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Background: Primary arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction using a bone–patellar tendon–bone (BTB) graft offers excellent long-term results for patients with ACL tears. When concurrent meniscal damage is present, the preferred treatment is repair of the meniscus. However, meniscectomy may be needed, which can result in insufficient meniscal function. Indications: ACL reconstruction performed concomitantly with meniscal allograft transplantation (MAT) is indicated for patients with ACL tears and meniscal insufficiency. This procedure is typically reserved for younger, active patients, such as the 38-year-old woman in this presentation. Technique Description: The patient was placed in the supine position. The BTB graft was harvested first using a standard medial midline incision. A posterior meniscus root tunnel was drilled, followed by drilling of the femoral tunnel for ACL reconstruction. The tibial tunnel for ACL reconstruction was subsequently created, after which tapping was performed for anterior meniscus root fixation. The meniscal allograft was secured using alternating vertical mattress inside-out sutures. Finally, the BTB graft was passed through the tibial and femoral tunnels. Results: Outcomes following ACL reconstruction with BTB autograft and MAT are positive, with a 5-year survival between 84% and 91%. ACL reinjury and long-term development of osteoarthritis are the most common complications. In this case, the patient returned to work within 7 months and reported 0 out of 10 pain. Discussion/Conclusion: ACL reconstruction with BTB autograft and concomitant MAT is a viable treatment option for patients with ACL tears in the context of meniscal deficiency. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: Acromioclavicular (AC) joint separations occur most often in young male patients, commonly in athletes. Initially described by Jones et al. in 2001, reconstruction with semitendinosus allograft via cerclage has been increasingly adopted in recent times, though this not been as well described in video journals. Indications: Operative management of AC joint separation is classically indicated in Rockwood grade IV or higher AC joint injuries and controversial for grade III separations. One such treatment is AC joint reconstruction with semitendinosus allograft as described in this 37-year-old male patient, with a grade IIIB AC joint separation. Technique Description: A 6-cm incision was created overlying the clavicle. No distal clavicle excision was performed, but coracoclavicular (CC) scar tissue was elevated with medial and lateral windows about the coracoid. A passing suture was placed around the coracoid, and holes were drilled in the clavicle at 17% and 31% of the total clavicle length, consistent with ratios described by Rios et al; 5-mm tunnels were created corresponding to the trapezial and conoid limbs of the CC ligaments and tapped to 5.5 mm. A semitendinosus allograft was passed and fixed with two 5.5 × 15 mm polyetheretherketone (PEEK) screws after primary fixation with a FiberTape cerclage looped around the coracoid and clavicle independently with use of a tensiometer for maximal tightening. A FiberTak was used to fix the additional graft limb at the acromion to stabilize the AC joint and reinforced on itself with 0 vicryl. The patient was placed in a sling and assigned physical therapy (PT) focusing on limiting shoulder abduction and forward flexion for the first 6 weeks. Results: At 6 months postoperation, the patient continues to progress from PT, with low pain and near full range of motion. Although PT protocols vary widely, a full recovery is expected by 6 months, with the patient able to return to work, lifting no greater than 50 pounds. Discussion/Conclusion: This study describes the treatment of an acute grade IV AC joint separation in a 37-year-old male patient. Further adoption of AC joint reconstruction utilizing a semitendinosus allograft via cerclage continues to be a viable option for patients requiring operative management. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: Osteochondritis dissecans (OCD) affects the shoulder in only 0.6% of patients aged 2 to 19 years with disease most commonly in the humeral head. When the glenoid is affected, it is often in male overhead throwing athletes and treated with fixation via autologous osteochondral plugs following bone marrow aspirate. Indications: The primary indication for surgical management of OCD is failure of conservative management, often with imaging showing disruption of the glenoid subchondral plate. This patient is an 18-year-old male pitcher with over 2 years of chronic, deep-seated shoulder pain unresponsive to conservative management. Technique Description: We present a primary arthroscopic technique of autologous bone marrow aspirate concentrate graft for management of OCD in an 18-year-old college baseball pitcher. The patient was placed in the left lateral decubitus position with an axillary roll and standard portals were established. A loose fragmented flap with no underlying osseous material was debrided and a 3-cm central area of bony loss was identified. Bone marrow aspirate of 80 mL was taken from the anterior superior iliac crest. The aspirate was mixed with Biocartilage (Arthrex) to fill the defect flush with the surrounding tissue and sealed with fibrin glue. Ports were closed and an abduction sling was applied. Results: A recent review article demonstrated that athletes who underwent surgical management of OCD lesions returned to sports an average of 1.2 months sooner than those managed non-operatively, though this difference was not significant. This patient had a full return to play at 9 months. At 1-year follow-up, he made a full recovery and is currently playing professionally without shoulder pain. Discussion/Conclusion: Autologous bone marrow aspirate defect filling is a viable treatment of OCD, even in high-level overhead throwing athletes. It allows for arthroscopic treatment with long-term success in the treatment of pain and function. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: Quadriceps autograft, though well established for anterior cruciate ligament reconstruction, is underutilized in posterior cruciate ligament (PCL) reconstruction largely due to slow adoption. All-inside meniscal ramp repair and quadriceps tendon autograft PCL reconstruction have been described in isolation, but not concomitantly in a video journal. Indications: PCL reconstruction is indicated in grade 3 isolated tears with instability that have not improved with nonoperative management and in instances with associated injuries such as meniscal ramp tears, as observed in this 18-year-old division I football player. Graft selection is dependent upon surgeon and patient preference, with quadriceps autograft delivering a viable option with desirable long-term outcomes. Technique Description: A partial-thickness quadriceps tendon autograft was harvested, the remnant PCL stump was debrided, and a reamer was used to drill the all-inside tibial tunnel for traction suture passage. An accessory low anterolateral portal was utilized to drill the femoral tunnel for passage of the femoral traction stitch. Traction sutures were withdrawn, and the graft was passed into the tibia, docked into the femur, fixated with an interference screw, and tensioned over the tibial button. A medial meniscal ramp tear was also identified and repaired in all-inside fashion with a 90° SutureLasso, polydioxanone suture (PDS), and suturetape via standard arthroscopic knot tying. Following the procedure, the patient began a PCL reconstruction rehabilitation protocol with a PCL rebound brace. Due to the meniscal ramp repair, toe touch weightbearing with the knee in extension during ambulation was completed for 6 weeks. Physical therapy (PT) focused on early quadriceps and patellar mobilization as well as active-assisted range of motion exercises. Results: At 6 months postoperation, the patient continued to progress in PT without major concerns. A full recovery and return to sport are expected approximately 9 to 12 months after surgery, as is consistent with the standard protocol. Discussion/Conclusion: This study describes the treatment of chronic PCL with concomitant meniscal ramp tear in a division I athlete. Further adoption of PCL reconstruction utilizing quadriceps autograft, even in the context of concomitant ligamentous or meniscal reconstruction, such as medial meniscal ramp repair, will aid in the widespread treatment of PCL injuries. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Background: Pectoralis major tendon (PMT) transfer is an effective surgical treatment for addressing subscapularis insufficiency in younger, active patients. Indications: The primary indication for a PMT transfer is subscapularis insufficiency or irreparable tear in an active, young patient that is not a candidate for reverse shoulder arthroplasty. In addition, patients should have an intact posterosuperior rotator cuff. In this case, the patient is a 41-year-old male with chronic anterior shoulder instability after failed open Bankart stabilization with subscapularis incompetency. Technique Description: The patient was placed in the beach-chair position and a standard deltopectoral approach was utilized. The conjoint tendon and adjacent musculocutaneous nerve were identified and retracted. Subsequently, the sternal head of the PMT was isolated from the clavicular head at the humeral insertion. It was then released, mobilized and passed inferior to the conjoined tendon for reapproximation at the lesser tuberosity with a suture anchor. Results: A previous systematic review demonstrated that patients with isolated subscapularis insufficiency who undergo PMT transfer have significant increase in Constant Score, range of motion, and internal rotation strength. Additionally, a retrospective case series evaluating 22 patients at a 10-year follow-up revealed maintained improvements in Constant Score, Simple Shoulder test, and Visual Analog scale for Pain. However, they found that strength on internal rotation and range of motion significantly regressed to baseline, preoperative levels. Discussion/Conclusion: PMT transfer for subscapularis insufficiency is a viable treatment option for symptomatic subscapularis tendon tears not amenable to repair. It allows for excellent long-term improvements in strength, range of motion and patient reported outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.