Purpose: The purpose of this study was to evaluate outcomes following open subpectoral biceps tenodesis for the treatment of isolated type II SLAP lesions in patients 45 years of age or younger and evaluate the rate of return to sport.
Methods: All patients included in the study were at least 2 years out from open subpectoral biceps tenodesis for treatment of an isolated type II SLAP lesion and were treated between December 2007 and March 2015. All patients older than 45, those who had prior surgery on the index shoulder, and those who had any concomitant reconstructive shoulder procedures were excluded. Read More
Purpose: To identify the risk factors predicting unsatisfactory postoperative clinical outcomes after double-bundle (DB) anterior cruciate ligament (ACL) reconstruction using multivariate logistic regression.
Methods: Inclusion criteria were consecutive DB ACL reconstructions from January 2006 to September 2012 with a minimum 3-year follow-up. Exclusion criteria included (1) a delay to surgery from initial injury of more than 4 years (210 weeks); (2) contralateral knee pathology; (3) the lack of postoperative 3-dimensional computed tomography; (4) single-bundle ACL reconstruction; (5) revision ACL reconstruction; (6) meniscus allograft transplantation after total or subtotal meniscectomy; (7) multiple ligament surgeries. Read More
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address:
Purpose: To investigate if patients younger than 50 years old had improved functional outcomes after subpectoral biceps tenodesis (BT) for the treatment of biceps reflection pulley (BRP) lesions at minimum 2-year postoperative follow-up.
Methods: Patients who had arthroscopically confirmed BRP tears that were treated with subpectoral BT and were at least 2 years out from surgery were included; patients were excluded if they had concomitant reconstructive or reparative procedures at index surgery. Patient-centered outcomes including return to activity, American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 Physical Component Summary (SF-12 PCS) scores, and patient satisfaction were collected. Read More
Purpose: To compare clinical efficacy and complication rate as measured by postoperative falls and development of peripheral neuritis between intra-articular blockade and femoral nerve block in patients undergoing arthroscopic hip surgery.
Methods: An institutional review board approved retrospective review was conducted on a consecutive series of patients who underwent elective arthroscopic hip surgery by a single surgeon, between November 2013 and April 2015. Subjects were stratified into 2 groups: patients who received a preoperative femoral nerve block for perioperative pain control, and patients who received an intra-articular "cocktail" injection postoperatively. Read More
Purpose: To develop a model using wearable inertial sensors to assess the performance of orthopaedic residents while performing a diagnostic knee arthroscopy.
Methods: Fourteen subjects performed a diagnostic arthroscopy on a cadaveric right knee. Participants were divided into novices (5 postgraduate year 3 residents), intermediates (5 postgraduate year 4 residents), and experts (4 faculty) based on experience. Read More
Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Electronic address:
Purpose: To assess the causes, surgical indications, patient-reported clinical outcomes, and complications in patients with deep gluteal syndrome causing sciatic nerve entrapment.
Methods: Three databases (PubMed, Ovid [MEDLINE], and Embase) were searched by 2 reviewers independently from database inception until September 7, 2016. The inclusion criteria were studies reporting on both arthroscopic and open surgery and those with Level I to IV evidence. Read More
Purpose: To critically evaluate the existing literature on hip capsule biomechanics, clinical evidence of instability, and outcomes of capsular management to answer the following question: Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability?
Methods: We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines to find articles using PubMed and Embase. Included studies were Level I through V studies and focused on hip capsule biomechanics, postarthroscopic instability, and clinical outcomes. Articles were excluded if they discussed treatment of the hip capsule during arthroplasty, dislocations without a history of arthroscopy, and pre-existing conditions. Read More
Purpose: The purpose of this meta-analysis was to determine overall objective graft failure rate, failure rate by graft type (allograft vs autograft reconstruction), instrumented laxity, and patient outcome scores following revision anterior cruciate ligament (ACL) reconstruction. Outcomes of interest were collected for all studies meeting the study inclusion criteria, but lower-level studies (level III/IV) were not pooled for quantitative synthesis due to high levels of heterogeneity in these study populations.
Methods: A comprehensive search strategy was performed to identify studies reporting outcomes of revision ACL reconstruction. Read More
Purpose: To evaluate the clinical outcomes of arthroscopic treatment in adolescent baseball players with posteromedial elbow impingement.
Methods: This retrospective study evaluated the clinical outcome of arthroscopic treatment for posteromedial elbow impingement in adolescent baseball players. Patients were eligible for participation if they had undergone surgery at least 2 years earlier and excluded if they had arthritis, loose bodies, osteochondritis dissecans, ulnar collateral ligament tear, flexor/pronator injuries or medial epicondylitis, or nerve problems. Read More
Purpose: Recurrent instability remains of concern after arthroscopic Bankart reconstruction. We evaluated various technical factors including anchor design, anchor material, number of anchors used, and interval closure on risk of recurrent instability after arthroscopic Bankart reconstruction.
Methods: A systematic review of MEDLINE and Cochrane databases was conducted, following PRISMA guidelines. Read More
Purpose: The purpose of the current study was to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to determine whether there were differences in 30-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic knees in a large national sample.
Methods: Patients who were diagnosed with a septic knee and underwent open arthrotomy or arthroscopy were identified in the 2005-2014 NSQIP data sets. Patient demographics and perioperative complications were characterized and compared between the 2 procedures. Read More
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.. Electronic address:
Purpose: To perform a systematic review on the techniques and a meta-analysis on the functional and objective outcomes after single-bundle (SB) versus double-bundle (DB) posterior cruciate ligament (PCL) reconstructions.
Methods: A systematic review of the techniques, as well as functional and objective outcomes of clinical studies comparing SB versus DB PCL reconstruction with a mean follow-up of at least 24 months and minimum level of evidence of III were performed. After review of the literature, a quality analysis of the studies (Detsky score) and a meta-analysis comparing raw mean differences in data between SB and DB PCL groups were performed. Read More
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address:
Purpose: This study aimed to evaluate the clinical outcomes of irreparable rotator cuff tears (RCT) treated with an arthroscopic partial repair, as well as the preoperative factors that may be related to greater improvement of clinical outcomes at short-term follow-up.
Methods: We retrospectively reviewed patients with irreparable RCT who underwent arthroscopic partial rotator cuff repair between January 2011 and April 2014. Minimal follow-up of 24 months was required. Read More
Purpose: To evaluate the treatment options, outcomes, and complications associated with proximal tibiofibular joint (PTFJ) instability, which will aim to improve surgical treatment of PTFJ instability and aid surgeons in their decision making and treatment selection.
Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Inclusion criteria were as follows: PTFJ instability treatment techniques, PTFJ surgical outcomes, English language, and human studies. Read More
Purpose: To evaluate the surgical outcomes of symptomatic discoid menisci after total meniscectomy, saucerization, and suture repair of tears of a discoid meniscus at short- and long-term follow-up.
Methods: A systematic review was conducted using the Pubmed and ScienceDirect databases in adherence with Preferred Reporting Items of Systematic Reviews and Meta-Analysis guidelines. Short- and long-term follow-up were defined as an average follow-up of <4 years and >4 years, respectively. Read More
Retrograde femoral nail malpositioning can obviously destroy knee trochlear cartilage. A solution is osteochondral allograft transplantation surgery. Although case reports are rarely published in Arthroscopy, we make an exception and publish a report of 2 cases of this complication (and how to treat it) because exposure of complications that have not been previously well-reported could allow future surgeons, and their patients, to solve-and, preferably, proactively avoid-similar problems. Read More
Purpose: To report the clinical and radiological results of patients with talar osteochondral lesions who were treated by microfracture and cell-free scaffold implantation in a single-step arthroscopic surgery.
Methods: Forty patients, treated with a single-step arthroscopic surgery, were evaluated in this single-center-based retrospective study. Patients with degenerative arthritis (n = 1), history of ankle fracture (n = 1), kissing lesions (n = 1), lower extremity deformity (n = 1), and lesions <1. Read More
Purpose: To investigate functional outcomes among competitive athletes undergoing osteochondral allograft (OCA) transplantation of the knee, including rates of return to play (RTP), and factors preventing RTP.
Methods: A retrospective review identified all competitive athletes (high school, intercollegiate, professional) undergoing isolated femoral condyle OCA from 2004 to 2013. Patient-reported outcome (PRO) questionnaires (Lysholm, International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMasters Universities Arthritis Index [WOMAC], 12-Item Short Form Health Survey [SF-12], Tegner, and Marx) and custom RTP surveys were administered. Read More
Is the double bundle structure of the anterior cruciate ligament (ACL) a myth? Derotation untwists the ACL and results in a flat ribbon structure. However, other researchers dispute this theory and revealed 2 distinct bundles separated by a synovial septum. The answer is simple: we do not know and the evidence is conflicting. Read More
Service d'Orthopédie Traumatologie, Centre Hospitalier de Versailles, Hôpital André Mignot, Le Chesnay, France.
Purpose: To investigate the effect of the anterior cruciate ligament (ACL) torsion in 90° knee flexion on the morphological appearance of the ACL.
Methods: Sixty knees from fresh frozen anatomical specimens were dissected. Eighteen knees were excluded according to selection criteria (torn ACL, mucoid degeneration of the ACL, arthritic lesions of the notch, or knees harboring synovial inflammatory pathologies). Read More
Tibial-side fixation of soft-tissue grafts in osteoporotic bone has become an important concern, as anterior cruciate ligament reconstruction indications push toward older patients. Although soft-tissue fixation with an interference screw and cortical button may be statistically stronger than graft fixation with a screw or button alone, this hybrid construct is probably not optimized from a clinical perspective. Read More
There are many bone block procedures described to treat glenoid bone defects in anterior shoulder instability and most of these techniques apparently result in anatomic reconstruction. However, anatomic restoration of the biconcave glenoid morphometry for bone defects in patients with anterior shoulder instability is nearly impossible. Read More
We have had significant progress in improving the biomechanical strength of arthroscopic rotator cuff repairs over the past 3 decades. The field has advanced from simple suture repairs to double-row, transosseous, massive cuff and rip-stop constructs. I do think our focus next should be on improving the biology of tendon healing to improve our clinical outcomes. Read More
It appears that implantation of a biodegradable subacromial spacer improves the function for patients with massive irreparable rotator cuff tears. In this issue of Arthroscopy, an interesting article dealing with the treatment of massive irreparable rotator cuff tears is published. Read More
Loss of shoulder motion, especially to flexion and external rotation, may increase the risk of nontraumatic shoulder and elbow injuries in elite pitchers. However, the etiology of these injuries is likely mulitifactorial, and before we direct our therapists to abandon sleeper stretches in favor of flexion and external rotation exercises, further research is needed to keep pitchers off the disabled list and on the mound. Read More
Sports Medicine and Shoulder Service Hospital for Special Surgery, New York, New York, U.S.A.
Purpose: The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2) describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury.
Methods: Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. Read More
The selection of an immobilization device and arm positioning may play a role in postoperative pain and healing after arthroscopic rotator cuff repair. Although the current evidence is inconclusive, it is important that we aim as a profession to produce meaningful evidence that will advance the care of our patients while controlling health care costs. Read More
In this month's issue, Hollman, Wolterbeek, Zijl, van Egeraat, and Wessel from Nieuwegein, The Netherlands, investigate an essential and most basic concern: how does an abduction brace compare to a simple sling after arthroscopic rotator cuff repair? A criticism of the study, well noted in Editorial Commentary by Kevin Plancher, is that Hollman et al. selected postoperative pain (rather than long-term clinical outcome) as their "primary" outcome measure. The primary outcome measure determines the conclusion of a study. Read More
Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England.
Purpose: To describe the results and functional scores in a group of patients who underwent arthroscopic excision of a symptomatic sternoclavicular joint (SCJ) disk tear with a minimum follow-up period of 2 years.
Methods: Between April 2010 and December 2014, 14 patients underwent arthroscopic excision of a torn SCJ disk. Patients whose intended surgery was an isolated diskectomy and underwent that surgery only, with no additional procedure, were included. Read More
Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address:
Purpose: To determine best practices for consistent and accurate evaluation of coronal alignment in patients with patellofemoral (PF) instability.
Methods: Six reviewers examined 239 knee magnetic resonance images (MRIs) in patients with PF instability and anterior cruciate ligament (ACL) rupture. Measurements included tibial tubercle-to-trochlear groove (TT-TG) distance measured at the most proximal and distal portions of the trochlea, tibial tubercle-to-PCL (TT-PCL) distance, and Dejour classification of trochlear dysplasia. Read More
Shoulder and Knee Clinic and Bhatia Hospital, Mumbai, India.
Purpose: To document the incidence of long head of the biceps tendon (LHBT) pathology in full-thickness reparable rotator cuff tears and report the clinical results of arthroscopic LHBT tenotomy combined with rotator cuff repair.
Methods: Between January 2012 and January 2014, 141 shoulders with full-thickness rotator cuff tears that had undergone arthroscopic repair were included for the analysis. The LHBT was thoroughly examined during arthroscopy, and tenotomy was performed in all patients with a pathologic LHBT. Read More
Department of Orthopaedic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
Purpose: To analyze failure rate in 2-year increments to determine if graft choice changed over time and graft failure rate.
Methods: A prospective 2002-2008 database was used to identify risk factors for anterior cruciate ligament (ACL) retear. Subjects who had primary ACL retear with no history of contralateral surgery and 2-year follow-up were included. Read More
Purpose: To report outcomes of a conjoined tendon transfer procedure in a small case series of young active patients of various activity levels with recurrent traumatic anterior shoulder instability.
Methods: A retrospective chart review identified 10 consecutive patients who underwent conjoined tendon transfer (8 open and 2 arthroscopic) for anterior glenohumeral instability from January 2009 through December 2012. The indications were traumatic anterior shoulder instability with 25% or greater anterior glenoid bone loss, engaging Hill-Sachs lesion, or absent anterior-inferior labral tissue with anterior capsular tissue that did not readily hold sutures or a combination of these deficiencies. Read More
Purpose: To evaluate the clinical results of an arthroscopy-assisted latissimus dorsi tendon transfer (aLD) for irreparable posterosuperior cuff tears as a primary surgery. The secondary aim of this study was to quantify the learning curve using the log-linear model. We hypothesized that aLD significantly improved shoulder function and that there was consistent reduction of the operative time in support of a learning-curve effect. Read More
Purpose: To compare the outcomes of patients who undergo a long head of the biceps (LHB) procedure (tenotomy or tenodesis) concomitant with rotator cuff repair (RCR) to those of patients who undergo isolated RCR.
Methods: Prospectively collected data were retrospectively reviewed on 80 patients, >18 years old, who underwent repair of a full-thickness rotator cuff tear and with 1-year patient-reported outcome scores collected June 2012 to March 2015. The exclusion criteria were concomitant procedures other than LHB tenotomy, tenodesis, or subacromial decompression; prior shoulder surgery; or other shoulder pathology. Read More
Purpose: To determine the location of the subscapularis split during arthroscopic Latarjet created by an inside-out technique passing a switching stick from the posterior portal across the glenohumeral joint.
Methods: An inside-out technique was used to arthroscopically create a subscapularis split in 20 fresh-frozen human cadaveric shoulders. The distance between the exit point of the switching stick and the upper border of the subscapularis and the anterior circumflex vessels was measured arthroscopically and after open dissection. Read More
Department of Orthopaedics, Tulane University, New Orleans, Los Angeles, U.S.A.. Electronic address:
Purpose: To evaluate the proximity to the radial nerve on cadaveric specimens of 2 modified anterolateral portals used for elbow arthroscopy.
Methods: Ten fresh cadaveric elbow specimens were prepared. Four-millimeter Steinman pins were inserted into 3 anterolateral portal sites in relation to the lateral epicondyle: (1) the standard distal anterolateral portal, (2) a modified direct anterolateral portal, and (3) a modified proximal anterolateral portal. Read More
Purpose: To investigate the 2-year postoperative clinical and subjective outcomes after arthroscopic rotator cuff repair (ARCR) with xenologous porcine dermal patch augmentation compared with ARCR alone.
Methods: Patients aged 60 years or older with a complete supraspinatus (SSP) tendon tear underwent primary ARCR with a transosseous-equivalent technique. By use of a matched-pair comparative trial design, a consecutive series of 20 patients receiving additional xenologous porcine dermal patch augmentation (patch group) was matched by tear location with 20 patients who received ARCR only (control group). Read More
Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands; Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands; Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands.
Purpose: To evaluate the results of endoscopic treatment in patients affected by mid-portion Achilles tendinopathy, by release of the paratenon combined with a resection of the plantaris tendon, regarding patient satisfaction, functional outcome, and pain scores.
Methods: This retrospective study evaluated patients endoscopically treated for mid-portion Achilles tendinopathy between 2000 and 2013. Patient satisfaction, functional outcome, pain scores, and health-related quality of life were measured by the use of a numeric rating scale, the Foot and Ankle Outcome Score, the Victorian Institute of Sport assessment for the Achilles tendon, the numeric rating scale for pain during running and during sports, and the EuroQol 5D (EQ-5D-3L) standardized questionnaire. Read More
Department of Orthopaedics, NU Hospital Group, Trollhättan/Uddevalla, Sweden; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Research and Development, NU Hospital Group, Trollhättan, Sweden.
Purpose: To radiographically assess the tibial tunnel up to 5 years after anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts and biocomposite interference screws.
Methods: Fifty-one patients underwent anatomic single-bundle ACL reconstruction with metal interference screws in the femur and biocomposite interference screws in the tibia. Standardized digital radiographs with weight-bearing anteroposterior and lateral views of the index knee were taken in the early postoperative period and at 2 and 5 years postoperatively. Read More
Purpose: To investigate whether microfracture with a cannulated hollow awl can yield more patent marrow channels and allow greater mobilization of the reparable cells to the defect compared to the conventional awl with blunt end in human knee joints.
Methods: Patients who were planned for 1-stage bilateral total knee arthroplasty due to degenerative osteoarthritis with well-preserved lateral femoral condylar cartilage were retrospectively included. A 10-mm × 20-mm, rectangular, full-thickness chondral defect was made on the lateral femoral condyle on each knee joint. Read More
Purpose: To investigate the clinical and radiographic outcomes of the modified arthroscopic Latarjet procedure at a minimum of 2 years after surgery.
Methods: Patients who had traumatic unidirectional anterior shoulder instability and treated with a modified arthroscopic Latarjet procedure were included. During surgery, the anterior capsule was preserved and repaired back to the glenoid after the coracoid transfer. Read More
Purpose: To determine the exact value of side-to-side difference (SSD) in heel height that was associated with combined anterior cruciate ligament (ACL) and fibular collateral ligament (FCL) tears (compared with an isolated ACL tear) and determine the clinical utility of heel height SSD in the assessment of this injury pattern.
Methods: Two patient groups were identified: (1) patients with isolated ACL tears and (2) patients with combined ACL-FCL tears but without additional collateral or cruciate ligament injuries. Determination of the amount of the heel height SSD was determined during the outpatient clinic visit. Read More
University of Toronto Sports Medicine (UTOSM) Program at Women's College Hospital, Toronto, Ontario, Canada; Division of Orthopaedic Surgery, Women's College and Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.
Purpose: To compare the time to return to sport and reinjury rate after platelet-rich plasma (PRP) injection versus control therapy (i.e., physiotherapy or placebo injection) in patients with acute grade I or II muscle strains. Read More
Purpose: To compare failure rates and clinical outcomes of osteochondral allograft transplantation (OCA) in anterior cruciate ligament (ACL)-intact versus ACL-reconstructed knees at midterm follow-up.
Methods: After a priori power analysis, a prospective registry of patients treated with OCA for focal chondral lesions ≥2 cm(2) in size with minimum 2-year follow-up was used to match ACL-reconstructed knees with ACL-intact knees by age, sex, and primary chondral defect location. Exclusion criteria included meniscus transplantation, realignment osteotomy, or other ligamentous injury. Read More
Purpose: To evaluate the association of preoperative intra-articular hip injection with surgical site infection after hip arthroscopy.
Methods: A large administrative database was used to identify all patients undergoing hip arthroscopy from 2007 to 2015 within a single private insurer and from 2005 to 2012 within Medicare in the United States. Those that received an ipsilateral preoperative intra-articular hip injection were identified. Read More
Purpose: To critically evaluate the quality, accuracy, and readability of readily available Internet patient resources for platelet-rich plasma (PRP) as a treatment modality for musculoskeletal injuries.
Methods: Using the 3 most commonly used Internet search engines (Google, Bing, Yahoo), the search term "platelet rich plasma" was entered, and the first 50 websites from each search were reviewed. The website's affiliation was identified. Read More