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    Combined Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Reconstruction for Recurrent Lateral Patellar Instability in Patients With Multiple Anatomic Risk Factors.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic and Mayo Foundation, Rochester, Minnesota, U.S.A.
    Purpose: To report the outcomes for combined tibial tubercle osteotomy (TTO) and medial patellofemoral ligament (MPFL) reconstruction and assess for potential risk factors for recurrent instability and/or poor outcomes.

    Methods: The medical record at our institution was reviewed for patients treated with MPFL reconstruction and TTO for recurrent lateral patellar instability from 1998 to 2014. Preoperative imaging was assessed for trochlear dysplasia according to the Dejour classification (high grade = B, C, D) and the presence of patella alta using the Caton-Deschamps ratio (>1. Read More

    Prediction of the Irreparability of Rotator Cuff Tears.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Orthopaedic Surgery, Pusan National University Yangsan Hospital, Busan, Republic of Korea.
    Purpose: To determine the influence of preoperative factors on reparability of rotator cuff tears (RCTs) and yield a predictive model for predicting irreparability preoperatively.

    Methods: Among patients with full-thickness RCTs, the reparable group underwent arthroscopic rotator cuff repairs for reparable RCTs whereas the irreparable group underwent alternative surgical procedures for irreparable RCTs. We analyzed age, sex, chronic pseudoparalysis (CPP), mediolateral and anteroposterior tear sizes, acromiohumeral distance (AHD), tangent sign, fatty infiltration (FI) (group 1, Goutallier stage 0 or 1; and group 2, Goutallier stage 2, 3, or 4), and tendon involvement (TI) (type 1, supraspinatus; type 2, supraspinatus and subscapularis; type 3, supraspinatus and infraspinatus; and type 4, all 3 tendons). Read More

    Topographic Analysis of 2 Alternative Donor Sites of the Ipsilateral Elbow in the Treatment of Capitellar Osteochondritis Dissecans.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands; Department of Orthopaedic Surgery, Flinders Medical Centre, Adelaide, Australia.
    Purpose: To find the best topographic subchondral bone match between the capitellum and 2 proposed alternative donor sites of the ipsilateral elbow for capitellar osteochondral autologous transplantation: the non-articulating part of the radial head and the lateral olecranon tip.

    Methods: In our retrospective database, 20 patients with an unremarkable computed tomography scan of the elbow despite clinical suspicion were identified for analysis. Included were patients aged 11 to 20 years with intact osseous structures and a computed tomography slice thickness of 1. Read More

    A History of Anterior Cruciate Ligament Reconstruction at the National Football League Combine Results in Inferior Early National Football League Career Participation.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    The Steadman Clinic, Vail, Colorado, U.S.A.; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.. Electronic address:
    Purpose: To evaluate whether players with a history of an anterior cruciate ligament reconstruction (ACLR) before the National Football League (NFL) Combine played or started fewer games and/or participated in fewer eligible snaps compared with NFL Combine participants without a history of knee injury or surgery.

    Methods: We performed a retrospective review of all players who participated in the NFL Combine between 2009 and 2015 and who had a history of an ACLR. NFL Combine participants were included if they had a previous ACLR or combined anterior cruciate ligament (ACL) injury and nonoperatively managed medial collateral ligament injury. Read More

    Influence of Tönnis Grade on Outcomes of Arthroscopic Management of Symptomatic Femoroacetabular Impingement.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Nashville Sports Medicine and Orthopaedic Center, Nashville, Tennessee, U.S.A.
    Purpose: To define the outcomes of arthroscopic correction of femoroacetabular impingement (FAI) based on Tönnis findings within a previously reported patient population, including a comparative analysis of Tönnis grade 0 and 1 versus grade 2 changes.

    Methods: Outcomes (modified Harris Hip Score [mHHS]) of a previously published study of arthroscopic correction of FAI were correlated with Tönnis grade. The inclusion criteria were the first 100 consecutive patients undergoing arthroscopic FAI correction with minimum 2-year follow-up. Read More

    Sectioning of the Anterior Intermeniscal Ligament Changes Knee Loading Mechanics.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Service d'orthopédie et de traumatologie, centre hospitalier de Versailles, Le Chesnay, France.
    Purpose: The purpose of this cadaver research project was to describe the biomechanical consequences of anterior intermeniscal ligament (AIML) resection on menisci function under load conditions in full extension and 60° of flexion.

    Methods: Ten unpaired fresh frozen cadaveric knees were dissected leaving the knee joint intact with its capsular and ligamentous attachments. The femur and tibia were sectioned 15 cm from the joint line and mounted onto the loading platform. Read More

    The Relationship of Femoral Tunnel Positioning in Medial Patellofemoral Ligament Reconstruction on Clinical Outcome and Postoperative Complications.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
    Purpose: To analyze the relation of the femoral tunnel (FT) positioning on clinical outcome.

    Methods: Patients with recurrent patellar dislocation who underwent medial patellofemoral ligament (MPFL) reconstruction with or without tibial tubercle osteotomy between 1998 and 2012 were included in this retrospective study. Strict postoperative lateral radiographs were mandatory. Read More

    Native Enthesis Preservation Versus Removal in Rotator Cuff Repair in a Rabbit Model.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, People's Republic of China. Electronic address:
    Purpose: The purpose of this study was to explore whether preservation of native enthesis during rotator cuff repair (RCR) results in a histologically and biomechanically better rotator cuff-greater tuberosity (RC-GT) connection in an animal model.

    Methods: Thirty-six New Zealand white rabbits were used in this study. The supraspinatus tendons were cut from the footprint to create a rotator cuff tear (RCT) on both shoulders, followed by immediate repair, with a 1 mm thick tendon stump remaining on the footprint. Read More

    Preoperative Depression Is Negatively Associated With Function and Predicts Poorer Outcomes After Hip Arthroscopy for Femoroacetabular Impingement.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Orthopaedic One, Upper Arlington, Ohio, U.S.A.
    Purpose: (1) To determine the prevalence of depression in patients undergoing hip arthroscopy for the treatment of femoroacetabular impingement (FAI) syndrome and (2) to determine whether depression has a statistically significant and clinically relevant effect on preoperative and postoperative patient-reported outcome scores.

    Methods: Consecutive subjects undergoing hip arthroscopy for FAI syndrome were retrospectively reviewed. The Beck Depression Inventory-II (BDI-II), Hip Outcome Score (HOS), and 33-item International Hip Outcome Tool (iHOT-33) were administered preoperatively and postoperatively. Read More

    Arthroscopic Latarjet Techniques: Graft and Fixation Positioning Assessed With 2-Dimensional Computed Tomography Is Not Equivalent With Standard Open Technique.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Clinique Générale Annecy, Annecy, France.
    Purpose: To analyze graft and fixation (screw and EndoButton) positioning after the arthroscopic Latarjet technique with 2-dimensional computed tomography (CT) and to compare it with the open technique.

    Methods: We performed a retrospective multicenter study (March 2013 to June 2014). The inclusion criteria included patients with recurrent anterior instability treated with the Latarjet procedure. Read More

    Outcomes of Arthroscopic Rotator Cuff Repair in Patients Who Are 70 Years of Age or Older Versus Under 70 Years of Age: A Sex- and Tear Size-Matched Case-Control Study.
    Arthroscopy 2018 May 19. Epub 2018 May 19.
    Department of Orthopaedic Surgery, School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea. Electronic address:
    Purpose: To compare the structural and clinical outcomes after arthroscopic rotator cuff repair (ARCR) of a case group aged 70 and above with those of a control group younger than 70, with the 2 groups matched for sex and tear size.

    Methods: The case group, comprising 53 patients 70 or older, and the control group, comprising 159 patients younger than 70, all received ARCR to 1 shoulder with symptomatic full-thickness rotator cuff tear. The case and the control subjects, who were matched for sex and tear size to minimize bias related to tendon healing, received ARCR during the same period. Read More

    Risk Factors for Abnormal Anteroposterior Knee Laxity After Primary Anterior Cruciate Ligament Reconstruction.
    Arthroscopy 2018 May 8. Epub 2018 May 8.
    Capio Artro Clinic, Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden.
    Purpose: To identify preoperative and intraoperative factors associated with abnormal anterior knee laxity after primary anterior cruciate ligament (ACL) reconstruction.

    Methods: A total of 5,462 patients who underwent primary ACL reconstruction at our institution from January 2000 to October 2015, with no associated ligament injuries, were included. Demographic data, information regarding graft used, concomitant meniscal surgery, and instrumented laxity were reviewed. Read More

    Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament-Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Géneral de Santé, Hopital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France.
    Purpose: To determine the visualization rate of the anterolateral ligament (ALL) in uninjured and anterior cruciate ligament (ACL)-deficient knees using 3-dimensional (3D) magnetic resonance imaging (MRI) and to characterize the spectrum of ALL injury observed in ACL-deficient knees, as well as determine the interobserver and intraobserver reliability of a 3D MRI classification of ALL injury.

    Methods: A total of 100 knees (60 ACL deficient and 40 uninjured) underwent 3D MRI. The ALL was evaluated by 2 blinded orthopaedic surgeons. Read More

    Assessing the Outcome of Hip Arthroscopy for Labral Tears in Femoroacetabular Impingement Using the Minimum Dataset of the British Non-arthroplasty Hip Register: A Single-Surgeon Experience.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
    Purpose: The aim of this study was to assess changes in British Non-arthroplasty Hip Register (NAHR) minimum dataset (MDS) patient-reported outcome measures (PROMs) after hip arthroscopy for femoroacetabular impingement (FAI) and define the relation between these and patient satisfaction. Secondary aims included exploring the impact of patient characteristics (age, sex, and social deprivation status) on MDS PROMs and satisfaction and determining the Net Promoter Score for hip arthroscopy for FAI.

    Methods: Preoperative data were collected from the NAHR, and postoperative data were collected through the NAHR, by mail, and by telephone survey. Read More

    Prevalence of High-Grade Cartilage Defects in Patients With Borderline Dysplasia With Femoroacetabular Impingement: A Comparative Cohort Study.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; The Steadman Clinic, Vail, Colorado, U.S.A.
    Purpose: To compare the prevalence, size, and location of Outerbridge grade III and IV cartilage defects on the femoral head and acetabulum between patients with borderline acetabular dysplasia and patients with non-borderline dysplasia who underwent hip arthroscopy for femoroacetabular impingement (FAI).

    Methods: Patients aged 18 years or older who underwent primary hip arthroscopy for correction of FAI and labral repair from November 2005 to April 2016 were included. We excluded patients with previous hip surgery, a radiographic hip joint space of 2 mm or less, and/or a lateral center-edge angle (LCEA) of less than 20° or greater than 40°. Read More

    Arthroscopic Repair of Lateral Ankle Ligament for Chronic Lateral Ankle Instability: A Systematic Review.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Hospital for Special Surgery, New York, New York, U.S.A.. Electronic address:
    Purpose: The purpose of this systematic review was to evaluate the current studies on arthroscopic lateral ankle ligament repair for chronic lateral ankle instability.

    Methods: A systematic search of MEDLINE, EMBASE, and Cochrane Library databases was performed during August 2017. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Read More

    Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopaedic Surgery, University of Virginia Health System, Charlottesville, Virginia, U.S.A.. Electronic address:
    Purpose: The purpose of this article is to (1) examine trends in preoperative and prolonged postoperative opioid analgesic use in patient undergoing hip arthroscopy, (2) characterize risk factors for prolonged opioid analgesic use following hip arthroscopy, and (3) explore preoperative and prolonged postoperative opioid analgesic use as independent risk factors for complications following hip arthroscopy.

    Methods: A private insurance database was queried for patients undergoing hip arthroscopy from 2007 to 2015 with a minimum of 6 months of follow-up. Independent risk factors for prolonged opioid analgesic use were determined. Read More

    Standardizing the Prearthritic Hip Joint Space Width: An Analysis of 994 Hips.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopedics, University of Colorado School of Medicine, University of Colorado, Aurora, Colorado, U.S.A.. Electronic address:
    Purpose: The purposes of this study were (1) to define a normal prearthritic hip joint space width (JSW) in symptomatic and asymptomatic patients with various degrees of acetabular coverage based on the lateral center edge angle (LCEA) and (2) to determine predictors of JSW using patient-specific variables.

    Methods: In a consecutive series of patients presenting to a hip preservation clinic between July 2012 and April 2016, a standard weight-bearing anteroposterior pelvic view was obtained. JSW was defined as the distance between the bony contour of the acetabular rim and femoral head in 2 locations (lateral and medial weight-bearing zone). Read More

    Inter-rater Reliability for Metrics Scored in a Binary Fashion-Performance Assessment for an Arthroscopic Bankart Repair.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    ProOrtho Clinic, Kirkland, Washington, U.S.A.. Electronic address:
    Purpose: To determine the inter-rater reliability (IRR) of a procedure-specific checklist scored in a binary fashion for the evaluation of surgical skill and whether it meets a minimum level of agreement (≥0.8 between 2 raters) required for high-stakes assessment.

    Methods: In a prospective randomized and blinded fashion, and after detailed assessment training, 10 Arthroscopy Association of North America Master/Associate Master faculty arthroscopic surgeons (in 5 pairs) with an average of 21 years of surgical experience assessed the video-recorded 3-anchor arthroscopic Bankart repair performance of 44 postgraduate year 4 or 5 residents from 21 Accreditation Council for Graduate Medical Education orthopaedic residency training programs from across the United States. Read More

    Patella Height Correlates With Trochlear Dysplasia: A Computed Tomography Image Analysis.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopaedic Surgery, Medical University of Innsbruck, Innsbruck, Austria.
    Purpose: The aim of this study was to investigate the position of the patella relative to the trochlea for a possible correlation with radiologic parameters characterizing the form of the trochlea.

    Methods: The computed tomography scans of 36 cases with patellofemoral instability and 30 without (mean age, 24.7 ± 6. Read More

    Comparative Matched-Pair Analysis of Keyhole Bone-Plug Technique Versus Arthroscopic-Assisted Pullout Suture Technique for Lateral Meniscal Allograft Transplantation.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea. Electronic address:
    Purpose: To compare the clinical outcomes and meniscal extrusion measured by magnetic resonance imaging (MRI) between the keyhole bone-plug technique and arthroscopic-assisted pullout suture technique in lateral meniscal allograft transplantation (MAT).

    Methods: Between October 2009 and February 2015, patients who underwent lateral MAT were retrospectively reviewed. The inclusion criteria were patients with symptomatic knees that had undergone total or subtotal meniscectomy who were treated with lateral MAT with a minimum follow-up period of 2 years. Read More

    Arthroscopic Incomplete Repair Using a "Hybrid Technique" for Large to Massive Rotator Cuff Tears: Clinical Results and Structural Integrity.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea. Electronic address:
    Purpose: The first aim of this study was to introduce the concept of hybrid repair (incomplete repair) for large to massive rotator cuff tears and to report clinical results and structural integrity of patients with a minimum 2-year follow-up. The second aim was to compare arthroscopic hybrid repair with partial repair for large to massive rotator cuff tears.

    Methods: We retrospectively evaluated 65 patients who underwent arthroscopic incomplete (hybrid) repair (45 patients) or partial repair (20 patients) for large to massive cuff tears from March 2011 to January 2015. Read More

    Minimizing Graft-Tunnel Mismatch in Allograft Anterior Cruciate Ligament Reconstruction Using Blumensaat's Line: A Cadaveric Study.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Andrews Research and Education Foundation, Gulf Breeze, Florida, U.S.A.
    Purpose: To evaluate the accuracy of Blumensaat's line (BL) in predicting the tendinous graft length and tibial tunnel length (TTL) in an independent-tunnel anterior cruciate ligament reconstruction (ACLR) using a bone-patellar tendon-bone (BTB) allograft.

    Methods: Eighteen ACLRs were performed on cadaveric specimens using an anteromedial portal technique. All knees had no previous surgeries or deformities. Read More

    Evaluation of Anterolateral Ligament Injuries and Concomitant Lesions on Magnetic Resonance Imaging After Acute Anterior Cruciate Ligament Rupture.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea. Electronic address:
    Purpose: To evaluate the prevalence and characteristics of anterolateral ligament (ALL) injuries with a ruptured acute anterior cruciate ligament (ACL) and to analyze the presence of concomitant bone contusions and meniscal lesions.

    Methods: From March 2015 to March 2017, we retrospectively analyzed 378 patients who underwent primary ACL reconstructions. Using magnetic resonance imaging, we evaluated the presence of ALL injury and concomitant lesions within 3 weeks of the injury. Read More

    Posterior Bony Impingement-Potential Mechanism of Ligamentum Teres Tears.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    St Vincent's Hospital, Melbourne, Australia; Melbourne University, Melbourne, Australia.
    Purpose: To describe a potential causal mechanism of ligamentum teres (LT) tears, a specific treatment for posterior impingement of the LT, and to report the minimum 2-year outcome of this treatment.

    Methods: We retrospectively reviewed data collected from 1,251 hip arthroscopies performed by the senior surgeon over a 26-month period. During this time, 424 LT tears were identified including 9 patients with isolated partial LT tears caused by impingement of the LT against a prominent acetabular fossa posterior wall and no other intra-articular pathology. Read More

    The Effect of Cartilage Fragments on Femoral Tunnel Widening After Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Controlled Study.
    Arthroscopy 2018 May 2. Epub 2018 May 2.
    Center for Sport Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China; Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, School of Medicine, Zhejiang University, Hangzhou, China. Electronic address:
    Purpose: To analyze the effect of cartilage fragments on tunnel widening and tendon-bone integration at 2 years' follow-up after anterior cruciate ligament reconstruction (ACLR).

    Methods: A prospective randomized controlled study was performed in 116 patients who underwent ACLR with autologous hamstring tendons augmented with cartilage fragments (study group, n = 56) or without any augmentation (control group, n = 60). All patients were followed up for 25. Read More

    Editorial Commentary: Knee Dislocations: What's Working and Who's Not.
    Arthroscopy 2018 May;34(5):1717-1718
    University of New Mexico.
    Knee dislocations are severe injuries that are being seen with increasing frequency. Surgical treatment of knee dislocations improves outcomes, but many patients are unable to return to physical occupations or sporting activities. Patient factors and associated trauma can significantly affect the patient's final functional activity level. Read More

    Editorial Commentary: Should We Stop Asking the Question of Whether Arthroscopic Knee Surgery Is Worth It?
    Arthroscopy 2018 May;34(5):1688-1689
    La Trobe University.
    The benefit of arthroscopic knee surgery for degenerative knee disease has been questioned. Recent clinical guidelines strongly recommend against its use in most patients with arthritis and that further research is unlikely to change this recommendation. However, we should never stop questioning and further evaluating the research literature, as other interpretations of data may be equally relevant and further analysis may shed new light on previous findings, particularly with regard to patients who respond poorly to nonoperative treatment. Read More

    Editorial Commentary: "Virtual Reality" Simulation in Orthopaedic Surgery: Realistically Helpful, or Virtually Useless?
    Arthroscopy 2018 May;34(5):1678-1679
    Mayo Clinic.
    Although we have come a long way, the rapidly expanding field of virtual reality simulation for arthroscopic surgical skills acquisition is supported by only a limited amount of evidence. That said, the good news is that the evidence suggests that simulator experience translates into improved performance in the operating room. If proving this relation is our ultimate goal, more work is certainly needed. Read More

    Editorial Commentary: Medial Meniscal Ramp Lesions: Lessons Learned From the Past in the Pursuit of Evidence.
    Arthroscopy 2018 May;34(5):1638-1640
    Sports Medicine Research Laboratory, Luxembourg Institute of Health.
    Thirty-five years after their initial description, ramp lesions of the medial meniscus in anterior cruciate ligament (ACL)-deficient knees are slowly being rediscovered. Routinely repaired in open ACL and peripheral reconstructions before the era of arthroscopic ACL reconstruction, ramp lesions have been largely ignored in the last 2 decades. Following the growing number of studies analyzing the causes of residual laxity after ACL reconstructions over the last decade, ramp lesions are increasingly being implicated, and thus investigated, but remain poorly understood. Read More

    Editorial Commentary: Polyurethane Meniscal Scaffold: A Perfect Fit or Flop?
    Arthroscopy 2018 May;34(5):1628-1630
    The goal of using a synthetic scaffold to establish a biomechanically functioning meniscus or provide an equivalent meniscus substitute is not achieved by the polycaprolactone-polyurethane Actifit scaffold. Recent research, that did not include a control group, shows that the revision rate is significant, and any improvements in patient outcomes could reflect the associated reconstructive surgery. Based on these data and similar published reports, it is premature to conclude that this implant is clinically indicated. Read More

    Editorial Commentary: Arthroscopic Fixation of Tibial Eminence Fractures-Which Technique Is the Best Has Not Been Defined Yet!
    Arthroscopy 2018 May;34(5):1617-1620
    N.E. University.
    The tibial eminence fractures are most frequently observed in children and adolescents increasingly. Their classification and management are mainly made by the displacement of the fracture fragment. The surgical management has evolved from open to arthroscopic techniques. Read More

    Editorial Commentary: Anteromedial Meniscofemoral Ligament of the Anterior Horn of the Medial Meniscus: I've Never Seen That Before; but Has It Seen Me?
    Arthroscopy 2018 May;34(5):1601-1602
    Alexandria, Minnesota.
    Although there is frequently an element of variability found in human anatomy, we tend to think of anatomic structures as following the pattern in which we, as surgeons, most frequently encounter them. Though it is possible that a variant pattern of a commonly encountered anatomic structure has "never been seen" by us as surgeons, the constant process of learning sometimes leads us to ask ourselves whether we have truly never encountered such a structure or condition before or whether we simply did not recognize it when it "saw us." Read More

    Editorial Commentary: The All-Epiphyseal Anterior Cruciate Ligament Distal Femoral Approach: Sockets or Tunnels?
    Arthroscopy 2018 May;34(5):1579-1581
    Hospital for Special Surgery and Weill Cornell Medicine.
    I believe that the distal femoral approach for anterior cruciate ligament reconstruction in the skeletally immature athlete with 3 to 6 years of remaining growth is best performed with an all-inside, all-epiphyseal technique using sockets rather than an outside-in approach creating tunnels. A shorter socket rather than a longer tunnel exposes a smaller surface area of the lateral distal femoral physis to potential compromise and resultant valgus malalignment. In addition, exiting the lateral femoral aspect of the epiphysis with a full-diameter tunnel as compared with a smaller diameter drill hole used to prepare a socket places the posterior articular cartilage, the lateral collateral ligament and anterolateral ligament footprints, and the popliteus tendon insertion at risk. Read More

    Editorial Commentary: Got Evidence? What We Really Need Is an Algorithm for Treating Symptomatic Bipartite Patella.
    Arthroscopy 2018 May;34(5):1559-1560
    La Jolla, California.
    Bipartite patella is an uncommon but potentially troublesome problem for young athletes. Numerous uncontrolled retrospective studies have reported good results after various treatments. What is needed are studies that will guide workup and support treatment decisions based on the condition of the cartilage surfaces of the fragment, presence of pseudoarthrosis, and size and location of the fragment. Read More

    Editorial Commentary: Platelet-Rich Plasma: Fountain of Youth, Cart Before the Horse, or Both?
    Arthroscopy 2018 May;34(5):1541-1542
    Tufts Medical Center.
    Platelet-rich plasma (PRP) injections have gained widespread popularity for the treatment of many orthopaedic conditions including osteoarthritis of the knee. Despite its increasing usage, there is comparatively little evidence regarding the mechanisms of action and relative roles of the multiple growth factors contained within PRP. That said, although future research will clarify the issue, current evidence suggests that PRP is safe and, for the treatment of knee osteoarthritis, effective. Read More

    Editorial Commentary: When Is Too Small, Too Small? Allograft Augmentation of Autologous Hamstring Grafts During Anterior Cruciate Ligament Reconstruction.
    Arthroscopy 2018 May;34(5):1517-1519
    Duke University Medical Center.
    Soft tissue allograft augmentation of small hamstring autografts, so-called hybrid grafts, has been proposed as an option during anterior cruciate ligament reconstruction (ACL-R). However, notable concerns exist with both small autograft use and allograft use during ACL-R, particularly in young, active patients. We currently choose to augment hamstring autografts with diameters <8. Read More

    Editorial Commentary: Cell-Based Therapy for Treatment of Chondral Lesions of the Patellofemoral Joint Using Particulated Juvenile Chondrocytes.
    Arthroscopy 2018 May;34(5):1506-1507
    Albuquerque, New Mexico.
    The potential of cell-based therapies to fill articular cartilage defects is no longer a "pipe dream." Filling an articular cartilage defect with at least a "mixed hyaline cartilage" repair is no longer a question. The task at hand is somehow refining and defining the when, where, what, and how of the cartilage-growing procedures. Read More

    Editorial Commentary: Don't Forgot the Hip in Swimmers and Multisport Athletes.
    Arthroscopy 2018 May;34(5):1478-1479
    Swimming results in significant and repetitive stress on the hip as well as other joints, and hip pain in swimmers should not be ignored. Stretching and strengthening are the mainstays of injury prevention, and recent literature supports that when indicated, femoroacetabular impingement surgical treatment in swimmers results in excellent outcomes including return to sport and frequently at a level of performance superior to pre-injury status. Read More

    Editorial Commentary: Hip Trochanteric Bursitis and Femoroacetabular Impingement: The Arthroscope Is Only the Tool.
    Arthroscopy 2018 May;34(5):1461-1462
    University of Salerno.
    Lateral hip pain is debilitating, with pain located at or around the greater trochanter, and trochanteric bursitis is one of the conditions that are part of the greater trochanter pain syndrome. At times, trochanteric bursitis coexists with femoroacetabular impingement. In such cases, the arthroscope is used as a soft tissue endoscope facilitating debridement of the bursa and functional lengthening of the fascia lata. Read More

    Editorial Commentary: Volition, Fear, and Faith: Elbow Arthroscopy and Nerve Injury.
    Arthroscopy 2018 May;34(5):1453-1454
    We strive to understand and present accurate risk assessment of transient and major nerve injuries to maintain our patients' faith as we choose to proceed with elbow arthroscopy. Our arthroscopic training, experience, and volume as well as patient obesity, osteoarthritis, and joint contracture should guide our decisions of which complex cases to expose our patients. Read More

    Editorial Commentary: Outcomes Reporting in Value-Based Care: It's Complicated.
    Arthroscopy 2018 May;34(5):1437-1438
    Patient-reported outcomes have received increasing attention as a tool to measure physician performance and value in health care. Lack of standardization, cost, and patient compliance remain significant barriers to the widespread acceptance of patient-reported outcomes in orthopaedic sports medicine. Read More

    Editorial Commentary: In a World of Endless Options, Is There a Single Solution? Management Options for Failed Anterior Instability Surgery in Athletes.
    Arthroscopy 2018 May;34(5):1428-1429
    There are many options to manage anterior instability of the shoulder. The management of athletes who have failed previous operative stabilization can make choosing a treatment solution difficult. A modified Latarjet without capsulolabral repair has been demonstrated to be a good choice when treating failed stabilization in a high-risk population with sufficient return to play and outcomes. Read More

    Editorial Commentary: The Coracoid Process as the Origin of Several Ligaments: What May Be Cut, What Must Be Refixed?
    Arthroscopy 2018 May;34(5):1412-1413
    University of Connecticut Health Center.
    The coracoid process is the origin of the trapezoid ligament, the deltoid ligament, and the coracoacromial ligament (CAL). Detailed knowledge about their anatomy is crucial for surgical procedures such as the reconstruction of the coracoclavicular ligaments or coracoid transfer. Although the coracoclavicular ligaments are considered important stabilizers of the acromioclavicular joint and are therefore highly protected, the CAL seems less important, which is why it is generally cut during coracoid transfer procedures. Read More

    Editorial Commentary: Can We Do Better While Spending Less: How Many Shoulder Rotator Cuff Anchors Are Enough?
    Arthroscopy 2018 May;34(5):1401-1402
    Icahn School of Medicine at Mount Sinai.
    We have published that shoulder rotator cuff tear is a highly cost-effective procedure, and to continue to improve value, a goal is to contain cost while maintaining or improving outcome. To bend the cost curve, reduction in direct costs (number of suture anchors used) could be a goal, and because rotator cuff repair failures are as much biologic as they are mechanical, the effect of adding anchors to improve outcomes has an obvious limit. Read More

    Editorial Commentary: Shoulder Glenoid Suture Anchor Insertion Depth: The Tip of an Iceberg.
    Arthroscopy 2018 May;34(5):1391-1392
    The term "translational research" means that the results of a bench-top analysis could quickly be applied, or translated, to the clinical setting. Nevertheless, cadaveric analysis is applicable primarily to the conditions tested. Care should be taken to consider that when it comes to investigation of shoulder glenoid suture anchor insertion, there are many variables and outcome measures to consider. Read More

    Quality Submissions and Editorial Commentaries Require Heavy Lifting: Journal Growth Risks Information Overload.
    Arthroscopy 2018 May;34(5):1379
    Our journal has grown in pages including more articles plus commentary. On the one hand, we see this as a subscriber benefit, but we also recognize that more is not always better. We risk information overload resulting in fatigue and the inability to read every word of every article. Read More

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