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Background: The supraspinatus is most frequently involved in rotator cuff tears, a common orthopaedic condition. However, the architecture of this muscle has been described only for the superficial, anterior, and posterior regions., Purpose: To determine the muscle architecture of the deep supraspinatus., Study Design: Descriptive laboratory study., Methods: Muscle architecture measurements were collected from 25 cadaveric supraspinatus specimens (13 intact [without tendon tears], 3 with partial-thickness tears, 9 with full-thickness tears). The muscle was divided into deep, superficial anterior, and superficial posterior regions. Pennation angle, raw and normalized fiber length, and sarcomere length and number were compared using repeated-measures analyses of variance., Results: First, mean architecture measurements were compared between regions using only the intact specimens (n = 13). The deep region had a lower mean pennation angle (3.3° ± 1.0°) compared with the posterior region (11.0° ± 3.9°; P < .0001), which in turn had a significantly higher pennation angle compared with the anterior region (7.6 ± 2.6°; P = .0005). Normalized fiber lengths in the deep region were 21.1% ( P = .0052) and 34.5% ( P < .0001) shorter than the posterior and anterior normalized fiber lengths, respectively. Sarcomere lengths in the deep region were longer (3.4 ± 0.2 μm) compared with the posterior (3.1 ± 0.2 μm; P = .0012) and anterior (3.2 ± 0.2 μm; P = .0390) regions. Sarcomere numbers also decreased in the deep region by 21.2% ( P = .0056) and 34.2% ( P < .0001) compared with the posterior and anterior regions, respectively., Conclusion: The deep supraspinatus had significantly lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres in series compared with other subregions within the muscle. These structural differences suggest a functionally unique "submuscle" within the supraspinatus., Clinical Relevance: Understanding the architecture of the supraspinatus muscle can provide insight into muscle function in health and disease. Specifically, this deep submuscle may play a different role in rotator cuff function than the rest of the muscle., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Financial support was received from the Wu Tsai Human Performance Alliance and the Joe and Clara Tsai Foundation. J.G.L. has received education payments from ImpactOrtho and SportsTek Medical, consulting fees from Vericel, nonconsulting fees from Vericel, investment payments from Anika Therapeutics, honoraria from Vericel, and hospitality payments from Medtronic. A.S. has received education payments from Arthrex, ImpactOrtho, and SportsTek Medical; consulting fees from Arthrex; and nonconsulting fees from Arthrex and ImpactOrtho. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2024.)

Background: Diagnosis and treatment of posterior shoulder instability (PSI) has improved with advances in imaging and surgical technique. However, the relationship between PSI and osteoarthritis (OA) remains unclear., Purpose: To evaluate a population-based cohort to (1) determine the rate of symptomatic OA, (2) identify patient characteristic risk factors for OA, and (3) evaluate the effect of posterior capsulolabral repair on OA progression., Study Design: Case-control study; Level of evidence, 3., Methods: After review of 324 patient records, we included 115 patients (14 female, 101 male) diagnosed with PSI between January 1994 and July 2012 with an average follow-up of 12.5 years (range, 5-23 years). Medical records were reviewed for patient characteristics, injury characteristics, surgical details (if any), and radiographic progression of OA. Kaplan-Meier survival was used to estimate survival free of OA; characteristics associated with OA progression were determined via univariate Cox regression models, and associated 95% CIs and hazard ratios (HRs) are presented., Results: Overall, 14% (16/115) of patients had radiographic progression of symptomatic glenohumeral arthritis, with 5-year survival of 88.3% (95% CI, 79.7%-97.3%). Older age at the time of instability diagnosis was associated with arthritis progression (10-year unit HR, 1.95; 95% CI, 1.26-3.03). Patients who underwent surgery demonstrated increased radiographic progression of OA (HR, 4.03; 95% CI, 1.23-13.23). There was a trend of increased OA in patients treated with labral debridement compared with repair despite lower baseline levels of OA; however, this difference was not statistically significant ( P = .09)., Conclusion: Symptomatic glenohumeral arthritis is not seen routinely in patients with PSI. Although uncommon, an age of at least 30 years at the time of diagnosis and surgical intervention were identified as risk factors for developing symptomatic arthritis at long-term follow-up., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: The authors acknowledge support from the Foderaro-Quattrone Musculoskeletal-Orthopaedic Surgery Research Innovation Fund. This study was partially funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program (T32AR56950). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. J.L. has received support for education from Peerless Surgical and Sequoia Surgical; speaking fees from Arthrex; and hospitality payments from Biomet, Encore Medical, and Wright Medical. A.J.K. has received research support from Aesculap/B. Braun, Arthritis Foundation, Ceterix, Exactech, Gemini Medical, and Histogenics; consulting fees from Arthrex, DePuy, JRF Ortho, Musculoskeletal Transplant Foundation (MTF), and Vericel; and speaking fees from Arthrex and MTF and is a board or committee member for MTF. D.L.D. has received research support from Arthrex and hospitality payments from GE Healthcare and is a board or committee member for the NBA/GE Strategic Advisory Board. Her spouse receives royalties from and owns stock/stock options in Sonex Health and Tenex Health. C.L.C. has received education payments from Arthrex and hospitality payments from Arthrex and Zimmer Biomet. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Surgical reconstruction of the anterior cruciate ligament (ACL) is one of the most common orthopaedic procedures, with an estimated 100,000 to 175,000 procedures performed annually. Recently, the all-inside reconstruction technique has come into favor and is theorized to be superior to the complete tibial tunnel technique., Purpose: To compare clinical and patient-reported outcomes (PROs) for hamstring autograft ACL reconstruction (ACLR) performed with an all-inside versus a complete tibial tunnel technique., Study Design: Cohort study; Level of evidence, 3., Methods: Patients who underwent hamstring autograft ACLR via either an all-inside approach (femoral and tibial sockets) or a complete tibial tunnel approach (femoral socket and full-length, transtibial tunnel) at a single institution between July 2011 and July 2015 were reviewed. Demographic information, preoperative comorbidities, surgical details, physical examination findings, and follow-up outcomes were extracted from the medical record. Physical examination data included pivot-shift, Lachman, and range of motion examinations, whereas PROs included the Tegner activity scale, Lysholm score, and International Knee Documentation Committee (IKDC) score at a minimum of 2 years after surgery. Return to sport and risk factors for failure were analyzed., Results: A total of 82 patients (mean ± SD age, 25.8 ± 10.2 years) who underwent all-inside reconstruction (median PRO follow-up, 30.1 months; range, 24.7-72.9 months) and 54 patients (mean ± SD age, 21.1 ± 7.3 years) who underwent complete tibial tunnel reconstruction (median PRO follow-up, 25.8 months; range, 23.9-74.5 months) met the inclusion criteria. PRO scores at latest follow-up were comparable between the all-inside versus the complete tibial tunnel groups (Lysholm score, 93.8 vs 94.4, P = .621; IKDC score, 93.5 vs 93.3, P = .497; Tegner activity score, 6.4 vs 6.8, P = .048). Complications (including graft failure) were experienced by 20% of patients in the all-inside group compared with 24% in the complete tibial tunnel group ( P = .530). Graft failure before the final follow-up was experienced by 10% of patients in the all-inside group compared with 19% in the complete tibial tunnel group ( P = .200). Mean return to sport was 12.5 months in the all-inside group versus 9.9 months in the complete tibial tunnel group ( P = .028)., Conclusion: All-inside and complete tibial tunnel hamstring autograft ACLR resulted in excellent physical examination findings and PROs at minimum 2-year follow-up. Both techniques successfully restored knee stability and patient function., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: B.A.L. receives royalties from Arthrex; is a paid consultant for Arthrex and Smith & Nephew; and receives research support from Arthrex, Biomet, Smith & Nephew, and Stryker. D.L.D. receives research support from Arthrex and is a member of the NBA/GE Strategic Advisory Board, and her spouse has stock/stock options in and receives royalties from Tenex Health and Sonex Health. C.L.C. has received educational support from Arthrex and Zimmer Biomet and hospitality payments from Arthrex. A.J.K. receives research support from Aesculap/B. Braun and the Arthritis Foundation; receives royalties from Arthrex; and is a paid consultant for Arthrex, Vericel, DePuy Orthopaedics, and the Musculoskeletal Transplant Foundation. M.J.S. receives royalties from Arthrex, is a paid consultant for Arthrex, receives research support from Stryker, and has received hospitality payments from Gemini Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: The preoperative assessment of cartilage lesions is critical to surgical planning and decision making. The accurate radiographic determination of acetabular cartilage damage has remained elusive for modern imaging modalities, including magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA). While risk factors have been individually described, no multivariable system exists for predicting high-grade cartilage damage., Purpose: To determine the preoperative predictors of grade 3 to 4 acetabular labrum articular disruption (ALAD) lesions., Study Design: Case-control study; Level of evidence, 3. Cohort study (diagnosis); Level of evidence, 1., Methods: Retrievable radiographs were reviewed from primary hip arthroscopic procedures performed at 2 high-volume institutions between December 2007 and April 2017. The predictive value of demographic and radiographic factors for the intraoperative documentation of ALAD grade 3 to 4 damage was analyzed and entered into a multivariable model, and a statistically guided scoring system for the damage risk was created using the Akaike information criterion. The scoring system was then prospectively validated on 167 patients who underwent primary hip arthroscopy between April 2017 and February 2018., Results: A total of 652 primary hip arthroscopic procedures in 614 patients (390 female, 224 male; mean age, 33.2 ± 12.5 years; mean body mass index, 26.9 ± 5.5 kg/m 2 ) from 2007 to 2017 were analyzed. Male sex (odds ratio [OR], 3.11; P < .01), age ≥35 years (OR, 1.96; P < .01), cam morphology (alpha angle >55°) (OR, 2.96; P < .01), and Tönnis grade 1 to 2 (grade 1: OR, 4.14; P < .01, and grade 2: OR, 9.29; P < .01) were univariate risk factors for intraoperatively documented high-grade damage. A multivariable scoring system, the Rapidly Assessed Predictor of Intraoperative Damage (RAPID) score (0-5 points), was generated based on sex, Tönnis grade, and cam morphology. Patients with increasing RAPID scores had an increasing risk of damage, with a 10.5% risk for those with 0 points and an 88.0% risk for those with 5 points ( P < .01). The area under the curve was 0.75 for the study group and 0.76 for the validation group ( P = .94)., Conclusion: While preoperative MRI has diagnostic value for hip arthroscopic surgery, the RAPID score provides added benefit as a readily employable, in-clinic system for predicting high-grade cartilage damage. The discriminatory value of the RAPID score compares favorably with previous MRI and MRA studies. This information will help the clinician and patient plan for high-grade damage and identify potential targets for cartilage treatment., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: M.H. has received hospitality payments from DePuy. D.E.H. has received educational support from Arthrex and Smith & Nephew and hospitality payments from Desert Mountain Medical and Stryker. D.B.F.S. is a paid speaker/presenter for Smith & Nephew and is a paid consultant for Smith & Nephew, Genzyme, and TiGenix. B.A.L. receives royalties from Arthrex and VOT Systems, is a paid consultant for Arthrex, and is a paid speaker/presenter for the Canadian Orthopaedic Association and Smith & Nephew. A.J.K. receives research support from Aesculap/B. Braun, the Arthritis Foundation, Ceterix, and Histogenics; receives royalties from Arthrex; is a paid consultant for Arthrex, Vericel, and DePuy; and has received honoraria from Vericel and the Musculoskeletal Transplant Foundation. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Background: Lateral meniscus posterior root tears (LMPRTs), if left untreated, can cause devastating effects to the knee, with rapid articular cartilage degeneration and loss of the meniscus as a secondary stabilizer. Detection and surgical repair of these defects have been linked to favorable outcomes, but preoperative identification of LMPRTs continues to be challenging., Purpose: To determine the rate of LMPRTs diagnosed preoperatively on magnetic resonance imaging (MRI) in a consecutive series of arthroscopically confirmed LMPRTs., Study Design: Case series; Level of evidence, 4., Methods: A retrospective cohort of 45 consecutive patients with arthroscopically confirmed LMPRTs between 2010 and 2017 were included in this study. The preoperative MRI report for each patient was evaluated and compared with intraoperative findings. Each preoperative MRI study was then reviewed by 2 fellowship-trained musculoskeletal radiologists who worked in consensus., Results: A total of 45 patients (32 males, 13 females) with arthroscopically confirmed LMPRTs and a mean age of 27 years (range, 14-54 years) were included in the study. Only 15 of 45 LMPRTs (33%) were initially diagnosed on preoperative MRI. Past or concurrent anterior cruciate ligament (ACL) reconstruction was present in 37 of 45 cases (82%). Upon retrospective review, 15 of the 30 missed LMPRTs were "clearly evident," 12 "subtly evident," and 3 "occult" (unavoidably missed). There were no significant differences in the rate of LMPRT diagnosis based on history of prior knee surgery, meniscus extrusion, or tearing of the meniscofemoral ligament., Conclusion: Despite improved identification of other meniscus tear patterns on MRI, a high percentage of LMPRTs were still missed. In the setting of previous ACL reconstruction, if the root cannot be confidently identified, the MRI interpretation should indicate that "the root is poorly visualized" to alert the surgeon to thoroughly evaluate this structure. The surgeon should maintain a high index of suspicion and carefully probe the posterior root of the lateral meniscus at the time of arthroscopy, especially in cases of ACL injury., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.J.K. receives research support from Aesculap/B. Braun, the Arthritis Foundation, Ceterix, and Histogenics; is a paid consultant for Arthrex and Vericel; and is on the board of the Musculoskeletal Transplant Foundation. D.B.F.S. receives research support from Arthrex, Ivy Sports, and Smith & Nephew and is a paid consultant for Cartiheal, Smith & Nephew, and Vericel. B.A.L. receives royalties from Arthrex; is paid consultant for Arthrex and Smith & Nephew; and receives research support from Arthrex, Biomet, Smith & Nephew, and Stryker. M.J.S. is a paid consultant for Arthrex, receives royalties from Arthrex, and receives research support from Stryker.