How much Improvement in Patient Reported Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction is associated with Surgeon-defined Satisfactory Outcomes? A JUPITER study.

Introduction: The extent of change in Patient Reported Outcome Measures (PROs) required to meet surgeon-defined satisfactory outcomes after isolated Medial Patellofemoral Ligament Reconstruction (MPFL-R) has not been reported. The primary aim of the study was to define the threshold value of maximal outcome improvement (MOI) in PROs associated with surgeon-defined satisfactory postoperative outcomes. The secondary aim was to identify the most effective PRO in predicting these outcomes and to evaluate the factors associated with it.

Establishing the Minimum Clinically Important Difference, Patient Acceptable Symptomatic State, and Substantial Clinical Benefit, After Isolated Medial Patellofemoral Ligament Reconstruction.

Purpose: To establish the minimum clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) for the Kujala score in patients who underwent isolated Medial patellofemoral ligament reconstruction (MPFLR) for patellar instability with a minimum 23 month follow-up.

Methods: This retrospective cohort study used a prospectively maintained database of patients undergoing primary MPFLR between April 2016 and June 2021. Patients with concomitant procedures, such as osteotomy, trochleoplasty, meniscus repair, other ligamentous reconstruction, and cartilage transplantation, were excluded.

Optimizing Patient Outcomes Following Osteochondral Allograft Transplantation: The Impact of 25 Years of Translational and Clinical Research.

This manuscript consolidates 25 years of interdisciplinary research and clinical advancement in optimizing patient outcomes following osteochondral allograft (OCA) transplantation. In this manuscript, we detail the results of over 1500 OCA procedures and 115 research publications, integrating hypothesis-driven basic science and translational research with clinical outcomes data. The study highlights groundbreaking advancements, including: Innovations in fresh OCA preservation techniques that extend graft viability; Minimization of immunogenic, thermal, and impaction effects to enhance graft integration and durability; Cutting-edge methods for donor-recipient topographic matching, supported by 3D modeling; Evolution of the surgical technique, including the development of orthobiologic approaches to optimize outcomes; Evaluating long-term clinical outcomes and the effect of concomitant procedures; Decision-support algorithms that improve patient selection and surgical planning using machine learning tools.

Establishing the Minimal Clinically Important Difference and Patient Acceptable Symptom State After Isolated Arthroscopic Posterior Medial Meniscal Root Repair.

Background: Significant clinical improvements have been shown after a posterior medial meniscal root (PMMR) repair; however, there is a lack of understanding of their effect on patients' perspectives.

Purpose: To (1) define the minimal clinically important difference (MCID) and the Patient Acceptable Symptom State (PASS) for patient-reported outcome measures (PROMs) after isolated PMMR repair; (2) investigate the role of preoperative, demographic, and intraoperative variables in predicting achievement of these thresholds.

Study Design: Case series; Level of evidence, 4.

Defining Clinically Meaningful Subgroups in Patients Undergoing Arthroscopic Rotator Cuff Repair Using Unsupervised Machine Learning.

Background: Outcomes after arthroscopic rotator cuff repair (RCR) are frequently measured through clinically significant outcomes (CSOs) such as the minimal clinically important difference, the substantial clinical benefit, and the Patient Acceptable Symptom State. Global achievement of CSOs is challenging to predict.

Purpose: To determine if unsupervised machine learning can identify distinct patient subgroups based on CSO achievement after elective arthroscopic RCR.

The Availability and Pricing of Orthobiologic Knee Injections in the Chicago Metropolitan Area: A Market Assessment Study.

Background: Despite mounting clinical evidence for the utility of orthobiologics in nonoperative management of orthopaedic pathology, the market for orthobiologic therapies remains largely unregulated by the Food and Drug Administration, giving rise to a wide range of pricing for these therapeutics by different provider types.

Purpose: To determine the availability and pricing for platelet-rich plasma (PRP), amniotic or adipose "stem cell," and bone marrow aspirate concentrate (BMC) injections for the treatment of knee osteoarthritis among orthopaedic sports medicine and alternative providers (eg, chiropractic clinics and stand-alone "regenerative medicine" clinics) in a major metropolitan city.

Study Design: Cross-sectional study.

Bone Marrow Aspirate Concentrate May Decrease Reoperation in Osteochondral Allograft Transplantation: A Prospective, Randomized, Double-Blind Investigation.

Purpose: To perform a prospective, double-blind, randomized controlled trial to assess differences in integration and patient-reported outcomes metrics (PROMs) of osteochondral allograft transplantation with and without bone marrow aspirate concentrate (BMAC) augmentation.

Methods: Patients (n = 36) undergoing osteochondral allograft transplantation of the knee were consented and enrolled in this prospective study. They were randomized to either iliac crest BMAC or sham incision groups and blinded to their allocation.

Risk Factors for Subchondral Insufficiency Fracture of the Knee in the Setting of Medial Meniscus Posterior Root Tear.

Background: Subchondral insufficiency fracture of the knee (SIFK) is commonly associated with medial meniscus posterior root tears (MMPRTs). However, there is limited research investigating risk factors for SIFK in patients with MMPRTs.

Purpose/hypothesis: The purpose of this investigation was to identify the risk factors for SIFK in patients with MMPRTs.

Sex-Based Differences in Clinically Significant Outcome Achievement Following Primary Osteochondral Allograft Transplantation of the Knee at a Minimum 5-Year Follow-up.

Background: Primary osteochondral allograft transplantation (OCA) of the knee has been shown to improve patient-reported outcome measure (PROM) scores at various follow-up time points. However, studies analyzing the effects of patient sex on primary OCA outcomes remain limited and show conflicting results.

Purpose: To compare PROM scores and clinically significant outcome (CSO) achievement rates at a minimum 5-year follow-up between male and female patients who underwent primary OCA of the knee.

Osteochondral Allograft Chondrocyte Viability Is Affected During Harvest by Irrigation Temperature and Reamer Speed.

Background: Previous literature shows that current osteochondral allograft (OCA) harvesting techniques lead to donor plug chondrocyte death during OCA transplant for treating focal knee cartilage defects.

Purpose: To evaluate the effects of drilling/reaming speed and irrigation temperature on chondrocyte viability during OCA harvest.

Study Design: Controlled laboratory study.

Medial Patellofemoral Ligament Reconstruction With Concomitant Tibial Tubercle Osteotomy.

Background: Patellar instability, often associated with medial patellofemoral ligament rupture, is prevalent in adolescents. Risk factors include trochlear dysplasia, patella alta, abnormal patellar tilt, and increased tibial tubercle to trochlear groove (TT-TG) distance.

Indication: A variety of surgical options are available for addressing patellar instability, and the selection of each technique should be tailored to the unique pathoanatomy of each patient.

Osteochondral Allograft Transplantation: A Technical Note.

Background: Chondral injuries in the knee are commonly discovered during knee arthroscopy procedures. Due to the poor restoration potential and avascular nature of cartilage, large defects are commonly treated with such surgical procedures. Treatment utilizing an osteochondral allograft (OCA) transplant for symptomatic focal cartilage defects in the patellofemoral joint has demonstrated strong, lasting clinical and radiographic outcomes.

Elevated Instability Resolution Angle Predicts Inferior Patient-Reported Outcomes in Isolated Medial Patellofemoral Ligament Reconstruction.

Purpose: To investigate the prognostic utility of an examination under anesthesia (EUA) by evaluating the patient-reported outcome scores (PROs) and failure rates of patients undergoing primary, isolated medial patellofemoral ligament reconstruction (MPFLR) relative to their EUA findings.

Methods: A retrospective review was performed on patients who underwent primary, isolated MPFLR between August 2015 and August 2021. During the EUA the instability resolution angle (IRA) was identified by applying a lateral force on the patella through increasing knee flexion and defined by the degree of flexion the patella ceased lateral translation.

Patient Age and Activity Level, Posterior Tibial Slope, and Use of Allograft Are Significant Risk Factors for Anterior Cruciate Ligament Reconstruction Failure: A Systematic Review.

Purpose: To assess the consistency of risk factor reporting for anterior cruciate ligament reconstruction (ACLR) failure after primary reconstruction, identify risk factors more frequently associated with ACLR failure, and help clinicians prevent reinjury in patients with risk factors for ACLR failure.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct a systematic review. Initial title and abstract screening yielded 561 studies, from which 76 studies were assessed for eligibility.

Saline Irrigation Mitigates Chondrocyte Viability Changes During Trochleoplasty.

Background: Trochleoplasty aims to correct trochlear dysplasia, an osseous cause of patellar instability. The procedure involves the use of a high-speed bur directly under femoral articular cartilage, which may place chondrocytes at risk of thermal necrosis.

Purpose/hypothesis: The purpose of this study was to investigate the effect of irrigation and offset used during a trochleoplasty procedure on trochlear chondrocyte viability.

Patient-Reported Outcomes Measurement Information System Captures Clinically Meaningful Improvement After Transtibial Pull-Out Repair of Medial Meniscal Posterior Root Tears: Two-Year Outcomes.

Purpose: To (1) establish cohort-specific minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) values and legacy knee-specific patient-reported outcome measures (PROMs) after isolated medial meniscal posterior root tear (MMPRT) repair using the transtibial pull-out repair technique; (2) determine achievement rates; and (3) analyze correlations among scores.

Methods: Patients undergoing primary isolated MMPRT transtibial pull-out repair with preoperative and minimum 2-year postoperative data were analyzed. PROMs included the PROMIS-Pain Interference (PI) score, PROMIS-Physical Function (PF) score, PROMIS-Depression (D) score, Knee Injury and Osteoarthritis Outcome Score Jr (KOOS Jr), and International Knee Documentation Committee (IKDC) score.

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review of Outcomes by Fixation Technique.

Background: Various medial patellofemoral ligament (MPFL) reconstruction techniques have been developed to minimize risks to the physis in skeletally immature patients.

Purpose: To examine outcomes of MPFL reconstruction (MPFLR) based on fixation technique in skeletally immature patients.

Study Design: Systematic review; Level of evidence, 4.

Anatomic Drivers of J-Sign Presence and Severity: If There Is a Jump, Look for a Bump.

Background: Medial patellofemoral ligament reconstruction is frequently indicated for recurrent lateral patellar instability. The preoperative presence and severity of a J-sign have been associated with poorer postoperative outcomes.

Purpose: To determine the underlying anatomic factors that contribute to the presence, severity, and jumping quality of the J-sign.

Comparison of Revision and Primary Osteochondral Allograft Transplantation at Midterm Follow-up: Patient Reported Outcomes, Survivorship, and Reoperation Rates.

Background: Previous studies have observed promising short-term outcomes after revision osteochondral allograft (OCA) transplantation. However, few studies have examined midterm outcomes after revision OCA transplantation.

Purpose: To examine midterm outcomes after revision OCA transplantation of the femoral condyle and evaluate reoperation and survivorship compared with a matched cohort of patients who underwent primary OCA transplantation.

Current Methods Used to Evaluate Glenoid Bone Loss: A Survey of Orthopaedic Surgeons.

Background: Evaluation of glenoid bone loss is critical in preoperative planning, as bone loss >13.5% has been associated with worse clinical outcomes. While 3-dimensional computed tomography (3D CT) and the Pico method have been the gold standard in bone loss evaluation, it is unclear how most orthopaedic surgeons evaluate for bone loss in practice.

Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort.

Background: Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.

Purpose: To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.

Study Design: Case-control study; Level of evidence, 3.

Osteochondral Allograft Transplantation With Concomitant Meniscal Allograft Transplantation Improves Clinical Outcomes and Yields High Patient Satisfaction: A Systematic Review.

Purpose: To conduct a systematic review evaluating subjective patient-reported outcomes, reoperations, and graft failure after concomitant osteochondral allograft (OCA) transplantation and meniscal allograft transplantation (MAT).

Methods: A literature search was performed by querying the MEDLINE, Embase, and PubMed databases according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The inclusion criteria were limited to peer-reviewed, English-language, Level I to IV studies with at least 10 patients that reported clinical outcomes and complications after OCA transplantation with concomitant MAT for osteochondral defects and meniscal deficiency with minimum 2-year follow-up.

The Presence of a Trochlear Bump and Patella Alta May Predict the Risk of Recurrent Instability After Isolated Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background: Medial patellofemoral ligament reconstruction (MPFLR) is an excellent surgical option for patients with recurrent patellar instability. This technique has demonstrated significant improvements in patient-reported outcomes, high rates of return to sport, and low rates of failure. However, there is debate regarding the use of isolated MPFLR in the setting of concomitant pathoanatomic features such as patella alta, trochlear dysplasia, or a lateralized tibial tubercle.

No Association Between Donor Variables and Clinically Significant Outcomes, Reoperations, and Failure After Osteochondral Allograft Transplantation.

Background: Mismatch between osteochondral allograft (OCA) donor and recipient sex has been shown to negatively affect outcomes. This study accounts for additional donor variables and clinically relevant outcomes.

Purpose: To evaluate whether donor sex, age, donor-recipient sex mismatch, and duration of graft storage affect clinical outcomes and failure rates after knee OCA transplantation.

Patellofemoral Cartilage Injury and Treatment.

Osteochondral and chondral injuries of the patellofemoral joint are common in active patients, and effective management requires a thorough physical and imaging evaluation, a detailed understanding of the unique anatomic and biomechanical joint properties contributing to these injuries, and an appropriate selection of treatment modality. Diagnosis of patellofemoral chondral injuries can be challenging, and differentiating between various causes of anterior knee pain is crucial to successful outcomes. Once identified, nonsurgical treatments including physical therapy, bracing, and injections are a mainstay of initial management.