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Background: The purpose of this study was to assess the clinical and radiographic outcomes of arthroscopic anatomic glenoid reconstruction (AAGR) used for primary vs. revision surgery for addressing anterior shoulder instability with bone loss., Methods: We performed a retrospective review on consecutive patients who underwent AAGR from 2012 to 2020. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of 2 years were included. Exclusion criteria included patients with incomplete primary patient-reported outcome scores (PROs), multidirectional instability, glenoid fracture, nonrigid fixation and concomitant humeral avulsion of the glenohumeral ligament, or rotator cuff repair. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) scores. Secondary outcomes included postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) scores, complications, recurrence of instability and computed tomographic (CT) evaluation of graft position, resorption, and healing., Results: There were 73 patients (52 primary and 21 revision) finally included. Both groups had comparable demographics and preoperative WOSI and DASH scores. The primary group had significantly better postoperative WOSI and DASH scores at final follow-up when compared to the revision group (WOSI: 21.0 vs. 33.8, P = .019; DASH: 7.3 vs. 17.2, P = .001). The primary group also showed significantly better WOSI scores than the revision group at the 6-month, 1-year, and 2-year time points (P = .029, .022, and .003, respectively). The overall complication rate was 9.6% (5 of 52) in the primary group and 23.8% (5 of 21) in the revision group. Both groups showed good graft healing and placement in the anterior-to-posterior and mediolateral orientation and had a similar rate of graft resorption and remodeling. There was no difference between the groups in the remainder of the CT measurements., Conclusion: Functional outcome scores and stiffness were significantly worse in patients undergoing an AAGR procedure after a failed instability surgery when compared with patients undergoing primary AAGR. There were no differences in postoperative recurrence of instability or radiographic outcomes. As a result, AAGR should be considered as a primary treatment option within current treatment algorithms for shoulder instability., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

The indications for bone block augmentation of the glenoid following recurrent anterior shoulder instability are expanding. Arthroscopic anatomic glenoid reconstruction (AAGR) is an evolving technique with similar clinical results to the Latarjet procedure and other open bone block procedures. Multiple types of bone grafts and fixation techniques have been described, with varying results on bony integration, resorption, articular congruity, and recurrence rates. This review focuses on biomechanics, patient workup, indications, current evidence, and the authors' preferred surgical technique for AAGR., Competing Interests: Disclosure There are no commercial or financial conflicts of interest to disclose. There are no funding sources for any of the authors., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: The purpose of this study was to compare the radiographic results of bridging rotator cuff reconstruction (BRR) with dermal allograft and maximal repair for large or massive, irreparable rotator cuff tears., Methods: This was a secondary analysis of data from a single-center, blinded-observer, randomized controlled trial that examined clinical outcomes of BRR compared with maximal repair. A sample size of 30 patients with magnetic resonance imaging (MRI)-proven large or massive (>3 cm), retracted rotator cuff tears and/or involvement of 2 or more tendons were randomly allocated to 1 of 2 groups: maximal repair or BRR using dermal allograft. MRIs were obtained preoperatively and 1 year postoperatively. The primary outcome of this study was the retear rate on MRI. Secondary outcomes included progression of muscle atrophy and fatty infiltration., Results: There was no difference in age or preoperative tear size between the 2 groups. Patients treated with BRR had decreased retear rate (21%) compared with patients who received maximal repair alone (87%). There was no difference in the number of patients who had progression of muscle atrophy (P = .088 for supraspinatus and P = .738 for infraspinatus) or fatty infiltration (P = .879 for supraspinatus and P = .693 for infraspinatus) between the 2 groups. A significant increase in mean postoperative supraspinatus muscle atrophy was identified in the maximal repair group (P = .034)., Conclusions: The results of this secondary analysis of a randomized controlled trial comparing radiographic results of maximal repair versus BRR using dermal allograft in the treatment of large or massive rotator cuff tears show that BRR results in a significantly reduced structural failure rate and a trend toward better preservation of supraspinatus muscle mass compared with maximal repair., Level of Evidence: Level I, secondary analysis of a randomized controlled trial., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Arthroscopic Bankart repair (ABR) has been accepted as a standard procedure for anterior shoulder instability with a minimum or no glenoid bone loss and an on-track Hill-Sachs lesion if present. However, several controversies exist in the surgical treatment of anterior shoulder instability. This article will discuss some of these controversies in, "simple," dislocations (without bone loss) as well as, "complex," (with critical bone loss). Determining which patients will benefit from an arthroscopic procedure depends on multiple factors including age, activity level, adequate determination of bone loss, performed with feasible and reliable imaging techniques. In the absence of concomitant significant bony and soft tissue pathology, ABR alone can provide satisfactory clinical results on a long-term basis. Controversies, including whether to remove cartilage from the edge of the glenoid, knotted versus knotless anchors, and routine rotator interval closure, still exist. In cases with significant bone loss, several bone restoring procedures have been described, such as, the Latarjet procedure, iliac crest bone graft, arthroscopic anatomic glenoid reconstruction with a frozen distal tibial allograft, and fresh distal tibial allograft reconstruction. This article will address these controversies and provide guidance based on available published data., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Raffy Mirzayan, MD reports a relationship with Arthrex Inc that includes: speaking and lecture fees. Ivan Wong reports a relationship with DePuy Mitek Inc that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Smith and Nephew Inc that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with CONMED Corp that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Stryker Orthopaedics that includes: consulting or advisory and speaking and lecture fees. Ivan Wong reports a relationship with Arthrex Inc that includes: consulting or advisory. Ivan Wong reports a relationship with Bioventus LLC that includes: speaking and lecture fees., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the outcome of revision rotator cuff bridging reconstruction (BR) as compared to primary BR in a large cohort of patients., Methods: A retrospective chart review was conducted for patients who underwent BR using dermal allograft for large/massive rotator cuff tears between 2010 and 2018. Patients who completed Western Ontario Rotator Cuff Index (WORC) and Disability of the Arm, Shoulder, and Hand (DASH) scores both pre- and postoperatively were included. Pre- and postoperative magnetic resonance imaging scans were compared to assess for differences in fatty infiltration, muscle atrophy, and graft status., Results: Eighty patients met the inclusion criteria, including 43 patients who underwent BR as a primary surgery and 37 patients who underwent revision BR. The mean follow-up duration was 5.7 ± 1.9 years in the primary group and 5.8 ± 2.0 years in the revision group. Both WORC and DASH scores significantly improved from pre- to postoperatively for both the primary and revision groups ( P < .05). The primary group had significantly better postoperative WORC and DASH scores at 6 months, 1 year, and final follow-up ( P < .05). Failure rate of the graft was higher in the revision group compared to primary group (14.3% vs 6.1%, respectively; P  = .337), and the amount of fatty infiltration of supraspinatus and infraspinatus muscles significantly improved in patients who received primary BR compared to revision BR ( P < .05)., Conclusions: BR using dermal allograft for large/massive irreparable rotator cuff tears showed improvement of functional outcomes, with primary cases resulting in better improvement in patient-reported outcomes compared to revision cases. Primary BR was also associated with better postoperative fatty infiltration of supraspinatus and infraspinatus muscles., Level of Evidence: Level III, retrospective cohort study., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: I.W. reports consulting fees from 10.13039/100008426DePuy Mitek, consulting fees from 10.13039/100009026Smith and Nephew, consulting fees from 10.13039/100019400CONMED Corp, and consulting fees from Bioventus LLC, outside the submitted work; is an editorial board member for the American Journal of Sports Medicine and Arthroscopy: The Journal of Arthroscopic and Related Surgery; and is a board or committee member for AANA, ISAKOS, and AAC. All other authors (J.K., S.S., J.M., J.-P.K.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 The Authors.)

Background: Despite the ongoing opioid epidemic, most patients are still prescribed a significant number of opioid medications for pain management after arthroscopic surgery. There is a need for consensus among orthopaedic surgeons and solutions to aid providers in analgesic strategies that reduce the use of opioid pain medications., Purpose: This position statement was developed with a comprehensive systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to synthesize the best available evidence for managing acute postoperative pain after arthroscopic surgery., Study Design: Position statement., Methods: The Embase, MEDLINE, PubMed, Scopus, and Web of Science databases were searched from inception until August 10, 2022. Keywords included arthroscopy , opioids , analgesia , and pain , and associated variations. We included exclusively RCTs on adult patients to gather the best available evidence for managing acute postoperative pain after arthroscopic surgery. Patient characteristics, pain, and opioid data were extracted, data were analyzed, and trial bias was evaluated., Results: A total of 21 RCTs were identified related to the prescription of opioid-sparing pain medication after arthroscopic surgery. The following recommendations regarding noninvasive, postoperative pain management strategies were made: (1) multimodal oral nonopioid analgesic regimens-including at least 1 of acetaminophen-a nonsteroidal anti-inflammatory drug-can significantly reduce opioid consumption with no change in pain scores; (2) cryotherapy is likely to help with pain management, although the evidence on the optimal method of application (continuous-flow vs ice pack application) is unclear; (3) and (4) limited RCT evidence supports the efficacy of transcutaneous electrical nerve stimulation and relaxation exercises in reducing opioid consumption after arthroscopy; and (5) limited RCT evidence exists against the efficacy of transdermal lidocaine patches in reducing opioid consumption., Conclusion: A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent vocal pain outcomes. Optimal strategies include multimodal analgesia with education and restricted/reduced opioid prescription., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: O.R.A. has received nonconsulting fees from CONMED. I.W. has received consulting fees from DePuy Mitek, Smith & Nephew, COMED, and Bioventus. J.W. has received research support from Arthrex, CONMED, Linvatec, Ossur, Smith & Nephew, and Zimmer Biomet; and education payments from Arthrex, CONMED, Linvatec, Ossur, Smith & Nephew, and Zimmer Biomet. J.G. has received research support from JRF Ortho, Arthrex, MiMedX, and InGeneron; education payments from Arthrex; and consulting fees from JRF Ortho, Vericel, Arthrex, and Tactile Orthopaedics. M.P. has received consulting fees from Arthrex and CONMED. R.D. has received research support from Smith & Nephew and honoraria from Sanofi. R.M. has received education payments from Arthrex, Gemini Medical, Smith & Nephew, and Linvatec; and consulting fees from Smith & Nephew. M.E.L. has received research support from Arthrex, CONMED, Linvatec, Ossur, Smith & Nephew, and Zimmer Biomet; and education payments from Arthrex, CONMED, Linvatec, Ossur, Smith & Nephew, and Zimmer Biomet. B.M. has received consulting fees from Arthrex and honoraria from Pendopharm. R.K.M has received a grant from Smith & Nephew; consulting fees from Smith & Nephew and Arthrex; nonconsulting fees from Tactile Orthopaedics; royalties from Tactile Orthopaedics; stock from Tactile Orthopaedics; and is on the Board for Tactile Orthopaedics. 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) 2023.)

Background: The all-inside anterior cruciate ligament reconstruction (ACLR) procedure uses a single hamstring tendon folded twice and secured to itself to form a 4-stranded graft. There are several possible configurations for preparing the graft., Purpose: To investigate the biomechanical properties of a new graft preparation technique in comparison with 2 commonly used configurations., Study Design: Controlled laboratory study., Methods: Five porcine flexor tendons were prepared into the test graft configuration: side-to-side fixation with a backup fixation at the button loop (graft M). The test configuration was compared with the results of a previous study that included grafts with simple interrupted sutures (graft A; n = 5) and end-to-end fixation (graft C; n = 5). All grafts were subjected to the same mechanical testing protocol to determine the mean failure load, stiffness, rate of elongation, and total elongation during both cyclic loading and pull to failure. Differences between groups were evaluated., Results: Graft A had a significantly lower failure load (637 ± 99 N) compared with graft M (883 ± 66 N; P = .002) and graft C (846 ± 26 N; P = .002). Graft A also had significantly lower stiffness (166 ± 12 N/mm) compared with graft M (215 ± 8 N/mm; P < .001) and graft C (212 ± 11 N/mm; P < .001). Graft C had a significantly lower elongation during cyclic loading (3.42 ± 0.24 mm) compared with graft M (4.37 ± 0.74 mm; P = .026) and graft A (4.90 ± 0.88 mm; P = .006). The unsecured fixation was the weakest graft, with the lowest failure load and stiffness. The new side-to-side configuration and end-to-end configuration were equally strong., Conclusion: The new side-to-side configuration was not biomechanically superior to the end-to-end configuration; however, they were both stronger than unsecured fixation., Clinical Relevance: As the all-inside ACLR is gaining popularity, this study provides surgeons with a new method of preparing grafts and evaluates the method with respect to currently used configurations., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Support for this study was received from the Edmonton Civic Employees Charitable Fund. The adjustable button-loop devices used were contributed by Arthrex. 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) 2021.)

Posterior shoulder instability is an uncommon and challenging cause of shoulder pain and dysfunction. Surgical management has less reliable results and higher failure rates compared with techniques for anterior shoulder instability. The presence of generalized ligamentous laxity further complicates options for surgical management. If primary capsulolabral repair fails, controversy exists as to the optimal revision procedure. This technical description and video present an arthroscopic technique for reconstruction of the posterior glenohumeral capsule with an acellular dermal allograft to treat posterior instability in a patient with Ehlers-Danlos syndrome and a previously failed posterior capsular plication.