Background: Focal chondral and osteochondral defects in the knee are often difficult to treat. One solution is the use of osteochondral allograft (OCA) transplantation. The literature deliberates lesions located in the medial femoral condyle (MFC), but little is discussed regarding the lateral femoral condyle (LFC). Purpose: To compare graft survivorship and patient-reported outcomes (PROs) among patients who underwent OCA transplantation of the LFC to the MFC. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 319 patients who underwent primary OCA transplantation of the LFC (n = 111) and MFC (n = 208) were identified. Reoperations were recorded, and OCA failure was defined as allograft removal. PROs included the Knee injury and Osteoarthritis Outcomes Score (KOOS), the International Knee Documentation Committee (IKDC) score, the modified Merle d’Aubigné-Postel score, and satisfaction. Results: Patients with MFC grafts were older than those with LFC grafts (33 and 26 years, respectively; P < .001) and had a slightly higher body mass index (25.6 and 24.4 kg/m 2 , respectively; P = .039). Diagnosis, sex, and allograft size did not differ between groups. Reoperations occurred in 27.9% of MFC grafts and 26.1% of LFC grafts ( P = .737). OCA failure occurred in 12% of MFC grafts and 9% of LFC grafts ( P = .413). The 10-year survivorship was 88% for MFC grafts and 92.9% for LFC grafts ( P = .543). Among in situ allografts, the mean follow-up duration was 9.4 years for MFC grafts and 8.6 years for LFC grafts ( P = .313). At the latest follow-up, the IKDC pain subscale and total scores were similar, but function subscale scores differed significantly between LFC (6.8 ± 2.4) and MFC (7.5 ± 2.1) patients ( P = .019). KOOS and Merle d’Aubigné-Postel scores were similar between patients with MFC and LFC grafts. Patients with MFC grafts reported higher satisfaction than those with LFC grafts (93.7% vs 86.3%, respectively; P = .041). Conclusion: OCA transplantation of the LFC demonstrates high graft survivorship and significant improvement in PROs at mid-term follow-up. Clinical outcomes, reoperation rates, and survivorship were comparable to OCA transplantation of the MFC. These findings suggest that OCA transplantation of the LFC represents a reliable treatment option in appropriately selected patients.

Background: Bone mineral density (BMD) plays a critical role in the success of total shoulder arthroplasty, as poor bone quality is associated with poor implant fixation, particularly in short stem and stemless designs that rely on metaphyseal fixation. However, dual-energy X-ray absorptiometry (DEXA) scans are not routinely obtained pre-operatively. Computed tomography-derived Hounsfield units (HUs) have emerged as a potential surrogate for BMD assessment, but HU values can have high variability, which limits accuracy. Phantom calibration may standardize HU values, but its benefit in the shoulder remains unclear. This study aimed to compare correlations of standard and phantom-calibrated (PC)-HU with DEXA-derived BMD, assess their diagnostic performance with receiver operating characteristic analysis, and identify HU thresholds for osteoporosis detection. Materials and methods: A retrospective analysis was performed on 84 shoulders from 76 patients, with some patients contributing bilateral shoulders. All patients underwent both shoulder computed tomography and DEXA within 1 year of total shoulder arthroplasty. Demographics, clinical information, and behavioral factors were collected. HU values were measured from the glenoid and proximal humerus and were calibrated to mg/cc using a phantom. Correlations between HU and DEXA T-scores in the femoral neck, total hip, and spine were evaluated using Spearman correlation. Receiver operating characteristic curve analysis was used to identify optimal HU thresholds for osteoporosis classification. Results: Both standard and PC HU (mg/cc) values of the glenoid and proximal humerus significantly correlated with DEXA T-scores (P < .001), though standard HU generally demonstrated stronger correlations. Optimal thresholds for identifying osteoporosis were 185.38 for the non-PC glenoid (sensitivity = 83.3%, specificity = 65.7%) and 30.90 for the proximal humerus (sensitivity = 78.6%, specificity = 75%). The PC glenoid threshold of 236.44 yielded slightly higher sensitivity (90.9%) but lower specificity (59.0%). PC proximal humerus HU did not demonstrate significant discriminatory power. Conclusion: The optimal thresholds for identifying osteoporosis were 185.38 HU for the non-PC glenoid, 30.90 HU for the non-PC proximal humerus, and 236.44 mg/cc for the PC glenoid. Both standard and PC HU values of the glenoid and proximal humerus significantly correlated with DEXA T-scores, although standard HU generally showed stronger correlations. These findings suggest that phantom-based calibration at these sites may offer no additional benefit in assessing systemic BMD.

Focal articular cartilage lesions of the knee present a significant clinical challenge, particularly in middle-aged patients who fall between the optimal candidacy of cartilage preservation and knee arthroplasty. Recent advancements in focal metallic resurfacing offer a promising joint-preserving alternative for this population. These implants are designed to treat well-defined, full-thickness chondral defects while maintaining native joint anatomy and delaying more invasive procedures. Careful patient selection, including lesion size, cartilage status, and mechanical alignment, is critical to success. Clinical studies have shown encouraging short- to mid-term outcomes, especially when comparing defect progression and revision rates to biologic treatment options. Despite mixed patient-reported outcomes and durability in certain implants, newer systems incorporating patient-specific designs and advanced materials may offer improved fixation and reduced opposing cartilage stress. A panel consensus supports their use in selected patients, though long-term data and high-level evidence remain limited. As technologies evolve, focal metallic resurfacing may increasingly serve as a viable intermediate option in knee preservation strategies, providing meaningful symptom relief and function restoration in appropriately selected patients.

Background: Osteochondral allograft (OCA) transplantation has demonstrated reliable long-term outcomes in treating chondral and osteochondral lesions of the knee. Although several pre- and intraoperative factors associated with graft failure have been identified, the temporal distribution of graft failures after OCA transplantation has not been described. Purpose: To evaluate the timing and rate of graft failure after knee OCA transplantation and to report conditional survivorship (CS) to inform postoperative patient counseling. Study Design: Case series; Level of evidence, 4. Methods: We identified 288 knees (267 patients) that underwent OCA transplantation by a single surgeon between 1997 and 2015, with a minimum follow-up of 10 years. Graft failure was defined as any reoperation requiring removal of the allograft. Nonfailure reoperation was defined as any surgical procedure on the affected knee that did not involve graft removal. Rates of graft failure and nonfailure reoperation were estimated using piecewise linear regression applied to inverse Kaplan-Meier curves. Kaplan-Meier analysis estimated overall and 10-year CS. Results: The median patient age was 33.1 years (range, 11-68 years), and 58% were male. Overall graft survivorship was 78% at 10 years. Graft failure occurred in 64 knees (22%) at a median of 2.7 years (range, 0.3-23.6) postoperatively. Annual failure rates were 4.9% in the first 3 years postoperatively and decreased to 1.5% from 3 to 10 years. Nonfailure reoperations occurred in 48 knees, with a median of 1.5 years postoperatively, and followed a similar temporal pattern, with most occurring in the early postoperative period. CS analysis demonstrated that grafts remaining in situ at 4 years postoperatively had a 90% probability of survival to 10 years. Conclusion: OCA transplantation of the knee demonstrated an overall 10-year graft survivorship of 78%. Graft failures were not uniformly distributed over time, with the highest failure rates occurring during the early postoperative period and substantially decreasing after 3 years postoperatively to a low steady-state of 1.5% annually. This temporal pattern was also noted with nonfailure reoperations, which occurred predominantly during the early postoperative period. CS analysis offers a patient-centered approach for interpreting these findings and may inform postoperative patient counseling.

BACKGROUND:There are few studies reporting the midterm outcomes of osteochondral allograft (OCA) transplantation for chondral lesions in the patellofemoral joint, particularly in patients who are not receiving a high rate of concomitant realignment procedures. PURPOSE:To report clinical outcomes among patients undergoing OCA transplantation of the patellofemoral joint, and compare differences between patellar, trochlear, and bipolar (patellar and trochlear) grafts. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:The authors identified 127 knees that underwent OCA transplantation in the patellofemoral compartment (51 patella, 47 trochlea, 29 bipolar patella and trochlea). A concomitant tibial tubercle osteotomy was performed in 5 knees (4%). Reoperations were documented, and OCA failure was defined as any reoperation that involved removal of the allograft. International Knee Documentation Committee (IKDC) subjective knee score, Knee injury and Osteoarthritis Outcome Score (KOOS), and satisfaction were assessed preoperatively and postoperatively with a minimum 2-year follow-up. RESULTS:Reoperations occurred in 49 knees (39%) at a median time to first reoperation of 1.9 years, and did not differ among patellar (47%), trochlear (30%), and bipolar (38%) grafts (P = .214). OCA failures occurred in 20 knees (16%) at a median of 4.4 years postoperatively. The failure rates for trochlear (9%), patellar (20%), and bipolar grafts (21%) did not differ (P = .227). Graft survivorship rates at 5 and 10 years were 91% and 82%, respectively (85% and 78% for patellar grafts, 100% and 93% for trochlear grafts, and 87% and 68% for bipolar grafts (P = .120). Among grafts in situ, the mean follow-up duration was 7.5 years (range, 2-19 years). Patients had significant improvements in IKDC and KOOS values at the latest follow-up (all P < .05), with no statistically significant differences among groups. Overall, 77% of cases reported being satisfied with the OCA transplantation (80% in the patellar group, 78% in the trochlear group, and 68% in the patellar and trochlear group; P = .555). CONCLUSION:Patients undergoing patellofemoral OCA transplantation exhibited high survival rates at 5 and 10 years, along with improved patient-reported outcomes when performed without concomitant tibial tubercle osteotomy. Trochlear grafts had greater survivorship than isolated patellar or bipolar grafts, and outcomes were comparable to those of OCA transplantation performed in the femoral condyles.

Pathologic extrusion of the meniscus, defined as displacement of more than 3 mm beyond the tibial plateau border, can disrupt tibiofemoral contact mechanics by reducing hoop strain resistance and increasing articular cartilage contact pressure. Meniscal extrusion following meniscal allograft transplantation is well documented, with studies reporting extrusion rates of over 40%. This Technical Note aims to describe the centralization of a meniscus allograft during transplantation.

Osteochondral allograft (OCA) transplantation is a successful treatment option for focal chondral and osteochondral lesions; however, outcomes vary by patient and intraoperative variables. Previous studies have compared outcomes of OCA transplantation using basic descriptive and surgical data; nonetheless, they do not account for possible confounding variables. The purpose of this study was to report overall survivorship of OCA transplantation using a large, long-term registry from a specialty cartilage practice and utilize a multivariable model to identify factors that best predict treatment failure. The use of a multivariable analysis allows for the simultaneous assessment of multiple risk factors while controlling for the influence of confounding factors. Case series; Level of evidence, 4. We identified 527 patients (560 knees) who underwent OCA transplantation between 1997 and 2021 for focal chondral lesions by a single surgeon and had a minimum follow-up of 2 years. Treatment failure was defined as any surgery involving the removal of the allograft or conversion to arthroplasty. Variables associated with treatment failure in univariate analyses were included in a multivariable logistic regression model to identify those with the greatest effect. The mean age of the participants was 32.6 years, the mean follow-up was 8.2 years, and 62% were men. Treatment failure occurred in 89 knees (15.9%) at a median of 3.9 years postoperatively. Graft survivorship was 89% at 5 years, 83% at 10 years, and 75% at 15 years. Univariate analysis identified patient age, body mass index (BMI), diagnosis type, anatomic location, number of grafts, total graft size, and number of previous surgeries to be associated with treatment failure. However, in the multivariate analysis, only patient age, BMI, diagnosis, and graft size independently predicted a higher risk of treatment failure after controlling for other variables. Specifically, patients who were aged ≥30 years were 2.13 times more likely than younger patients to experience a treatment failure. Patients with a BMI of ≥30 kg/m2 were 2.24 times more likely to experience treatment failure compared with patients with a BMI of <30 kg/m2. Patients with degenerative chondral lesions, avascular necrosis, or osteoarthritis were more likely to experience treatment failure compared with patients with osteochondritis dissecans. Grafts with a total surface area of >8 cm2 were 2.12 times more likely to fail than those ≤8 cm2. OCA transplantation performed in all settings yielded effective long-term results, with graft survivorship of 83% at 10 years postoperatively. Patient age ≥30 years, BMI of ≥30 kg/m2, diagnosis, and graft size >8 cm2 were independently associated with a higher risk of treatment failure when controlling for other variables. Understanding the effect of clinical variables in a multivariable model is useful for counseling patients on the odds of treatment failure.

BACKGROUND:Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients. PURPOSE:To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee. STUDY DESIGN:Case series; Level of evidence, 4. METHODS:Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d'Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft. RESULTS:There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm2. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d'Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively. CONCLUSION:OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.

Osteochondral allograft transplantation in the knee is an effective procedure to treat isolated and complex pathologies of articular cartilage. Osteochondral allograft transplantation has an overall high graft survivorship, ranging between 78% to 91% at 10 years. Patients report significant improvements in pain and function and high satisfaction.

Anterior cruciate ligament (ACL) injuries are common in the athletic population. ACL repair with bridge enhancement is an emerging technology with promising clinical outcomes in patients with a proximal to midsubstance ACL tears. Currently, there are a variety of fixation methods described for isolated ACL repair, including suspensory and anchor techniques. This technical note describes a bridge enhanced ACL restoration procedure technique, using suture anchors for the femoral fixation. Advantages of this technique include more rigid fixation and avoiding need for accessory over-the-top incision. Additionally, the surgical workflow is more similar to an ACL reconstruction with intra-articular screw fixation, which may be more readily adopted by some surgeons.

ObjectivesImage-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates, but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referral or equipment. An optimal technique would be safe, accurate, and have few barriers to implementation. The purpose of this study was to define the accuracy of glenohumeral needle placement via an anterior landmark-guided approach as assessed by direct arthroscopic visualization.MethodsA consecutive series of adult patients undergoing shoulder arthroscopy in the beach chair position were included in this study. Demographic and procedural data were collected. Time required to perform the injection, precise location of the needle-tip, and factors that affected accuracy of injection were also assessed.ResultsA standardized anterior landmark-guided glenohumeral joint injection was performed in the operating room prior to surgery and location of the needle tip was documented by arthroscopic visualization with a low complication profile and few barriers to implementation. A total of 81 patients were enrolled. Successful intra-articular glenohumeral needle placement by Sports Medicine and Shoulder/elbow fellowship trained orthopaedic surgeons was confirmed in 93.8% (76/81) of patients. Average time to complete the procedure was 24.8 seconds. There were no patient-related variables associated with non-intra-articular injection in the cohort.ConclusionsThis study demonstrated a technique of anterior landmark-guided glenohumeral injection has an accuracy of 93.8% and requires less than 30 seconds to perform. This method is safe, yields similar accuracy to image-guided procedures with improved cost-and time-efficiency, and less radiation exposure. No patient-related factors were associated with inaccurate needle placement. Anterior landmark-guided glenohumeral injections may be utilized with confidence by providers in the clinical setting.Level of EvidenceLevel 5.

Objectives: Focal chondral and osteochondral defects in the knee are problematic and are often difficult to treat. One solution is the use of osteochondral allograft (OCA) transplantation. A majority of the literature deliberates lesions located to the medial femoral condyle (MFC), but little is discussed regarding the lateral femoral condyle (LFC). Given the limited data, the purpose of this study was to compare graft survivorship and patient-reported outcomes (PROs) among patients who underwent OCA transplantation of the MFC or LFC. Methods: A total of 208 patients who underwent primary OCA transplantation of the MFC and 111 patients who underwent primary OCA transplantation of the LFC between 1997 and 2021 were identified from a prospectively collected single-surgeon cartilage registry. Overall, 66% were male and the mean age was 30.5 years. Most patients presented for OCA for osteochondritis dissecans (57%). Mean allograft size was 6.7 cm2. All patients had a minimum 2-year follow-up. Reoperations following the OCA transplantation were captured. Failure of the allograft was defined as removal of the graft (OCA revision or conversion to arthroplasty). PROs were measured both pre and postoperatively using the Knee Injury and Osteoarthritis Outcomes Scores (KOOS), International Knee Documentation Committee (IKDC), and Merle d’Aubigné-Postel scales. Patient satisfaction was also assessed. Results: Patients with MFC grafts were older than patients with LFC grafts (33 years and 26 years respectively; p<0.001) and had a slightly higher BMI (25.6 and 24.4 respectively; p=0.039). There were no differences between groups in regard to diagnosis, sex, number of allografts transplanted, or size of the allograft. Reoperations occurred in 27.9% of patients with MFC grafts and 26.1% of patients with LFC grafts (p=0.737). OCA failure occurred in 12% of MFC grafts and 9% of LFC grafts (p=0.413). The 10-year survivorship was 88% for MFC grafts and 92.9% for LFC grafts (p=0.543) (Figure 1). Among patients who had the allograft in situ at latest follow-up, the mean follow-up duration was 9.4 years for MFC grafts and 8.6 years for LFC grafts (p=0.313). At latest follow-up, KOOS, IKDC, and Merle d’Aubigné-Postel scores were similar between patients with MFC and LFC grafts. Patients with MFC grafts reported a slightly higher rate of satisfaction compared to patients with LFC grafts (93.7% and 86.3% respectively, p=0.041). Conclusions: Little data is available comparing treatment of medial and lateral femoral condyle lesions with osteochondral allografts. Clinical perception is that LFC lesions have inferior outcome to MFC lesions, but we did not find this to be true. We found little difference in reoperation rates and survivorship, as well as patient-reported clinical outcomes as measured on the KOOS, IKDC, and Merle d’Aubigné-Postel scales. There was a small difference in patient satisfaction. We conclude that there is similar outcome when using allografts for either medial or lateral femoral condyle lesions.

Background: Fresh osteochondral allograft (OCA) transplantation is an effective technique for the treatment of focal chondral and osteochondral defects in the knee. Coronal-plane malalignment leads to increased contact forces within a compartment and subsequently the cartilage repair site and may lead to higher failure rates. However, the magnitude of the effect of coronal-plane malalignment on graft survivorship and clinical outcomes has not been well characterized. Purpose: To evaluate how varus malalignment affects graft survival and patient-reported outcomes after isolated OCA transplantation of the medial femoral condyle (MFC). Study Design: Cohort study; Level of evidence, 3. Methods: A total of 70 patients (74 knees) who underwent primary OCA transplantation of the MFC between 2005 and 2019 were identified from a prospectively collected single-surgeon cartilage registry with a minimum 2-year follow-up. Coronal-plane alignment was evaluated utilizing standing hip-to-ankle radiographs. OCA failure, defined as removal of the graft or conversion to arthroplasty, and reoperations were recorded. Patient-reported outcomes were obtained preoperatively and postoperatively using the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, modified Merle d'Aubigne-Postel score, and overall patient satisfaction score. Results: The mean mechanical tibiofemoral angle for patients with varus alignment was 3.9 degrees of varus (range, 1.1 degrees to 8.9 degrees) and for patients with nonvarus alignment it was 0.02 degrees of valgus (range, 3.6 degrees varus to 4.6 degrees valgus). Graft survivorship was 95.3% in the varus group and 95.8% in the nonvarus group (P = .918) at 5 years postoperatively. Reoperations after OCA transplantation occurred in 14.0% of the varus group and 22.6% of the nonvarus group (P = .336). The mean International Knee Documentation Committee total score improved from 45.2 preoperatively to 74.8 at latest follow-up in the varus group and from 40.5 preoperatively to 72.3 at latest follow-up in the nonvarus group. Patient satisfaction was >85%. Conclusion: Patients undergoing isolated OCA transplantation of the MFC had high rates (>90%) of graft survivorship and significant improvements in pain and function. Patients with mild preexisting varus malalignment were found to have no difference in the failure rate or clinical outcomes compared with patients with nonvarus alignment.

Background:This article examines the wide range of surgical reconstruction options available for acromioclavicular (AC) joint injuries. However, the lack of consensus regarding the most suitable surgical techniques is attributed to the high and variable failure rates observed with current approaches. Methods:This article presents a comprehensive overview of the current surgical principles and techniques used by renowned experts in the field of AC shoulder injury management. Results:It emphasizes the significance of addressing horizontal and rotational instability in AC injuries and highlights the impact of impaired scapular biomechanics. Conclusion:By exploring these emerging concepts and strategies, the article aims to lay the foundation for future studies aimed at improving treatment outcomes and patient management.

Articular cartilage defects in the knee and ankle are frequently seen in football (soccer) players and are often a result of trauma, but occasionally are the consequence of occult underlying conditions such as osteochondritis dissecans. Symptoms such as pain, swelling, and inability to ramp up may limit an athlete's performance and ability to compete. Initial evaluation includes a careful history and physical exam, including assessment of overall limb and joint alignment, ligamentous stability, meniscal damage, as well as associated degenerative change. Though nonoperative management serves as the mainstay for treatment in high-level athletes, surgical options are indicated in situations where symptoms persist. Osteochondral allograft (OCA) transplantation, in particular, allows for restoration of hyaline cartilage with predictable healing and accelerated return to activity. With appropriate indications and surgical technique, graft survival following OCA transplantation can exceed 90% at 10 years postoperatively, allow for predictable (70%-80%) return to sport, and produce clinically meaningful improvements in patient-reported outcomes. Full return to sports is often possible between 4 and 10 months postoperatively. Careful attention to postoperative rehabilitation and strength progression prior to return to sport is imperative to prevent graft overload, joint inflammation, or secondary injury to other knee structures such as meniscus or ligamentous structures. This article reviews the overall indications, technique, and outcomes of OCA transplantation in the athletic population.

IntroductionThough musculoskeletal complaints account for roughly one-quarter of primary care and emergency department visits, only 2% of US medical school curriculum is devoted to musculoskeletal disease. Many graduating students demonstrate poor knowledge and report low confidence in treating musculoskeletal disorders. This study defines the current state of musculoskeletal curriculum of medical schools in detail to identify variations and potential shortcomings.MethodsAll eleven medical schools in California were invited to participate in an in-depth survey detailing the design and content of their musculoskeletal curriculum.ResultsA response rate of 100% was achieved. Overall, schools devoted an average of 58.7 h to musculoskeletal medicine, of which more than half was spent covering anatomy. The primary instructor for musculoskeletal medicine was a clinician in four schools (36.4%). Six schools offered a dedicated musculoskeletal physical exam course. No schools required students to complete a clinical rotation in musculoskeletal medicine. There was high variability among institutions when evaluating core subject coverage.DiscussionThere is large variation in the content and structure of musculoskeletal instruction among California medical schools. Increased curricular time, integration of preclinical and clinical experiences, greater specialist participation, and standardized objectives may provide more consistent and comprehensive musculoskeletal education.

The purpose of this study was to determine the (1) reoperation rate and (2) 30-day complication rate in a large insurance database. Methods: The Truven Database was queried for subjects that underwent meniscus allograft transplantation (Current Procedural Terminology code 29868) in the outpatient setting with minimal 2-year follow-up. Patients without confirmed laterality and patients that underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using International Classification of Diseases, 9th Revision, Clinical Modification codes. Results: A total of 284 patients (mean age of 26.2 +/- 10.4 years; 49.6% females) were included in this study with mean follow up of 43.2 +/- 19.2 months. One hundred and sixty-seven subjects (58.8%) undergoing meniscus allograft transplantation underwent reoperation at an average of 11.9 +/- 12.2 months postoperatively. There was a low number of subjects that required ipsilateral unicompartmental knee arthroplasty and total knee arthroplasty postoperatively (0.7% and 1.1%, respectively). The overall 30-day complication rate following meniscus allograft transplantation was 1.4%. Conclusions: Patients undergoing meniscus allograft transplantation have a 58.8% reoperation rate at final follow up with low (1.4%) 30-day complication rates in a large insurance database.

BACKGROUND:Fresh osteochondral allograft transplantation is an appealing option to address a failed cartilage repair surgical procedure, given the ability to treat large lesions and to address the subchondral osseous changes commonly seen in the revision setting. We hypothesized that osteochondral allograft transplantation after failed cartilage repair would result in low failure rates and improved function and that improved graft incorporation on postoperative magnetic resonance imaging (MRI) would correlate with a superior clinical outcome. METHODS:A retrospective review of prospectively collected data was used to identify 43 patients treated with fresh osteochondral allograft transplantation after a previous cartilage repair surgical procedure and having a minimum follow-up of 2 years. Clinical outcomes were evaluated using the Short Form-36 (SF-36) score, International Knee Documentation Committee (IKDC) Subjective Knee Score, Marx Activity Scale, Knee Outcome Survey-Activities of Daily Living (KOS-ADL) Questionnaire, Cincinnati Sports Activity Score, and Cincinnati Overall Symptom Assessment. Postoperative MRI scans were obtained at a mean time of 19.7 months and were independently reviewed by a musculoskeletal radiologist using the Osteochondral Allograft MRI Scoring System (OCAMRISS). RESULTS:At a mean 3.5-year follow-up after osteochondral allograft transplantation, significant improvements (p < 0.05) in SF-36 Physical Function, SF-36 Pain, KOS-ADL, IKDC Subjective Knee Score, and Cincinnati Overall Symptom Assessment were seen. Over 90% of grafts remained in situ at the time of the latest follow-up, although 17 knees (40%) underwent reoperation, the majority for arthroscopic debridement or manipulation for stiffness. Body mass index (BMI) of >30 kg/m was associated with worse clinical outcomes. The mean total OCAMRISS score demonstrated poorer allograft integration in patients with graft failure, but the total score did not meaningfully correlate with clinical outcome scores. However, better individual articular cartilage appearance and osseous integration subscores were associated with better clinical outcome scores. CONCLUSIONS:Significant improvements in pain and function were seen following fresh osteochondral allograft transplantation after failed cartilage repair, with an overall graft survival rate of >90%. Patients with greater bone and cartilage incorporation on MRI had superior clinical outcomes, although persistent osseous edema was frequently seen. We concluded that osteochondral allograft transplantation is an effective salvage treatment after failed cartilage repair and recommend further evaluation of techniques to optimize graft integration. LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.