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Proteins with expanded polyglutamine repeats cause Huntington's disease and other neurodegenerative diseases. Transcriptional dysregulation and loss of function of transcriptional co-activator proteins have been implicated in the pathogenesis of these diseases. Huntington's disease is caused by expansion of a repeated sequence of the amino acid glutamine in the abnormal protein huntingtin (Htt). Here we show that the polyglutamine-containing domain of Htt, Htt exon 1 protein (Httex1p), directly binds the acetyltransferase domains of two distinct proteins: CREB-binding protein (CBP) and p300/CBP-associated factor (P/CAF). In cell-free assays, Httex1p also inhibits the acetyltransferase activity of at least three enzymes: p300, P/CAF and CBP. Expression of Httex1p in cultured cells reduces the level of the acetylated histones H3 and H4, and this reduction can be reversed by administering inhibitors of histone deacetylase (HDAC). In vivo, HDAC inhibitors arrest ongoing progressive neuronal degeneration induced by polyglutamine repeat expansion, and they reduce lethality in two Drosophila models of polyglutamine disease. These findings raise the possibility that therapy with HDAC inhibitors may slow or prevent the progressive neurodegeneration seen in Huntington's disease and other polyglutamine-repeat diseases, even after the onset of symptoms.

The lepton pair production rate at finite temperature and at nextto-leading-order (NLO) is calculated for quark-gluon plasma at non-zero net baryon density. Yields are obtained using a (3+1)D multicomponent simulation capable of reproducing hadronic observables measured in the RHIC Beam Energy Scan (BES). Spectra of intermediate invariant mass dileptons are compared with measurements from the STAR collaboration. The result of a study where the temperature information obtained from the dilepton spectrum from heavyion collisions performed at different energies and centralities is presented.

Changes in the frequency content of sounds over time are arguably the most basic form of information about the behavior of sound-emitting objects. In perceptual studies, such changes have mostly been investigated separately, as aspects of either pitch or timbre. Here, we propose a unitary account of "up" and "down" subjective judgments of frequency change, based on a model combining auditory correlates of acoustic cues in a sound-specific and listener-specific manner. To do so, we introduce a generalized version of so-called Shepard tones, allowing symmetric manipulations of spectral information on a fine scale, usually associated to pitch (spectral fine structure, SFS), and on a coarse scale, usually associated timbre (spectral envelope, SE). In a series of behavioral experiments, listeners reported "up" or "down" shifts across pairs of generalized Shepard tones that differed in SFS, in SE, or in both. We observed the classic properties of Shepard tones for either SFS or SE shifts: subjective judgements followed the smallest log-frequency change direction, with cases of ambiguity and circularity. Interestingly, when both SFS and SE changes were applied concurrently (synergistically or antagonistically), we observed a trade-off between cues. Listeners were encouraged to report when they perceived "both" directions of change concurrently, but this rarely happened, suggesting a unitary percept. A computational model could accurately fit the behavioral data by combining different cues reflecting frequency changes after auditory filtering. The model revealed that cue weighting depended on the nature of the sound. When presented with harmonic sounds, listeners put more weight on SFS-related cues, whereas inharmonic sounds led to more weight on SE-related cues. Moreover, these stimulus-based factors were modulated by inter-individual differences, revealing variability across listeners in the detailed recipe for "up" and "down" judgments. We argue that frequency changes are tracked perceptually via the adaptive combination of a diverse set of cues, in a manner that is in fact similar to the derivation of other basic auditory dimensions such as spatial location.

Electromagnetic radiation from the quark-gluon plasma (QGP) is an important observable to be considered in heavy ion collision experiments. I will provide an update on recent advancements from perturbation theory and quenched lattice simulations. The resummed next-to-leading order (NLO) emission rate has recently been decomposed into transverse and longitudinal components, and extended to non-zero baryon chemical potential. The associated spectral function has also been tested against the Euclidean correlator, for continuum-extrapolated lattice data (at μB = 0).

Aim: Confining cAMP production to discrete subcellular locations makes it possible for this ubiquitous second messenger to elicit unique functional responses. Yet, factors that determine how and where the production of this diffusible signaling molecule occurs are incompletely understood. The fluid mosaic model originally proposed that signal transduction occurs through random interactions between proteins diffusing freely throughout the plasma membrane. However, it is now known that the movement of membrane proteins is restricted, suggesting that the plasma membrane is segregated into distinct microdomains where different signaling proteins can be concentrated. In this study, we examined what role lipid raft and non-raft membrane domains play in compartmentation of cAMP signaling in adult ventricular myocytes.Methods and Results: The freely diffusible fluorescence resonance energy transfer-based biosensor Epac2-camps was used to measure global cytosolic cAMP responses, while versions of the probe targeted to lipid raft (Epac2-MyrPalm) and non-raft (Epac2-CAAX) domains were used to monitor local cAMP production near the plasma membrane. We found that β-adrenergic receptors, which are expressed in lipid raft and non-raft domains, produce cAMP responses near the plasma membrane that are distinctly different from those produced by E-type prostaglandin receptors, which are expressed exclusively in non-raft domains. We also found that there are differences in basal cAMP levels associated with lipid raft and non-raft domains, and that this can be explained by differences in basal adenylyl cyclase activity associated with each of these membrane environments. In addition, we found evidence that phosphodiesterases 2, 3, and 4 work together in regulating cAMP activity associated with both lipid raft and non-raft domains, while phosphodiesterase 3 plays a more prominent role in the bulk cytoplasmic compartment.Conclusion: These results suggest that different membrane domains contribute to the formation of distinct pools of cAMP under basal conditions as well as following receptor stimulation in adult ventricular myocytes.

The rapid spread of quagga mussels (Dreissena rostriformis bugensis) has lead to their invasion of Lake Mead, Nevada, the largest reservoir in North America and partially responsible for providing water to millions of people in the southwest. Current strategies for mitigating the growth and spread of quagga mussels primarily include physical and chemical means of removing adults within water treatment, delivery, and hydropower facilities. In the present study, germicidal ultraviolet light (UV-C) was used to target the larval stage of wild-caught quagga mussel. The lethal effect of UV-C was evaluated at four different doses, 0.0, 13.1, 26.2, and 79.6 mJ/cm2. Tested doses were determined based on results from preliminary trials. The results demonstrate that germicidal UV-C is effective in controlling the free-swimming life history stages of larval quagga mussels.

Abstract Introduction Human tails and pseudotails are rare sacrococcygeal lesions that are associated with a wide variety of anomalies and syndromes. Anorectal malformations are also relatively uncommon congenital defects that often occur in conjunction with syndromes or other congenital abnormalities. The anomalies associated with both disorders determine the timing and approach to surgical correction. We present an unusual case of a patient with both imperforate anus and a pseudotail in the absence of a syndrome or other associated anomalies and we emphasize the necessity of a thorough preoperative evaluation. Case presentation A Caucasian girl was born at term after an uncomplicated pregnancy and was noted at birth to have a skin-covered posterior midline mass and imperforate anus with a fistula to the vaginal vestibule. Ultrasound and magnetic resonance imaging revealed a predominately fatty lesion without presacral extension and ruled out associated spinal and cord abnormalities. The patient underwent diversion with colostomy and a mucous fistula in the newborn period as a fistulogram demonstrated a long fistulous tract to normal rectum and it was anticipated that anoplasty and resection of the mass would require extensive posterior dissection. The sacrococcygeal mass was removed during posterior sagittal anorectoplasty at the age of six weeks which was determined to be a pseudotail because of the composition of brown fat and cartilage. The patient is now 14 months old with normal bowel function after a colostomy takedown. Conclusion A comprehensive preoperative assessment and thoughtful operative plan were necessary in this unusual case because of the extensive differential diagnosis for sacrococcygeal masses in the newborn and the frequency of anomalies and syndromes associated with tail variants and imperforate anus. The pediatricians and neonatologists who initially evaluate such patients and the surgeons who correct these disorders must be aware of the potential pitfalls in their management.

Abstract Background Congenital hemiplegia is the most common form of cerebral palsy (CP) accounting for 1 in 1300 live births. These children have limitations in capacity to use the impaired upper limb and bimanual coordination deficits which impact on daily activities and participation in home, school and community life. There are currently two diverse intensive therapy approaches. Traditional therapy has adopted a bimanual approach (BIM training) and recently, constraint induced movement therapy (CIMT) has emerged as a promising unimanual approach. Uncertainty remains about the efficacy of these interventions and characteristics of best responders. This study aims to compare the efficacy of CIMT to BIM training to improve outcomes across the ICF for school children with congenital hemiplegia. Methods/Design A matched pairs randomised comparison design will be used with children matched by age, gender, side of hemiplegia and level of upper limb function. Based on power calculations a sample size of 52 children (26 matched pairs) will be recruited. Children will be randomised within pairs to receive either CIMT or BIM training. Both interventions will use an intensive activity based day camp model, with groups receiving the same dosage of intervention delivered in the same environment (total 60 hours over 10 days). A novel circus theme will be used to enhance motivation. Groups will be compared at baseline, then at 3, 26 and 52 weeks following intervention. Severity of congenital hemiplegia will be classified according to brain structure (MRI and white matter fibre tracking), cortical excitability using Transcranial Magnetic Stimulation (TMS), functional use of the hand in everyday tasks (Manual Ability Classification System) and Gross Motor Function Classification System (GMFCS). Outcomes will address neurovascular changes (functional MRI, functional connectivity), and brain (re)organisation (TMS), body structure and function (range of motion, spasticity, strength and sensation), activity limitations (upper limb unimanual capacity and bimanual motor coordination), participation restrictions (in home, school and recreation), environmental (barriers and facilitators to participation) and quality of life. Discussion This paper outlines the theoretical basis, study hypotheses and outcome measures for a matched pairs randomised trial comparing CIMT and BIM training to improve outcomes across the ICF. Trial Registration ACTRN12609000912280

Amniotic-derived products have been used for decades in various medical subspecialties and have proven to be a safe method of allograft tissue transplantation. These products have shown promising preclinical and early clinical results in the treatment of tendon/ligament injuries, cartilage defects, and osteoarthritis. The therapeutic benefits of amniotic-derived products are likely due to intrinsic properties, such as their structure as an extracellular matrix and concentration of growth factors, as well as anti-inflammatory, antifibrotic, and antimicrobial molecules. We performed a narrative review, evaluating the pre-clinical and clinical use of amniotic-derived products in musculoskeletal injuries such as osteoarthritis, Achilles tendinopathy, plantar fasciitis, lateral epicondylitis, chronic stenosing tenosynovitis, and nerve, cartilage and tendon repair or reconstruction, along with fracture healing treatment. In vitro and pre-clinical studies using amniotic-derived products for orthopedic treatments have shown promising results and provide the foundation for further human trials to be conducted. With the rise of commercially available biologics, incorporating amniotic products into orthopedic practice is becoming more accessible, while further studies investigating long-term outcomes and potential adverse events are necessary., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: In comparison to primary reverse shoulder arthroplasty (RSA) procedures, revision arthroplasty can be a longer and more complex procedure leading to an increased risk of complications. The reported rates of infection in primary RSA range from 1% to 19% and the cost impact on patients and health care systems is significant, leading to multiple revision surgeries. The purpose of this study was to evaluate the postoperative outcomes, complications, and revision rates for revision reverse shoulder arthroplasty (rRSA) due to infection compared with rRSA for noninfectious causes., Methods: Patients who underwent rRSA between 2009 and 2020 by a single fellowship-trained orthopedic surgeon at a single institution were retrospectively identified through a prospectively collected database. Patients were separated into 2 cohorts based on revision diagnosis: (1) rRSA due to infection (rRSAi) and (2) rRSA due to noninfectious causes (rRSAn). Patient-reported outcome scores (PROs), including the Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, University of California-Los Angeles shoulder score, Shoulder Arthroplasty Smart score, and active range of motion (ROM) were collected preoperatively and at a minimum 1-year follow-up. Postoperative complications and revision rates were also collected., Results: A total of 93 patients (n = 19 rRSAi group, n = 74 rRSAn group) with a mean age of 68 years were included in this analysis. All baseline demographics were comparable between groups. No significant differences were found in preoperative or postoperative PROs and ROM between the 2 groups. Postoperative complication rates and revision rates were comparable between the groups., Conclusion: RSA due to infection results in similar patient-reported outcome scores, range of motion, and revision rates when compared to rRSA for noninfectious causes. Our results suggest that despite the unique challenges associated with rRSA for infection, patient outcomes do not differ from cases attributed to noninfectious causes. More efforts are warranted to further validate and contextualize these findings, considering the protentional influence of patient-specific and implant-specific factors., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate clinical and radiographic outcomes, return to sport, failure rate, operations and complications in patients undergoing microfracture of the knee, including the femoral condyle, tibial plateau, patella and trochlea, at a mean 10-year or greater follow-up., Methods: A literature search was performed by querying SCOPUS, PubMed, Medline and the Cochrane Central Register for Controlled Trials from database inception through May 2023 according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Inclusion criteria were level I-IV human studies reporting on outcomes, reoperations and complications following microfracture of the knee at a mean 10-year or greater follow-up. Biomechanical and epidemiological studies, including patients undergoing concomitant realignment procedures, and studies with patients under 18 years old were excluded. Data regarding failure, as defined by each study, as well as reoperations were gathered. Study quality was assessed via the Methodological Index for Nonrandomized Studies criteria., Results: Nine studies from 2003 to 2018, consisting of 727 patients (mean age 38.9 ± 8.1 years; range 25.8-47.6) undergoing microfracture for chondral defects in the knee were identified. Mean follow-up ranged from 10 to 17 years. Males composed 56.5% of patients, with a mean defect size ranging from 2.3 to 4.01 cm 2 . Based on radiographs at follow-up, osteoarthritis progression occurred in 40%-48% of patients. Magnetic Resonance Observation of Cartilage Repair Tissue scores were low. Patient-reported outcome measures showed significant improvement in postoperative scores at final follow-up. Return-to-sport rate ranged from 17.2% to 20%. Longitudinal analysis revealed declining clinical outcomes and return-to-sport rates from short- and mid- to long-term follow-up. There was high variability in failure definition and reoperations, with 2.9%-41% of patients requiring total knee arthroplasty., Conclusions: At a mean 10-year or greater follow-up, microfracture for chondral defects of the knee 2-4 cm 2 in size demonstrated a high rate of osteoarthritis progression with poor healing of the chondral defect and low overall return-to-sport rates. Failure and reoperation rates ranged from 2.9% to 41%, with declining outcomes from short- and mid- to long-term follow-up. The advantages of microfracture relating to availability, complexity, and cost should be weighed against concerns about long-term success, particularly with medium-size and larger lesions., Level of Evidence: Level IV systematic review., Competing Interests: J. C. has received consulting fees from Arthrex, CONMED Linvatec Corporation, Ossur, Smith & Nephew, Vericel, Stryker Corporation and DePuy Synthes Products; support for education from Arthrex, Medwest Associates and Smith & Nephew; speaking fees from Linvatec, Arthrex and Smith & Nephew; hospitality payments from Medical Device Business Services, Medwest Associates, Smith & Nephew, Linvatec and Stryker and a grant from Arthrex. M. V. S. has received speaking and faculty, education and hospitality payments from Arthrex and education and hospitality payments from Elite Orthopaedics. M. J. M. has received consulting, faculty & speaking and hospitality payments from Arthrex; education payments from Elite Orthopaedics; consulting and hospitality payments from Heron Therapeutics and consulting and hospitality payments from Pacira Pharmaceuticals. R. H. B. has received support for education from Elite Orthopaedics. D. M. K. has received support for education from Smith & Nephew, Elite Orthopaedics and Medwest Associates; hospitality payments from Arthrex, Encore Medical, Stryker and Smith & Nephew; honoraria from Encore Medical and a grant from Arthrex. The remaining authors declare no conflict of interest., (© 2024 The Author(s). Journal of Experimental Orthopaedicspublished by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

The Women's National Basketball Association (WNBA) has grown in popularity since its induction in 1996. Furthermore, it is well known that female athletes are at an increased risk of anterior cruciate ligament (ACL) tears compared with their male counterparts. The purpose was to examine the player positions and player movements during basketball games and practices that contribute to ACL tears in WNBA players. Player position and demographics from WNBA players who suffered an ACL tear from 1996 to 2021 were collected from publicly available sources. Entertainment and Sports Programming Network (ESPN) news reports and video analysis were reviewed to determine what movements each player was performing when the injury occurred. Injured players were matched with two noninjured players by age, position, height, and league experience. Performance statistics were collected one season prior to injury and compared with the matched controls. A total of 62 WNBA players with ACL injuries were identified with an average age of 26.7 (±3.9) years. More guards and forward were seen in the injured cohort and more players were injured while driving to the basket ( p  < 0.05). ACL injuries occurred more commonly during games than in practice ( p  < 0.05). Compared with controlled match cohort, the players who suffered ACL tears started more games ( p  = 0.007), had higher minutes played per game ( p  = 0.003), more field goals per game ( p  = 0.04), more field goal attempts per game ( p  = 0.03), more 3-point attempts per game ( p  = 0.04), more rebounds per game ( p  = 0.04), more steals per game ( p  = 0.02), and more points per game ( p  = 0.02). WNBA guards and forward were more likely to tear their ACL, especially while driving to the basket during real game play. Additionally, players with higher playing times, rebounds, and steals per game had higher rates of ACL tears. However, there was no impact on their performance on season statistics after returning to sport. LEVEL OF EVIDENCE:  III., Competing Interests: None declared., (Thieme. All rights reserved.)

Introduction: Numerous studies demonstrate that modifiable lifestyle risk factors can influence patient outcomes including survivability, quality of life, and postoperative complications following orthopaedic surgery. The purpose of this study was to determine the impact of modifiable lifestyle risk factors on postoperative medical and surgical complications following a total joint arthroplasty (TJA) in a large national healthcare system., Methods: A retrospective chart review of a large national health system database was performed to identify patients who underwent TJA between 2017 and 2021. TJA included total knee arthroplasty, total hip arthroplasty, and total shoulder arthroplasty. Modifiable lifestyle risk factors were defined as tobacco use, narcotic drug abuse, hypertension, and diabetes mellitus. Postoperative medical complications and postoperative surgical complications were collected. Logistic regression and odds ratio point estimate analysis were conducted to assess for associations between postoperative complications and modifiable lifestyle risk factors., Results: Of the 16,940 patients identified, the mean age was 71 years, mean BMI was 29.7 kg/m 2 , and 62% were women. We found that 3.5% had used narcotics, 8.7% were past or current smokers, 24% had diabetes, and 61% had hypertension; in addition, 5.4% experienced postoperative medical complications and 6.4% experienced postoperative surgical complications. Patients who used narcotics were 90% more likely to have postoperative complications (p < 0.0001) and 105% more likely to experience prosthetic complications (p < 0.0001). Similarly, patients with tobacco use were 65% more likely to have postoperative complications (p < 0.0001) and 27% more likely to experience prosthetic complications., Conclusions: Our results demonstrate critical rates of increased postoperative medical and surgical complications after TJA for patients with narcotic abuse, tobacco use, or diabetes mellitus. Furthermore, adopting preoperative interventions and optimization programs informed by our findings on specific modifiable risk factors could aid orthopaedic surgeons in optimizing patient health., Level of Evidence: III; Retrospective study., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: To systematically review the effectiveness and validity of orthopaedic surgery training using simulation technologies including augmented reality, virtual reality, and/or mixed reality within arthroscopic shoulder surgery., Methods: A literature search was conducted of the EMBASE and PubMed databases from inception to January 2024 per the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Included studies described arthroscopic shoulder surgery simulation training among orthopaedic surgery trainees. Exclusion criteria included studies assessing nonarthroscopic and nonshoulder simulations, non-English-language studies, case reports, animal studies, studies with overlapping cohorts, and review articles. Simulation characteristics, performance measurements, and validity assessed were extracted. The Cochrane risk-of-bias tool and Newcastle-Ottawa Scale assessed study quality. Simulation type, validation type, and simulation outcomes were assessed., Results: A total of 15 included articles, published from 2011 to 2021, evaluated 421 residents or fellows and 17 medical students. Virtual reality was used in 40% of studies and mixed reality in 60%. The most common outcomes assessed were time to completion (80%), visualizing and probing task performance (60%), and the Arthroscopic Surgery Skill Evaluation Tool (33.3%). Construct validity was assessed in 46.7% of studies, transfer validity in 26.7%, face validity in 20%, and content validity in 6.7%. Three studies demonstrated improved performance in those undergoing simulation training compared with nonsimulation groups. Two studies (13.3%) demonstrated improved time-to-task completion and decreased camera distance traveled when using simulation training. One study demonstrated that postgraduate year 1 and postgraduate year 5 residents derived the greatest benefit from simulation training., Conclusions: Arthroscopic shoulder simulation training may benefit the surgical skills of orthopaedic residents of all levels of experience as measured by time-to-completion, accuracy, and efficiency of surgical movements. Simulation training exhibits differences in operative time between more- and less-experienced orthopaedic surgeons and trainees. Virtual reality simulation training may result in more-efficient orthopaedic surgical techniques., Level of Evidence: Level III, systematic review of level I-III studies., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: In recent years, artificial intelligence (AI) has seen substantial progress in its utilization, with Chat Generated Pre-Trained Transformer (ChatGPT) is emerging as a popular language model. The purpose of this study was to test the accuracy and reliability of ChatGPT's responses to frequently asked questions (FAQ) pertaining to reverse shoulder arthroplasty (RSA)., Methods: The ten most common FAQs were queried from institution patient education websites. These ten questions were then input into the chatbot during a single session without additional contextual information. The responses were then critically analyzed by two orthopedic surgeons for clarity, accuracy, and the quality of evidence-based information using The Journal of the American Medical Association (JAMA) Benchmark criteria and the DISCERN score. The readability of the responses was analyzed using the Flesch-Kincaid Grade Level., Results: In response to the ten questions, the average DISCERN score was 44 (range 38-51). Seven responses were classified as fair and three were poor. The JAMA Benchmark criteria score was 0 for all responses. Furthermore, the average Flesch-Kincaid Grade Level was 14.35, which correlates to a college graduate reading level., Conclusion: Overall, ChatGPT was able to provide fair responses to common patient questions. However, the responses were all written at a college graduate reading level and lacked reliable citations. The readability greatly limits its utility. Thus, adequate patient education should be done by orthopedic surgeons. This study underscores the need for patient education resources that are reliable, accessible, and comprehensible., Level of Evidence: IV., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the patient-reported outcomes (PROs), knee stability, and complications in prospective comparative studies of patients undergoing augmented anterior cruciate ligament (ACL) repair compared with anterior cruciate ligament reconstruction (ACLR)., Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Human clinical studies of Level I-II evidence comparing PROs, knee stability, and complications after ACL repair and reconstruction were included, and a qualitative analysis was performed. Excluded studies included those lacking reporting outcomes, studies that performed open ACLR or repair, studies published before the year 2000, and studies with evidence Levels III-IV. Study quality was assessed using the Cochrane Collaboration's risk of bias tool., Results: Seven Level I-II studies were retained, comprising 190 ACLR and 221 repairs (75 bridge-enhanced ACL repair [BEAR], 49 suture augmentation [SA], and 97 dynamic intraligamentary stabilization [DIS]). At final follow-up, re-rupture rates varied between 0 and 14% (BEAR) versus 0 and 6% (ACLR) and mean side-to-side differences measured using KT-1000 testing ranged from 1.6 to 1.9 mm (BEAR) versus 1.7 to 3.14 mm (ACLR). For DIS versus ACLR, mean anterior tibial translation values at final follow-up were 1.7 mm (DIS) versus 1.4 mm (ACLR), and re-rupture rates ranged from 20.8% to 29% (DIS) versus 17% to 27.2% (ACLR). For SA versus ACLR, the mean side-to-side difference ranged from 0.2 to 0.39 mm (SA) versus 0.33 to 0.4 mm (ALCR), whereas the re-rupture rates were 10% (SA) versus 0% (ACLR). International Knee Documentation Committee, Tegner, Lysholm, and Knee Injury and Osteoarthritis Outcome scores across both cohorts exhibited statistically significant, and comparable improvement, from baseline to final follow-up ranging from 1 to 5 years., Conclusions: Augmented ACL repair results in similar patient-reported outcome measures in comparison with ACLR. However, augmented ACL repair may be associated with greater rates of failure, given re-rupture rates of up to 14%, 29%, and 10% for BEAR, DIS, and SA, respectively., Level of Evidence: Level II, systematic review of Level I-II studies., Competing Interests: Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: J.C. reports board membership for American Orthopaedic Society for Sports Medicine, with Arthroscopy Association of North America, and International Society of Arthroscopy Knee Surgery and Orthopaedic Sports Medicine; consulting or advisory for Arthrex, CONMED Corp, and Ossur Americas; and consulting or advisory and speaking and lecture fees form Smith & Nephew. B.J.C. reports funding grants from B Braun Medical, board membership for American Journal of Sports Medicine, Arthroscopy Association of North America, and Journal of American Academy of Orthopaedic Surgeons; consulting or advisory and funding grants from Arthrex; equity or stocks from Bandgrip and OSSIO; consulting or advisory with Elsevier and Operative Techniques in Sports Medicine; and funding grafts from JRF Ortho and National Institutes of Health. N.N.V. reports board membership with American Orthopaedic Society for Sports Medicine, American Shoulder and Elbow Surgeons, Arthroscopy Association of North America, Slack Incorporated; funding grants from Arthrex, Breg, and Ossur Americas; and consulting or advisory and funding grants from Stryker; and IP royalties and funding grants from Smith & Nephew. All other authors (R.S.B., J.B.V-E., L.P., E.C., J.S., A.M., G.J., J.R.G., S.A.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare patient-reported outcomes, failure rates, risk factors for failure, and complications in patients with bucket-handle meniscus tears (BHMTs) undergoing repair with inside-out (IO) versus all-inside (AI) techniques., Methods: A literature search was performed using the PubMed, Embase, and Scopus databases from database inception to August 2023 according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria consisted of Level I to IV clinical studies published in the past 10 years with greater than 2 years of follow-up that evaluated patient-reported outcome scores and/or the incidence of failure after IO or AI repairs for BHMTs. Clinical studies not reporting outcomes or failure rates, older studies using outdated implants, animal studies, reviews, letters to the editor, case reports, cadaveric studies, and articles not written in the English language or with English-language translation were excluded. Study quality was assessed using the Methodological Index for Non-randomized Studies (MINORS) criteria. Outcomes were reported as ranges and qualitatively compared., Results: A total of 16 studies published from 2013 to 2023, consisting of 1,062 patients with BHMTs, were identified. Thirteen studies (14 cohorts, 649 patients) reported on AI repair (mean age range, 23.7-32 years) and 7 studies (7 cohorts, 413 patients) reported on IO repair (mean age range, 16.7-34.6 years). Both groups had improved postoperative Lysholm and Tegner scores. Decreased range of motion was the most commonly reported complication in the AI group (range, 2.6%-4%), whereas adhesions for arthrofibrosis were the most commonly reported complication in the IO group (n = 12; range, 6%-7.9%). The overall reported failure rate ranged from 6.9% to 20.5% within the AI group and from 0% to 20% within the IO group., Conclusions: AI and IO repair techniques for BHMTs both result in improved Lysholm and Tegner scores. However, broad ranges of failure are reported in the literature, with overall failure rates ranging from 6.9% to 20.5% after AI repair and from 0% to 20% after IO repair. Younger age and isolated medial BHMT repair are the most frequently reported risk factors for the AI technique, whereas postoperative stiffness is the most frequently reported complication after both repair techniques., Level of Evidence: Level IV, systematic review of Level I to IV studies., Competing Interests: Disclosures The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

While infrequently reported, isolated injuries to the proximal tibiofibular (TF) joint primarily occur in young, athletic patients participating in sporting activities requiring explosive, high-impact movements, increasing the risk for potential twisting injuries, especially across a hyperflexed knee. The proximal TF joint is stabilized by bony, muscular and ligamentous structures, including both the anterior and posterior proximal TF complexes, with the anterior complex providing more robust stability. Proximal TF injuries frequently involve anterior and lateral displacement of the proximal fibula relative to its native articulation with the tibia. Proper diagnosis is dependent on careful and meticulous history and physical examination, as missed injuries are common, leading to the potential for continued pain, weakness and disability, especially in athletic patients. While spontaneous joint reduction has been reported, injuries may require formal closed reduction, with irreducible and chronic injuries requiring open reduction and stabilization, with recent investigations reporting satisfactory outcomes following anatomic reconstruction of the proximal TF ligament., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Social media plays an important role in healthcare and physician selection by facilitating direct communication with patients and impacting physician ratings. A concern however is the increased online scrutiny and negative impact on patient satisfaction with these connections. This study aimed to investigate whether social media activity by fellowship-trained shoulder and elbow surgeons impacts patient's perceptions and ratings on physician review websites (PRWs)., Methods: The American Shoulder and Elbow Surgeons physician directory was used to identify currently practicing shoulder and elbow surgeons in the United States. Physician ratings were collected from Healthgrades, Google reviews, and Vitals. The surgeons were divided into two groups: social media users (SMU) and non- SMU (NSMU). The association of social media use with online physician ratings was evaluated using simple and multilinear regressions., Results: A total of 385 American Shoulder and Elbow Surgeons surgeons were included and 21.3% were SMU. SMU were younger (mean age, 48 years) compared to NSMU (mean age, 51 years) (P = .01), all other demographics were comparable including sex (P = .797), medical degree (P = .114), and geographic location within the United States (P = .49). SMU had significantly higher ratings on Healthgrades (P < .001) and Vitals (P < .001). However, social media use did not impact the total number of ratings on PRWs. Additionally, surgeons who utilized Facebook had higher physician ratings and number of website reviews on Healthgrades (P = .028 and P = .014, respectively). In addition, surgeons who used Twitter had higher ratings on Healthgrades (P < .001) and Vitals (P = .001). Surgeons with a greater average number of likes per post on Twitter had significantly higher average ratings across all three sites (P = .004). Surgeons with a greater number of Twitter followers and greater average number of likes per post had significantly higher average ratings on Healthgrades (P = .052 and P = .005, respectively) while surgeons with a greater average number of likes per post had significantly higher average ratings on Vitals (P = .006). Finally, surgeons with a greater average posting frequency on Instagram had significantly higher average ratings across all websites (P = .029)., Conclusion: Shoulder and elbow surgeons who use Twitter and Facebook had significantly higher online ratings. However, the increased use of these platforms in terms of postcontent, postfrequency, comments, and number of followers was not as influential on PRWs. This suggests that social media is an important marketing and outreach method for orthopedic surgeons to improve their ratings and patient reviews., (Copyright © 2024. Published by Elsevier Inc.)

Background: As orthopedic surgery becomes increasingly competitive, orthopedic surgeons are now pursuing advanced degrees more frequently to enhance their resumes or gain additional expertise. The specific impact of this additional training and education on a surgeon's career trajectory is not well defined. The purpose of this study was to understand the impact of an advanced degree on the academic career of orthopedic shoulder and elbow surgeons., Methods: Orthopedic shoulder and elbow fellowship-trained surgeons were identified using the directory listed on the American Shoulder and Elbow Surgeons website. Demographics, education, and current professional roles were obtained. Research productivity was obtained using SCOPUS and Google Scholar. Advanced degrees were defined as those additional to the primary medical degree (Doctor of Medicine [MD] or Doctor of Osteopathic Medicine [DO]). Outcome measures collected included timing of advanced degree obtainment, current academic and leadership roles, leadership on journal editorial boards, and research productivity. Statistical analysis was performed using the chi-square test and Mann-Whitney U test to determine the association of advanced degrees on outcome measures., Results: In total, 893 orthopedic shoulder and elbow surgeons were identified, of whom 129 had advanced degrees. Most common advanced degrees included Master of Science (MS/MSc; 43%), Master of Business Administration (MBA; 23%), and Doctor of Philosophy (PhD; 13%). The most common period of degree obtainment was before medical school (35%) with the least common times being after medical school/before residency (0.9%) and between residency and fellowship training (0.9%). Surgeons who held advanced degrees demonstrated greater research productivity, with a higher h-index (p < 0.001), a greater number of citations (p < 0.001), and more publications (p < 0.001). Of the 523 shoulder and elbow surgeons who worked at an academic institution, those holding advanced degrees were more likely to serve as orthopedic department chair (p < 0.001) and serve an editorial board position (< 0.001)., Conclusion: This study found that having an advanced degree as an orthopedic shoulder and elbow surgeon was linked to higher research impact and productivity and an increased likelihood of becoming a department chair and holding an editorial position. These significant findings can help future trainees and department leadership in understanding the importance and impact of additional training on career trajectories for academic faculty., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To compare patient-reported outcomes (PROs), failure, and healing rates after all-inside (AI) repair versus inside-out (IO) repair for the treatment of meniscal radial tears., Methods: A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Level of Evidence I through IV human clinical studies evaluating PROs and/or the incidence of failure and healing after AI versus IO repairs for meniscal radial tears were included. Clinical failure was defined by the presence of joint-line tenderness; a positive McMurray test; and mechanical symptoms, such as locking, catching, or giving way. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria and the Modified Coleman Methodology Score., Results: Ten studies published from 2008 to 2023 comprising 205 patients were identified, including 142 patients who underwent AI repair and 63 patients who underwent IO repair for radial meniscus tears. Postoperative Lysholm and Tegner scores ranged from 90.8 to 95.6 and 5.7 to 8.2, respectively, in the AI repair group, compared with 86.9 to 94.2 and 6 to 7.5, respectively, in the IO repair group. All patients exceeded published values for minimal clinically important difference for the Lysholm score. Clinical failure ranged from 0% to 40% in the AI group and 0% to 62.5% in the IO group. Healing assessments on second-look arthroscopy revealed failure rates ranging from 0% to 13.3% in the AI group and 0% to 39% in the IO group. Complete and partial healing ranged from 28.6% to 92.3% in the AI group and from 25% to 70% in the IO group. Chondral damage on second-look arthroscopy ranged from 0% to 95% in the IO group and 0% to 57.7% in the AI group. Postoperative complications ranged from 0% to 2% within the AI group, whereas no complications were reported in the IO group. No implant-related complications were reported in any study group., Conclusions: Both all-inside and inside-out repairs for meniscal radial tears demonstrated improved PROs; however, current literature suggests that the IO technique may have higher failure rates both clinically and on second-look arthroscopy., Level of Evidence: Level IV, systematic review of Level III and IV studies., Competing Interests: Disclosures The authors (L.D., G.R.J. F.A., E.S.M., S.A.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. J.C. reports personal fees from Smith & Nephew, personal fees from Arthrex, personal fees from CONMED Linvatec, personal fees from Ossur, other from American Orthopaedic Society for Sports Medicine, other from Arthroscopy Association of North America, other from International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, outside the submitted work., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: To systematically review the patient-reported outcomes and postoperative complications following tuberoplasty for the treatment of massive irreparable rotator cuff tears., Methods: A literature search was conducted using PubMed and EMBASE computerized databases from database inception to June 2023 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Included studies evaluated clinical outcomes, postoperative complications, and reoperation rates following tuberoplasty for the treatment of massive irreparable rotator cuff tears. Exclusion criteria consisted of non-English language, cadaveric studies, case reports, animal studies, studies with overlapping cohorts, letters to editors, and review articles. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Clinical outcome scores included the visual analog scale for pain, University of California Los Angeles score, and Constant score., Results: Seven studies from 2002 to 2023 consisting of 123 patients with a mean age of 66.5 years (mean range, 63-70.4 years) were included. The mean follow-up time ranged from 18 to 98 months. The mean Methodological Index for Non-Randomized Studies score was 13.5 (range, 13-15). At final follow-up, the mean postoperative visual analog scale pain scores ranged from 2.3 to 2.5, University of California-Los Angeles shoulder score from 27.2 to 27.7, and Constant scores from 59.2 to 90.6. Postoperative active forward flexion and abduction ranged from 131° to 165°, and 123° to 160°, respectively. The change in acromiohumeral distance postoperatively ranged from -1 mm to -0.6 mm. The rate of postoperative complications ranged from 0% to 19% of patients, while 0% to 19% of patients underwent revision surgery to reverse shoulder arthroplasty., Conclusions: Tuberoplasty for the treatment of massive irreparable rotator cuff tears results in good clinical outcomes with significant pain relief in select populations. However, the variable reoperation rates should be considered when counseling patients., Level of Evidence: Level IV, systematic review of Level IV studies., Competing Interests: Disclosures The authors (J.C., E.E., S.L., D.Q.J., A.D., G.R.J., V.J.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Objective: To review and update the literature regarding outcomes following surgical management of chronic, grade III posterolateral corner (PLC) injuries, with an emphasis on estimating failure rates based upon objective parameters in light of the 2019 expert consensus, while secondarily comparing the failure rates of anatomic versus non-anatomic reconstruction techniques., Methods: A literature search was performed using the PubMed, Embase, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of level I-IV human clinical studies reporting subjective and objective outcomes in patients following surgical management for chronic (>6 weeks from injury) grade III PLC injuries, with a minimum two-year follow-up. The criterion for objective surgical failure was based on post-operative varus stress radiographs and defined as a side-to-side difference of 3 ​mm or more of lateral gapping., Results: A total of six studies, consisting of 10 separate cohorts encompassing a total of 230 patients, were identified. PLC reconstruction was performed in all cohorts, with 80 ​% (n ​= ​8/10) of these cohorts utilising an anatomic reconstruction technique. A failure rate ranging from 4.3 ​% to 36 ​% was found. Subgroup analysis revealed a failure rate of 4.3 ​%-24.2 ​% for anatomic reconstruction techniques, whereas a 0 ​%-36 ​% failure rate was found for non-anatomic reconstruction. Arthrofibrosis was the most common complication (range, 0 ​%-12.1 ​%) following surgery. 0 ​%-8 ​% of patients required revision PLC surgery., Conclusion: PLC reconstruction yields a wide variability in failure rates according to the side-to-side difference of 3 ​mm or more of lateral gapping on post-operative varus stress radiographs, with low revision rates following anatomic and non-anatomic reconstruction techniques., Level of Evidence: IV; Systematic Review of Level III and IV studies., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To investigate the accuracy of ChatGPT's responses to frequently asked questions prior to rotator cuff repair surgery., Methods: The 10 most common frequently asked questions related to rotator cuff repair were compiled from 4 institution websites. Questions were then input into ChatGPT-3.5 in 1 session. The provided ChatGPT-3.5 responses were analyzed by 2 orthopaedic surgeons for reliability, quality, and readability using the Journal of the American Medical Association Benchmark criteria, the DISCERN score, and the Flesch-Kincaid Grade Level., Results: The Journal of the American Medical Association Benchmark criteria score was 0, indicating the absence of reliable source material citations. The mean Flesch-Kincaid Grade Level was 13.4 (range, 11.2-15.0). The mean DISCERN score was 43.4 (range, 36-51), indicating that the quality of the responses overall was considered fair. All responses cited making final decision-making to be made with the treating physician., Conclusions: ChatGPT-3.5 provided substandard patient-related information in alignment with recommendations from the treating surgeon regarding common questions around rotator cuff repair surgery. Additionally, the responses lacked reliable source material citations, and the readability of the responses was relatively advanced with a complex language style., Clinical Relevance: The findings of this study suggest that ChatGPT-3.5 may not effectively supplement patient-related information in the context of recommendations provided by the treating surgeon prior to rotator cuff repair surgery., Competing Interests: Disclosures All authors (E.E., C.M., D.S., P.Y-H., G.R.J., D.M.K., V.J.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The purpose of this review was to compare clinical outcomes, return to sport (RTS), and complications in comparative studies examining patients undergoing primary Latarjet procedure versus Latarjet in the revision setting following soft tissue stabilization., Methods: A literature search was conducted using PubMed and Scopus databases using Preferred Reporting Items for Systematic Meta-Analyses guidelines. Inclusion criteria consisted of level I to III human clinical studies reporting clinical outcomes (Visual Analogue Pain Scale [VAS]), RTS metrics, and complications in patients following primary versus revision Latarjet procedures. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria., Results: A total of seven studies, consisting of 1170 patients (n=1179 shoulders) with a mean age of 26.4 years, consisting of 91.9% males (n=1083/1179 shoulders), were identified. Mean final follow-up was 46.4 (mean range, 7.3-72.2) months. A total of 748 primary and 431 revision Latarjet procedures were analyzed. Complications were reported in 9.6% (range, 0%-24.2%) of patients undergoing primary and 20.2% (range, 0%-40.7%) in patients undergoing revision procedures (p=0.22). There was no significant difference in the RTS rate between patients undergoing primary (87.3%; range, 83.8%-92.1%) versus Latarjet as a revision procedure (78.9%; range, 60%-100%) (p=0.08). Moreover, no significant difference in postoperative VAS was observed in patients undergoing primary versus Latarjet as a revision procedure (p=0.21). Recurrent shoulder subluxation was significantly greater in patients undergoing revision (12.0%; n=31/259 shoulders; range, 0%-20.7%) compared to primary procedures (3.3%; n=27/511 shoulders; range, 0%-9%) (p<0.001)., Discussion: Patients undergoing primary and revision Latarjet demonstrated overall similar rates of complications and return to sport. Of clinical importance, Latarjet as a revision procedure possessed a risk of recurrent subluxation 3.6 times higher than primary Latarjet. While effective, patients should be counseled regarding the differing prognosis between Latarjet as a primary or revision procedure., Level of Evidence: III; Systematic review and meta-analysis., (Copyright © 2023 The Author(s). Published by Elsevier Masson SAS.. All rights reserved.)

This commentary responds to Moti Gorin's article "What Is the Aim of Pediatric 'Gender-Affirming' Care?" We argue that Gorin's case against pediatric gender-affirming care rests upon numerous false conceptual binaries: female/male, public/private, objective/subjective, and medically necessary/elective. Drawing on feminist bioethics, we show how such dichotomous thinking is both inaccurate and marginalizing of gender minorities., (© 2024 The Hastings Center.)

Purpose of Review: This review addresses the evolving intersection of sleep-disordered breathing (SDB) and heart failure, a topic of increasing clinical significance due to the high prevalence of SDB in heart failure patients and its impact on morbidity and mortality. It reflects recent advancements in diagnostic methodologies and therapeutic strategies. It emphasizes the need for heightened awareness among healthcare providers about the complex relationship between SDB and various forms of heart failure., Recent Findings: Recent studies underscore the high incidence of SDB in heart failure patients, varying with the cause of heart failure. Emerging diagnostic tools, including home sleep tests and advanced inpatient screening methods, have improved the early detection and accurate diagnosis of SDB. Novel treatment modalities, like hypoglossal and phrenic nerve stimulation, are promising, especially where conventional therapies are inadequate. The review also discusses the complexities of managing SDB in the context of different heart failure subtypes., Summary: Findings from recent literature suggest that improved screening, diagnosis, and innovative treatment of SDB in heart failure patients can reduce morbidity, mortality, and healthcare costs. This review emphasizes the need for personalized treatment approaches tailored to individual patient profiles, highlighting the potential of new technologies and multidisciplinary strategies in clinical practice., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: The purpose of this study was to provide a comprehensive analysis on observed trends regarding the impact of the COVID-19 pandemic on telemedicine application in orthopaedics compared to other procedural, non-emergent specialties., Methods: This was a retrospective review of all telemedicine and in-person visits at a large single institution from January to December 2020. The number of patient visits, visit type, location, and provider specifics were collected. Comparisons were made between subspecialties (orthopaedic surgery, oncology, family medicine, rheumatology) for analyses., Results: All specialties included were not conducting virtual visits at the beginning of 2020. By April 2020, orthopaedic virtual visits spiked to an all-time high of 33.5% of all patient visits as compared to oncology at 25.5%, rheumatology at 92.9%, and family medicine at 94%. By the end of the study period, orthopaedic virtual visits decreased back down to 6.5% of patient visits compared to oncology at 7.0%, and family medicine (17.4%) and rheumatology (26.2%). Orthopaedic providers practicing greater than 20 years had the highest average virtual visit rates., Conclusion: Although the COVID-19 pandemic has posed unique challenges for healthcare providers, there was a great advancement in the rollout and application of telemedicine. To mitigate the spread of infection from coronavirus and given the recent adjustments to reimbursement policies and HIPAA regulations, orthopaedics saw a dramatic expansion of telemedicine since April 2020. The pandemic may have served as a catalyst to adopt telehealth into clinical practice. However, telehealth saw a downtrend trend by December 2020, particularly in procedure-based fields like orthopaedics and oncology., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Purpose: To compare the efficacy of common intra-articular injections used in the treatment of knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC), with a minimum follow-up of 6-months., Methods: A literature search was conducted using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in August 2022 in the following databases: PubMed/MEDLINE, Scopus, Cochrane Database of Controlled Trials, and the Cochrane Database of Systematic Reviews. Level I to II randomized clinical trials with a minimum follow-up of 6 months that investigated the treatments of interest were included. Patient-reported outcome scores for pain and function at baseline and at latest follow-up were extracted, and the change in scores was converted to uniform 0 to 100 scales. Arm-based Bayesian network meta-analysis using a random-effects model was created to compare the treatment arms in pain and function., Results: Forty-eight studies comprising a total of 9,338 knees were included. The most studied intra-articular injection was HA (40.9%), followed by placebo (26.2%), PRP (21.5%), CS (8.8%), and then BMAC (2.5%). HA and PRP both led to a significant improvement in pain compared with placebo. HA, PRP, and BMAC all led to a significant improvement in function scores when compared with placebo. Surface under the cumulative ranking curves (SUCRAs) of the interventions revealed that PRP, BMAC, and HA were the treatments with the highest likelihood of improvement in both pain and function, with overall SUCRA scores of 91.54, 76.46, and 53.12, respectively. The overall SUCRA scores for CS and placebo were 15.18 and 13.70, respectively., Conclusions: At a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Additionally, PRP exhibited the highest SUCRA values for these outcomes when compared with BMAC, HA, and CS., Level of Evidence: Level II, meta-analysis of Level I to II studies., Competing Interests: Disclosures The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify the risk of anterior cruciate ligament (ACL) injury in adolescent athletes based on sex, sport, and sport affiliation., Methods: A literature search was performed using 3 online databases (PubMed, Cochrane Library, and EMBASE) from database inception to November 2023 per the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies consisted of Level I or II studies reporting on ACL injury exposures in time (hours) or injuries per 1,000 athlete-exposures (AEs) (1 game or practice) in adolescent athletes. Exclusion criteria consisted of non-English studies, case reports, animal/cadaveric studies, and review articles. Methodological quality and bias assessment of the included studies was assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. ACL injuries were analyzed and pooled to calculate incidence rates (IRs), per-season risk, and relative risk (RR) based on sex, sport, and sport affiliation (club sport participation vs school sport participation)., Results: A total of 1,389 ACL injuries over 19,134,167 AEs were identified (IR, 0.075; 95% confidence interval [CI], 0.071-0.079). Of these, 670 ACL injuries were reported in female athletes over 7,549,892 AEs (IR, 0.089; 95% CI, 0.087-0.091) with 719 in males over 11,584,275 AEs (IR, 0.062; 95% CI, 0.058-0.067). The greatest RR for ACL injury in females was in soccer (RR, 3.12; 95% CI, 2.58-3.77) for AEs. The greatest per-season risk of ACL injuries reported in female athletes occurred in soccer (1.08%), basketball (1.03%), and gymnastics (1.01%). The greatest per-season risk of ACL injuries reported in male athletes occurred in football (0.82%), lacrosse (0.64%), and soccer (0.35%). Club sport participation, in both AEs (RR, 3.94; 95% CI, 3.19-4.87) and hours of exposure (RR, 1.57; 95% CI, 1.07-2.28), demonstrated an increased risk of ACL injury., Conclusions: The risk of ACL injuries was 1.56-fold greater in adolescent female athletes compared with male athletes. The highest-risk sport for females was soccer. Participation in club sports possessed higher rates of injury compared with school sports., Level of Evidence: Level II; meta-analysis of Level I and II studies., Competing Interests: Disclosures The authors (J.C., E.E., B.L., S.L. D.M.K., D.J.K., G.R.J., J.C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To systematically review the literature to provide an updated evaluation of postoperative clinical outcomes, return to play (RTP), and postoperative complications after primary ulnar collateral ligament reconstruction (UCLR) in throwing and nonthrowing athletes at minimum 2-year follow-up., Methods: A literature search was performed on November 25, 2023, by querying the Embase, PubMed, and Scopus online databases using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The inclusion criteria consisted of Level I to IV human clinical studies reporting postoperative outcomes and/or complications after primary UCLR with minimum 2-year follow-up. The exclusion criteria consisted of non-English-language studies; biomechanical, animal, and cadaveric studies; review articles; letters to the editor; and studies not reporting postoperative outcomes or complications. Study quality was evaluated using the Methodological Index for Non-Randomized Studies criteria. The incidence of reported complications among the included studies was extracted. Clinical outcome scores included the Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow (KJOC) score, Andrews-Timmerman (AT) score, and satisfaction score. RTP data were also extracted., Results: A total of 21 studies published from 2006 to 2023, consisting of 2,452 patients (2,420 male patients) with a mean age of 21.7 years (mean range, 12-65 years) and mean follow-up period of 50.5 months (mean range, 24-151.2 months), were included. The mean Methodological Index for Non-Randomized Studies score was 16 (range, 13-20). A total of 46% of patients (1,138 of 2,452) underwent concomitant ulnar nerve transposition. Palmaris graft was the most frequently used method (66.6%; n = 1,799), followed by hamstring graft (26.0%, n = 703). At the final follow-up, mean postoperative KJOC scores ranged from 72.0 to 88.0; mean AT scores, from 83.6 to 98.3; and mean satisfaction scores, from 86.1 to 98.3. The overall RTP rate ranged from 62.5% to 100% at a mean range of 9.5 to 18.5 months. The total incidence of complications ranged from 0% to 31.8%, with 0% to 7.4% of patients undergoing revision surgery., Conclusions: UCLR was commonly performed using a palmaris graft, with concomitant ulnar nerve transposition reported in 46% of patients. At a mean follow-up of 50.5 months, mean postoperative KJOC scores ranged from 72 to 98.3, AT scores ranged from 83.6 to 98.3, and satisfaction scores ranged from 86.1 to 98.3, with variable RTP rates., Level of Evidence: Level IV, systematic review of Level II to IV studies., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify the influence of residency program characteristics, including the presence of under-represented minorities in medicine (URiM) and/or female program directors (PDs), on the race and sex distribution of orthopaedic surgery residency trainees., Methods: All active and Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs from 2017-2021 that reported usable information in the Residency Explorer Tool were included. Data collected included program characteristics, as well as faculty and resident sex distribution, ethnicity, race, and demographic characteristics. The PDs' specific sex, ethnicity, race, and demographic characteristics were collected using residency program websites. The prevalence of factors in programs with the top quartile of female and URiM residents was compared with that in programs with the bottom 3 quartiles., Results: Data were obtained from 148 of 200 Accreditation Council for Graduate Medical Education-accredited programs (3,694 residents). The 52 excluded programs had no usable information in the Residency Explorer Tool or on an identifiable program website. Overall, 15.9% of residents in orthopaedic surgery residency programs were women and 14% were under-represented minorities. The rates of female PDs and chairs were 12.4% and 6.9%, respectively, whereas those of URiM PDs and chairs were 8.3% and 4.6%, respectively. Programs with more female residents were not associated with female PDs (P = .79) or URiM PDs (P = .48). Programs with a greater percentage of URiM residents were not associated with URiM PDs (P = .16). Larger programs (P = .021) and university-based programs (P = .048) had a greater percentage of female residents. Orthopaedic residency programs with visa sponsorship had a greater percentage of URiM residents (P = .017)., Conclusions: Programs with a higher percentage of female or URiM residents did not show a significant association with having female or URiM PDs. Larger programs and university-affiliated programs were more likely to have a larger percentage of female residents, whereas programs that offered visa sponsorship had a higher percentage of URiM residents., Clinical Relevance: This study highlights factors influencing diversity among orthopaedic surgery residents. Although the presence of female or URiM PDs does not influence the percentage of female or URiM residents, other program characteristics such as size, affiliation, and visa sponsorship offer potentially actionable insights for promoting greater diversity in orthopaedic training. Doing so may increase under-represented groups within the field and could ultimately impact patient care and improve health care equity., Competing Interests: Disclosures All authors (V.J.S., A.L., G.L., A.V.D., C.K.F., C.A.F., G.R.J., L.K.C.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)