Sage Orthopaedics

Recurrent shoulder instability is a prevalent condition, with glenoid bone loss as a common cause. Arthroscopic repair using distal tibial allografts provides long-lasting treatment by restoring glenoid surface area and presumably avoids risks of sensitization against donor human leukocyte antigen (HLA). Two case studies have challenged this assumption, suggesting that small bone allografts are able to induce host adaptive immune responses to donor HLA. The incidence of small bone allograft HLA sensitization and its effects on resorption and patient outcomes are unclear. In conclusion, sensitization against donor HLA after small bone graft allografting was not previously considered but has been brought to light as a possibility. Aside from potential complications for future organ transplants, HLA sensitization does not introduce a risk for adverse outcomes or higher grades of resorption compared with nonsensitized patients after small bone allografting for shoulder instability.   Click here to read the articl

Five articles from the April 2021 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Arthroscopic Bankart Repair Versus Immobilization for First Episode of Anterior Shoulder Dislocation Before the Age of 25: A Randomized Controlled Trial", "Return-to-Play Outcomes in Professional Baseball Players After Nonoperative Treatment of Incomplete Medial Ulnar Collateral Ligament Injuries: A Long-Term Follow-up Study", "Concussion History and Balance Performance in Adolescent Rugby Union Players", "Risk of Conversion to Arthroplasty After Hip Arthroscopy: Validation of a Published Risk Score Using an Independent, Prospectively Collected Database", and "Effect of Early Residua

This special edition podcast highlights the top 10 articles of 2020  that caught the most public attention based on their Altmetric scores. 1. A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by Injury Prevention Programs: A Systematic Review of Randomized Controlled Trials and Cluster–Randomized Controlled Trials With Meta-analysis 2. The Use of Recombinant Human Growth Hormone to Protect Against Muscle Weakness in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pilot, Randomized Placebo-Controlled Trial 3. Foot Core Training to Prevent Running-Related Injuries: A Survival Analysis of a Single-Blind, Randomized Controlled Trial 4. Video Confirmation of Head Impact Sensor Data From High School Soccer Players 5. Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison of Nonoperative Management, Partial Meniscectomy, and Repair 6. Lower Limb Kinetic Asymmetries in Professional Soccer Players With and Without Anterior Cruciate Ligament Reconstruction: Nine Mo

Patellofemoral joint degeneration and dysfunction after anterior cruciate ligament reconstruction (ACLR) are increasingly recognized as contributors to poor clinical outcomes. In conclusion, patellofemoral deep cartilage matrix disruption, as assessed by MRI UTE-T2*, was associated with reduced sports and recreational function and with gait metrics reflective of altered patellofemoral loading. As such, the findings provide new mechanistic information important to improving clinical outcomes related to patellofemoral dysfunction after ACLR.   Click here to read the article.

Five articles from the March 2021 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Predicting Risk of Recurrent Patellofemoral Instability With Measurements of Extensor Mechanism Containment", "Structural Consequences of a Partial Anterior Cruciate Ligament Injury on Remaining Joint Integrity: Evidence for Ligament and Bone Changes Over Time in an Ovine Model", "The Lateral Femoral Notch Sign Is Correlated With Increased Rotatory Laxity After Anterior Cruciate Ligament Injury: Pivot Shift Quantification With A Surgical Navigation System", "Outcomes of Open and Endoscopic Repairs of Chronic Partial- and Full-Thickness Proximal Hamstring Tendon Tears: A Multicenter S

Correction of high posterior tibial slope is an important treatment option for revision of anterior cruciate ligament (ACL) failure as seen in clinical and biomechanical studies. In cases with moderate to severe medial compartment arthritis, an additional varus correction osteotomy may be added to improve alignment. In conclusion, combined varus and slope correction led to a relevant decrease of ATT in the ACL-deficient and ACL-reconstructed cadaveric knee. ACL graft forces were significantly decreased after combined varus and slope correction. Thus, our biomechanical findings support the treatment goal of a perpendicular-aligned tibial plateau for ACL insufficiencies, especially in cases of revision surgery.   Click here to read the article.

Five articles from the February 2021 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Characterization of the Proximal Long Head of Biceps Tendon Anatomy Using Magnetic Resonance Imaging: Implications for Biceps Tenodesis", "Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction", "Clinical Efficacy of Platelet-Rich Plasma Injection and Its Association with Growth Factors in the Treatment of Mild to Moderate Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Clinical Trial Compared with Hyaluronic Acid", "Development of a Predictive Algorithm for Symptomatic Hip Abductor Tears in Patient

Bone stress injuries (BSIs) occur in up to 20% of runners and military personnel. Typically, after a period of unloading and gradual return to weightbearing activities, athletes return to unrestricted sports participation or military duty approximately 4 to 14 weeks after a BSI diagnosis, depending on the injury location and severity. However, the time course of the recovery of the bone’s mechanical competence is not well-characterized, and reinjury rates are high. Bone density declined in both the injured and the uninjured legs and, on average, did not return to baseline for 3 to 6 months after a tibial BSI diagnosis. The observed time to the recovery of baseline vBMD, coupled with the high rate of recurrent BSIs, suggests that improved return-to-sports and military duty guidelines may be in order.   Click here to read the article.

Five articles from the January 2021 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Determining On-/Off-track Lesions in Glenohumeral Dislocation Using Multiplanar Reconstruction Computed Tomography Is Easier and More Reproducible Than Using 3-dimensional Computed Tomography", "Microstructural and Mechanical Properties of the Anterolateral Ligament of the Knee", "Changes in Matrix Components in the Developing Human Meniscus", "Prediction of Shoulder Pain in Youth Competitive Swimmers: The Development and Internal Validation of a Prognostic Prediction Model", and "Incidence of Femoroacetabular Impingement and Surgical Management Trends Over Time".   Click here to r

Adult medial patellofemoral ligament (MPFL) reconstruction techniques are not appropriate for the skeletally immature patient given the proximity of the distal femoral physis. Biomechanical consequences of reconstructions aimed at avoiding the physis have not been adequately studied. In conclusion, in this cadaveric simulation, the epiphyseal technique allowed for a more isometric ligament until midflexion, when the patella engaged within the trochlear groove. The adductor sling and adductor transfer grafts became tighter in flexion, resulting in potential loss of motion, pain, graft stretching, and failure. Marginal between-condition differences in patellofemoral contact mechanics and patellar kinematics were observed in late flexion.   Click here to read the article.

Five articles from the December 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Augmentation of Anatomic Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis Does Not Significantly Affect Rotatory Knee Laxity: A Time Zero, In Vivo Kinematic Analysis", "Functional Outcome of Sesamoid Excision in Athletes", "Time Required to Achieve Clinically Significant Outcomes After Arthroscopic Rotator Cuff Repair", "Differences in Clinical Presentations and Surgical Outcomes of Gluteus Medius Tears Between Men and Women", and "90-Day Complication Rate After the Latarjet Procedure in a High-Volume Center".   Click here to read the articles.

Blood flow restriction therapy (BFRT) has been increasingly applied to improve athletic performance and injury recovery. Validation of BFRT has lagged behind commercialization, and currently the mechanism by which this therapy acts is unknown. BFRT is one type of ischemic therapy, which involves exercising with blood flow restriction. Repetitive restriction of muscle blood flow (RRMBF) is another ischemic therapy type, which does not include exercise. In conclusion, ischemic therapy did not induce gains in muscle mass, contractility strength, fiber cross-sectional area, or satellite cell density locally or systemically in this model, although the RRMBF group did have elevated GH levels on ELISA.   Click here to read the article.

Five articles from the November 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "The Incidence of Kaplan Fiber Injury Associated With Acute Anterior Cruciate Ligament Tear Based on Magnetic Resonance Imaging", "Characteristics of Soccer Players Undergoing Primary Hip Arthroscopy for Femoroacetabular Impingement: A Sex- and Competitive Level–Specific Analysis", "Bone Marrow Stimulation in Arthroscopic Repair for Large to Massive Rotator Cuff Tears With Incomplete Footprint Coverage", "Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players", and "Rate of Force Development Remains Reduced in the Knee Flexors 3 to 9 Mo

Tibial spine fractures (TSFs) are relatively rare pediatric injuries. Postoperative arthrofibrosis remains the most common complication, with few studies having examined factors associated with its development. In conclusion, surgeons should be cognizant of arthrofibrosis risk in younger patients with concomitant ACL tears and traumatic injuries not resulting from athletics. Furthermore, postoperative immobilization in a cast should be avoided given the high risk of arthrofibrosis. Concomitant ACL injury is associated with a higher return to the operating room for MUA.   Click here to read the article.

Five articles from the October 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Steep Posterior Tibial Slope and Excessive Anterior Tibial Translation Are Predictive Risk Factors of Primary Anterior Cruciate Ligament Reconstruction Failure: A Case-Control Study With Prospectively Collected Data", "Optimal Treatment of Cam Morphology May Change the Natural History of Femoroacetabular Impingement", "Anchor-Based Femoral Fixation for Physeal-Sparing Medial Patellofemoral Ligament Reconstruction: A Time-Zero Biomechanical Comparison With Tenodesis Screw Fixation", "Arthroscopic Biceps Tenodesis Outcomes: A Comparison of Inlay and Onlay Techniques", and "Performanc

The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known. In conclusion, smaller height (

Five articles from the September 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Human Rotator Cuff Tears Have an Endogenous, Inducible Stem Cell Source Capable of Improving Muscle Quality and Function After Rotator Cuff Repair", "An Iliopsoas Impingement Lesion in the Absence of Painful Internal Snapping May Not Require Iliopsoas Fractional Lengthening", "Location of the Suture Anchor in Hill-Sachs Lesion Could Influence Glenohumeral Cartilage Quality and Limit Range of Motion After Arthroscopic Bankart Repair and Remplissage", "Epidemiology, Treatment, and Performance-Based Outcomes of Symptomatic Spondylolysis and Isthmic Spondylolisthesis in American Prof

The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. Expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, characterization of intraarticular inflammation away from cam deformity as well as the nature of the adjacent synovial tissue has also not been extensively characterized. In conclusion, hip cartilage exhibits an osteoarthritic phenotype in patients with early FAI similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident in late-stage disease.   Click here to read the article.

Five articles from the August 2020 issue summarized in five minutes, with the addition of a brief editorial commentary. The 5-in-5 feature is designed to give readers an overview of articles that may pique their interest and encourage more detailed reading. It may also be used by busy readers who would prefer a brief audio summary in order to select the articles they want to read in full. The featured articles for this month are, "Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer 24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery", "Posterior Rotational and Translational Stability in Acromioclavicular Ligament Complex (ACLC) Reconstruction: A Comparative Biomechanical Analysis in Cadaver Specimens", "An In-Depth Analysis of Graft Rupture and Contralateral ACL Rupture Rates After Pediatric ACL Reconstruction", "Concussion Symptom Cut-offs for Identification and Prognosis of Sports related Concussion: The Role of Time Since Injury", and "Long-term Outcomes and Survivor

Injuries to the hamstring complex most commonly involve the proximal musculotendinous junction of the long head of the biceps femoris (MTJ-BFlh). Nonoperative management of these injuries is associated with prolonged rehabilitation and high risk of recurrence. To our knowledge, the surgical management of acute MTJ-BFlh injuries has not been previously reported. In conclusion, surgical repair of acute MTJ-BFlh injuries enables return to preinjury level of sporting function with low risk of recurrence at short-term follow-up.   Click here to read the article.