based care model. Concomitantly, there have been changes in inflation-adjusted surgeon reimbursements for arthroscopic meniscectomies. Nationally, albeit at different rates, there has been a decrease in partial meniscectomy utilization. We feel that this is in part due to the change in healthcare economics and reimbursements as well as the growing evidence that partial meniscectomy may not be as efficacious in the treatment of degenerative meniscus tears as we once thought...

PURPOSE: To determine if the platelet dose administered during a platelet-rich plasma (PRP) injection for knee osteoarthritis (OA) impacts clinical outcomes. METHODS: A systematic review was performed by searching PubMed, Cochrane Library, and Embase for randomized controlled trials with at least one study arm using PRP for knee OA. Only studies that provided a platelet count, concentration, or dose with a minimum of 6-month outcome scores were included. Studies in which the PRP group had statistically significant positive outcomes were separated from those without statistical significance...

PURPOSE: To evaluate the clinical and structural outcomes of using injectable atelocollagen during arthroscopic rotator cuff repair (ARCR) for small to medium-sized rotator cuff tears. METHODS: This retrospective study reviewed patients with small to medium size full-thickness tears who underwent ARCR from 2016 to 2022 with minimum 1 year follow-up. Propensity score (PS) matching was used to reduce bias. Tendon integrity was evaluated using magnetic resonance imaging (MRI) at postoperative 6 months...

PURPOSE: To (1) compare the efficacy of immersive virtual reality (iVR) to nonimmersive virtual reality (non-iVR) training in hip arthroscopy on procedural and knowledge-based skills acquisition and (2) evaluate the relative cost of each platform. METHODS: Fourteen orthopaedic surgery residents were randomized to simulation training utilizing an iVR Hip Arthroscopy Simulator (n = 7; PrecisionOS) or non-iVR simulator (n = 7; ArthroS Hip VR; VirtaMed). After training, performance was assessed on a cadaver by 4 expert hip arthroscopists through arthroscopic video review of a diagnostic hip arthroscopy...

PURPOSE: To evaluate sex-based differences in 30-day postoperative emergency department (ED) visits, 90-day complications, and two-year secondary surgery rates following the Latarjet procedure for the treatment of recurrent shoulder instability. METHODS: A national administrative claims database was used to identify patients with International Classification of Diseases (ICD)-10 diagnosis codes for shoulder subluxation or dislocation on the day of first-time stabilization with the Latarjet technique between 2015 and 2021...

PURPOSE: To report the clinical outcomes of arthroscopic debridement for the treatment of Kellgren Lawrence (KL) grades I and II (mild), and III (moderate) knee osteoarthritis (OA) at minimum 1-year follow-up. METHODS: A systematic review of primary literature was performed in concordance with PRISMA guidelines using the Medline, Embase, and Cochrane databases for studies regarding arthroscopic debridement/chondroplasty for management of knee OA at minimum 1-year follow-up...

PURPOSE: To analyze current literature assessing return to sport (RTS) outcomes following platelet rich plasma (PRP) injections for the non-operative treatment of ulnar collateral ligament (UCL) injuries. METHODS: A systematic review of PubMed, Embase, and Web of Science databases was conducted in June 2023 to identify studies assessing RTS following PRP injections for UCL injuries. Tear severity, leukocyte content of PRP, rehabilitation protocol, and RTS outcomes were collected...

PURPOSE: The purposes of this study were (1) to define the time to achievement of clinically significant outcomes (CSOs) following primary gluteus medius and/or minimus (GM) repair and (2) to identify factors associated with delayed CSO achievement. METHODS: Patients who underwent primary GM repair between January 2012 and June 2021 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score - Activities of Daily Living (HOS-ADL) were retrospectively identified...

Hip capsular preservation literature shows varying outcome. Capsular preservation is most common in the United States. Different surgeons prefer, and different patients require simple periportal capsulotomies versus wider exposure with T-type capsulotomy and traction stitches. Revision cases require wider expose. Paramount is adequate bony decompression in patients with FAI, but capsular preservation may also be universally recommended. Finally, in addition to revision indications, some hip phenotypes may require more aggressive capsular management...

ACL reconstruction with internal bracing (IB), and ACL repair with IB when indicated, reduces graft or repair failure. IB is safe and protects ligament reconstruction and repairs. It should not be misunderstood as a synthetic ligament. To be effective, suture tape must be independently secured with the knee in full extension, reflecting the terminal length of the ACL. Regardless of graft type the graft must be cyclically tensioned independent of the IB to allow for creep, and when properly performed, this significantly increases the ultimate tensile strength of the construct and reduces graft elongation, without stress shielding...

All-inside ACL reconstruction is the most minimally invasive ACL reconstruction technique available. Systematic review and meta-analysis shows equally excellent outcomes for all-inside ACL reconstruction as compared to full tibial tunnel ACL reconstruction. Advantages of all-inside technique may include improved tibial side fixation, improved stability, less tunnel.

Cartilage restoration techniques continue to grow in complexity, expanding from traditional marrow-stimulation or isolated chondroplasty of chondral lesions to various grafting procedures. Microfracture can induce a less favorable biologic response that includes formation of type I fibrocartilage and development of subchondral cystic changes or sclerosis. Thus, chondral graft options that restore native type II hyaline cartilage are favored. Autologous osteochondral transfer (AOT) is a favorable graft option because it provides native type II hyaline cartilage on an autologous subchondral scaffold that most-closely emulates the native chondral environment, and clinical studies demonstrate better functional outcomes and RTS compared to other cartilage grafting and bone-marrow stimulation procedures...

Superior capsular reconstruction (SCR) was developed to restore patient biomechanics for patients with massive irreparable rotator cuff repair (MIRCT) that precludes shoulder arthroplasty. Current studies have shown excellent short-term clinical outcomes and improved pain and functional scores, a high complication rate including re-tear, loss of fixation, or incomplete healing. An alternative, reverse total shoulder arthroplasty (rTSA) is a reliable and safe method to ensure good muscle strength and return to play in this patient group...

The health of the articular cartilage is an important determinant of success with hip arthroscopy. Recent research has demonstrated that articular cartilage damage on both the acetabular and femoral sides of the hip joint place patients at higher risk of failure following a primary hip arthroscopy, leading to the need for a revision arthroscopy or total hip arthroplasty. This risk appears to increase with degree of cartilage damage and manifests at the mid-term and long-term follow-up timepoints. Future studies may use this conclusion as a justification to characterize chondral defects in greater detail, reporting on defect size and location, in addition to grade...

Knee lateral extra-articular tenodesis procedures (LEAPS) reduce graft rupture rates when performed at the time of ACL reconstruction. However, in the setting of revision ACL reconstruction, LEAPS is less studied and remains controversial. Many studies support combined procedures (ACL + LEAPS), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding may be unnecessarily generated by the publication of low quality studies...