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Table of Contents
doi : 10.1016/S0749-8063(21)00297-8
Volume 37, Issue 5, May 2021, Pages A9-A10, A12-A16
Articular Cartilage Restoration Requires Cells, Scaffolds, Growth Factors, and Mechanical Stimulation
Mark G.SiegelM.D.James H.LubowitzM.D.Jefferson C.BrandM.D.Michael J.RossiM.D., M.S.
doi : 10.1016/j.arthro.2021.03.014
Volume 37, Issue 5, May 2021, Pages 1359-1360
Tissue engineering requires cells, scaffolds, growth factors, and mechanical stimulation. In terms of cartilage restoration or repair, various innovative approaches are evolving, using host or allograft cells, biomimetic scaffolds, matrices, or membranes including hyaluronic acid, as well as diverse biological and growth factors. A current approach for the treatment of chondral or osteochondral defects enhances a microfracture procedure (introducing autologous, mesenchymal stem cells) with dehydrated micronized allograft extracellular matrix (scaffold), platelet-rich plasma (containing anabolic, anticatabolic, and anti-inflammatory growth factors), a fibrin glue sealant, and careful rehabilitation providing mechanical stimulation. Early results are encouraging; long-term outcomes including a larger number of study subjects remain to be reported.
Regarding “Intra-articular Mesenchymal Stromal Cell Injections Are No Different From Placebo in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials”
ChristopherCentenoM.D.RobertBurnhamM.D.PaulRowanM.D.AdrianLeM.D.GerardMalangaM.D.MichaelFreemanMed.Dr., Ph.D.
doi : 10.1016/j.arthro.2021.02.026
Volume 37, Issue 5, May 2021, Pages 1361-1362
Author Reply To “Regarding ‘Intra-articular Mesenchymal Stromal Cell Injections Are No Different From Placebo in the Treatment of Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials’”
WenliDaiM.D.XiLengM.D.JianWangM.D.ZhanjunShiM.D.JinChengM.D.XiaoqingHuM.D.YingfangAoM.D., Ph.D.
doi : 10.1016/j.arthro.2021.02.025
Volume 37, Issue 5, May 2021, Pages 1362-1364
Arthroscopy in Rheumatology
Robert W.IkeM.D.Kenneth C.KalunianM.D.
doi : 10.1016/j.arthro.2021.02.024
Volume 37, Issue 5, May 2021, Pages 1364-1365
Regarding “Editorial Commentary: Artificial Intelligence in Sports Medicine Diagnosis Needs to Improve”
Prem N.RamkumarM.D., M.B.A.Jaret M.KarnutaM.S.Benedict U.NwachukwuM.D., M.B.A.Riley J.WilliamsM.D.
doi : 10.1016/j.arthro.2021.03.011
Volume 37, Issue 5, May 2021, Pages 1365-1367
Response to “Regarding ‘Editorial Commentary: Artificial Intelligence in Sports Medicine Diagnosis Needs to Improve’”
Kyle N.KunzeM.D.Evan M.PolceB.S.JorgeChahlaM.D., Ph.D.
doi : 10.1016/j.arthro.2021.03.012
Volume 37, Issue 5, May 2021, Pages 1367-1368
Author Reply: Artificial Intelligence in Sports Medicine
Nikolaos K.PaschosM.D., Ph.D.
doi : 10.1016/j.arthro.2021.03.013
Volume 37, Issue 5, May 2021, Pages 1368-1369
Regarding “What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients”
LorenzoProiettiM.D.GianlucaCiolliM.D.KatiaCoronaSimoneCercielloM.D.
doi : 10.1016/j.arthro.2021.03.021
Volume 37, Issue 5, May 2021, Pages 1369-1371
Author Reply to “Regarding ‘What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients’”
Steven L.BokshanM.D.Brett D.OwensM.D.
doi : 10.1016/j.arthro.2021.03.019
Volume 37, Issue 5, May 2021, Pages 1371-1372
Regarding “Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study”
Patrick A.SmithM.D.Gregory S.DiFeliceM.D.Wiemi A.DouoguihM.D.BertrandSonnery-CottetM.D.J. LeePaceM.D.
doi : 10.1016/j.arthro.2021.03.018
Volume 37, Issue 5, May 2021, Pages 1372-1374
Author Reply to “Regarding ‘Suture Tape Augmentation Has No Effect on Anterior Tibial Translation, Gap Formation, or Load to Failure of Anterior Cruciate Ligament Repair: A Biomechanical Pilot Study’”
CharlesQinM.D.FaridAmirouchePh.D.Jason L.KohM.D.AravindAthivirahamM.D.
doi : 10.1016/j.arthro.2021.03.020
Volume 37, Issue 5, May 2021, Pages 1374-1375
Regarding “Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial”
Evan L.FlatowM.D.
doi : 10.1016/j.arthro.2021.03.023
Volume 37, Issue 5, May 2021, Pages 1375-1376
Commentary Author Reply to “Regarding ‘Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial’”
Andrew J.SheeanM.D.
doi : 10.1016/j.arthro.2021.03.022
Volume 37, Issue 5, May 2021, Page 1376
Author Reply to “Regarding ‘Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial’”
Cory A.KwongM.D., F.R.C.S.C.Jarret M.WoodmassM.D., F.R.C.S.C.Eva M.GusnowskiM.D., M.Sc.Aaron J.BoisM.D., M.Sc., F.R.C.S.C.JustinLeblancM.D., M.Sc., F.R.C.S.C.Kristie D.MoreM.Sc.Ian K.Y.LoM.D., F.R.C.S.C.
doi : 10.1016/j.arthro.2021.03.024
Volume 37, Issue 5, May 2021, Pages 1376-1377
Multiple Ligament Knee Reconstructions
Edward R.FloydM.S.abJill K.MonsonP.T.acRobert F.LaPradeM.D., Ph.D.a
doi : 10.1016/j.arthro.2021.03.033
Volume 37, Issue 5, May 2021, Pages 1378-1380
Patients with multiligament knee injuries require a thorough examination (Lachman, posterior-drawer, varus, valgus, and rotational testing). Diagnoses are confirmed with magnetic resonance imaging as well as stress radiographs (posterior, varus, and valgus) when indicated. Multiple systematic reviews have reported that early (<3 weeks after injury) single-stage surgery and early knee motion improves patient-reported outcomes. Anatomic-based reconstructions of the torn primary static stabilizers and repair of the capsular structures and any tendinous avulsions are performed in a single-stage. Open anteromedial or posterolateral incisions are preferentially performed first to identify the torn structures and to prepare the posterolateral corner (PLC) and medial knee reconstruction tunnels. Next, arthroscopy allows preparation of the anterior cruciate ligament (ACL) and double-bundle (DB) posterior cruciate ligament (PCL) tunnels. Careful attention to tunnel trajectory minimizes the risk for convergence. Meniscal tears are preferentially repaired (root and ramp tears are commonly seen in this patient group). Graft passage is performed after all tunnels are reamed. The graft tensioning and fixation sequence is as follows: anterolateral bundle of the PCL to restore the central pivot, posteromedial bundle of the PCL, ACL, PLC (including fibular [lateral] collateral ligament), and posteromedial corner (including medial collateral ligament). Graft integrity and full knee range of motion should be verified before closure. Physical therapy commences on postoperative day 1 with immediate knee motion (flexion from 0°-90°; prone for DB-PCL reconstruction) and quadriceps activation. Patients are nonweightbearing for 6 weeks. Patients with ACL-based reconstructions wear an immobilizer for 6 weeks then transition to a hinged ACL brace. Patients with PCL-based reconstructions transition into a dynamic PCL brace once swelling subsides and wear it routinely for 6 months. Functional testing and stress radiography are performed to validate return to sports.
Limited Predictive Value of the Instability Severity Index Score: Evaluation of 217 Consecutive Cases of Recurrent Anterior Shoulder Instability
Travis J.DekkerM.D.bLiam A.PeeblesB.A.aAndrew S.BernhardsonM.D.bPetarGolijaninB.S.cGiovanniDi GiacomoM.D.dThomas R.HackettM.D.abCAPTMatthew T.ProvencherM.D., MC, USNRab
doi : 10.1016/j.arthro.2020.12.185
Volume 37, Issue 5, May 2021, Pages 1381-1391
Editorial Commentary: Should We Condemn the Shoulder Instability Severity Index Scoring System? Not at All!... Can We Improve Its Radiographic Component? Yes, We Can!
PascalBoileauM.D., Ph.D.aFrédéricBalgM.D., F.R.C.S.C.bc
doi : 10.1016/j.arthro.2021.02.008
Volume 37, Issue 5, May 2021, Pages 1392-1396
Is patient selection necessary in shoulder instability surgery? Absolutely. The risk-benefit discussion that the surgeon must have with the patient before proposing an arthroscopic Bankart repair remains crucial to provide informed consent. The most important preoperative risk factors are incorporated in the instability severity index (ISI) score to assist surgeons in the decision-making process. This 10-point score is based on factors derived from a preoperative questionnaire, physical examination, and simple plain radiographs. Using this score at the first visit, the surgeon can explain to the patient and family why a Bankart repair may be contraindicated and why other surgical options may be more suitable. A recent study found that the ISI score has no limited predictive value when applied in a preselected population of military patients without severe bone loss or hyperlaxity. This is not surprising because the authors analyzed a preselected patient population with lower risk than the general population. The value of the ISI scoring system relies on the fact that this tool has been developed after evaluation of arthroscopic Bankart repair in an unselected patient population and that there is no need for sophisticated imaging studies to make the decision. This scoring system should not be condemned but complemented with preoperative advanced imaging studies (computed tomography [CT] scanning or magnetic resonance imaging) to assess the severity of the bone lesions more accurately. Today, the choice of the surgical procedure depends not only on the clinical risk factors included in the ISI score (age, type of sports, level of practice, hyperlaxity) but also on the presence, location and size of bony lesions, as identified and measured on advanced CT scanning images.
Editorial Commentary: Recurrence After Arthroscopic Bankart Repair: What the Instability Severity Index Score Will and Will Not Predict
MattiaLoppiniM.D., Ph.D.abMarioBorroniM.D.aGiacomoDelle RoseM.D.b
doi : 10.1016/j.arthro.2021.02.005
Volume 37, Issue 5, May 2021, Pages 1397-1399
The recurrence of shoulder instability is a challenging complication after anterior open or arthroscopic stabilization in patients with glenohumeral instability. Use of the arthroscopic Bankart procedure has increased over the last decade, because of its less invasiveness and low complication rates compared with the Latarjet procedure. However, arthroscopic repair has the possibility of a greater recurrent instability rate. The Instability Shoulder Index Score (ISIS) has been developed to predict the success of isolated arthroscopic Bankart repair for the management of recurrent anterior shoulder instability. The risk factors associated with the recurrence of instability are age, level and type of sports participation, shoulder hyperlaxity, and humeral and glenoid bony lesions. The ISIS is a validated tool to predict the recurrence of dislocation after arthroscopic surgery in patients with shoulder instability. The arthroscopic Bankart procedure can be performed in patients with ISIS ?3 with a low risk of recurrence of glenohumeral instability. The Latarjet procedure should be recommended in patients with ISIS >6. The management of patients with ISIS between 4 and 6 is still controversial and ranges from arthroscopic Bankart procedure with the addition of remplissage to the Latarjet procedure. Because advanced imaging techniques, such as computed tomography scans, allow us to assess appropriately the glenoid and humeral bone defect, their use is recommended in addition to ISIS.
Anterior Cable Reconstruction of the Superior Capsule Using Semitendinosus Allograft for Large Rotator Cuff Defects Limits Superior Migration and Subacromial Contact Without Inhibiting Range of Motion: A Biomechanical Analysis
Maxwell C.ParkM.D.aVictor T.HungB.S.bAnthony F.DeGiacomoM.D.aMichelle H.McGarryM.S.bGregory J.AdamsonM.D.bThay Q.LeePh.D.b
doi : 10.1016/j.arthro.2020.12.183
Volume 37, Issue 5, May 2021, Pages 1400-1410
Editorial Commentary: If the Massive Rotator Cuff Tear is Irreparable, Just Fix the Rotator Cable
ErikHohmannM.B.B.S., F.R.C.S., F.R.C.S. (Tr.&Orth.), Ph.D., M.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.01.016
Volume 37, Issue 5, May 2021, Pages 1411-1413
Large and massive rotator cuff tears are not always reparable and present a difficult clinical problem. If surgery is warranted surgical options range from arthroscopic debridement, partial repairs, degradable spacers, tendon transfers, and more superior capsular reconstruction. The rotator cable is formed by the deep layer of the coracohumeral ligament and the crescent structure running from the anterior insertion site of the supraspinatus to the inferior border of the infraspinatus. The role of the rotator cable is not clear but seems to play a role in reducing tendon stress and influence glenohumeral kinematics. In this laboratory-based cadaver study the anterior cable was reconstructed with semitendinosus allograft treating large “irreparable” rotator cuff defects. Reconstruction resulted in reduced superior migration and subacromial contact forces without inhibiting range of motion.
Comparison of Hook Plate Fixation Versus Arthroscopic Coracoclavicular Fixation Using Multiple Soft Anchor Knots for the Treatment of Acute High-Grade Acromioclavicular Joint Dislocations
Yon-SikYooM.D., Ph.D.bEun KyungKhilM.D.cWooyoungImM.D.aJeung YeolJeongM.D.a
doi : 10.1016/j.arthro.2020.12.189
Volume 37, Issue 5, May 2021, Pages 1414-1423
Editorial Commentary: Suture Button–Anchor Fixation Is Preferable to Hook Plate Fixation for Acute Acromioclavicular Joint Dislocations: Form and Function Need to Be United
Michael D.FeldmanM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.01.051
Volume 37, Issue 5, May 2021, Pages 1424-1426
Both hook plate fixation and suture button–anchor fixation have been reported to yield good results in the treatment of acute acromioclavicular joint reconstruction. In addition to a mandatory secondary procedure, hook plate fixation clearly has an increased prevalence of post-traumatic acromioclavicular arthritis in the short term that is likely to progress in the long term. Conversely, suture button–anchor fixation—a minimally invasive technique that creates less soft-tissue disruption, does not require hardware removal, and does not violate the acromioclavicular joint—is more likely to promote primary healing of the coracoclavicular ligaments, reduce the risk of late displacement, and minimize the development of post-traumatic acromioclavicular arthritis. As stated by the noted architect Frank Lloyd Wright, it is not only about form (i.e., alignment), it is about function as well.
Glenoid Pathology, Skeletal Immaturity, and Multiple Preoperative Instability Events Are Risk Factors for Recurrent Anterior Shoulder Instability After Arthroscopic Stabilization in Adolescent Athletes
Timothy T.ChengM.D.aEric W.EdmondsM.D.abTracey P.BastromM.A.bAndrew T.PennockM.D.ab
doi : 10.1016/j.arthro.2020.12.211
Volume 37, Issue 5, May 2021, Pages 1427-1433
Editorial Commentary: Anterior Shoulder Instability in Adolescent Athletes: "Slaying the Hydra" Is a Subtle Art
Anish G.R.PottyM.D.(Editorial Board)Hugo C.RodriguezM.B.S
doi : 10.1016/j.arthro.2021.02.014
Volume 37, Issue 5, May 2021, Pages 1434-1436
Anterior shoulder instability in adolescent athletes can be cumbersome to identify and treat. An algorithm is to divide the patients into primary and revision cases then to further subdivide patients who have glenoid bone loss <20% and/or an engaging or off-track Hill–Sachs lesion. A bipolar lesion with either of these conditions is an indication for a bone block open Laterjet procedure. In the revision setting, the threshold for Laterjet is lower. Soft-tissue lesions are indications for a Bankart or labral repair. With the proper attention given to concomitant labral, biceps, and rotator cuff pathology, Hill-Sachs lesions less than 1 cm are left alone. However, in situations where lesions are deeper than 1 cm, an arthroscopic remplissage is indicated. An optimal repair aims to create a labral bumper and a bony bed for the soft tissue to heal, whereas inferior quality of soft tissue indicates a segmental labral reconstruction. Reconstructing large capsular rents with torn ligaments with allograft anterior capsular repair is also needed for proper biomechanical restoration.
Career Longevity and Performance After Shoulder Instability in National Football League Athletes
Lafi S.KhalilM.D.aToufic R.JildehM.D.aMuhammad J.AbbasB.S.aMichael J.McIntoshB.S.cArbenSokoliB.S.dNicholas D.CominosB.S.eKelechi R.OkorohaM.D.b
doi : 10.1016/j.arthro.2020.12.225
Volume 37, Issue 5, May 2021, Pages 1437-1445
Editorial Commentary: Operative Versus Nonoperative Management of Shoulder Instability in the National Football League Athlete: Do What Needs to Be Done—Treatment Choice Does Not Affect Future Performance or Games Played
Timothy R.McAdamsM.D.
doi : 10.1016/j.arthro.2021.01.053
Volume 37, Issue 5, May 2021, Pages 1446-1448
Shoulder instability is common in the National Football League athlete. Nonoperative versus operative treatment of shoulder labrum injury without bone loss depends on many factors, including type and direction of instability, presence or absence of pain and recurrent instability that limits function, and player and season situational issues. Prophylactic surgical treatment in an effort to enhance future player performance and increase the number of future games played should be discouraged. Management of shoulder instability should be based on clinical indication and surgical stabilization should not be done prophylactically in the hope of increasing the number of future games played or enhancing performance.
No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series
XunqiCheowM.B.B.S., M.R.C.S.AndyYewPh.D.Benjamin Fu HongAngM.B.B.S., M.R.C.S., M.Med., F.R.C.S., F.A.M.S.Denny Tjiauw TjoenLieM.B.B.S., M.R.C.S., F.R.C.S., F.A.M.S.
doi : 10.1016/j.arthro.2020.12.226
Volume 37, Issue 5, May 2021, Pages 1449-1454
Editorial Commentary: Arthroscopic Repair of Partial Thickness Rotator Cuff Tears: What Do We Know So Far and Where Should We Put the Focus of Our Future Research?
Luciano A.RossiM.D., Ph.D.
doi : 10.1016/j.arthro.2021.01.015
Volume 37, Issue 5, May 2021, Pages 1455-1457
The available evidence shows that arthroscopic repair using either the transtendon in situ repair technique or the tear completion and subsequent repair technique are associated with favorable results in the short term. Likewise, the location of the lesions (articular or bursal) does not seem to significantly influence the clinical results, regardless of the technique used. Specifically with regard to the surgical technique of choice in the case of deciding to complete the tear and then repair it, it remains to be defined more clearly in future investigations whether it is better to repair with a single- or double-row technique, whether associated subacromial decompression has any advantage and what the results of this technique are in the subgroup of athletes, especially in competitive and overhead athletes in whom repair of rotator cuff tears has shown unfavorable outcomes mainly at the expense of a low return to the same level of sport.
Mid- and Long-Term Outcome After Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Refixation—Good to Excellent Results in Spite of Some Loss of Stability of the Distal Radioulnar Joint
GerhildThalhammerM.D.aThomasHaiderM.D., Ph.D.abMartinLaufferM.D.cHeinrich-GeertTünnerhoffM.D.c
doi : 10.1016/j.arthro.2021.01.056
Volume 37, Issue 5, May 2021, Pages 1458-1466
Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Provides Clinically Significant Outcome Benefit at Minimum 5-Year Follow-Up
Edward C.BeckM.D., M.P.H.aBenedict U.NwachuckwuM.D., M.B.A.bKyleenJanB.S.cShane J.NhoM.D., M.S.c
doi : 10.1016/j.arthro.2020.12.188
Volume 37, Issue 5, May 2021, Pages 1467-1473.e2
Editorial Commentary: Adolescent Patients Undergoing Hip Arthroscopy Require a Considerable Improvement in Postoperative Outcomes Scores to Achieve Substantial Clinical Benefit: The International Hip Outcome Tool-33 Seems Optimal for Measuring Substantial Clinical Benefit In Young, Active Patients
BrianCashM.D.AnilRanawatM.D.
doi : 10.1016/j.arthro.2021.01.032
Volume 37, Issue 5, May 2021, Pages 1474-1476
Arthroscopic treatment of femoroacetabular impingement syndrome in adolescents is increasing, with evidence supporting similarly improved outcomes as in adult populations. Adolescent patients present unique challenges compared with adult counterparts, often with greater demands on their hips and greater baseline functional statuses. Further, elective surgery in adolescents demands long-lasting outcomes for treatment success. There is increased effort in the orthopaedic literature to define improvements in outcomes that are significant to the patient, including minimal clinically important difference, substantial clinical benefit, and patient acceptable symptomatic state. Delineation of these benchmarks in the adolescent population is important for measuring the success of arthroscopic hip surgery as indications are refined. The international Hip Outcome Tool (iHOT)-33 seems optimal for measuring substantial clinical benefit in young, active patients. Finally, the iHOT-12 has been shown to lose little information compared with the iHOT-33 and it is less burdensome for patients.
Defining the Maximum Outcome Improvement of the Modified Harris Hip Score, the Nonarthritic Hip Score, the Visual Analog Scale For Pain, and the International Hip Outcome Tool-12 in the Arthroscopic Management for Femoroacetabular Impingement Syndrome and Labral Tear
David R.MaldonadoM.D.aCynthiaKyinB.A.bJacobShapiraM.D.bPhilip J.RosinskyM.D.bMitchell B.MeghparaM.D.bbHari K.AnkemM.D.bAjay C.LallM.D., M.S.bcdBenjamin G.DombM.D.bcd
doi : 10.1016/j.arthro.2021.01.002
Volume 37, Issue 5, May 2021, Pages 1477-1485
no abstract
Editorial Commentary: Maximal Outcome Improvement: Another Arrow in the Quiver
Benedict U.NwachukwuM.D., M.B.A.(Editorial Board)
doi : 10.1016/j.arthro.2021.03.001
Volume 37, Issue 5, May 2021, Pages 1486-1487
Clinically important outcome assessment has been a point of increasing emphasis in the orthopaedic literature. The minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit are the most reported in the hip preservation literature. Maximal outcome improvement (MOI) is now also being reported; however, its relation to patients undergoing hip preservation surgery is not well understood. The threshold values that represented satisfaction with surgery were 54.8%, 52.5%, 55.5%, and 55.8% of the MOI for the modified Harris Hip Score, Nonarthritic Hip Score, visual analog scale score for pain, and International Hip Outcome Tool-12 score, respectively. Although the MOI is helpful for characterizing outcome improvement, established measures such as substantial clinical benefit may be better used to grade outcomes in patients with high preoperative function.
Development and Internal Validation of Supervised Machine Learning Algorithms for Predicting Clinically Significant Functional Improvement in a Mixed Population of Primary Hip Arthroscopy
Kyle N.KunzeM.D.bEvan M.PolceB.S.aBenedict U.NwachukwuM.D., M.B.A.bJorgeChahlaM.D., Ph.D.aShane J.NhoM.D., M.S.a
doi : 10.1016/j.arthro.2021.01.005
Volume 37, Issue 5, May 2021, Pages 1488-1497
Editorial Commentary: Personalized Hip Arthroscopy Outcome Prediction Using Machine Learning—The Future Is Here
Joshua D.HarrisM.D.(Associate Editor)
doi : 10.1016/j.arthro.2021.02.032
Volume 37, Issue 5, May 2021, Pages 1498-1502
Machine learning and artificial intelligence are increasingly used in modern health care, including arthroscopic and related surgery. Multiple high-quality, Level I evidence, randomized, controlled investigations have recently shown the ability of hip arthroscopy to successfully treat femoroacetabular impingement syndrome and labral tears. Contemporary hip preservation practice strives to continually refine and improve the value of care provision. Multiple single-center and multicenter prospective registries continue to grow as part of both United States–based and international hip preservation–specific networks and collaborations. The ability to predict postoperative patient-reported outcomes preoperatively holds great promise with machine learning. Machine learning requires massive amounts of data, which can easily be generated from electronic medical records and both patient- and clinician-generated questionnaires. On top of text-based data, imaging (e.g., plain radiographs, computed tomography, and magnetic resonance imaging) can be rapidly interpreted and used in both clinical practice and research. Formidable computational power is also required, using different advanced statistical methods and algorithms to generate models with the ability to predict individual patient outcomes. Efficient integration of machine learning into hip arthroscopy practice can reduce physicians’ “busywork” of data collection and analysis. This can only improve the value of the patient experience, because surgeons have more time for shared decision making, with empathy, compassion, and humanity counterintuitively returning to medicine.
Low Back Pain Improves After Surgery for Lesser Trochanteric–Ischial Impingement
MunifHatemM.D., M.Sc.Hal DavidMartinD.O.
doi : 10.1016/j.arthro.2021.01.006
Volume 37, Issue 5, May 2021, Pages 1503-1509
Editorial Commentary: Hip–Spine Syndrome: When the Hip Does Not Move, the Spine Labors Double
JuanG?mez-HoyosM.D.
doi : 10.1016/j.arthro.2021.02.038
Volume 37, Issue 5, May 2021, Pages 1510-1511
When the hip does not move, the spine labors double. For example, limited hip extension results in lumbar spine hyperextension and an increase in spinal facet joint loading due to premature coupling. Patients who undergo hip surgery show significant improvement in concomitant lower back problems, and symptomatic low back pain resolves in approximately 80% of patients after total hip arthroplasty. When an impairment in hip range of motion (limitation or asymmetry) is identified, a logical relationship to lumbar pathology should be explored, and treatment options may include interventions that improve hip joint range of motion.
Clinically Significant Outcomes Following the Treatment of Focal Cartilage Defects of the Knee With Microfracture Augmentation Using Cartilage Allograft Extracellular Matrix: A Multicenter Prospective Study
Brian J.ColeM.D., M.B.A.aEric D.HaunschildB.S.aThomasCarterM.D.bJohnMeyerD.O.aLisa A.FortierPh.D.cRonGilatM.D.ad
doi : 10.1016/j.arthro.2021.01.043
Volume 37, Issue 5, May 2021, Pages 1512-1521
White Blood Cell Count Is the Most Reliable Test for the Diagnosis of Septic Arthritis After Anterior Cruciate Ligament Reconstruction: An Observational Study of 38 Patients
Giuseppe GianlucaCostaM.D.aAlbertoGrassiM.D.aMircoLo PrestiPh.D.aSergioCialdellaM.D.aEleonoraZampariniM.D.bPierluigiVialePh.D.bGiuseppeFilardoPh.D.cStefanoZaffagniniPh.D.a
doi : 10.1016/j.arthro.2020.11.047
Volume 37, Issue 5, May 2021, Pages 1522-1530.e2
Editorial Commentary: Synovial Fluid White Blood Cell Is the Gold Standard to Detect Infection After Anterior Cruciate Ligament Reconstruction: Don’t Hesitate to Aspirate
James MichaelPaciM.D.
doi : 10.1016/j.arthro.2020.12.221
Volume 37, Issue 5, May 2021, Pages 1531-1533
Notch Volume Measured on Magnetic Resonance Imaging Is Better Than 2-Dimensional Notch Parameters for Predicting Noncontact Anterior Cruciate Ligament Injury in Males
VivekJhaM.S.aAbhishekPanditM.S.b
doi : 10.1016/j.arthro.2020.11.050
Volume 37, Issue 5, May 2021, Pages 1534-1543.e1
To evaluate and compare intercondylar notch volume with other 2-dimensional notch parameters (measured on magnetic resonance imaging [MRI]) for prediction of noncontact anterior cruciate ligament (ACL) injury in males.
Editorial Commentary: Femoral Notch Volume: Too Much Information?
ScottTashmanPh.D.
doi : 10.1016/j.arthro.2021.01.028
Volume 37, Issue 5, May 2021, Pages 1544-1546
Femoral intercondylar notch size and volume are some of the many morphometric knee measures that have been associated with increased risk of anterior cruciate ligament (ACL) injury. The merits of relatively simple measures such as notch width versus more complex 3-dimensional notch volume have been debated, and there is some evidence suggesting that volumetric measures may have a stronger association with injury risk. The application for this information is, however, unclear. Notch volume appears to be just one of many nonmodifiable risk factors that contribute in a small way to the complex puzzle that is ACL injury risk. Although studying notch morphology may be an interesting academic exercise, it is difficult to see how notch measurements would be useful for injury prevention or to improve care after ACL injury.
Outcomes at 20 Years After Meniscectomy in Patients Aged 50 to 70 Years
AlessandroApratoM.D.aLuisangeloSordoM.D.bAngeloCostantinoM.D.aLuigiSabatiniM.D.aLucaBarberisM.D.aDiegoTestaM.D.bAlessandroMassèM.D., Prof.a
doi : 10.1016/j.arthro.2020.11.053
Volume 37, Issue 5, May 2021, Pages 1547-1553
Editorial Commentary: Surgical Management of Degenerative Meniscus Lesions Is a Second- But Not a First-Line Treatment
RomainSeilM.D., Ph.D.acdChristopheJacquetM.D.bPhilippeBeaufilsM.D, Ph.D.e
doi : 10.1016/j.arthro.2021.02.035
Volume 37, Issue 5, May 2021, Pages 1554-1556
The 20-year progression of osteoarthritis (OA) after arthroscopic partial meniscectomy (APM) in patients aged between 50 and 70 bears a long-term risk of conversion to total knee arthroplasty of 15.7%. Negative predictors at the time of surgery are the degree of knee OA, lateral meniscectomy, age at surgery, and malalignment. This confirms the evolution of the natural history of knee OA, but most importantly, it provides arguments to further restrain indications of APM in degenerative meniscus lesions (DMLs). An improved understanding of the consequences of APM for DMLs allows to increasingly limit the indications of this procedure, thus rendering it pertinent and efficient. Over the last years, the numbers of APM have been declining in several countries. This reduction required many surgeons to undergo a paradigm shift. This change cannot be induced by an anathema but by educational programs and guidelines based on broad consensus of the surgical communities, like the 2016 European Meniscus Consensus Project initiated by the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA). It provided a reference frame for the management of DMLs, based both on scientific literature and balanced expert opinion. The proposed decisional algorithm introduced APM not as a first- but as a second-line treatment of DMLs in symptomatic patients. A recent survey presented earlier this month at the international conference “The Meniscus” among ESSKA members showed that a majority of the 460 respondents were familiar with the ESSKA consensus and that 66% of them changed their practice following its publication. Paradigm changes take time. The history of meniscus repair showed that it takes many years to develop medical and surgical practice. And there is a good reason for this. Paradigms are not fashionable that come and go with the seasons. The medical and orthopaedic communities need to get them right by improving clinical science and balancing discussions.
Editorial Commentary: Arthroscopic Partial Meniscectomy Is Not a First-Line Treatment for Degenerative Meniscus Tear: To Meniscectomize or Not to Meniscectomize?
Joan C.MonllauM.D., Ph.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.01.034
Volume 37, Issue 5, May 2021, Pages 1557-1558
A painful knee with a degenerative meniscal tear is a quite common problem in the middle-aged patient. Arthroscopic partial meniscectomy is too often used to alleviate pain and seems to work in the short-term. However, arthroscopic partial meniscectomy does not guarantee success, particularly in the long run, particularly in patients with greater grades of osteoarthritis, patients who are older than 60 years, female patients, patients with malalignment, and patients having lateral meniscectomy. There is a need for better science to recommend arthroscopic meniscectomy in those cases.
Anterior Cruciate Ligament Reconstruction Graft Preference Most Dependent on Patient Age: A Survey of United States Surgeons
Eric N.BowmanM.D., M.P.H.aOrrLimpisvastiM.D.bBrian J.ColeM.D., M.B.A.cNeal S.ElAttracheM.D.b
doi : 10.1016/j.arthro.2021.01.042
Volume 37, Issue 5, May 2021, Pages 1559-1566
Preoperative Opioid Use Is Associated With Persistent Use, Readmission and Postoperative Complications After Arthroscopic Knee Surgery
RyanRidenourM.D.ChristopherKowalskiM.D.AdityaYadavalliM.D.DjibrilBaPh.D.GuodongLiuPh.D.DouglasLesliePh.D.JesseBibleM.D.MichaelAynardiM.D.MatthewGarnerM.D.AmanDhawanM.D.
doi : 10.1016/j.arthro.2020.12.187
Volume 37, Issue 5, May 2021, Pages 1567-1572
Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome
Michael J.RossiM.D., M.S.(Assistant Editor-in-Chief)
doi : 10.1016/j.arthro.2021.02.029
Volume 37, Issue 5, May 2021, Pages 1573-1576
Opioid research in sports medicine and arthroscopic surgery has exploded in the last few years. The literature definitively shows that preoperative opioid usage—in so-called opioid exposed, tolerant, and familiar patients—increases postoperative usage, readmission rates, and medical complications, yielding poorer outcome. Strategies to combat the deleterious effects of preoperative opioid use should be used to include ownership and acknowledgment of the problem, adherence to opioid prescribing protocols, and use of a multimodal anesthesia program that can mitigate the adverse effects by limiting abuse and preventing potential poor outcome. Adding patient education programs to change patient modifiable risk factors shows promise while simultaneously optimizing appropriate patient expectations that are linked to increased outcome. Thus, opioid mitigation, sparing, or altogether avoidance through improved education programs and opioid prescribing protocols will likely be the future of sports medicine and arthroscopic surgery to optimize patient outcome.
The Ideal Hinge Axis Position to Reduce Tibial Slope in Opening-Wedge High Tibial Osteotomy Includes Proximalization-Extension and Internal Rotation
Claire D.EliasbergM.D.aKyle J.HancockM.D.aEricaSwartwoutB.A.aHugoRobichaudP.Eng.bAnil S.RanawatM.D.a
doi : 10.1016/j.arthro.2020.12.203
Volume 37, Issue 5, May 2021, Pages 1577-1584
Editorial Commentary: Anterolateral Hinge Position Decreases the Slope in Opening-Wedge High Tibial Osteotomy: A Key Point in Treating an Anterior Cruciate Ligament–Deficient, Varus Knee
Juan PabloMartinez-CanoM.D., M.Sc.(Editorial Board)
doi : 10.1016/j.arthro.2021.01.050
Volume 37, Issue 5, May 2021, Pages 1585-1587
The orthopaedic surgeon who performs opening-wedge high tibial osteotomy (HTO) has to be aware of the behavior of the tibial slope depending on variations in the location of the hinge and in the inclination of the osteotomy. The most important point is that changing both the inclination and the rotation axis of the osteotomy cut affects the tibial slope. There is a natural trend to unintentionally increase the tibial slope when performing an opening-wedge HTO. However, an increased tibial slope has been established as a risk factor for both primary and recurrent anterior cruciate ligament (ACL) injuries, whereas slope-reducing osteotomies decrease anterior tibial translation and protect the ACL graft. To reduce tibial slope in opening-wedge HTO, it seems more practical to internally rotate the osteotomy, establishing an anterolateral hinge, than to change the inclination of the cut, given that it seems more predictable and technically easier to perform internal rotation during surgery. Trying to achieve both internal rotation and extension increases the complexity of the osteotomy. Not every osteotomy needs to have an anterolateral hinge; in fact, decreasing the tibial slope would be a disadvantage in the posterior cruciate ligament–deficient knee. However, for the ACL-deficient knee with varus malalignment, aiming to decrease the tibial slope using an anterolateral hinge could be considered during preoperative planning.
Osteochondral Allograft Transplantation of the Knee in Adolescent Patients and the Effect of Physeal Closure
RonGilatM.D.abEric D.HaunschildB.S.aHaileyHuddlestonB.S.aKevin C.ParvareshM.D.aJorgeChahlaM.D., Ph.D.aAdam B.YankeM.D., Ph.D.aBrian J.ColeM.D., M.B.A.a
doi : 10.1016/j.arthro.2020.12.204
Volume 37, Issue 5, May 2021, Pages 1588-1596
Editorial Commentary: Osteochondral Allografting Is a “Kid-Friendly” Cartilage Repair Procedure
WilliamBugbeeM.D.
doi : 10.1016/j.arthro.2021.02.027
Volume 37, Issue 5, May 2021, Pages 1597-1598
Fresh osteochondral allograft transplantation has been my preferred procedure for chondral and osteochondral lesions for many decades. This is particularly true for patients younger than 18 years of age, where diagnoses such as osteochondritis dissecans, osteochondral fractures, and osteonecrosis predominate, rendering the situation as much a “bone problem” as a “cartilage problem.” In the universe of cartilage-repair techniques, osteochondral allografts are particularly useful when bone defects must be managed. Furthermore, allografts have stood the test of time for safety, efficacy, and durability, even in a young, active population. For me, I don't think twice about using fresh allografts in young patients. I might even have to admit that an osteochondral allograft transplantation procedure for an osteochondritis dissecans lesion in a patient younger than 18 years old is my favorite surgery!
Predictors of Pediatric Anterior Cruciate Ligament Injury: The Influence of Steep Lateral Posterior Tibial Slope and Its Relationship to the Lateral Meniscus
Thomas C.EdwardsB.Sc (Hons), M.B.B.S., M.R.C.S.aAli Z.NaqviB.Sc(Hons), M.B.B.S., M.R.C.S.bNinaDela CruzM.D.bChinmay M.GuptePh.D., F.R.C.S (T&O), M.A (Oxon), B.M.B.Ch.a
doi : 10.1016/j.arthro.2020.12.235
Volume 37, Issue 5, May 2021, Pages 1599-1609
Editorial Commentary: The Ratio of Tibial Slope and Meniscal Bone Angle is a Strong Predictor for Anterior Cruciate Ligament Injury: A Steep Hill and a Shallow Speed Bump are a Hazardous Combination
SteffenSauerM.D.aMarkClatworthyF.R.A.C.S.b
doi : 10.1016/j.arthro.2021.02.006
Volume 37, Issue 5, May 2021, Pages 1610-1611
The lateral tibial posterior slope (LTPS) and the lateral meniscal bone angle (MBA) are important geometrical features of the knee joint and have therefore been of interest in the setting of anterior cruciate ligament injury (ACL) and ACL reconstruction. An emerging body of evidence suggests that LTPS is an independent risk factor for primary and recurrent ACL injury. Furthermore, biomechanical and clinical evidence is emphasizing the crucial contribution of the lateral meniscus to rotatory knee stability. Thus, not surprisingly, the MBA has also been shown to be an independent risk factor regarding ACL injury. The ratio of LTPS and MBA is a relatively new idea but has shown to be highly predictive for primary and recurrent ACL injury and may be used to identify patients at high risk of ACL reconstruction failure.
Lesion Size May Predict Return to Play in Young Elite Athletes Undergoing Microfracture for Osteochondral Lesions of the Talus
Kyung TaiLeeM.D., Ph.D.aSi YoungSongM.D.cJegalHyukM.D.bSung JaeKimM.D., Ph.D.c
doi : 10.1016/j.arthro.2020.12.206
Volume 37, Issue 5, May 2021, Pages 1612-1619
Time-Driven Activity-Based Costing Provides a Lower and More Accurate Assessment of Costs in the Field of Orthopaedic Surgery Compared With Traditional Accounting Methods
DylanKoolmeesB.S.aDavid N.BernsteinM.D., M.B.A.bEric C.MakhniM.D., M.B.A.a
doi : 10.1016/j.arthro.2020.11.028
Volume 37, Issue 5, May 2021, Pages 1620-1627
To analyze the implementation and benefits of time-driven activity-based costing (TDABC) in the field of orthopaedic surgery.
Editorial Commentary: The Value of Time-Driven, Activity-Based Costing in Health Care Delivery
PrakashJayakumarM.D., Ph.D.aBrianTrianaM.D., M.B.A.bKevin J.BozicM.D., M.B.A.a
doi : 10.1016/j.arthro.2020.12.239
Volume 37, Issue 5, May 2021, Pages 1628-1631
Time-driven activity-based costing (TDABC) provides a powerful approach to more targeted cost accounting based on resources actually used by patients during a cycle of care. Since its introduction in 2004 by Kaplan and Anderson, TDABC has gained increasing popularity in defining the actual costs of care for various orthopaedic processes and pathways. TDABC may demonstrate lower costs of care compared with traditional cost accounting methods, including ratio of costs to charges and relative value units. Weaknesses of traditional methods include approaching costs through the lens of charges, revenue, processes and procedures, adopting a “top-down” approach, and potentially overestimating costs. In contrast, TDABC builds costs from the individual level, taking a front-line, condition-focused, and patient-centered view. Existing organizational decision-making is oriented around revenue metrics (relative value units and ratio of costs to charges) rather than cost metrics, yet alternative payment models are shifting toward fixed revenues for certain conditions or procedures. The variability, including both financial upside and loss, will primarily be a function of the cost of care—a number that is profoundly opaque in most health care settings. We view TDABC as an approach that sheds light on variation, offers a more granular differentiation of costs compared with traditional approaches, mitigates risk, and sparks opportunities for increasing operational efficiency and waste reduction. The goal is to identify and provide the greatest-value orthopaedic care.
A Comprehensive Analysis of Medicare Reimbursement to Physicians for Common Arthroscopic Procedures: Adjusted Reimbursement Has Fallen Nearly 30% From 2000 to 2019
M. LaneMooreB.S.aJordan R.PollockB.S.aJack M.HaglinB.S.aMatthew P.LeBlancB.S.bJaymeson R.ArthurM.D.cDavid G.DeckeyM.D.cJoshua S.BinghamM.D.acAnikarChhabraM.D.ac
doi : 10.1016/j.arthro.2020.11.049
Volume 37, Issue 5, May 2021, Pages 1632-1638
Editorial Commentary: Medicare Cost-Containment Programs Reduce Reimbursement, Complicate Care, and Increase Administrative Costs: Alarm Bells Are Ringing and Physicians Must Get Involved
Andrew S.NeviaserM.D.
doi : 10.1016/j.arthro.2020.12.233
Volume 37, Issue 5, May 2021, Pages 1639-1640
Medicare cost-containment efforts have uniformly led to a reduction in physician reimbursement offset by increasing administrative burdens and costs and complicating delivery of care. Surgeons who face decreasing compensation for Medicare patients may be forced to limit the number of these patients for whom they care. Decreasing physician reimbursement from Medicare typically translates into a similar reduction by private payers. Administrators who come at a cost have yet to show proven value. All of this translates into limiting our ability to care for patients. We are facing a critical moment for potential change prompted by a global health crisis, a new administration, a new legislature, and an increased appreciation for health care delivery among the American public. As physicians, we need to be active participants in changing the system, placing a greater priority on delivering optimal care at optimal cost. We should use this moment when the American public is focused on the need for health care to reprioritize Medicare funding and physician reimbursement while urging reductions of government spending on bureaucracy. This requires actively lobbying lawmakers and speaking collectively.
Arthroscopic Transosseous Repair of Foveal Tears of the Triangular Fibrocartilage Complex: A Systematic Review of Clinical Outcomes
Hyoung-SeokJungM.D., Ph.D.aSeong HwanKimM.D., Ph.D.bChan WooJungM.D.aSung JongWooM.D.cJong PilKimM.D., Ph.D.dJae-SungLeeM.D., Ph.D.a
doi : 10.1016/j.arthro.2020.12.209
Volume 37, Issue 5, May 2021, Pages 1641-1650
Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage
YukioAbeM.D., Ph.D.
doi : 10.1016/j.arthro.2021.01.019
Volume 37, Issue 5, May 2021, Pages 1651-1653
The ulnar head attachment of triangular fibrocartilage complex is divided into 2 sections: the distal radioulnar ligament consists of superficial and deep bundles on both the palmar and dorsal sides, which attach at the fovea and the base of the ulnar styloid. A tear on the ulnar side of triangular fibrocartilage complex inevitably occurs at these attachments. Both magnetic resonance imaging and distal radioulnar joint (DRUJ) arthroscopy are crucial. DRUJ arthroscopy can clarify the tear location. An ulnar styloid tear can be treated by capsular repair. However, a foveal tear should be reattached to the fovea because this tear could cause gross DRUJ instability. There are several ways to reattach the bundles to the fovea, including single- or double-tunnel or bone anchors, and open versus arthroscopic.
The Anterolateral Ligament of the Knee: An Updated Systematic Review of Anatomy, Biomechanics, and Clinical Outcomes
Connor P.LittlefieldB.A.aJohn W.BelkB.A.aDarby A.HouckB.A.aMatthew J.KraeutlerM.D.bRobert F.LaPradeM.D., Ph.D.cJorgeChahlaM.D., Ph.D.dEric C.McCartyM.D.a
doi : 10.1016/j.arthro.2020.12.190
Volume 37, Issue 5, May 2021, Pages 1654-1666
Editorial Commentary: This Is the Way: Extra-Articular Augmentation Is an Essential Consideration in Contemporary Anterior Cruciate Ligament Surgery
Theodore B.ShybutM.D.(Editorial Board)
doi : 10.1016/j.arthro.2021.01.014
Volume 37, Issue 5, May 2021, Pages 1667-1669
Since the rediscovery of the anterolateral ligament, extra-articular augmentation (EA) has evolved from controversial to an essential consideration in contemporary anterior cruciate ligament reconstruction surgery. Anterolateral ligament (ALL) reconstruction and lateral extra-articular tenodesis are 2 common methods. Indications among early adopters pioneering anterolateral ligament reconstruction at anterior cruciate ligament surgery included revision anterior cruciate ligament (ACL) case, chronic ACL tear, high-grade pivot shift, and patients with hyperlax, hypermobile knees. Newer indications include young patient age, pivoting sport/high-demand/high-risk athlete, and concurrent medial meniscus repair. Questions remain regarding best practices as indications continue to evolve regarding technique, graft choice, angle/position of reconstruction fixation, and whether EA should be reconstructed routinely. This fast-moving surgical evolution serves as a reminder of 2 key concepts; first, that anterior cruciate ligament tears occur more fundamentally in the setting of anterolateral rotatory instability, in which concurrent soft tissue injuries are common, and, second, that even our best “anatomic” reconstructions do not fully recapitulate the native ACL, both of which give impetus to reconstructing the ALL.
Tibial Tubercle Osteotomy May Not Provide Additional Benefit in Treating Patellar Dislocation With Increased Tibial Tuberosity–Trochlear Groove Distance: A Systematic Review
Yi-FanSongM.M.Hai-JunWangM.D.XinYanM.M.Fu-zhenYuanM.D.Bing-BingXuM.D.You-RongChenM.D.JingYeM.M.Bao-ShiFanB.S.Jia-KuoYuM.D.
doi : 10.1016/j.arthro.2020.12.210
Volume 37, Issue 5, May 2021, Pages 1670-1679.e1
Editorial Commentary: Treating Patients With Recurrent Patellar Instability With an Individualized, Anatomic Approach Is Needed: Learn From the Anterior Cruciate Ligament
Jeremy M.BurnhamM.D.
doi : 10.1016/j.arthro.2021.01.018
Volume 37, Issue 5, May 2021, Pages 1680-1682
Treatment algorithms for recurrent patellofemoral instability have evolved over time. Early treatment techniques focusing specifically on pain have been replaced by evidence-based and anatomically appropriate procedures such as ligament reconstruction, osteotomies, and trochleoplasty. Bony and soft-tissue factors contribute to recurrent patellofemoral instability, but the exact indications for soft-tissue, bony, and combined procedures remain controversial. Personally, I am much more likely to combine tibial tubercle osteotomy with medial patellofemoral ligament reconstruction in a patient with trochlear dysplasia, patella alta, and a large J-sign (in addition to an elevated tibial tubercle to trochlear groove distance). As in cases of anterior cruciate ligament injury, in cases of patellofemoral instability we must consider bony morphologic features in addition to soft-tissue status.
Significantly Lower Infection Risk for Anterior Cruciate Ligament Grafts Presoaked in Vancomycin Compared With Unsoaked Grafts: A Systematic Review and Meta-analysis
MichelleXiaoB.S.Seth L.ShermanM.D.Marc R.SafranM.D.Geoffrey D.AbramsM.D.
doi : 10.1016/j.arthro.2020.12.212
Volume 37, Issue 5, May 2021, Pages 1683-1690
Editorial Commentary: Is It Time for the Vancomycin Wrap to Become a Universal Recommendation for the Prevention of Septic Arthritis Following Anterior Cruciate Ligament Reconstruction?
Christopher JohnVertulloM.B.B.S., Ph.D., F.R.A.C.S.(Orth.), F.A.Orth.A.
doi : 10.1016/j.arthro.2021.02.002
Volume 37, Issue 5, May 2021, Pages 1691-1693
Septic arthritis is a devastating complication of anterior cruciate ligament (ACL) reconstruction, which can still occur in approximately 1% of patients despite appropriate intravenous antibiotic prophylaxis and other recommended preventative measures being undertaken. The infection is most likely secondary to the autograft becoming contaminated during harvest and preparation, introducing bacteria into the joint on insertion. Presoaking ACL grafts in 5 mg/mL vancomycin is a novel method developed to eradicate this bacterial contamination and is supported by compelling Level III evidence from multiple observational trials showing a dramatic reduction in infection rates without any evidence of increased graft failure. As such, it is time for this technique to become a universal recommendation? That said, as observational studies using a historical cohort as a comparator are at risk of various biases, Level I evidence is ultimately required for infection prophylaxis methods to be recognized as a universal recommendation in infection control guidelines. Consequently, future research endeavors on the “vancomycin wrap” should focus on randomized controlled trials, possibly nested within ACL registries.
Clinical and Research Medical Applications of Artificial Intelligence
Prem N.RamkumarM.D., M.B.A.abKyle N.KunzeM.D.cHeather S.HaeberleM.D.acJaret M.KarnutaM.S.aBryan C.LuuB.S.adBenedict U.NwachukwuM.D., M.B.A.cRiley J.WilliamsM.D.c
doi : 10.1016/j.arthro.2020.08.009
Volume 37, Issue 5, May 2021, Pages 1694-1697
Artificial intelligence (AI), including machine learning (ML), has transformed numerous industries through newfound efficiencies and supportive decision-making. With the exponential growth of computing power and large datasets, AI has transitioned from theory to reality in teaching machines to automate tasks without human supervision. AI-based computational algorithms analyze “training sets” using pattern recognition and learning from inputted data to classify and predict outputs that otherwise could not be effectively analyzed with human processing or standard statistical methods. Though widespread understanding of the fundamental principles and adoption of applications have yet to be achieved, recent applications and research efforts implementing AI have demonstrated great promise in predicting future injury risk, interpreting advanced imaging, evaluating patient-reported outcomes, reporting value-based metrics, and augmenting telehealth. With appreciation, caution, and experience applying AI, the potential to automate tasks and improve data-driven insights may be realized to fundamentally improve patient care. The purpose of this review is to discuss the pearls, pitfalls, and applications associated with AI.
