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Background: The Latarjet procedure is considered the gold standard for treating patients with anterior shoulder instability in the presence of critical glenoid bone loss. Proponents of the Latarjet contend that its efficacy is in-part attributable to the "sling effect" of the conjoint tendon; however, recent studies have demonstrated similar restoration of anterior stability in patients undergoing free bone block (FBB) procedures. The purpose of this systematic review was to evaluate the biomechanical and clinical evidence for the sling effect., Methods: A systematic review was performed per PRISMA guidelines. PubMed/MEDLINE, EMBASE, Web of Science, and Cochrane were queried separately for (1) controlled laboratory studies comparing the restoration of anterior stability with and without an intact, tensioned conjoint tendon and (2) comparative clinical studies comparing patient outcomes after Latarjet versus a FBB procedure. A descriptive synthesis of the controlled laboratory studies and a quantitative meta-analysis of comparative clinical studies was performed., Results: Six controlled laboratory studies and four comparative clinical studies were included. Four of the laboratory studies supported the presence of a sling effect, whereas two studies concluded there was no added effect; however, their data trended in favor of improved anterior stability with the sling effect. Meta-analysis of the four comparative clinical studies demonstrated no difference between Latarjet and FBB for any range of motion measure, outcome score, or the odds of recurrent instability (Odds ratio: 0.83, 95% confidence interval: 0.20-3.52), which is concordant with the findings of each individual study., Conclusion: While both Latarjet and FBB procedures are efficacious in restoring stability, our critical review of the literature suggests that the reduction in anterior translation attributed to the "sling effect" in biomechanical cadaveric studies is not clinically relevant when sufficient anterior glenoid bone has been restored., (Copyright © 2025. Published by Elsevier Inc.)

Context: In patients with musculoskeletal (MSK) conditions, pain is the leading contributor to disability and significantly limits mobility and dexterity. This narrative review describes the efficacy and safety of topical analgesics in common use today., Evidence Acquisition: Secondary literature gained via a literature search using PubMed.gov and the Cochrane library were used., Study Design: Recent literature (2000-2023) on several major classes of topical analgesics and topical delivery systems were reviewed to provide strength of recommendation taxonomy (SORT) levels. A total of 86 articles were reviewed., Level of Evidence: Level 2., Results: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) and cabbage leaf wraps (CLW) appear to be best suited for multiple types of acute MSK pain, and topical nitroglycerin is helpful when used specifically for rotator cuff pain in patients seeking relief while performing activities of daily living and willing to treat for long periods of time. For compounded topical formulations, it may be better to offer single agent creams based on patient preferences. Little data support the use of cryotherapy. Traumeel could be a promising natural analgesic that compares with diclofenac. Topical lidocaine appears best suited for postherpetic neuropathic pain. O24 is a reasonable alternative with a low risk profile to treat pain in patients with fibromyalgia syndrome., Conclusion: Choice of topical agents should be guided by current evidence accounting for type of pain, medication side effects, patient comorbidities, as well as patient preference, convenience, and cost., Strength-Of-Recommendation Taxonomy (sort): Of the topical analgesics and modalities reviewed, SORT level A evidence was found for topical NSAID use in decreasing MSK pain, topical lidocaine for postherpetic neuralgia, and nitroglycerin patches for treating rotator cuff pain if used for prolonged periods of time. Alternative treatments such as CLW and Traumeel show promising results (SORT level B)., Competing Interests: The authors report no potential conflicts of interest in the development and publication of this article.

Introduction: Adductor-related groin pain involves an injury to the common aponeurosis connecting the rectus abdominus and adductor longus to the pubis. It commonly occurs in sports that require cutting and pivoting and can result in significant loss of playing time. Platelet-Rich Plasma (PRP) is often indicated for treatment of musculoskeletal disorders and may represent an alternative treatment for patients with adductor-related groin pain. The purpose of this case report is to describe the non-surgical management of adductor-related groin pain in a competitive soccer player with a with an ultrasound (US)-guided PRP injection and physical therapy management., Case Description: A 17-year-old male competitive soccer player with right-sided adductor-related groin pain was treated with an US-guided PRP and a multi-phased physical therapy regimen based on tissue healing and individual patient/criteria progression. The patient completed 12 physical therapy sessions over six weeks post PRP injection., Outcomes: At the end of treatment, clinically meaningful improvements were observed in pain intensity, passive range of motion, strength (handheld dynamometry, Biodex), functional tests, psychosocial (OSPRO-YF) and patient-reported outcomes (HAGOS, LEFS). The subject returned to sport at six weeks post injection without limitation and at three months follow up, the subject reported that he had returned to 95% of his previous level of play., Discussion: This case report may offer support for PRP as an alternative treatment in the management of adductor-related groin pain. Incorporation of PRP as an adjunct to physical therapy led to improvements on all outcomes that surpassed the clinical significance change criteria., Level of Evidence: 5., (© The Author(s).)

A Division I baseball pitcher presented with chronic forearm pain in his throwing arm while pitching. Physical examination was remarkable for point tenderness over the radial tunnel. A postexertion magnetic resonance imaging (MRI) scan revealed edema around the posterior interosseous nerve. The patient underwent decompression of the nerve along with radial tunnel release, which resulted in full resolution of symptoms and return to full baseball activities. Radial tunnel syndrome is a rare phenomenon but can occur in throwing athletes. MRI immediately after a pitching session aided in accurate diagnosis and successful surgical management., Competing Interests: The following author declared potential conflicts of interest: K.W.F. has received consulting fees from Arthrex and Exactech.

Context: Elbow medial ulnar collateral ligament (UCL) injuries have become increasingly common in athletes. Despite this, rehabilitation protocols appear to vary drastically, which may explain the clinical equipoise regarding optimal management., Objective: This systematic review reports rehabilitation characteristics reported after UCL injuries and compares reported outcomes based on early versus delayed rehabilitation., Data Sources: Our search utilized PubMed/MEDLINE, Embase, Web of Science, and Cochrane to identify all articles on UCL rehabilitation published between January 1, 2002 and October 1, 2022., Study Selection: Studies in English with ≥5 patients that reported rehabilitation protocols for UCL injuries were evaluated., Study Design: Systematic review., Level of Evidence: Level 4., Data Extraction: Data included sample characteristics, time to achieve physical therapy milestones, outcome scores, and return-to-play (RTP) rate and timing., Results: Our review included 105 articles with a total of 15,928 elbows (98% male; weighted mean age, 23 years; follow-up, 47 months), with 15,077 treated operatively and 851 treated nonoperatively. The weighted mean time patients spent adhering to nonweightbearing status was 42 days. The mean time until patients were given clearance for active range of motion (ROM) 15 days, full ROM 40 days, and elbow strengthening exercises 32 days. The mean time until all restrictions were lifted was 309 days. The mean time to begin a throwing program was 120 days. Across all rehabilitation characteristics, protocols for patients undergoing nonoperative management started patients on rehabilitation earlier. After UCL reconstruction, earlier active ROM (≤14 days), elbow strengthening (≤30 days), no restrictions (≤180 days), and throwing (≤120 days) postoperatively led to earlier RTP without a negative effect on functional outcome scores., Conclusion: Current literature provides a spectrum of protocols for elbow UCL rehabilitation, regardless of management. Nonoperative patients began ROM activities, strengthening, and throwing programs sooner than operative patients, and earlier milestones led to earlier RTP., Competing Interests: The following authors declared potential conflicts of interest: K.A.H. has received consulting fees from LinkBio Corp. J.J.K. has received consulting fees from Exactech and LinkBio Corp. J.O.W. has received consulting fees and royalties from Exactech. B.S.S. has received royalties from Exactech, Innomed, and Responsive Arthroscopy. R.P.R. has received academic support from Arthrex. W.R.A. has received consulting fees from Exactech.

Background: The need for capsular closure during arthroscopic hip labral repair is debated., Purpose: To compare pain and functional outcomes in patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure., Study Design: Cohort study., Methods: Outcomes were compared between patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure at up to 2 years postoperatively and with stratification by age and sex. Patients with lateral center-edge angle <20°, a history of instability, a history of prior arthroscopic surgery in the ipsilateral hip, or a history of labral debridement only were excluded. Subanalysis was performed between patients undergoing no capsular closure who were propensity score matched 1:1 with patients undergoing repair or plication based on age, sex, and preoperative Modified Harris Hip Score (MHHS). We compared patients who underwent T-capsulotomy with concomitant capsular closure matched 1:5 with patients who underwent an interportal capsulotomy with concomitant capsular repair based on age, sex, and preoperative MHHS., Results: Patients undergoing capsular closure (n = 1069), compared with the no-closure group (n = 230), were more often female (68.6% vs 53.0%, respectively; P < .001), were younger (36.4 ± 13.3 vs 47.9 ± 14.7 years; P < .001), and had superior MHHS scores at 2 years postoperatively (85.8 ± 14.5 vs 81.8 ± 18.4, respectively; P = .020). In the matched analysis, no difference was found in outcome measures between patients in the capsular closure group (n = 215) and the no-closure group (n = 215) at any follow-up timepoint. No significant difference was seen between the 2 closure techniques at any follow-up timepoint. Patients with closure of the capsule achieved the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the 1-year MHHS at a similar rate as those without closure (MCID, 50.3% vs 44.9%, P = .288; PASS, 56.8% vs 51.1%, P = .287, respectively). Patients with T-capsulotomy achieved the MCID and the PASS for the 1-year MHHS at a similar rate compared with those with interportal capsulotomy (MCID, 50.1% vs 44.9%, P = .531; PASS, 65.7% vs 61.2%, P = .518, respectively)., Conclusion: When sex, age, and preoperative MHHS were controlled, capsular closure and no capsular closure after arthroscopic hip labral repair were associated with similar pain and functional outcomes for patients up to 2 years postoperatively., Competing Interests: One or more of the authors declared the following potential conflict of interest or source of funding: M.W.M. has received education payments from CGG Medical and Fortis Surgical LLC. K.W.F. has received nonconsulting fees from Arthrex, Arthrosurface Inc, Baudax Bio, and CGG Medical; education payments from CGG Medical and Arthrex; consulting fees from Exactech, Arthrex, and Flexion Therapeutics; and honoraria from Baudax Bio. R.P.R. has received education payments from CGG Medical, Arthrex, and Smith & Nephew and grant payments from Arthrex. K.H. has received consulting fees from LinkBio Corp. 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 Ethical approval for this study was obtained from the University of Florida (reference No. 16614)., (© The Author(s) 2024.)

Purpose: To assess return to sport (RTS) in the high-risk young athlete population with capitellar osteochondritis dissecans (OCD) undergoing arthroscopic microfracture (MFX) with or without debridement as well as associated indications, clinical outcomes, radiographic outcomes, and complications., Methods: A literature search of all published literature in the English language from PubMed, EMBASE, Scopus, and Cochrane from database inception to April 4, 2022, was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies presented demographics and outcomes for adolescent (<21 years old) patients diagnosed with capitellar OCD who underwent arthroscopic MFX (or drilling/subchondral drilling) or MFX (or drilling/subchondral drilling) with debridement (or loose body removal/chondroplasty). Studies containing multiple surgical techniques that did not distinguish characteristics and outcomes of individual patients by surgical technique were excluded. Additionally, if there was overlap in patient populations between 2 studies, the study with less outcome data was excluded. Extracted data included study properties, patient demographics, lesion characteristics, surgery details, and patient outcomes, including range of motion, outcome scores, and RTS rates. Bias was assessed via the Methodological Index for Non-Randomized Studies (MINORS)., Results: Nine studies of 136 patients and 138 elbows met criteria. Included articles were published between 2005 and 2020 with MINORS scores of 8 to 14 (50% to 88%). The age ranged from 12.7 to 15.7 years with most patients being involved in baseball or gymnastics and a rate of dominant elbow involvement of 55% to 100%. Patient follow-up ranged from 16 to 138 months. All 9 studies reported RTS, ranging from 65% to 100%. Six of these studies categorized the level to which the patient returned, with patients RTS at the same level of competition ranging from 60% to 100%. Six studies reported complications, with a range rate of 0% to 43%; there were a total of 10 complications, 7 of which required reoperations., Conclusions: Arthroscopic MFX with or without arthroscopic debridement is a safe and effective treatment for OCD lesions of the capitellum in young, athletic patients. Included studies reported improved clinical, radiographic, and patient-reported outcomes. Aside from 1 study reporting an RTS of 65%, the rate of RTS ranged from 86% to 100%. The percentage of patients returning to sport at the same level of competition ranged from 60% to 100% with a time to RTS ranging from 4.1 to 5 months. A single study reported a complication rate of 43%, while remaining studies reported complication rates between 0% and 19%, with loose bodies being the most common complication requiring reoperation. Follow-up ranged from 16 to 138 months., Level of Evidence: Level IV, systematic review of Level IV studies., (Copyright © 2023 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Hypothesis/purpose: The purpose of this study was to compare PROMs in patients undergoing anterior glenoid labral repair using all-suture versus conventional anchors. We hypothesized PROMs would be similar between groups., Methods: We performed a retrospective review of the Arthrex Global Surgical Outcomes System (SOS) database, querying patients who underwent arthroscopic glenoid labral repair between 01/01/2015 and 12/31/2020. Patients aged 18-100, who had isolated glenoid labrum repair with at least 12-month follow-up were included. The visual analog pain scale (VAS), Western Ontario Shoulder Instability Index, Veteran's RAND 12-items health survey, single assessment numeric evaluation and the American Shoulder and Elbow Surgeons score (ASES) were compared preoperatively, 3 months, 6 months, 1 year and 2 years postoperatively in patients who received all-suture anchors versus conventional anchors in the setting of anterior glenoid labrum repair. Our primary aim was comparison of PROMs between patients receiving all-suture versus conventional suture anchors. Secondarily, a sub-analysis was performed comparing outcomes based on anchor utilization for patients with noted anterior instability., Results: We evaluated 566 patients, 54 patients receiving all-suture anchors and 512 patients receiving conventional anchors. At two-year follow-up there was no significant difference between the two groups in PROMs. In a sub-analysis of isolated anterior labrum repair, there was an improvement in ASES (P = 0.034) and VAS (P = 0.039) with the all-suture anchor at two-year follow-up., Conclusions: All-suture anchors provide similar or superior pain and functional outcome scores up to 2 years postoperatively compared to conventional anchors., Clinical Relevance: As all-suture anchors gain popularity among surgeons, this is the largest scale study to date validating their use in the setting of glenoid labrum repair. Institutional Review Board (IRB): IRB202102550., (© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

Background: Orthopedic surgery is among the least diverse specialties in medicine. This systematic review analyzes gender, racial, and ethnic diversity within orthopedic sports medicine and aims to raise awareness and provide guidance for future strategies that support underrepresented minorities in medicine (URMs) and women in joining the orthopedic sports medicine workforce. We hypothesize that at all tiers of training, there is a lack of gender, racial, and ethnic parity in academic rank, leadership positions, and research productivity., Methods: A search of all published literature in the English language from PubMed, Embase, Cochrane, and Scopus databases, between January 1, 2010, and August 18, 2023, was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies presented demographics regarding diversity within orthopedic sports medicine and provided trends in applicants, attendings, leadership, and/or research. Bias was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) study checklist., Results: Thirteen studies published between 2016 and 2023 with STROBE scores 15.5 to 21.5 (70.5% to 97.7%) met criteria, and pertinent data were extracted. The percent of female orthopedic sports medicine surgeons from 2010 to 2019 increased from 5% (n = 138) to 6% (n = 206) with a compound annual growth rate of 0.2% (r2 = 0.97; p < 0.001). Females and URMs are underrepresented at the highest levels of orthopedic sports medicine leadership including department chair (female: 0% [n = 0]), division chief (female: 4% [n = 4]; URM: 3% [n = 3]), and fellowship director (female: 3.3% [n = 3]; URM: 4.4% [n = 4]). Studies from prominent orthopedic sports medicine journals (American Journal of Sports Medicine, Arthroscopy, Journal of Shoulder and Elbow Surgery, and Sports Health) show a 12.1% increase in female involvement in orthopedic sports medicine research from 1972 to 2018; however, this increase captures 59.3% (n = 2,953) females with degrees other than an MD., Conclusions: Although increasingly more females and underrepresented minorities are joining orthopedic sports medicine, the rate of diversification remains slow and current involvement in leadership and research is minimal. Targeted efforts aimed at increasing research opportunities and inspiring interest through mentorship for URMs and females in orthopedics is essential to drive change toward parity., Level of Evidence: Level IV. Systematic Review. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B22)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Case: A 53-year-old man presented with simultaneous, bilateral proximal hamstring ruptures. He underwent open, staged surgical repair of the proximal hamstrings, followed by a modified course of rehabilitation. At 2-year follow-up, the patient reports excellent outcomes., Conclusion: Simultaneous, bilateral, 3-tendon rupture of the proximal hamstrings is a rare lower extremity injury. Surgical treatment of such injuries presents several unique challenges. Staged surgical repair is an effective treatment option., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C204)., (Copyright © 2023 by The Journal of Bone and Joint Surgery, Incorporated.)

Background: Studies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes., Purpose: To compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database., Study Design: Cohort study; Level of evidence, 3., Methods: A global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests., Results: A total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up ( P = .042) and the onlay tenodesis technique at 2 years of follow-up ( P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up., Conclusion: Biceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.J.K. has received consulting fees from Exactech and LinkBio. R.C.S. has received education payments from Medinc of Texas, consulting fees and nonconsulting fees from Acumed, and hospitality payments from Exactech and Integra LifeSciences. T.W.W. has received consulting fees and royalties from Exactech. M.W.M. has received education payments from Fortis Surgical. K.W.F. has received education payments from Arthrex and CCG Medical; consulting fees from Exactech, Pacira Therapeutics and Arthrex; nonconsulting fees from Arthrex, Baudex, CCG Medical, and Arthrosurface; and honoraria from Baudex. J.O.W. has received education payments from Pinnacle and hospitality payments from Acumed, Stryker, and Zimmer Biomet. R.P.R. has received grant support from Arthrex and education payments from Arthrex and Smith & Nephew. 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.)

Injuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL reconstruction. The purpose of our study was to understand the biomechanical effects of ACL reconstruction with an ALL internal brace augmentation. We hypothesized that (1) sectioning of the ALL while preserving other lateral extra-articular structures would lead to significant internal rotation laxity and gap formation and (2) ALL repair with internal brace augmentation would lead to reduction in internal rotation instability and gap formation. In total, 10 fresh-frozen cadaveric knees were thawed and biomechanically tested in internal rotation for 10 cycles of normal physiologic torque in the intact, ACL-deficient, ACL/ALL-deficient, ACL-reconstructed, and ALL-repaired conditions. Each condition was tested at 30, 60, and 90 degrees of flexion. Following the final ALL-repaired condition, specimens were additionally subjected to a final internal rotation to failure at 1 degree at the last-tested degree of flexion. Kinematic measurements of angle and linear gap between the femur and tibia were calculated in addition to torsional stiffness and failure torque. As hypothesized, ALL repair with internal brace augmentation significantly reduced internal rotation angular motion and gap formation at flexion angles greater than 30 degrees. Additionally, ALL sectioning produced nonsignificant increases in internal rotation laxity and gap formation compared with ACL-deficient and ACL-reconstructed states, which did not support our other hypothesis., Competing Interests: R.P.R. reports non-financial support from Arthrex, Inc. during the conduct of the study. D.P.B. reports non-financial support from Arthrex, Inc. during the conduct of the study. J.S.S. reports non-financial support from Arthrex, Inc. during the conduct of the study. A.R.M. reports non-financial support from Arthrex, Inc. during the conduct of the study. A.C.L. reports non-financial support from Arthrex, Inc., during the conduct of the study. J.R.D. reports non-financial support from Arthrex, Inc. during the conduct of the study; personal fees and non-financial support from Arthrex, Inc., personal fees from DJO, LLC, personal fees from In2Bones, outside the submitted work., (Thieme. All rights reserved.)

An adolescent female patient presented with atraumatic left knee pain and limited flexion. MRI demonstrated evidence of a soft tissue lesion abutting the posterior cruciate ligament. Differential diagnosis included pigmented villonodular synovitis (PVNS) and fibroma of the tendon sheath (FTS). Following arthroscopic biopsy, histopathological evaluation confirmed FTS. The tumour was then excised via an arthroscopic approach. This case report provides a unique example of FTS abutting the cruciate ligaments in an uncommonly young female patient. It highlights the importance of including benign processes, such as FTS, in the differential with more aggressive-type diagnoses like PVNS. Furthermore, this case exemplifies an appropriate surgical indication for FTS. Finally, it emphasises the importance of communication and collaboration among orthopaedic subspecialists in providing safe and effective arthroscopic treatment of this unique tumour presentation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes., Hypothesis: It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered., Study Design: Cohort study; Level of evidence, 3., Methods: The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex., Results: Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis ( P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores ( P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures., Conclusion: Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.C.S. has received education payments from MedInc, speaking fees from Acumed, and hospitality payments from Integra LifeSciences. T.W.W. has received consulting fees and royalties from Exactech. K.W.F. has received education payments from Exactech; consulting fees from Arthrex, Exactech, and Flexion Therapeutics; speaking fees from Arthrex, Arthrosurface, and CGG Medical; honoraria from Arthrosurface and Baudax Bio; and hospitality payments from Rotation Medical. J.O.W. has received education payments from Pinnacle and hospitality payments from Acumed and Zimmer Biomet. R.P.R. has received grant support from Arthrex and education payments from Arthrex and Smith & Nephew. M.W.M. has received education payments from Fortis Surgical and speaking fees from Arthrex. M.C.F. has received hospitality payments from Arthrex. J.J.K. has received consulting fees from Exactech and hospitality payments from Integra LifeSciences. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results., Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip., Study Design: Controlled laboratory study., Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct., Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6)., Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation., Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by Arthrex in the form of direct funding as well as in kind donations of cadaveric specimens and surgical products used in the completion of the study aims. A.C.L. has received research support from Arthrex, Stryker, and Medacta; education payments from Arthrex, Medwest, and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Zimmer Biomet. M.K.R. has received research support from Arthrex, education payments from Smith & Nephew, and hospitality payments from Prime Surgical. R.P.R. has received research support from Arthrex and education payments from Arthrex and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. B.A.E. has received consulting fees, nonconsulting fees, and royalties from Arthrex. B.G.D. has received research support from Arthrex, ATI, Stryker, and Pacira Pharmaceuticals; education payments from Arthrex, Breg, and Medwest; consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; speaking fees from Arthrex and Pacira Pharmaceuticals; honoraria from Medacta; and royalties from Amplitude, Arthrex, DJO Global, MAKO Surgical, Medacta, Stryker, and Orthomerica. B.G.D has also had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. 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.)

Background: The purpose of this study is to present surgical outcomes after humeral head allograft augmentation and glenoid-based procedures in patients with active, uncontrolled seizure activity and anterior shoulder instability., Methods: A retrospective review of a surgical database for patients with active seizure disorder and with recurrent shoulder instability managed with humeral head augmentation was performed. All patients underwent surgical intervention. Postoperative outcomes including Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons questionnaire, and the Short Form Health Survey (SF-12) were recorded at a minimum of 2 years. We hypothesized that appropriate management of the bony defects in these bipolar injuries would result in low recurrence and satisfactory outcomes., Results: Ten patients including 8 males and 2 females (15 shoulders) with active seizure-related shoulder instability underwent surgical intervention including allograft bone grafting of the Hill-Sachs lesion for anterior shoulder instability. The average age was 27 years. All patients reported recurrent seizures postoperatively, but only one sustained a shoulder dislocation after surgery that was unrelated to seizure activity.Self-reported satisfaction was "much better" or "better" in 92% of shoulders. Average outcome scores were as follows: American Shoulder and Elbow Surgeons score = 67 (33-100), Shoulder Pain and Disability Index = 32.5 (0-83), Simple Shoulder Test = 9.4 (5-12), SF-12 PCS = 44.1 (21-65), and SF-12 MCS = 50.6 (21-61). The average follow-up was 4.8 years., Conclusion: Management of bipolar shoulder injuries with humeral head allograft augmentation and glenoid based surgery leads to low recurrence rates and good clinical outcomes in patients with uncontrolled, seizure-related shoulder instability., (© 2021 The Authors.)

Bone loss often complicates revision total knee arthroplasty (TKA). Management of metaphyseal defects varies, with no clearly superior technique. Two commonly utilized options for metaphyseal defect management include porous-coated metaphyseal sleeves and tantalum cones. A systematic review was conducted according to the international Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We combined search terms "Total knee arthroplasty" AND/OR "Sleeve," "Cone" as either keywords or medical subject heading (MeSH) terms in multiple databases according to PRISMA recommendations. All retrieved articles were reviewed and assessed using defined inclusion and exclusion criteria. A total of 27 studies (12 sleeves and 15 cones) of revision TKAs were included. In the 12 studies on sleeve implantation in revision TKAs, 1,617 sleeves were implanted in 1,133 revision TKAs in 1,025 patients. The overall rate of reoperation was 110/1,133 (9.7%) and the total rate of aseptic loosening per sleeve was 13/1,617 (0.8%). In the 15 studies on tantalum cone implantation in revision TKAs, 701 cones were implanted into 620 revision TKAs in 612 patients. The overall rate of reoperation was 116/620 (18.7%), and the overall rate of aseptic loosening per cone was 12/701 (1.7%). Rates of aseptic loosening of the two implants were found to be similar, while the rate of reoperation was nearly double in revision TKAs utilizing tantalum cones. Variability in the selected studies and the likely multifactorial nature of failure do not allow for any definitive conclusions to be made. This review elucidates the necessity for additional literature examining revision TKA implants., Competing Interests: None declared., (Thieme. All rights reserved.)

This is a case report of a 48-year-old man with multiple transient ischemic attacks and a known hypoplastic right vertebral artery (VA) who presented after a syncopal event while turning his head to the left. The objective of this study is to demonstrate the necessity of proper diagnosis and management of cerebrovascular pathology including imaging and surgical intervention in patients with known anatomical anomalies. This study was conducted at Massachusetts, United States of America. Our patient's history was significant for a hypoplastic right VA and a stenotic segment of the right VA at the C3-C4 junction. There was also degeneration of the C3-C4 facet on the left, with osteophyte formation compressing the VA, and a fusion of the C2-C3 segment. Imaging demonstrated obliteration of the left VA flow with head rotation to the left and subsequent reconstitution of flow in the neutral position. After consultation, the patient decided to proceed with surgical management with an anterior cervical discectomy and fusion at the level of C3-C4. Symptoms of vertebrobasilar insufficiency including syncopal episodes resolved after treatment. VA anomalies, although uncommon, are important to understand. Our patient presented with an anomalous right VA, as well as severe degenerative changes to the C2/C3 vertebrae that contributed to the development of Bow Hunter's syndrome. It is essential that proper monitoring and follow-up has to be carried out in patients with abnormal cerebral vasculature to minimize the occurrence of Bow Hunter's syndrome., Competing Interests: There are no conflicts of interest.

Purpose: Cervical disc replacement has become an acceptable alternative to anterior cervical fusion for the surgical treatment of cervical spine spondylosis resulting in radiculopathy or myelopathy following anterior discectomy and decompression. This concise overview considers the current state of knowledge regarding the continued debate of the role of cervical disc replacement with an update in light of the latest clinical trial results., Methods: A literature review was performed identifying clinical trials pertaining to the use of cervical disc replacement compared to cervical discectomy and fusion. Single level disease and two level disease were considered. Outcome data from the major clinical trials was reviewed and salient points identified., Results: With lengthier follow-up data becoming available, the equivalence of CDR in appropriately selected cases is becoming clear. This is chiefly manifested by reduced re-operation rates and reduced incidence of adjacent level disease in those treated with arthroplasty., Conclusion: Cervical disc replacement shows emerging equivalence in outcomes compared to the gold standard anterior cervical discectomy and fusion. Further longer term results are anticipated to confirm this trend.

Contamination of the root canal system by persistent, enteric bacteria via leakage through interim restorations has been well documented. This in vitro study evaluated the ability of interappointment medications to prevent contamination of the root canal system by Enterococcus faecalis. Coronally unsealed, medicated tooth roots fixed in a closed system were contaminated daily with a standardized, aerobic, broth culture of E. faecalis. Four medications were evaluated (n = 15): group A, calcium hydroxide/methylcellulose paste; group B, camphorated parachlorophenol/calcium hydroxide paste; group C, 1% chlorhexidine/methylcellulose gel; and group D, calcium hydroxide points. The mean number of days to contamination as indicated by turbidity in the closed system was the following: group A, 37; group B, 46; group C, 16; group D, 5; and a positive control (no medication), 3. A one-way analysis of variance with a Scheffe post hoc test (p = 0.05) detected significant differences in effectiveness with A and B superior to C and D, and C superior to D.