Editorial Commentary: Is "Patch and Run" the New Way to Address Partial Rotator Cuff Tears?

Partial rotator cuff tears are managed nonoperatively as a first-line treatment modality. When operative intervention is indicated, the appropriate technique has yet to be clearly elucidated. Operative management includes in situ repair, tear completion with repair, and more recently, bioinductive collagen patch implantation.

Arthroscopic Repair of an Isolated Posterior Cruciate Ligament Avulsion.

Posterior cruciate ligament (PCL) injuries are uncommon, with isolated PCL injuries being even more rare. Low-grade injuries are typically managed conservatively. In cases of multiligamentous knee injuries, high-level athletes, or continued instability following nonoperative management, surgical intervention typically comprises PCL reconstruction.

Effect of the USMLE Step 1 Grading Change on Orthopedic Surgery Residency Applications: National Resident Matching Program Charting Outcomes From 2011 to 2024.

Background: This study evaluated differences in orthopedic surgery residency applicant statistics in the 2024 National Resident Matching Program (NRMP) Charting Outcomes, the first report to include applicants with a pass/fail designation on the United States Medical Licensing Examination (USMLE) Step 1.

Materials And Methods: Data were collected from the NRMP reports, which are released every 2 to 3 years, for 2011, 2014, 2016, 2018, 2020, 2022, and 2024. The number of research items (abstracts, presentations, and publications), USMLE Step 2 scores, volunteer experiences, and work experiences for matched and unmatched applicants were recorded.

Investigating the relationship between subacromial balloon spacer study outcomes and study funding.

Background: Subacromial balloon spacers are implants used for the treatment of irreparable rotator cuff tears. Many studies on subacromial balloon spacers use industry funding and existing literature has shown that industry funding can impact reported outcomes in research. This study aims to evaluate the outcomes of industry-funded balloon spacer studies.

Patients Undergoing Microfracture With Allograft Cartilage and Autologous Platelet-Rich Plasma Augmentation for Chondromalacia in the Hip Achieving High Rates of Meaningful Outcomes at 2-Year Follow-Up.

Purpose: To evaluate rates of achieving meaningful outcomes and clinical failure at 2 years after undergoing microfracture augmented with allograft cartilage with autologous platelet-rich plasma and to identify predictors of conversion to total hip arthroplasty (THA).

Methods: Data from a prospective series of consecutive patients with Outerbridge grade 4 chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with allograft cartilage between January 2017 and June 2022 were analyzed. Patient-reported outcomes were collected preoperatively and at a minimum of 2 years postoperatively.

Identifying clinically meaningful subgroups following open reduction and internal fixation for proximal humerus fractures: a risk stratification analysis for mortality and 30-day complications using machine learning.

Background: Identification of prognostic variables for poor outcomes following open reduction internal fixation (ORIF) of displaced proximal humerus fractures have been limited to singular, linear factors and subjective clinical intuition. Machine learning (ML) has the capability to objectively segregate patients based on various outcome metrics and reports the connectivity of variables resulting in the optimal outcome. Therefore, the purpose of this study was to (1) use unsupervised ML to stratify patients to high-risk and low-risk clusters based on postoperative events, (2) compare the ML clusters to the American Society of Anesthesiologists (ASA) classification for assessment of risk, and (3) determine the variables that were associated with high-risk patients after proximal humerus ORIF.

Botulinum Toxin as an Adjunctive Therapy for Immobilization of a Distal Humerus Fracture in Parkinson's Disease-Associated Psychosis: A Case Report.

BACKGROUND Attainment of extremity immobilization in orthopedic trauma patients experiencing psychosis is often uniquely challenging. Many fractures, including those of the distal humerus, require a period of immobilization postoperatively to optimize fracture healing. Patients with Parkinson's disease have also been shown to have lower rates of union after fracture compared to the general population.

Arthroscopic Treatment Is a Safe and Effective Alternative to Open Treatment for Acute Septic Arthritis of the Native Knee: A Systematic Review.

Purpose: To compare complication rates, reoperation rates, and subjective outcomes after arthroscopic and open irrigation and debridement for treatment of native knee septic arthritis.

Methods: Following The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the Embase, Cochrane, and PubMed databases was performed. Comparative studies reporting clinical outcomes after arthroscopic versus open treatment for septic arthritis of the native knee in human adults were included.

Bilateral Knee Lyme Arthritis in Children: A Report of 3 Cases.

Cases: Three patients presented with bilateral knee pain, effusion, decreased range of motion, and difficulty ambulating. Synovial analysis demonstrated leukocytosis in bilateral knees with positive serum enzyme-linked immunosorbent assay. All cases were managed with antibiotics and anti-inflammatories.

Prediction of Admission Costs Following Anterior Cervical Discectomy and Fusion Utilizing Machine Learning.

Study Design: Retrospective case series.

Objective: Predict cost following anterior cervical discectomy and fusion (ACDF) within the 90-day global period using machine learning models.

Background: The incidence of ACDF has been increasing with a disproportionate decrease in reimbursement.

Two Intramedullary and 1 Extramedullary Cortical Button, With or Without Interference Screw, Show Biomechanical Properties Superior to Native Tendon in Repair of the Distal Biceps Tendon: A Systematic Review and Network Meta-analysis of Biomechanical Performance.

Purpose: The aim of this study was to use a systematic review and network meta-analysis (NMA) to compare the failure strength, maximum strength, stiffness, and displacement of available constructs for distal biceps repair.

Methods: An NMA was conducted to determine the performance of 2 all-suture suture anchors (2x ASA), 2 intramedullary cortical buttons (2x IM CB), 2 suture anchors (2x SA), extramedullary cortical buttons (EM CB), extramedullary cortical button plus interference screw (EM CB+IFS), interference screw (IFS), single intramedullary cortical button (IM CB), single suture anchor (SA), transosseous suture (TOS), tension slide technique (TST), and tension slide technique plus suture tape (TST+ST). Analysis consisted of arm-based network meta-analysis under Bayesian random-effects model with Markov Chain Monte Carlo (MCMC) sampling.

Fragility of statistically significant findings from randomized clinical trials of surgical treatment of humeral shaft fractures: A systematic review.

Background: Despite recent meta-analyses of randomized controlled trials (RCTs), there remains no consensus regarding the preferred surgical treatment for humeral shaft fractures. The fragility index (FI) is an emerging tool used to evaluate the robustness of RCTs by quantifying the number of participants in a study group that would need to switch outcomes in order to reverse the study conclusions.

Aim: To investigate the fragility index of randomized control trials assessing outcomes of operative fixation in proximal humerus fractures.

Return to work following shoulder arthroplasty: A systematic review.

Background: Many patients prioritize the ability to return to work (RTW) after shoulder replacement surgeries such as total shoulder arthroplasty (TSA), reverse TSA (rTSA), and shoulder hemiarthroplasty (HA). Due to satisfactory clinical and functional long-term outcomes, the number of shoulder replacements performed will continue to rise into this next decade. With younger individuals who compose a significant amount of the workforce receiving shoulder replacements, patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.

Prediction of total healthcare cost following total shoulder arthroplasty utilizing machine learning.

Background: Given the increase in demand in treatment of glenohumeral arthritis with anatomic total (aTSA) and reverse shoulder arthroplasty (RTSA), it is imperative to improve quality of patient care while controlling costs as private and federal insurers continue its gradual transition toward bundled payment models. Big data analytics with machine learning shows promise in predicting health care costs. This is significant as cost prediction may help control cost by enabling health care systems to appropriately allocate resources that help mitigate the cause of increased cost.

Liposomal Bupivacaine Associated with Cost Savings during Postoperative Pain Management in Fragility Intertrochanteric Hip Fractures.

Background: Intertrochanteric hip fractures are among the most common and most expensive diagnoses in the Medicare population. Liposomal bupivacaine is a novel preparation of a commonly used analgesic agent that, when used intraoperatively, decreases narcotic requirements and hospital length of stay and increases the likelihood of discharge to home. The purpose of this investigation was to determine whether there was an economic benefit to utilizing intraoperative liposomal bupivacaine in patients with fragility intertrochanteric hip fractures in comparison to a group of patients who did not receive liposomal bupivacaine.

No Difference in Clinical Outcomes for Arthroscopic Suprapectoral Versus Open Subpectoral Biceps Tenodesis at Midterm Follow-up: A Randomized Prospective Analysis.

Background: We have previously reported the 1-year outcomes of arthroscopic suprapectoral biceps tenodesis (ASPBT) versus open subpectoral biceps tenodesis (OSPBT) for the management of long head of the biceps tendon (LHBT) pathology. While patients had similar 1-year biceps muscle strength and pain, longer-term functional outcomes are unknown.

Purpose: To directly compare clinical outcomes of ASPBT versus OSPBT with interference screw fixation, distal to the bony bicipital groove, at a minimum of 2 years' follow-up.

How Long Does It Take to Achieve Clinically Significant Outcomes After Isolated Biceps Tenodesis?

Background: Clinically significant outcomes (CSOs) connect patient-reported outcome measures data to patient-perceived benefit. Although investigators have established threshold values for various CSOs, the timeline to achieve these outcomes after isolated biceps tenodesis (BT) has yet to be defined.

Purpose: To define the time-dependent nature of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) achievement after isolated BT.

Management of proximal biceps tendon pathology.

The long head of the biceps tendon is widely recognized as an important pain generator, especially in anterior shoulder pain and dysfunction with athletes and working individuals. The purpose of this review is to provide a current understanding of the long head of the biceps tendon anatomy and its surrounding structures, function, and relevant clinical information such as evaluation, treatment options, and complications in hopes of helping orthopaedic surgeons counsel their patients. An understanding of the long head of the biceps tendon anatomy and its surrounding structures is helpful to determine normal function as well as pathologic injuries that stem proximally.

Return to Sport Following Distal Triceps Repair.

Purpose: The purpose of this investigation was to examine the timeline of return-to-sport following distal triceps repair; evaluate the degree of participation and function upon returning to sport; and identify risk factors for failure to return to sport.

Methods: Patients who underwent distal triceps repair with a minimum of 1 year of follow-up were retrospectively reviewed. Patients completed a subjective sports questionnaire and were scored on a visual analog scale for pain; the Mayo Elbow Performance Index; the Quick Disabilities of the Arm, Shoulder, and Hand; and the Single Assessment Numerical Evaluation.

Return to Work After Pectoralis Major Repair.

Background: Pectoralis major repair (PMR) is an infrequent injury that occurs during resistance training, most commonly during the eccentric phase of muscle contraction. As the incidence of weight training continues to increase, it is important to understand the outcomes after PMR.

Purpose: To evaluate the rate and duration of return to work in patients undergoing PMR.

Delaying ACL reconstruction beyond 6 months from injury impacts likelihood for clinically significant outcome improvement.

Background: The effect of surgical latency on outcomes of anterior cruciate ligament reconstruction (ACLR) is a topic that is heavily debated. Some studies report increased benefit when time from injury to surgery is decreased while other studies report no benefit. The purpose of our analysis was to compare achievement of clinically significant outcomes (CSOs) in patients with greater than six months of time from injury to ACLR to those with less than or equal to six months of time to surgery.

A Risk Stratification Nomogram to Predict Inpatient Admissions After Total Shoulder Arthroplasty Among Patients Eligible for Medicare.

The goal of this study was to establish a risk stratification nomogram to aid in determining the need for inpatient admission among patients who were eligible for Medicare and were undergoing primary total shoulder arthroplasty (TSA). The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify all patients older than 65 years who underwent primary TSA between 2006 and 2016. The primary outcome measure was inpatient admission, as defined by hospital length of stay longer than 2 days.

Publication Rates of Abstracts Presented at Pediatric Orthopaedic Society of North America Meetings Between 2013 and 2016.

Background: Academic conferences such as the annual Pediatric Orthopaedic Society of North America (POSNA) meeting provide opportunities to present up-to-date scientific work that can influence clinical decision making. This study reviewed 4 years of abstracts presented at POSNA to assess trends in poster and podium presentation publication rates and associated metrics and the impact of academic presentations on the pediatric orthopaedic literature.

Methods: All abstracts presented at POSNA annual meetings from 2013 to 2016 were analyzed for presentation type, subspeciality, level of evidence, study design, peer-reviewed publication within 4 years of presentation, 1-year publication rates, journal impact factors, number of authors, and citations of the final publication.

Isolated Biceps Tenodesis and Tenotomy: A Systematic Review of Indications and Patient Satisfaction.

Biceps tenodesis and tenotomy are increasingly being used as treatment options for shoulder pathology, but patient satisfaction remains largely unstudied. A systematic review of the MEDLINE database was conducted to identify clinical outcome studies on isolated biceps tenodesis or tenotomy that reported patient satisfaction. Within the 15 investigations that were included, the indication for tenotomy was rotator cuff pathology, whereas the indication for tenodesis was biceps pathology or type 2 superior labral tear from anterior to posterior.