Purpose:To evaluate the inter-rater reliability and sensitivity of the GNRB arthrometer compared with the KT1000 and clinical examination with the Lachman test for patients with an anterior cruciate ligament (ACL) injury. Methods:Patients with ACL injury were examined preoperatively and postoperatively by 2 examiners. One examiner also performed a clinical examination and an examination with the KT1000. Side-to-side difference of ≥3 mm was classified as an ACL injury for both the GNRB and the KT1000. The interclass correlation was used to evaluate inter-reliability, and a paired t-test was used to identify differences between examiners. The sensitivity was calculated preoperatively. Results:A total of 20 patients underwent preoperative assessment with the GNRB, whereas 17 were available postoperatively. The GNRB diagnosed 12/20 and 13/20 for the 2 examiners, respectively, as having ACL injuries preoperatively, whereas the KT1000 diagnosed 19/20. Postoperatively, 5/17 and 4/17, respectively, had a side-to-side difference of ≥3 mm with the GNRB versus 7/17 for the KT1000, hence indicating an ACL injury or insufficient reconstruction. Clinical examination concluded that 15/17 had a manual Lachman of ≤+1. The interclass correlations between examiners were 0.80 for the involved side preoperatively and 0.84 postoperatively, considered moderate to good. Sensitivity for the GNRB was 60% and 65% for examiners 1 and 2, respectively. For the KT1000, it was 95%. Conclusions:In this study, the GNRB had a high inter-rater reliability, even with limited experience with the device. However, it was inferior to the KT1000 in correctly identifying ACL deficiency preoperatively in patients with ACL injury. Level of Evidence:Level III, prospective comparative study.
Purpose:To compare the reimbursement practices of public managed care (MC) insurance versus private commercial insurance (COM) for hip arthroscopy using the current procedural terminology (CPT) code 29999. Methods:The CPT codes and corresponding reimbursements of hip arthroscopies that employed code 29999 performed from January 2020 to December 2024 in a multihospital health system were analyzed. Patients' insurance carriers were identified and grouped into either MC or COM. MC consisted of Medicaid and Medicare. The outcomes analyzed were as follows: whether any reimbursement was obtained, total dollar amount paid, percentage of the billing that was reimbursed, and the percentage of CPT 29999 charge that was reimbursed. Results:One hundred thirty-seven hip arthroscopies met the inclusion criteria. COM fulfilled at least part of the reimbursement (i.e., not completely deny the entire claim) in 100% of cases, whereas MC provided at least some payment in 94.1% of claims (P = .02). However, there was no significant difference in the total dollar amount ($3191.18 vs $3563.02; P = .109) or percentage of the total charge (20.0% vs 21.7%; P = .220) reimbursed by MC relative to COM, respectively. Similarly, there was no significant difference in the percentage of CPT code 29999 reimbursed between MC and COM (25.0 vs 21.2%; P = .185). Conclusions:COM was less likely to completely deny a claim relative to MC and reimbursed approximately 10% higher than MC. However, there was no significant difference between payors in the percentage of the billing that was reimbursed or the percentage of reimbursement specifically for CPT code 29999. Regardless of insurance type, there is a low percentage of reimbursement for unlisted hip arthroscopy procedures. Clinical Relevance:As hip arthroscopy becomes more common, it is important to understand reimbursement patterns to ensure patients receive appropriate care and surgeons are compensated. This study provides insights that help surgeons navigate these dynamics and deliver high-quality care, regardless of a patient's insurance provider.
Purpose:To investigate the influence of anchor density on tendon footprint contact mechanics in knotless all-suture anchor compression bridge constructs. Methods:Unicortical polyurethane solid foam blocks with a cancellous density of 20 lb/ft3 and a cortical density of 40 lb/ft3 simulated bone. Tendons were replicated with 4.76-mm-thick 40A durometer polyurethane rubber sized to 27 × 12 mm. Test groups consisted of two 2.6-mm all-suture anchor single-row knotless compression bridge constructs evaluated at interanchor distances of 10, 15, 20, and 25 mm. A 3-anchor construct was also evaluated for the 25-mm (large tear) condition. The repair sutures of each construct were individually hooked onto a zeroed, handheld force gauge and manually tensioned to create a minor (<5 N) compressive preload through the tendon. Constructs were incrementally tensioned by +25 N on each suture until failure. Contact area (mm2), compressive force (N), and contact pressure (kPa) were recorded from the loaded sensing elements in the bridge region. Results:The 25-mm, 3-anchor construct resulted in significantly greater compressive force than any of the 2-anchor groups (107 ± 9 N, P < .001). Adding a third anchor to the 25-mm bridge resulted in 37% more compressive force when compared with its 2-anchor equivalent. Contact area increased linearly with increasing bridge length. The largest contact area measured at 195 ± 11 mm2, observed in the 25-mm bridge distance with both the 2- and 3-anchor constructs. The largest contact pressure was achieved in the 10 mm group (1020 ± 58 kPa). Contact pressure significantly decreased with increasing bridge distance and was restored with the addition of a third anchor (683 ± 96 kPa) (P < .001). Conclusions:An inverse relation was identified wherein increasing knotless suture bridge length decreased tendon footprint contact pressure in single-row repairs. The addition of an in-line third anchor in a simulated large-tear model (25 mm) improved contact pressure and compressive force. Clinical Relevance:The addition of a third knotless all-suture anchor to large single-row suture bridge repairs shows a noticeable improvement in tendon footprint restoration at time zero.
Purpose:To evaluate patient-reported outcomes after endoscopic bursectomy and iliotibial band lengthening for the treatment of greater trochanteric pain syndrome. Methods:Patients >18 years who underwent endoscopic bursectomy and iliotibial band lengthening for treatment of greater trochanteric pain syndrome were included. Patient-reported outcomes were collected preoperatively and postoperatively at 1-year follow-up. Outcome measures included Hip Outcome Score Activity of Daily Living score and Sports subscales, modified Harris Hip Score, and University of California, Los Angeles activity score. Data was analyzed using Wilcoxon rank-sum tests and Fisher's exact tests. Results:The study included 25 individual patients (17 preoperative and 13 postoperative data points; and 5 patients provided both). The cohort had a mean age of 53.6 years (range, 27-86), and 73% were women. Significant improvements in functional scores were observed across all outcome measures. The median (interquartile range) total Hip Outcome Score Activity of Daily Living improved from 43.8 (27.9, 60.3) preoperatively to 91.2 (72.1, 95.6) postoperatively (P < .001). Hip Outcome Score-Sports improved from 25.0 (5.0, 50.0) preoperatively to 80.0 (57.5, 97.5) postoperatively (P = .001). Level of function during usual activities improved from 45.0 (10.0, 50.0) to 80.0 (75.0, 95.0) (P = .001). Total function score improved from 34.5 (26.0, 56.8) to 90.2 (72.1, 92.3) (P = .001). The modified Harris Hip Score improved from 33.0 (24.0, 51.0) to 77.0 (53.0, 85.0) (P < .001). University of California, Los Angeles activity score improved from 3.0 (2.0, 4.0) preoperatively to 6.0 (3.0, 9.0) postoperatively (P = .028). Conclusions:Endoscopic bursectomy and iliotibial band lengthening were associated with improvements in patient-reported pain and function in patients with chronic greater trochanteric pain syndrome. Although these results are compelling, they should be interpreted with caution because of the relatively small sample size. Level of Evidence:Level IV, retrospective case series.
Purpose:To compare patient-reported outcomes, return to sport (RTS), and reinjury rates after meniscus repair in patients over and under the age of 40 years old. Methods:Meniscus repair cases performed at a single tertiary care center between December 2010 and August 2021 with a minimum 2-year follow-up data were reviewed. Patient-reported outcome measures, RTS, and reinjury data were obtained from an institutional knee registry and prospective surveys. Patients were classified as (1) <40 years old with isolated meniscus repair, (2) ≥40 years old with isolated meniscus repair, (3) <40 years old with meniscus repair and anterior cruciate ligament reconstruction, and (4) ≥40 years old with meniscus repair and anterior cruciate ligament reconstruction. Results:One hundred thirty patients were included, 91 were <40 years old and 39 were ≥40 years old (56% men). Of the tears, 66.2% (n = 86) were medial, 26.9% (n = 35) were lateral, and 6.9% (n = 9) were both medial and lateral. In patients with concomitant anterior cruciate ligament reconstruction, there were no statistically significant differences in 2-year International Knee Documentation Committee scores (P = .58), RTS (P = .80), or meniscus repair failure rates (P > .99) between different age groups. In isolated meniscus repairs, there were no statistically significant differences in 2-year International Knee Documentation Committee scores (P = .72), RTS (P = .24), or meniscus repair failure rates (P = .54) between age groups. At 2-year follow-up, over 80% of patients in both age groups achieved the minimum clinically important difference across all patient-reported outcomes, with no significant differences in minimum clinically important difference achievement between patients younger than 40 years and those aged 40 years or older. Conclusions:In this study, we found that patients 40 years or older who undergo meniscus repair experience similar 2-year patient-reported outcome measures, RTS, and failure rates compared with patients younger than 40. Level of Evidence:Level III, retrospective comparative study.
Purpose:To evaluate return-to-sport (RTS) outcomes and patient-reported outcomes in soccer players after primary hip arthroscopic labral repair for femoroacetabular impingement syndrome. Methods:All patients undergoing primary hip arthroscopy with labral repair for femoroacetabular impingement syndrome from 2011 to 2022 were retrospectively reviewed. Patients who had a minimum 2-year follow-up, played soccer, and had no prior hip surgery were included. Patient-reported outcome measures and RTS were collected at the final follow-up. Logistic regression was used to assess associations between potential covariates (e.g., age, sex, and level of play) and RTS. Results:Forty-eight hips in 41 patients (21 men [51%]) with a mean age at surgery of 21.9 years (range 13-41 years) were included. Thirty-two out of the 41 patients (78%) played at either the recreational or high school level. After removing those who did not return for nonmedical reasons, 29 out of 36 (81%) patients were able to return to soccer. Among patients with available patient-reported outcome measures, significantly greater postoperative scores were seen in the RTS group for Hip Outcome Score-Activities of Daily Living (95 vs 85) and Hip Outcome Score-Sport (88 vs 71, both P < .05). Soccer players younger than 25 years had significantly higher odds of RTS compared with those aged 25 years or older (odds ratio = 8.8, P = .006). Five hips (10%) underwent revision at the final follow-up. Conclusions:Soccer players undergoing primary hip arthroscopic labral repair for femoroacetabular impingement syndrome reported an 81% RTS rate at a minimum 2-year follow-up, with most returning at the same or higher level of play. At a mean follow-up of 5.5 years, most patients achieved Patient Acceptable Symptom State thresholds. Younger age was associated with a higher likelihood of return to sport. Level of Evidence:Level IV, therapeutic retrospective case series.
Purpose:To evaluate a minimum 5-year follow-up of patients who were treated with either bipolar radiofrequency microtenotomy (RFM) or physical therapy (PT) for midportion Achilles tendinopathy between 2016 and 2018. Methods:All subjects who participated in a previous randomized controlled trial (n = 38) between 2016 and 2018 were invited to fill out a questionnaire between January and July 2025 to evaluate the outcomes at a minimum of 5-year follow-up. Patients who had undergone further surgical treatment were excluded. Visual analog scale (VAS) for pain and Foot and Ankle Outcome Score (FAOS) were used to assess clinical outcomes. Results:A total of 25 out of the 38 (66%) invited subjects were included: 13 (65%) in the RFM group and 12 (67%) in the PT group. Both treatment groups had significantly improved VAS at the minimum 5-year follow-up compared with preintervention. The RFM group improved from 7.3 ± 1.2 to 0.3 ± 0.8 (P = .002), whereas the PT group improved from 5.7 ± 0.3 to 2.2 ± 2.6 (P = .010). The RFM group had significantly better VAS than the PT group at the minimum 5-year follow-up (P = .019). All parameters in the FAOS were significantly improved for patients in both the RFM group and the PT group. Quality of life was the only variable of the FAOS with significantly better results for RFM in comparison with PT (P = .047). Conclusions:In this study, patients with chronic midportion Achilles tendinopathy reported significant improvements in VAS and FAOS 6 to 9 years after intervention with either RFM or PT. The RFM group reported significantly better outcomes in VAS and quality of life. However, because of loss to follow-up, the study is underpowered, and the results should be interpreted with caution. Level of Evidence:Level II, therapeutic, poor-quality randomized controlled trial (<80% f/u).
Purpose:To evaluate the safety and efficacy of an arthroscopic technique of suprapectoral biceps tenodesis using a standard absorbable double-loaded suture anchor. Methods:This retrospective study includes all patients who underwent arthroscopic biceps tenodesis by the senior author between December 2017 and June 2020. Biceps tenodesis was performed in patients who had failed conservative management and exhibited evidence of biceps pathology at the time of surgery that appeared to be contributing to the patient's pain. Evaluation criteria included integrity of the repair by physical examination, American Shoulder and Elbow Surgeons score, visual analog scale for pain, and recording any complications and the need for revision surgery. Results:A total of 80/96 patients (83%) were available for evaluation at a minimum of 2 years including 43 men and 37 women with an average age of 53 (range 17-72). Postoperatively, the average in-office follow-up was 17 months (range 1.5-79 months), and the average phone contact follow-up was 55 months (range 24-89 months). Ninety-one percent (73/80) of patients in this series maintained normal biceps contour. The average American Shoulder and Elbow Surgeons score improved from 41 (range: 0-82) to an average of 83 (range 18-100) (P < .001). Visual analog scale pain score improved from 7 (range: 2-10) to 3 (range: 0-8) (P < .001). Minimal clinically important difference thresholds (1.47 for Visual analog scale, 14.3 for American Shoulder and Elbow Surgeons score) were met by 81% and 78.5% of patients, respectively. There were 5 minor complications. Four additional patients complained of pain at the bicipital groove, and a total of 5 patients required revision surgery for either biceps failure or ongoing pain. Conclusions:Arthroscopic suprapectoral biceps tenodesis using a standard suture anchor is safe and effective in the management of symptomatic biceps pathology refractory to conservative management. It offers reliable improvements in pain and function while maintaining biceps contour. It has a low complication rate, avoiding many of the potential complications reported after an open approach. Level of Evidence:Level IV, retrospective therapeutic study.
Purpose:To examine the 5- and 10-year incidence of post-traumatic osteoarthritis (PTOA) after isolated, primary meniscal surgery differentiating between meniscal repair and meniscectomy, in pediatric patients. Methods:Pediatric patients (≤16 years) undergoing primary meniscectomy or meniscal repair (2010-2023) with ≥5-year follow-up were identified in the PearlDiver database. Exclusion criteria included prior or concomitant knee injuries, surgeries, or syndromes. Delayed surgery was defined as ≥90 days after diagnosis. PTOA diagnosis was defined by billing codes. Motion restoration procedures (MRPs) before PTOA diagnosis were recorded. Multivariable logistic and Cox regression were used to assess risk factors for PTOA at 5 and 10 years. Results:A total of 7555 meniscectomy (mean age 14.7, 50% women) and 2797 meniscal repair (mean age 14.4 years, 46% women) patients met inclusion criteria. At 5 years, PTOA occurred in 2.2% of meniscectomy and 1.4% of repair patients. At 10 years, rates were 2.3% and 1.5%, respectively. Average time to PTOA was 737 days (meniscectomy) and 862 days (repair). When disaggregated by sex, there was no significant difference in sex makeup of those who did and did not develop PTOA (P = .430). In the meniscectomy group, risk factors for 10-year PTOA included MRP (hazard ratio [HR] 6.28, P < .001), age ≥12 at surgery (HR 4.84, P = .027), and obesity (HR 1.84, P < .001). In the repair group, MRPs (HR 5.23, P = .023) and depression (HR 2.02, P = .027) were significant. These same risk factors were identified for 5-year PTOA. Conclusions:The 10-year incidence of PTOA was 2.2% after meniscectomy and 1.5% after meniscal repair in pediatric patients. MRPs were a consistent risk factor. Age ≥12 and obesity were associated with PTOA after meniscectomy. Depression was associated with PTOA after repair. Level of Evidence:Level III, retrospective cohort study.
Purpose:To assess the relationships between hip-specific patient-reported outcomes (PROs) metrics and general health and pain measures before and after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Methods:This was a retrospective study of patients undergoing hip arthroscopy for FAIS at a single institution from 2014 to 2025. PRO scores, including hip-specific scores of modified Harris hip score (mHHS) and Hip Disability and Osteoarthritis Outcome Score (HOOS), as well as general health scores including 12-Item Short Form Survey (SF-12) physical and mental components and visual analog scale pain, were collected. Spearman correlation coefficients were calculated to assess the relationship between hip-specific outcome scores and quality of life metrics across multiple pre- and postoperative time points. Results:Six hundred sixty-eight patients (53.9% female) average age 34.3 years, body mass index 24.6, and mean follow-up 20.1 ± 14.0 months (range 3-60) were included. Both hip-specific PRO tools (HOOS and mHHS) showed at least strong-moderate, but mostly strong, correlations with both the visual analog scale pain scale and SF-12 physical component score preoperatively and at all time points postoperatively (Spearman's ρ range: -0.64 to -0.81, P < .01). The HOOS Total and mHHS had only poor or nonsignificant correlations with the SF-12 mental component score. At 1-, 2-, and 5-year follow-up after surgery, 75.3% to 81.6% of patients achieved minimal clinically important difference (MCID) for HOOS Total and 63.3% to 65.9% for mHHS. Furthermore, 61.4% to 73.5% of patients achieved MCID for SF-12 physical component score, whereas only 33.2% to 44.9% achieved MCID for SF-12 mental component score. Conclusions:Hip-specific PRO scores have significant, strong correlations with both pain and physical function metrics before and after hip arthroscopy for FAIS. However, there was little to no correlation between hip-specific PROs and mental health metrics in this cohort. Level of Evidence:Level IV, retrospective case series.
Purpose To evaluate patient use and acceptability of an adjunct digital exercise program for anterior cruciate ligament (ACL) reconstruction rehabilitation, as well as overall patient engagement with rehabilitation. Methods Consecutive patients who underwent primary ACL reconstruction were enrolled in a digital ACL rehabilitation exercise program (PhysioAid, Canada) as an adjunct to usual postoperative care for 35 weeks after surgery. Patient use was measured by the number of digital exercise prescriptions opened. Patient acceptability was evaluated via an online questionnaire. Overall patient engagement was assessed by the number of rehabilitation‐related queries submitted, completion of patient‐reported outcomes, and attendance at the 6‐month postoperative functional testing clinic. Results A total of 450 patients were enrolled. Of these, 289 patients (64.2%) opened at least 1 digital exercise prescription. Completed questionnaires were returned by 221/450 patients (49.1%). Of the respondents, 176 (79.6%) reported using the digital exercise prescriptions, and 165 respondents) (74.6%) indicated these were helpful. A greater proportion of patients who opened the digital exercise prescriptions submitted queries regarding their rehabilitation (24.2% vs 14.9%), completed their 6‐month postoperative ACL‐quality of life questionnaire (40.8% vs 28.0%), and attended their 6‐month functional testing visit (49.8% vs 39.1%). However, none of these differences reached statistical significance. Conclusions The adjunct digital exercise program showed meaningful patient uptake and was considered helpful by most respondents. Clinical Relevance About one‐third of patients fail to complete evidence‐based rehabilitation within 6 months after ACL reconstruction, with barriers being multifactorial. This study may provide a method to overcome some of these barriers, which is crucial for improving rehabilitation outcomes.
Purpose:To evaluate the clinical and radiologic outcomes at a 2-year follow-up of arthroscopic rotator cuff repair (RCR) augmented with superior capsular reconstruction (SCR) using the long head of the biceps tendon (LHBT) in patients with reparable posterosuperior rotator cuff tears. Methods:This retrospective, multicenter study included patients who underwent arthroscopic RCR with LHBT-based SCR at 2 institutions: Center A (October 2020 to March 2023) and Center B (June 2022 to July 2024), with a follow-up of 2 years. Indications included reparable supraspinatus and/or infraspinatus tears with Patte stage 2-3 retraction and Goutallier grade 3-4 fatty infiltration. Patients underwent RCR with either in situ LHBT fixation (Center A) or rerouted LHBT fixation to the center of the greater tuberosity (Center B). Exclusion criteria included prior shoulder surgery, infection, irreparable subscapularis tear, or loss to follow-up. Clinical outcomes were assessed using the visual analog scale, American Shoulder and Elbow Surgeons score, and range of motion. Radiologic evaluation included acromiohumeral distance, Hamada grade, and repair integrity via ultrasound or magnetic resonance imaging. Results:After excluding 10 patients, 58 were included (N = 26, Center A; N = 32, Center B), and their 2-year clinical outcomes were compared. Visual analog scale improved from 5.9 ± 1.5 to 2.1 ± 1.3, and American Shoulder and Elbow Surgeons score from 41.2 ± 10.0 to 73.6 ± 12.7 (P < .001). Minimal clinically important difference was achieved in 96.5% (visual analog scale) and 94.8% (American Shoulder and Elbow Surgeons). Range of motion improved significantly in forward elevation, abduction, and external rotation. Acromiohumeral distance (increased from 8.1 to 9.0 mm [P < .001]) with no progression in Hamada grade. Both centers showed comparable improvements with no significant differences in outcomes between techniques. Conclusions:Arthroscopic RCR augmented with SCR using the LHBT resulted in significant improvements in pain, function, and range of motion at the 2-year follow-up in patients with reparable rotator cuff tears. Both in situ and rerouted LHBT-based SCR techniques produced comparable clinical and structural outcomes, with no significant differences observed between the 2 methods, with the potential for type II error due to low power. Level of Evidence:Level III, retrospective comparative case series.
Purpose:To compare outcomes of hip arthroscopy using Patient-Reported Outcomes Measurement Information System (PROMIS) scores in patients with a history of smoking versus nonsmokers. Methods:Patients who underwent hip arthroscopy at our institution between January 2015 and June 2024 and had PROMIS data including physical function (PF), pain interference (PI), and depression scores were collected and split into 2 groups based on smoking history. Patients were included in this study if they were aged ≥18 years at the time of surgery and underwent hip arthroscopy for the treatment of femoroacetabular impingement syndrome, with preoperative PROMIS and postoperative PROMIS scores ≥1 year. The group of smokers was then propensity-matched to the group of nonsmokers based on age at surgery, body mass index, sex, race, and insurance status. Continuous variables were calculated as mean ± standard deviation and compared using 2-tailed t-tests while categorical variables were compared using chi-square analysis between the 2 groups. Mean clinically important difference was defined as one-half the standard deviation of preoperative PROMIS scores. Patient acceptable symptomatic state thresholds were 51.8 for PF and 51.9 for PI. Results:Two hundred eighty-seven nonsmokers and 88 smokers met inclusion criteria and had minimum 1-year follow-up. Eighty-seven smokers (87 hips) were propensity-matched to 171 nonsmokers (171 hips). The mean follow-up time was 28.4 ± 16.2 months. There were no differences in the groups with regard to sex (P = .88), age at surgery (P = .25), race (P = .50), body mass index (P = .88), or insurance status (P = .96). There were no significant differences in procedures such as labral repairs, femoroplasties, or acetabuloplasties performed. Both groups experienced improvement from preoperative to postoperative PROMIS scores for all domains. The nonsmokers group showed significantly greater preoperative PF (P = .0053), PI (P = .0024), and depression (P < .001) scores and significantly greater postoperative PF (P = .0043), PI (P = .017), and depression (P = .0019) scores. No differences were seen in the achievement of mean clinically important difference between groups (PF: 52.9% vs 52.6%, P = .97; PI: 31% vs 33.9%, P = .64). No differences were seen in patient acceptable symptomatic state between groups (PF: P = .23, PI: P = .77). Conclusions:Patients with a smoking history showed significant improvement in PROMIS scores following hip arthroscopy. Smokers began and ended recovery with lower PROMIS scores, indicating that smoking affects baseline status and final outcomes, despite comparable improvement. No differences were seen in the achievement of mean clinically important difference. Level of Evidence:Level III, retrospective comparative study.
Purpose:To identify 2- to 5- and >10-year complications of trochleoplasty and define rates of postoperative patellofemoral arthritis. Methods:PubMed, Embase, and Web of Science were queried for terms related to trochleoplasty. Included studies were clinical studies using trochleoplasty to manage patellofemoral instability and were published in English in peer-reviewed journals. Excluded studies were systematic reviews, meta-analyses, cadaveric studies, animal studies, and case reports. Patient demographics, follow-up time, concomitant procedures, complications, and subsequent surgeries were collected. Studies were grouped by follow-up time into <2, 2 to 5, 5 to 10, and >10 years. Results:Thirty-five studies met inclusion criteria with 1336 patients (64% female). There were 142 (10.6%) patients with less than 2 years of follow-up, 871 (65.2%) with 2 to 5 years, 221 (16.5%) with 5 to 10 years, and 102 (7.6%) with more than 10 years. The complication rates ranged from 0% to 33%. Seven (20%) studies specifically reported on postoperative arthritis. In patients with <2 years, the most common complication was arthrofibrosis at rates of 0% to 6.3%. Patellofemoral arthritis was the most common complication in patients with 2 to 5 (0%-35.3%), 5 to 10 (0%-17.4%), and >10 years of follow-up (0%-92.3%). In patients with more than 10 years of follow-up, rates of patellofemoral arthritis worse than Iwano grade 2 were as high as 65%. Recurrent instability rates varied widely across studies and follow-up times from 0% to 33.3%. Conclusions:Patients undergoing trochleoplasty for patellar instability may experience low rates of recurrence but are prone to postoperative stiffness at <2- and 2- to 5-year follow-up. Complications following trochleoplasty in isolation are worse than when concomitant procedures are done. After 10 years, the incidence of all patellofemoral arthritis is as high as 92%, and more severe patellofemoral arthritis is as high as 65%, which is greater than the progression in patients with patellofemoral instability. Level of Evidence:Level IV, systematic review of Level II to IV studies.
Purpose:To evaluate the effect of perioperative dexamethasone on patient-reported pain, functional outcomes, and minimal clinically important difference (MCID) achievement following arthroscopic rotator cuff repair. Methods:Patients who underwent rotator cuff repair between 2013 and 2023 were identified and divided into groups. Those who received peri operative dexamethasone were compared with controls. Outcomes included visual analog scale (VAS) pain, patient-reported outcomes measurement information system (PROMIS) upper extremity, PROMIS pain interference, and MCID. Multivariate logistic and linear regression models adjusted for age, sex, body mass index, diabetes, race/ethnicity, smoking, and preoperative opioid use. Subgroup analyses were performed by tear size. Results:A total of 309 patients was included (187 dexamethasone and 122 control). Dexamethasone administration was associated with improved functional recovery and sustained pain reduction. PROMIS upper extremity and PROMIS pain interference scores favored Dexamethasone at 6 weeks, 3 months, and 6 months (all P < .01). VAS pain was significantly lower at 12 months (1.9 ± 2.9 vs 3.1 ± 3.5, P = .003) and 24 months (1.0 ± 2.5 vs 1.8 ± 3.1, P = .035). Only 37% of patients completed a 2-year follow-up, limiting the strength of these long-term comparisons. In small/medium tears, MCID achievement for VAS was greater at 6 weeks (31% vs 21%, P = .041) and 3 months (34% vs 21%, P = .012). Logistic regression confirmed dexamethasone as an independent predictor of early MCID (OR 1.67, 95% CI 1.02-2.73, P = .041). Large/massive tears showed transient VAS improvement without MCID benefit. Opioid consumption did not differ between groups (all P > .12). Dexamethasone reduced ondansetron use in large/massive tears at 0-4 hour (β = -0.34, P = .04) and in small/medium tears at 4-8 hour (β = -0.19, P = .04), with no differences for other antiemetics. Complication rates were similar (11.2% vs 4.9%, P = .055). Conclusions:Perioperative intravenous dexamethasone is a safe adjunct to arthroscopic rotator cuff repair, supporting early antiemetic benefits, durable pain relief, and selective improvements in patient-reported outcomes. Benefits appear most pronounced in small/medium tears at early follow-up and large/massive tears at later stages, suggesting tear size-specific response. Level of Evidence:Level III, retrospective comparative study.
Purpose:To assess the impact of personality traits on postoperative functional outcomes in patients undergoing common orthopaedic sports medicine surgeries. Methods:A systematic review of PubMed (MEDLINE), Scopus (EMBASE, MEDLINE, COMPENDEX), and Cochrane Central database from inception to October 1, 2024, was conducted. Primary articles that investigated the relationship between preoperative psychosocial characteristics (i.e., resilience, grit, self-efficacy, catastrophizing, locus of control, optimism) and postoperative surgical outcomes after undergoing sports medicine/arthroscopy procedures (shoulder, hip, and knee arthroscopy) were included. Results:A total of 20 studies investigating the association between preoperative personality traits and postoperative functional outcomes were reviewed. Among the personality traits examined, resilience (9 studies), pain catastrophizing (7 studies), self-efficacy (3 studies), grit (2 studies), locus of control (1 study), and optimism (1 study) were analyzed. High preoperative resilience was significantly correlated with improved postoperative outcomes in 5 of 9 studies, particularly in knee arthroscopy cohorts. Pain catastrophizing showed mixed results, with 3 of 7 studies indicating a significant correlation between low pain catastrophizing and better postoperative outcomes. All 3 studies examining self-efficacy showed a positive relationship with postoperative outcomes. Higher preoperative grit exhibited improved postoperative outcomes among all included studies, whereas locus of control and optimism had no significant impact in the 1 study that met the inclusion criteria. Among the 3 studies that explored relationship between baseline personality traits and minimal clinically important difference in postoperative outcomes, no studies found a significant correlation. Conclusions:Resilience, self-efficacy, and grit emerged as personality traits with potential associations with postoperative functional outcomes in orthopaedic sports medicine patients. The remaining personality traits of pain catastrophizing, locus of control, and optimism showed either mixed results or no correlation with functional outcomes. When assessed, no study found a correlation between preoperative traits and achievement of minimal clinically important difference in outcomes. Level of Evidence:Level IV, systematic review of Level II to IV studies.
Purpose:To compare the outcomes of the transtibial technique (TT) and the translateral technique (TLL) for anterior cruciate ligament (ACL) reconstruction in an Asian population. Methods:Patients who underwent either TT or TLL for ACL reconstruction between 2019 and 2021 were identified. Inclusion criteria were skeletal maturity, a magnetic resonance imaging-diagnosed ACL tear, completion of at least 2 of 3 postoperative assessments, and a minimum follow-up of 24 months. Data collected include patient demographics, patient-reported outcome measure scores (Tegner activity scale and Lysholm score), objective clinical outcome scores (KT-1000), and medical records review to identify complications. Results:The average follow-up time was 15.2 months (range: 6 to 24 months) in TT versus 17.5 months (range: 6 to 24 months) in TLL, P value = .622. Recovery of quadriceps function in a cohort of 134 patients was identified as the only significant difference in postoperative functional outcomes between the TT and TLL groups. At 12 months, the extension range of motion in TLL was statistically better than TT (TT: 1.1 ± 3.4 [-2.2, 4.4] vs TLL: -0.9 ± 2.9 [-3.7, 2.0], P = .005). KT-1000 measurement, Tegner activity scale, and Lysholm score were not statistically significant between the TT and TLL groups at 24 months. The follow-up rate (n [%]) between the TT and TLL groups at 12 months was 59 (78.7%) and 50 (84.7%), respectively, and at 24 months was 55 (77.3%) and 47 (79.7%), respectively. Conclusions:In this Asian cohort, transtibial and translateral ACL reconstruction showed similar short-term outcomes. Small, transient differences in extension recovery favoring TLL did not persist at 24 months. Level of Evidence:Level III, retrospective comparative study.
Purpose:To characterize the epidemiology of upper extremity injuries among elite college baseball players in 1 league over 5 seasons. Methods:Deidentified arm injury reports were recorded from the 2018, 2019, 2021, 2022, and 2023 Cape Cod Baseball League (CCBL) seasons. Included injuries were those that happened to CCBL players during the above 5 seasons, impacted the upper extremity, occurred during official CCBL practice or gameplay settings, and were recorded by League athletic trainers. Injuries were recorded by team athletic trainers according to a standardized reporting guide and then reviewed and compiled by the league's athletic training coordinator. Data were analyzed with descriptive and inferential statistics, including chi-square tests of independence and linear regression. Results:A total of 162 upper extremity injuries were reported across 5 summer seasons for a mean of 32.4 ± 4.2 injuries per season. The average upper extremity injury rate across all 5 seasons was 2.22 injuries per 1000 athletic exposures. There was no significant injury trend from 2018 to 2023 (R2 = .434, P = .227). Almost 40% (61/154) of injuries were reinjuries, and overuse (120/158, 75.9%) was more common than trauma (38/158, 24.1%) regarding mechanism of injury. Muscles/tendons (e.g., strain) (97/161, 60.2%) were the most injured structure, and the shoulder (92/162, 56.8%) was the most frequently injured anatomic region. More than half (89/158, 56.3%) of injuries occurred in pitchers. Nearly all (146, 90.1%) injuries occurred during games instead of during practice (injury rate ratio = 9.1 [5.5, 15.3]). Significantly more injuries were time-loss injuries (105/162, 64.8%) than non-time-loss (P < .001). Conclusions:Among upper extremity injuries recorded across 5 seasons in the CCBL, injuries were predominantly due to overuse, most often involved shoulder anatomy, and frequently resulted in missed playing time. More than half of the injuries occurred in pitchers, and reinjuries were common. Level of Evidence:Level IV, epidemiological case series.
Purpose:To evaluate bilateral isokinetic performance symmetry of knee extensors and flexors 6 months after anterior cruciate ligament reconstruction using a rectus femoris tendon autograft. Methods:This retrospective case series included patients consecutively recruited at a single tertiary sports medicine center between January 2023 and July 2024. Inclusion required primary anterior cruciate ligament reconstruction with a rectus femoris autograft, no prior knee surgeries, and a minimum 6-month follow-up; patients with revision or multiligamentous procedures were excluded. Isokinetic testing was performed at 6 months using a computerized dynamometer. The nonoperative limb was tested first, followed by the operative limb. Patients performed 5 maximal effort trials at 60°/s for both extension and flexion. Measured outcomes included peak torque (PT), PT normalized to body weight, angle at PT, total work (TT), and mean power (PM) for both knee extension and flexion. Paired t-tests compared operated and nonoperated limbs. Statistical significance was set at P ≤ .05. Results:Thirty-one male patients (mean age, 26.3 ± 4.7 years) were included, with a mean follow-up of 6.2 ± 0.4 months. At 6 months, the operated limb achieved 71% of contralateral PT and 75% of contralateral PM, with significant deficits in extension PT (P < .001), PT normalized to body weight (P < .001), TT (P < .001), and PM (P = .002), while no significant difference was found for angle at PT (P = .457). Flexor performance showed near-complete recovery, with the operated limb reaching 93% of contralateral peak torque and 90% of TT, with P = .355, .340, .902, .153, and .316 for PT, PT normalized to body weight, angle at PT, TT, and PM, respectively. Conclusions:At 6 months, anterior cruciate ligament reconstruction with a rectus femoris autograft was associated with complete recovery of knee flexor performance but persistent deficits in knee extensor performance. Level of Evidence:Level IV, retrospective case series.
Purpose:To compare failure rates and patient-reported outcome measures (PROMs) across 5 arthroscopic, suprapectoral biceps tenodesis fixation techniques: tenodesis screw, tenodesis anchor, expanding tenodesis anchor, onlay with single all-suture anchor, and soft tissue tenodesis in the bicipital groove with suture. Methods:This was a retrospective cohort study approved by the Institutional Review Board, including patients age 18 years or older who underwent arthroscopic, suprapectoral biceps tenodesis between 2014 and 2024 with a minimum of 6 months of clinical follow-up. Exclusion criteria included cervical pathology, chronic pain syndromes, revisions, and workers' compensation cases. Patients completed PROMs including pain Visual Analog Scale (VAS), the American Shoulder and Elbow Surgeons (ASES) survey, the Simple Shoulder Test (SST), and a site-specific questionnaire. Clinical failures were recorded from clinic notes. Statistics were calculated using JMP Pro 18.0.1. Results:In total, 351 patients were enrolled: 79 with tenodesis screw, 69 with tenodesis anchor, 74 with expanding tenodesis anchor, 55 with single all-suture anchor, and 74 with soft tissue tenodesis. The average patient age was 61.7 ± 9.44 years for females and 61.8 ± 9.49 years for males. The average follow-up was 4.70 ± 2.44 years for females and 4.82 ± 1.77 years for males. The clinical failure rate was 2.28% (n = 8: 2 females and 6 males) with no differences between fixation techniques (P = .882). The overall rate of patient-reported "Popeye" deformity was 4.84% (n = 17: 4 females and 13 males, P = .130). PROMs, including pain VAS, ASES, and SST scores, were comparable across techniques (P = .280, .201, .095, respectively). Conclusions:Patients had similar outcomes regardless of arthroscopic, suprapectoral biceps tenodesis fixation technique. Approximately 1 in 20 patients reported a perceived "Popeye" deformity with longer-term follow-up of 5 years. Level of Evidence:Level III, retrospective comparative study.
