Background: Bone marrow stimulation (BMS) and patch augmentation (PA) are 2 adjuncts used during rotator cuff repair (RCR) to support the repair construct and promote healing. Purpose: To systematically review the literature to compare the clinical efficacy and retear rate outcomes of RCR with PA versus RCR with BMS. Study Design: Systematic review; Level of evidence, 2. Methods: A systematic review was conducted by searching the PubMed, the Cochrane Library, and Embase databases to identify Level 1 and 2 studies that compared the clinical efficacy of RCR alone with RCR plus BMS or RCR plus PA. The search phrase used was rotator cuff repair AND (patch OR augmentation OR bioinductive OR implant OR bone marrow stimulation OR microfracture OR crimson duvet OR BMS) . Patients were assessed based on the visual analog scale for pain, the Constant-Murley score, the American Shoulder and Elbow score, and retear rates. Results: Twenty studies (Level 1 or 2) met the inclusion and exclusion criteria, including 351 patients undergoing RCR with PA (mean age, 60 years) and 475 patients undergoing RCR with BMS (mean age, 59.9 years). The mean follow-up time was 20.6 months in the PA group and 21.1 months in the BMS group. None of the included studies directly compared PA and BMS, and there were no significant differences in weighted improvements among patient-reported outcomes from pre- to postoperative values between augmentation groups. Patients undergoing RCR with PA demonstrated no significant difference in retear rates at the latest follow-up compared with patients undergoing RCR with BMS. High heterogeneity among the included studies in the augmentation technique and tear grade was noted. Conclusion: Patients undergoing RCR with PA or BMS have demonstrated similar improvements in both patient-reported and functional outcomes. Further randomized controlled studies are needed to directly compare these 2 RCR augmentation groups, as well as compare different patch types and different BMS techniques.

BACKGROUND:Platelet-rich plasma (PRP) is emerging as a popular augmentation technique in the context of rotator cuff repair (RCR) to strengthen the repair construct and promote healing. Previous studies examining the efficacy of PRP augmentation during RCR have described heterogeneous results. PURPOSE:To determine whether platelet concentration of a PRP injection as an adjunct of RCR impacts clinical outcomes and retear rates. STUDY DESIGN:Systematic review and meta-analysis; Level of evidence, 2. METHODS:A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify level 1 and 2 studies that evaluated the clinical efficacy of RCR augmented with PRP. The search phrase used was "rotator cuff repair AND (PRP OR platelet rich plasma OR platelet-rich plasma)." Included randomized controlled trials were classified as utilizing high-dose or low-dose PRP based on their platelet concentration factor as a >4-fold increase over whole blood. The outcomes evaluated were the standardized mean differences of visual analog scale scores, Constant-Murley scores, American Shoulder and Elbow Surgeons scores, and University of California-Los Angeles scores, and pooled odds ratios of retear rates. Mixed-effects and random-effects meta-analyses were performed along with meta-regression to evaluate relationships in patient outcomes associated with PRP platelet dose. RESULTS:Ten studies (level 1 or 2) met inclusion criteria, including 696 patients (346 PRP, 350 control). The mean patient age at the time of repair was 54.3 years, and the mean follow-up time was 25.7 months. Of the 10 studies, 6 utilized low-dose PRP and 4 utilized high-dose PRP. In both the meta-analysis and meta-regression analyses, there were no significant differences in mean postoperative scores for all patient-reported outcomes or in mean retear rates between platelet dosage groups (all P > .05). CONCLUSION:Platelet concentration may not influence the clinical outcomes and retear rates of patients undergoing RCR with PRP augmentation. Further studies that adequately report PRP procedures and composition regarding PRP as an RCR augmentation are necessary to achieve confidence in their clinical application and efficacy.

OBJECTIVE:Anterior cruciate ligament injury is a major risk factor for the development of post-traumatic osteoarthritis, with cartilage degeneration frequently occurring despite successful reconstruction surgery. There is a growing need for sensitive, non-invasive imaging techniques to detect early biochemical changes in cartilage before irreversible structural damage occurs. This study aimed to evaluate the response of tibiofemoral cartilage to controlled biomechanical loading in healthy individuals, and in patients six- and twelve-months post anterior cruciate ligament reconstruction using quantitative magnetic resonance imaging. METHODS:We employed quantitative relaxometry (T2 and T1ρ mapping) in conjunction with a custom-built pneumatic loading device capable of applying functional, in-scanner mechanical loading (0.5 Hz, 50% body weight) to the knee joint. The scans were conducted before and after loading in 12 healthy controls (6 males, 6 females, 27.3±5.7 years old) and 27 post-operative patients (12 males, 15 females, 25.4±5.8 years old). The surgical cohort was further stratified into symptomatic and asymptomatic subgroups based on clinical outcomes. RESULTS:Biomechanical loading led to different quantitative relaxometry outputs between the six- and twelve-month post-operative time points. Across all patients, T2 values increased after biomechanical loading by 8% and 7% at six- and twelve-month time points, respectively. However, our current loading scheme did not lead to MR relaxometry differences between healthy and post-surgery cohorts. Meanwhile, for ligament reconstruction patients, we found increased relaxometry values due to biomechanical load at both time points post-surgery. CONCLUSION:Biomechanical loading alters the structure and relaxivity of the knee cartilage, and T1ρ may be a more meaningful quantitative metric for post-ligament reconstruction evaluation.

BACKGROUND:Online physician review websites are being increasingly utilized by patients when choosing their surgeon. Although most reviews are positive, extremely negative reviews can significantly compromise a physician's online reputation. The purpose of this study was to analyze factors that contribute to negative reviews for orthopedic shoulder surgeons. METHODS:One hundred orthopedic shoulder surgeons were randomly selected from the "find a doctor" tool on the American Shoulder and Elbow Surgeons website. A search was performed for all reviews listed under the selected surgeons on the following sources: Google Reviews, Healthgrades, Vitals, and Yelp. For each website, a surgeon's average rating, total number of reviews, and number of 1-star reviews was recorded. One-star reviews with comments were then reviewed to categorize the complaint(s), determine whether they referenced a clinical or nonclinical issue, and determine whether the complaint referenced a surgical or nonsurgical episode of care. Categorical variables were analyzed using a chi-square test. RESULTS:A total of 7,616 reviews were analyzed and 722 (9.5%) were identified as 1-star. After application or exclusion criteria, 329 single-star reviews with 837 total complaints were included for analysis. Of the 329 single-star reviews, 237 (72.0%) were from nonsurgical patients and 92 (28.0%) were from surgically treated patients. Nonsurgical patients had a significantly higher rate of total complaints per each review than surgical patients (1.76 vs. 0.78, P = .034). The most common complaints were regarding bedside manner (160 complaints), insufficient time with the provider (82 complaints), uncontrolled pain (73 complaints), and rude staff (72 complaints). Poor surgical outcomes were noted in terms of complication (66 complaints), reoperation (26 complaints), and readmissions (2 complaints). CONCLUSION:For orthopedic shoulder surgeons, the most common complaints are nonclinical and include poor bedside manner, wait time, and insufficient time with the provider. Relatively few negative reviews referenced objective measures of health care quality such as complications or surgical outcomes. These results provide a deeper understanding of the reasons for patient dissatisfaction in shoulder surgery, which can be considered when striving to maintain a favorable online reputation.

BACKGROUND:Persistent knee pain can develop after anterior cruciate ligament injury with subsequent anterior cruciate ligament reconstruction (ACLR) despite a functionally intact graft. PURPOSE:To identify the prevalence of clinically significant knee pain in patients at 2, 6, and 10 years after ACLR. STUDY DESIGN:Cohort study; Level of evidence, 2. METHODS:3272 patients were enrolled into the Multicenter Orthopaedic Outcomes Network (MOON) between 2002 and 2008 across 7 centers. Each patient completed a questionnaire at baseline that included demographic characteristics, injury factors, participation in sports, and validated outcome measures including the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale (scored 0-100 with higher scores signifying less pain). Each patient completed the questionnaire again at 2, 6, and 10 years postoperatively. Three different criteria were used to define clinically significant knee pain: KOOS pain ≤70 points, KOOS pain ≤80 points, or responding "moderate,""severe," or "extreme" to a KOOS pain question. RESULTS:Median age in the cohort was 23 years (interquartile range, 17-27 years) at the time of enrollment, and 44% of patients were female. A total of 2798 patients (85%) responded to the questionnaire at 2 years postoperatively, with 2759 (84%) responding at 6 years and 2526 (77%) at 10 years. The prevalence of those with KOOS pain ≤70 was 9.3%, 9.0%, and 9.1% at 2, 6, and 10 years after surgery, respectively. The prevalence of KOOS pain ≤80 was 16.6%, 16.3%, and 15.7% at each timepoint, respectively. When a KOOS pain response of "moderate,""severe," or "extreme" was used, the prevalence was 26.3%, 22.9%, and 22.6% at 2, 6, and 10 years, respectively. Interestingly, very few patients had persistent pain at all 3 follow-up points: 48 (1.6%) reported a KOOS pain score ≤70 points, 103 (3.5%) reported a KOOS pain score ≤80 points, and 161 (5.6%) reported moderate or severe pain. CONCLUSION:The prevalence of clinically significant postoperative knee pain after ACLR was up to 26% at 2 years postoperatively, a percentage that remained unchanged or slightly decreased at 6- and 10-year follow-up. Despite this finding, it was uncommon for individual patients to report clinically significant knee pain at multiple follow-up timepoints.

BACKGROUND:Authorship patterns in medical journals continue to evolve with expanding team science, academic incentives, and updated authorship guidance. Previous American Journal of Sports Medicine (AJSM) work (1994-2014) reported rising author counts and a growing share of international contributors. HYPOTHESIS/PURPOSE:To update AJSM authorship trends (2014, 2019, 2020, and 2024) and test whether the past decade shows greater mean authors per article, more international and/or academic groups, and a higher proportion of nonphysician first authors. STUDY DESIGN:Cross-sectional bibliometric analysis. METHODS:We reviewed AJSM articles in 2014, 2019, 2020, and 2024 via the journal archive; editorials, letters, society news, and corrigenda were excluded. For each article, we recorded the first/last author's highest degree and sex, the number of authors, country (United States vs international), and institution type (academic vs nonacademic). Articles with >20 authors were excluded. Differences across years were tested with a chi-square test (Bonferroni-adjusted α = .0083) and a 1-way analysis of variance with the Tukey honest significant difference post hoc test. RESULTS:A total of 1482 articles met the inclusion criteria (2014: n = 336; 2019: n = 383; 2020: n = 383; and 2024: n = 380). Article volume did not differ significantly across years (χ2[3] = 4.30; P = .23). From 2014 to 2024, article volume increased by 13.1%. Mean authors per article increased from 5.82 (2014) to 6.47 (2019), 6.55 (2020), and 7.02 (2024) (F[3,1470] = 15.69; P < .0001); all but the 2019 versus 2020 pairwise contrasts were significant. International groups increased from 42.6% (2014) to 51.3% (2024) (χ2[3] = 8.92; P = .03). No pairwise comparison met the Bonferroni threshold (α =.0083); the lowest P value was .0097 (2014 vs 2019). Bachelor of Arts/Bachelor of Science first authorship rose (χ2[3] = 13.78; P = .003), reaching 9% (2020) and 11% (2024). Sex distributions for first and last authors did not change (all P > .05). Twelve articles exceeded the >20-author cutoff and were excluded. CONCLUSION:From 2014 to 2024, AJSM authorship shows expanding team size, increased international participation, and a higher proportion of bachelor's-level first authors-largely medical trainees-while sex representation remained stable. These patterns underscore the need for transparent contributorship and mentorship to maintain rigor as collaboration intensifies.

Background: Before the rise of arthroscopic rotator cuff repair (RCR), mini-open RCR was the preferred method of repairing a torn rotator cuff. However, in the recent fluid shortage that limited the viability of performing arthroscopic procedures, we felt that mini-open RCR could be a viable method to achieve satisfactory patient outcomes while limiting arthroscopic fluid utilization. Little information, particularly in video form, exists describing how to perform a mini-open RCR. Indications: Our patient presented with a symptomatic chronic rotator cuff tear that was affecting her ability to work. She wanted to undergo surgical intervention at a specific time to minimize the impact of the recovery time on her work. At that time, we were experiencing a fluid shortage, which limited our ability to perform arthroscopic procedures; thus, we elected to perform a mini-open RCR. Technique Description: We utilized a small 4-cm incision on the lateral aspect of the shoulder and performed a deltoid split to expose the rotator cuff tear. In a similar fashion to an arthroscopic procedure, we debrided the rotator cuff footprint. We then performed a double-row transosseous equivalent repair through the open incision, as would be performed arthroscopically. Results: Previous literature suggests that mini-open RCR leads to similar functional and patient-reported outcomes as arthroscopic RCR. The open procedure may have a shorter operative time. Some evidence indicates that mini-open RCR may lead to an early increase in pain compared with arthroscopic repair, which tends to normalize within 1 week. We were able to limit the amount of arthroscopic fluid utilized to ≤3 L per case. Discussion/Conclusion: While mini-open RCR may be an older technique, there are instances when either arthroscopic equipment or fluid may not be available, and mini-open RCR may be the most viable technique for repair. Mini-open RCR can achieve satisfactory outcomes comparable to arthroscopic RCR. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

BACKGROUND:Anterior cruciate ligament (ACL) graft tears and contralateral ACL tears are both relatively common after primary ACL reconstruction (ACLR). There is little prior work comparing the outcomes of reconstruction after these injuries. HYPOTHESIS:The authors hypothesize that patient-reported outcome measures (PROMs) and activity level are lower after revision ACLR than after primary contralateral ACLR. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:From a cohort of 2333 patients who underwent primary unilateral ACLR, 267 were identified who underwent subsequent revision ACLR or primary contralateral ACLR within 5 years of primary ACLR. After exclusion of 11 patients who had both injuries, 256 were eligible for the study, including 124 who underwent revision ACLR and 132 who underwent primary contralateral ACLR. Patients were contacted for follow-up at 6 years after the primary ACLR, and PROMs were collected, including subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score for pain (KOOS-Pain) and knee-related quality of life (KOOS-QOL), and Marx activity level. Patient demographics, surgical factors, and PROMs were compared between groups. Beta regression models with identity link were used to determine whether side of subsequent surgery (revision vs primary contralateral ACLR) was a significant predictor of outcome. RESULTS:Of 256 patients, 223 (87%) were contacted and completed PROMs at 6 years after the primary ACLR. At baseline, there were no significant differences between groups except that the subsequent revision group had a lower incidence of partial lateral meniscectomy and a higher incidence of lateral meniscal repair and was more likely to have received allograft for the primary ACLR than the subsequent contralateral reconstruction group. The median time from primary ACLR to second ACL surgery was lower in the revision group (1.3 years) than the contralateral group (2.0 years; P < .001). When controlling for demographics, surgical factors, and baseline PROMS, the revision ACL group demonstrated a 7.8-point lower International Knee Documentation Committee score (P < .001), a 3.2-point lower KOOS-Pain score (P = .012), a 10.4-point lower KOOS-QOL score (P < .001), and 2.0-point lower Marx score (P = .002) than the contralateral ACLR group. CONCLUSION:Patients who undergo revision ACLR within 5 years of primary ACLR demonstrate poorer PROMs and lower activity levels than those who undergo primary contralateral ACLR during this period. These 2 groups of patients should not be pooled to study outcomes of ACLR.

Quadriceps tendon ruptures are significant injuries that impair knee function and mobility. Complete disruption of the knee extensor mechanism requires prompt operative repair to restore function. The 2 most popular techniques for tendon repair use either transosseous drill tunnels with suture fixation or unicortical drill holes with suture anchors. Each method is associated with advantages and disadvantages. Challenges of transosseous suture repair include knot volume and an increased risk of repair gapping after tensioning. Complications related to traditional suture anchor repair often are related to implant pullout and/or patella fracture. All-suture anchors used in a transosseous approach minimize these risks while combining the benefits of transosseous suture repair with the biomechanical advantages of suture-anchor fixation. The purpose of this Technical Note is to describe a technique that addresses limitations associated with current quadriceps tendon repair techniques by using a hybrid approach with knotless all-suture anchors through 2 transosseous patella bone tunnels.

Background:Glenohumeral instability can be addressed surgically with repair of the capsulolabral complex, the "Bankart" repair, or bone augmentation with coracoid autograft, the "Latarjet" procedure. Superior return-to-sport (RTS) rates with either Bankart repair or Latarjet have yet to be delineated, and it remains unclear which surgical procedure is optimal. Purpose:To review the current literature and report on RTS data for patients who received Bankart repair or Latarjet to address glenohumeral instability. Study Design:Systematic review; Level of evidence, 4. Methods:This systematic review and meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines by an individual researcher screening through 3 databases (PubMed, Cochrane Library, Embase) for articles including RTS rates after Bankart repair and Latarjet. Eight studies that met inclusion and exclusion criteria were included for review. Results:Meta-analysis included 874 athletes who underwent shoulder stabilization: 479 Bankart repair and 395 Latarjet. An overall 94.4% of athletes returned to sport with no statistically significant difference between the surgical groups. Of 665 athletes, 68.1% returned to sport at the same level or higher with no statistically significant difference between the groups. RTS time among the 665 athletes averaged 6 months with no statistically significant difference between the groups. A total of 56 athletes did not RTS: 33 (7.4%) Bankart repair and 23 (6.3%) Latarjet. There was a statistically significant difference (P < .0001) in recurrent instability rates. Bankart repair (14.8%) was 4 times more likely to result in recurrent instability as compared with Latarjet (3.5%). A total of 85 athletes, 71 Bankart repair and 14 Latarjet, had recurrent instability with 53.5% (7.9% overall) and 100% (3.5% overall) requiring a revision procedure, respectively. Conclusion:Bankart repair and Latarjet have a high RTS rate with no significant difference in rate, rate of return to previous level of play, or time. One of 4 athletes will not return to the level played before surgery, independent of stabilization technique. Bankart repair is 4 times more likely to result in recurrent instability as compared with Latarjet.

PURPOSE:To determine whether patients undergoing arthroscopic partial meniscectomy (APM) with synovitis treated by synovectomy exhibit similar outcomes to those without synovitis after 24-month follow-up. METHODS:A total of 181 patients who underwent primary APM at a single institution between 2018 and 2022 were included: 87 without synovitis and 94 with synovitis treated via synovectomy involving at least two compartments. Synovitis extent was assessed intraoperatively by the surgeon. Nine Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, including three derived from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), were collected preoperatively and at 24 months postoperatively. Patient demographics, surgical details, preoperative Kellgren-Lawrence (KL) osteoarthritis (OA) grade and intraoperative outerbridge chondral scores were compared between cohorts. 'Failures' underwent subsequent ipsilateral knee surgery during follow-up. 'Responders' reached the minimal clinically important difference (MCID) by 24 months. Time-to-response analysis using Cox regression compared the time to achieve MCID between groups. RESULTS:There were no significant differences in demographics between the cohorts including age, body mass index, sex, smoking status and number of comorbidities. The treated synovitis group demonstrated greater preoperative OA severity (median KL: 2 vs. 1.5; p = 0.013) and intraoperative chondral degeneration (median global outerbridge: 2 vs. 1; p < 0.001). All nine KOOS subscales improved between baseline and 24-month follow-up (all p < 0.001). At 24 months, all KOOS subscales were similar between groups (all p > 0.05), except WOMAC Stiffness, which was higher in the treated snifters group (24.9 vs. 17.9; p = 0.025). Time-to-response analysis showed no difference in time to MCID achievement (374 vs. 362 days; p = 0.727), and failure rates were also similar (7.4% vs. 11.5%; p = 0.498). CONCLUSIONS:Despite greater OA severity and chondral degeneration, snifters treated with synovectomy in patients undergoing APM did not result in worse KOOS scores, delayed clinical response or increased risk of subsequent ipsilateral knee surgery compared to APM without synovitis. LEVEL OF EVIDENCE:Level III.

Background:Orthopaedic sports medicine fellowships are highly competitive, yet objective data defining characteristics of successful applicants remain limited. Hypothesis:It was hypothesized that greater academic productivity, top-tier residency training, and certain demographic factors would be associated with matching into a top-ranked orthopaedic sports medicine fellowship. Study Design:Cross-sectional study. Methods:We retrospectively reviewed applicants who matched into one of the top 10 orthopaedic sports medicine fellowships from 2020 to 2025, as identified by previous applicant preference rankings. Applicant data were obtained from publicly available sources and verified by 2 independent reviewers. Variables included sex, degree type, residency program ranking, geographic region, and research productivity (total publications, primary publication count, H-index, and sports-related publications). Multivariate logistic regression assessed predictors of matching into top 5 versus 6th- to 10th-ranked programs. Results:Among 226 matched applicants, 87.7% were male and 99.1% held a doctorate in medicine degree. The mean total publication count was 12.4, mean H-index was 8.2, and 30.5% trained at a top 20 orthopaedic residency. Applicants matching into top 5 programs had significantly higher research metrics than those in the 6th- to 10th-ranked programs: total publications (20.1 vs 4.7), primary publication count (6.2 vs 1.6), and sports-related publications (11.4 vs 1.9). On regression analysis, total publications, H-index, and residency ranking were independent predictors of matching into a top 5 program. Conclusion:Matching into a top orthopaedic sports medicine fellowship is associated with higher academic productivity and training at a top-tier residency program.

Anterior cruciate ligament (ACL) injuries lead to an increased risk of osteoarthritis (OA). However, efforts to diagnose OA before irreversible changes to the joint occur remain limited. In this work, we utilized both quantitative MRI (qMRI) and displacements under applied loading MRI (dualMRI) to determine if relaxometry measures derived from qMRI and strains derived from dualMRI correlate with patient-reported outcomes at six months post unilateral ACL reconstruction. Quantitative MRI (T2, T2*, T1ρ) measurements and dualMRI strains (transverse, axial, and shear strains) were quantified in the medial articular tibiofemoral cartilage of 35 participants at six-months post unilateral ACL reconstruction. The relationships between patient-reported outcome scores and all MRI metrics were quantified using general linear mixed-effects models and a combined best-fit multicontrast MRI model was then developed. Higher femoral shear and transverse strains were significantly correlated with worse patient-reported outcomes. No relaxometry measures were correlated with patient-reported outcome scores. We identified the best-fit model for predicting patient-reported outcome score using multiple MRI measures and patient-specific information. The best-fit model significantly predicted patient-reported outcome score (p < 0.001, R2 = 0.52) better than any one individual MRI metric alone. This work presents the first use of dualMRI in vivo in a cohort of participants at risk for developing osteoarthritis. Our results indicate that both shear and transverse strains are highly correlated with patient-reported outcome severity, and may represent early biomechanical changes associated with symptomatic burden, which could potentially inform future efforts to identify individuals at risk for developing osteoarthritis.

Background: Arthroscopic shoulder capsuloligamentous repair can be performed in the beach-chair (BC) or lateral decubitus (LD) position. Patient positioning may influence anchor placement. Limited research exists evaluating these 2 positioning techniques, specifically with respect to anchor position and trajectory. Purpose/Hypothesis: The purpose of this study was to perform a cadaveric imaging analysis of arthroscopic anterior shoulder stabilization in the LD and BC positions. It was hypothesized that repairs performed in the LD position would demonstrate more accurate anterior inferior anchor positioning. Study Design: Controlled laboratory study. Methods: Nine matched pairs of cadaveric shoulders (18 total shoulders) were used. Specimens underwent arthroscopic anterior inferior labral repair using 3 suture anchors placed in the 3:30, 4:30, and 5:30 positions. Repairs were performed by 2 fellowship-trained orthopaedic surgeons each trained in a respective technique. Specimens then underwent computed tomography analysis to evaluate anchor position and trajectories. Target anchor location was determined using a 3-dimensional computed tomography glenoid model, using ImageJ software, with the clockface overlaid onto the glenoid. The 3-o’clock position was set at 0° for reference, with the 3:30, 4:30, and 5:30 anchor positions set at −15°, −45°, and −75°, respectively. One-tailed t tests were used to compare anchor position deviation with target ideals. Results: Inferior anchor (5:30) placement was found to be more accurate in the LD position, while superior anchor (3:30) placement was found to be more accurate in the BC position. Specifically, the LD group did not demonstrate statistically significant deviation from the target ideal (−75°) for the 5:30 anchor. The true deviance for the LD group from the 5:30 target angle was between −78.6° and −58.5° ( P = .178), while the BC group did not demonstrate statistically significant deviation for the target ideal (−15°) for the 3:30 anchor. The true deviance from the target angle was between −37.9° and 1.79° ( P = .732). Both groups demonstrated adequate anchor trajectories. Conclusion: Both positioning techniques remain safe and efficacious. The LD position may offer improved inferior anchor placement, and the BC position may offer improved superior anchor placement. Additional studies are warranted to further elucidate the advantages and disadvantages of each position. Clinical Relevance: Knowledge pertaining to the accuracy of anchor placement based on patient positioning and anchor location may aid surgeons in choosing operating positions to potentially optimize anchor placement during arthroscopic anterior shoulder stabilization surgery.

Background: Medial meniscal repair performed at the time of primary anterior cruciate ligament reconstruction (ACLR) has been shown to be significantly associated with subsequent surgery, and subsequent surgery has been associated with increased Knee injury and Osteoarthritis Outcome Score (KOOS) pain score and decreased patient satisfaction. Hypothesis/Purpose: The purpose was to determine if medial meniscal repair decreases KOOS pain 10 years after ACLR and to assess the consequences of subsequent surgery on the development of KOOS pain. The authors hypothesized that medial meniscal repair performed at the time of primary ACLR decreases the likelihood of developing KOOS pain. It was further hypothesized that surgery performed subsequent to medial meniscal repair and primary ACLR increases KOOS pain 10 years after ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Our inclusion criteria were all patients undergoing unilateral primary ACLR from 2002 to 2008 who were enrolled in the Multicenter Orthopaedic Outcomes Network without a history of medial or lateral meniscal surgery and contralateral ACLR. Causal mediation analysis using R software (Version 4.2.3) was employed to compare 2 effects on the development of significant knee pain, as represented by a KOOS pain score <80, at 10-year follow-up: (1) medial meniscal repair for longitudinal tears >10 mm in medial-to-lateral length and (2) medial meniscal excision at baseline of ACLR. A directed acyclic graph was constructed to provide a qualitative representation of the influence of known confounders that have been shown to affect the outcome of interest. Missing data were multiply imputed using multivariate imputation by chained equations. All tests were 2-sided, assuming a type I error rate of .05. Results: In total, 2387 participants (1074 female [45%]; 1313 male [55%]) were included in the final analysis. In 1502 (62.9%) cases, there was no medial meniscal tear reported. Of the 885 cases with medial meniscal tears, no treatment was performed in 109 (12.4%), meniscal excision was performed in 396 (44.7%), and meniscal repair was performed in 380 (42.9%). An overall 1825 of 2387 (76.5%) patients reported KOOS pain at 10-year follow-up: 252 (13.8%) had KOOS pain <80 and 1573 had ≥80. In the KOOS pain <80 group, 75 (29.8%) had subsequent surgery. In the KOOS pain ≥80 group, 223 (14.2%) had subsequent surgery. The step-by-step approach to causal mediation analysis demonstrated that a medial meniscal procedure (ie, no treatment for the tear, repair, or excision) significantly affected the likelihood of subsequent surgery (χ 2 = 28.9; P < .001) and subsequent surgery significantly increased the likelihood of KOOS pain <80 (χ 2 = 17.3; P < .001). However, the direct effect of a successful medial meniscal repair without subsequent surgery decreased the likelihood of KOOS pain <80 by 7.1% when compared with medial meniscal excision (95% CI, –13.3% to −1%; P = .024). When subsequent surgery was performed after medial meniscal repair and ACLR, the likelihood of KOOS pain <80 increased by 2.9% (95% CI, 1.1%-5.3%; P < .001.) Conclusion: Successful medial meniscal repair performed at the time of primary ACLR decreased clinically significant knee pain 10 years postoperatively. However, the mediating effect of subsequent surgery was significant and diminished the overall contribution of medial meniscal repair in decreasing the likelihood of KOOS pain. Continued efforts should be made to decrease the likelihood of subsequent surgery after medial meniscal repair performed at the time of primary ACLR.

Background:Meniscal tears are a common knee injury in athletes, necessitating effective repair techniques. Despite the prevalence of meniscal tears, there is limited literature comparing the efficacy of the 2 primary suture methods-all-inside and inside-out-in the athletic population. Purpose:To evaluate the postoperative outcomes and failure rates of the all-inside versus inside-out suture techniques in meniscal repairs among athletes. Study Design:Systematic review; Level of evidence, 4. Methods:Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted across the PubMed, Cochrane, and Embase databases on July 26, 2023, yielding 245 studies, of which 7 were included in this review. Studies reporting postoperative outcomes and failure rates of both suture techniques were included. Failure was defined as the need for subsequent surgery due to a persistent meniscal tear. Outcome measures included the Tegner, Lysholm, and International Knee Documentation Committee scores. Differences between groups and subgroups were assessed using the Welch t test and the odds ratio. Wilcoxon tests were used as a sensitivity analysis to confirm the results of the Welch t tests. Heterogeneity was assessed with the I 2 statistic and the Bartlett test. All statistical analyses were done using R. Results:Seven studies-published between 2009 and 2023-met the inclusion criteria, including 469 operations in 458 patients. A total of 199 operations used the all-inside technique, and 270 operations used the inside-out technique. Of the 469 operations, 377 had documentation on laterality (medial meniscal repair versus lateral meniscal repair), with 167 patients undergoing medial meniscal repair and 210 patients undergoing lateral meniscal repair. Each all-inside repair was done with the Fast-Fix device. The all-inside technique showed a statistically significant increase in failure rate compared with the inside-out technique (23.1% vs 12.2%; P = .003). This trend was exaggerated in all-inside repairs for the medial meniscus versus the lateral meniscus (58.1% vs 11.8%; P = 2.6 × 10-5). When excluding all radial tears, the all-inside technique again had an increased rate of failure compared with the inside-out repairs (20.7% vs 8.3%; P = .01). No significant difference was found in postoperative Tegner scores between all-inside and inside-out repairs (5.9 vs 6.5; P = 0.45). Conclusion:Our review demonstrated that medial meniscal repairs with the all-inside technique using the Fast-Fix device had a higher failure rate compared with those with the inside-out technique; this trend is not seen for lateral meniscal repairs. Based on the findings of this study, surgeons should consider the inside-out technique first for athletic patients presenting with medial meniscal tears who want to return to their sport. Given the limited scope of existing studies combined with more recent utilization of novel all-inside meniscal repair devices that may not be captured in the present study, additional high-quality, prospective studies in this area are needed to validate these findings.

Background:Medicaid coverage is associated with longer appointment wait times, poorer health outcomes, and decreased access to care compared with private insurance across multiple medical specialties. Currently, there is a paucity of data assessing the effect of Medicaid coverage on new patient access to care and appointment wait times for orthopaedic sports medicine surgeons. Purpose:To assess the effect of insurance status on patient access to care and appointment wait times for sports medicine-trained orthopaedic surgeons specializing in hip, knee, and shoulder arthroscopy. Study Design:Cross-sectional study. Methods:Sports medicine-trained orthopaedic surgeons were identified using the American Academy of Orthopaedic Surgeons patient-facing database, and physicians were categorized by joint specialization (hip, knee, or shoulder). Mystery callers posing as either Medicaid or Blue Cross/Blue Shield (BCBS) insured patients with a textbook presentation of a nonurgent hip, knee, or shoulder injury contacted physicians to request the next available new patient appointment. The number of business days until the first available new patient appointment was recorded and analyzed using a linear mixed model of Poisson regression. Results:A total of 1046 telephone calls were made to 523 unique orthopaedic sports medicine clinics in 48 states. Of the 385 included physicians, 129 (34%) did not accept Medicaid. Patients with Medicaid experienced a 20% longer wait time for a new patient appointment compared with patients with BCBS (incidence rate ratio [IRR], 1.20 [95% CI, 1.14-1.26]; P < .001), with median wait times of 13 days (IQR, 7-23 days) and 12 days (IQR, 6-20 days), respectively. Additionally, patients with Medicaid experienced increased wait times in specific geographic locations (P < .05) and a greater increase in wait times at academic institutions compared with private practices (IRR, 1.36 [95% CI, 1.13-1.62]; P = .001), with median wait times of 19 days (IQR, 15-22 days) and 14 days (IQR, 12-15 days), respectively. No significant difference in access to care or wait time was identified between hip, knee, and shoulder arthroscopic surgeons (P = .68). Our model achieved an R 2 value of 0.93, demonstrating strong explanatory power. Conclusion:Patients with Medicaid experienced decreased access to care, with 34% of sports medicine-trained orthopaedic surgeons declining to accept Medicaid insurance. Among surgeons who accepted Medicaid, patients with Medicaid experienced slightly longer wait times for a new patient appointment compared with patients with private (BCBS) insurance. Additionally, patients with Medicaid experienced significantly longer wait times at academic institutions and in specific geographic locations. The present findings highlight a critical disparity in care, further underscoring the need for additional research to identify the cause and implement solutions.