BACKGROUND:Developed in recent years, CrossFit has gained much popularity in the industrialized world due to various advantages such as scalability, availability and high sense of community. Nonetheless, with growing interest, reports on associated injury have also emerged, highlighting the need for better characterization and analysis of specific risk factors. Our goal was therefore to characterize injuries related to CrossFit and to describe specific risk factors associated with their occurrence. METHODS:We conducted a cross-sectional study by using a questionnaire aimed at CrossFit athletes responding to personally delivered questionnaires nationwide. RESULTS:A total of 502 fully answered our questionnaire. Athletes who reported injury had a slightly higher mean weight (P=0.065) and Body Mass Index (P=0.059) compared to their non-injured counterparts and the most affected area was the upper extremity (N.=133, 26.4%) followed by the shoulder (N.=101, 20.1%). Athletes who performed preworkout warmup exercises were significantly more prone to report an injury (P=0.007) as well as those who had prior injury in the affected area. Backward stepwise regression model assessing injury predictors revealed that preworkout warmup (OR 1.816; 95% CI 1.095-3.011; P=0.021) and preinjury local pain (OR 1.554; 95% CI 1.004-2.046; P=0.048) in CrossFit athletes were significant predictors of injuries. CONCLUSIONS:Pretraining warm-ups and preinjury localized pain were found to predict significant injury among CrossFit athletes.

Climate change requires managers to bolster long-term resilience of fisheries and concurrently improve short-term responsiveness of management systems to prevailing ecological conditions, all while avoiding unintended harm to stocks in a highly uncertain context. There has been substantial effort dedicated to developing the scientific information and tools needed to inform climate-ready fisheries, yet implementation of these approaches has been limited in the United States management system. Meanwhile, climate impacts on fisheries are already occurring, making fish and fishing communities highly vulnerable to sudden, and often detrimental, changes. There is a need to accelerate adaptation efforts, and near-term action is critical even without the full complement of information and tools in hand. Here, existing climate-ready approaches were compiled and synthesized to offer a comprehensive and structured perspective on priority actions that can be taken in the next 1-2 years to increase the resilience and adaptability of fish stocks and communities that rely on them. From the review there are three main findings: 1) 45% of the management actions can be implemented in this short timeframe, 2) Nearly all actions identified can be implemented in the current fishery and regulatory framework, and 3) While new approaches are needed, managers should proceed with caution to avoid maladaptation and choose a no- or low- maladaptation risk approach wherever possible.

INTRODUCTION:In recent years, there has been a rapid increase in the number of joint replacement surgeries. This surge can be attributed to two primary factors. Firstly, the aging demographic of the population plays a significant role. Secondly, the substantial enhancements in surgical outcomes have contributed to the growing prevalence of these procedures. Over the past two decades, surgeons have incorporated robotic assistance into joint replacement surgeries. During this period, a substantial body of evidence has accumulated, endorsing the effectiveness of robotic joint replacement procedures in achieving favourable clinical and radiographic results. The continuous evolution of technology has led to the development of various robotic systems, each distinct in its features and underlying principles. These distinctions encompass the extent of robotic involvement in surgery, the compatibility of the robotic system with different implant types, and the specific imaging modalities required during pre-operative preparations. This review aims to provide an overview of the current literature pertaining to the diverse range of robotic systems in use. It includes a comparative analysis of clinical and radiographic outcomes achieved through robotic replacements and concludes by discussing the necessary adaptations and considerations in light of these findings.

Seasonal harvest restrictions are a common strategy in fisheries management, designed to mitigate fishing pressure on economically and recreationally valuable fish and invertebrate stocks. However, uncertainty regarding recreational fishing effort responses to seasonal closures can lead to unintended consequences for target and non-target species. This is especially true in the Gulf of Mexico reef fishery, where anglers can switch among multiple target species and discard mortality for co-occurring species is high. Therefore, understanding the drivers of recreational fishing effort is needed to support management decisions. This study addresses knowledge gaps by employing a statistical model to analyze the relationships between recreational reef fish effort (measured in angler-trips) and species-specific seasonal management in the Gulf of Mexico along the west coast of Florida. We focused on ecological and management variables surrounding gag (M. microlepis), red grouper (E. morio), and red snapper (L. campechanus), which are among the most recreationally sought-after species targeted along the west coast of Florida. We also considered environmental covariates such as seasonal patterns, inter-annual changes in species abundance, and socioeconomic factors (i.e., numbers of saltwater fishing licenses sold and economic trends). Our analysis indicated considerable variation in effects of seasonal, environmental, and management predictors on recreational effort that were region-specific. Notably, management predictors related to both red snapper and gag, such as the fraction of a month open to harvest (both species) and the length of the red snapper season, directly influenced recreational effort. Given recent substantial reductions in the Gulf of Mexico gag season, we were particularly interested in the effect of gag management on angler-trips, but we did not find strong evidence that effort concentration has taken place for this species at this time. This information provides foundational insights into the seasonal, biological, and anthropogenic drivers of recreational angler reef fish effort along the west coast of Florida. This model, or related frameworks, could be valuable in forecasting future trends in recreational effort along the west coast of Florida specifically and the Gulf of Mexico more generally, and may be instrumental for managers seeking to comprehend the consequences of changes to seasonal reef fishery management.

Background/Objectives: Osteoarthritis (OA) is a common disease that affects almost half the population at some point in their lives, causing pain and decreased functional capacity. New conservative treatment modalities are being proposed to provide symptomatic relief and delay surgical intervention. This study aimed at evaluating the safety of the novel liposomal boundary lubricant, injected intra-articularly in patients with moderate knee OA. Additionally, the effect on the functionality and life quality was assessed. Methods: Eighteen of the twenty screened subjects met inclusion criteria and were enrolled in the study. After receiving a single IA injection of AqueousJoint, patients were prospectively evaluated at baseline and at 2, 4, 8, 12, and 26 weeks. Numeric Pain Rating Scale (NRS), Knee injury and Osteoarthritis Outcome Score (KOOS), Short Form Health Survey (SF12) and range of motion were also recorded. Results: The final analysis was conducted on 18 subjects. No adverse events related to the investigational product were observed in the study. No serious adverse events were observed at all. A significant decrease in pain was demonstrated at all time points vs. baseline (Friedman X2 = 35.08, p < 0.001). Significant improvement was demonstrated in KOOS pain, symptoms, sports, and ADL subscales (p < 0.001). Conclusions: Despite a relatively small sample, it was demonstrated that single IA AqueousJoint injection is a safe procedure, resulting in significant pain reduction, higher ADL score, and higher KOOS sport scores. The effects lasted up to 6 months.

Objectives This study examines the impact of pulmonary embolism (PE) on mortality among patients with femoral neck fractures, exploring the predictive value of preoperative PE for postoperative occurrences and associated mortality over a 5-year follow-up period. Methods We analyzed 2256 patients over 60 years old admitted with femoral neck fractures, focusing on those who developed DVT or PE postoperatively. Surgical intervention aimed within 48 hours without pharmacological thromboprophylaxis, utilizing mechanical prophylaxis instead. Postoperative management included Enoxaparin administration. Data analysis employed SPSS 21, with chi-squared tests, T-tests, and multivariate logistic regression to explore mortality and PE incidence. Results PE was diagnosed in 1.4% of patients, with a notable mortality contrast between patients with PE (87%) and those without (59.7%) over 5 years. A history of preoperative PE emerged as a significant risk factor for postoperative PE. Despite surgical variations, no significant correlation was found between surgery type and PE incidence. Early postoperative weight-bearing and institutional rehabilitation did not significantly alter PE incidence rates. Conclusions The study underscores the significant mortality risk associated with preoperative PE in femoral neck fracture patients. It highlights the necessity for vigilant PE risk assessment and management, challenging assumptions about the protective role of early mobility and rehabilitation in PE incidence. Further research is essential to refine patient care strategies and improve outcomes.

Many of the world’s fisheries are “data-limited” where the information does not allow precise determination of fish stock status and limits the development of appropriate management responses. Two approaches are proposed for use in data-limited stock management strategy evaluations to guide the evaluations and to understand the sources of uncertainty: rejection sampling methods and the incorporation of more complex socio-economic dynamics into management evaluations using agent-based models. In rejection sampling (or rejection filtering) a model is simulated many times with a wide range of priors on parameters and outcomes are compared multiple filtering criteria. Those simulations that pass all the filters form an ensemble of feasible models. The ensemble can be used to look for robust management strategies, robust to both model uncertainties. Agent-based models of fishery economics can be implemented within the rejection framework, integrating the biological and economic understanding of the fishery. A simple artificial example of a difference equation bio-economic model is given to demonstrate the approach. Then rejection sampling is applied to an agent-based model for the hairtail (Trichiurus japonicas) fishery, where an operating model is constructed with rejection/agent-based methods and compared to known data and analyses of the fishery. The usefulness of information and rejection filters are illuminated and efficacy examined. The methods can be helpful for strategic guidance where multiple states of nature are possible as a part of management strategy evaluation.

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient’s knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19–56 years) were enrolled. The average postoperative follow-up was 35.4 months (27–53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8–10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23–100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0–90°. The group’s mean flexion range of motion was 123 ± 16° (90–150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures.

Introduction: Hip fractures in the elderly are related to increased mortality. The identification of patients at risk is essential. Several nutritional and inflammatory parameters were investigated in an effort to find a prognostic indicator for mortality following fragility hip fractures (FHF) surgery. We aim to evaluate their utility and compare between the different factors. Methods: A retrospective cohort study of patients 65 years and older, who underwent surgery following fragility hip fractures between January 2012 and June 2020, was conducted. Patients who died within 90 days were matched at a 1:1 ratio with surviving controls, based on age, gender, fracture type, and comorbidities. Nutritional and inflammatory indices, including serum albumin, protein energy malnutrition (PEM), albumin-to-globulin ratio (AGR), prognostic nutritional index (PNI), the systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and the neutrophile-to-lymphocyte ratio (NLR), were compared between groups. Results: 304 patients were included, 152 in each group. Patients’ demographics were similar. Among all indices evaluated, only the PLR significantly differed between the study groups (236.9 ± 193.5 for the study group vs. 186.6 ± 119.3 for the control group (p = 0.007). In patients who survived the initial hospitalization, the PEM was also found to be correlated with 90 days mortality. Discussion: The PLR was found to be correlated with mortality risk following FHF surgery. As it can be easily calculated from accessible blood tests, we recommend its’ routine assessment as a screening tool for personalized management of patients at high risk for mortality.

This paper presents a gravity-based behavioral algorithm designed to simulate the dynamic decision-making processes of purse seine fishers in the Eastern Pacific Ocean. The algorithm captures the complex interplay between fishers’ actions, environmental conditions, and regulatory constraints. It comprises two core strategies: an action strategy and a destination strategy. The action strategy involves selecting the most favorable course of action based on estimated values and preferences, while the destination strategy uses gravity fields to determine attractive ocean cell locations. These fields are modulated by real-time circumstances, guiding fishers toward areas of high value. Calibration against real-world data from the Inter-American Tropical Tuna Commission (IATTC) observer database is ongoing, with a focus on achieving accurate representation of action frequencies and species-specific catch per action type. Initial calibration results highlight the need for further refinement. While still a work in progress, this algorithm provides a robust foundation for capturing the intricate dynamics of purse seine fishing, adapting to evolving conditions, and informing policy evaluations. Future enhancements include adaptive fishing strategies and incorporating fleet-level interactions for a more comprehensive understanding of fishing behaviors.

Introduction: Anticoagulation use in the elderly is common for patients undergoing femoral neck hip surgery. However, its use presents a challenge to balance it with associated comorbidities and benefits for the patients. As such, we attempted to compare the risk factors, perioperative outcomes, and postoperative outcomes of patients who used warfarin preoperatively and patients who used therapeutic enoxaparin. Methods: From 2003 through 2014, we queried our database to determine the cohorts of patients who used warfarin preoperatively and the patients who used therapeutic enoxaparin. Risk factors included age, gender, Body Mass Index (BMI) > 30, Atrial Fibrillation (AF), Chronic Heart Failure (CHF), and Chronic Renal Failure (CRF). Postoperative outcomes were also collected at each of the patients' follow-up visits, including number of hospitalization days, delays to theatre, and mortality rate. Results: The minimum follow-up was 24 months and the average follow-up was 39 months (range: 24-60 months). In the warfarin cohort, there were 140 patients and 2055 patients in the therapeutic enoxaparin cohort. Number of hospitalization days (8.7 vs. 9.8, p = 0.02), mortality rate (58.7% vs. 71.4%, p = 0.003), and delays to theatre (1.70 vs. 2.86, p < 0.0001) were significantly longer for the anticoagulant cohort than the therapeutic enoxaparin cohort. Warfarin use best predicted number of hospitalization days (p = 0.00) and delays to theatre (p = 0.01), while CHF was the best predictor of mortality rate (p = 0.00). Postoperative complications, such as Pulmonary Embolism (PE) (p = 0.90), Deep Vein Thrombosis (DVT) (p = 0.31), and Cerebrovascular Accidents (CVA) (p = 0.72), pain levels (p = 0.95), full weight-bearing status (p = 0.08), and rehabilitation use (p = 0.34) were similar between the cohorts. Conclusion: Warfarin use is associated with increased number of hospitalization days and delays to theatre, but does not affect the postoperative outcome, including DVT, CVA, and pain levels compared to therapeutic enoxaparin use. Warfarin use proved to be the best predictor of hospitalization days and delays to theatre while CHF predicted mortality rate.

Femoral neck shortening is a common phenomenon following osteosynthesis for femoral neck fractures, which was shown to have a negative effect on hip function. There is paucity of literature on the effect of shortening on the ipsilateral limb mechanical axis and knee coronal alignment. We hypothesized that postoperative femoral neck shortening can alter the limb’s mechanical axis into valgus. Of 583 patients screened, 13 patients with severe neck shortening (< 10 mm) following femoral neck fracture fixation, were found eligible and agreed to participate. A full-length lower limb radiographs were obtained and radiographic parameters (offset, neck-shaft angle, HKA, mLPFA, mDLFA, mMPTFA, MAD, MAD-r) as well as functional scores were obtained. Statistically significant differences in mechanical axis deviation ratio (MAD-r) were found between the ipsilateral and the contralateral extremities (0.41 ± 0.16 versus 0.55 ± 0.11, p = 0.03). A correlation between femoral neck length differences and MAD was not statistically significant although a tendency towards lateral deviation of the mechanical axis was noted (r = − 0.5, p = 0.077). A negative correlation was found between a greater difference in the femoral neck length and the SF12 score, both in the physical and the mental parts (r = − 0.69, p = 0.008; r = − 0.58, p = 0.035, respectively). We found a more lateralized mechanical axis in limbs that demonstrated post-operative ipsilateral femoral neck severe shortening. These findings may provide a possible explanation and rationale for knee pain and perhaps for the development of knee osteoarthritis as a sequalae of femoral neck shortening. Further investigation and larger cohort, long-term studies are needed to further explore this hypothesis.

Acute distal patella tendon avulsion from the tibial tubercle (TT) is a relatively rare injury that is usually described in the adolescents or elderly population in their 7th or 8th decades. Bifocal avulsion fractures of the patella tendon from the TT and the distal pole of the patella are exceptionally rare in adults. In this case report, we present a 52-year-old healthy old male who was treated for bifocal avulsion of the patellar tendon with open reduction and internal fixation augmented with two ULTRATAPE sutures. To our knowledge, this is the first case report to describe this injury in a healthy middle-aged patient.

It is important to incorporate fisher motivations and behavior into fisheries management models. Incorrect behavioral assumptions may yield ineffective incentives or interventions or even produce unintended consequences. To understand fisher behavior in a developing country, we surveyed 93 Indonesian snapper fishers. Results suggest they consider competing aspects such as income, personal reputation, and sociocultural norms when deciding where and what to fish; they update beliefs about location, bountifulness, and catchability of target fish stocks through direct observations, inferences over geographical similarities, and social interactions with other fishers, and they evaluate satisfaction economically as well as socially. Information sharing and social knowledge are likely port-specific, representing local sociocultural norms rather than being related to vessel size, target catch, or other demographics. The prevalence of information sharing and imitation patterns suggests that fisher decision-making in Indonesian snapper fisheries has a significant sociocultural component. We discuss implications for fisheries management models and for policy decisions.

Reverse oblique intertrochanteric fractures are classified by the AO/OTA as 31A3 and account for 2–23% of all trochanteric fractures. The Gamma 3-Proximal Femoral Nail (GPFN) and the Expendable Proximal Femoral Nail (EPFN) are among the various devises used to treat this fracture. The aim of this study was to compare outcomes and complication rates in patients with AO/OTA 31A1-3 fractures, treated by either a GPFN or an EPFN. A total of 67 patients (40 in the GPFN group and 27 in the EPFN group, average age 78.8 years) were treated in our institution between July 2008 and February 2016. Data on postoperative radiological variables, including peg location and tip–apex distance (TAD), as well as orthopedic complications, such as union rate, surgical wound infection and cut-outs rates were also recorded, along with the incidence of non-orthopedic complications and more surgical data. Functional results were evaluated and quantified using the Modified Harris Hip Score (MHHS) and by the Short Form 12 Mental Health Composite questionnaire (SF-12 MHC) in order to assess the quality of life. The total prevalence of postoperative orthopedic complications including postoperative infection showed a significant difference with a p-value of 0.016 in favor of the EPFN group. Nonetheless, the frequency of revision did not differ between the two groups, being 0.134. The main orthopedic complication in both groups was head cut-out of the GPFN lag screw and the EPFN expendable peg, which was 20% and 7.4%, respectively, and required a revision surgery using a long nail or total hip replacement (THR). However, the average TAD did not significantly differ between groups which might be due to a relatively low cohort to reach a significant difference. Nonunion rate of 5% occurred solely in the GPFN group, with similar results of intraoperative open reduction between both groups. The EPFN group achieved better scores in both questionnaires (p = 0.027 and p = 0.046, respectively). Both the MHHS and SF-12 MCS values significantly differed between groups, with the EPFN group achieving better scores than the GPFN group in both questionnaires (p = 0.027 and p < 0.05, respectively). According to this study, the EPFN yields better results in comparison with the GPFN, with relatively less complications rate, for the treatment of unstable reverse oblique pertrochanteric fracture. In light of this results, we conclude that the EPFN might be as good as GPFN for the treatment of reverse oblique intertrochanteric fractures. Level III retrospective study. The local institutional review board of the Tel Aviv Medical Center approved this study and all the surgeries were done exclusively in this institution.

Thumb Carpometacarpal (CMC) total joint arthroplasty is commonly performed with increasing numbers worldwide. We present a case of Prosthetic Joint Infection (PJI) leading to severe septic shock and disseminated septic emboli 8 months following uneventful thumb CMC arthroplasty. Such extensive and life-threatening infection following thumb CMC arthroplasty has not been reported. Level of Evidence: Level V (Therapeutic).

Platelet-Rich Plasma (PRP) injection has become a desirable alternative to Partial Plantar Fasciotomy (PPF) surgery and steroid injection for patients with chronic plantar fasciitis (CPF) due to its potential for shorter recovery times, reduced complications, and similar activity scores. As such, we compared PRP treatment to PPF surgery in patients with CPF. Between January 2015 and January 2017, patients were randomly divided into two groups, a PRP treatment group, and a PPF group. All procedures were performed by a single foot and ankle fellowship-trained specialist surgeon. Visual Analog Score (VAS) and Roles-Maudsley Scale (RM) were collected during the preoperative visit and 3, 6, and 12 months postoperatively. The patients were also closely followed by a physiotherapist. There were 16 patients in each group after four patients refused to participate. Patients in the PPF had low Roles-Maudsley Scale (RM) scores compared to the PRP group one-year after treatment (3.77 vs. 2.72, p < 0.0001). Both procedures showed a reduction in RM scores during the follow-up year (9 to 1.62 for PPF and 8.7 to 2.4 for PRP). There was no significant change in VAS pain between the two groups (p = 0.366). Patients treated with PRP injection reported a significant increase in their activity scores, shorter recovery time, and lower complication rates compared to PPF treatment. Moreover, with respect to existing literature, PRP may be as efficient as steroid injection with lower complication rates, including response to physical therapy. Therefore, PRP treatment may be a viable option before surgery as an earlier line treatment for CPF. Level of Clinical Evidence: II.

INTRODUCTION:Total joint arthroplasty (TJA) is amongst the most common elective orthopedic surgeries. Since their introduction in 1951 there have been changes not only in prosthesis design and surgical approaches, but also in patient management, anesthesia, drug regimen and robotic arm assistance. These changes led to advancement in patient safety and shorter hospitalization. Today TJA is accessible for a wider age and function range of patients, which has led to an exponential growth in the number of procedures conducted.

IntroductionWide resections of periacetabular tumors create a sizeable bony defect that inevitably results in severe loss of function. Reconstruction of such defects usually requires using large metal implants, a feature associated with considerable surgery extension and complications. The aim of this study is to report resection with no reconstruction of the bony defect. In this retrospective study, we reviewed a consecutive series of 16 patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bone defect.MethodsRecords were reviewed of 16 consecutive patients diagnosed with malignant periacetabular tumors and underwent en-bloc resection without reconstructing their remaining bony defect. Measurements included: the duration of surgery, blood loss, hemoglobin levels and the need for blood transfusions, data on other hospitalization characteristics, and intraoperative and postoperative complications.ResultsSixteen patients with malignant periacetabular bone tumors and extensive bone destruction underwent wide periacetabular tumor resection with a mean follow-up of 75 months and a mean age of 53 years. The average HOOS score was 46 (range: 20 to 76), and the mean MSTS score was 13% (range: 0 to 15). The mean operative time was 4.1 h, and the mean blood loss was 1200 ml. At their most recent follow-up, patients had a mean shortening of their operated extremity of 4.8 cm, and all could ambulate with assisting devices.ConclusionWide resection of periacetabular tumors without reconstruction provides acceptable levels of function and was associated with shorter surgical time, less blood loss and fewer postoperative complications compared to resection with reconstruction. Therefore, this approach may be considered a viable surgical option in patients with an extensive malignant periacetabular.Level IIIRetrospective study.

INTRODUCTION:Shoulder dislocation occurs when the head of the humerus disengages from the glenoid bone. About 95% of shoulder dislocations are traumatic, while the other 5% are not trauma-related in a patient with predisposing factors such as generalized ligamentous laxity. Ninety percent of shoulders dislocate anteriorly from direct force on the arm in the "ABER" position (Abduction- External Rotation). Usually, dislocations are accompanied by injuries to the shoulder that may lead to recurrent anterior shoulder instability and in the long-run, osteoarthritis of the shoulder joint. In the case of traumatic shoulder dislocation in the younger population or competitive sport players, accompanied with bone injury on X-ray's (Bony Bankart or Hill-Sachs), surgical treatment is recommended as soon as possible to avoid recurring dislocation and further joint damage. There are several options to treat recurrent shoulder instability, including soft tissue procedures, bone procedures, and a combination of these procedures. Surgery can be performed by an open or arthroscopic approach.